scholarly journals P050 Oral Inflammatory Changes Associated With Inflammatory Bowel Disease in Spondyloarthritis Associated With Early Endoscopic Findings

2021 ◽  
Vol 116 (1) ◽  
pp. S13-S13
Author(s):  
Parra Izquierdo Viviana ◽  
Chumacero Katherin ◽  
Alvarado Julio ◽  
Buenahora Maria ◽  
Monsalve Monica ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Endoscopic Findings ◽  
Inflammatory Bowel ◽  
Inflammatory Changes

Chronic Nonspecific Inflammatory Bowel Disease of the Cecum and Proximal Colon in Children With Grossly Normal-Appearing Colonic Mucosa: Diagnosis by Colonoscopic Biopsies

PEDIATRICS ◽  
1987 ◽  
Vol 80 (2) ◽  
pp. 255-261
Author(s):  
Melvin B. Heyman ◽  
Jay A. Perman ◽  
Linda D. Ferrell ◽  
M. Michael Thaler
Keyword(s):  
Inflammatory Bowel Disease ◽  
Abdominal Pain ◽  
Bowel Disease ◽  
Colonic Mucosa ◽  
Disease Process ◽  
Proximal Colon ◽  
Chronic Abdominal Pain ◽  
Medical Attention ◽  
Inflammatory Bowel ◽  
Inflammatory Changes

The diagnosis of inflammatory bowel disease rests on radiologic, endoscopic, and histologic creteria. Five patients, 2 to 17 years of age, sought medical attention because of chronic abdominal pain, diarrhea, and heme-positive stools. Rectal biopsies, visual inspection of colonic mucosa through the colonoscope, and contrast radiographs of the large and small intestine yielded nonspecific results. Serial endoscopic biopsies demonstrated a gradient of inflammatory changes diminishing in severity distally from the ileocecal valve and cecum. The disease process was most evident in specimens from the cecum, whereas biopsies distal to the transverse colon had a normal histologic appearance in all five patients. Biopsies from the proximal colon may provide evidence of inflammatory bowel disease not detectable using standard techniques. The combination of chronic abdominal pain, diarrhea, and heme-positive stools associated with inflammatory changes in biopsy specimens obtained from the proximal colon, but normal findings on radiologic, colonoscopic, and rectal biopsy examinations, may represent an early stage in the evolution of chronic nonspecific inflammatory bowel disease, including ulcerative colitis or regional enteritis (Crohn disease).

scholarly journals Ilececum: A Comprehensive Review

2019 ◽  
Vol 2019 ◽  
pp. 1-21
Author(s):  
Shou-jiang Tang ◽  
Ruonan Wu
Keyword(s):  
Inflammatory Bowel Disease ◽  
Terminal Ileum ◽  
Bowel Disease ◽  
Ileocecal Valve ◽  
Screening Colonoscopy ◽  
Gi Bleeding ◽  
Comprehensive Review ◽  
Endoscopic Findings ◽  
Inflammatory Bowel ◽  
Ileal Intubation

For gastrointestinal endoscopists, the ileocecum is the finishing line during colonoscopy and it is identified by three endoscopic landmarks: terminal ileum, ileocecal valve, and the appendiceal orifice. Although ileal intubation is recommended during routine screening colonoscopy, it is not required in most cases of screening colonoscopy. Ileal intubation is indicated in certain circumstances such as suspected inflammatory bowel disease and GI bleeding. There is much pathology that can be observed within the ileocecum. Careful and systematic examination should be stressed during GI endoscopic training and practice. In this review, the authors demonstrate its anatomy, endoscopic findings, and pathologies.

scholarly journals SAT0386 USEFULNESS OF THE FECAL CALPROTECTIN AS SCREENING TOOL FOR INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH SPONDYLOARTHRITIS AND NO DIGESTIVE SYMPTOMS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1142.3-1142
Author(s):  
C. Merino Argumánez ◽  
M. Espinosa ◽  
C. Ramos Giráldez ◽  
O. Rusinovich ◽  
N. De la Torre ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Small Intestine ◽  
Capsule Endoscopy ◽  
Bowel Disease ◽  
Screening Tool ◽  
Fecal Calprotectin ◽  
Screening Tools ◽  
Hla B27 ◽  
Endoscopic Findings ◽  
Inflammatory Bowel

