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Feathers A, Lovasi GS, Grigoryan Z, Beem K, Datta SK, Faleck DM, Socci T, Maggi R, Swaminath A. Crohn's Disease Mortality and Ambient Air Pollution in New York City. Inflamm Bowel Dis 2023:izad243. [PMID: 37934758 DOI: 10.1093/ibd/izad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The worldwide increase in Crohn's disease (CD) has accelerated alongside rising urbanization and accompanying decline in air quality. Air pollution affects epithelial cell function, modulates immune responses, and changes the gut microbiome composition. In epidemiologic studies, ambient air pollution has a demonstrated relationship with incident CD and hospitalizations. However, no data exist on the association of CD-related death and air pollution. METHODS We conducted an ecologic study comparing the number of CD-related deaths of individuals residing in given zip codes, with the level of air pollution from nitric oxide, nitrogen dioxide, sulfur dioxide (SO2), and fine particulate matter. Air pollution was measured by the New York Community Air Survey. We conducted Pearson correlations and a Poisson regression with robust standard errors. Each pollution component was modeled separately. RESULTS There was a higher risk of CD-related death in zip codes with higher levels of SO2 (incidence rate ratio [IRR], 1.16; 95% confidence interval [CI], 1.06-1.27). Zip codes with higher percentage of Black or Latinx residents were associated with lower CD-related death rates in the SO2 model (IRR, 0.58; 95% CI, 0.35-0.98; and IRR, 0.13; 95% CI, 0.05-0.30, respectively). There was no significant association of either population density or area-based income with the CD-related death rate. CONCLUSIONS In New York City from 1993 to 2010, CD-related death rates were higher among individuals from neighborhoods with higher levels of SO2 but were not associated with levels of nitric oxide, nitrogen dioxide, and fine particulate matter. These findings raise an important and timely public health issue regarding exposure of CD patients to environmental SO2, warranting further exploration.
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Affiliation(s)
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Zoya Grigoryan
- Department of Internal Medicine, Lenox Hill Hospital, New York, NY, USA
| | | | - Samit K Datta
- Gastroenterology, Department at Skagit Regional Health in Mt. Vernon, WA
| | - David M Faleck
- Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas Socci
- Division of Gastroenterology, Lenox Hill Hospital, New York, NY, USA
| | - Rachel Maggi
- Division of Gastroenterology, Lenox Hill Hospital, New York, NY, USA
| | - Arun Swaminath
- Division of Gastroenterology, Lenox Hill Hospital, New York, NY, USA
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Du B, Fu Y, Han Y, Sun Q, Xu J, Yang Y, Rong R. The lung-gut crosstalk in respiratory and inflammatory bowel disease. Front Cell Infect Microbiol 2023; 13:1218565. [PMID: 37680747 PMCID: PMC10482113 DOI: 10.3389/fcimb.2023.1218565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/28/2023] [Indexed: 09/09/2023] Open
Abstract
Both lung and gut belong to the common mucosal immune system (CMIS), with huge surface areas exposed to the external environment. They are the main defense organs against the invasion of pathogens and play a key role in innate and adaptive immunity. Recently, more and more evidence showed that stimulation of one organ can affect the other, as exemplified by intestinal complications during respiratory disease and vice versa, which is called lung-gut crosstalk. Intestinal microbiota plays an important role in respiratory and intestinal diseases. It is known that intestinal microbial imbalance is related to inflammatory bowel disease (IBD), this imbalance could impact the integrity of the intestinal epithelial barrier and leads to the persistence of inflammation, however, gut microbial disturbances have also been observed in respiratory diseases such as asthma, allergy, chronic obstructive pulmonary disease (COPD), and respiratory infection. It is not fully clarified how these disorders happened. In this review, we summarized the latest examples and possible mechanisms of lung-gut crosstalk in respiratory disease and IBD and discussed the strategy of shaping intestinal flora to treat respiratory diseases.
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Affiliation(s)
- Baoxiang Du
- College of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yan Fu
- College of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuxiu Han
- College of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qihui Sun
- College of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jinke Xu
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Yong Yang
- Shandong Antiviral Engineering Research Center of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Rong Rong
- College of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
- Key Laboratory of Traditional Chinese Medicine Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan, China
- Shandong Provincial Key Laboratory of Traditional Chinese Medicine for Basic Research, Shandong University of Traditional Chinese Medicine, Jinan, China
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3
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Slonovschi E, Kodela P, Okeke M, Guntuku S, Lingamsetty SSP. Surgical Treatment in Ulcerative Colitis, Still Topical: A Narrative Review. Cureus 2023; 15:e41962. [PMID: 37588306 PMCID: PMC10427119 DOI: 10.7759/cureus.41962] [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: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
In this paper, different studies were integrated to conclude the impact of ulcerative colitis (UC) on the patient's vital prognosis, specifically highlighting the association with colorectal cancer (CRC). These severe complications have led us to consider studying the role of preventive surgery in managing UC. This study reviewed total preventive colectomy in UC patients for preventing the onset of CRC, the role of surgery in UC management, and its potential as a definitive treatment for the condition. The study also emphasized the effectiveness of annual colonoscopic monitoring and preventive colectomy in reducing the incidence of colorectal cancer (CRC). It discussed the role of laparoscopic surgery in minimizing postoperative complications and highlighted that partial surgical resection of the colon can be a viable option, offering improved bowel function without increasing the risk of CRC-related mortality. Elective surgery has an important place in UC management by preventing the development of forms requiring emergency surgery. Although surgery can cure UC, it can lead to significant postoperative complications and adverse effects.
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Affiliation(s)
- Eduard Slonovschi
- Department of Surgery, Universitatea de Medicină și Farmacie Iuliu Haţieganu Facultatea de Medicină, Cluj-Napoca, ROU
| | - Pratyusha Kodela
- Department of Research, Shri B. M. Patil Medical College, Hospital and Research Center, Bijapur Liberal District Educational Association (BLDEA) University, Vijayapura, IND
| | - Monalisa Okeke
- Department of Research, Drexel University College of Medicine, Philadelphia, USA
| | - Sandeep Guntuku
- Department of Internal Medicine, Mamata Medical College, Khammam, IND
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4
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Saha BK, Wayne MT, Chenna P. A 52-Year-Old Woman With a History of Ulcerative Colitis and New Onset Severe Dyspnea. Chest 2023; 163:e211-e217. [PMID: 37164585 DOI: 10.1016/j.chest.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 12/17/2022] [Indexed: 05/12/2023] Open
Abstract
CASE PRESENTATION A 52-year-old woman was referred to the pulmonary office for evaluation of worsening dyspnea in August 2022. She had been diagnosed with asthma 22 years ago after she experienced chronic cough, sputum production, occasional wheezing, and mild exertional shortness of breath. Over the years, she was treated with different inhalers and was currently on triple inhaler therapy. A pulmonary function test in 2020 was normal. She had a history of ulcerative colitis and underwent a total colectomy in 1998. In the early 2000s, the patient also experienced episcleritis. Her other medical conditions included hyperlipidemia, gout, and gastroesophageal reflux disease.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL.
| | - Max T Wayne
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St, Louis, MO
| | - Praveen Chenna
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St, Louis, MO
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5
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Vorel ES, Mehta JJ, Russo ME, Muego MP, Borek RC, Kelly JA, Greenfield ME. A 7-Year-Old With Persistent Fever and Cough. Pediatrics 2022; 150:189214. [PMID: 36017677 DOI: 10.1542/peds.2021-050751] [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] [Accepted: 01/05/2022] [Indexed: 11/24/2022] Open
Abstract
A previously healthy, fully immunized 7-year-old girl presented with a 7-week history of daily fevers and a worsening cough with persistently elevated inflammatory markers. Before admission, she had an unrevealing outpatient workup by infectious disease, rheumatology, pulmonology, and otorhinolaryngology for her fever and other symptoms. Multiple courses of antibiotics had no effect, but brief courses of steroids seemed to modestly alleviate her symptoms. At an outside hospital, a computed tomography neck and chest scan revealed mediastinal lymphadenopathy. She was subsequently transferred to the authors' institution. Her examination was notable for a febrile, tired-appearing girl in respiratory distress with a muffled voice and inspiratory stridor. Her laboratory tests revealed leukocytosis with left shift, microcytic anemia, and hypoalbuminemia, as well as elevated inflammatory markers, ferritin, and fecal calprotectin. Her peripheral smear, uric acid, and lactate dehydrogenase were all within normal limits. Infectious study results, including blood and urine cultures, cytomegalovirus serologies, and Bartonella serologies were negative. On the second read of her outside computed tomography imaging, her lymphadenopathy was felt to be nonpathologic. Based on a recommendation by rheumatology, an ophthalmologic examination was obtained, which revealed bilateral anterior uveitis; however, rheumatologic laboratory test results returned negative. Her fevers continued, and inflammatory markers remained elevated despite antibiotics. On day 6 of hospitalization, she developed worsening respiratory distress, necessitating intubation and transfer to the ICU. Repeat laryngoscopy and bronchoscopy revealed severe purulent tracheitis; however, throat cultures remained sterile. Her clinical deterioration without identification of an offending organism prompted additional evaluation for a systemic etiology.
