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| Crohn's Disease, My gastro room blog |
Incidence 5-10 / 100000 , more men
1 parent with CD, 10 % chance chlid with CD
If both parents have IBD, 30 % chance of the disease by 30 years
Macroscopic features typical of Crohn's disease include:
1 parent with CD, 10 % chance chlid with CD
If both parents have IBD, 30 % chance of the disease by 30 years
Macroscopic features typical of Crohn's disease include:
- Confluent, deep linear ulcers, aphthoid ulcers
- Skip lesions
- Strictures
- Fistulas
- Rectal sparing.
Histological features typical of Crohn's disease include:
- Transmural inflammation
- Non-caseating granulomas (may occur in other conditions)
- Lymphocytic infiltrate & Lymphoid aggrigates
- preseved crypt architecture
- Goblet cells normal (goblet cell depletion is seen in ulcerative colitis).
- In approximately 50% - ileum and colon are affected
- In approximately one third - disease is confined to the small bowel (primarily terminal ileum)
- In approximately 20-25% - disease is confined to the colon.
| The major symptoms: diarrhoea, abdominal pain and weight loss. Constitutional symptoms:malaise, lethargy, anorexia, nausea, vomiting and low-grade fever may be present and in 15% of these patients there are no gastrointestinal symptoms. |
- Site of disease
- Activity of disease
- Behaviour of disease (fistulating, stricturing, or inflammatory).
80% of patients with Crohn's disease will have surgery during their lifetime
75% require surgery in the first 10 years
75% return to work 1 year post diagnosis
Pregancy: 1/3 improve, 2/3 worsen
A patient with Crohn's disease presents to the clinic bringing with her a number of questions about the prognosis of her disease. The following features are more common in Crohn's disease than ulcerative colitis, except:-
ReplyDelete1-Gall stones
2-Erthema Nodosum
3-Kidney stones
4-Sclerosing Cholangitis
5-Macrocytic anaemia
Although there has been vigorous research to identify a specific pathogen responsible for causing an appropriate and sustained inflammatory response seen in Crohn’s disease, to date no such pathogen has been identified. M. paratuberculosis, which is the bacteria responsible for causing Johne’s disease, a similar granulomatous bowel disease found in ruminants, has received the most attention over the years. Attempts to isolate this organism from specimens from patients with Crohn’s disease as well as empiric antibiotic treatment have yielded equivocal results. Mild physiologic inflammatory changes are seen in healthy intestinal mucosa exposed to normal gut flora, which may indicate a readiness to respond more aggressively to true pathogens. Many different animal models have demonstrated that in a genetically susceptible host, when normal commensal bacteria (and not necessarily a specific pathogen) are introduced into the gut, an inappropriate level of inflammation will be demonstrated, similar to that seen in IBD.
ReplyDeleteMTX is a folate antagonist that may be used as an alternate immunomodulator to 6-MP or azathioprine. In a randomized, controlled trial that compared weekly MTX 25 mg given intramuscularly with placebo in steroid-dependent Crohn’s patients with active disease, almost 40% of MTX-treated patients compared with 19% of placebo patients achieved remission off steroids over 16 weeks. Most patients responded by the eighth week of treatment. Although studies in rheumatoid arthritis have shown equal efficacy in patients treated with subcutaneous as compared with intramuscular MTX, oral administration is not as reliable secondary to variable intestinal absorption, especially in patients with small bowel inflammation. MTX is an abortifacient and also teratogenic; further, it is toxic to sperm. Therefore, it is not appropriate for women or men who wish to conceive. Men should wait at least three months after therapy ends before attempting to conceive; highly effective birth control must be used while the patient is taking this medication. Side effects associated with MTX include stomatitis, nausea, diarrhea, hair loss, mild leukopenia, abnormal liver enzymes, and, rarely, liver fibrosis. Obesity, alcohol, and diabetes may increase the risk of hepatotoxicity.
ReplyDeleteAlthough Crohn’s disease does not follow a mendelian genetic model, familial susceptibility lends clear support for a genetic predisposition. First-degree family members are 14 to 15 times more likely to be diagnosed with Crohn’s disease than the general population. In families with multiple members who have inflammatory bowel disease, phenotypic concordance is generally observed; that is to say, all family members usually have either Crohn’s disease or UC, although mixed kindreds can occur. In monozygotic twins, a concordance of up to 67% will be seen, which means that the environment plays a role in the development of Crohn’s disease as well. Approximately one fifth of patients with Crohn’s disease will report a family history of the disease.
