Crohn's Symptoms Research Articles

Osteopathic Findings and Treatment of Patient with Crohn’s Disease and Post-Ileocecal Resection: A Case Report

Abstract Crohn’s disease is a form of inflammatory bowel disease (IBD) that chronically damages the lining of the digestive tract. The symptoms of Crohn’s disease can vary secondary to its severity, ranging from asymptomatic patients to those suffering from constant abdominal pain, diarrhea, blood loss, and fatigue. Patients with Crohn’s disease endure a decreased quality of life depending on the extent of their symptoms. Crohn’s disease can be differentiated from other forms of IBD by its location in the gastrointestinal (GI) tract and distinct gross and microscopic morphology. This disease can affect any portion of the GI tract, but most commonly affects the terminal ileum and colon. The affected portion exhibits transmural inflammation, where all layers of the bowel are damaged, leading to strictures and fistulas. In this case of a patient with fistulizing fibro-stenotic Crohn’s disease, ileocecal resection was required. 1-week post-surgery, the patient suffered from continuous pain and discomfort with sympathetic nervous system overactivity. The somatic dysfunctions diagnosed on osteopathic structural examination were addressed with osteopathic manipulative treatment (OMT) and directed to restore the functionality of her sympathetic and parasympathetic nervous systems. The patient’s symptoms were found to have improved after the application of OMT. The results of this case study suggest that treating post-surgery patients using osteopathic techniques, specifically following ileocecal resection, can improve their post-op symptoms and reduce the need for post operative oral pain medications. Patient’s consent for this case report was obtained in written and verbal form.

A CASE STUDY ON AYURVEDIC MANAGEMENT OF CROHN’S DISEASE

Introduction- Diseases of the digestive system constitute a significant role in increasing the disease burden in society. Grahani Roga (Disorder of gastro-intestinal tract especially duodenum and lower G.I Tract), according to Ayurveda, is a disease related to gastrointestinal disorders. Observation- A clinically diagnosed male patient with Crohn's disease 20 years old. The signs and symptoms of Crohn’s disease are like the manifestations of Grahani Roga, as explained in Ayurveda texts. Most of the symptoms of Grahani Roga, as mentioned in Ayurveda, resemble Crohn’s Disease. These include loss of appetite, fever, weight loss, diarrhea, depression. So, there can be a correlation between the two conditions. To provide practical insights into the therapeutic concepts of Ayurveda, a diagnosed case of Crohn’s Disease in a preview of Grahani Roga is discussed in this article. The condition was managed with the help of holistic Herbal and Herbo-mineral compounds mentioned in authentic Ayurveda texts. In this Case Study, treatment given to the patient consisted of a combination of herbs like Kutaj, Bilwa, Darvi, Kamdudha, Vidangadi, Pachak, and Rasasindur with Anupan (co-administer of medicine) of Ghee. Classical Herbo-mineral compounds like Kutajghan vati, Shankh vati, Suwarnmalini Vasant and Panchamrut parpati play an essential role in the treatment plan. According to Ayurveda, it is concluded that there is a correlation between the signs and symptoms of Crohn’s Disease and Grahani Roga. Nidan Parivarjana, Pathya- Apathya also play a vital role in Grahani Roga.

Gestational breast cancer in a patient with Crohn\u2019s disease: two\xa0case reports

BackgroundDiagnosis of breast cancer during gestation is a rare occurrence. In addition, the diagnosis of breast cancer in a patient with Crohn’s disease is not common. We present a rare case of gestational breast cancer in a patient with Crohn’s disease, with a concurrent breast cancer diagnosis in her sister.Case presentationA 31-year-old Syrian woman with Crohn’s disease was diagnosed with breast cancer at 30 weeks gestation; she received neoadjuvant chemotherapy during gestation. Incidentally, her 37-year-old sister was also diagnosed concomitantly with breast cancer. Both sisters underwent and successfully completed surgery and adjuvant therapy. At a 5-year review, both patients showed no signs of recurrence. The Crohn’s disease symptoms have also improved after chemotherapy, and the baby born after gestational chemotherapy is currently 5 years old with normal psychomotor development and without any congenital malformations.ConclusionsThis case report highlights the impact of gestation on breast cancer outcomes, the possibility of giving chemotherapy during gestation, and the effect of chemotherapy on the symptoms of Crohn’s disease.