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Affiliation(s)
| | - Jay J Mehta
- Department of Pediatrics.,Division of Rheumatology.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael E Russo
- Department of Pediatrics.,Division of Infectious Diseases.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa P Muego
- Department of Pediatrics.,Division of Pulmonary and Sleep Medicine.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan C Borek
- Division of Otolaryngology, Department of Pediatric Surgery.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janice A Kelly
- Department of Pediatrics.,Division of Gastroenterology, Hepatology, and Nutrition.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Morgan E Greenfield
- Department of Pediatrics.,Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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6
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Schmid F, Chao CM, Däbritz J. Pathophysiological Concepts and Management of Pulmonary Manifestation of Pediatric Inflammatory Bowel Disease. Int J Mol Sci 2022; 23:ijms23137287. [PMID: 35806292 PMCID: PMC9266732 DOI: 10.3390/ijms23137287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
Pulmonary manifestation (PM) of inflammatory bowel disease (IBD) in children is a rare condition. The exact pathogenesis is still unclear, but several explanatory concepts were postulated and several case reports in children were published. We performed a systematic Medline search between April 1976 and April 2022. Different pathophysiological concepts were identified, including the shared embryological origin, “miss-homing” of intestinal based neutrophils and T lymphocytes, inflammatory triggering via certain molecules (tripeptide proline-glycine-proline, interleukin 25), genetic factors and alterations in the microbiome. Most pediatric IBD patients with PM are asymptomatic, but can show alterations in pulmonary function tests and breathing tests. In children, the pulmonary parenchyma is more affected than the airways, leading histologically mainly to organizing pneumonia. Medication-associated lung injury has to be considered in pulmonary symptomatic pediatric IBD patients treated with certain agents (i.e., mesalamine, sulfasalazine or infliximab). Furthermore, the risk of pulmonary embolism is generally increased in pediatric IBD patients. The initial treatment of PM is based on corticosteroids, either inhaled for the larger airways or systemic for smaller airways and parenchymal disease. In summary, this review article summarizes the current knowledge about PM in pediatric IBD patients, focusing on pathophysiological and clinical aspects.
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Affiliation(s)
- Florian Schmid
- Catholic Children’s Hospital Wilhelmstift, 22149 Hamburg, Germany;
| | - Cho-Ming Chao
- Department of Pediatrics, University Medical Center Rostock, 18057 Rostock, Germany;
- Cardio-Pulmonary Institute (CPI), University of Giessen and Marburg Lung Center (UGMLC), German Center of Lung Research (DZL), Justus-Liebig-University, 35398 Giessen, Germany
| | - Jan Däbritz
- Department of Pediatrics, University Medical Center Greifswald, 17475 Greifswald, Germany
- Correspondence:
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Duryee MJ, Ahmad R, Eichele DD, Hunter CD, Mitra A, Talmon GA, Singh S, Smith LM, Rosen MJ, Dhawan P, Thiele GM, Singh AB. Identification of Immunoglobulin G Autoantibody Against Malondialdehyde-Acetaldehyde Adducts as a Novel Serological Biomarker for Ulcerative Colitis. Clin Transl Gastroenterol 2022; 13:e00469. [PMID: 35287144 PMCID: PMC9038499 DOI: 10.14309/ctg.0000000000000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/06/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is associated with immune responses with oxidative stress wherein high levels of malondialdehyde result in the formation of a highly stable and immunogenic malondialdehyde-acetaldehyde adduct (MAA). Thus, this study evaluated the status of MAA and anti-MAA antibody isotypes in IBD and their potential as novel serological biomarkers for differentiating ulcerative colitis (UC) from Crohn's disease (CD). METHODS Levels of MAA and anti-MAA antibodies were examined in patients with IBD (171), non-IBD gastrointestinal diseases (77), and controls (83) from 2 independent cohorts using immunohistochemistry and enzyme-linked immunosorbent assay. Receiver operating characteristic curves and Youden cutoff index from logistic regression were used to determine the sensitivity and specificity. RESULTS The MAA and blood immunoglobulin G (IgG) anti-MAA antibody levels were significantly elevated in IBD compared with non-IBD patients (P = 0.0008) or controls (P = 0.02). Interestingly, patients with UC showed higher levels of IgG anti-MAA (P < 0.0001) than patients with CD including those with colonic CD (P = 0.0067). The odds ratio by logistic regression analysis predicted stronger association of IgG anti-MAA antibody with UC than CD. Subsequent analysis showed that IgG anti-MAA antibody levels could accurately identify (P = 0.0004) UC in the adult cohort with a sensitivity of 75.3% and a specificity of 71.4% and an area under the curve of 0.8072 (0.7121-0.9024). The pediatric cohort also showed an area under the curve of 0.8801 (0.7988-0.9614) and precisely distinguished (P < 0.0001) UC with sensitivity (95.8%) and specificity (72.3%). DISCUSSION Circulating IgG anti-MAA antibody levels can serve as a novel, noninvasive, and highly sensitive test to identify patients with UC and possibly differentiate them from patients with CD.
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Affiliation(s)
- Michael J. Duryee
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Rizwan Ahmad
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Derrick D. Eichele
- Division of Gastroenterology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Carlos D. Hunter
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Ananya Mitra
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Geoffrey A. Talmon
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shailender Singh
- Division of Gastroenterology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lynette M. Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Michael J. Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Punita Dhawan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Geoffrey M. Thiele
- Division of Rheumatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Amar B. Singh
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
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8
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Mutua V, Gershwin LJ. A Review of Neutrophil Extracellular Traps (NETs) in Disease: Potential Anti-NETs Therapeutics. Clin Rev Allergy Immunol 2021; 61:194-211. [PMID: 32740860 PMCID: PMC7395212 DOI: 10.1007/s12016-020-08804-7] [Citation(s) in RCA: 232] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Activated neutrophils release neutrophil extracellular traps (NETs) in response to a variety of stimuli. NETosis is driven by protein-arginine deiminase type 4, with the release of intracellular granule components that function by capturing and destroying microbes, including viral, fungal, bacterial, and protozoal pathogens. The positive effects of pathogen control are countered by pro-inflammatory effects as demonstrated in a variety of diseases. Components of NETS are non-specific, and other than controlling microbes, they cause injury to surrounding tissue by themselves or by increasing the pro-inflammatory response. NETs can play a role in enhancement of the inflammation seen in autoimmune diseases including psoriasis, rheumatoid arthritis, and systemic lupus erythematosis. In addition, autoinflammatory diseases such as gout have been associated with NETosis. Inhibition of NETs may decrease the severity of many diseases improving survival. Herein, we describe NETosis in different diseases focusing on the detrimental effect of NETs and outline possible therapeutics that can be used to mitigate netosis. There is a need for more studies and clinical trials on these and other compounds that could prevent or destroy NETs, thereby decreasing damage to patients.
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Affiliation(s)
- Victoria Mutua
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California Davis, 1 Shields Ave, Davis, CA, USA.
| | - Laurel J Gershwin
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California Davis, 1 Shields Ave, Davis, CA, USA
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Cao W, Deng X, Xu C, Wang X, Yu Y, Xu X, Li J, Xiao Y. Crohn's disease with pulmonary granuloma in a child: a case report and review of the literature. Transl Pediatr 2021; 10:1728-1736. [PMID: 34295788 PMCID: PMC8261598 DOI: 10.21037/tp-21-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/20/2021] [Indexed: 12/25/2022] Open
Abstract
Crohn's disease (CD) is a chronic granulomatous disease that affects the gastrointestinal system. Additionally, CD has multiple extraintestinal manifestations, and bronchopulmonary manifestations are extremely rare. Pulmonary lesions can occur before the diagnosis of CD; thus, pulmonary manifestations are often overlooked, which leads to misdiagnoses. Herein, we present a case with pulmonary nodules being exhibited before the patient was diagnosed with CD. To the best of our knowledge, only a few cases concerning this phenomenon have been reported. We describe an 11-year-old boy with a two-year history of anemia and without any gastrointestinal symptoms. He did not receive any thorough inspection until arthralgia occurred. Multiple nodules were found in his bilateral lungs via computed tomography scan. Combined with the child's medical history, physical examinations, and all of the investigations, the final diagnosis was CD with pulmonary nodules and arthritis. After 2 months of treatment, the patient's symptoms had significantly improved. To summarize the clinical manifestations, auxiliary examination features, and treatments of CD in children with pulmonary involvement, we also review the relevant characteristics of pulmonary involvement in CD patients. This case indicates the importance of recognizing the pulmonary manifestations of CD. Clinicians should be aware of the possibility of CD when their patients have lung nodules, even in children with no typical manifestations of CD.
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Affiliation(s)
- Wei Cao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xing Deng
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Chundi Xu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xinqiong Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yi Yu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xu Xu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jia Li
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yuan Xiao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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10
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Suzuki Y, Monteiro RC, Coppo R, Suzuki H. The Phenotypic Difference of IgA Nephropathy and its Race/Gender-dependent Molecular Mechanisms. KIDNEY360 2021; 2:1339-1348. [PMID: 35369654 PMCID: PMC8676395 DOI: 10.34067/kid.0002972021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 02/08/2023]
Abstract
IgA nephropathy (IgAn), defined by the pre dominant de position of IgA in the glomerular mesangium, is the most common form of GN throughout the world. However, its incidence, sex distribution, clinical presentation, and progression and pathogenic initiating factors are largely variable and do not fit such a simple definition. To assess the heterogeneity of this disease, we recently conducted a clinical survey on the presentation and clinical management of patients with IgAn in Europe and Japan. This clinical survey highlights similarities and differences in patients from different cont inents. The survey revealed obvious differences between nations in the frequency of gastrointestinal complications, including inflammatory bowel diseases (IBD) and celiac disease, which were more frequent in European patients. Such findings are compatible with susceptibility loci related to intestinal immunity and IBD in recent genome wide association studies (GWAS) on IgAn. However, most of the molecules in these mucosal-related loci fulfill the immunologic function not only of gut-associated lymphoid tissue (GALT), but also nasopharyngeal/bronchial-associated lymphoid tissues (NALT/BALT). Indeed, a similar frequency of macrohematuria coinciding with upper respiratory infection, a hallmark manifestation of this disease, was found in the survey, emphasizing the pathogenic roles of these molecules in the NALT/BALT of patients with IgAn. Recent experimental and clinical studies including GWAS on multiple common infections and IBD indicate immune crosstalk between GALT and NALT/BALT, and some related mediators, such as TNF superfamily ligands (APRIL/BAFF). This review explains the epidemiologic heterogeneity of this disease with the clinical survey, and discusses race and sex-dependent molecular mechanisms.
