1
|
Desmedt V, Geldof J, Hoorens A, Lobaton T. Case report and review of literature: IgG4-gastroduodenitis in upper GI Crohn's disease: two separate entities or just a marker of disease severity? Front Med (Lausanne) 2024; 11:1388940. [PMID: 39099590 PMCID: PMC11294937 DOI: 10.3389/fmed.2024.1388940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/07/2024] [Indexed: 08/06/2024] Open
Abstract
A 20-year-old man was presented with ulcerative gastritis and duodenitis complicated by pyloric stenosis. Helicobacter pylori infection was excluded, and the lesions did not respond to treatment with proton pump inhibitors. No other parts of the intestinal tract showed signs of inflammation. Histopathological review showed signs of chronic inflammation with granuloma formation. A tentative diagnosis of isolated upper gastrointestinal (UGI) Crohn's disease was performed. However, additional work-up revealed significantly positive IgG4 staining as well as elevated IgG4 serum levels. Since granulomatous disease is unlikely in IgG4-related disease, an eventual diagnosis of overlapping IgG4-related disease and Crohn's disease (CD) was performed. Treatment with systemic steroids and anti-TNF in combination with azathioprine led to rapid symptomatic improvement. In this article, we review the available literature on IgG4-related gastroduodenitis, granulomatous gastritis, and upper GI CD. We suggest the possibility that IgG4-infiltration may be a marker of severely active inflammatory bowel disease rather than a separate disease entity.
Collapse
Affiliation(s)
- Valérie Desmedt
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
| | - Jeroen Geldof
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, University Hospital Ghent, Ghent, Belgium
| | - Triana Lobaton
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| |
Collapse
|
2
|
Zhang J, Qian X, Zhu L, Da B, Zhao X, He Q, Wang L, Li Y, Wang Z. Clinical outcomes of serial endoscopic balloon dilation for duodenal Crohn's disease-associated strictures. Surg Endosc 2024:10.1007/s00464-024-10992-8. [PMID: 38914885 DOI: 10.1007/s00464-024-10992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/08/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Endoscopic balloon dilation (EBD) is a safe and effective treatment for Crohn's disease (CD)-associated strictures. However, serial EBDs have rarely been reported. This study aimed to evaluate the efficacy and safety of serial EBDs for treating CD-associated duodenal strictures compared with intermittent EBDs. METHODS Patients with CD-associated duodenal strictures who underwent EBD were recruited. The clinical data, stricture characteristics, number of EBDs, dilation diameter, complications, surgical interventions, and follow-up periods were recorded. Patients were divided into a serial dilation group and an intermittent dilation group to analyze the differences in safety and efficacy. RESULTS Forty-five patients with duodenal CD-associated strictures underwent a total of 139 dilations. A total of 23 patients in the serial dilation group underwent 72 dilations, for a median of 3 (range 3 ~ 4) dilations per patient, and 22 patients in the intermittent dilation group underwent 67 dilations, for a median of 3 (range 1 ~ 6) dilations per patient. Technical success was achieved in 97.84% (136/139) of the patients. During the follow-up period, three patients in the intermittent dilation group underwent surgery, and the total clinical efficacy was 93.33% (42/45). No difference in safety or short-term efficacy was noted between the two groups, but serial EBDs exhibited significantly greater clinical efficacy between 6 months and 2 years. No significant difference in recurrence-free survival was observed, but the median longest recurrence-free survival and recurrence-free survival after the last EBD in the serial dilation group were 693 days (range 298 ~ 1381) and 815 days (range 502 ~ 1235), respectively, which were significantly longer than the 415 days (range 35 ~ 1493) and 291 days (range 34 ~ 1493) in the intermittent dilation group (p = 0.013 and p = 0.000, respectively). At the last follow-up, the mean diameter of the duodenal lumen was 1.17 ± 0.07 cm in the serial dilation group, which was greater than the 1.11 ± 0.10 cm in the intermittent dilation group (p = 0.018). We also found that the Simple Endoscopic Score for Crohn's Disease was associated with an increased risk of surgical intervention (HR 2.377, 95% CI 1.125-5.020; p = 0.023) and recurrence at 6 months after the last EBD (HR 0.698, 95% CI 0.511-0.953; p = 0.024), as assessed by univariate analysis. CONCLUSIONS Compared to the intermittent EBDs, serial EBDs for duodenal CD-associated strictures exhibit greater clinical efficacy within two years and could delay stricture recurrence. We suggest that serial EBDs can be a novel option for endoscopic treatment of duodenal CD-associated strictures.
