Manifestation Of Crohn's Disease Research Articles

Intestinal Obstruction Due to Ileotransverse Anastomosis Stenosis Secondary to Crohn's Disease: A Case Report

Introduction: Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. This report explores a case of intestinal obstruction resulting from stenosis of ileotransverse anastomosis, secondary to Crohn's disease. Epidemiology: The macroscopic features of Crohn's disease vary, including patchy inflammation, ulcers, and stenosis. Stenosis is a common occurrence, particularly in the terminal ileum, affecting 30-40% of individuals with Crohn's disease. OBJECTIVE: To describe a clinical case of intestinal obstruction due to ileotransverse anastomosis stenosis secondary to Crohn's disease, aiming to recognize its behavior and determine surgical management in patients with a high suspicion of this condition. Patient and Method: A 35-year-old female diagnosed with ankylosing spondylitis, recent Crohn's disease, and intestinal obstruction. Surgical history includes exploratory laparotomy, right hemicolectomy, and ileotransverse anastomosis due to acute appendicitis. Current symptoms led to surgical exploration, revealing extensive adhesions and stenosis at the anastomosis. Results: The patient underwent resection of the affected intestinal segment and the creation of a terminal ileostomy, successfully resolving the obstruction. Comprehensive preoperative evaluation, diagnostic confirmation through imaging, and appropriate surgical intervention played critical roles in achieving a positive outcome. Discussion: The discussion emphasizes the complexities associated with Crohn's disease surgery, highlighting common complications such as infection, fistulas, and anastomotic stenosis. The case underscores the need for a cautious surgical approach and the importance of early consideration of Crohn's disease in patients with intestinal obstruction. Conclusions: This case report underscores the significance of recognizing Crohn's disease in patients presenting with intestinal obstruction. Appropriate surgical management, though challenging due to the heightened risk of complications, is essential for improving treatment outcomes. A comprehensive approach, from timely diagnosis to surgical intervention, is crucial for effectively addressing Crohn's disease manifestations and enhancing patient quality of life.

Perianal Imaging in Crohn Disease: Current Status With a Focus on MRI, From the AJR Special Series on Imaging of Inflammation.

Fistulizing perianal disease, a frequent, chronic, and often debilitating manifestation of Crohn disease (CD) in adults and children, has been relatively refractory to treatment in the past. The advent of biologic agents such as anti-tumor necrosis factor-α and cellular therapies, used in conjunction with a range of surgical interventions, has greatly improved disease outcomes, although complete remission can still be elusive. This Special Series review considers current perianal imaging options, specifically pelvic MRI and endoanal and transperineal ultrasound, as well as their roles in the diagnosis, management, and assessment of treatment response. Pelvic MRI is the first-line modality for imaging perianal CD, given the complexity of fistulas encountered in CD. MRI technical acquisition parameters for adults and children and an approach to MRI interpretation and reporting are provided. Anatomic classification systems for fistulizing peri-anal disease are presented. We also explore the history, current landscape, and future developments of MRI features of perianal disease as imaging biomarkers, to quantify activity and severity and to consider CD MRI-based inflammatory activity scores. We discuss the reliability and validation of a number of indexes (including the pediatric MRI-based perianal CD [PEMPAC] index, the MR novel index for fistula imaging in CD [MAGNIFI-CD], the Van Assche index, and the modified Van Assche index), their potential to quantify treatment response, and possible prognostic capabilities.

ВНЕКИШЕЧНЫЕ ПРОЯВЛЕНИЯ БОЛЕЗНИ КРОНА И ХРОНИЧЕСКОГО НЕСПЕЦИФИЧЕСКОГО ЯЗВЕННОГО КОЛИТА В ПОЛОСТИ РТА

Subject. The review allows us to consider the issues of etiopathogenesis, the prevalence of Crohn disease and ulcerative colitis, as well as their manifestations on the oral mucosa.
 The aim is to conduct a systematic analysis of modern indigenous and foreign literary sources to determine some features of etiopathogenesis, prevalence and manifestations in the oral cavity of Crohn disease and chronic non-specific ulcerative colitis.
 Methodology. The search for research works on the etiology and pathogenesis of Crohn disease, ulcerative colitis was carried out using the following databases: PubMed, Web of Science, elibrary.ru , Scopus in the period from 2010 to 2021, as well as the review includes some significant publications concerning the manifestations in the oral cavity of CD and NCUC for the period from 2014 to 2021. The following keywords were used: chronic ulcerative colitis, Crohn disease, caries, periodontal disease, oral mucosa, aphthae, dysbiosis.
 Results. Among the main dental diseases, pathology of hard tissues, inflammatory diseases of periodontal tissues, pathology of the oral mucosa against the background of pronounced dysbiosis most often prevails. During a comprehensive examination of these patients, it is very important to analyze not only the features of the manifestations of Crohn disease and ulcerative colitis, but also to evaluate their manifestations on the hard tissues of the teeth, the oral mucosa and periodontal tissues.
 Conclusions. Thus, the analysis of the literature data obtained is of particular relevance for identifying some features of the state of dental status in CD and NCUC in the Republic of Bashkortostan and the basis for the development of algorithms for diagnostic features of the management of this category of persons.