Risk factors for symptomatic anastomotic postoperative recurrence following ileo-colic resection in Crohn's disease.

Crohn's disease is a chronic inflammatory bowel disease characterized by alternating periods of exacerbation and remission. Surgical resection is not curative and postoperative recurrence (POR) remains a challenge in these patients. The aim of this study was to identify clinical variables that influence the risk of symptomatic anastomotic POR in patients with ileo-colonic Crohn's disease. A retrospective study of Crohn's disease patients who had undergone ileo-colic resection between January 2014 and December 2018 was performed. For each patient, data including demographic information, Crohn's disease clinical setting, preoperative radiological data, operative and histological data, pre- and postoperative medication history and postoperative clinical course, including recurrence of disease, were extracted. Symptomatic anastomotic POR was defined as symptoms of Crohn's disease in the presence of confirmed anastomotic POR (endoscopic and/or radiological POR). For the study period, 104 patients were eligible and included for analysis. The cumulative probability of symptomatic anastomotic POR was 14%, 30%, 42%, 50% and 50% at 1, 2, 3, 4 and 5years, respectively. Two clinical variables on multivariate analysis were associated with increased risk of symptomatic anastomotic POR, namely age <17years at diagnosis [hazard ratio (HR) 2.17, p=0.019] and gastrointestinal involvement (extent) >30cm (HR 1.85, p=0.048). This study describes the natural history of POR after ileo-colic resection for Crohn's disease, as defined by endoscopic, radiological and clinical outcomes. Age <17years at diagnosis and gastrointestinal involvement (extent) >30cm were independent risk factors for symptomatic anastomotic POR.

3159 A Case of Takayasu's Arteritis in a Patient With Crohn's Disease

INTRODUCTION: Takayasu's Arteritis is a rare, chronic inflammation of the large vessels, particularly the aorta and its primary branches. Though etiology is largely unknown, the pathogenesis is thought to be due in part to inflammation in vascular tissue. The vast majority of cases worldwide have been in females from 10-40 years of age. Cases of Takayatsu's Arteritis have been reported in patients with Inflammatory Bowel Disease. CASE DESCRIPTION/METHODS: We present the case of a 41 y/o Caucasian female, with long standing Crohn's Disease (2006) who reports to our clinic for evaluation in 2010. At the time of presentation, Crohn's symptoms were mild. Over the next four years the patient had multiple flares and was treated with multiple agents. In 2017 she underwent a laparoscopic hemicolectomy after colonoscopy revealed a marked stricture proximal to her terminal ileum. DISCUSSION: Pathology from the surgery revealed a neuroendocrine tumor. Subsequent Osteoscan was negative but a CT revealed circumferential thickening of the proximal thoracic aorta at the origin of the left subclavian artery, indicative of aortitis. The findings were consistent with a diagnosis of Takayatsu's Arteritis.