Collapse
Affiliation(s)
- Juanjuan Zhang
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Xiaoli Qian
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Lin Zhu
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Binlin Da
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Xiaofan Zhao
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Qin He
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Lixin Wang
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Yi Li
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Zhiming Wang
- Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
| |
Collapse
|
3
|
Akah O, Haddadin R, Shah P. An Unusual Presentation of Crohn's Disease in an Elderly Patient: A Report of a Rare Case. Cureus 2024; 16:e57977. [PMID: 38738074 PMCID: PMC11086951 DOI: 10.7759/cureus.57977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Crohn's disease is a chronic inflammatory bowel disease that primarily affects the terminal ileum and proximal colon. The exact cause is unknown but likely involves genetic factors, environmental triggers, and immune dysregulation. This case report delineates the choice of diagnostics for a 70-year-old patient presenting with symptoms indicative of small bowel obstruction. Initial assessments and imaging suggested a common clinical scenario, yet further investigation uncovered an unexpected diagnosis of Crohn's disease, a condition infrequently encountered in this age demographic.
Collapse
Affiliation(s)
- Ozoemena Akah
- Internal Medicine, MountainView Hospital, Las Vegas, USA
| | | | - Pinak Shah
- Internal Medicine, MountainView Hospital, Las Vegas, USA
| |
Collapse
|
4
|
Amadu M, Soldera J. Duodenal Crohn's disease: Case report and systematic review. World J Methodol 2024; 14:88619. [PMID: 38577197 PMCID: PMC10989410 DOI: 10.5662/wjm.v14.i1.88619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/16/2023] [Accepted: 01/18/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease, including ulcerative colitis, microscopic colitis, and Crohn's disease (CD), has a global impact. This review focuses on duodenal CD (DCD), a rare subtype affecting the duodenum. DCD's rarity and asymptomatic nature create diagnostic challenges, impacting prognosis and patient well-being. Delayed diagnosis can worsen DCD outcomes. AIM To report a rare case of DCD and to discuss the diagnostic challenges and its implications on prognosis. METHODS A systematic literature search, following the PRISMA statement, was conducted. Relevant studies were identified and analysed using specific Medical Subject Terms (MeSH) from PubMed/MEDLINE, American Journal of Gastroenterology, and the University of South Wales database. Data collection included information from radiology scans, endoscopy procedures, biopsies, and histopathology results. RESULTS The review considered 8 case reports and 1 observational study, involving 44 participants diagnosed with DCD, some of whom developed complications due to delayed diagnosis. Various diagnostic methods were employed, as there is no gold standard workup for DCD. Radiology scans [magnetic resonance imaging (MRI), computed tomography (CT), and upper gastrointestinal X-ray], endoscopy procedures (colonoscopy and esophagogastroduodenoscopy), biopsies, and clinical suspicions were utilized. CONCLUSION This review discusses DCD diagnosis challenges and the roles of CT, MRI, and fluoroscopy. It notes their limitations and compares findings with endoscopy and histopathology studies. Further research is needed to improve diagnosis, emphasizing scan interpretation, endoscopy procedures, and biopsies, especially in high-risk patients during routine endoscopy.