S2404 Metastatic Crohn's Disease: An Unusual Dermatologic Manifestation of Crohn's Disease

S2404 Metastatic Crohn's Disease: An Unusual Dermatologic Manifestation of Crohn's Disease

The role of TNF-alpha gene (-238G/A and -308G/A) polymorphisms in the etiology and pathogenesis of inflammatory bowel diseases in various ethnic groups

This literature review deals with specifics of the natural course of inflammatory bowel disease (IBD) in patients from various ethnic groups and -308G/A and -238G/A promoter polymorphisms in tumor necrosis factor-alpha (TNF-α) gene. The search in PubMed, Medline, Еlibrary.ru databases has led to identify in total 20 studies, including 2 meta-analyses, on the role of TNF-α-308G/A and -238G/A gene polymorphism in the etiology and pathophysiology of IBD. The TNF-α-308G/A polymorphism is associated with increased secretion of this proinflammatory cytokine, whereas the TNF-α-238G/A genotype is characterized by reduced TNF-α secretion. A number of studies have shown an association between TNF-α-308G/A gene polymorphism and severe course of IBD, requiring more active treatment of patients (cytostatics, corticosteroids, biological agents). Some investigators have found that the patients carriers of TNF-α-308G/A had a higher probability of surgical interventions. The association between TNF-α-308G/A and the phenotypic characteristics of IBD has been identified in studies performed in Europe, Asia, and Russia. The association of this polymorphism with the prevalence of ulcerative colitis has been proven in some studies, in particular, in the Asian population. Similar associations have been noted in few publications originating from Europe and North America, while some studies have found no links between TNF-α-308G/A, -238G/A, and the course of IBD. TNF-α-238G/A gene polymorphism has not shown any significance for the prevalence and course of ulcerative colitis and Crohn's disease. One can assume that the differences in the study results arising from one and the same geographical area are related to genetic heterogeneity of the study groups, phenotypic variances between the study subjects, as well as relatively small sample sizes. Currently, the search for genetic, biochemical and other prognostic criteria for IBD course is in progress. There are studies in progress to investigate the mechanisms of transformation of the genetic information into the particulars of ulcerative colitis and Crohn's disease manifestations, with consideration of ethnicity.

Суставной синдром как внекишечное проявление болезни Крона: обзор литературы и клинический случай

Суставной синдром как внекишечное проявление болезни Крона: обзор литературы и клинический случай

Pathophysiology and Diagnosis of Ulcerative Colitis and Crohn Disease

Inflammatory bowel disease (IBD) encompasses both ulcerative colitis and Crohn disease, and is characterized by recurrent bouts of inflammation of the gastrointestinal tract. IBD affects approximately 4 million people worldwide, and rates are gradually increasing. This review covers the etiology, epidemiology, definition and pathophysiology, extraintestinal manifestations, and other disease-related complications of IBD. Figures show the distribution of ulcerative colitis and Crohn disease by location, several colonoscopic photographs of patients with ulcerative colitis as well as those with Crohn disease, computed tomography images of patients with Crohn disease, small bowel follow-through and fluoroscopic spot images of a patient with chronic structuring Crohn disease, and a computed tomographic scan showing extraenteric manifestations of Crohn disease. Tables list the differential diagnosis of ulcerative colitis, types of infectious colitis, complications of IBD, diagnostic criteria of toxic colitis, physical signs of Crohn disease, differences between Crohn disease and ulcerative colitis, and common extraintestinal manifestations of IBD. This review contains 11 highly rendered figures, 7 tables, and 63 references.

Pathophysiology and Diagnosis of Ulcerative Colitis and Crohn Disease

Inflammatory bowel disease (IBD) encompasses both ulcerative colitis and Crohn disease, and is characterized by recurrent bouts of inflammation of the gastrointestinal tract. IBD affects approximately 4 million people worldwide, and rates are gradually increasing. This review covers the etiology, epidemiology, definition and pathophysiology, extraintestinal manifestations, and other disease-related complications of IBD. Figures show the distribution of ulcerative colitis and Crohn disease by location, several colonoscopic photographs of patients with ulcerative colitis as well as those with Crohn disease, computed tomography images of patients with Crohn disease, small bowel follow-through and fluoroscopic spot images of a patient with chronic structuring Crohn disease, and a computed tomographic scan showing extraenteric manifestations of Crohn disease. Tables list the differential diagnosis of ulcerative colitis, types of infectious colitis, complications of IBD, diagnostic criteria of toxic colitis, physical signs of Crohn disease, differences between Crohn disease and ulcerative colitis, and common extraintestinal manifestations of IBD. This review contains 11 highly rendered figures, 7 tables, and 63 references.