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Affiliation(s)
- Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Renato C. Monteiro
- Faculty of Medicine, University of Paris, Paris, France,Center for Research on Inflammation, Paris, France,Inflamex Laboratory of Excellence, Paris, France,Immunology Department, Bichat Hospital, Assistance Publique de Paris, Paris, France
| | | | - Hitoshi Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
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11
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Barnes EL, Loftus EV, Kappelman MD. Effects of Race and Ethnicity on Diagnosis and Management of Inflammatory Bowel Diseases. Gastroenterology 2021; 160:677-689. [PMID: 33098884 DOI: 10.1053/j.gastro.2020.08.064] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/07/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
Abstract
Although Crohn's disease (CD) and ulcerative colitis (UC) have been considered as disorders that affect individuals of European ancestry, the epidemiology of the inflammatory bowel diseases (IBDs) is changing. Coupled with the increasing incidence of IBD in previously low-incidence areas, the population demographics of IBD in the United States are also changing, with increases among non-White races and ethnicities. It is therefore important to fully understand the epidemiology and progression of IBD in different racial and ethnic groups, and the effects of race and ethnicity on access to care, use of resources, and disease-related outcomes. We review differences in IBD development and progression among patients of different races and ethnicities, discussing the effects of factors such as access to care, delays in diagnosis, and health and disease perception on disparities in IBD care and outcomes. We identify research priorities for improving health equity among minority patients with IBD.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Michael D Kappelman
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Zangara MT, Bhesania N, Liu W, Cresci GAM, Kurowski JA, McDonald C. Impact of Diet on Inflammatory Bowel Disease Symptoms: An Adolescent Viewpoint. CROHN'S & COLITIS 360 2020; 2:otaa084. [PMID: 36777758 PMCID: PMC9802055 DOI: 10.1093/crocol/otaa084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 12/19/2022] Open
Abstract
Background Dietary modification shows promise as therapy in inflammatory bowel disease (IBD); however, it is unknown whether adolescents are interested in a dietary approach. Methods Cross-sectional survey of adolescents with IBD ages 14-21 on disease knowledge, dietary habits, and perceptions of diet therapy. Results A total of 132 subjects (48.5% female), mean age of 17.8 years and median disease length of 5 years (range 0, 16), completed the survey. Diet was perceived as a symptom trigger by 59.8% of subjects, and 45.4% had tried using diet as a treatment for symptom resolution, often without physician supervision and with limited success. Subjects experiencing active disease symptoms as determined by Manitoba IBD Index were more likely to be currently modifying their diet compared to subjects without active disease symptoms (odds ratio = 4.11, confidence interval = 1.58, 10.73, P = 0.003). Conclusions Adolescents with IBD perceive a relationship between diet and disease symptoms and are interested in dietary modification as a symptom management option.
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Affiliation(s)
- Megan T Zangara
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Natalie Bhesania
- Division of Pediatric Gastroenterology and Nutrition, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gail A M Cresci
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA,Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA,Department of Pediatric Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jacob A Kurowski
- Department of Pediatric Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine McDonald
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA,Address correspondence to: Christine McDonald, PhD, Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 ()
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13
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Gupta SJ, Gupta VL, Kothari HG, Samarth AR, Gaikwad NR, Parmar SM. Assessment of Occult Pulmonary Involvement in Ulcerative Colitis. Inflamm Intest Dis 2020; 5:144-150. [PMID: 32999887 DOI: 10.1159/000508772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction Nearly 50% of patients with inflammatory bowel disease (IBD) experience at least one extraintestinal manifestation. Bronchopulmonary involvement is rare in IBD. Pulmonary function test (PFT) abnormality in cases of ulcerative colitis (UC) has been reported to be 17-55%. Occult pulmonary disease may be diagnosed using variables of the PFT. Hence, we aim to evaluate the frequency and type of pulmonary dysfunction in patients with UC in remission. Methods Eighty-three patients of UC in remission and 48 controls underwent the PFT including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Tiffeneau value (FEV1/FVC), and midexpiratory flow (MEF 25-75%) rate with a spirometer. The patients were divided based on the age of onset of UC into A1 (<16 years), A2 (16-40 years), and A3 (>40 years) and based on the extent of disease into E1 (proctitis), E2 (left-sided colitis), and E3 (extensive colitis). Results Patients with UC had significantly abnormal PFT compared with controls (51 [61.5%] vss. 8 [16.67%]; p = 0.000). Patients with UC commonly had a restrictive pattern (33 [64.47%]) of PFT followed by small airway disease (11 [21.56%]) and obstructive pattern (7 [13.72%]). Pulmonary involvement in cases of UC was more in E3 followed by E2 and E1. Pulmonary involvement was more in the late age of onset of disease. BMI was positively and significantly correlated with FEV1 and FVC. Hemoglobin had a positive and significant correlation with FEV1 while a negative correlation with FEV1/FVC and MEF 25-75%. All predictors except for age were found to contribute in higher risk (OR > 1) for PFT abnormality. Conclusion Patients with UC have chronic pulmonary inflammation leading to different patterns of lung involvement in the form of restrictive, obstructive airway, and small airway disease. Patients with UC commonly have a restrictive pattern of pulmonary involvement. Impairment of the PFT is related to the disease extent and the age of onset of disease. Assessment of the PFT using a spirometer is a noninvasive, simple, cost-effective, and reliable method for early detection of occult pulmonary involvement in patients of UC.
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Affiliation(s)
- Sudhir J Gupta
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Vineet L Gupta
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Harit G Kothari
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Amol R Samarth
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Nitin R Gaikwad
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Sahil M Parmar
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
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14
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Necrobiotic Pulmonary Nodules in Ulcerative Colitis: Not Just a "Crohnic" Phenomenon. ACG Case Rep J 2020; 7:e00438. [PMID: 32903944 PMCID: PMC7447367 DOI: 10.14309/crj.0000000000000438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/21/2020] [Indexed: 01/07/2023] Open
Abstract
Necrobiotic pulmonary nodules are an exceptionally rare extraintestinal manifestation of inflammatory bowel disease. Recognition is imperative because it may mimic other autoimmune pathologies such as granulomatosis with polyangiitis or sarcoidosis. We describe a 19-year-old man with a known history of ulcerative colitis who was found to possess bilateral pulmonary nodules on computed tomography imaging. Investigations that included an extensive autoimmune and infectious workup were inconclusive. Biopsy of the nodules revealed fibrinous exudate and palisading histiocytes that confirmed the diagnosis. He was started on prednisone therapy. A follow-up computed tomography a month later revealed near complete resolution.
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15
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Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate. World J Gastrointest Surg 2019; 11:261-270. [PMID: 31171957 PMCID: PMC6536884 DOI: 10.4240/wjgs.v11.i5.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease (CD) and malignant ones like colon cancer (CC).
AIM To investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.
METHODS This is a sub-group analysis of the European Society of Coloproctology’s prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.
RESULTS Three hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.
CONCLUSION Patients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complications' rate was not different between the two groups.