Collapse
Affiliation(s)
- Muniratu Amadu
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
| | - Jonathan Soldera
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
| |
Collapse
|
5
|
An Obscure Presence of Gastroduodenal Involvement in a Newly Diagnosed Ileocolic Crohn’s Disease Patient. Case Rep Gastrointest Med 2022; 2022:2200438. [DOI: 10.1155/2022/2200438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 12/28/2022] Open
Abstract
Whereas typical Crohn’s disease is confined to the terminal ileum and presents with abdominal pain and diarrhea, gastroduodenal manifestations of Crohn’s disease are rare, with often asymptomatic patient presentations and inconclusive diagnostic testing. It is, however, a more severe form of Crohn’s disease and thus warrants treatment with steroids and biologics much earlier than its ileocolonic counterpart. We present the case of a young, otherwise healthy, male with newly diagnosed ileocolonic Crohn’s disease with concurrent gastroduodenal involvement that initially failed management with biologic agents. We discuss the clinical manifestations and often obscure pathology of gastroduodenal Crohn’s disease and highlight the necessity of performing a concurrent esophagogastroduodenoscopic evaluation on newly diagnosed ileocolonic Crohn’s disease to assess the presence of upper gastrointestinal involvement.
Collapse
|
6
|
Zhang J, Qian X, Yan W, Diao Y, Da B, Shen J, Wang Z, Zhu W. Single-balloon Enteroscopy for Evaluation of Small Bowel Crohn Disease Strictures: Peripheral Blood Lymphocytes As a Risk Factor for Strictures. Surg Laparosc Endosc Percutan Tech 2022; 32:741-746. [PMID: 36468898 DOI: 10.1097/sle.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Few reports have focused on single-balloon enteroscopy (SBE) for evaluation of small bowel Crohn disease (CD) strictures. The aim of this study was to analyze the relationships between peripheral blood inflammatory markers and small bowel CD strictures observed by SBE. MATERIALS AND METHODS CD patients who underwent SBE between January 2016 and December 2020 were enrolled. The clinical characteristics and peripheral blood inflammatory markers were collected and analyzed to screen for predictive factors significantly associated with small bowel CD strictures. RESULTS A total of 221 CD patients underwent SBE. The lymphocyte (LC) counts in peripheral blood were significantly lower in the active group (n=178) than in the inactive group (n=43) according to the simple endoscopic score for CD (SES-CD), P =0.011, and was correlated with the SES-CD ( r =-0.134, P =0.047). The LC levels were significantly lower in the stricture group (n=116) than in the nonstricture group (n=105) based on whether small bowel strictures developed, P =0.000, and LC was a risk factor for strictures in the multivariate analysis [hazard ratio (HR), 2.332; 95% CI, 1.102-4.937; P =0.027]. In the subgroup analysis, LC levels notably decreased after stricture aggravation ( P =0.000). Forty-seven patients who underwent small bowel resection underwent SBE at 6 to 12 months after surgery. The LC level was significantly lower in the postoperative patients with strictures ( P =0.025), and LC (HR, 4.444; 95% CI, 1.265-15.617; P =0.020) was a risk of postoperative strictures by univariate analysis, but the age at diagnosis (HR, 6.462; 95% CI, 1.272-22.560; P =0.022) was an independent risk factor by multivariate analysis. CONCLUSION Peripheral blood LC levels were correlated with SES-CD and gradually decreased as the intestinal stricture increased in small bowel CD patients. The LC level was also significantly lower in the postoperative CD patients with strictures. The level of LC was a risk factor for small bowel strictures. These results suggest that peripheral blood LC could be a novel marker of small bowel CD strictures to guide CD diagnosis and therapy.
