Lip swelling and constipation: Pretest probability of cutaneous signs for crohn's disease in the absence of typical gastrointestinal symptoms

2020 ◽  
Vol 4 (1) ◽  
pp. 42
Author(s):  
Minnelly Luu ◽  
MaggieL Chow
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Gastrointestinal Symptoms ◽  
Pretest Probability

Profuse Diarrhea after Misoprostol Use in a Patient with a History of Crohn's Disease

1992 ◽  
Vol 26 (9) ◽  
pp. 1092-1093 ◽  
Author(s):  
Julie S. Johnson ◽  
James A. Karboski ◽  
Glenys O. Williams
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Data Extraction ◽  
Gastrointestinal Symptoms ◽  
Personal Communication ◽  
Watery Diarrhea ◽  
Synthetic Analog ◽  
Ulcer Disease ◽  
History Of

OBJECTIVE: To report a case of profuse diarrhea after misoprostol use in a patient with a history of Crohn's disease and to discuss the role of eicosanoids in Crohn's disease. DATA SOURCES: Patient medical records, case reports, review articles identified by MEDLINE, and personal communication with the physician, patient, and manufacturer. DATA EXTRACTION: From interviews, the manufacturer, and pertinent published sources by one author and reviewed by the others. DATA SYNTHESIS: A 55-year-old woman presented to clinic complaining of multiple joint pains. Her medical history was significant for peptic ulcer disease, hypertension, and Crohn's disease in remission since May 1989. Her joint pains were treated with ibuprofen 600 mg po qid and misoprostol 200 μg po qid (after meals and at bedtime). Following the administration of three doses of ibuprofen and misoprostol, the patient experienced abdominal cramps, pain, and voluminous, watery diarrhea for two days. Upon discontinuation of the ibuprofen and misoprostol, all of her gastrointestinal symptoms resolved within 12 hours. Rechallenge with ibuprofen alone failed to produce a recurrence of symptoms. Enhanced synthesis of intestinal eicosanoids has been demonstrated in Crohn's disease. Misoprostol, a synthetic analog of one of the eicosanoids, could induce a flare-up of Crohn's disease as suggested in this patient. CONCLUSIONS: Misoprostol should be used with caution in patients with known inflammatory bowel disease.

scholarly journals Immunolocalization of leptin and leptin receptor in colorectal mucosa of ulcerative colitis, Crohn’s disease and control subjects with no inflammatory bowel disease

2020 ◽  
Author(s):  
Flavia Merigo ◽  
Alessandro Brandolese ◽  
Sonia Facchin ◽  
Federico Boschi ◽  
Marzia Di Chio ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Lamina Propria ◽  
Leptin Receptor ◽  
Gastrointestinal Symptoms ◽  
Lymphatic Vessels ◽  
Mucosal Inflammation ◽  
Colorectal Mucosa ◽  
Inflammatory Bowel

Abstract The expression of leptin and leptin receptor (Ob-R) has been partially elucidated in colon of patients with inflammatory bowel diseases (IBDs), even though leptin is involved in angiogenesis and inflammation. We previously reported overexpression of GLUT5 fructose transporter, in aberrant clusters of lymphatic vessels in lamina propria of IBD and controls. Here, we examine leptin and Ob-R expression in the same biopsies. Specimens were obtained from patients with ulcerative colitis (UC), Crohn’s disease (CD) and controls who underwent screening for colorectal cancer, follow-up after polypectomy or with a history of lower gastrointestinal symptoms. Immunohistochemistry revealed leptin in apical and basolateral membranes of short epithelial portions, Ob-R on the apical pole of epithelial cells. Leptin and Ob-R were also identified in structures and cells scattered in the lamina propria. In UC, a significant correlation between leptin and Ob-R in the lamina propria was found in all inflamed samples, beyond non-inflamed samples of the proximal tract, while in CD, it was found in inflamed distal samples. Most of the leptin and Ob-R positive areas in the lamina propria were also GLUT5 immunoreactive in inflamed and non-inflamed mucosa. A significant correlation of leptin or Ob-R expression with GLUT5 was observed in the inflamed distal samples from UC. Our findings suggest that there are different sites of leptin and Ob-R expression in large intestine and those in lamina propria do not reflect the status of mucosal inflammation. The co-localization of leptin and/or Ob-R with GLUT5 may indicate concomitance effects in colorectal lamina propria areas.

