RESUMO
BACKGROUND AND STUDY AIMS: Mucosal healing (MH) is a crucial indicator of therapeutic effectiveness and prognosis in Crohn's disease (CD). Rapid achievement and long-term maintenance of MH can alleviate the financial and psychological burden on patients. This study aimed to investigate the factors associated with MH in CD patients and enhance clinicians' understanding. PATIENTS AND METHODS: Patients diagnosed with CD between January 2010 and December 2019 at our hospital were included and divided into two groups based on the attainment of MH during the follow-up period. Demographic data, symptoms, disease classification, laboratory examination results, and treatments were collected and compared between the two groups. Factors with a P-value <0.2 were subjected to multivariate logistic regression analysis to identify the related factors of MH. RESULTS: Multivariate logistic regression analysis of CD patients revealed that educational level [odds ratio (OR) = 8.167, 95 % confidence interval (CI) 1.440-46.303, P = 0.018] and biological therapy (OR = 15.291, 95 % CI 1.404-166.543, P = 0.025) were associated with MH. CONCLUSION: Educational level and biological therapy are factors related to MH in CD patients. These findings suggest that the use of biological therapy and patients' better understanding of the disease contribute to achieving MH.
RESUMO
BACKGROUND: Fibromuscular dysplasia (FMD) is a type of unexplained nonatherosclerotic vascular disease that usually involves the renal and internal carotid arteries and rarely involves the mesenteric artery. Mesenteric artery FMD is difficult to distinguish from Crohn's disease (CD) and Behcet's disease (BD) solely based on symptoms. Patients with mesenteric artery FMD can present with an acute abdomen, but case reports of patients who have a long medical history and undergo multiple bowel resections are extremely rare. CASE PRESENTATION: The patient was a 45-year-old woman with an 11-year history of intermittent lower abdominal pain and fever. At the age of 34 years, she underwent right hemicolectomy and appendectomy due to an acute abdomen. She suffered from oral ulcers between 34 and 36 years old. A clinical diagnosis of presumed CD was made by the age of 41, and she was treated with mesalazine; however, the effect was poor. At the age of 42, she came to our centre, and based on her atypical symptoms and examination results, we thought she had CD. Hence, she was treated with glucocorticoids for 3 years. However, when she was 45, due to steroid dependence, thalidomide tablets were added. Unfortunately, she suffered from another episode of intestinal obstruction. Therefore, she underwent enterectomy. The postoperative histopathological diagnosis was mesenteric artery FMD. She no longer underwent pharmacotherapy after the surgery. Although she did not have any of her previous symptoms and postoperative colonoscopy showed no signs of recurrence, splenomegaly and abnormal routine blood results were still present. CONCLUSIONS: Patients with mesenteric artery FMD can present with an acute abdomen. In addition, the symptoms and endoscopic manifestations of mesenteric artery FMD may appear similar to CD and BD. Hence, it is difficult to make a clear clinical diagnosis and proceed with treatment. Mesenteric artery FMD often requires surgical pathology to confirm its diagnosis. For patients who suffer from this disorder, surgery may be the best choice to improve the patient's quality of life.