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16
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Affiliation(s)
- O. Haagen Nielsen
- Dept. of Medicine P, Division of Gastroenterology, and Dept. of Obstetrics and Gynaecology YA, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B. Andreasson
- Dept. of Medicine P, Division of Gastroenterology, and Dept. of Obstetrics and Gynaecology YA, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S. Bondesen
- Dept. of Medicine P, Division of Gastroenterology, and Dept. of Obstetrics and Gynaecology YA, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - O. Jacobsen
- Dept. of Medicine P, Division of Gastroenterology, and Dept. of Obstetrics and Gynaecology YA, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S. Jarnum
- Dept. of Medicine P, Division of Gastroenterology, and Dept. of Obstetrics and Gynaecology YA, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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17
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Proksell SS, Greer JB, Theisen BK, Davis PL, Rosh JR, Keljo DJ, Goyal A, Shah SA, Brand MH, Herfarth HH, Cross RK, Siegel CA, Koltun WA, Isaacs KL, Regueiro MD. IBD LIVE Case Series: Case 9: Do Race and Extraintestinal Manifestations Affect Treatment of Severe Crohn's Colitis? Inflamm Bowel Dis 2018; 24:698-713. [PMID: 29562279 DOI: 10.1093/ibd/izx114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Siobhan S Proksell
- Gastroenterology Fellow Year Iii, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Julia B Greer
- Assistant Professor of Medicine, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian K Theisen
- Assistant Professor of Pathology, Department of Pathology, George Washington University Hospital, Washington, D.C
| | - Peter L Davis
- Clinical Associate Professor of Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joel R Rosh
- Director, Division of Gastroenterology and Nutrition, Goryeb Children's Hospital, Atlantic Health, Morristown, New Jersey.,Professor of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David J Keljo
- Interim Chief, Pediatric Gastroenterology, Hepatology, and Nutrition and Co-Director, Inflammatory Bowel Disease Center, Children's Hospital of Pittsburgh of Upmc, Pittsburgh, Pennsylvania.,Professor of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alka Goyal
- Associate Professor of Pediatrics, Director of Inflammatory Disease Service, Division of Gastroenterology, Hepatology and Nutrition, Children's Mercy Hospital, Kansas City, Missouri
| | - Samir A Shah
- Chief of Gastroenterology, The Miriam Hospital, Providence, Rhode Island.,Clinical Professor of Medicine, Warren Alpert School of Medicine At Brown University, Providence, Rhode Island
| | - Myron H Brand
- Clinical Professor of Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,Medical Director, Shoreline Surgery Endoscopy Center, Connecticut Gastroenterology Consultants, New Haven, Connecticut
| | - Hans H Herfarth
- Professor of Medicine, Division of Gastroenterology and Hepatology, Co-Director Unc Multidisciplinary Center For Inflammatory Bowel Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Raymond K Cross
- Professor of Medicine, Director of Inflammatory Bowel Disease Program, University of Maryland School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Corey A Siegel
- Associate Professor of Medicine and of The Dartmouth Institute For Health Policy & Clinical Practice, Geisel School of Medicine At Dartmouth, Hanover, New Hampshire.,Director of The Inflammatory Bowel Disease Center At The Dartmouth-Hitchcock Medical Center In Lebanon, New Hampshire
| | - Walter A Koltun
- Chief, Division of Colon and Rectal Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Director, Hershey Penn State IBD Center, Professor of Surgery, Peter and Marshia Carlino Chair In IBD, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kim L Isaacs
- Professor of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
| | - Miguel D Regueiro
- Professor of Medicine, Associate Chief For Education, Co-Director, Inflammatory Bowel Disease Center, Head, IBD Clinical Program, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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18
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Segal JP, Oke S, Hold GL, Clark SK, Faiz OD, Hart AL. Systematic review: ileoanal pouch microbiota in health and disease. Aliment Pharmacol Ther 2018; 47:466-477. [PMID: 29205422 DOI: 10.1111/apt.14454] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/06/2017] [Accepted: 11/14/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The resident gut microbiota is essential for physiological processes; the disturbance of its balance is linked to intestinal inflammation. The ileoanal pouch is a model for the study of intestinal inflammation, as inflammation of the pouch is common and mostly develops within 12 months following ileostomy closure. This allows the longitudinal study of the microbiota, giving insight into the microbiota changes during transition from a normal to an inflamed pouch. AIM To explore the literature on the microbiota of the ileoanal pouch in health and disease. METHODS A systematic computer search of the on-line bibliographic databases MEDLINE and EMBASE was performed between 1966 and February 2017. Randomised controlled trials, cohort studies and observational studies were included. Studies were included if they reported microbiota analysis on faecal samples or tissue from the ileoanal pouch. RESULTS Twenty-six papers were eligible. Following ileostomy closure, anaerobic bacteria are the abundant species in the ileoanal pouch with presence of a diverse microbiota key to maintaining a healthy ileoanal pouch. Acute pouchitis is associated with an increase in Clostridia species, while chronic pouchitis is associated with an increase in Staphylococcus aureus. In the treatment of pouchitis, a decrease in Clostridia species appears to be associated with treatment response. CONCLUSION The microbiota plays an important role in both the inflamed and the healthy ileoanal pouch. A direct causal relationship between individual microbiota changes and inflammation has not yet been established, but manipulation of the ileoanal pouch microbiota may be a novel therapeutic avenue to explore.
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Affiliation(s)
- J P Segal
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - S Oke
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - G L Hold
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - S K Clark
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - O D Faiz
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - A L Hart
- St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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19
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Inoue K, Kusunoki T, Fujii T. Organizing pneumonia as an extraintestinal manifestation of Crohn's disease in a child. Pediatr Pulmonol 2017; 52:E64-E66. [PMID: 28493298 DOI: 10.1002/ppul.23717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/04/2017] [Indexed: 11/07/2022]
Abstract
Crohn's disease (CD) is a chronic inflammatory disorder with an unknown etiology that commonly involves the gastrointestinal tract, and bronchopulmonary manifestations only occur in 0.4% of cases. There have not been any reports about pulmonary involvement in pediatric CD patients. We experienced a 14-year-old boy with Crohn's disease diagnosed with organizing pneumonia by chest CT-guided biopsy examination. His pneumonia was intractable despite the administration of multiple antibiotics, and steroid therapy was very effective. In pediatric patients with CD whose lung disease does not respond to antibiotics, OP should be considered as a possible diagnosis.
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Affiliation(s)
- Kenji Inoue
- Shiga Medical Center for Children, Moriyama, Shiga, Japan
| | | | - Tatsuya Fujii
- Shiga Medical Center for Children, Moriyama, Shiga, Japan
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20
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Swaminath A, Feathers A, Ananthakrishnan A, Falzon L, Ferry SL. Systematic review with meta-analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn's disease. Aliment Pharmacol Ther 2017; 46:645-656. [PMID: 28815649 PMCID: PMC5798240 DOI: 10.1111/apt.14253] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/30/2017] [Accepted: 07/15/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite potential adverse-events in a paediatric population, corticosteroids are used to induce remission in paediatric Crohn's disease. Exclusive enteral nutrition also induces remission, but is infrequently used in the USA because corticosteroids are considered the superior therapy. New data have become available since the publication of the most recent meta-analysis in 2007. AIM To see if current literature supports the use of EEN versus CS in paediatric populations. METHODS All studies with comparator arms of exclusive enteral nutrition and an exclusive corticosteroids, with remission clearly defined were identified by searching eight online databases. RESULTS Of 2795 identified sources, nine studies met our inclusion criteria. Eight of these (n = 451), had data that could be abstracted into our meta-analysis. Exclusive enteral nutrition was as effective as corticosteroids in inducing remission (OR = 1.26 [95% CI 0.77, 2.05]) in paediatric Crohn's disease. There was no difference between Exclusive enteral nutrition and corticosteroids efficacy when comparing newly diagnosed Crohn's (OR = 1.61 [95% CI .87, 2.98]) or relapsed (OR = 0.76 [95% CI .29-1.98]). Intestinal healing was significantly more likely among patients receiving Exclusive enteral nutrition compared to corticosteroids (OR = 4.5 [95% CI 1.64, 12.32]). There was no difference in the frequency of biomarker normalisation including CRP (OR = 0.85 [95% CI .44, 1.67]) and faecal calprotectin (OR 2.79 [95% CI .79-10.90]). CONCLUSIONS There is no difference in efficacy between exclusive enteral nutrition and corticosteroids in induction of remission in Crohn's disease in a paediatric population. Exploratory analyses suggest that a greater proportion of patients treated with exclusive enteral nutrition achieved mucosal healing.
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Affiliation(s)
- Arun Swaminath
- Division of Gastroenterology, Lenox Hill Hospital, New York, NY,
USA
| | | | | | - Louise Falzon
- Columbia University Medical Center, New York, NY, USA
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21
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Monasta L, Pierobon C, Princivalle A, Martelossi S, Marcuzzi A, Pasini F, Perbellini L. Inflammatory bowel disease and patterns of volatile organic compounds in the exhaled breath of children: A case-control study using Ion Molecule Reaction-Mass Spectrometry. PLoS One 2017; 12:e0184118. [PMID: 28859138 PMCID: PMC5578606 DOI: 10.1371/journal.pone.0184118] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 08/20/2017] [Indexed: 12/22/2022] Open
Abstract
Inflammatory bowel diseases (IBD) profoundly affect quality of life and have been gradually increasing in incidence, prevalence and severity in many areas of the world, and in children in particular. Patients with suspected IBD require careful history and clinical examination, while definitive diagnosis relies on endoscopic and histological findings. The aim of the present study was to investigate whether the alveolar air of pediatric patients with IBD presents a specific volatile organic compounds’ (VOCs) pattern when compared to controls. Patients 10–17 years of age, were divided into four groups: Crohn’s disease (CD), ulcerative colitis (UC), controls with gastrointestinal symptomatology, and surgical controls with no evidence of gastrointestinal problems. Alveolar breath was analyzed by ion molecule reaction mass spectrometry. Four models were built starting from 81 molecules plus the age of subjects as independent variables, adopting a penalizing LASSO logistic regression approach: 1) IBDs vs. controls, finally based on 18 VOCs plus age (sensitivity = 95%, specificity = 69%, AUC = 0.925); 2) CD vs. UC, finally based on 13 VOCs plus age (sensitivity = 94%, specificity = 76%, AUC = 0.934); 3) IBDs vs. gastroenterological controls, finally based on 15 VOCs plus age (sensitivity = 94%, specificity = 65%, AUC = 0.918); 4) IBDs vs. controls, built starting from the 21 directly or indirectly calibrated molecules only, and finally based on 12 VOCs plus age (sensitivity = 94%, specificity = 71%, AUC = 0.888). The molecules identified by the models were carefully studied in relation to the concerned outcomes. This study, with the creation of models based on VOCs profiles, precise instrumentation and advanced statistical methods, can contribute to the development of new non–invasive, fast and relatively inexpensive diagnostic tools, with high sensitivity and specificity. It also represents a crucial step towards gaining further insights on the etiology of IBD through the analysis of specific molecules which are the expression of the particular metabolism that characterizes these patients.
