Crohn＇s disease （CD） is a chronic relapsing and remitting autoinflammatory disorder of the gastrointestinal tract that has many intestinal and extraintestinal complications. The purpose of treatment is long-term re...Crohn＇s disease （CD） is a chronic relapsing and remitting autoinflammatory disorder of the gastrointestinal tract that has many intestinal and extraintestinal complications. The purpose of treatment is long-term remission, reduction of complications, and improvement of patients＇ quality of life. In many cases, this can be quite challenging and it is necessary to have a well thought out management strategy. We present the case of a 38-year-old woman with fistulizing CD that manifested as diffuse abdominal pain and bloody diarrhea accompanied by arthralgia. In addition, there were ulcerative lesions surrounded by cutaneous inflammation and erythema on her extremities, indicative of pyoderma gangrenosum. The patient was treated with high doses of parenteral methylprednisolone without any improvement and was started on adalimumab. A positive response to adalimumab therapy was observed： after 2 mo of therapy, the ulcerative skin lesion healed completely and the enterogastric fistula was closed affcer 5 mo adalimumab treatment. Adalimumab might be a suitable initial as well as maintenance therapy in patients with complicated CD.展开更多
AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METH...AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METHODS: A cohort of patients with independently confirmed typical histopathological changes was investigated. Fifty-three patients with histologically proved MC (46 with CC, 7 with LC) were included. The existence of diarrhea or constipation and the co-existence of autoimmune diseases were also investigated and all data were retrospectively analyzed.RESULTS: Twenty-three (43.39%) of MC patients had chronic constipation (20 in CC, 3 in LC patients). Twentyfour(45.28%) of MC patients had autoimmune disease and the diagnosis of autoimmune disease was always prior to MC. Sjogren's syndrome was associated only with the constipation subgroup.CONCLUSION: The Janus face of MC resembles the subgroups of irritable bowel syndrome. The co-existence of autoimmune diseases and MC is confirmed in both the constipation and diarrhea subgroups.展开更多
AIM:To assess the efficacy of intravenous cyclophos-phamide pulse therapy for refractory inflammatory boweldisease(IBD).METHODS:We included in our cohort eight patientswith(moderate/severe)steroid refractory IBD(4 wit...AIM:To assess the efficacy of intravenous cyclophos-phamide pulse therapy for refractory inflammatory boweldisease(IBD).METHODS:We included in our cohort eight patientswith(moderate/severe)steroid refractory IBD(4 withulcerative colitis and 4 with Crohn's disease).They allreceived 6 cycles of intravenous cyclophosphamide(800mg)per month.RESULTS:Patients entered into remission after the sec-ond/third cyclophosphamide pulse.Disease activity de-creased.There were no side effects and toxicity.All thepatients went into long lasting remission.All Crohn's diseasepatients and 3 of 4 ulcerative colitis patients achievedcomplete remission.One patient with ulcerative colitisshowed an impressive clinical response but did not enterinto remission.For the maintenance,patients with Crohn'sdisease were treated with methotrexate(15 mg/wk)andpatients with ulcerative colitis were treated with azathio-prine(2.5 mg/kg body weight/d).CONCLUSION:Remission was maintained in all pa-tients for 6 mo on the average.The drug was well toler-ated.These findings suggest that aggressive immuno-suppressive therapy may be useful in some refractorypatients and further controlled study should be consid-ered in order to fully evaluate this type of treatment as apotential therapy for IBD.展开更多
Celiac disease (CD) is an autoimmune disorder of the small intestine that occurs in genetically predisposed people at all ages.However,it can be associated also to other immunopathological disorders,and may be associa...Celiac disease (CD) is an autoimmune disorder of the small intestine that occurs in genetically predisposed people at all ages.However,it can be associated also to other immunopathological disorders,and may be associated with abnormal histology in segments of the gut other than the small bowel including colonic inflammation.While guidelines for endoscopic investigation of the jejunum are well defined,no indication is defined for colonic investigation.We describe four cases of concurrent CD and microscopic colitis (MC) diagnosed at our department over a 10-year period and analyzed the main features and outcomes of CD in this setting.The symptoms of these patients were improved initially by a gluten-free diet before the onset of MC symptoms.Two of the patients were siblings and had an atypical form of CD.The other two patients with CD and MC also presented with fibrosing alveolitis and were anti-Saccharomyces cerevisiae antibody positive.The co-existence of immune-mediated small bowel and colonic inflammatory and pulmonary diseases are not well-known,and no systematic approach has been used to identify the lifelong patterns of these immune-based diseases.Patients can develop,or present with CD at any stage in life,which can co-exist with other gastrointestinal diseases of (auto-) immune origin.In addition,the fa-milial co-existence and prevalence of MC in patients with a prior diagnosis of CD are unclear.Clinicians managing celiac disease should be aware of these associations and understand when to consider colon investigation.展开更多
文摘Crohn＇s disease （CD） is a chronic relapsing and remitting autoinflammatory disorder of the gastrointestinal tract that has many intestinal and extraintestinal complications. The purpose of treatment is long-term remission, reduction of complications, and improvement of patients＇ quality of life. In many cases, this can be quite challenging and it is necessary to have a well thought out management strategy. We present the case of a 38-year-old woman with fistulizing CD that manifested as diffuse abdominal pain and bloody diarrhea accompanied by arthralgia. In addition, there were ulcerative lesions surrounded by cutaneous inflammation and erythema on her extremities, indicative of pyoderma gangrenosum. The patient was treated with high doses of parenteral methylprednisolone without any improvement and was started on adalimumab. A positive response to adalimumab therapy was observed： after 2 mo of therapy, the ulcerative skin lesion healed completely and the enterogastric fistula was closed affcer 5 mo adalimumab treatment. Adalimumab might be a suitable initial as well as maintenance therapy in patients with complicated CD.