Vulvar Manifestations of Crohn's Disease

Crohn's disease is an inflammatory bowel disorder with several well-known extraintestinal manifestations, such as erythema nodosum, uveitis, and arthritis. Less commonly observed are vulvar manifestations, which have primarily been discussed in case reports or small case series. These cases generally highlight patients with histopathology limited to noncaseating granulomas. As these histological findings are identified in bowel biopsies from only approximately 50% of patients with gastrointestinal Crohn's disease, there is likely an under-recognition and underdiagnosis of vulvar lesions as Crohn's disease manifestations. We describe the largest case series to date involving patients with vulvar Crohn's disease, discuss the varied clinical presentations, and describe the histopathological findings, which include noncaseating granulomas, ulcerations, lymphatic lesions, and even dysplasia and carcinoma. Our findings underscore the importance of keeping vulvar Crohn's disease on the differential diagnosis when faced with a range of vulvar symptoms and suggest that regular gynecological surveillance in patients with Crohn's disease may be of benefit.

Poster 208: Sudden Onset of Severely Debilitating Extraintestinal Manifestations of Crohn Disease: A Case Report

Poster 208: Sudden Onset of Severely Debilitating Extraintestinal Manifestations of Crohn Disease: A Case Report

Low-Dose CT Examinations in Crohn's Disease: Impact on Image Quality, Diagnostic Performance, and Radiation Dose

The objective of this study was to evaluate the image quality and diagnostic performance of simulated low-dose MDCT examinations in patients with Crohn's disease. Thirty-five MDCT examinations from 25 patients (14 males and 11 females; age range, 16-86 years) with known or suspected Crohn's disease were retrospectively evaluated. The MDCT images (5 mm thickness) were modified by artificially introducing noise using volume CT noise simulation software to simulate low-dose MDCT data acquired with noise indexes (NIs) of 18-35. The 175 MDCT image data sets generated were then randomized and reviewed by two readers to assess the subjective image quality and diagnostic accuracy for confidently detecting Crohn's disease findings on a 5-point scale (1, definitely absent; 5, definitely present). The image quality, diagnostic performance, and radiation dose from the original MDCT examinations served as a reference standard for comparison. The simulated low-dose CT images with elevated NIs of 18-25 yielded optimal image quality and concordant diagnostic accuracy with standard-dose scans with a mean baseline volume CT dose index of 16 +/- 3.34 (SD) mGy (image quality score, 4-4.9 vs 4.95, respectively; p = 0.4). Images simulating NIs of 30-35 were considered degraded because of excessive image noise and presented lower diagnostic performance (range of image quality score, 3-3.6; weighted kappa = 0.25-0.37; p < 0.001). Diagnostic performance and reader confidence for the determination of Crohn's disease manifestations in cases in which the reference standard was positive were higher at NIs of < or = 25 compared with NI of 30 (reader confidence score, 4.5 vs 3.6, respectively; p < 0.05) and an NI of 35 (3.2, p < 0.05). Compared with the standard-dose examination, a 31-64% reduction in radiation dose was estimated for NI levels of 18-25, which corresponds to image noise of 19-27 HU in subcutaneous fat. Processed MDCT images with the introduction of noise to simulate low-dose MDCT examinations with NI levels of 18-25 allows substantial dose reduction for CT examinations in Crohn's disease without compromising diagnostic information.

Perianales Fistelleiden bei Morbus Crohn – Biologika und Chirurgie: Ein lohnendes Konzept?

Perianal fistulas and abscesses are a common manifestation in Crohn's disease (CD), seen in about 30 - 40 % of the patients. Often they are combined with CD of the anal canal and occur as a complex system of fistulas. The evaluation of these fistulas can be done with endoscopic ultrasound or magnetic resonance imaging, the conceptual accuracy of both methods is high. There are accepted therapeutic concepts for surgery and for the conventional drug therapy according to the classification of the fistulas. In contrast, the therapeutic regimens for a complex perianal fistulising CD are not convincing, especially not for maintainance therapy. However, several studies about therapy with anti-TNF-alpha antibodies have shown good results while long-time results with other recent anti-TNF-alpha antibodies apart from infliximab are still lacking. In this review article we analyse the current literature and develop a stage-adapted therapy for the use of biologicals and surgery in fistulising perianal CD.

