RESUMO
Crohn disease treatment is a considerable challenge for a medical doctor. Gaining clinical remission is not enough. The important factor taken into account in treatment is gaining clinical remission and complete mucosal healing. Treatment useful in mucosal healing consists of immunosupresants as azathioprine, 6-markaptopurin, methotrexate and biological treatment. Important factors influencing mucosal healing is choice of medical treatment and its proper timing. More aggressive treatment in top-down scheme appears to be more successful in this aspekt than classical treatment with use of steroids. This data requires verification with more clinical trials.
Assuntos
Doença de Crohn/tratamento farmacológico , Doença de Crohn/fisiopatologia , Mucosa Intestinal/fisiopatologia , Regeneração , Humanos , Imunossupressores/uso terapêutico , Regeneração/efeitos dos fármacos , Indução de Remissão , Resultado do TratamentoRESUMO
We herein report a 44-year-old man suffering from systemic edema due to protein-losing enteropathy (PLE) with superior mesenteric vein (SMV) obstruction and development of collateral veins, which subsequently proved to be a chronic result of thrombosis and a complication of Crohn's disease (CD). PLE was supposedly induced by both intestinal erosion and thrombosis-related lymphangiectasia, which was histologically proven in his surgically-resected ileal stenosis. Elemental diet and anti-TNFα agent improved his hypoalbuminemia after surgery. The rarity of the simultaneous coexistence of SMV obstruction and PLE and the precedence of these complications over typical abdominal symptoms of CD made the clinical course complex.
Assuntos
Doença de Crohn/complicações , Doença de Crohn/fisiopatologia , Veias Mesentéricas/fisiopatologia , Enteropatias Perdedoras de Proteínas/etiologia , Enteropatias Perdedoras de Proteínas/fisiopatologia , Trombose Venosa/fisiopatologia , Adulto , Doença de Crohn/terapia , Humanos , Masculino , Enteropatias Perdedoras de Proteínas/terapia , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/etiologia , Trombose Venosa/terapiaRESUMO
Many children with inflammatory bowel disease, mainly Crohn's disease, suffer from malnutrition and growth retardation. Maintenance of adequate nutrition is extremely important in the management of pediatric patients with Crohn's disease. This can usually be achieved by exclusive elemental formulae and polymeric formulae and rarely necessitates the use of parenteral nutrition. This review presents an update on the nutritional aspects of inflammatory bowel disease in children.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Doença de Crohn/fisiopatologia , Doenças Inflamatórias Intestinais/fisiopatologia , Criança , Humanos , Desnutrição/prevenção & controleRESUMO
Growth retardation, delayed puberty, decreased bone mass, altered bone architecture, hypovitaminosis D and skeletal muscle mass deficits are common in children with inflammatory bowel diseases. The Crohn's and Colitis Foundation of America sponsored a multidisciplinary workshop on the subject of Bone and Skeletal Growth in Pediatric IBD, held in New York City in November 2011. The topic of the workshop was a key recommendation of the Foundation's Pediatric Challenges meeting in 2005. The Litwin Foundation provided a generous grant to support this crucial research and workshop through the CCFA. The workshop featured 15 presentations by researchers from the United States, Canada, Switzerland, Germany, and the United Kingdom and a number of posters elucidating diverse aspects of the problem of growth retardation and compromised bone health in pediatric Crohn's disease and ulcerative colitis. The workshop comprised original, basic, and clinical research and relevant reviews of underlying genetics, molecular biology, endocrinology, immunology, and bone physiology research. Investigators funded by CCFA and the Litwin Family Foundation are marked by an asterisk after their name in the text. Workshop presentations fell under 3 broad categories: "Mechanisms of Suppression and Growth of Bone Cell Function by Inflammation," "Impact of IBD on Growth and Bone Health," and "Approaches to Address Growth Failure and Low Bone Mass in Children with IBD," summarized herein. We have cited the publications that resulted from this granting mechanism in the appropriate section and references for pertinent updates on each topic.
Assuntos
Doenças do Desenvolvimento Ósseo/prevenção & controle , Colite Ulcerativa/fisiopatologia , Doença de Crohn/fisiopatologia , Transtornos do Crescimento/prevenção & controle , Doenças Musculares/prevenção & controle , Criança , Humanos , Relatório de PesquisaRESUMO
Clinical remission has been the therapeutic goal of Crohn's disease treatment for many years. While it has helped to ameliorate the symptoms, this treatment strategy has not brought about significant changes in the need for abdominal surgery in the natural history of Crohn's disease. The advent of biological agents (biologics) has shown that it is possible to induce and maintain mucosal healing in a significant proportion of treated patients. Data is also emerging to show that this has translated to fewer instances of hospitalisation and surgery for these patients. This is a paradigm shift in the therapeutic goal of Crohn's disease treatment.