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Affiliation(s)
- Lorenzo Monasta
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
- * E-mail:
| | - Chiara Pierobon
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Andrea Princivalle
- Occupational Medicine, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Stefano Martelossi
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Annalisa Marcuzzi
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Francesco Pasini
- Occupational Medicine, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Luigi Perbellini
- Occupational Medicine, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
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22
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Chiu K, Wright JL. Large and Small Airway Disease Related to Inflammatory Bowel Disease. Arch Pathol Lab Med 2017; 141:470-473. [PMID: 28234576 DOI: 10.5858/arpa.2016-0188-rs] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although airway disease associated with inflammatory bowel disease is uncommon, its involvement may have severe clinical consequences. This article reviews the breadth of pathologic processes that can be expected in the various sizes of airways, and provides a differential diagnosis from other airway diseases that can be found in association with inflammatory bowel disease. It also makes suggestions as to how airway disease can be best differentiated by using appropriate special stains.
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Affiliation(s)
| | - Joanne Lynne Wright
- From the Department of Pathology, St Paul's Hospital, Vancouver, British Columbia, Canada
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23
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Tulic MK, Piche T, Verhasselt V. Lung-gut cross-talk: evidence, mechanisms and implications for the mucosal inflammatory diseases. Clin Exp Allergy 2016; 46:519-28. [PMID: 26892389 DOI: 10.1111/cea.12723] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The mucosal immune system (including airway, intestinal, oral and cervical epithelium) is an integrated network of tissues, cells and effector molecules that protect the host from environmental insults and infections at mucous membrane surfaces. Dysregulation of immunity at mucosal surfaces is thought to be responsible for the alarming global increase in mucosal inflammatory diseases such as those affecting the gastrointestinal (Crohn's disease, ulcerative colitis and irritable bowel syndrome) and respiratory (asthma, allergy and chronic obstructive pulmonary disorder) system. Although immune regulation has been well-studied in isolated mucosal sites, the extent of the immune interaction between anatomically distant mucosal sites has been mostly circumstantial and the focus of much debate. With novel technology and more precise tools to examine histological and functional changes in tissues, today there is increased appreciation of the 'common mucosal immunological system' originally proposed by Bienenstock nearly 40 years ago. Evidence is amounting which shows that stimulation of one mucosal compartment can directly and significantly impact distant mucosal site, however the mechanisms are unknown. Today, we are only beginning to understand the complexity of relationships and communications that exist between different mucosal compartments. A holistic approach to studying the mucosal immune system as an integrated global organ is imperative for future advances in understanding mucosal immunology and for future treatment of chronic diseases. In this review, we particularly focus on the latest evidence and the mechanisms operational in driving the lung-gut cross-talk.
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Affiliation(s)
- M K Tulic
- Université de Nice Sophia-Antipolis, EA 6302 Tolérance Immunitaire, Nice, France.,The International Inflammation 'in-FLAME' Network, Worldwide Universities Network, Perth, WA, Australia
| | - T Piche
- Université de Nice Sophia-Antipolis, EA 6302 Tolérance Immunitaire, Nice, France.,Department of Gastroenterology and Nutrition, Hôpital de l'Archet 2, CHU de Nice, Nice, France
| | - V Verhasselt
- Université de Nice Sophia-Antipolis, EA 6302 Tolérance Immunitaire, Nice, France.,The International Inflammation 'in-FLAME' Network, Worldwide Universities Network, Perth, WA, Australia
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24
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Ooi CJ, Makharia GK, Hilmi I, Gibson PR, Fock KM, Ahuja V, Ling KL, Lim WC, Thia KT, Wei SC, Leung WK, Koh PK, Gearry RB, Goh KL, Ouyang Q, Sollano J, Manatsathit S, de Silva HJ, Rerknimitr R, Pisespongsa P, Abu Hassan MR, Sung J, Hibi T, Boey CCM, Moran N, Leong RWL. Asia-Pacific consensus statements on Crohn's disease. Part 2: Management. J Gastroenterol Hepatol 2016; 31:56-68. [PMID: 25819311 DOI: 10.1111/jgh.12958] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 02/05/2023]
Abstract
The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field.
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Affiliation(s)
- Choon Jin Ooi
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Ida Hilmi
- Division of Gastroenterology and Hepatology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Peter R Gibson
- Monash University Department of Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Kwong Ming Fock
- Department of Gastroenterology, Changi General Hospital, Singapore
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Khoon Lin Ling
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Wee Chian Lim
- Department of Gastroenterology, Tan Tock Seng Hospital, Singapore
| | - Kelvin T Thia
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Shu-chen Wei
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Poh Koon Koh
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Khean Lee Goh
- Division of Gastroenterology and Hepatology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Qin Ouyang
- Division of Gastroenterology, Department of Internal Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jose Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Sathaporn Manatsathit
- Department of Medicine, Division of Gastroenterology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - H Janaka de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Pises Pisespongsa
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Joseph Sung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | | | | | - Neil Moran
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
| | - Rupert W L Leong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
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Ji XQ, Ji YB, Wang SX, Zhang CQ, Lu DG. Alterations of pulmonary function in patients with inflammatory bowel diseases. Ann Thorac Med 2016; 11:249-253. [PMID: 27803750 PMCID: PMC5070433 DOI: 10.4103/1817-1737.191877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM The aim of this study was to investigate the alterations of pulmonary function tests (PFTs) and their relationship with disease activity in inflammatory bowel diseases (IBDs). METHODS Sixty-four IBD patients (31 Crohn's disease [CD] and 33 ulcerative colitis [UC]) and thirty healthy individuals (controls) were studied with regard to the following parameters of PFTs: Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), their ratio, mid-forced expiratory flow of 25-75% (FEF 25-75), residual volume, total lung capacity, and diffusing capacity of the lung for carbon monoxide (DLCO). The disease activity was calculated using the Crohn's Disease Activity Index for CD and Mayo Clinic Score for UC. Correlation analysis was performed between disease activity and sputum cytology and PFTs. RESULTS Nineteen of the 31 CD patients (61.29%) and 17 of the 33 UC patients (51.52%) but none of the controls showed at least one abnormal PFTs (P < 0.05). Compared with controls, both CD and UC patients exhibited a significant reduction in FEV1 (P < 0.05), FVC (P < 0.05), FEF 25-75 (P < 0.05), and DLCO (P < 0.05). The majority with decreased measurements of PFTs were in the active phase of diseases (P < 0.05). IBD activity scores correlated negatively with some parameters of PFTs and positively with lymphocytosis and eosinophilia of sputum (P < 0.05). CONCLUSIONS Pulmonary function disorders are significantly common in IBD patients. The impairment in active disease is significantly greater than in remission.
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Affiliation(s)
- Xiao-Qing Ji
- Division of Disinfectant and Supply, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China, India
| | - Yan-Bo Ji
- Class of 2014, School of Nursing, Shandong University, Jinan 250012, Shandong Province, China
| | - Shan-Xin Wang
- Department of Internal Medicine, The Third Chinese Traditional Hospital of Jinan, Jinan 250300, Shandong Province, China
| | - Cai-Qing Zhang
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - De-Gan Lu
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
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Hayek AJ, Pfanner TP, White HD. Inflammatory bowel disease of the lung: The role of infliximab? Respir Med Case Rep 2015; 15:85-8. [PMID: 26236612 PMCID: PMC4501542 DOI: 10.1016/j.rmcr.2015.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 12/17/2022] Open
Abstract
Pulmonary extra-intestinal manifestations (EIM) of inflammatory bowel disease are well described with a variable incidence. We present a case of Crohn's disease with pulmonary EIM including chronic bronchitis with non-resolving bilateral cavitary pulmonary nodules and mediastinal lymphadenopathy successfully treated with infliximab. Additionally, we present a case summary from a literature review on pulmonary EIM successfully treated with infliximab. Current treatment recommendations include an inhaled and/or systemic corticosteroid regimen which is largely based on case reports and expert opinion. We offer infliximab as an adjunctive therapy or alternative to corticosteroids for treatment of inflammatory bowel disease related pulmonary EIM.
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Affiliation(s)
- Adam J Hayek
- Department of Internal Medicine, Baylor Scott & White Health and Texas A&M HSC College of Medicine, USA
| | - Timothy P Pfanner
- Department of Internal Medicine, Division of Gastroenterology, Baylor Scott & White Health, USA
| | - Heath D White
- Department of Internal Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Baylor Scott & White Health, USA
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Lemberg DA, Day AS. Crohn disease and ulcerative colitis in children: an update for 2014. J Paediatr Child Health 2015; 51:266-70. [PMID: 25039307 DOI: 10.1111/jpc.12685] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 12/11/2022]
Abstract
Crohn disease (CD) and ulcerative colitis (UC), the two main types of inflammatory bowel disease (IBD), have become increasingly common in Australasian children and adolescents in recent years. Furthermore, CD and UC are seen more often in younger children. These conditions are typically more extensive in children and tend to follow more severe disease courses than in adults. Although many children may present with typical symptoms (such as abdominal pain or bloody diarrhoea), others have atypical features (including oral ulceration, short stature or skin manifestations). In addition, many children with IBD will have altered growth or nutrition, which may compromise normal linear growth and pubertal development. Early identification and full assessment of children presenting with possible IBD are essential to avoid consequences of diagnostic delay and to optimise short- and long-term outcomes. Management of IBD encompasses various options and should be undertaken within a team-based, child and family-focused, multidisciplinary setting.
