scholarly journals Erythema Nodosum and Pyoderma Gangrenosum in 50 Patients with Crohn’s Disease

2005 ◽  
Vol 19 (10) ◽  
pp. 603-606 ◽  
Author(s):  
Hugh J Freeman
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pyoderma Gangrenosum ◽  
Complex Disease ◽  
Erythema Nodosum ◽  
Colonic Disease ◽  
Detection Rates ◽  
Dependent Effect ◽  
Age Dependent ◽  
Dermatological Disorders

Erythema nodosum and pyoderma gangrenosum may occur in Crohn's disease. In the present evaluation of consecutive patients with Crohn's disease spanning more than two decades, erythema nodosum was seen in 45 patients and pyoderma gangrenosum was seen in seven patients. Forty-one of 566 women (7.2%) and nine of 449 men (2.0%) were affected. Of these, 45 (4.4%) had erythema nodosum and seven (0.7%) had pyoderma gangrenosum, including two (0.2%) with both dermatological disorders at different times during their clinical courses. Recurrent erythema nodosum was also detected in nine patients (20%) including eight women, while recurrent pyoderma gangrenosum was seen in two patients (28.6%). There was an age-dependent effect on the appearance of erythema nodosum in women, with the highest percentages seen in those younger than 20 years of age. Detection rates for erythema nodosum in women only approached the low mens' rates in Crohn's disease at older than 40 years of age. Most patients with these dermatological disorders had colonic disease with or without ileal involvement as well as complex disease, usually with penetrating complications. The present study documents a sex-based and age-dependent effect on the clinical expression of erythema nodosum in Crohn's disease. This suggests that some components of the inflammatory process in Crohn's disease may be modulated by estrogen-mediated events, particularly in adolescents and young adults.

scholarly journals Erythema nodosum progressing to pyoderma gangrenosum as a complication of Crohn's disease.

1983 ◽  
Vol 59 (698) ◽  
pp. 791-793 ◽  
Author(s):  
A. Gellert ◽  
E. S. Green ◽  
E. R. Beck ◽  
C. M. Ridley
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pyoderma Gangrenosum ◽  
Erythema Nodosum

Improvement of a ‘Leaky' Intestinal Barrier

2017 ◽  
Vol 35 (1-2) ◽  
pp. 21-24 ◽  
Author(s):  
Eduard F. Stange
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Barrier ◽  
Bacterial Attachment ◽  
Phase Iii ◽  
Colonic Disease ◽  
Mucus Layer ◽  
Tissue Destruction ◽  
Liquid Form ◽  
Mucus Production

In Crohn's disease, the mucus layer appears to be defective in terms of low defensin levels and lack of antibacterial activity. These deficiencies actually explain the Montreal phenotypes and the stable localization of disease in the terminal ileum with low α-defensins from Paneth cells and/or low β-defensins in colonic disease, respectively. Conversely, in ulcerative colitis (UC) the defensin production is normal or even induced, but the mucus layer is thinner and patchy, more in the liquid form and also chemically altered so that antibacterial peptides are not retained and lost into the luminal bacterial bulk. Therefore, both barrier problems allow slow bacterial attachment and invasion, ultimately triggering the massive response of adaptive immunity and tissue destruction. Therefore, leakiness should refer to the antibacterial barrier and not to the general barrier against small molecules, such as mannitol or lactulose, which are not antigenic. The most promising approach in UC seems to be the use of probiotics or the natural compound lecithin as a stabilizer of mucus structure to enhance the barrier. While a phase II study has yielded positive results, the results of the ongoing phase III study are eagerly awaited. It is quite possible that the protective effect of smoking in UC is related to mucus production in the colon also, but this is not an option. Another alternative would be to shift cell differentiation in the colon towards goblet cell; the relevant differentiation factors are known. In Crohn's disease, the direct oral application of defensins might be effective if release and binding to the mucus are achieved. In the experimental colitis model, this works quite well. In conclusion, in a situation where enthusiasm about so-called biologics is declining due to loss of response over time, searching for the primary defects in inflammatory bowel disease and treating them may well be worthwhile, although it is unlikely to provide rapid relief.

Erythema nodosum as an early sign of Crohn's disease

2007 ◽  
Vol 46 (s3) ◽  
pp. 27-29 ◽  
Author(s):  
Jaap J. A. J. van der Velden ◽  
Ariënne M. W. van Marion ◽  
Bernd Kremer ◽  
Jos M. J. A. A. Straetmans ◽  
Charles J. M. Henquet ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Erythema Nodosum ◽  
Early Sign

Colonoscopy in Childhood

PEDIATRICS ◽  
1984 ◽  
Vol 73 (5) ◽  
pp. 594-599
Author(s):  
Eric Hassall ◽  
Glen N. Barclay ◽  
Marvin E. Ament
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Abdominal Pain ◽  
Crohn's Disease ◽  
Barium Enema ◽  
Colonic Disease ◽  
Radiographic Diagnosis ◽  
Inflammatory Bowel ◽  
Fiberoptic Colonoscopy

