Significant association of strictures and internal fistula formation in Crohn's disease

Oberhuber, Georg; Stangl, Petra C.; Vogelsang, Harald; Schober, Ewald; Herbst, F.; Gasché, Christoph

doi:10.1007/s004280000226

Cited by 119 publications

(74 citation statements)

References 12 publications

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“…Crohn's disease and ulcerative colitis have different clinical courses and natural histories, [11][12][13] and, in most instances, on the basis of haematoxylin and eosin staining of the biopsy specimen, one can be readily favoured over the other. [14][15][16][17][18][19] The two conditions do, however, share several histological features, and so in a proportion of cases a clear distinction is not possible (indeterminate colitis).…”

Section: Ibd Comprises Two Distinct Clinicopathological Entitiesmentioning

confidence: 99%

Comparison of RANTES expression in Crohn’s disease and ulcerative colitis: an aid in the differential diagnosis?

Ansari¹,

Abdulla

Zayyani

et al. 2006

J Clin Pathol

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Background:RANTES (regulated on activation, normal T cell expressed and secreted) expression is increased in inflammatory bowel disease (IBD). RANTES is produced at higher levels in granulomatous conditions, so increased RANTES expression can be expected in Crohn’s disease compared with ulcerative colitis.Aim:To compare RANTES expression between intestinal biopsy specimens of patients with Crohn’s disease and those with ulcerative colitis.Materials and methods:A prospective study of patients presenting with lower gastrointestinal symptoms at the Bahrain Specialist Hospital from July 2004 to April 2005 was carried out. Endoscopic colonic biopsy specimens were taken from every patient and subjected to (a) routine haematoxylin and eosin staining examination by light microscopy, (b) immunohistochemistry for examination of RANTES protein expression by light microscopy and (c) in situ hybridisation for examination of RANTES mRNA expression by light microscopy. RANTES expression was assessed and quantified.Results:58 patients were enrolled to the study. Of them, 40 had IBD (21 had Crohn’s disease and 19 had ulcerative colitis), 15 were controls with normal colonic biopsy results or non-inflammatory lesions and 3 had colonic inflammatory lesions other than IBD. RANTES expression in lymphocytes or histiocytes was significantly higher (p = 0.04) in new patients with ulcerative colitis than in those with Crohn’s disease analysed by immunohistochemistry (IHC).Conclusion:RANTES expression in lymphocytes or histiocytes is significantly higher in patients with ulcerative colitis than in those with Crohn’s disease. Hence, RANTES IHC can be an effective method for distinguishing between biopsy specimens of patients with ulcerative colitis from those of patients with Crohn’s disease, where routine histological features are indeterminate. RANTES IHC may prove to be a useful technique for identifying early or equivocal granulomas.

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Section: Ibd Comprises Two Distinct Clinicopathological Entitiesmentioning

confidence: 99%

Comparison of RANTES expression in Crohn’s disease and ulcerative colitis: an aid in the differential diagnosis?

Ansari¹,

Abdulla

Zayyani

et al. 2006

J Clin Pathol

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“…The pathology of CD is characterized by obstructing intestinal strictures because of inflammation (with high levels of hemoglobin), fibrosis (high levels of collagen), or a combination of both [4,5]. Inflammatory strictures are usually medically treated, while fibrotic strictures are irreversible and may have to be removed surgically.…”

Section: Introductionmentioning

confidence: 99%

“…The fibrotic stricture can be characterized by its: 1) increased collagen content in the submucosa (below tissue surface and maybe up to several millimeters in deep), and 2) the loss of stratified tissue architecture [8][9][10]. Conventional imaging technologies including Ultrasound (US) imaging [10], Computed Tomography (CT) [4,5,11] and Magnetic Resonance Imaging (MRI) [1,9] have been attempted to identify fibrotic intestinal strictures by resolving the stratified architecture in the strictures. However the diagnostic accuracy is limited as these modalities cannot assess intestinal strictures at the molecular level.…”

Section: Introductionmentioning

confidence: 99%

Characterizing intestinal inflammation and fibrosis in Crohn’s disease by photoacoustic imaging: feasibility study