Collapse
Affiliation(s)
| | - Xiaoli Qian
- Research Institute of General Surgery, Jinling Hospital
| | - Wei Yan
- Research Institute of General Surgery, Jinling Hospital
| | - Yanqing Diao
- Research Institute of General Surgery, Jinling Hospital
| | - Binlin Da
- Research Institute of General Surgery, Jinling Hospital
| | | | - Zhiming Wang
- Research Institute of General Surgery, Jinling Hospital
| | - Weiming Zhu
- Research Institute of General Surgery, Jinling Hospital
| |
Collapse
|
7
|
Cohen BL. Gastroduodenal and Jejunoileal Crohn's Disease. Gastroenterol Hepatol (N Y) 2022; 18:418-421. [PMID: 36397770 PMCID: PMC9666814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Benjamin L Cohen
- Co-Section Head and Clinical Director for Inflammatory Bowel Disease Department of Gastroenterology, Hepatology & Nutrition Digestive Diseases and Surgery Institute Cleveland Clinic Cleveland, Ohio
| |
Collapse
|
8
|
Upper gastrointestinal tract involvement is more prevalent in Korean patients with pediatric Crohn's disease than in European patients. Sci Rep 2020; 10:19032. [PMID: 33149222 PMCID: PMC7642352 DOI: 10.1038/s41598-020-75938-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022] Open
Abstract
In pediatric Crohn’s disease (CD) patients, it is important to define the disease phenotype at diagnosis for stratifying risk. In this retrospective study, we aimed to assess the disease phenotype compared to EUROKIDS registry and analyze disease outcome of pediatric CD patients according to upper gastrointestinal (GI) tract involvement. A total of 312 patients were included. The median age at diagnosis was 13.7 years and 232 patients (74.4%) were identified to have upper GI involvement at diagnosis. In Korean pediatric CD patients, there were significant differences in male predominance (72.8% vs. 59.2, p < 0.001), proportion of upper GI involvement (74.4% vs. 46.2%, p < 0.001), and perianal disease (62.1% vs. 8.2%, p < 0.001) compared to data in the EUROKIDS registry. Younger age (OR 2.594, p = 0.0139) and ileal involvement (OR 2.293, p = 0.0176) at diagnosis were associated with upper GI involvement. There were no significant differences in disease outcomes between patients with and without upper GI tract involvement. This study revealed that upper GI involvement is more prevalent in Korean patients with pediatric Crohn’s disease than in European patients, and the disease outcome did not appear to differ according to upper GI tract involvement.
Collapse
|
9
|
Appel KL, Wang L, Xi D, Bhardwaj V. Isolated Severe Stricturing Duodenal Crohn Disease in a Pediatric Patient. JPGN REPORTS 2020; 1:e003. [PMID: 37206610 PMCID: PMC10191493 DOI: 10.1097/pg9.0000000000000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/14/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Keren L. Appel
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital Los Angeles (CHLA), Los Angeles, California
| | - Linda Wang
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital Los Angeles (CHLA), Los Angeles, California
| | - Dong Xi
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital Los Angeles (CHLA), Los Angeles, California
| | - Vrinda Bhardwaj
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital Los Angeles (CHLA), Los Angeles, California
| |
Collapse
|
10
|
Sousa M, Proença L, Carlos Silva J, Ribeiro Gomes AC, Afeto E, Carvalho J. Duodenal Crohn's Disease Complicated by Pancreatitis and Common Bile Duct Obstruction. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:33-36. [PMID: 31970238 DOI: 10.1159/000499767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/21/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Crohn's disease (CD) is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. Duodenal CD is a rare clinical entity, with the majority of the patients being symptomless - its diagnosis requires a high level of clinical suspicion. CASE PRESENTATION We present the case of a 29-year-old male patient with a 2-month history of weight loss, epigastric pain and postprandial vomiting. He underwent upper endoscopy, which revealed a circumferential duodenal ulcer causing non-transposable luminal stenosis and was medicated with proton pump inhibitors. While awaiting gastroenterology consultation, he presented at the emergency department for sudden onset of abdominal pain with dorsal irradiation, nausea and vomiting. Laboratory tests showed anaemia and increased liver enzymes, amylase and lipase. Abdominal computed tomography showed ectasia of the common bile duct (CBD) and intrahepatic biliary tract and a small amount of gas in the main pancreatic duct associated with duodenal thickening. The case was interpreted as probable CD complicated by pancreatitis and obstruction of the CBD, and he was hospitalized under antibiotic therapy and hydrocortisone with improvement of the condition. After discharge, he underwent colonoscopy that revealed several ulcers in the ileum and magnetic resonance imaging that showed distension of the stomach with reduction of the calibre of the transition from the duodenal bulb to the second portion of the duodenum in a 10- to 15-mm extension, as well as associated dilatation of the intrahepatic bile ducts and CBD and diffuse and regular ectasia of the main pancreatic duct. Combination therapy with azathioprine and infliximab was initiated; the patient presented clinical response at 12 weeks and endoscopic/imaging remission at 9 months. DISCUSSION/CONCLUSION Hepatobiliary and pancreatic manifestations are common in CD patients involving multiple mechanisms. In this case report, we pre-sent a patient with duodenal CD complicated with pancreatitis and CBD obstruction due to distortion phenomena by duodenal stenosis, a condition that is rarely described.
