Vascular involvement in inflammatory bowel disease: pathogenesis and clinical aspects.

Crohn's disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel disease (IBD), are chronic inflammatory conditions, characterized by a microvascular and also macrovascular involvement. Chronically inflamed intestinal microvessels of IBD patients have demonstrated significant alterations in their physiology and function compared with vessels from healthy and uninvolved IBD intestine. Recently, some studies have revealed that the poor mucosal healing, refractory inflammatory ulcerations and damage in the IBD intestine could depend on microvascular dysfunction, resulting in diminished vasodilatory capacity and tissue hypoperfusion in the IBD gut. Furthermore, several data show that the activation of intestinal endothelium plays a critical role in the pathogenesis and/or in perpetuating and amplifying the inflammatory process in IBD and, consequently, it is now emerging as a potential use of anticoagulant or coagulation-related drugs in treating IBD. IBD is also associated with an increased risk of macrovascular venous and arterial thrombosis. Thrombotic events occur prevalently as deep vein thrombosis and pulmonary embolism. They happen at an earlier age than in non-IBD patients. Prothrombotic risk factors in IBD patients could be distinguished as acquired, such as active inflammation, immobility, surgery, steroid therapy, and use of central venous catheters, and inherited. Furthermore, it has been found that IBD, per se, is an independent risk factor for thrombosis. The prevention of thromboembolic events in IBD patients includes the elimination of removable risk factors and, if thrombosis occurs, a pharmacological therapy similar to that used for thromboembolic events occurring in the general population.

Extraintestinal manifestations in inflammatory bowel disease.

Inflammatory bowel diseases (IBD) can be really considered to be systemic diseases since they are often associated with extraintestinal manifestations, complications, and other autoimmune disorders. Indeed, physicians who care for patients with ulcerative colitis and Crohn's disease, the two major forms of IBD, face a new clinical challenge every day, worsened by the very frequent rate of extraintestinal complications. The goal of this review is to provide an overview and an update on the extraintestinal complications occurring in IBD. Indeed, this paper highlights how virtually almost every organ system can be involved, principally eyes, skin, joints, kidneys, liver and biliary tracts, and vasculature (or vascular system) are the most common sites of systemic IBD and their involvement is dependent on different mechanisms.

Regression of EI2-stage low-grade gastric MALT-lymphoma after H. pylori eradication.

To our knowledge there are only a few reports showing a role of eradication therapy for H. pylori in the treatment of low-grade MALT-lymphoma, of stage EI2. We report a rare case of MALT-lymphoma, invading all of the gastric wall, which regressed after eradication of H. pylori. The regression was well documented by endoscopic ultrasonography (EUS). A 70-year-old man was referred to us for upper endoscopy that showed a single ulcer of 3cm in diameter at the gastric angulus. Histology, immunohistochemistry and PCR analyses diagnosed a low-grade MALT-lymphoma in the presence of H. pylori infection. EUS showed a tumor invasion of all the gastric wall. The serosa layer, also, appeared irregular and interrupted in some points. The lymph nodes around the duodenum and the stomach were not involved. An anti-H. pylori therapy was started. After 1 year from the diagnosis, EUS showed the reappearance of the normal layers of the stomach. The patient is actually disease free. This result suggests that in EI2-stage gastric lymphoma of MALT type, in the absence of both high-grade malignancy foci and t(11;18)(q21;q21) chromosomal translocation, an eradication treatment may be considered as a first therapeutic option.

Small bowel diseases.

The study of small bowel disease is hampered by the organ length and shape. Malabsorption syndromes, small bowel bleeding, intestinal obstruction are analyzed with reference to the clinical characteristics and present laboratory and instrumental tests used in diagnosis. The introduction of sophisticated diagnostic imaging procedures, both endoscopic and radiologic have contributed to a better understanding of the symptomatic patterns.

CT findings and clinical activity in Crohn's disease.

The aim of this study was to evaluate clinical correlations of CT signs in proven Crohn's disease. Fifty patients were studied by means of multidetector CT. Clinical activity was assessed using Crohn's disease activity index (CDAI) score and some laboratory parameters. All patients with CDAI>150 had CT study scored as pathological. Seventy-nine percent of patients with CDAI<150 showed abnormalities in CT exam. CT findings correlate with some parameters of disease activity, thus underlining the usefulness of performing CT enteroclysis in Crohn's disease patients.