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Affiliation(s)
- Daniel A Lemberg
- Department of Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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28
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Jung YS, Park DI, Ye BD, Cheon JH, Kim YS, Kim YH, Kim JS, Chae HS, Baik GH, Han DS. Long-term clinical outcomes of urban versus rural environment in Korean patients with Crohn's disease: results from the CONNECT study. J Crohns Colitis 2015; 9:246-51. [PMID: 25602024 DOI: 10.1093/ecco-jcc/jjv003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AIMS Environmental factors and genetic predisposition are thought to play important roles in the pathogenesis of Crohn's disease [CD]. Although numerous studies have reported the positive association between urban environment and CD development, few studies have compared the clinical outcomes between urban and rural environments. Therefore, this study aimed to compare the clinical characteristics and long-term prognosis between urban and rural populations of patients with CD. METHODS This retrospective multicenter cohort study included 1002 Korean patients diagnosed with CD [743 urban residents and 259 rural residents] between 1982 and 2008 from 32 medical centers. The clinical outcomes of urban versus rural populations were compared using the KaplanMeier method and log-rank test. RESULTS Disease distribution and behavior of the urban population did not differ from those of the rural population. There were no significant differences in the cumulative probabilities of perianal fistula [P = 0.086] and intestinal complications such as stricture [P = 0.109], fistula [P = 0.952], abscess [P = 0.227], and perforation [P = 0.382] between the two groups. In addition, no significant differences were observed between the two groups with regard to the cumulative probabilities of immunosuppressant use [P = 0.527] and biologic agent use [P = 0.731]. Although the cumulative probability of surgery in the urban population was significantly higher than that in the rural population [P = 0.040], this difference was mainly established within the first year from diagnosis [19.1% vs 13.5%, P = 0.042] and observed only among patients diagnosed in 2005-2008 [P = 0.033]. CONCLUSIONS There were no differences in terms of disease presentation and natural history between urban and rural populations, except for a higher rate of surgery in the urban population who were recently diagnosed with CD.
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Affiliation(s)
- Yoon Suk Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hiun Suk Chae
- Department of Internal Medicine, Uijeongbu St Mary's Hospital, College of Medicine, Catholic University of Korea, Uijeongbu, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, ChunCheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Korea
| | - Dong Soo Han
- Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea
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Abstract
BACKGROUND There is increasing recognition of Crohn's disease (CD) in non-white populations. However, reports of racial disparities in the phenotype of CD are still inconsistent. AIM : The aim of this study was to test the hypothesis that African American (AA) patients have higher incidence of severe fistulizing perianal Crohn's disease (FPD) compared with white patients. METHODS Cross-sectional analysis of 333 adult CD patients treated at The Mount Sinai Hospital with infliximab between May 2011 and December 2011 was conducted. Self-reported race/ethnicity was recorded and proportions of each group with FPD were compared across the population. RESULTS Among all 333 evaluable CD patients on infliximab, 73.6% were white, 11.4% AA, 13.2% Hispanic, and 1.8% Asian. Of these 333 patients, 88 had FPD: only 48 of these (54.5%) were white, whereas fully 18 (20.5%) were AA, 20 (22.7%) were Hispanic, and 2 (2.3%) were Asian. Thus, patients receiving infliximab for FPD were significantly more likely to be AA or Hispanic than white (AA vs. whites: risk ratio=2.63; 95% confidence interval, 1.74-3.96; P=<0.0001; Hispanics vs. whites: risk ratio=2.32; 95% confidence interval, 1.54-3.50; P=0.0001). There was no statistically significant difference between AA and Hispanics. CONCLUSION CD patients at our medical center with FPD requiring infliximab therapy were significantly more likely to be AA or Hispanic.
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Hiyoshi M, Kawai K, Shibuya M, Ozawa T, Kishikawa J, Nirei T, Tanaka T, Tanaka J, Kiyomatsu T, Tada T, Kanazawa T, Kazama S, Shoda H, Sumitomo S, Kubo K, Yamaguchi H, Ishihara S, Sunami E, Kitayama J, Yamamoto K, Watanabe T. Tracheobronchitis with dyspnea in a patient with ulcerative colitis. Intern Med 2015; 54:749-53. [PMID: 25832936 DOI: 10.2169/internalmedicine.54.3142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 42-year-old man with a one-year history of ulcerative colitis who presented with exacerbated bloody diarrhea, a productive cough and increasing breathing difficulties. Colonoscopy revealed typical deep ulcers in the rectosigmoid colon and atypical multiple sucker-like ulcers in the transverse colon, and computed tomography of the chest demonstrated wall thickening of the trachea and bronchi. In addition, bronchoscopy showed ulcers in the trachea, and histopathology disclosed findings of necrosis and inflammation of the subepithelial tissue of the trachea. Based on these findings, the patient's respiratory symptoms were strongly suspected to be due to ulcerative colitis-related tracheobronchitis. Treatment with systemic corticosteroids subsequently resulted in a rapid clinical improvement.
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Affiliation(s)
- Masaya Hiyoshi
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital; 2.Department of Surgical Oncology, Faculty of Medical Sciences, the University of Tokyo, Japan
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Ji XQ, Wang LX, Lu DG. Pulmonary manifestations of inflammatory bowel disease. World J Gastroenterol 2014; 20:13501-13511. [PMID: 25309080 PMCID: PMC4188901 DOI: 10.3748/wjg.v20.i37.13501] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/04/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Extraintestinal manifestations of inflammatory bowel disease (IBD) are a systemic illness that may affect up to half of all patients. Among the extraintestinal manifestations of IBD, those involving the lungs are relatively rare and often overlooked. However, there is a wide array of such manifestations, spanning from airway disease to lung parenchymal disease, thromboembolic disease, pleural disease, enteric-pulmonary fistulas, pulmonary function test abnormalities, and adverse drug reactions. The spectrum of IBD manifestations in the chest is broad, and the manifestations may mimic other diseases. Although infrequent, physicians dealing with IBD must be aware of these conditions, which are sometimes life-threatening, to avoid further health impairment of the patients and to alleviate their symptoms by prompt recognition and treatment. Knowledge of these manifestations in conjunction with pertinent clinical data is essential for establishing the correct diagnosis and treatment. The treatment of IBD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management. Corticosteroids, both systemic and aerosolized, are the mainstay therapeutic approach, while antibiotics must also be administered in the case of infectious and suppurative processes, whose sequelae sometimes require surgical intervention.
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Basson A, Swart R, Jordaan E, Mazinu M, Watermeyer G. The association between race and Crohn's disease phenotype in the Western Cape population of South Africa, defined by the Montreal Classification System. PLoS One 2014; 9:e104859. [PMID: 25118187 PMCID: PMC4130615 DOI: 10.1371/journal.pone.0104859] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/18/2014] [Indexed: 12/13/2022] Open
Abstract
Background Inter-racial differences in disease characteristics and in the management of Crohn's disease (CD) have been described in African American and Asian subjects, however for the racial groups in South Africa, no such recent literature exists. Methods A cross sectional study of all consecutive CD patients seen at 2 large inflammatory bowel disease (IBD) referral centers in the Western Cape, South Africa between September 2011 and January 2013 was performed. Numerous demographic and clinical variables at diagnosis and date of study enrolment were identified using an investigator administered questionnaire as well as clinical examination and patient case notes. Using predefined definitions, disease behavior was stratified as ‘complicated’ or ‘uncomplicated’. Results One hundred and ninety four CD subjects were identified; 35 (18%) were white, 152 (78%) were Cape Coloured and 7(4%) were black. On multiple logistic regression analysis Cape Coloureds were significantly more likely to develop ‘complicated’ CD (60% vs. 9%, p = 0.023) during the disease course when compared to white subjects. In addition, significantly more white subjects had successfully discontinued cigarette smoking at study enrolment (31% vs. 7% reduction, p = 0.02). No additional inter-racial differences were found. A low proportion of IBD family history was observed among the non-white subjects. Conclusions Cape Coloured patients were significantly more likely to develop ‘complicated’ CD over time when compared to whites.
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Affiliation(s)
- Abigail Basson
- Dietetics Department, University of the Western Cape, Bellville, Western Cape, South Africa
- * E-mail:
| | - Rina Swart
- Dietetics Department, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Esme Jordaan
- Biostatistics Unit, Medical Research Council of South Africa, Parow, Western Cape, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Mikateko Mazinu
- Biostatistics Unit, Medical Research Council of South Africa, Parow, Western Cape, South Africa
| | - Gillian Watermeyer
- Department of Gastroenterology, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
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Abstract
Ulcerative colitis is a chronic inflammatory disease of the large intestine that often develops in the young. A few new treatment options have become available in the past decade, but management of a large proportion of patients still remains challenging because of side effects, unresponsiveness and cost. A novel strategy targeting trafficking of immune cells to the sites of inflammation involves reducing expression or binding of adhesion molecules to integrins. Natalizumab was the first therapeutic antibody blocking infiltration of leukocytes, but because of lack of selectivity to the gut and associated risk of progressive multifocal leukoencephalopathy, it will probably never be tested in ulcerative colitis. In this article we discuss molecules that block leukocyte trafficking to inflamed bowel that have been tested in ulcerative colitis. Because of favourable efficacy and safety data, we will review the development, pharmacology and clinical data of vedolizumab, a gut-selective α4β7 antibody, in depth.
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Affiliation(s)
- Svend T Rietdijk
- Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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34
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Lu DG, Ji XQ, Liu X, Li HJ, Zhang CQ. Pulmonary manifestations of Crohn’s disease. World J Gastroenterol 2014; 20:133-141. [PMID: 24415866 PMCID: PMC3886002 DOI: 10.3748/wjg.v20.i1.133] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/09/2013] [Accepted: 12/06/2013] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease (CD) is a systemic illness with a constellation of extraintestinal manifestations affecting various organs. Of these extraintestinal manifestations of CD, those involving the lung are relatively rare. However, there is a wide array of lung manifestations, ranging from subclinical alterations, airway diseases and lung parenchymal diseases to pleural diseases and drug-related diseases. The most frequent manifestation is bronchial inflammation and suppuration with or without bronchiectasis. Bronchoalveolar lavage findings show an increased percentage of neutrophils. Drug-related pulmonary abnormalities include disorders which are directly induced by sulfasalazine, mesalamine and methotrexate, and opportunistic lung infections due to immunosuppressive treatment. In most patients, the development of pulmonary disease parallels that of intestinal disease activity. Although infrequent, clinicians dealing with CD must be aware of these, sometimes life-threatening, conditions to avoid further impairment of health status and to alleviate patient symptoms by prompt recognition and treatment. The treatment of CD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management.
