Crohn's disease: ancient and modern

Twin Brothers and a Sister With CD: A Case Report

Crohn’s disease (CD) has an unknown etiology, but it has a genetic component. Many cases of familial CD have been reported. We describe a Kosovar Albanian family with 6 children, of whom 3 have CD: monozygotic twins and their sister. As far as we know, this is the first such report of CD within a Kosovar family.

A review of the therapeutic management of Crohn's disease

Crohn's disease is a chronic inflammatory, relapsing-remitting, and progressive gastrointestinal disorder with an often-negative impact on the physical, emotional, and psychological well-being. Over the past two decades, the medical compendium for the treatment of Crohn's disease has increased significantly, enabling treatment beyond symptoms. Indeed, early and timely use of effective medical therapy has been reflected by improved outcomes with reduction in surgery and ability to achieve clinical and endoscopic remission, reduce corticosteroid dependance, and prevent long-term complications in more patients. In this review, we discuss the key milestones in the medical management of Crohn's disease.

Infiltrating the Curriculum: Integrating Medical History with Existing Surgical Pathology Tutorials

This article was migrated. The article was marked as recommended. Objective: To assess medical students' perspective on medical history embedded into a pre-existing learning module. Design, Setting, and Participants: This study was performed in 2018 at the University of Tasmania; participants were medical students in year three of the Bachelor of Medicine Bachelor of Surgery course. This was a cross-sectional study which used a mixed-method survey before and after a lecture series to assess medical students' perspectives on history of medicine. Intervention: Historical perspectives were incorporated into existing surgical pathology tutorials. Main outcome measures: Students completed a survey on medical history before and after the lecture series. The survey used both qualitative and quantitative measures to assess students' perception of the utility of medical history and how it was taught in this project. Results: In the initialquestionnaire, students indicated they believed medical history would help make them better doctors and enhance their learning of pathology. In the final questionnaire, students agreed that learning medical history was important in becoming a doctor. Students enjoyed the content and found the integration of history and pathology beneficial to learning. Conclusion: This study demonstrates one method by which to increase medial history teaching without major alterations to an existing medical curriculum.

Integrating omics for a better understanding of Inflammatory Bowel Disease: a step towards personalized medicine

Background

Inflammatory Bowel Disease (IBD) is a multifactorial chronic disease. Understanding only one aspect of IBD pathogenesis does not reflect the complex nature of IBD nor will it improve its clinical management. Therefore, it is vital to dissect the interactions between the different players in IBD pathogenesis in order to understand the biology of the disease and enhance its clinical outcomes.

Aims

To provide an overview of the available omics data used to assess the potential mechanisms through which various players are contributing to IBD pathogenesis and propose a precision medicine model to fill the current knowledge gap in IBD.

Results

Several studies have reported microbial dysbiosis, immune and metabolic dysregulation in IBD patients, however, this data is not sufficient to create signatures that can differentiate between the disease subtypes or between disease relapse and remission.

Conclusions

We summarized the current knowledge in the application of omics in IBD patients, and we showed that the current knowledge gap in IBD hinders the improvements of clinical decision for treatment as well as the prediction of disease relapse. We propose one way to fill this gap by implementing integrative analysis of various omics datasets generated from one patient at a single time point.

A Historical Argument for Changing the Name of a Major Syndrome

Dr Aldred Scott Warthin discovered a "cancerous" family in the early 1900s, mapped its kindred, and studied their diseases to the extent possible in his day. His seminal article was published in 1913. Dr Henry Lynch took Warthin's studies and began using more modern techniques to characterize this so-called "Family G," beginning in the 1960s. Somehow in this process, Warthin's observations became "Lynch syndrome." We need a better name for this condition, and propose "Warthin-Lynch syndrome" to also honor its primary discoverer.

A tale of two diseases: the history of inflammatory bowel disease

'Inflammatory bowel disease' (IBD) sounds like a straightforward term - a disease of inflammation in the bowel. However, the history of IBD reveals a story of a nefariously complex set of idiopathic conditions. IBD defies definition, in part because its pathophysiology is not completely understood. For the same reason and despite substantial advances in research, IBD also defies cure. At best, IBD can be defined as a disease of disruption - disrupted physiology, microbiology, immunology and genetics. The term 'IBD' is most often used to describe two separate conditions: ulcerative colitis (UC) and Crohn's disease (CD). This paper reviews the history of IBD, considering the ever-evolving understanding of both UC and CD. Beyond its intrinsic interest, the history of IBD exemplifies a pattern that is becoming increasingly familiar in the 21st century - the story of a chronic, incurable disease that defies the best efforts to treat it.

Focal inflammatory infiltrations in gastric biopsy specimens are suggestive of Crohn's disease. Crohn's Disease Study Group, Germany

BACKGROUND

Crohn's disease is a systemic inflammatory disease that may involve all regions of the gut.

METHODS

Thirty-six patients with Crohn's disease and 36 age- and sex-matched control patients were prospectively evaluated by upper endoscopy. Biopsy specimens were taken from the oesophagus, duodenum, and 10 locations in the antrum and corpus.

RESULTS

Granulomas were found in four patients (11.13%) with Crohn's disease but in none of the control patients (P > 0.5). In 23 of 36 patients (63.9%) with Crohn's disease focal inflammatory infiltrations were found, as compared with 7 of 36 (19.4%) of the controls (P < 0.001). For focal inflammatory infiltrations, an odds ratio of 7.33 (2.55-21.38) was calculated, which increased to 20.04 (4.07-98.45) when only specimens from the angulus were considered. Helicobacter pylori infection was present in 13 of 36 controls (36.1%) and in 3 of 36 patients (8.3%) with Crohn's disease (P = 0.009).

CONCLUSION

These data suggest that Crohn's disease is typically associated with focal inflammatory infiltrations of the gastric mucosa.