Background:Fecal calprotectin (FC) is a biomarker of bowel inflammation widely spread in diagnosis and follow-up of inflammatory bowel disease (IBD). It is classically estimated that 5% of patients with axial spondyloarthritis (SpA) also have IBD; coexistence of both conditions has definite impact in clinical decisions. Proactive detection of both diseases should be advisable, though appropriate screening tools are still lacking.Objectives:To evaluate the usefulness of FC for the diagnosis of IBD in patients diagnosed with SpA with no clinical suggestive manifestations or previous diagnosis of IBD.Methods:Patients from a Rheumatology clinic diagnosed with SpA who met ASAS criteria and did not present digestive symptoms suggestive of IBD were consecutively included. Demographics, clinical and analytical data of SpA (uveitis, HLA B27, acute phase reactants) at the time of inclusion, and treatment history were collected. Patients with a positive FC (> 50 mg/Kg) underwent ileocolonoscopy with biopsies of colon and terminal ileum. Patients who were recommended to avoid NSAIDs 2-4 weeks before stool collection and endoscopy.Patients with no endoscopic findings underwent a second determination of fecal calprotectine. If persisted positive, capsule endoscopy was performed to evaluate small intestine.Results:98 patients included; 47% male, mean age 46.1 (20-74) years. BASDAI 3.6 ± 2.5. HLA B27 positive in 78% of patients, high ESR in 31.6%, high CRP in 9.2%. FC positive in 49 patients (50%): mean 147 mg/kg (range 0-3038).47 underwent ileocolonoscopy: In 13 cases (26.5%), endoscopic findings were suggestive of IBD (7 Crohn’s disease and 1 ulcerative colitis). Microscopic inflammation was found in 2 additional cases. Among those 34 patients with normal ileocolonoscopy, 16 patients refused further investigations; among the remining 18 patients, a second FC was positive in 16. Capsule endoscopy showed findings suggestive of small intestine IBD in 6 additional patients.In patients with high FC levels,those with high CRP and ESR were more likely to have IBD(29% v 16% and 29% v 12% respectively). Patients with a history ofuveitis(18% vs 12%) orpsoriasis(33% v 16%) also had a higher prevalence of IBD, although none of those differences reached statistical significance.FC was higher insmokers(72%v 44%; p=0.03). There were no significant differences regarding HLA B27. No statistically significant differences were found in FC between patients with high FC who were diagnosed with IBD and those who were not.Conclusion:In our study, patients with SpA and no clinical feature suggestive of IBD who showed FC> 50 mg/kg had high prevalence of IBD, which could indicate theusefulness of FC as screening tool for IBD in patients with SpA.Patients with SpA and other immune-mediated condition or elevated CRP, seem to be more likely to have subclinical IBD.Disclosure of Interests:None declared

scholarly journals Current perspectives on the diagnosis and management of functional anorectal disorders in patients with inflammatory bowel disease

2018 ◽  
Vol 11 ◽  
pp. 175628481881695 ◽  
Author(s):  
Gaurav B. Nigam ◽  
Jimmy K. Limdi ◽  
Dipesh H. Vasant
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Significant Proportion ◽  
Future Research ◽  
Anorectal Dysfunction ◽  
Inflammatory Bowel ◽  
Treatment Escalation ◽  
Inflammatory Changes ◽  
Neuromuscular Coordination ◽  
Quiescent Disease

Despite advances in inflammatory bowel disease (IBD) therapies, a significant proportion of patients with quiescent disease experience persistent, debilitating symptoms of faecal incontinence (FI), urgency and defaecatory disorders due to anorectal dysfunction. Such symptoms are often underreported or misdiagnosed and can lead to potentially premature treatment ‘escalation’ and under-utilisation of pelvic floor investigations. In this review article, we consider putative pathophysiological post-inflammatory changes resulting in altered anorectal sensitivity, motility and neuromuscular coordination and how this may drive symptoms in quiescent IBD. Finally, we discuss a pragmatic approach to investigating and managing anorectal dysfunction and highlight areas for future research for this often-neglected group of patients.

scholarly journals P853 Amoebic colitis mimicking inflammatory bowel disease: a report of four cases

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S656-S657
Author(s):  
Q Tufail ◽  
D O’Meara ◽  
A Thi ◽  
F Lim ◽  
C Richards
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Subtotal Colectomy ◽  
Rescue Therapy ◽  
Diagnostic Challenge ◽  
Travel History ◽  
Endoscopic Findings ◽  
Amoebic Colitis ◽  
Inflammatory Bowel ◽  
Intravenous Steroids

Abstract Background Amoebic colitis, caused by Entamoeba histolytica is an emerging diagnostic challenge for gastroenterologists in developed countries. Due to the similarity of symptoms and endoscopic findings, it can be easily misdiagnosed as inflammatory bowel disease (IBD) with a potentially devastating outcome especially if patient receives immunosuppression. The aim of this study is to look into the misdiagnosed cases to identify the challenges in differentiating amoebic colitis from IBD and to outline strategies to avoid this Methods Clinical and electronic case notes for the 4 patients, who were misdiagnosed as IBD between September 2015 to February 2019 at University Hospitals of Leicester U.K. were reviewed. The histology of resected colon specimens and endoscopic colonic biopsies were re-reviewed specifically for amoebic trophozoites. Results Three were male and 1 female. 1 patient was Caucasian while 3 patients were British Asian. Their mean age was 47.75 years (range 28–71). 3 cases were new IBD presentations while 1 patient was misdiagnosed as IBD since 2015. Two patients had a travel history to India and travelled to South East Asia 12 months prior to presentation. The travel history for 1 patient was not available. All 4 cases presented with bloody diarrhoea and had an endoscopic examination around the time of diagnosis which suggested acute inflammation likely IBD. Three were treated as ulcerative colitis while 1 patient was treated as Crohn’s disease. One patient required rescue therapy with cyclosporin while on intravenous steroids. As clinical symptoms worsened with rescue therapy, the patient required a subtotal colectomy. Similarly the patient who was treated for Crohn’s disease with Azathioprine and intravenous steroids, required subtotal colectomy due to recurrent flare ups. The other two cases were successfully treated with antimicrobial after the diagnosis of amoebic colitis although one of them received adalimumab prior to the correct diagnosis. The diagnosis of amoebic colitis was made through histological examination of the resected colon in 2 patients, colonic biopsy in 1 patient and stool E. histolytica DNA polymerase chain reaction (PCR) in 1 patient. Conclusion All 4 cases who were misdiagnosed as IBD had the diagnostic challenge of differentiating IBD from amoebic colitis due to similarity of symptoms and the endoscopic findings. Travel history is an important clue and should be considered for any patient presenting with colitis. New local guidelines were introduced to screen all patient with colitis for E. histolytica with serology and stool PCR. Patients requiring immunosuppression for suspected IBD are commenced on antimicrobial cover until E. histolytica results are available.