文摘AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METHODS: A cohort of patients with independently confirmed typical histopathological changes was investigated. Fifty-three patients with histologically proved MC (46 with CC, 7 with LC) were included. The existence of diarrhea or constipation and the co-existence of autoimmune diseases were also investigated and all data were retrospectively analyzed.RESULTS: Twenty-three (43.39%) of MC patients had chronic constipation (20 in CC, 3 in LC patients). Twentyfour(45.28%) of MC patients had autoimmune disease and the diagnosis of autoimmune disease was always prior to MC. Sjogren's syndrome was associated only with the constipation subgroup.CONCLUSION: The Janus face of MC resembles the subgroups of irritable bowel syndrome. The co-existence of autoimmune diseases and MC is confirmed in both the constipation and diarrhea subgroups.
文摘AIM:To assess the efficacy of intravenous cyclophos-phamide pulse therapy for refractory inflammatory boweldisease(IBD).METHODS:We included in our cohort eight patientswith(moderate/severe)steroid refractory IBD(4 withulcerative colitis and 4 with Crohn's disease).They allreceived 6 cycles of intravenous cyclophosphamide(800mg)per month.RESULTS:Patients entered into remission after the sec-ond/third cyclophosphamide pulse.Disease activity de-creased.There were no side effects and toxicity.All thepatients went into long lasting remission.All Crohn's diseasepatients and 3 of 4 ulcerative colitis patients achievedcomplete remission.One patient with ulcerative colitisshowed an impressive clinical response but did not enterinto remission.For the maintenance,patients with Crohn'sdisease were treated with methotrexate(15 mg/wk)andpatients with ulcerative colitis were treated with azathio-prine(2.5 mg/kg body weight/d).CONCLUSION:Remission was maintained in all pa-tients for 6 mo on the average.The drug was well toler-ated.These findings suggest that aggressive immuno-suppressive therapy may be useful in some refractorypatients and further controlled study should be consid-ered in order to fully evaluate this type of treatment as apotential therapy for IBD.
文摘Celiac disease (CD) is an autoimmune disorder of the small intestine that occurs in genetically predisposed people at all ages.However,it can be associated also to other immunopathological disorders,and may be associated with abnormal histology in segments of the gut other than the small bowel including colonic inflammation.While guidelines for endoscopic investigation of the jejunum are well defined,no indication is defined for colonic investigation.We describe four cases of concurrent CD and microscopic colitis (MC) diagnosed at our department over a 10-year period and analyzed the main features and outcomes of CD in this setting.The symptoms of these patients were improved initially by a gluten-free diet before the onset of MC symptoms.Two of the patients were siblings and had an atypical form of CD.The other two patients with CD and MC also presented with fibrosing alveolitis and were anti-Saccharomyces cerevisiae antibody positive.The co-existence of immune-mediated small bowel and colonic inflammatory and pulmonary diseases are not well-known,and no systematic approach has been used to identify the lifelong patterns of these immune-based diseases.Patients can develop,or present with CD at any stage in life,which can co-exist with other gastrointestinal diseases of (auto-) immune origin.In addition,the fa-milial co-existence and prevalence of MC in patients with a prior diagnosis of CD are unclear.Clinicians managing celiac disease should be aware of these associations and understand when to consider colon investigation.