scholarly journals P455 Adherence to enteral nutrition therapy by adults with active Crohn’s disease is associated with conscientiousness personality trait

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S406-S407
Author(s):  
C Wall ◽  
A McCombie ◽  
R Mulder ◽  
A Day ◽  
R Gearry
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Personality Trait ◽  
Gastrointestinal Symptoms ◽  
Nutrition Therapy ◽  
Control Group ◽  
Healthy Controls ◽  
Eating Behaviours ◽  
Exclusive Enteral Nutrition

Abstract Background Conscientiousness is a personality trait characterised by the ability to control impulses, delay gratification, set and reach goals, and plan in advance. Conscientious people are more likely to be non-smokers, do physical activity and practice healthy eating behaviours. They are also more likely to be adherent to medication. The aim of this study was to assess whether people with Crohn’s disease who score high on conscientiousness are more likely to be adherent to enteral nutrition (EN) therapy than low scorers. Methods Adults aged 16 to 40 years with newly diagnosed Crohn’s disease or having a flare of disease were invited by their gastroenterologist to use nutrition therapy to induce disease remission. Nutrition therapy was either eight weeks of exclusive enteral nutrition (EN) or two weeks of exclusive EN followed by six weeks of partial EN and one meal per day. A convenience control group of healthy participants with no history of gastrointestinal symptoms was also recruited to use exclusive EN for two weeks. Adherence to EN was self-reported fortnightly using a standardised questionnaire. Non-adherence was defined as patients who repeatedly ate foods while using EN or ate more than one meal per day on partial EN. Patients who could not initiate or did not tolerate the EN formula were included in the non-adherent group. Prior to starting nutrition therapy, conscientiousness was measured using the well-validated conscientiousness subset of the Big Five Inventory. Results Twenty-three (59%) of the 39 patients recruited with Crohn’s disease completed and adhered to the eight-week treatment. Reasons for non-adherence by the 14 patients who did not complete treatment included: could not initiate EN (n = 4), non-response at week 4 (n = 2), intolerance of EN (n = 7) or repeated eating of food or started eating food again prior to the end of treatment (n = 2). Seventeen (81%) of the 21 healthy controls completed and adhered to 2 weeks of exclusive EN. Reasons for non-adherence were could not initiate EN (n = 3) or intolerance of the formula (n = 1). Adherence and completion of EN therapy were associated with a greater mean conscientiousness score 35.57 (95% CI: 32.88, 38.25) compared with the non-adherence group mean 30.13 (95% CI: 26.53, 33.73), p = 0.014. Mean conscientiousness score of the healthy controls who completed exclusive EN was similar to the Crohn’s disease group (36.65 (95% CI: 33.53, 39.77), p > 0.05). Conclusion Conscientiousness was associated with adherence to EN therapy. EN therapy can be a cognitively and emotionally demanding treatment and this personality trait should ideally be considered when determining suitable candidates for EN therapy.

Mo1839 Prevalence and Severity of Concomitant Gastrointestinal Symptoms in Crohn's Disease

2016 ◽  
Vol 150 (4) ◽  
pp. S790 ◽  
Author(s):  
Dana Pan ◽  
Christopher V. Almario ◽  
William D. Chey ◽  
Brennan Spiegel
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Gastrointestinal Symptoms

scholarly journals S2464 An Unusual Case of Metastatic Crohn’s Disease Without Gastrointestinal Symptoms