scholarly journals Crohn’s-like reaction in diverticular disease

Gut ◽  
1998 ◽  
Vol 42 (3) ◽  
pp. 392-395 ◽  
Author(s):  
A Gledhill ◽  
M F Dixon
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Chronic Inflammatory Bowel Disease ◽  
Older Individuals ◽  
Histological Features ◽  
Inflammatory Bowel ◽  
Inflammatory Changes ◽  
Chronic Inflammatory Bowel

Background—Diverticulitis and Crohn’s disease affecting the colon occur at similar sites in older individuals, and in combination are said to carry a worse prognosis than either disease in isolation. It is possible that diverticulitis may initiate inflammatory changes which resemble Crohn’s disease histologically, but do not carry the clinical implications of chronic inflammatory bowel disease.Aims—To evaluate histological features and clinical outcome in individuals initially diagnosed histologically as having both Crohn’s colitis and diverticulitis.Patients—Eleven consecutive individuals having a colonic resection showing histological features of both Crohn’s disease and diverticulitis.Methods—Retrospective review of histological specimens, case notes, and discharge letters.Results—In nine patients, the Crohn’s-like reaction was confined to the segment bearing diverticula. They had no clinical evidence of Crohn’s disease.Conclusion—A Crohn’s-like inflammatory response can be a localised reaction to diverticulitis and does not necessarily indicate chronic inflammatory bowel disease.

Algorithm to Predict Which Children With Chronic Abdominal Pain Are Low Suspicion for Significant Endoscopic Findings

2018 ◽  
Vol 58 (1) ◽  
pp. 79-87
Author(s):  
Jacob A. Mark ◽  
Kristen Campbell ◽  
Dexiang Gao ◽  
Robert E. Kramer
Keyword(s):  
Inflammatory Bowel Disease ◽  
Abdominal Pain ◽  
Bowel Disease ◽  
Diagnostic Algorithm ◽  
Specialty Care ◽  
Chronic Abdominal Pain ◽  
Challenging Problem ◽  
Endoscopic Findings ◽  
Intestinal Pathology ◽  
Inflammatory Bowel

Chronic abdominal pain (CAP) is a common and challenging problem in pediatric primary and specialty care. We developed a diagnostic algorithm to organize workup for gastrointestinal causes of CAP and improve identification of patients who are low suspicion (LS) or high suspicion (HS) to have significant intestinal pathology identified with endoscopy. We retrospectively used this algorithm to categorize 150 outpatients with CAP as LS (n = 99) or HS (n = 51) and examined subsequent endoscopic findings for all patients. There were 6% significant diagnoses in the LS group compared with 34% in the HS group ( P < .0001). The LS group had no patients with celiac or inflammatory bowel disease. These results can be used to help a clinician approach CAP, and discuss with families the likelihood of endoscopy finding a cause for CAP based on LS or HS designation.

scholarly journals Crohn's Disease and Urinary Bladder Mass

1995 ◽  
Vol 1 (4) ◽  
pp. 233-236 ◽  
Author(s):  
Gregory T. Bales ◽  
Francis H. Straus, II ◽  
Glenn S. Gerber
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Transitional Cell ◽  
Diagnostic Dilemma ◽  
Pathologic Evaluation ◽  
Inflammatory Bowel ◽  
Inflammatory Changes ◽  
Bladder Mass

The presence of a bladder mass in a patient with inflammatory bowel disease poses a diagnostic dilemma. We present the case of a 26-year-old male with a bladder mass who had not previously been diagnosed with Crohn's disease. Initial biopsies of the bladder mass were consistent with inflammatory changes, but superficial transitional cell carcinoma could not be reliably excluded. Subsequent evaluation confirmed the presence of Crohn's disease with bladder involvement, and the patient underwent bowel resection and partial cystectomy. Pathologic evaluation demonstrated Crohn’s disease and no evidence of malignancy. Accurate differentiation of benign and malignant bladder masses in patients with inflammatory bowel disease may be difficult and requires cooperation between pathologists and clinicians.

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