A review was made of 139 fiberoptic colonoscopies performed between 1975 and 1982 on 113 patients aged 1 month to 20 years. General anesthesia was used in four procedures. All others were done under sedation with meperidine (mean dose 2.9 mg/kg) and diazepam (mean dose 0.5 mg/kg). Indications were rectal bleeding in 52 patients; assessment and surveillance of known inflammatory bowel disease in 33 patients; and diagnostic evaluation of abdominal pain, diarrhea, and/or fever in 28 patients. The cecum was reached in 84% of diagnostic examinations. Comparison of findings on colonoscopy with barium enema in 75 patients showed agreement in 46, colonoscopic superiority in 25, and barium enema superiority in four. Bleeding sufficient to cause anemia was seen in 10/26 patients with polyps. Five minor complications and no major complications occurred. Flexible fiberoptic colonoscopy and polypectomy may be done usefully in childhood by physicians well versed and experienced with these procedures. Colonoscopy and biopsy changed the radiographic diagnosis from ulcerative colitis to Crohn's disease in several cases and indicated greater extent of colonic disease in several cases of ulcerative colitis and Crohn's disease. Colonoscopy is usually the most sensitive and accurate diagnostic tool for the evaluation of colonic disease, but barium enema and colonoscopy are complementary tests and barium enema should usually precede colonoscopy, with certain exceptions.

scholarly journals P160 A novel PillCam Crohn’s capsule score (Eliakim score) for quantification of mucosal inflammation in Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S218-S219
Author(s):  
R Eliakim ◽  
D Yablecovitch ◽  
A Lahat ◽  
B Ungar ◽  
E Shachar ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Clinical Remission ◽  
Colonic Disease ◽  
Study Cohort ◽  
The Novel ◽  
Colonic Preparation ◽  
Pearson's R ◽  
Pearson’S R

Abstract Background Capsule endoscopy (CE) is an important modality for monitoring of Crohn’s disease (CD). We recently established that small bowel (SB) inflammation on CE quantified by a Lewis score >350 accurately predicts risk of relapse within 2 years in CD patients in clinical remission. Recently, a novel pan-enteric capsule (PillCam Crohn’s (PCCE), Medtronic, USA) was approved for use. However, no quantitative index for pan-enteric PCCE is currently available. The current study was undertaken as a sub-study of a prospective randomised controlled CURE-CD trial aiming to optimise treatment of CD patients in remission using a PCCE- based treat-to-target approach; the aim of this ancillary study was to compare the correlation and reliability of the novel PCCE inflamatory score (Eliakim score) with the Lewis score as performed by 2 independent experienced CE readers. Methods The study cohort includes CD patients in clinical remission (CDAI<150). The patients were prospectively enrolled and underwent patency capsule evaluation; if excreted within 30 h, PCCE was performed following bowel preparation. PCCE was repeated every 6 months; if no colonic disease was detected on first PCCE, subsequent examinations were performed without colonic preparation. Each PCCE was independently reviewed by 2 experienced readers (RE (reader 1);UK (reader 2)). All studies were scored using the Lewis score and Eliakim score (comprised of a sum of scores for most common and most severe lesions multiplied by percentage of involvement per bowel segment (3 for small bowel and 2 for colon) with an additional stricture score). Pearson’s and Spearman’ correlation, Cohen’s kappa and inter-rater reliability coefficient (IRC) between the scores and the readers were calculated as appropriate. Results Forty PCCE exams were included. The median LS was 225 for both readers (interquartile range (IQR)—157–815 for reader 1, 33- 1125 for reader 2). Both readers identified significant SB inflammation (LS>350) in 17/40 (42.5%) of the patients with strong agreement between the readers (Spearman’s r = 0.87, p < 0.0001). The median PCCE score was 6 (4–14.75) and 4 (2–14.75) for reader 1 and 2, respectively. There was a high IRC between the two readers for LS (0.88, p < 0.0001 for absolute agreement) and PCCE score (0.91, p < 0.0001). For the small bowel, the correlation between LS and PCCE was moderate for reader 1 (Pearson’s r = 0.72, p < 0.0001 and strong for reader 2 Pearson’s r = 0.84, p < 0.0001). Conclusion There is a need for a quantitative pan-enteric score for the novel Pillcam Crohns capsule. The presently proposed score, while mandating further clinical validation, has strong inter-reader reliability and moderate-to-strong correlation with the validated small bowel capsule score (LS)

Plantar Erythema nodosum in a Patient with Crohn‘s Disease

Dermatology ◽  
1999 ◽  
Vol 199 (2) ◽  
pp. 190-190 ◽  
Author(s):  
F. Châtillon ◽  
C. Chizzolini ◽  
G. Kaya ◽  
L. Borradori ◽  
C. Hauser
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Erythema Nodosum

Pyoderma gangrenosum as first manifestation of Crohn’s disease

2019 ◽  
Vol 23 (1) ◽  
pp. 79-80 ◽  
Author(s):  
A. Rizzuto ◽  
G. Gallo ◽  
M. Trompetto ◽  
R. Sacco
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pyoderma Gangrenosum

scholarly journals Ostomy Complications in Crohn's Disease

2019 ◽  
Vol 32 (04) ◽  
pp. 314-322
Author(s):  
Armen Aboulian
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pyoderma Gangrenosum ◽  
Surgical Procedure ◽  
Parastomal Hernia ◽  
Fistula Formation ◽  
The Common ◽  
Peristomal Skin ◽  
Skin Conditions ◽  
Mucocutaneous Junction

AbstractOstomy creation is a routine surgical procedure that has earned its place high in the surgeon's armamentarium in dealing with challenging situations. However, it is not without its complications. In this article, we review the common complications including parastomal hernia, prolapse, mucocutaneous junction separation with ischemia and stenosis, peristomal skin conditions, and infections. Additionally, we review conditions that arise in association with underlying Crohn's disease, such as peristomal inflammation, fistula formation, and pyoderma gangrenosum.

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