Crohn\u2019s disease in a developing African mission hospital: a case report

BackgroundA case is reported of innocuous intestinal obstruction requiring surgical intervention that was confirmed to be Crohn’s disease histopathologically in a resource-constrained rural mission hospital in Cameroon.Case presentationA 70-year man of Kumbo origin from Northwest region of Cameroon with a history of crampy right lower-quadrant abdominal pain, non-bloody, non-mucoid diarrhea alternating with constipation presented to my institution. Abdominal examination of the patient revealed an ill-defined mass in the right iliac fossa and visible peristalsis. An abdominal computed tomographic scan and barium enema study confirmed a complex ascending colonic and cecal tumor. The patient underwent exploratory laparotomy. The intraoperative finding was a huge complex inflammatory mass involving the cecum, terminal ileum, and sigmoid colon. He subsequently had sigmoidectomy with end–to-end sigmoidorectal anastomosis and a cecal resection, and the proximal ascending colon was exteriorized because end mucoid fistula and terminal ileostomy were performed. The histopathological diagnosis confirmed Crohn’s disease. The patient subsequently received five courses of adjuvant chemotherapy consisting of azathioprine, methotrexate, mesalamine, and methylprednisolone. He had complete disease remission and subsequently had closure of ileostomy with satisfactory postoperative status. The most recent follow-up abdominal computed tomographic scan and colonoscopy revealed disease-free status. The patient is also currently receiving a maintenance dose of rectal mesalamine and oral omeprazole treatment. He has been followed every 2 months in the surgical outpatient clinic over the last 16 months with satisfactory clinical outcome.ConclusionsCrohn’s disease is uncommon in Africa, and this entity is encountered sparingly. The signs and symptoms of Crohn’s disease overlap with many other abdominal disorders, such as tuberculosis, ulcerative colitis, irritable bowel syndrome, and others. Several publications in the literature describe that it is difficult to make an accurate diagnosis of this disease, despite the fact that many diagnostic armamentaria are available to suggest its presence. Most of the patients with Crohn’s disease are treated conservatively, and a few may require surgical intervention, especially those presenting with complications such as intestinal obstruction, perforations, and abscess as well as fistula formations, as seen in this index patient. Crohn’s disease is considered by many to be a very rare disease in Africa. It is interesting to know that Crohn’s disease, which affects mainly young adults, may debut at any age. The rarity and clinical curiosity of this entity suggested reporting of my patient’s case. Evidence-based up-to-date information on Crohn’s disease is also documented.

Young Investigator: A Rare Case of Crohnʼs Disease-Associated Aortitis

RESULTS: A 33 year-old woman with history of Crohn's disease complicated by enteropathic arthropathies presented with symptoms of complete gastrointestinal obstruction. She had history of ongoing ileocolitis despite therapy with certolizumab. Due to persistent obstruction symptoms, she underwent an uneventful laparoscopic ileocecectomy. On post-operative day number two, she developed fever, chest pain, tachycardia and shortness of breath. Her WBC was elevated to 10 K/microL, with CRP 10 mg/L, total IgG and IgG2 noted to be elevated with normal IgG4 levels. Interferon release assay for tuberculosis was negative. A chest CT revealed ascending aortitis, which was later confirmed with MR angiography. She was started on high-dose corticosteroids and ultimately transitioned to infliximab (5 mg/kg) and subcutaneous methotrexate with resolution of aortitis on follow-up imaging. While her aortitis has remained in remission, her intestinal Crohn's symptoms and arthralgias are recurring despite recently increasing infliximab dose to 10mg/kg every 6 weeks, with therapeutic levels and no evidence of anti-infliximab antibodies. CONCLUSION(S): Extraintestinal manifestations (EIM) of inflammatory bowel disease are commonly found in approximately one-third of patients. They typically manifest as peripheral or axial arthropathies, dermatologic manifestations including pyoderma gangrenosum and erythema nodosum, ocular involvement including uveitis or episcleritis, and primary sclerosing cholangiopathy. While very uncommon, there also appears to be some degree of overlap between Crohn's disease and large vessel vasculitides. Initial evaluation should exclude diagnoses of Takayasu's arteritis, Behcet's disease, sarcoidosis, ankylosing spondylitis, and connective tissue disorders. Infectious etiologies such as tuberculosis and syphilis should also be eliminated. Upon exclusion of these disease processes causing aortic inflammation, the diagnosis of a Crohn's-related EIM should be considered. Only a few cases of aortitis associated with Crohn's disease have been reported in the literature but this appears to be a very rare phenomenon. Severe cases of aortitis carry the risk of aortic rupture when inflammation is left untreated. Fortunately, aortitis appears to be readily responsive to high dose corticosteroid therapy, as was the case in our patient. If significant valvular disease is present (i.e. severe aortic regurgitation), this may require valvular replacement surgery. Interestingly, there have been reports of Crohn's-related aortitis developing in the setting of anti-TNF therapy, again requiring corticosteroid therapy for resolution. As such, we will need to monitor our patient closely to detect any signs of recurrent aortitis.