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Abstract
Increasing numbers of adolescents are being diagnosed with Crohn's disease or ulcerative colitis, the two main subtypes of inflammatory bowel disease. These young people face many short- and long-term challenges; one or more medical therapies may be required indefinitely; their disease may have great impact, in terms of their schooling and social activities. However, the management of adolescents with one of these incurable conditions needs to encompass more than just medical therapies. Growth, pubertal development, schooling, transition, adherence, and psychological well-being are all important aspects. A multidisciplinary team setting, catering to these components of care, is required to ensure optimal outcomes in adolescents with inflammatory bowel disease.
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Affiliation(s)
- J Bishop
- Paediatric Gastroenterology, Starship Children’s Hospital, Auckland, New Zealand
| | - DA Lemberg
- Department of Gastroenterology, Sydney Children’s Hospital, Sydney, Australia
| | - AS Day
- Department of Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand
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36
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Day AS, Burgess L. Exclusive enteral nutrition and induction of remission of active Crohn's disease in children. Expert Rev Clin Immunol 2013; 9:375-83; quiz 384. [PMID: 23557272 DOI: 10.1586/eci.13.12] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Exclusive enteral nutrition is an effective therapy for the management of active Crohn's disease, especially in children and adolescents. This therapeutic approach involves the use of a liquid nutritional product with the exclusion of normal diet for a period of many weeks. Although recent studies have helped to delineate some aspects of how exclusive enteral nutrition should be used, there remain many gaps in our understanding. In addition, several recent reports have provided intriguing insights into the mechanisms of this nutritional approach.
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Affiliation(s)
- Andrew S Day
- Department of Paediatrics, University of Otago (Christchurch), Christchurch Hospital, Christchurch, New Zealand.
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37
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Day AS. A review of the use of complementary and alternative medicines by children with inflammatory bowel disease. Front Pediatr 2013; 1:9. [PMID: 24400255 PMCID: PMC3860894 DOI: 10.3389/fped.2013.00009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 04/18/2013] [Indexed: 01/23/2023] Open
Abstract
The Inflammatory Bowel Diseases (IBDs) are diagnosed more commonly in children and adolescents. Following diagnosis, the key objectives are to achieve and then maintain remission. Although some therapies are able to effectively modify and modulate inflammatory events, none of the available interventions cure these conditions. Consequently, children and their parents face uncertainty and may look to alternative management options as ways to help their child, which may include various complementary and alternative medicines (CAMs). A number of studies have shown that many children with IBD receive or are given CAM agents. This article reviews the rates and patterns of CAM use in children with IBD, and emphasizes the increasing importance of these aspects of the management of children with IBD.
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Affiliation(s)
- Andrew S Day
- Department of Paediatrics, University of Otago Christchurch Christchurch, New Zealand
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38
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Vadlamudi NB, Navaneethan U, Thame KA, Kelly DR, Dimmitt RA, Harris WT. Crohn's disease with pulmonary manifestations in children: 2 case reports and review of the literature. J Crohns Colitis 2013; 7:e85-92. [PMID: 22704660 DOI: 10.1016/j.crohns.2012.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/07/2012] [Accepted: 05/08/2012] [Indexed: 02/07/2023]
Abstract
Crohn's disease (CD) is a chronic granulomatous disease of unknown etiology that affects primarily the gastrointestinal system but can be associated with extraintestinal manifestations. Latent pulmonary involvement in children with CD has been described, but symptomatic pulmonary disease has rarely been reported in children. In this review, we report two pediatric cases, one with pleural effusion at the time of CD diagnosis and the other with bilateral cavitary lesions in a previously diagnosed CD patient. We review the current literature and summarize the diagnosis and management of pulmonary involvement in CD. Awareness of these pulmonary complications of CD in children may lead to more prompt diagnosis, guide appropriate therapy, and decrease morbidity.
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Affiliation(s)
- Narendra B Vadlamudi
- Division of Pediatric Gastroenterology and Nutrition, Children's of Alabama, Birmingham, AL 35233, USA.
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Day AS, Ledder O, Leach ST, Lemberg DA. Crohn's and colitis in children and adolescents. World J Gastroenterol 2012; 18:5862-9. [PMID: 23139601 PMCID: PMC3491592 DOI: 10.3748/wjg.v18.i41.5862] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/02/2012] [Accepted: 07/09/2012] [Indexed: 02/06/2023] Open
Abstract
Crohn's disease and ulcerative colitis can be grouped as the inflammatory bowel diseases (IBD). These conditions have become increasingly common in recent years, including in children and young people. Although much is known about aspects of the pathogenesis of these diseases, the precise aetiology is not yet understood, and there remains no cure. Recent data has illustrated the importance of a number of genes-several of these are important in the onset of IBD in early life, including in infancy. Pain, diarrhoea and weight loss are typical symptoms of paediatric Crohn's disease whereas bloody diarrhoea is more typical of colitis in children. However, atypical symptoms may occur in both conditions: these include isolated impairment of linear growth or presentation with extra-intestinal manifestations such as erythema nodosum. Growth and nutrition are commonly compromised at diagnosis in both Crohn's disease and colitis. Consideration of possible IBD and completion of appropriate investigations are essential to ensure prompt diagnosis, thereby avoiding the consequences of diagnostic delay. Patterns of disease including location and progression of IBD in childhood differ substantially from adult-onset disease. Various treatment options are available for children and adolescents with IBD. Exclusive enteral nutrition plays a central role in the induction of remission of active Crohn's disease. Medical and surgical therapies need to considered within the context of a growing and developing child. The overall management of these chronic conditions in children should include multi-disciplinary expertise, with focus upon maintaining control of gut inflammation, optimising nutrition, growth and quality of life, whilst preventing disease or treatment-related complications.
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Lu DG, Ji XQ, Zhao Q, Zhang CQ, Li ZF. Tracheobronchial nodules and pulmonary infiltrates in a patient with Crohn's disease. World J Gastroenterol 2012; 18:5653-7. [PMID: 23112563 PMCID: PMC3482657 DOI: 10.3748/wjg.v18.i39.5653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 07/26/2012] [Accepted: 07/29/2012] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease is a granulomatous systemic disorder of unknown etiology. Obvious pulmonary involvement is exceptional. Tracheal involvement in Crohn’s disease is even more unusual, only a few cases have been reported to date. We herein report a rare case of tracheobronchial nodules and pulmonary infiltrates in both lungs as a complication of Crohn’s disease. A 42-year-old man underwent pancolectomy for multiple broken colon caused by Crohn’s disease. Forty days later pulmonary symptoms and radiologic abnormalities were noted. A search for bacterial (including mycobacteria) and fungal in the repeated sputum proved negative. The treatment consisted of intravenous antimicrobials for one month, but there was no improvement in pyrexia or cough and radiologic abnormalities. Fibreoptic bronchoscopy (FOB) was performed and revealed nodes in the trachea and the right upper lobe opening. Histopathology of tracheobronchial nodules and bronchial mucosa biopsy specimen both showed granulomatous inflammation with proliferation of capillaries and inflammatory cells. Oral steroid and salicylazosulfapyridine were commenced and led to marked improvement in symptoms and an almost complete resolution of his chest radiograph. Repeated FOB showed that nodes in the trachea disappeared and the ones in the right upper lobe opening diminished obviously. Crohn’s disease can be associated with several respiratory manifestations. The form of tracheal and bronchopulmonary involvement in Crohn’s disease is rare and responded well to steroids.
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Sonnenberg A, Walker JT. Occupational mortality associated with inflammatory bowel disease in the United States 1984-1998. Inflamm Bowel Dis 2012; 18:1249-53. [PMID: 21710539 DOI: 10.1002/ibd.21807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 05/26/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND The occurrence of Crohn's disease (CD) and ulcerative colitis (UC) is shaped by environmental influences. Many such environmental risk factors vary potentially with occupational exposure. We used a large national database to study the occupational variation of mortality associated with CD and UC. METHODS The National Occupational Mortality Surveillance database contains data from the death certificate linked with information about the occupation and industry of each deceased individual. Deaths were grouped by gender, ethnicity, disease type, occupation, and industry. Mortality by occupation and industry were expressed as age-adjusted proportional mortality ratio. RESULTS A total of 3110 inflammatory bowel disease (IBD) patients were included in the present analysis. IBD mortality was low among blue collar workers and high among white collar workers. It was low among farming occupations, manufacturing occupations, and manual laborers. It was high among secretaries, professionals, sales workers, homemakers, managerial occupations, and teachers. There was a strong correlation between the occupational distribution of CD and UC that applied to men and women alike. The overall distribution among different industries corroborated the patterns observed with respect to the occupational distribution. CONCLUSIONS The correlations between the occupational distribution of CD and UC support the contention that environmental influences shape the occurrence of both diseases. Such influence must vary by occupation and, to a lesser extent, also by industry. It must be similar for both types of IBD.
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Affiliation(s)
- Amnon Sonnenberg
- Department of Veterans Affairs Medical Center, Portland, Oregon, USA.