ReplyDeleteOne or more EIMs will develop in an estimated 6% to 25% of Crohn’s disease patients, which may be categorized as those associated with small bowel disease versus colonic involvement as well as by those that occur independently of disease activity versus those that parallel disease activity. Neither erythema nodosum nor pyoderma gangrenosum is exclusive to inflammatory bowel disease.
ReplyDeletePatients with Crohn’s disease have a higher risk of cholelithiasis, with the major risk factor being the number of ileal resections. They also have a higher risk of nephrolithiasis.
Calcium oxalate kidney stones are seen in patients with Crohn’s disease who have had ileal resections or who have extensive ileal inflammation and resultant fat malabsorption as free fatty acids bind to calcium, which then decreases the calcium available to bind and clear oxalate. Oxalate is then absorbed, and hyperoxaluria and calcium oxalate stones are formed. Uric acid stones may occur with significant volume depletion and hypermetabolic state.
Th17 cells are a relatively newly discovered important cell lineage involved in the pathogenesis of IBD. These cells produce IL-6 and IL-17, the latter of which is a key proinflammatory cytokine and not only activates T cells but also multiple other cell types, which then promote the production of a cascade of proinflammatory cytokines. It also expresses IL-23 receptor, activation of which by IL-23 is important in the development of colitis in mouse models. Traditionally, the Th1 cell pathway has been implicated in Crohn’s disease and the Th2 cell pathway has been implicated in UC, but more recent data suggest that this represents an oversimplification of the Th cell role in the pathogenesis of IBD. T regulatory cells down-regulate both the Th1 and Th2 pathways via the production of IL-10 and transforming growth factor β.
ReplyDeleteWhat do you know about NOD2/CARD15 as it relates to Crohn’s disease?
ReplyDeleteWith the ability of scientists to perform automated rapid DNA sequencing, genomewide association studies have uncovered more than 30 genetic loci that may be associated with Crohn’s disease. The first such definitive genetic susceptibility locus was the NOD2/CARD15 on chromosome 16 (nucleotide-binding oligomerization domain, also known as caspase-recruitment domain). Three allelic variants are most commonly associated with Crohn’s disease in European and American populations and include two missense mutations and one frameshift insertion. These variants are contained within the leucine-rich repeat region of the gene and lead to interference of the binding of the gene product protein to muramyl dipeptide, contained within the cell walls of both gram-positive and -negative bacteria. Although the exact mechanisms are unclear, this leads to a defective innate immune response, which in turn might cause increased chronic activation of adaptive immunity. If an individual carries mutations on both chromosomes (homozygous), the odds ratio of development of Crohn’s disease is 17 compared with 2.5 for a heterozygote. Twenty percent to 30% of Crohn’s patients are believed to carry at least one allelic variant of this gene. Genetic polymorphisms of NOD2/CARD15 are associated with a younger disease onset, the ileal location, and the stricturing subtype
Colorectal cancer, cancer of the large intestine, is the fourth most common cancer in North America. Many cases of colorectal cancer are associated with low levels of physical activity and with diets that are low in fruits and vegetables. Individuals with a family history of the disease have a higher risk. I crumble with this disease for 5 years also with a lot of scaring thought in my head because i was just waiting for death every day of my life until My Son came to me in the hospital explaining to me that he has find a herbal healer from Nigeria to cure my Colo-Rectal Cancer,I was so shocked with the ideal also i was excited inside of me.My son asked me to let us give him a try because we have really heard a lot of scammer pretending to cure all sort of diseases with herbal medicine and some of them never get a positive result at the end of it all but we was very confident on this herbal doctor,like i said we give him a try and he sent me a herbal medicine to drink for three weeks, Sincerely I'm telling you today I' alive and healthy no more laying on sick bed,No more Colo-Rectal Cancer.I'm sharing this testimony on here for people who are sick to contact this Wonderful man,His name is Dr Itua.And His contact Whatsapp_+2348149277967____Email... drituaherbalcenter@gmail.com.He can cure those diseases like:Bladder cancerBreast cancerColorectal cancerKidney cancerLeukemiaLung cancerNon-Hodgkin lymphomaProstate cancerSkin cancerUterine cancerParkinson's,Alzheimer’s disease,Bechet’s disease,Crohn’s disease
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