New Diagnosis Of Crohn's Disease Research Articles

Pelvic Abscess with Initial Presentation of Crohn’s Disease in Pregnancy Leading to Maternal Sepsis

Background: A new diagnosis of Crohn disease during pregnancy is uncommon. Intra-abdominal abscess as an initial feature of Crohn disease during pregnancy is rare. Case: A 26-year-old healthy primigravida woman at 33 weeks of gestation presented with abdominal pain and an abdominal mass. Labor was induced at 37 weeks to expedite postpartum evaluation. On postpartum day 2 she developed septic shock and multiorgan failure. Emergent exploratory laparotomy revealed an intra-abdominal abscess involving the right colon and terminal ileum. Pathology was consistent with Crohn’s disease. Conclusion: Intra-abdominal abscess from Crohn’s disease is a rare occurrence during pregnancy and may be associated with significant maternal morbidity. When diagnosis in the postpartum period is uncertain and the differential diagnosis includes Crohn’s disease or abscess, early postpartum evaluation may prevent complications.

Characterization of inflammatory bowel disease in elderly patients: A review of epidemiology, current practices and outcomes of current management strategies.

The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients. Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, increasing age at diagnosis has been associated with a lower likelihood of having any of a family history of IBD, perianal disease in CD and extraintestinal manifestations. Although response to drug therapies appears to be similar in elderly patients and younger individuals, the elderly are more likely to receive 5-aminosalicylic acid agents, and less likely to receive immunomodulators and biologics. Corticosteroid use in the elderly is comparable with use in younger individuals. The rates of surgical intervention appear to be lower for elderly CD patients but not elderly UC patients. Elderly individuals with UC are more likely to need urgent colectomy, which is associated with an increased mortality rate. Elective surgery is associated with similar outcomes among the elderly and young patients with IBD. Therefore, the use of immunomodulators and biologics, and earlier consideration of elective surgery for medically refractory disease in elderly patients with IBD, should be emphasized and further evaluated to prevent complications of chronic corticosteroid(s) use and to prevent emergency surgery.

P-024 YI The Incidence of Crohn’s Disease and Rate of Early Surgery in the U.S. Military Health Care System

Surgery is often required to treat complications of Crohn's Disease (CD) such as medically refractory inflammation, fistulas or strictures. Surgical intervention, especially early in the disease course, may be decreasing with the advent of more effective medical therapy for CD as gastroenterologists rely more readily on immunosuppressive strategies before referring for surgery. The US Military Health System (MHS) has a diverse population of patients with equal access, and the direct care military treatment facilities (MTF) utilize the same electronic medical record (EMR) nationwide. The aim of this study was to calculate the incidence of CD in a nationwide military population and to further characterize the CD population, while also assessing outcomes such as surgery, hospitalization and emergency room visits during the first 2 years of disease. Using the EMR and healthcare claims databases under the MHS Data Repository (MDR), the total number of new diagnoses of CD were examined from 2009 to 2012. The data collected were derived from a nationwide network of military treatment facilities and included a total study population of 3.2 million. For each new diagnosis of CD, demographic variables, basic laboratory data, other chronic comorbidities, and serious associated diseases or complications were analyzed. Outcomes such as ER visits, admissions, surgeries and deaths were also recorded up to 2 years from the time of diagnosis. Seven hundred and three new diagnoses of Crohn’s disease were identified. The average annual incidence of CD was 7.3 per 100,000 patients per year. Fifty-two percent of patients were male. Fifty-three percent of patients were under the age of 35. Within two years of diagnosis, 9% patients underwent surgery for CD with an average annual rate of 1 surgery for every 11 new diagnoses per year. Within two years of diagnosis, 38% of patients were admitted to the hospital (71% of these admissions were directly related to CD). Seven percent of patients were admitted to the ICU and 64% were seen in the ER. Two percent required total parenteral nutrition. No patients died. Three percent of patients were diagnosed with Clostridium difficile colitis. Two percent of patients had a pulmonary embolism or deep vein thrombosis. Our study shows a similar incidence rate of CD compared to an earlier large population study in the US (7.3/100,000 compared to 7.9/100,000), which suggests a stable incidence over time. The early surgery rate in our study is lower than that found in other published studies. This may correlate with a trend of decreasing reliance on surgery in the era of biologic medications. Our hospitalization rate is slightly higher than that reported in an earlier study in Olmsted County (32% at 1 year), but lower than that reported in an earlier study from Denmark (83% at 1 year) which indicates that treatments are more effective, but the disease still portends significant morbidity and utility of healthcare resources. Further research may help further elucidate the effects that the biologic agents have had in improving outcomes and reducing surgery in non-referral centers.