When accommodations conflict, documentation is important

An unusual lawsuit highlights the importance of documentation when resolving conflicting claims to accommodations. Two students at Ohio State University lived in the same sorority house. One of the students claimed to be allergic to dogs and to have Crohn's disease with Crohn's symptoms exacerbated by anxiety from her allergic response to dogs, but because no dogs then resided in the sorority house, she did not immediately need or seek an accommodation related to dogs, though she obtained several Crohn's‐related academic accommodations. The other student later secured a lease and sought and obtained authorization to keep a dog as an emotional support animal as an accommodation for her psychiatric impairments.

Treatment of orofacial granulomatosis: a case report

BackgroundOrofacial granulomatosis is a relatively recent term coined by Wiesenfield et al. in 1985 to define granulomatous lesions of oral mucosa without intestinal involvement. When it presents in a triad encompassing facial nerve palsy, lip swelling, and fissured or furrowed tongue it is called Melkersson–Rosenthal syndrome while monosymptomatic or oligosymptomatic forms are referred to as granulomatous cheilitis. It is an uncommon clinicopathologic entity which is distinct from classic Crohn’s disease. The NOD2 variant which is commonly associated with Crohn’s has not been shown to have any association with orofacial granulomatosis.Case presentationWe present a case of a 31-year-old white man who had painful swelling of the lip with oral ulcers and difficulty eating for 2 to 3 years. He was diagnosed as having granulomatous cheilitis based on characteristic biopsy findings. There was serologic evidence of Crohn’s disease with anti-Saccharomyces cerevisiae antibodies. However, he was not found to have any gastrointestinal involvement based on computed tomography enterography, and upper and lower endoscopies. He failed to respond to nonsteroidal anti-inflammatory drugs, steroids, and dapsone therapy but responded well to high doses of infliximab.ConclusionsOur case questions whether granulomatous cheilitis really exists or is it simply a variant of Crohn’s disease with only oral presentation. Our patient did not have symptoms of Crohn’s disease; moreover, endoscopic studies and computed tomography enterography were unremarkable for evidence of intestinal involvement. Our case is also the first reported case where high-dose infliximab alone has been used with sustained response for approximately 8 months. In conclusion, more research is needed to assess the underlying pathology as well as ideal treatment options for patients with orofacial granulomatosis. We propose that high-dose infliximab should be considered in patients who do not respond to traditional therapies.

Inducing remission in Crohn's disease

Affecting approximately 115 000 people in the UK (Crohn's and Colitis UK, 2013), Crohn's disease is a chronic inflammatory disease of the gastrointestinal (GI) tract, presenting with periods of relapse and remission (National Institute for Health and Care Excellence (NICE), 2015). The inflammation is intermittent, with sections of unaffected GI tract between the inflamed sections. Symptoms of Crohn's disease vary between individuals, but include loss of appetite, mouth ulceration, weight loss, diarrhoea, fatigue, abdominal pain and anaemia (Crohn's and Colitis UK, 2013). As well as the associated psychological impact of Crohn's disease, it can also result in a range of physical complications including malnutrition, intestinal strictures, abscesses, fistulas and cancers (NICE, 2015).

Biology: A slow-motion epidemic.

The symptoms of Crohn's disease and ulcerative colitis, the two main forms of inflammatory bowel disease (IBD), can be severe and lifelong. And the condition is becoming increasingly common worldwide.

Noninvasive Colonic Phaeohyphomycosis Caused by Exophiala Oligosperma in a Patient With Crohnʼs Disease

