[Percutaneous drainage of a presacral and spinal extra-dural abscess complicating Crohn's disease]. / Drainage percutané d'un abcès présacré et rachidien extra-dural compliquant une maladie de Crohn.

A 43-year-old man with Crohn's disease was hospitalized because of bilateral radicular pain secondary to a presacral abscess penetrating into the extra-dural space from L5 to S3. Conservative treatment using computed tomography guided percutaneous drainage of the abscess and parenteral antibiotherapy allowed complete recovery.

[What is the prognosis in unclassified colitis? Results of a cohort study of 104 patients in the Northern-Pas-de-Calais region]. / Que deviennent les colites aiguës inclassées? Résultats d'une étude de cohorte de 104 malades dans la région Nord-Pas-de-Calais. Registre des Maladies Inflammatoires du Tube Digestif du Nord-Quest de la France.

Acute unclassified colitis could be the first attack of inflammatory bowel disease, particularly chronic ulcerative colitis or acute non specific colitis regarded as being of infectious origin without recurrence. The aim of this work was to determine the outcome of 104 incidental cases of acute unclassified colitis diagnosed during the year 1988 at a census point made 2.5 to 3 years later and to search for demographic and clinical discriminating data for final diagnosis. Thirteen patients (12.5%) were lost to follow up. Another final diagnosis was made in three other patients: two had salmonellosis and one diverticulosis. Of the remaining 88 patients, 46 (52.3%) relapsed and were subsequently classified as inflammatory bowel disease: 54% ulcerative colitis, 33% Crohn's disease and 13% chronic unclassified colitis. Forty-two (47.7%) did not relapse and were considered to have acute non specific colitis. The mean age at onset was significantly lower in patients with inflammatory bowel disease (32.3 years) than in patients with acute non specific colitis (42.6 years) (P < 0.001). No clinical data (diarrhea, abdominal pain, bloody stool, mucus discharge fever, weight loss) was predictive of the final diagnosis. In this series, 52.3% of patients initially classified as having an acute unclassified colitis had a final diagnosis of inflammatory bowel disease after a 2.5-3 years follow-up. These data warrant a thorough follow up of acute unclassified colitis, especially when it occurs in patients < 40 years.

Anti-endothelial cell antibodies in sera from patients with inflammatory bowel disease.

IgG anti-endothelial cell antibodies (AECA) have been described in sera from patients with vasculitis and other immune disorders such as systemic lupus erythematosus. Presence of AECA may be relevant to the hypothesis that Crohn's disease (CD) is a form of intestinal vasculitis. The aim of this study was to search for IgG AECA among 141 patients with CD, 94 patients with ulcerative colitis (UC) and 71 healthy blood donors and to assess the relationship between AECA and demographic or disease data. The cut-off point was defined from the mean OD values + 2 SD obtained from healthy blood donors. Seventeen percent of sera from patients with CD were positive for IgG AECA, whereas 24.5% of sera from patients with UC were positive. Among disease data, only a significant relationship between presence of IgG AECA and CD activity was noticed. These results might reinforce the hypothesis that intestinal vascular injury may be an important event in CD. However, detection of AECA in an almost similar percentage of patients with UC is more suggestive of an immune response to hidden endothelial self-antigen exposed after endothelial cell damage or a further marker of disturbed immunoregulation in inflammatory bowel disease.

A controlled trial comparing ciprofloxacin with mesalazine for the treatment of active Crohn's disease. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID).

OBJECTIVE: The aim of this randomized controlled study was to investigate the efficacy of ciprofloxacin compared with mesalazine in treating active Crohn's disease. METHODS: Patients with a mild to moderate flare-up of Crohn's disease (mean Crohn's Disease Activity Index [CDAI]; 217; range, 160-305) were randomized to receive ciprofloxacin 1 g/day or Pentasa 4 g/day for 6 wk. Complete remission was defined at wk 6 as a CDAI < or = 150 associated with a decrease (delta) in CDAI > 75. Partial remission was defined as a CDAI < or = 150 with 50 < delta CDAI < 75 or a CDAI > 150 with delta CDAI > 50 at wk 6. Group sequential procedure with triangular continuation regions was used to monitor the trial through the difference in complete remission rates, every 20 patients included. RESULTS: Inclusion of patients was stopped at the second step, i.e., after 40 inclusions, with the conclusion of no difference in complete remission rates between ciprofloxacin- and Pentasa-treated groups. Among the 18 patients taking ciprofloxacin, two decided to stop treatment during the trial and three were considered as treatment failures because of deterioration at wk 3. Among the 22 patients taking mesalazine, one patient was lost to follow-up and eight patients were considered as treatment failures. Complete remission was observed in 10 patients (56%) treated with ciprofloxacin and 12 patients (55%) treated with mesalazine and partial remission was observed in three and one patient, respectively. CONCLUSIONS: This study suggests that ciprofloxacin 1 g/day is as effective as mesalazine 4 g/day in treating mild to moderate flare-up of Crohn's disease.