Lei

Johnson

Liu

et al. 2016

Biomed. Opt. Express

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Abstract:The pathology of Crohn's disease (CD) is characterized by obstructing intestinal strictures because of inflammation (with high levels of hemoglobin), fibrosis (high levels of collagen), or a combination of both. The accurate characterization of the strictures is critical for the management of CD. This study examines the feasibility of characterizing intestinal strictures by Photoacoustic imaging (PAI) without extrapolation from superficial biopsies. Ex vivo normal rat colon tissue, inflammatory and fibrotic intestinal strictures in rat trinitrobenzene sulfonic acid (TNBS) model were first differentiated by a PA-US parallel imaging system. Surgically removed human intestinal stricture specimens were afterwards imaged by a multiwavelength acoustic resolution PA microscope (ARPAM). The experiment results suggest that PAI is a potential tool for the diagnosis of the diseased conditions in intestinal strictures. 2166-2185 (1990). 14. R. Richards-Kortum and E. Sevick-Muraca, "Quantitative optical spectroscopy for tissue diagnosis," Annu. Rev.Phys. Chem. 47(1), 555-606 (1996). 15. H. Messmann, E. Endlicher, G. Freunek, P. Rümmele, J. Schölmerich, and R. Knüchel, "Fluorescence endoscopy for the detection of low and high grade dysplasia in ulcerative colitis using systemic or local 5-aminolaevulinic acid sensitisation," Gut 52 (

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“…In this case, the most common indications are symptomatic stricture (Figure 1) or mixed forms (which causes intra-abdominal abscess or complex fistulas) [9]. Followed by the colorectal location, which the most common indication is the resistance to medical treatment of non-stricturing non penetrating form followed by colonic stricture (Figure 2).…”

Section: Type and Topography Of Lesionsmentioning

confidence: 99%

“…The most common location of lesions which required surgery is the terminal ileum [9] and the ileocecal junction [10][11][12][13][14]. In this case, the most common indications are symptomatic stricture (Figure 1) or mixed forms (which causes intra-abdominal abscess or complex fistulas) [9].…”

Section: Type and Topography Of Lesionsmentioning

confidence: 99%

Surgical Management of Primary Crohn’s Disease

Makni¹

2017

Austin J Gastroenterol

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Inflammatory bowel disease is a chronic gastrointestinal condition that is characterized by chronic gastrointestinal inflammation. The management of Crohn's disease is complex and requires skill, knowledge and experience with current advances in the field. Over the past several years, there have been a number of achievements and progress made in the care and management of this disorder. The diagnostic tools have greatly improved. The therapeutic armamentarium has expanded. The genetics of IBD has become more detailed and the role of the gut microbiome has been better defined. The evolution of biological agents has revolutionized the way we approach this disease. However, surgery is still required in more than 80% of patients with Crohn's disease (CD). This article aims to study the epidemiological, anatomical and therapeutic principles of surgical forms of CD. Keywords:Crohn's disease; Surgery; Recurrence; Stricture; Fistula IntroductionSurgery is required in more than 80% of patients with Crohn's disease (CD) [1]. The aim of surgery is not to cure the disease, which evolves in most cases to the recurrence of the remaining intestine [2]. Surgical treatment of intestinal lesions caused by CD is guided by two main criteria: operate only complicated forms, and refractory to medical treatment, and perform an intestinal resection as limited as possible, removing only lesions responsible for the symptoms observed. Indeed, perineal CD is problematic as regards to the diagnostic, prognostic and specific management. Over the past several years, there have been a number of achievements and progress made in the care and management of this disorder. However, surgery is still required in more than 80% of patients with Crohn's disease (CD). This article aims to study the epidemiological, anatomical and therapeutic principles of surgical forms of CD. The indications of surgical managementMultidisciplinary approach is now mandatory to discuss the therapeutic strategy and the time for surgery. The indication for surgery in CD depends on a number of factors-complications, clinical course, relapse and location. We could say that surgery is timely in any of the following situations: failure of medical treatment, onset of specific complications related to the disease or to pharmacological treatment, dysplasia or cancer and stagnated or retarded growth in children [3,4]. Chronic complications of Crohn's diseaseSurgery in the era of medical management: Today's, medical management (immunosuppressants, biological therapies) has been used increasingly and was initiated much earlier during the course of CD. However, this evolving therapeutic strategy was not associated with a decrease in the need for surgery or in a decrease of the occurrence of intestinal complications. The real benefit is that large intestinal resections became more unusual [5].Time for surgery: Identifying the best time for surgery is not always an easy task. In order to determine the best time for surgery

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Significant association of strictures and internal fistula formation in Crohn's disease

Cited by 119 publications

References 12 publications

Comparison of RANTES expression in Crohn’s disease and ulcerative colitis: an aid in the differential diagnosis?

Comparison of RANTES expression in Crohn’s disease and ulcerative colitis: an aid in the differential diagnosis?

Characterizing intestinal inflammation and fibrosis in Crohn’s disease by photoacoustic imaging: feasibility study

Surgical Management of Primary Crohn’s Disease

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