Acute lower gastrointestinal bleeding in Crohn's disease: characteristics of a unique series of 34 patients. Belgian IBD Research Group.

OBJECTIVE: Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease, which represents a diagnostic and therapeutic challenge. The aim of this study was to define epidemiological characteristics and therapeutic options of hemorrhagic forms of Crohn's disease. METHODS: Thirty-four cases of hemorrhagic forms of Crohn's disease were studied retrospectively. Acute lower gastrointestinal hemorrhage was defined as acute rectal bleeding originating in diseased bowel and requiring a transfusion of at least 2 units of red blood cells within 24 h. Upper gastrointestinal tract hemorrhage or anal lesions and postoperative bleeding were excluded. RESULTS: Mean age at time of hemorrhage was 34.2 +/- 14 yr. Mean duration of disease before the hemorrhage was 5.6 +/- 6 yr. The hemorrhage occurred during a flare up of the disease in 35% of cases. The hemorrhage revealed Crohn's disease in 23.5% of cases. The hemorrhage was more frequent in colonic disease (85%) than in isolated small bowel disease (15%) (p < 0.0001). The origin of bleeding was identified in 65% of cases, by colonoscopy (60%), by angiography (3 patients), or at surgery (1 patient). The bleeding lesion was an ulcer in 95% of cases, most often in the left colon. The treatment was surgical in 20.5% (colectomy in 36%), endoscopical (7 patients, including 5 successes), or medical. Hemorrhage recurred in 12 patients (35%) within a mean time of 3 yr (4 days-8 yr), requiring surgery in 3 cases. No death was observed. CONCLUSIONS: This study performed in a series characterized by a nonsurgical recruitment, the largest to date, shows that hemorrhagic forms of Crohn's disease may reveal disease in 23.5%, occurs in quiescent Crohn's disease in two-thirds of cases. Given the potential efficacy of endoscopical or medical treatment, as well as the absence of mortality, a conservative approach may be suggested as first-line therapy in the majority of patients.

Epidemiology of inflammatory bowel disease in Brussels' area (1992-1993).

A prospective epidemiological study on inflammatory bowel diseases (IBD) patients was performed in Brussels' area from April 1st, 1992 to 30th March, 1993. The mean annual incidence for Crohn's diseases (CD) was 4.1/10(5) inhabitants/year among native Belgian people and 6.4/10(5) inhabitants/year for subjects issued from Moroccan families. For ulcerative colitis, the incidence was 3.7/10(5) inhabitants/year for native Belgian people and only 1.2/10(5) inhabitants/year for Moroccan subjects. The male/female sex ratio was 0.4 for CD and 1.9 for UC. At the time of diagnosis, the mean age was 34 years for CD and 38 years for UC. For both diseases, the age peak was between 20 and 29 years. Cigarette smoking was significantly higher in CD (48%) than in UC patients (12%). Family history was about 10% for both diseases.

[Anorectal localization of chronic inflammatory diseases of the intestines]. / Localisation ano-rectale des maladies inflammatoires chroniques de l'intestin.

In Ulcerative Colitis (UC), the rectum is always involved, but the disease may be extended to the left colon (distal colitis) or the entire organ (pancolitis). Secondary perineal lesions (erythema, fissures, hemorrhoids) are limited to local irritation related to the diarrheic syndrome; specific ano-rectal lesions are related to the mucosal inflammatory process, but others pathological situations may be observed and are due to the postoperative status (stenotic ileo-anal anastomosis, pouch inflammation). Ano-rectal localisation of Crohn's Disease (CD), sometimes underestimated, is clinically more complex (abscess, fistula, ulcer, etc) and requires precise classical (endoscopy, conventional radiology) or more modern (echo-endoscopy, nuclear magnetic resonance) investigations. The treatment is more difficult (medical conservative, "a minima" or more extended surgery). Differential diagnosis, symptoms, methods of investigation and appropriated therapeutical choices are successively developed.

An unusual cause of subocclusion in Crohn's disease.

Enteroliths as a cause of intermittent small bowel obstruction is a uncommon clinical entity. We present the case of a patient with Crohn's disease in whom a false primary enterolith--an apricot seed--was responsible for numerous episodes of subobstruction. The association of Crohn's disease with different types of enterolith is discussed.

A randomized, multi-observer, comparative evaluation of conventional fiberendoscopy and videoendoscopy in the upper GI tract.

In a comparative, histologically controlled study, no significant difference was found in the accuracy of conventional fiberendoscopy and videoendoscopy in the diagnosis of upper gastrointestinal tract lesions. Both techniques permitted accurate description of focal and/or ulcerative lesions, but videoendoscopy did not provide better sensitivity than fiberendoscopy in the diagnosis of superficial, non-ulcerative, inflammatory changes. The same results were obtained on checking the reproducibility of the macroscopic diagnosis by a delayed review of recorded videotapes.

Juxtapapillary duodenal diverticula: association with biliary stone disease.

In order to explore the relationship between duodenal diverticula and biliary stone disease, we reviewed 2231 endoscopic retrograde cholangio-pancreatography procedures. We found at least one juxtapapillary diverticulum per 239 patients (10.8%). The occurrence of duodenal diverticula increases with age. Patients with duodenal diverticula were older, had more gallbladder stones, more common bile duct stones, had undergone cholecystectomy more frequently, and experienced more frequently common bile duct stone recurrence after cholecystectomy. We thus confirm an association between the presence of diverticula of the second part of the duodenum, and biliary stone pathology, including gallbladder stones, common bile duct stones, and recurrent stones after cholecystectomy. We discuss the aetiopathogeny of this affection.

[Endoscopic findings compared with clinical findings in diverticular disease of the colon]. / Données endoscopiques confrontées aux données cliniques dans la maladie diverticulaire du côlon.

In a retrospective study of 702 consecutive colonoscopies, the authors observed 185 cases of diverticulosis or moderate diverticulitis. They studied the colonic diseases associated with the presence of diverticula (78 cases) and discussed the role of endoscope in the approach of colonic diverticulosis.

Campylobacter pylori-associated gastritis: a double-blind placebo-controlled trial with amoxycillin.

We randomly assigned 45 adult patients with Campylobacter pylori-confirmed antral gastritis to 8 days of treatment with 1 g amoxycillin suspension twice a day, or placebo, according to a double-blind study design. At the end of therapy, 91% of patients treated with amoxycillin demonstrated clearance of the organism from the antrum, compared with 16% in the placebo group (p less than 0.001). Active antral gastritis resolved in 68% of patients in the amoxycillin group versus only 9% in the placebo group (p less than 0.001). No significant difference was observed when looking at the evolution of chronic only gastritis. No significant improvement was observed in the assessment of clinical symptoms and endoscopic appearance. Reappearance of C. pylori and significant worsening of the histological score of active gastritis was observed after 2 wk in all patients. In a second study phase, 18 patients initially not cleared of their bacteria received amoxycillin single blind for 14 days. Clearance of bacteria associated with improvement or resolution of active gastritis was observed in 72% of the cases. In this subgroup, all patients investigated after 1 month were recolonized with C. pylori and, again, had histological active gastritis. We conclude that amoxycillin is effective in treating active antral gastritis associated with C. pylori, but not in preventing relapses, which occur in all cases within 1 month after therapy.