Collapse
Affiliation(s)
- Mafalda Sousa
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Luísa Proença
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - João Carlos Silva
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Ana Catarina Ribeiro Gomes
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Edgar Afeto
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
11
|
Avalueva EB, Bakulin IG, Sitkin SI, Vorobyev SL, Belyakov IA, Trushnikova NA, Karpeeva YS. Crohn’s disease with isolated gastric involvement as an example of a rare disease phenotype: a clinical case. ALMANAC OF CLINICAL MEDICINE 2019; 47:592-602. [DOI: 10.18786/2072-0505-2019-47-074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Crohn's disease (CD), along with ulcerative colitis, is one of the predominant nosological forms of inflammatory bowel diseases. In CD, any part of the gastrointestinal tract can be affected; however, the process is commonly associated with terminal ileum or colon involvement. CD cases with isolated or mixed involvement of upper gastrointestinal tract (esophagus, stomach, and duodenum) are rare and least studied types of the disease. In isolated stomach involvement, the complaints are non-specific and include epigastric pain, gastric dyspepsia, early satiety, decreased appetite, and nausea. Isolated CD of upper gastrointestinal tract can be diagnosed after comprehensive work-up and always requires a high diagnostic level, including clinical, endoscopic and morphological one. We present a clinical case of CD with isolated stomach involvement in a 62-year-old woman. The diagnosis was confirmed by the histopathological findings of an epithelioid cell granuloma in the gastric antrum. Treatment with systemic corticosteroids reduced the disease clinical activity and improved the histological characteristics of the gastric biopsy sampled obtained by endoscopy. In this clinical case, there were specific macroscopic gastric lesions found at endoscopy in CD patients with upper gastrointestinal tract involvement, which is characterized by thickened longitudinal folding and linear grooves. This type of lesion has been described in the literature as “bamboo joint-like appearance”.Conclusion: Comprehensive assessment of clinical manifestations, endoscopic and histopathological specific features is crucial for the timely diagnosis and treatment of inflammatory bowel diseases.
Collapse
Affiliation(s)
- E. B. Avalueva
- North-Western State Medical University named after I.I. Mechnikov;
Diagnostic Center with Clinic
| | - I. G. Bakulin
- North-Western State Medical University named after I.I. Mechnikov
| | - S. I. Sitkin
- North-Western State Medical University named after I.I. Mechnikov;
State Research Institute of Highly Pure Biopreparations;
Almazov National Medical Research Centre
| | | | | | | | | |
Collapse
|
12
|
Pimentel AM, Rocha R, Santana GO. Crohn’s disease of esophagus, stomach and duodenum. World J Gastrointest Pharmacol Ther 2019; 10:35-49. [PMID: 30891327 PMCID: PMC6422852 DOI: 10.4292/wjgpt.v10.i2.35] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/31/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease with involvement of the esophagus, stomach and duodenum has a prevalence of 0.5% to 4% in symptomatic adult patients, but some studies have shown that these results may be underestimated, since upper gastrointestinal endoscopy is not performed routinely in the initial evaluation of the disease in adult patients, as it is in the pediatric population. In general, involvement of the upper gastrointestinal tract in Crohn’s disease occurs concomitantly with involvement of the lower gastrointestinal tract. The diagnosis depends on clinical, endoscopic, histological and radiological evaluation. The presence of aphthoid ulcers, longitudinal ulcers, bamboo-joint-like appearance, stenoses and fistulas are endoscopic findings suggestive of the disease, and it is important to exclude the presence of Helicobacter pylori infection. The primary histological findings, which facilitate the diagnosis, are the presence of a chronic inflammatory process with a predominance of lymphoplasmacytic cells and active focal gastritis. The presence of epithelioid granuloma, although less frequent, is highly suggestive of the disease in the absence of chronic granulomatous disease. Treatment should include the use of proton pump inhibitors associated with corticosteroids, immunomodulators and biological therapy according to the severity of the disease.