2021 ◽  
Vol 116 (1) ◽  
pp. S1041-S1041
Author(s):  
Michelle Baliss ◽  
Christopher Nguyen ◽  
Mohammad Abdallah ◽  
Alexander Dang
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Unusual Case ◽  
Gastrointestinal Symptoms ◽  
Metastatic Crohn's Disease

scholarly journals Asymptomatic Crohn’s disease identified in a patient being treated with secukinumab: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1989358
Author(s):  
Wasim Haidari ◽  
Sarah Al-Naqshabandi ◽  
Christine S Ahn ◽  
Richard S Bloomfeld ◽  
Steven R Feldman
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Gastrointestinal Symptoms ◽  
Good Choice ◽  
History Of ◽  
Inflammatory Bowel ◽  
Multiple Ulcers ◽  
New Onset

IL-17 antagonism is among the most potent treatments for psoriasis. Generally safe, new onset and exacerbations of inflammatory bowel disease may occur in association with IL-17 therapy. We describe a patient with long-standing history of psoriasis and psoriatic arthritis in whom asymptomatic Crohn’s disease was identified during treatment with secukinumab. The patient underwent an elective colonoscopy for colorectal cancer screening which revealed inflammation and multiple ulcers in the terminal ileum suggestive of Crohn’s disease. While the patient did not have any gastrointestinal symptoms, he was diagnosed as having asymptomatic Crohn’s disease. Given the association of inflammatory bowel disease with secukinumab treatment, secukinumab was discontinued. Although in this patient, Crohn’s disease was identified during treatment with secukinumab, a direct causal relationship cannot be assumed. Medications that are effective for both psoriasis and inflammatory bowel disease may be a good choice in patients with psoriasis who have comorbid Crohn’s disease or develop inflammatory bowel disease during treatment with another biologic.

scholarly journals Delayed Diagnosis of Vulvar Crohn’s Disease in a Patient with No Gastrointestinal Symptoms

2018 ◽  
Vol 10 (3) ◽  
pp. 263-267
Author(s):  
Leah Ellis Wells ◽  
David Cohen
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Delayed Diagnosis ◽  
Gastrointestinal Symptoms ◽  
Symptomatic Improvement ◽  
Initial Therapy ◽  
Symptom Improvement ◽  
Factor Α ◽  
Necrosis Factor

Though Crohn’s disease primarily affects the gastrointestinal tract, cutaneous Crohn’s disease of the vulva can occur in the absence of gastrointestinal symptoms, complicating the diagnosis. Once clinicians suspect cutaneous Crohn’s disease, antibiotics and traditional immunosuppressants comprise initial treatment. Unfortunately, sometimes these therapies are not effective, or they provide only short-lived symptomatic improvement. A few case reports have found tumor necrosis factor-α inhibitors to be helpful in such refractory cases. We describe a patient with long-standing, painful vulvar Crohn’s lesions with no gastrointestinal manifestations of the disease. Her diagnosis was delayed for years, and initial therapy with antibiotics and steroids was unsuccessful. Finally, the patient experienced effective and long-lasting symptom improvement with infliximab (RemicadeTM).

scholarly journals Exercise and Crohn’s Disease: Speculations on Potential Benefits

2006 ◽  
Vol 20 (10) ◽  
pp. 657-660 ◽  
Author(s):  
Victor Ng ◽  
Wanda Millard ◽  
Constance Lebrun ◽  
John Howard
Keyword(s):  
Physical Activity ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Gastrointestinal Symptoms ◽  
The United States ◽  
Chronic Inflammatory Bowel Disease ◽  
Potential Benefits ◽  
Patient Groups ◽  
Inflammatory Bowel ◽  
Low Intensity Exercise

Crohn’s disease (CD) is a chronic inflammatory bowel disease that affects nearly one million people in the United States and Canada. While current pharmaceutical treatments are effective in controlling symptoms, patients continue to experience a reduced quality of life (QOL). Based on preliminary studies, QOL in CD patients may be improved by engaging in physical activity. Exercise may decrease CD activity and reduce psychological stress. Current research also suggests that low-intensity exercise does not exacerbate gastrointestinal symptoms and does not lead to flare-ups. Furthermore, exercise appears to reduce CD symptoms and improve QOL. In summary, physical activity may be beneficial to certain patient groups, but more studies are needed before broad recommendations can be made.