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Pain-Prado E, Rais A, Madhi F, Orzechowski C, Dubern B, Epaud R. Pulmonary and hepatic nodular lesions precede the diagnosis of Crohn's disease in an 8-year-old girl: a case study and review of the literature. Acta Paediatr 2012; 101:e86-9. [PMID: 22040226 DOI: 10.1111/j.1651-2227.2011.02505.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To describe a novel clinical observation and to provide a review the literature about lung involvement in children with Crohn disease (CD). METHODS An 8-year-old girl presented with pulmonary and hepatic granulomatous lesions, followed 6 months later by abdominal and general symptoms, resulting in the diagnosis of CD. Differential diagnosis between CD and sarcoidosis and a review of the literature about lung lesions in children with CD are discussed. RESULTS Crohn disease can be associated with pulmonary lesions, developing before, at the same time or after occurrence of digestive symptoms. CONCLUSIONS This report highlights not only the importance of looking for lung lesions in CD but also underscores the necessity of considering the diagnosis of CD in incomplete presentation evoking sarcoidosis.
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Affiliation(s)
- Eloïse Pain-Prado
- Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie, France
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M'Koma AE, Moses HL, Adunyah SE. Inflammatory bowel disease-associated colorectal cancer: proctocolectomy and mucosectomy do not necessarily eliminate pouch-related cancer incidences. Int J Colorectal Dis 2011; 26:533-52. [PMID: 21311893 PMCID: PMC4154144 DOI: 10.1007/s00384-011-1137-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colorectal cancer (CRC), the most lethal long-term complication of inflammatory bowel disease (IBD), is the culmination of a complex sequence of molecular and histologic derangements of the colon epithelium that are initiated and at least partially sustained by prolonged chronic inflammation. Dysplasia, the earliest histologic manifestation of this process, plays an important role in cancer prevention by providing the first clinical alert that this sequence is under way and by serving as an endpoint in colonoscopic surveillance of patients at high risk for CRC. Restorative proctocolectomy (RPC) is indicated for patients with IBD, specifically for ulcerative colitis that is refractory to medical treatment, emergency conditions, and/or in case of neoplastic transformation. Even after RPC with mucosectomy, pouch-related carcinomas have recently been reported with increasing frequency since the first report in 1984. We review IBD-associated CRC and pouch-related neoplasia prevalence, adverse events, risk factors, and surveillances. METHODS Literature of IBD-associated CRC patients and those undergoing RPC surgeries through 2010 were prospectively reviewed. RESULTS We found 12 studies from retrospective series and 15 case reports. To date, there are 43 reported cases of pouch-related cancers. Thirty-two patients had cancer in the anal transit zone (ATZ); of these, 28 patients had mucosectomy. Eleven patients had cancer found in the pouch body. CONCLUSION RPC with mucosectomy does not necessarily eliminate risks. There is little evidence to support routine surveillance of pouch mucosa and the ATZ except for patients associated with histological type C changes, sclerosing cholangitis, and unremitting pouchitis.
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Affiliation(s)
- Amosy E M'Koma
- Department of Biochemistry and Cancer Biology, Meharry Medical College School of Medicine, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208-3599, USA.
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D'Andrea N, Triolo L, Margagnoni G, Aratari A, Sanguinetti CM. Methotrexate-induced pneumonitis in Crohn's disease. Case report and review of the literature. Multidiscip Respir Med 2010; 5:312-9. [PMID: 22958737 PMCID: PMC3463052 DOI: 10.1186/2049-6958-5-5-312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 07/30/2010] [Indexed: 12/30/2022] Open
Abstract
Methotrexate (MTX) is a folate-antagonist used in several neoplastic and inflammatory diseases. Reports of pulmonary complications in patients given low-dose MTX therapy are increasing. Pulmonary toxicity from MTX has a variable frequency and can present with different forms. Most often MTX-induced pneumonia in patients affected by rheumatoid arthritis (RA) is reported.In this paper we describe a case of MTX-related pneumonitis in a relatively young woman affected by Crohn's disease who presented non-productive cough, fever and dyspnea on exercise. Chest X-ray demonstrated bilateral interstitial infiltrates and at computed tomography (CT) ground-glass opacities appeared in both lungs. At spirometry an obstructive defect was demonstrated. A rapid improvement of symptoms and the regression of radiographic and spirometric alterations was achieved through MTX withdrawal and the introduction of corticosteroid therapy.
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Affiliation(s)
- Nadia D'Andrea
- Pneumology Unit, San Filippo Neri General Hospital, Rome, Italy.
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Arai R. Serologic markers: impact on early diagnosis and disease stratification in inflammatory bowel disease. Postgrad Med 2010; 122:177-85. [PMID: 20675980 DOI: 10.3810/pgm.2010.07.2184] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is difficult to diagnose, and differentiating between ulcerative colitis (UC) and Crohn's disease (CD) can be challenging. Overlapping symptoms of UC and CD often delay diagnosis, despite availability of endoscopic, radiologic, and histologic tools. This delay in diagnosis is quite common in clinical practice, which may also delay initiation of appropriate treatment. Abnormal immune responses found in IBD have led to the use of serum biomarkers (eg, anti-Saccharomyces cerevisiae antibody [ASCA], perinuclear antineutrophil cytoplasmic antibody [pANCA], antibodies to flagellin [anti-CBir1]) to improve diagnostic confidence in IBD. These biomarkers are beginning to be used to stratify patients with UC and CD according to disease phenotype and risk of complications. Associations between quantity and quality of immune reactivity and severe disease phenotypes are increasingly evident. This suggests that serologic panels of multiple IBD biomarkers can be used to identify the relative risk of progression to complicated disease behaviors, and that this information may ultimately impact therapeutic decisions. This review discusses the diagnostic process and challenges in IBD, with emphasis on the role that serologic markers may play in addressing these challenges.
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Affiliation(s)
- Ronen Arai
- Digestive Care of North Broward, Coral Springs, FL 33065, USA.
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Roblin E, Pecciarini N, Yantren H, Dubois R, Hameury F, Bellon G, Bouvier R, Lachaux A. [Granulomatous pulmonary involvement preceding diagnosis of Crohn disease: a pediatric case report]. Arch Pediatr 2010; 17:1308-12. [PMID: 20709507 DOI: 10.1016/j.arcped.2010.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 12/06/2009] [Accepted: 06/15/2010] [Indexed: 12/11/2022]
Abstract
Crohn disease (CD) is a chronic bowel disorder that may affect many other organs such as the eyes, hepatobiliary system, skin, and joints. Pulmonary involvement in association with CD is a classic but uncommon manifestation. It can be primitive with granulomas or secondary to treatments. We report on the case of a teenager in whom the onset of CD was dominated by respiratory symptoms. Because of this presentation, we also suspected opportunistic infections such as tuberculosis and other granulomatous pulmonary diseases such as sarcoidosis or hypersensitivity pneumonitis.
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Affiliation(s)
- E Roblin
- Service d'hépatologie, gastroentérologie et nutrition pédiatrique, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France.
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47
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Respiratory involvement in inflammatory bowel diseases. Multidiscip Respir Med 2010; 5:173-82. [PMID: 22958334 PMCID: PMC3463044 DOI: 10.1186/2049-6958-5-3-173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 04/15/2010] [Indexed: 12/21/2022] Open
Abstract
Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD) and are due to a dysregulation of the antimicrobial defense normally provided by the intestinal mucosa. This inflammatory process may extend outside the bowel to many organs and also to the respiratory tract. The respiratory involvement in IBD may be completely asymptomatic and detected only at lung function assessment, or it may present as bronchial disease or lung parenchymal alterations. Corticosteroids, both systemic and aerosolized, are the mainstay of the therapeutical approach, while antibiotics must be also administered in the case of infectious and suppurative processes, whose sequels sometimes require surgical intervention. The relatively high incidence of bronchopulmonary complications in IBD suggests the need for a careful investigation of these patients in order to detect a possible respiratory involvement, even when they are asymptomatic.
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Teles Martins C, Rosal Gonçalves J. [Boundaries of the lung - Relationship to the gastrointestinal system]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010; 16:133-48. [PMID: 20054513 DOI: 10.1016/s0873-2159(15)30011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The relation between the respiratory and gastrointestinal systems has been long recognized and depends on various anatomical, physiological and pathological mechanisms. The certain recognition of some interactions, such as the relation between asthma and gastroesophageal reflux, is more or less intuitive to the pulmonogist, whereas other areas of confluence are more easily missed, such as the relation between airway disorders and inflammatory bowel disease. The purpose of this article is to review the interaction between the lung and the gastrointestinal systems, as far as anatomy, physiology, pathology, clinical manifestations and therapeutical options go.
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Kim MH, Ki HS, Cho DK, Yoon KW, Park SY, Kim HS, Choi SG, Rew JS. Clinical Features in Patients with Ulcerative Colitis. Chonnam Med J 2010. [DOI: 10.4068/cmj.2010.46.3.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Min-Hyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Seok Ki
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Keun Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Won Yoon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Gyu Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Sun Rew
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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50
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Lee HJ, Park BH, Son JY, Jung JY, Hwang S, Chon YE, Kim EY, Lim JE, Lee KJ, Yoon YW, Kim YS, Kim SK, Chang J, Shim HS, Cho SH, Park MS. A Case of Bronchilolitis Obliterans Organizing Pneumonia in a Patient with Ulcerative Colitis. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.68.3.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyun Jung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Hoon Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Young Son
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ye Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sena Hwang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Eun Chon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Eun Lim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Jong Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoe Wun Yoon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Se Kyu Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Chang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Sub Shim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Ho Cho
- Department of Pathology, Bundang CHA Hospital, CHA University College of Medicine, Seongnam, Korea
| | - Moo Suk Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
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