Collapse
Affiliation(s)
- Andréa Maia Pimentel
- Programa de Pós graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Bahia, Brazil
| | - Raquel Rocha
- Departamento de Ciências da Nutrição, Universidade Federal da Bahia, Salvador 40110-060, Bahia, Brazil
| | - Genoile Oliveira Santana
- Programa de Pós graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Bahia, Brazil
| |
Collapse
|
13
|
Wang X, Cui X, Zhu C, Li M, Zhao J, Shen Z, Shan X, Wang L, Wu H, Shen Y, Ni Y, Zhang D, Zhou G. FKBP11 protects intestinal epithelial cells against inflammation‑induced apoptosis via the JNK‑caspase pathway in Crohn's disease. Mol Med Rep 2018; 18:4428-4438. [PMID: 30221722 PMCID: PMC6172375 DOI: 10.3892/mmr.2018.9485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 07/31/2018] [Indexed: 12/12/2022] Open
Abstract
Endoplasmic reticulum (ER) stress in intestinal epithelial cells (IECs) has an important role in the pathogenesis of Crohn's disease (CD). FK506 binding protein 11 (FKBP11), a member of the peptidyl‑prolyl cis‑trans isomerase family, is involved in the unfolded protein response (UPR) and is closely associated with inflammation. Previous bioinformatics analysis revealed a potential association between FKBP11 and human CD. Thus, the present study aimed to investigate the potential significance of FKBP11 in IEC homeostasis and CD. In the present study, increased expression of FKBP11 was detected in the intestinal inflammatory tissues of patients with CD. Furthermore, the results of the present study revealed that overexpression of FKBP11 was accompanied by increased expression levels of the ER stress marker 78 kDa glucose‑regulated protein in the colon tissues of a 2, 4, 6‑trinitrobenzenesulphonic acid‑induced mouse colitis model. Using interferon‑γ (IFN‑γ)/tumor necrosis factor‑α (TNF‑α)‑stimulated IECs as an ER stress and apoptosis cell model, the associated of FKBP11 with ER stress and apoptosis levels was confirmed in IECs. Overexpression of FKBP11 was revealed to significantly attenuate the elevated expression of pro‑apoptotic proteins (Bcl2 associated X apoptosis regulator, caspase‑12 and active caspase‑3), suppress the phosphorylation of c‑Jun N‑terminal kinase (JNK), and decrease apoptosis of IFN‑γ/TNF‑α stimulated IECs. Knockdown of FKBP11 by transfection with small interfering RNA further validated the aforementioned results. In conclusion, these results suggest that the UPR protein FKBP11 may protect IECs against IFN‑γ/TNF‑α induced apoptosis by inhibiting the ER stress‑associated JNK/caspase apoptotic pathway in CD.
Collapse
Affiliation(s)
- Xiaotong Wang
- Department of Hepatology and Gastroenterology, The Fifth's People's Hospital of Suzhou, Suzhou, Jiangsu 215000, P.R. China
| | - Xiaopeng Cui
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Chuanwu Zhu
- Department of Hepatology and Gastroenterology, The Fifth's People's Hospital of Suzhou, Suzhou, Jiangsu 215000, P.R. China
| | - Ming Li
- Department of Hepatology and Gastroenterology, The Fifth's People's Hospital of Suzhou, Suzhou, Jiangsu 215000, P.R. China
| | - Juan Zhao
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Zhongyi Shen
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xiaohang Shan
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Liang Wang
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Han Wu
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Yanting Shen
- Clinical Medical Research Center, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - You Ni
- Clinical Medical Research Center, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Dongmei Zhang
- Clinical Medical Research Center, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Guoxiong Zhou
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| |
Collapse
|
14
|
Ling C, Gavin M, Hanson J, McCarthy DM. Progressive Epigastric Pain with Abnormal Liver Tests in a Patient with Crohn's Disease: Don't DILI Dally. Dig Dis Sci 2018; 63:1751-1755. [PMID: 29934698 DOI: 10.1007/s10620-018-5135-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Christina Ling
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC10-5550, Albuquerque, NM, 87131, USA. .,Division of Gastroenterology and Hepatology, Department of Medicine, Raymond G. Murphy VA Medical Center, 1501 San Pedro SE, Albuquerque, NM, 87108, USA.