Wireless capsule endoscopy versus enteroclysis in the diagnosis of small-bowel Crohnʼs disease

The aim of this study was to prospectively compare the diagnostic yield of wireless capsule endoscopy (WCE) and enteroclysis in the detection of Crohn's disease (CD) of the small bowel. Twenty-nine patients with known CD (group 1) suspected to have more extensive small-bowel involvement and 26 patients, who were suspected to suffer from CD but did not have an earlier history of it (group 2) were prospectively evaluated with enteroclysis and WCE. Each examiner was blinded to the results of other investigations. Enteroclysis was unsuccessful in two patients from group 1 8 and six patients from group 2, respectively. In group 1, abnormal findings consistent with CD were detected in 20 patients by using WCE and in 11 patients by using enteroclysis, out of the total 27, at per-protocol analysis (74.1 vs. 40.7%, P<0.05). Of the 11 patients who had ileal CD on enteroclysis, three had more extensive small-bowel disease, which was detected only by WCE. In group 2, WCE showed findings consistent with CD in 13 of 20 patients, in contrast with enteroclysis, which was positive for CD in only six of 20 patients (65 vs. 30%, P<0.05). Three more patients had findings compatible with CD on WCE, but they failed their enteroclysis. Overall, a new diagnosis of CD was made in 16 patients. WCE has a higher diagnostic yield than enteroclysis in the detection of CD of the small bowel, both in patients with known and newly suspected CD.

The Utility of Capsule Endoscopy in Patients With Suspected Crohn's Disease

In patients with suspected Crohn's disease (CD), little is known about the test characteristics of capsule endoscopy (CE) in the diagnosis of this condition. We sought to determine the utility of CE for the subsequent diagnosis of CD in patients suspected to have this condition. All patients who underwent CE at a single tertiary-care center for investigation of suspected small bowel CD, and who had a 12-month follow-up, were included in the study. All patients had undergone other investigations that were normal or equivocal. The test characteristics of CE were determined on the basis of capsule findings of small bowel ulcers and a subsequent new diagnosis of CD within 12 months of CE. The study included 102 patients with 12-month follow-up data. The majority (75%) met the established criteria to define "suspected Crohn's disease" as an indication for CE. Most had undergone computed tomography scan or small bowel follow-through (92%) and colonoscopy (99%) before CE. There were abnormal CE findings suggestive of CD in 39 patients. The prevalence rate of a new diagnosis of CD by 12 months in the study population was 13%. Using the presence of more than 3 ulcers as the criterion for an abnormal CE study, the sensitivity of CE for the diagnosis of CD was 77%, the specificity was 89%, the positive predictive value (PPV) was 50%, and the negative predictive value (NPV) was 96%. In patients with suspected CD, CE has a high sensitivity and a NPV for this condition. The PPV varies depending on the patient population and the criteria for a CE diagnosis of CD.

The Early Use of Immunosuppression Reduces Morbidity in Patients With Moderately Severe or Severe Crohn's Disease

The Early Use of Immunosuppression Reduces Morbidity in Patients With Moderately Severe or Severe Crohn's Disease