Gut inflammation in children with cystic fibrosis on high-dose enzyme supplements

Marshall, Tom; Croft, NM; Ferguson, Anne

doi:10.1016/s0140-6736(95)91864-7

Cited by 34 publications

(11 citation statements)

References 7 publications

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“… Intestinal alterations due to CFTR dysfunction may result in malnutrition with consistent respiratory muscle weakness and comprised innate lung defences [ 54 ], an impaired barrier function with consequent bacterial translocation to the lungs, and release of inflammatory mediators (cytokines such as interleukin (IL)-8, IL-1 and tissue necrosis factor (TNF)-a, immunoglobulins, lactoferrin, neutrophil elastase, and calprotectin [ 11 – 17 ]) into the systemic circulation, contributing to lung inflammation and impaired lung function. Inflammatory mediators in the lung (cytokines such as IL-8, IL-6, IL-1 and TNF-a, complement factor 5A, neutrophils, proteases (elastase), oxigen radicals, and leukotriene B4 [ 58 , 59 ]) are released into the systemic circulation and will reach the intestine or, alternatively, can be swallowed with sputum (together with lung bacteria) and enter the gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence for intestinal inflammation in CF has been found in both human and animal studies [ 5 , 11 , 12 , 13 , 14 , 15 , 16 ]. Raised levels of cytokines (TNF-α), interleukins (IL-1β, IL-8), immunoglobulins (IgM, IgG), neutrophil elastase and calprotectin were demonstrated in faeces and whole gut lavage of CF patients [ 5 , 11 , 12 , 13 , 16 , 17 ]. Also increased mononuclear cell infiltration of the lamina propria has been shown in duodenal biopsies [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Evidence for a Cystic Fibrosis Enteropathy

et al. 2015

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BackgroundPrevious studies have suggested the existence of enteropathy in cystic fibrosis (CF), which may contribute to intestinal function impairment, a poor nutritional status and decline in lung function. This study evaluated enterocyte damage and intestinal inflammation in CF and studied its associations with nutritional status, CF-related morbidities such as impaired lung function and diabetes, and medication use.MethodsSixty-eight CF patients and 107 controls were studied. Levels of serum intestinal-fatty acid binding protein (I-FABP), a specific marker for enterocyte damage, were retrospectively determined. The faecal intestinal inflammation marker calprotectin was prospectively studied. Nutritional status, lung function (FEV1), exocrine pancreatic insufficiency (EPI), CF-related diabetes (CFRD) and use of proton pump inhibitors (PPI) were obtained from the medical charts.ResultsSerum I-FABP levels were elevated in CF patients as compared with controls (p<0.001), and correlated negatively with FEV1 predicted value in children (r-.734, p<0.05). Faecal calprotectin level was elevated in 93% of CF patients, and correlated negatively with FEV1 predicted value in adults (r-.484, p<0.05). No correlation was found between calprotectin levels in faeces and sputum. Faecal calprotectin level was significantly associated with the presence of CFRD, EPI, and PPI use.ConclusionThis study demonstrated enterocyte damage and intestinal inflammation in CF patients, and provides evidence for an inverse correlation between enteropathy and lung function. The presented associations of enteropathy with important CF-related morbidities further emphasize the clinical relevance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evidence for a Cystic Fibrosis Enteropathy

et al. 2015

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“…An ulcerative ileitis “Crohn-like”, as a result of the chronic pancreatic enzymes taking, has been described in the literature (Thomson and Tam 1994 ; Croft et al 1995 ; Smyth et al 1994 ; FitzSimmons et al 1997 ). According to the patient's medical history, our pathologist suggested it as a possible differential diagnosis, since in the specimen, apart from strictures and submucosal fibrosis with dense inflammatory cells, there were no granulomas, which are instead a feature of the CD.…”