Introduction:Exophiala oligosperma is an uncommon fungal pathogen which can cause infection in immunocompromised patients. The majority of these infections are cutaneous, but fatal systemic infections have been reported. There are no reported cases of E. oligosperma causing colonic infection in the literature. To the best of our knowledge, this is a first reported case of an E. oligosperma induced non-invasive colonic phaeohyphomycosis in an immunocompromised patient with Crohn's disease treated successfully with voricanozole. Case Report: A 27 year old female with Crohn's disease on adalimumab and prednisone presented with persistent fever for three weeks. Index Crohn's symptoms were improving since initiation of adalimumab but diarrhea continued. The patient had no abdominal tenderness. Labs were remarkable for only mild anemia. After extensive work up, only colitis was noted on an abdominal computed tomography (CT) scan. A colonoscopy was done to attempt to further assess source of fever which showed worsened sigmoid colitis with pseudopolyps. Random biopsies showed inflammation. Multiple tissue samples cultured grew black mold with speciation consistent with E. oligosperma. Tissue biopsies did not show invasive fungal elements. Adalimumab was discontinued and patient was started on voricanozole. Fever resolved and the patient reported improvement in diarrhea after starting antifungal therapy. Discussion:E. oligosperma is a fungal strain that was indentified in 2003 by de Hoog et al.There are only six reported cases of phaeohyphomycosis associated with E. oligosperma in the literature. Cutaneous infections are more common with this pathogen but invasive infections are reported, including prosthetic valve endocarditis, dialysis-associated peritonitis, and disseminated infections. We describe a case of noninvasive colonic phaeohyphomycosis associated with E. oligosperma manifested by fever and gastrointestinal symptoms. Gross appearance of colon mucosa can look inflamed or darkly pigmented. Tissue culture is often needed for diagnosis. Histological finding of granulation suggests invasive infection. Superficial colonic mucosal infection can be treated with voricanozole; however, invasive phaeohyphomycosis usually requires surgical resection.

A Novel Presentation of 6-Mercaptopurine Toxicity in a Patient With IBD

Pancreatitis and drug fever are well-known idiopathic side effects of the immunomodulatory drugs. Erythema nodosum (EN) and episcleritis are well-known extra intestinal manifestations of Inflammatory Bowel Disease (IBD). We present a unique case of 6-MP induced pancreatitis, drug fever, episcleritis, and erythema nodosum in a patient with IBD. A 30-year-old female with Ulcerative Colitis status post proctocolectomy with an IPAA re-presented with inflammatory arthritis and diarrhea. Endoscopy showed proximal ileitis consistent with Crohn's. She was started on combination immunosuppression with adalimumab and 6-MP. She later presented to clinic with six days of epigastric pain, vomiting, fevers, and scleral injection. Three days prior she had developed multiple red, tender, non-pruritic nodules on her anterior tibia bilaterally. Her bowel frequency had improved from 12 to 4 stools per day. She was febrile with an elevated lipase, CRP, and a neutrophil predominant leukocytosis. She was diagnosed with pancreatitis and admitted. Liver enzymes were not elevated and imaging was negative for biliary disease. There was no history of alcohol consumption. Blood, urine, and stool cultures were negative and her stool was negative for c. difficile. Dermatology concluded the lesions were consistent with EN and ophthalmology concluded the scleral injection was consistent with episcleritis. The 6-MP was stopped and the patient improved rapidly. By hospital day 2, she was tolerating a normal diet and her leukocytosis had resolved. The lower extremity rash also rapidly improved. Throughout the patient's hospitalization, there was no change in the character or frequency of the patient's bowel movements. While pancreatitis and EN are documented side effects of 6-MP, the combination along with episcleritis and presence of fever make for a novel presentation of 6-MP toxicity in a patient with IBD. Although IBD flare was on the differential as well as inflammatory panniculitis secondary to pancreatitis, the improvement in baseline Crohn's symptoms with medical therapy, the timing of new symptoms related to initiation of 6-MP, as well as rapid improvement in symptoms after discontinuation of 6-MP are all indicative of a drug-related etiology. While this is a very unique case, its importance lies with appropriate management of thiopurine toxicity which includes quick clinical recognition and discontinuation of the medication which can be challenging in such complicated patients.Figure 1Figure 2

