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The American Journal of Gastroenterology Aug 2020It is unclear how baseline endoscopic characteristics in Crohn's disease (CD) affect the ability to achieve endoscopic remission (ER). We aimed to determine the...
INTRODUCTION
It is unclear how baseline endoscopic characteristics in Crohn's disease (CD) affect the ability to achieve endoscopic remission (ER). We aimed to determine the endoscopic prognostic factors that influence achieving ER in CD.
DESIGN
This post hoc analysis of SONIC (NCT00094458; YODA #2019-3980) evaluated baseline and week 26 endoscopy indices in 172 patients using the CD Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for CD. The impact of baseline ulcer depth and size on achieving week 26 ER was assessed using multivariate logistic regression models adjusted for confounders.
RESULTS
The ER rate of ileal ulcers was significantly lower than ER rates throughout the colon (P < 0.0001). Ileal ulcers >2 cm were less likely to achieve ER compared with smaller ulcers {odds ratio (OR) 0.31 (95% confidence interval [CI] 0.11-0.89), P = 0.03}. Similarly, rectal ulcers >2 cm were associated with reduced odds of week 26 ER (OR 0.26 [95% CI 0.08-0.80], P = 0.02). Ulcer size in other colonic segments did not affect the achievement of week 26 ER. Deep ileal and rectal ulcers >2 cm compared with smaller or superficial ulcers were even less likely to achieve week 26 ER (ileum: OR 0.10, 95% CI 0.02-0.68, P = 0.02; rectum: OR 0.12, 0.02-0.82, P = 0.03). High baseline Simple Endoscopic Score for CD (≥16) or CDEIS scores (≥12) did not affect achieving week 26 ER.
DISCUSSION
Patients with larger and deep ulcers in the ileum or rectum may have difficulty achieving ER. Overall degree of endoscopic inflammation as measured numerically by endoscopic scores does not affect the likelihood of achieving week 26 ER.
Topics: Adult; Colonoscopy; Crohn Disease; Female; Humans; Ileum; Male; Prognosis; Rectum; Severity of Illness Index
PubMed: 32759621
DOI: 10.14309/ajg.0000000000000617 -
Clinical Gastroenterology and... Jan 2021
Topics: Cytomegalovirus; Cytomegalovirus Infections; Gastrointestinal Hemorrhage; Humans; Intestinal Diseases; Ulcer
PubMed: 31958504
DOI: 10.1016/j.cgh.2020.01.015 -
Diseases of the Colon and Rectum Aug 2020A 22-year-old man presents to your office with a perianal abscess and occasional mild crampy abdominal pain. You take him to the operating room for an examination under...
A 22-year-old man presents to your office with a perianal abscess and occasional mild crampy abdominal pain. You take him to the operating room for an examination under anesthesia (EUA) with incision and drainage of the abscess and note a transphincteric fistula tract through which you place a seton and 2 large skin tags. The anal canal and rectum are without ulceration, but there are mild proctitis and nonprolapsing internal hemorrhoids. Because of a concern for Crohn's disease (CD), he undergoes magnetic resonance enterography and colonoscopy. The magnetic resonance enterography shows inflammation in 20 cm of the distal terminal ileum, and colonoscopy reveals approximately 10 ulcers <5 mm in the terminal ileum without significant narrowing. He is seen in consultation for the initiation of a monoclonal antibody and returns to see you in the office after his first 3 infusions. He is feeling well, has significantly decreased drainage from the perianal fistula, but would really like his seton and skin tags removed while you are there.
Topics: Abscess; Anal Canal; Antibodies, Monoclonal; Colonoscopy; Crohn Disease; Drainage; Humans; Ileum; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Rectal Fistula; Treatment Outcome; Ulcer; Young Adult
PubMed: 32692067
DOI: 10.1097/DCR.0000000000001748 -
Surgery Today 2002Following restorative proctocolectomy, seven cases with staple line ulcer around the pouch anal anastomosis and/or staple line in the ileal pouch were experienced. Their...
PURPOSE
Following restorative proctocolectomy, seven cases with staple line ulcer around the pouch anal anastomosis and/or staple line in the ileal pouch were experienced. Their clinical, endoscopical characteristics were analyzed.
METHODS
The patients noted anal bleeding following restorative proctocolectomy were examined with colonofiberscopy and histological study was conducted.
