Involvement In Crohn Research Articles

Crohn's Disease of the Esophagus

SummaryEsophageul involvement wilh C'rohn's disease has been rarely reported and pathologic documentation of granulomutous disease is often missing. A 12‐year‐old hoy who presented initially with dysphagia, odynophagia, and weight loss was found to have granulomatous esophagitis, gastritis, and subsequent colitis by endoscopic examination. Esophageal manometry showed a hypertensive lower esophageal sphincter with normal peristalsis and sphincter relaxation. The esophageal symptoms responded to oral steroids and sulfasalazine without any specific treatment for acid peptic disease. This case is the youngest reported patient with Crohn's disease of the esophagus. A review of the medical literature illustrates salient clinical, radiographic, endoscopic, and pathologic features of esophageal involvement in Crohn's disease. This case and the summarized cases emphasize the potential significance of esophageal symptoms in patients with Crohn's disease.

Latent pulmonary involvement in Crohn's disease: biological, functional, bronchoalveolar lavage and scintigraphic studies.

We have investigated the following pulmonary related parameters in 22 patients with Crohn's disease who were free of clinical pulmonary symptoms and had normal chest roentgenograms and in 25 controls: serum angiotensin converting enzyme, pulmonary function tests, bronchoalveolar lavage (lymphocyte count and subpopulations, macrophage viability and superoxide anion release by macrophages) and pulmonary scannings. Serum angiotensin converting enzyme was lower in Crohn's disease (14.1 +/- 5.1) than in controls (25.2 +/- 4.7) (p less than 0.001). Twelve of 22 Crohn's disease (54%) had a bronchoalveolar lavage lymphocytosis (greater than 18% alveolar lymphocytes). Bronchoalveolar lavage lymphocytes subpopulations were quite variable. Twelve of 17 Crohn's disease (71%) had an increase spontaneous and/or stimulated superoxide anion production by alveolar macrophages. Six of 12 Crohn's disease (50%) had an increase physiologic dead space in the upper part of their lung against one of 11 controls (9%). These data suggest that most patients with Crohn's disease have a latent pulmonary involvement.

Scintigraphic diagnosis of inflammatory small bowel stenoses in Crohn disease using 111In oxine-labeled leukocytes

17 patients with known small bowel involvement in Crohn's disease (clinically active, n = 14; clinically inactive, n = 3) were examined within 8 days via barium enemas of the small bowel (Pansdorf's method or enteroclysis) and by 111In-oxine labelled leucocytes. From 19 radiologically diagnosed small bowel stenoses 14 were classified as inflammatory and 5 as non-inflammatory. The leucocyte scan also showed 14 inflammatory stenoses. The not inflamed stenoses could not be diagnosed scintigraphically. The barium enemas of the small bowel and the leukocyte scans both correctly diagnosed the acute inflamed segments. The inability to show non-inflamed segments (n = 5) and to localise small bowel stenoses exactly is disadvantageous in the scan. The advantage of the leucocyte scan is a non-invasive examination without specific bowel preparation and the possibility to diagnose additionally inflamed large bowel segments (n = 4), fistulas and abscesses (n = 2). The leucocyte scan offers a useful expansion of the diagnostic tools in small bowel diseases, especially in radiological problems in patients with Crohn's disease.

Crohn's disease: A scanning electron microscopic study

A scanning electron microscopic study of Crohn's disease was done using surgically resected specimens. Grossly normal resection margins as well as nonulcerated portions from diseased areas were selected for study. Scanning electron microscopic findings in Crohn's disease included changes in villous size and shape, villous fusion and epithelial bridge formation, goblet cell hypertrophy and hyperplasia, and increased secretion of mucus. These changes were marked in involved areas, and many were also present in six of seven margins of resection available for study in the ileal group. The abnormalities found in grossly normal margins of resection suggest a more widespread involvement than can be appreciated by gross and light microscopic examination of the specimen. Formation of the increased coat of mucus observed may be stimulated by a number of agents and could contribute to an enhanced barrier function in areas of early involvement in Crohn's disease, thereby decreasing the uptake of toxic or antigenic macromolecules. A decrease in bacterial superinfections would also be facilitated. Later lesions, with severe villous changes and hypersecretion of mucus, may favor the uptake of toxic and antigenic macromolecules as well as aid in the establishment of bacterial superinfections.

Crohn's disease simulating tuberculous ureteritis.

A case of ureteral obstruction due to perforation of an ileal segment, affected by Crohn's disease, into the extraperitoneal space is described. After a right hemicolectomy combined with uretero-cutaneous fistula and subsequent replacement of the ureter by ileum, the patient is in very good condition. Urinary stasis has completely ceased. The following points are of special interest: 1. false diagnosis of tuberculosis, 2. rarity of ureteral involvement in Crohn's disease, 3. possibility of recurrence of the disease within the ileal segment taken for ureteral replacement.