No siempre es una enfermedad de Crohn: amebiasis como diagnóstico diferencial de la enfermedad inflamatoria intestinal

Deza, Diego Casas; Barrio, Mónica Llorente; Báez, Rosario María Monzón; Calvo, Luis Javier Lamuela; Ruiz, Marta Gascón; Lisbona, A; López, Santiago García

doi:10.1016/j.gastrohep.2019.03.006

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Inflammatory bowel disease (IBD) is common in developed countries and an increasing incidence and prevalence of inflammatory bowel disease has been witnessed in developing countries. Because the clinical features of amoebic colitis resemble those of IBD, and therefore the risk of misdiagnosis is high [ 3 – 6 ]. The consequences of not recognizing amebic colitis can be catastrophic [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of endoscopic and pathological findings of amebic colitis

et al. 2021

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Background The clinical features of amoebic colitis resemble those of inflammatory bowel disease (IBD), and therefore the risk of misdiagnosis is very high. The aim of this study was to analyse the characteristics of the endoscopic and pathological findings of amebic colitis and the lessons from our patients, which were useful for diagnosing the amebic colitis timely and avoiding the serious complication. Methods We retrospectively reviewed data of all amebic colitis admitted to Beijing Friendship Hospital from January 2015 to January 2020. Cases were diagnosed by clinical presentation, laboratory examinations, and colonoscopy with biopsy and histological examination, no ELISA stool antigen or PCR tests were used. Results 16 patients were diagnosed with amebic colitis by the colonoscopy accompanied by biopsy and microscopic examination. At first time, 12 (75%) patients were misdiagnosed as IBD. Cecum was the most common site of amebic colitis (100%), and the caecum and rectum were also involved in many lesions (68.75%). Multiple lesions of erosion and/or ulcer were recognized in all patients (100%).The endoscopic findings included multiple irregular shaped ulcers and erosions with surrounding erythema, and the ulcers and erosions were covered by the white or yellow exudates. The intervening mucosae between the ulcers or erosions were normal. The features of rectums can be divided to 2 types: in 6 patients (54.5%), the irregular ulcer or erosions covered with white or yellow exudates were observed in rectum and cecum, and the bloody exudates in rectum were more severe than those in cecum; in other 5 patients (45.5%), rectal lesions were much less severe than those in cecum, the small superficial erosion or reddened mucosa were observed in the rectal ampulla. All patients were diagnosed as detection of amebic trophozoites from HE-stained biopsy specimens. The number of trophozoites ranged from 1/HPF to > 50/HPF. Among 16 cases, mild architectural alteration of colon crypt were observed in 10 cases (62.5%), and serious architectural alteration of colon crypt was found which had crypt branch in 1 case (16.7%). Cryptitis was observed in 12 cases (75%) and its severity was mild or moderate. No crypts abscess was observed in all cases. Conclusions The colonoscopy with histological examination are very important to diagnose the amebic colitis. Detect the amoebic trophozoites in the exudates by histological examination is the vital. Sometimes a negative biopsy does not rule out amebiasis, repeated biopsies may be needed to make the diagnosis.

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Section: Introductionmentioning

confidence: 99%

Characteristics of endoscopic and pathological findings of amebic colitis

et al. 2021

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A case report of refractory amebic colitis and literature review

Shao,

Lv,

Zhou

et al. 2024

Medicine

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Rationale: Amebic colitis has been less prevalent in recent times in China, and the similarity of its symptoms to those of inflammatory bowel disease (IBD) results in the difficulty of early identification and diagnosis. Patient concerns: A 31-year-old male who exhibited intermittent diarrhea and hematochezia was highly suspected as IBD initially. Despite the partial relief of symptoms following the administration of mesalamine, the endoscopic ulcers remained largely unchanged. Diagnoses: Two years after the onset of mesalamine therapy, amebic cysts were detected in stool microscopy and trophozoites were found on the surface of cecal ulcers. The patient was then diagnosed with amebic colitis. Interventions: After 2 rounds of standardized metronidazole treatment, amebic colitis remained refractory until diloxanide was administered. Outcomes: The patient remained asymptomatic, and the mucosa of colon was normal during the annual follow-up. Lessons: Individuals newly diagnosed with IBD should undergo essential screening for amebiasis. And the use of steroids should be taken with caution, especially in cases where the effect of mesalamine is limited. For symptomatic intestinal amebiasis, even after the administration of tissue amebicides, the continued use of luminal amebicides is necessary to prevent recurrence.

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New Medical Approaches in Crohn’s Disease Treatment

Miron¹

2023

AnnalsARSciMed

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Crohn's disease is a lifelong, relapsing systemic inflammatory disease of unknown etiology, mainly caused by an impaired immune response, characterized by chronic inflammation of any part of the gastrointestinal tract, with an increasing incidence worldwide. This disease is associated with multiple extraintestinal manifestations and patients frequently present persistent diarrhea, abdominal pain and weight loss. It affects people of all ages, but its onset generally occurs at a young age. Several triggers have been implicated in the etiopathology of Crohn's disease, including a dysregulated immune system, an altered intestinal microbiome, genetic susceptibility and environmental factors, but the main cause of the disease still remains an enigma. Due to its debut at a young age, in most cases, a long-term and early established treatment is undoubtedly required to prevent its progression with multiple intestinal and extraintestinal complications. Nowadays, novel biologic therapies or small-molecule drugs may deeply change the innate history of this pathology and could also decrease the rate of complications and the need for surgery. In order to establish the proper diagnosis, endoscopy with the histological evaluation of biopsy specimens represents the most reliable method, even if less invasive biomarkers are being developed. Crohn's disease is a comprehensive disease and the treatment should be adapted to each patient’s underlying pathogenetic mechanism.

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No siempre es una enfermedad de Crohn: amebiasis como diagnóstico diferencial de la enfermedad inflamatoria intestinal

Cited by 3 publications

References 5 publications

Characteristics of endoscopic and pathological findings of amebic colitis

Characteristics of endoscopic and pathological findings of amebic colitis

A case report of refractory amebic colitis and literature review

New Medical Approaches in Crohn’s Disease Treatment

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