European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis

Background CARD15 mutations alter bowel immunity and increase susceptibility to Crohn 0 s disease (CD). However, the relation between these mutations and Crohn 0 s perianal fistulas has not been fully clarified. Aims To assess whether CARD15 mutations are associated with risk of developing Crohn's perianal fistulas and whether these mutations are predictors of the response of perianal fistulas to antibiotics. Methods CARD15 mutations were investigated in 203 consecutive CD patients. Presence/absence of history of perianal fistula was recorded. Patients with history of perianal fistula were divided into two groups (with/without CARD15 mutations), and response to antibiotics was evaluated in both groups. Results Of the 203 patients, 60 (29.6%) showed at least one CARD15 mutation and 55 (27.1%) had history of perianal fistula. History of perianal fistula was identified in 13 (21.7%) patients with mutations and in 42 (29.4%) patients without mutations (P = 0.260). Mean age at diagnosis of first perianal fistula was similar in patients with/without CARD15 mutations (28.7 ± 9.8 versus 29.7 ± 10.1 years, P = 0.758). Average time between disease onset and diagnosis of first perianal fistula was also similar in the two groups (4.6 ± 5.1 versus 5.0 ± 5.9 years, P = 0.816). Response of perianal fistulas to antibiotics (metronidazole alone or combined with ciprofloxacin) was significantly higher in patients without CARD15 mutations (7.7% versus 40.5%, P = 0.041). Conclusions In CD, CARD15 mutations are not associated with risk of developing perianal fistulas or with time of their outbreak. Nevertheless, patients with perianal fistulas and CARD15 mutations showed worse response to antibiotics.

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“…Diagnosis of CD was based on accepted clinical, endoscopic, radiologic, and histologic criteria [27].…”

Section: Patientsmentioning

confidence: 99%

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

et al. 2010

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“…35,36 Three patients who had the diagnosis of indeterminate colitis at the time of 25OHD measurement were given the diagnosis of UC for the purpose of data analysis. These patients had skip lesions in the colon but absence of lesions in the ileum and UGI tract, no histologic evidence of granulomas, and behavior of their disease typical of UC.…”

Section: Population and Clinical Characteristicsmentioning

confidence: 99%

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Pappa¹,

Gordon

Saslowsky³

et al. 2006

Pediatrics

188

144

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OBJECTIVES-Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report (1) the prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration ≤15 ng/mL) in a large population with inflammatory bowel disease, (2) factors predisposing to this problem, and (3) its relationship to bone health and serum parathyroid hormone concentration.PATIENTS AND METHODS-A total of 130 patients (8-22 years of age) with inflammatory bowel disease, 94 with Crohn disease and 36 with ulcerative colitis, had serum 25-hydroxyvitamin D, intact parathyroid hormone, and lumbar spine bone mineral density (using dual-energy x-ray absorptiometry) measured at Children's Hospital Boston. RESULTS-The prevalence of vitamin D deficiency was 34.6%. Mean serum 25-hydroxyvitamin D concentration was similar in patients with Crohn disease and ulcerative colitis, 52.6% lower among patients with dark skin complexion, 33.4% lower during the winter months (December 22 to March 21), and 31.5% higher among patients who were taking vitamin D supplements. Serum 25-hydroxy-vitamin D concentration was positively correlated with weight and BMI z score, disease duration, and serum albumin concentration and negatively correlated with erythrocyte sedimentation rate. Patients with Crohn disease and upper gastrointestinal tract involvement were more likely to be vitamin D deficient than those without it. Serum 25-hydroxyvitamin concentration was not associated with lumbar spine bone mineral density z score or serum parathyroid hormone concentration.CONCLUSIONS-Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn disease. The long-term significance of hypovitaminosis D for this population is unknown at present and merits additional study. Copyright © 2006 by the American Academy of PediatricsAddress correspondence to Helen M. Pappa, MD, MPH, Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. helen.pappa@childrens.harvard.edu. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2011 November 1. Available reports on the vitamin D status of adults with CD place the prevalence of 25OHD concentration ≤15 ng/mL between 22% and 70%, depending on the study. 21-31 Serum 25OHD concentration was found to be <10 ng/mL in 8% to 45% of adults with CD. 21,22,24,26 One study reports a negative relationship among disease duration, Crohn Disease Activity Index, ferritin, C-reactive protein, cholesterol, 24 and 25OHD concentration.Other studies report that smoking 21 and small bowel resection 30,32 are also negativel...

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“…Crohn's disease (CD) can involve any part of the intestinal tract with different manifestations including inflammation, stricture or penetration, as described by the Montreal classification [17]. Nevertheless, in 90 % of patients the disease is localized at the terminal ileum and 40-55 % of the patients show an ileum and colonic involvement [5,18]. Only 15-25 % of the patients show only colonic localization [5].…”

Section: Small Intestine Contrast Ultrasonography (Sicus)mentioning

confidence: 99%

Ultrasonographic findings in Crohn’s disease

2014

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In recent years transabdominal bowel sonography has become a first-line modality both in the diagnosis and in the follow-up of inflammatory bowel diseases, especially Crohn's disease, reaching values of sensitivity ranging from 84 to 93 %. In particular, its role is very useful in the early diagnosis of complications such as stenosis, phlegmons, abscesses and fistulae. According to the available literature the ability of US to provide information about disease activity is still under debate and further studies are necessary. In this regard, of fundamental importance is the use of additional techniques such as color-and power-Doppler and contrast-enhanced ultrasound. The purpose of this paper is to report the main sonographic intestinal and extraintestinal findings detectable in Crohn's disease.Keywords Transabdominal bowel sonography Á Crohn's disease Á Color and power Doppler Á CEUS Á Disease activity Riassunto Nel corso degli ultimi anni l'ecografia delle anse intestinali è andata affermandosi come metodica di prima linea nella diagnosi e nel follow-up delle malattie infiammatorie croniche intestinali, soprattutto nella malattia di Crohn, con valori di accuratezza diagnostica dell'84-93 %. In particolare il suo ruolo risulta preminente nella precoce diagnosi delle complicanze, quali stenosi, flemmoni, ascessi e fistole. In accordo con la letteratura disponibile più discussa rimane la capacità di fornire informazioni circa l'attività di malattia ed ulteriori studi appaiono necessari. A tal proposito è fondamentale l'utilizzo di metodiche quali color e power Doppler e l'ecografia con mezzo di contrasto (CEUS). Scopo del presente lavoro è quello di riportare i principali quadri ecografici intestinali ed extra-intestinali evidenziabili nella malattia di Crohn.

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European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis

Cited by 518 publications

References 164 publications

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Ultrasonographic findings in Crohn’s disease

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