Intestinal carcinoid tumour: Case report

Abstract Background Carcinoid of the small intestine, is a well-differentiated neuroendocrine tumour that rarely presents with clinical signs. This tumour can be associated with other conditions, such as inflammatory bowel disease, presenting a wide range of symptoms. In some cases they have an aggressive and highly symptomatic behaviour; thus, clinical suspicion must be high to make an early diagnosis. Clinical case A 60 year-old male patient with Crohn's disease and gastrointestinal symptoms attributed to this disease within the last year. He presented with intestinal obstruction initially treated with conservative management with no improvement. Exploratory laparotomy was performed finding a mesenteric tumour that caused the bowel obstruction. Bowel resection with primary anastomosis was performed. The pathology report showed an intestinal carcinoid tumour with lymph node metastases. The patient recovered well, and was discharged without complications to continue medical treatment and follow-up by the Oncology department. Conclusion In almost 42% of the cases, the most common site of carcinoid tumours is the small intestine, and of these, 41% are presented as locoregional disease. Patients with Crohn's disease present a higher incidence. In these cases, the most common presentation is an acute intestinal obstruction (90%). Surgery is usually curative, and follow up is important as the symptoms of Crohn's disease can hide any recurrence.

Antitubercular Therapy Improves Clinical Symptoms of Crohn's Disease Initially but Long-term Complications Are High

Antitubercular Therapy Improves Clinical Symptoms of Crohn's Disease Initially but Long-term Complications Are High

A Case of Crohn’s Disease Admitted with Acute Abdomen Pain

Crohn’s disease is an inflammatory disorder and may affect any part of gastrointestinal tract. The signs and symptoms of Crohn’s disease are similar to many other abdominal disorders. Crohn’s disease does not typically present as an acute abdomen. However, Crohn’s disease should be considered in the differential diagnosis of patients with abdominal pain, especially relevant to patients with a long history of vague abdominal complaints and those with unexplained weight loss or growth retardation. In this case report, we present such a patient of acute abdomen admitted to us after appendectomy and diagnosed Crohn’s disease finally.

Mongersen, an Oral SMAD7 Antisense Oligonucleotide, and Crohn’s Disease

BackgroundCrohn’s disease–related inflammation is characterized by reduced activity of the immunosuppressive cytokine transforming growth factor β1 (TGF-β1) due to high levels of SMAD7, an inhibitor of TGF-β1 signaling. Preclinical studies and a phase 1 study have shown that an oral SMAD7 antisense oligonucleotide, mongersen, targets ileal and colonic SMAD7.MethodsIn a double-blind, placebo-controlled, phase 2 trial, we evaluated the efficacy of mongersen for the treatment of persons with active Crohn’s disease. Patients were randomly assigned to receive 10, 40, or 160 mg of mongersen or placebo per day for 2 weeks. The primary outcomes were clinical remission at day 15, defined as a Crohn’s Disease Activity Index (CDAI) score of less than 150, with maintenance of remission for at least 2 weeks, and the safety of mongersen treatment. A secondary outcome was clinical response (defined as a reduction of 100 points or more in the CDAI score) at day 28.ResultsThe proportions of patients who reached the primary end point were 55% and 65% for the 40-mg and 160-mg mongersen groups, respectively, as compared with 10% for the placebo group (P<0.001). There was no significant difference in the percentage of participants reaching clinical remission between the 10-mg group (12%) and the placebo group. The rate of clinical response was significantly greater among patients receiving 10 mg (37%), 40 mg (58%), or 160 mg (72%) of mongersen than among those receiving placebo (17%) (P=0.04, P<0.001, and P<0.001, respectively). Most adverse events were related to complications and symptoms of Crohn’s disease.ConclusionsWe found that study participants with Crohn’s disease who received mongersen had significantly higher rates of remission and clinical response than those who received placebo. (Funded by Giuliani; EudraCT number, 2011-002640-27.)

Destabilizing Bodies, Destabilizing Disciplines: Practicing Liminality in Music Therapy

