Extraintestinal Manifestations Of Crohn Research Articles

Cholelithiasis in inflammatory bowel disease

Cholelithiasis is considered an extraintestinal manifestation of Crohn's ileitis but has not been associated with ulcerative colitis. To evaluate if an increased risk of cholelithiasis exists in patients with ulcerative colitis, biliary ultrasonography was performed on 159 patients with inflammatory bowel disease, 114 patients with ulcerative colitis, and 45 patients with Crohn's disease. A control population of 2453 residents of the town near the authors' institute was also studied. An echographic survey of gallstones was performed on the control subjects, who participated in the Multicentrica Italiana Colelitiasi (MICOL). Seventeen patients with inflammatory bowel disease had gallstones (10.7 percent), 11 patients with ulcerative colitis had gallstones (9.6 percent), and 6 patients with Crohn's disease had gallstones (13.3 percent). In the control population, diagnosis of cholelithiasis was made in 239 subjects (9.7 percent). An estimate of the relative risk (odds ratio) of gallstones in ulcerative colitis and Crohn's disease and also in 4 subgroups formed on the basis of the extent of disease (total ulcerative colitis, partial ulcerative colitis, Crohn's disease with ileitis, Crohn's disease without ileitis) with respect to the general population was calculated using logistic regression with gallstones, sex, age, and body mass index as independent variables and inflammatory bowel disease as a dependent variable. The author's findings show an increased risk of gallstones in both patients with Crohn's disease (odds ratio = 3.6; 95 percent confidence limits = 1.2 - 10.4; P = 0.02) and patients with ulcerative colitis (odds ratio = 2.5; 95 percent confidence limits = 1.2 - 5.2; P = 0.01). The risk was highest in patients with Crohn's disease involving the distal ileum (odds ratio = 4.5; 95 percent confidence limits = 1.5 - 14.1; P = 0.009) and in patients with total ulcerative colitis extending to the cecum (odds ratio = 3.3; 95 percent confidence limits = 1.3 - 8.6; P = 0.01). These results confirm that there is an increased risk of gallstones in Crohn's ileitis but they show that there also exists an increased risk in patients with total ulcerative colitis.

Pyoderma gangrenosum and Crohn's disease. Eight cases and a review of the literature.

Pyoderma gangrenosum is an ulcerative cutaneous lesion of unknown cause that has been associated with chronic diseases. Its association with inflammatory bowel disease has classically been with chronic ulcerative colitis; however, scattered cases have appeared in which pyoderma gangrenosum has accompanied Crohn's disease. Collected series have indicated an incidence varying between 0.16 per cent in the Mayo Clinic series of 1954 to 1.5 per cent in the Cleveland Clinic series of 1975. We have reviewed the records of eight patients with pyoderma gangrenosum and Crohn's disease who were seen at the Lahey Clinic between 1957 and 1980. During this period, 961 patients with Crohn's disease were seen (an incidence of 0.8 per cent). The ages of the patients ranged between 16 and 65 years. In two of the eight patients, the onset of pyoderma gangrenosum was coincident with the onset of the bowel symptoms; in the remaining six patients, the onset of pyoderma gangrenosum averaged 7.3 years after the onset of bowel disease. The diagnosis of Crohn's disease was made histopathologically for five patients; for the rest, the diagnosis was clinical. Lesions of pyoderma gangrenosum were seen on the legs of all eight patients; two patients had additional lesions of the trunk. In five patients, the activity of the skin lesions paralleled that of the bowel disease. Distribution of Crohn's disease in patients with pyoderma gangrenosum is similar to that previously reported—five with ileocolitis, two with colitis, and one with ileitis. Other extraintestinal manifestations of Crohn's disease in this group of patients were perianal disease in two, erythema nodosum in one, arthritis in one, and iritis in one. The diagnosis of pyoderma gangrenosum was confirmed pathologically in only one patient, emphasizing the subjective clinical nature of this diagnosis. This report represents the largest detailed series of patients with pyoderma gangrenosum and Crohn's disease to date.