Calprotectin or Lactoferrin: Do They Help

2016 ◽  
Vol 34 (1-2) ◽  
pp. 98-104 ◽  
Author(s):  
Emily K. Wright
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Inflammation ◽  
Gastrointestinal Symptoms ◽  
Treat To Target ◽  
Clinical Relapse ◽  
Markers Of Inflammation ◽  
Fecal Biomarkers

Background: The diagnosis and monitoring of inflammatory bowel disease (IBD) has traditionally relied on clinical assessment, serum markers of inflammation and endoscopic examination. Fecal biomarkers such as calprotectin (FC) and lactoferrin (FL) are predominantly derived from neutrophils, are easily detectable in the feces and are now established as valuable markers of intestinal inflammation. In recent years, a ‘treat to target' concept has emerged for the management of IBD. Adequate control of inflammation in IBD at a biochemical level is quickly becoming an important target in IBD management. Key Messages: Fecal biomarkers have been shown to be significantly and consistently increased in both adult and pediatric patients with IBD versus those without IBD. Fecal biomarkers are therefore useful in determining those patients with gastrointestinal symptoms who are likely to benefit from colonoscopy versus those in whom colonoscopy is likely to be normal. Fecal biomarkers correlate significantly with endoscopic disease in both Crohn's disease and ulcerative colitis. Suggested cutoffs for FC for endoscopically active disease in IBD range from 50 to 280 μg/g. Fecal biomarkers reflect the success of treatment intensification and can help predict clinical relapse. Both FC and FL are accurate in the detection of postoperative endoscopic recurrence of Crohn's disease, and FC may be clinically useful in predicting those patients with acute severe ulcerative colitis who may progress to colectomy. There are limitations to these fecal tests including a false positive rate and intra-individual variability. Conclusions: This review focuses on the role of fecal biomarkers in the diagnosis, monitoring and management of IBD and how best to interpret results. We will discuss the emerging role of these biomarkers in the IBD management landscape including FC-guided drug dosing and the development of home-based testing and e-health applications. Fecal biomarker results must always be interpreted in a clinical context. Endoscopic assessment remains the gold standard for diagnosis and monitoring of IBD.

scholarly journals Challenges in Crohn’s Disease Management after Gastrointestinal Cancer Diagnosis

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 574
Author(s):  
Claudio Fiorillo ◽  
Carlo Alberto Schena ◽  
Giuseppe Quero ◽  
Vito Laterza ◽  
Daniela Pugliese ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Crohn's Disease ◽  
Cancer Diagnosis ◽  
Gastrointestinal Cancer ◽  
De Novo ◽  
Gastrointestinal Symptoms ◽  
Chronic Inflammatory Bowel Disease ◽  
Neoplastic Disease ◽  
Increased Risk

Crohn’s disease (CD) is a chronic inflammatory bowel disease with a progressive course, potentially affecting the entire gastrointestinal tract from mouth to anus. Several studies have shown an increased risk of both intestinal and extra-intestinal cancer in patients with CD, due to long-standing transmural inflammation and damage accumulation. The similarity of symptoms among CD, its related complications and the de novo onset of gastrointestinal cancer raises difficulties in the differential diagnosis. In addition, once a cancer diagnosis in CD patients is made, selecting the appropriate treatment can be particularly challenging. Indeed, both surgical and oncological treatments are not always the same as that of the general population, due to the inflammatory context of the gastrointestinal tract and the potential exacerbation of gastrointestinal symptoms of patients with CD; moreover, the overlap of the neoplastic disease could lead to adjustments in the pharmacological treatment of the underlying CD, especially with regard to immunosuppressive drugs. For these reasons, a case-by-case analysis in a multidisciplinary approach is often appropriate for the best diagnostic and therapeutic evaluation of patients with CD after gastrointestinal cancer onset.

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