Crohn Disease of the Esophagus: A Review of the Literature

Esophageal Crohn disease is a difficult disease both to diagnose and treat. The diagnosis is made in patients with other extraintestinal manifestations of Crohn disease in whom other esophageal pathology has been ruled out. This often requires integration of clinical, endoscopic, radiographic, and histologic findings. Despite its relative rarity, it does cause severe symptoms that are difficult to treat. Treatment requires careful integration of medical, endoscopic, and surgical techniques. This review aims to discuss the significant literature regarding diagnosis and treatment of this important manifestation of inflammatory bowel disease. There is additional discussion of the literature regarding the efficacy of newer medical and endoscopic therapies, including biologic agents and removable polymer stents.

Early oral presentation of Crohn's disease

Inflammatory changes of the oral mucosa in children can have a variety of infectious and non-infectious etiologies. We report on a 10-year-old boy with progressive cobblestone-like changes and erosions of oral mucosa over six months, which turned out to be early oral manifestations of Crohn disease.

Erstmanifestation eines Morbus Crohn in der Spätschwangerschaft: Indikation zur Ileozäkalresektion mit nachfolgendem Spontanpartus

The initial manifestation ofCrohn's disease in pregnancy is a very rare event. In the following we report on a 34-year-old patient in the 36th week of gestation, who was suspected of having acute appendicitis. During the operation we found a severe ileitis terminalis like Crohn's disease, which required an ileocaecal resection. In spite of maximal tocolysis she delivered spontaneously 5 days after the operation (preterm delivery). The subsequent developments were uncomplicated. We discuss the clinical symptoms, surgical and obstetric therapies and we review diagnostic problems in pregnancy.

Extra-intestinal manifestations of crohn disease respond to infliximab

Extra-intestinal manifestations of crohn disease respond to infliximab

Secondary amyloidosis of the liver as the primary manifestation of Crohns disease

Secondary amyloidosis of the liver as the primary manifestation of Crohns disease

Brain white-matter lesions in celiac disease: a prospective study of 75 diet-treated patients.

Celiac disease (CD), or gluten sensitivity, is considered to be a state of heightened immunologic responsiveness to ingested gluten proteins in genetically predisposed individuals. The gastrointestinal manifestation suggests a severe enteropathy of the small intestine with malabsorption, steatorrhea, and weight loss because of a deranged mucosal immune response. Neurologic complications occur, especially epilepsy, possibly associated with occipital calcifications or folate deficiency and cerebellar ataxia. There have been reports of brain white-matter lesions as an extraintestinal manifestation in Crohn disease and ulcerative colitis but not in CD. In this study, 75 diet-treated mainly pediatric patients with biopsy-proven CD underwent prospectively clinical neurologic examinations, laboratory investigations, electroencephalography, computed tomography, and magnetic resonance imaging. The age range was 2.8 to 24.2 years with a mean of 11.6 years. The mean period of gluten exposure was 2.4 years. Ten patients had neurologic findings such as febrile seizures, single generalized seizures, mild ataxia, and muscular hypotonia with retarded motor development. No folate deficiency was found. The hippocampal regions showed no abnormalities. Computed tomography did not reveal any cerebral calcifications, but magnetic resonance imaging detected unilateral and bilateral T2-hyperintensive white-matter lesions in 15 patients (20%). There was no correlation between these lesions and dietary compliance or neurologic or electroencephalographic abnormalities. The mean gluten exposure time of these patients was slightly increased (not significant). Focal white-matter lesions in the brain may represent an extraintestinal manifestation of CD. They may be ischemic in origin as a result of a vasculitis or caused by inflammatory demyelination. They seem to be more typical of pediatric CD than cerebral calcifications. Their prognostic value is unclear and needs to be elucidated in additional studies. CD should be suggested as a differential diagnosis in children with unclear white-matter lesions even without intestinal symptoms.

Percutaneous Management of Multiple Bilateral Liver Abscesses Complicating Crohn Disease

Liver abscess is a rare complication of Crohn disease. A case of multiple, bilateral, pyogenic liver abscesses appearing as a recurrent manifestation of Crohn disease in a 34-year-old man is reported. Conservative management with antibiotics, double-catheter drainage, and multiple aspirations was successful. The liver abscesses disappeared with no recurrence during a 5-year follow-up period.

Manifestations of Crohn disease at US.

Crohn disease is a chronic inflammatory disorder of the intestines that is characterized by multiple episodes of exacerbation and remission. Although barium studies and endoscopy remain the most valuable tools for assessment of mucosal and luminal changes, sonography has proved to be a safe and noninvasive modality for characterization of mural and perienteric changes. Ultrasonography (US) can accurately demonstrate the classic features of Crohn disease as well as the complications frequently associated with the disease. The addition of color Doppler imaging may allow differentiation of chronic from active bowel wall thickening. In expert hands, US appears to be a sensitive modality for preliminary investigation of patients with symptomatic Crohn disease. US can also be used to assess the response to treatment and to detect postoperative recurrence. Finally, US enables accurate selection of patients in whom the possibility of surgery or percutaneous intervention would justify other means of investigation, particularly computed tomography.