Section: Discussionmentioning

confidence: 99%

“…The technique for intestinal anastomoses in CD is still controversial, and, to date, there is no evidence of outcome difference between hand-sewn and stapled anastomosis (Scarpa et al 2003 ). A temporary end-ileostomy or a diverting loop-ileostomy proximal to the anastomosis, can be considered in CD, especially in case of peritonitis with hemodynamic instability and when the patient’s general conditions and nutritional status are extremely poor (Ikeuchi and Yamamura 2002 ; Nordentoft et al 2000 ; Kesici et al 2011 ; Collet e Silva et al 2000 ; Neudecker et al 2002 ; Agresta et al 2012 ; O’Sullivan et al 1996 Apr; Favuzza et al 2009 ; Karoui et al 2009 ; Myers et al 2008 ; Thomson and Tam 1994 ; Croft et al 1995 ; Smyth et al 1994 ; FitzSimmons et al 1997 ; Greenstein et al 1985 , 1987 ; Abascal et al 1982 ; Parray et al 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn’s acute ileitis with free perforation and faecal peritonitis: first ever reported laparoscopic treatment

Birindelli¹,

Tugnoli²,

Beghelli³

et al. 2016

SpringerPlus

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IntroductionLaparoscopy for abdominal surgical emergencies is gaining increasing acceptance given the spreading of advanced laparoscopic skills among modern surgeons, as it may allow at the same time an accurate diagnosis and appropriate treatment of acute abdomen. The use of the laparoscopic approach also in case of diffuse peritonitis is now becoming accepted provided hemodynamic stability, despite the common belief in the past decades that such severe condition represented an indication for conversion to open surgery or an immediate contraindication to continue laparoscopy. Crohn’s Disease (CD) is a rare cause of acute abdomen and peritonitis, only a few cases of CD acute perforations are reported in the published literature; these cases have always been approached and treated by open laparotomy.Case descriptionWe report on a case of a faecal peritonitis due to an acute perforation caused by a terminal ileitis in an undiagnosed CD. The patient underwent diagnostic laparoscopy followed by a laparoscopic ileo-colic resection and primary intracorporeal anastomosis, with a successful postoperative outcome.ConclusionsComplicated CD has to be considered within the possible causes of small bowel non-traumatic perforation. Emergency laparoscopy with resection and primary intra-corporeal anastomosis can be feasible and may be a safe and effective minimally invasive alternative to open surgery even in case of faecal peritonitis, in selected stable patients and in presence of appropriate laparoscopic colorectal surgical skills and experience. To the best of our knowledge the present experience is the first ever reported case managed with a totally laparoscopic extended ileocecal resection with intracorporeal anastomosis in case of acutely perforated CD and diffuse peritonitis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1619-x) contains supplementary material, which is available to authorized users.

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“…UC “Crohn-like”, coming from a chronic pancreatic enzyme taking, has been also described in the literature [ 26 , 37 , 38 ].…”

Section: Conditions Related To Ileitismentioning

confidence: 99%

Facing Terminal Ileitis: Going Beyond Crohn’s Disease

Goulart

Barbalho²,

Gasparini

et al. 2016

Gastroenterol Res

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Terminal ileitis (TI) is an inflammatory condition of the terminal portion of the ileum that may occur acutely with right lower quadrant pain followed or not by diarrhea, or exhibit chronic obstructive symptoms and bleeding and normally it is associated to Crohn’s disease (CD) although it may be associated to other different conditions. This review intended to contribute to a better understanding of TI in order to help in the diagnosis, medical approach and patient care. This work was performed on a survey of articles collected in different databases and a retrospective search was carried out to identify relevant studies in the field. Pathological conditions such as ulcerative colitis, the intake of non-steroidal anti-inflammatory drugs, infectious diseases, eosinophilic enteritis, malignant diseases, spondyloarthropathies, vasculitides, ischemia, sarcoidosis, amyloidosis and others may be related to ileitis but it is commonly referred to CD. To a correct therapeutic approach, it is necessary to understand the causes of this inflammation process. The performance of a clinical, laboratory, endoscopic, and histopathological evaluation of the individuals is crucial to the correct diagnosis and treatment once the inflammation of the ileum may occur due to different pathological conditions besides CD, leading to difficulties in the diagnosis. Thus, an individual approach is necessary once the correct diagnosis is crucial for the immediate therapeutic approach and recovering of the patient.

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Gut inflammation in children with cystic fibrosis on high-dose enzyme supplements

Cited by 34 publications

References 7 publications

Evidence for a Cystic Fibrosis Enteropathy

Evidence for a Cystic Fibrosis Enteropathy

Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn’s acute ileitis with free perforation and faecal peritonitis: first ever reported laparoscopic treatment

Facing Terminal Ileitis: Going Beyond Crohn’s Disease

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