Histologic Features Of Crohn's Disease Research Articles

S2765 Autologous Graft vs Host Disease: An Unusual and Unexpected Cause of Bowel Obstruction

INTRODUCTION: Autologous-graft versus host disease (auto-GVHD) is an extremely rare entity comprising only 0.9% of cases of lymphoma patients undergoing autologous hematopoietic stem cell transplantation (HSCT). Although very uncommon, it can lead to serious complications including abdominal pain, rectal bleeding, and profuse diarrhea. We present a very rare case of auto-GVHD leading to small bowel obstruction. CASE DESCRIPTION/METHODS: A 39 year-old man with history of large B cell lymphoma underwent autologous-HSCT after treatment with R-CHOP and cyclophosphamide plus dexamethasone following a relapse. Days later developed fever, nausea, vomiting, abdominal pain and diarrhea. Laboratories showed leukopenia, thrombocytopenia, elevated liver enzymes and bilirubin. Tests for infectious diarrhea were negative. Colonoscopy showed elevated whitish lesions and diffuse loss of vascular pattern up to mid transverse and biopsies revealed marked crypt loss, regenerative atypia with rare apoptotic bodies. A diagnosis of auto-GVHD was entertained. Steroids were started and tapered off after clinical improvement. Months later there was worsening of symptoms associated with distended and tender abdomen with diminished bowel sounds. Abdominal CT scan showed ileal inflammation associated with small bowel dilatation. Colonoscopy showed a stricture at ileum with associated friable mucosa. Biopsy revealed chronic active ileitis and necrotic purulent material with associated ulcer, negative for CMV. Resection of ileal segment was performed and steroids given for 6 weeks. DISCUSSION: The differential diagnosis included auto-GVHD, lymphoma recurrence and Crohn's disease (CD). Lymphoma was unlikely given negative immunohistochemistry and PET scan. No classic endoscopic or histologic features of CD were observed. This led to a diagnosis of GVHD, a multisystem disorder that commonly complicates allogeneic-HSCT but is exceedingly rare in autologous-HSCT. The pathophysiology is unknown and establishing the diagnosis is a challenging task. The clinical presentation of Auto-GVHD is similar to allogeneic GVHD, with the skin, gastrointestinal tract and liver the principal target organs. It commonly begins with a maculopapular rash, diarrhea, hematochezia, abdominal pain, vomiting, and elevated liver tests. The diagnosis of auto-GVHD can be made on the basis of ongoing GI symptoms, endoscopic evidence of mucosal abnormalities, and histological findings of apoptotic epithelial cells or crypt cell dropout with lymphocytic infiltrate.Figure 1.: Elevated whitish lesions, loss of vascular pattern diffusely.Figure 2.: Glandular apoptosis and crypt cell drop out.

Inflammatory bowel disease in Icelandic children 1951–2010. Population-based study involving one nation over six decades

Aim and background. We describe the changes in incidence and disease location of inflammatory bowel disease (IBD) in children in one country over six decades. Iceland is an island with centralized health information. Children with IBD are cared for in only two hospitals. Iceland is therefore well suited for nationwide epidemiologic studies. Material and methods. All IBD patients 16 years and younger diagnosed in Iceland from 1950–2010 were included. Patients were identified retrospectively from 1950–1989, and propectively from 1990–2010, by reviewing pathology and charts for all patients diagnosed with IBD. Criteria for the diagnosis of ulcerative colitis (UC) were history of blood in stools for >3 weeks, characteristic endoscopic appearance of continuous inflammation of the colon, and histologic appearance of acute and chronic inflammation of the colon without granulomata. Criteria of Crohn's disease (CD) were history of abdominal pain, blood in stools, and endoscopic, radiologic, and histologic features of CD. Results. One hundred and ten children were diagnosed with IBD, 61 with UC, 44 with CD, and 5 with indeterminate disease. The median age was 13.7 ± 2.6, with sex distribution varying from decade to decade. From 1980 until 2000, there was a dramatic increase in the incidence of IBD from 1.2 per 100,000 children <16 years of age to 5.6 per 100,000. However, in the past decade, the incidence has plateaued. Conclusion. In this population-based pediatric study, we report an increase in the incidence of IBD from 1950–2000. Incidence in Icelandic children is lower than in published studies from other Northern European countries.

Differential diagnosis between Crohn's disease and intestinal tuberculosis in China

To evaluate the values of clinical findings in differential diagnosis between Crohn's disease (CD) and intestinal tuberculosis (ITb), so that better diagnosis strategies could be found, we analysed the records of 30 patients with ITb and 30 patients with CD retrospectively. We reviewed the cardinal symptomatic and physical, radiological, colonoscopic, pathological findings in the patients. Some cardinal symptomatic and physical, radiographic and colonscopic features of CD and ITb were positive correlation. Its Pearson correlation coefficients were 0.976, 0.953 and 0.961, respectively (p = 0.000, 0.003 and 0.000). Some histological features of CD and ITb had no correlation. Its Pearson correlation coefficient was 0.140 (p = 0.765). It is difficult to differentiate CD from ITb in clinical practice. The differential diagnosis depends largely upon colonoscopy and histopathology.

Quantitative PCR analysis of TNF-alpha and IL-1 beta mRNA levels in pediatric IBD mucosal biopsies.

Inflammatory bowel disease (IBD) is associated with increased activation of intestinal immune cells, whose overproduction of proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) is implicated in mediating the sustained inflammatory response. Studies to date have largely reported qualitative differences in cytokine gene expression between IBD and controls. Our aim was to perform quantitative analysis of intestinal mucosal mRNA expression in colonic biopsies from pediatric IBD patients using a competitive polymerase chain reaction. IL-1 beta and TNF-alpha were expressed in all IBD and control biopsies. Compared to controls, IL-1 beta mRNA levels were increased in involved tissue from Crohn's disease (CD) patients, but not in histologically uninvolved CD or in ulcerative colitis (UC) mucosa. IL-1 beta expression in the latter groups were equivalent to those found in tissue from patients with eosinophilic colitis (EOC). Significantly higher levels of IL-1 beta mRNA were found in uninvolved mucosa from CD patients who presented with a relapse of disease activity, as compared to newly diagnosed cases with histological features of CD at an early stage. TNF-alpha mRNA transcripts were also significantly elevated in involved CD mucosa, but not in the other groups. TNF-alpha gene expression in CD-involved tissue decreased with disease duration. Follow-up of the patients revealed that high cytokine expression in uninvolved CD tissue correlated with an early clinical relapse. In conclusion, quantitative determination of proinflammatory cytokine gene expression reveals differences between the type, severity, and clinical course in patients with IBD.