RESULTS
Staple line ulcer was seens in seven cases (2.3%, 7/304). The onset was immediate or within 2 months postoperatively in 5 cases. Bleeding occurred in all the patients and lower abdominal pain, anal pain, increased bowel movements and anal fissure were seen frequently. Ulcers were linear along the staple line and there were no cases complicated by simultaneous pouchitis. Most of the patients responded to treatments with metronidazol, 5-ASA, and topical or oral steroids, although one patient required ligation of bleeding ulcer and two complicated perianal excoriation required ileostomy.
CONCLUSION
Staple line ulcer should be recognized as different complication to pouchitis.
Topics: Adenomatous Polyposis Coli; Adult; Colitis, Ulcerative; Female; Humans; Ileal Diseases; Male; Middle Aged; Proctocolectomy, Restorative; Surgical Stapling; Ulcer
PubMed: 11998938
DOI: 10.1007/s005950200003 -
Microbiology and Immunology 1996The role of intestinal bacteria in induction and repression of ulcer formation in the ileum of rats treated with one of the nonsteroidal antiinflammatory drugs (NSAIDs),...
The role of intestinal bacteria in induction and repression of ulcer formation in the ileum of rats treated with one of the nonsteroidal antiinflammatory drugs (NSAIDs), 5-bromo-2-(4-fluorophenyl)-3-(4-methylsulfonylphenyl) thiophene (BFMeT), was examined in this study. BFMeT was administered by intragastric gavage once at doses of 500-1,500 mg/kg of body weight to Wistar rats treated with and without antibiotics (bacitracin, neomycin, streptomycin), germ-free rats and gnotobiotic rats, and 72 hr later their gastrointestinal tracts were examined for ulcer formation. A single oral administration of BFMeT induced ileal ulcers in specific pathogen-free rats. However, the rats given antibiotics to reduce the intestinal bacteria had no ulcers. BFMeT-treated germ-free rats and gnotobiotic rats mono-associated with Bifidobacterium adolescentis or Lactobacillus acidophilus also had no intestinal ulcers. However, the drug induced ileal ulcers in gnotobiotic rats mono-associated with Eubacterium limosum or Escherichia coli. An overnight culture of B. adolescentis or L. acidophilus or yogurt containing Bifidobacterium breve and Streptococcus thermophilus, when given as drinking water, inhibited ulcer formation in the ileum of rats treated with BFMeT. Gram staining of the ileal contents of normal rats revealed that 97.4% of the stained microorganisms were Gram-positive rods and only 1.2% were Gram-negative rods. In the group of rats with ulcers induced by BFMeT, the Gram-positive rods decreased by 56.4% and the Gram-negative rods including Escherichia coli, Klebsiella, Proteus and Bacteroides increased by 37.3%. However, in the group of rats administered the Bifidobacterium culture, the Lactobacillus culture or yogurt, the percentages of the Gram-negative rods were decreased. Although Lactobacillus was a major bacterium in the ileum of normal rats, the Gram-negative facultatively anaerobic rods E.coli, Klebsiella and Proteus were increased in the ulcerated ileum of rats treated with BFMeT, suggesting that these bacteria are associated with ulcer formation in rats treated with NSAIDs, and that Lactobacillus and Bifidobacterium inhibit it by repressing the growth of ulcer-inducing bacteria.
Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bacteria; Germ-Free Life; Ileal Diseases; Intestines; Rats; Rats, Wistar; Specific Pathogen-Free Organisms; Thiophenes; Ulcer
PubMed: 8887349
DOI: 10.1111/j.1348-0421.1996.tb01108.x -
Digestive Diseases and Sciences Sep 2015
Topics: Enteritis; Female; Humans; Ileal Diseases; Jejunal Diseases; Male; Ulcer
PubMed: 25939542
DOI: 10.1007/s10620-015-3674-0 -
Digestive Diseases and Sciences Dec 2021Cecal intubation is essential during colonoscopy, and observation of the terminal ileum is performed in most clinical practices. However, data on terminal ileal (TI)...
BACKGROUND
Cecal intubation is essential during colonoscopy, and observation of the terminal ileum is performed in most clinical practices. However, data on terminal ileal (TI) ulcers observed incidentally during colonoscopy are rare.
AIM
We aimed to identify the characteristics and clinical course of TI ulcers observed incidentally during colonoscopy.