| | - Michael Gavin
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC10-5550, Albuquerque, NM, 87131, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Raymond G. Murphy VA Medical Center, 1501 San Pedro SE, Albuquerque, NM, 87108, USA
| | - Joshua Hanson
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Denis M McCarthy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC10-5550, Albuquerque, NM, 87131, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Raymond G. Murphy VA Medical Center, 1501 San Pedro SE, Albuquerque, NM, 87108, USA
| |
Collapse
|
15
|
Lightner AL, Fletcher JG. Duodenal Crohn's Disease-a Diagnostic Conundrum. J Gastrointest Surg 2018; 22:761-763. [PMID: 29043578 DOI: 10.1007/s11605-017-3591-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/13/2017] [Indexed: 01/31/2023]
Abstract
Gastroduodenal Crohn's disease is rare as most often the disease is found in the terminal ileum and colon rather than the upper gastrointestinal tract. The most common phenotype is stricturing disease which can lead to obstructive-like symptoms. Medical treatment options include proton pump inhibitors and biologic therapy. Endoscopic and surgical intervention may be needed to relieve the obstructive-like symptoms from the stricturing phenotype.
Collapse
Affiliation(s)
- Amy L Lightner
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| | | |
Collapse
|
16
|
Abstract
Symptomatic duodenal Crohn's disease (CD) is an uncommon disease presentation, especially in isolation. The most common duodenal disease phenotype is stricturing disease rather than inflammatory or perforating. Most patients are asymptomatic and are therefore diagnosed incidentally by cross-sectional imaging or endoscopy. Medical management includes proton pump inhibitor therapy and immunosuppressive therapy including corticosteroids, immunomodulatory therapy, and biologic therapy. Symptomatic strictures can often be treated medically or endoscopically, and do not always require surgery. Surgical options include resection with primary anastomosis, bypass with a gastrojejunostomy, and strictureplasty. Treatment recommendations are largely based on limited evidence from small series and expert opinion. Therefore, the optimal treatment algorithm remains largely subjective and undefined.
Collapse
Affiliation(s)
- Amy L Lightner
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
17
|
Inayat F, Ullah W, Hussain Q, Shafique K. Crohn's disease presenting as gastric outlet obstruction: a therapeutic challenge? BMJ Case Rep 2017; 2017:bcr-2016-218181. [PMID: 28455456 DOI: 10.1136/bcr-2016-218181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Isolated gastric Crohn's disease with initial presentation related to gastric outlet obstruction is an unusual clinicopathological entity. We undertake here a literature review of this rare initial presentation of isolated gastric Crohn's disease and discuss the formidable diagnostic and therapeutic challenges encountered in such patients.
Collapse
Affiliation(s)
- Faisal Inayat
- New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, New York, USA
| | | | | | - Khurram Shafique
- Department of Pathology, SUNY Downstate Medical Center, New York, USA
| |
Collapse
|
18
|
Song DJ, Whang IS, Choi HW, Jeong CY, Jung SH. Crohn's disease confined to the duodenum: A case report. World J Clin Cases 2016; 4:146-150. [PMID: 27326400 PMCID: PMC4909460 DOI: 10.12998/wjcc.v4.i6.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/23/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
Crohn’s disease (CD) can involve any part of the gastrointestinal tract from the mouth to anus. However, gastroduodenal CD is rare with a frequency reported to range between 0.5% and 4.0%. Most patients with gastroduodenal CD have concomitant lesions in the terminal ileum or colon, but isolated gastroduodenal Crohn’s disease is an extremely rare presentation of the disease accounting for less than 0.07% of all patients with CD. The symptoms of gastroduodenal CD include epigastric pain, dyspepsia, early satiety, anorexia, nausea, vomiting, and weight loss. The diagnosis of gastroduodenal CD requires a high level of clinical suspicion and can be made by comprehensive clinical evaluation. Here we report a rare case of isolated duodenal CD not confirmed by identification of granuloma on biopsy, but diagnosed by clinical evaluation.
Collapse
|