Our project began with a consideration of how disability studies might enrich the practice of music therapy. Originally, we were interested in how a greater awareness of disability issues might help music therapists, especially because of the often medicalized (and arguably pathologized) implications of the terms (“health” and “help”) which define their field and which frame the therapist/client relationship. On these grounds, we argued that greater awareness of the cultural context for such implications might aid the therapist. At the outset, it seemed straightforward enough. But our own unstable embodiments kept disrupting our conversations. The corporeal intransigencies of our bodies as we dealt with the symptoms of Crohn’s disease, autism and multiple sclerosis moved us beyond a critique of disciplinary purity which constructs each field as distinct to an analysis of privilege, power and passing that extends to multiple disciplines and pedagogical practices. In our paper, we raise questions about how the illusion of (st)able bodies can reinforce hierarchies (between therapist/client, teacher/student, helper/helped, ablebodied/disabled), especially when the person “in charge” does not have to disclose or discuss the instability of her own body. Upon that privilege rests an array of power dynamics, and we believe that a purposeful contemplation of our own embodiment has to be more central to praxis, whether as therapists, scholars, teachers or professionals. To do this, we must be aware not only of others’ but also of our own relationship to disability -- socially, culturally, and as a marker of identity and potential (in)access to power.

Incidence and predictors of clinical response, re-induction dose, and maintenance dose escalation with certolizumab pegol in Crohn's disease.

Certolizumab pegol (CERT) is indicated for reducing the signs and symptoms of Crohn's disease (CD) and maintaining clinical response. Patients losing response received an extra "capture" re-induction dose in the PRECiSE 4 study. We examined the use of certolizumab in a retrospective cohort of patients with CD at a single inflammatory bowel disease center. We conducted a retrospective chart review of all adult patients with CD treated with CERT at the University of Chicago from April 22, 2008 to May 1, 2011. Demographics, disease characteristics, inflammatory bowel disease therapies, surgeries, CERT dosing, and clinical outcomes were recorded. Predictors of clinical response, re-induction dosing, and maintenance dose escalation were evaluated. Univariate, multivariate, and Kaplan-Meier analyses were performed for predictive variables of clinical response, re-induction dosing, and maintenance dose increases. One hundred ten patients were identified; 23 were excluded. The remaining 87 patients had a sustained clinical response of 31.0%, remission of 14.9%, minimal or no response of 31.0%; 37.9% initially responded but lost response. In total, 35.6% of patients received a single re-induction dose of 400 mg after a mean of 29 weeks, predicted by prior anti-tumor necrosis factor (P = 0.007) and absence of perianal disease (P = 0.006); only 5 patients (16.1%) maintained a durable response or remission; 11.5% increased maintenance dosage after a mean of 50 weeks; all but 1 subsequently stopped CERT. Some patients with CD (31%) achieved a sustained response. The majority of patients receiving re-induction dosing did not achieve a sustained clinical response. Previous treatment with anti-tumor necrosis factor therapy was associated with reduced responses, suggesting that CERT may be more effective as an initial anti-tumor necrosis factor therapy.

Recurrent IgA nephropathy complicated with Crohn's disease after renal transplantation.

A 27-year-old man was diagnosed with IgA nephropathy and Crohn's disease. He had been diagnosed with proteinuria and hematuria since he was 20years old. Diarrhea had been a continuing problem during the past 5months. Neither corticosteroid therapy nor tonsillectomy was performed. Hemodialysis was required at age of 30, while the symptoms of Crohn's disease were ameliorated by an elemental diet. He received a renal transplant from his mother 4months after starting dialysis therapy. The initial immunosuppression therapy consisted of methylprednisolone, mycofenolate mofetil, cyclosporine, and basiliximab. Eight months after transplantation, proteinuria and hematuria appeared and serum creatinine was 1.4mg/dL. Relapse of IgA nephropathy was confirmed by the one-year protocol biopsy. He had suffered from tonsillitis at 32months after the transplantation. Urinary protein increased to 3g/day and serum creatinine was elevated to 2.04mg/dL. Renal biopsy was performed 2weeks after the urinary findings were aggravated. The cellular crescents constituted 36% of the glomeruli. The findings of rejection were not confirmed in both biopsies. Tonsillectomy was performed thereafter. No additional immunosuppressive therapy was added. Proteinuria and hematuria disappeared at 4 and 20months, respectively, after tonsillectomy, even when the symptoms of Crohn's disease worsened 69months and 89months after transplantation. A renal biopsy was performed 101months after transplantation. Although IgA in the mesangium area was confirmed by immunohistochemical staining, no active lesion was seen. Tonsillectomy along with immunosuppressants for the graft might be an effective treatment for some patients with active recurrent IgA nephropathy.