METHODS
Between January 2008 and December 2018, medical records from multi-centers reporting asymptomatic subjects who underwent biopsy on TI ulcers during colonoscopy were retrospectively reviewed. The characteristics of endoscopic findings and clinical course of TI ulcers were analyzed, and the factors affecting the clinical course of TI ulcers were evaluated.
RESULTS
The median follow-up durations from first to second colonoscopy and from second to third colonoscopy were 20 months (interquartile range, 12-36) and 24 months (interquartile range, 12-34), respectively. A total of 134 subjects were included in the analysis. The histopathologic findings of TI ulcers were mostly chronic or active ileitis/inflammation (92.7%). On the second colonoscopy, 59 (44.0%) patients had no ulcers, 38 (28.4%) showed a decrease in size or number, and 37 (27.6%) patients showed no change in ulcers. Among 62 subjects who underwent a third colonoscopy, 14 (10.4%) had decreased size or number, 10 (7.5%) had no ulcer change, and two (1.5%) had increased ulcer size or number. In multivariate logistic regression analysis, a star shape was the only factor affecting continuation without improvement of incidental TI ulcers.
CONCLUSIONS
Most TI ulcers observed incidentally showed no unusual findings on biopsy and improved on follow-up colonoscopy without treatment.
Topics: Adult; Aged; Colonoscopy; Female; Follow-Up Studies; Humans; Ileal Diseases; Ileum; Incidental Findings; Male; Middle Aged; Remission, Spontaneous; Retrospective Studies; Ulcer
PubMed: 33723699
DOI: 10.1007/s10620-020-06781-7 -
Gastroenterologia Y Hepatologia Feb 2014
Topics: Anemia; Blood Transfusion; Capsule Endoscopy; Choristoma; Crohn Disease; Diagnosis, Differential; Diagnostic Errors; Endoscopy, Digestive System; Gastric Mucosa; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Male; Meckel Diverticulum; Ulcer; Young Adult
PubMed: 24094624
DOI: 10.1016/j.gastrohep.2013.07.011 -
Endoscopy Apr 2022
Topics: Endoscopy, Gastrointestinal; Gastric Mucosa; Humans; Meckel Diverticulum; Ulcer
PubMed: 33910256
DOI: 10.1055/a-1471-1857 -
Journal of Crohn's & Colitis Feb 2020Based on genetics and natural history, Crohn's disease can be separated into two entities, an ileal and a colonic disease. Protein-based approaches are needed to...
BACKGROUND AND AIMS
Based on genetics and natural history, Crohn's disease can be separated into two entities, an ileal and a colonic disease. Protein-based approaches are needed to elucidate whether such subphenotypes are related to distinct pathophysiological processes.
METHODS
The proteome of ulcer edges was compared with that of paired control tissue samples [n = 32 biopsies] by differential proteomics in the ileum and the colon of Crohn's disease patients [n = 16]. The results were analysed using a hypothesis-driven approach [based on the literature] and a hypothesis-free approach [pathway enrichment analyses] to determine common and segment-specific pathophysiological processes associated with ileal and colonic CD ulcer edges. To confirm the involvement of a key pathway highlighted by proteomics, two proteins were also studied by immunochemistry.
RESULTS
In the ileum and the colon, 4428 and 5204 proteins, respectively, were identified and quantified. Ileal and colonic ulcer edges differed in having a distinct distribution of proteins associated with epithelial-mesenchymal transition, neutrophil degranulation, and ribosomes. Ileal and colonic ulcer edges were similarly characterized by an increase in the proteins implicated in the endoplasmic reticulum protein-processing pathway and a decrease in mitochondrial proteins. Immunochemistry confirmed the presence of endoplasmic reticulum stress in the mucosa of ileal and colonic ulcer edges.
CONCLUSION
This study provides protein-based evidence for partially distinct pathophysiological processes being associated with ileal and colonic ulcer edges in Crohn's disease patients. This could constitute a first step toward the development of gut segment-specific diagnostic markers and therapeutics.
Topics: Adult; Aged; Colon; Colonic Diseases; Crohn Disease; Female; Humans; Ileal Diseases; Ileum; Male; Middle Aged; Proteomics; Ulcer
PubMed: 31282946
DOI: 10.1093/ecco-jcc/jjz130