Granulomatous (ileo) colitis

Recurrence in Crohn's colitis: the numbers game

There has been great controversy about the proper role of operation in the management of colonic Crohn's disease because of disagreement about the frequency of recurrence. Since, in our retrospective studies, the majority of patients with colonic Crohn's disease had a previous diagnosis of ulcerative colitis, accurate determination of the recurrence rate in colonic Crohn's disease requires review of all patients with colonic inflammatory bowel disease in order to define the population at risk. Using objective means for diagnosis and for the assessment of outcome, we have found that recurrent disease after ileostomy and colectomy occurred in a minority (approximately 16%) of the patients. Both Crohn's colitis and ulcerative colitis followed a generally favorable postoperative course after this procedure, since even those patients who developed recurrent disease usually were rehabilitated by one or more revisions of the ileostomy. We believe that needed operations should not be avoided solely because of a diagnosis of colonic Crohn's disease, since the high recurrence rates and poor prognoses reported in many studies are based on falsely low numbers of those at risk.

Serum lysozyme in Crohn's disease and ulcerative colitis

Serum lysozyme (muramidase) concentrations were determined in patients with different types of inflammatory bowel disease and in normal subjects. The mean (plus or minus S.E.M.) lysozyme concentration for each group was as follows: controls, 8.8 plus or minus 0.3, ulcerative colitis, 9.3 plus or minus 0.6, Crohn's disease, 26.3 plus or minus 1.4. a and bacterial and nonbacterial enteritis, 8.9 plus or minus 0.7 mug per milliliter. Thus, mean enzyme levels were significantly greater in Crohn's disease than in ulcerative colitis (p smaller than 0.001), bacterial and nonbacterial enteritis (p smaller than 0.001) and healthy volunteers (p smaller than 0.001). The elevation of serum lysozyme in Crohn's disease may be related to tissue macrophages because no correlation was found between either the serum lysozyme concentration and the white-cell counts or the absolute numbers of circulating granulocytes or monocytes. Our findings suggest that serum lysozyme may be useful in the differential diagnosis of Crohn's disease from other types of bowel inflammation.