Assuntos
Doença de Crohn/fisiopatologia , Doença de Crohn/terapia , Mucosa Intestinal/fisiopatologia , Produtos Biológicos/uso terapêutico , Diagnóstico por Imagem , Endoscopia , Hospitalização , Humanos , Inflamação , Mucosa Intestinal/patologia , Indução de Remissão , Resultado do Tratamento , Úlcera/complicaçõesRESUMO
The clinical management of Crohn's disease (CD) has evolved in recent years from symptom control to healing of mucosal lesions. Mucosal healing, induced and maintained by immunomodulators and/or biologicals, has been shown to alter the disease course in patients with CD. As a consequence, long-term disease outcomes have been dramatically improved, in particular since the introduction of anti-tumor necrosis factor (TNF) agents. CD patients with active inflammation (ileocolonic ulcers and/or increased C-reactive protein levels) benefit most from treatment with TNF antagonists. Since healing of the inflamed mucosa is now considered an important treatment goal, endoscopic monitoring is gradually entering routine practice. Therefore, the mucosal appearance will more and more influence the therapeutic decision making process. Mucosal healing has also become an end-point in therapeutic trials. We will summarize some of the fundamental issues regarding mucosal healing and discuss data to support its clinical relevance in the management of CD.
Assuntos
Doença de Crohn/fisiopatologia , Mucosa Intestinal/fisiopatologia , Humanos , Monitorização Fisiológica , Resultado do TratamentoRESUMO
Desmoids are rare tumors resulting from the proliferation of fibroblasts. They occur in association with familial adenomatous polyposis (FAP), but they may also occur in the post-traumatic peri-partum or post-abdominal surgery setting, and a few present spontaneously. Presenting features of desmoids are protean and largely relate to the anatomical area of involvement. We describe a 50 year old male not known to have Crohn's disease and without FAP who presented with multiple desmoids. Investigation of post-operative diarrhea confirmed a diagnosis of Crohn's disease. This is the first report of a male patient, who had never undergone prior abdominal surgery, presenting with Crohn's disease and abdominal desmoid tumors. The reasons why Crohn's disease and desmoids may be associated are explored, focusing particularly on alternations in the fibrogenic cytokine TGF-ß now known to be involved in the pathogenesis of both diseases.
Assuntos
Doença de Crohn/complicações , Doença de Crohn/fisiopatologia , Fibromatose Abdominal/etiologia , Fibromatose Abdominal/fisiopatologia , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Fibromatose Abdominal/diagnóstico , Fibromatose Abdominal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Fator de Crescimento Transformador beta/metabolismo , Resultado do TratamentoRESUMO
OBJECTIVE: This meta-analysis of randomized controlled trials was conducted to evaluate the efficacy and tolerability of two drug groups (immunoregulators and antibiotics) in the treatment of fistula in Crohn's disease (CD). METHODS: PubMed, Embase, Scopus, Google Scholar, and Web of Science were searched for clinical trial studies investigated the effects of immunoregulators and antibiotics in the treatment of fistulizing CD. Clinical response and adverse effects were the key outcomes of interest. Data were searched from the time period of 1966 through June 2010. RESULT: Eleven randomized placebo-controlled clinical trials that met our criteria (nine in different immunoregulators and two in antibiotics) were included in the analysis. Pooling of data showed that immunoregulators and antibiotics are significantly effective for at least a 50% reduction from baseline in the number of open actively draining fistulas with relative risk (RR) of 2.57 (95% CI of 1.55-4.25, P=0.0003) in four trials and 2.05 (95% CI of 1.03-4.08, P= 0.0414) in two trials respectively. The summary of RR for complete closure of fistulas in nine trials was 2.65 with a 95% CI of 1.66-4.22 and a significant RR (P < 0.0001). In regard to the tolerability, both immunoregulators and antibiotics showed insignificant adverse effects in comparison to placebo with an RR of 1.11 (95% CI of 0.96-1.27, P= 0.1513) and 0.6 (95% CI of 0.36-1, P= 0.0515), respectively and discontinuation because of these adverse effects in drug-treated groups was the same as placebo. Data about severe adverse effects were only available for immunoregulators that showed a significantly higher incidence when compared to placebo (RR= 2.24 with a 95% CI of 1.05-4.79; significant at P= 0.0374). CONCLUSION: This meta-analysis demonstrates the efficacy of immunoregulators and antibiotics in fistulizing CD. Regarding the safety, mild to moderate adverse effects were the same in both antibiotic and immunoregulators groups in comparison to the placebo but incidence of severe adverse effects in immunoregulator groups was higher than that of antibiotics.