Ileal Crohn's disease is best treated by surgery

Windsor, Alastair

doi:10.1136/gut.51.1.11

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…Sensory transducer cells such as enterochromaffin cells in the gut epithelium release 5-HT that activate intrinsic sub-mucosal and myenteric afferent neurons (53,54). There is strong functional and electrophysiological evidence that myenteric intrinsic primary afferent neurons are involved in mechano- and chemosensitive responses in the GI tract (55-57). Reduced expression of serotonin reuptake transporter (SERT), required to terminate the action of 5-HT in the gut, can be induced during inflammatory conditions such as ulcerative colitis (58).…”

Section: Putative Mechanisms To Explain Ibs-like Symptoms In Gs Indivmentioning

confidence: 99%

Between Celiac Disease and Irritable Bowel Syndrome: The “No Man's Land” of Gluten Sensitivity

2009

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The repertoire of gastrointestinal (GI) symptoms is finite; however, the etiologies and mechanisms underlying symptom generation and perception are diverse and, in many cases, unknown. This review examines the clinical and experimental evidence exploring the putative relationship between gluten sensitivity (GS) and the generation of GI symptoms. It explores the hypothesis that, in a proportion of patients, GS causes functional bowel disorder (FBD)-like symptoms. We propose a model for investigating and understanding the induction of GI symptoms and dysfunction by gluten in FBD and organic disease. We hypothesize that, even in the absence of fully developed celiac disease, gluten can induce symptoms similar to FBD. We discuss the hypothesis that GS and post-infectious irritable bowel syndrome (IBS) provide two triggers that can explain at least part of the spectrum that constitutes IBS, further advancing an understanding of the role of mucosal responses to luminal factors in FBDs. We propose that the animal model of GS in human leukocyte antigen (HLA)-DQ8 mice allows investigation of mucosal pathophysiological changes that occur before the onset of full-blown inflammation in a GS host. A better understanding of how gluten can cause symptoms in sensitive individuals will illuminate the interaction between host genotype, diet, and intestinal microbiota in generating one of the most common GI conditions.

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Section: Putative Mechanisms To Explain Ibs-like Symptoms In Gs Indivmentioning

confidence: 99%

Between Celiac Disease and Irritable Bowel Syndrome: The “No Man's Land” of Gluten Sensitivity

2009

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“…Early surgery may offer several advantages: the re‐operation rate for recurrent disease is not increased, 22–24 the quality of life of the patient improves greatly compared to prolonged disease activity and long‐term medical treatment, 25–27 and early resection, prior to the development of advanced or complicated disease, reduces post‐operative morbidity and, possibly, the extent of the resected specimen 20, 28, 29 . In more recent years, the improvements in medical treatment, particularly the widespread use of immunosuppressants, have favoured a conservative approach in the management of CD, reserving surgery only for refractory or complicated disease 24, 30, 31 . However, despite the widespread use of immunosuppressants, the natural history of the disease, in terms of reduction of complications and need for surgery remains unchanged 32 …”

Section: Introductionmentioning

confidence: 99%

Early versus late surgery for ileo‐caecal Crohn’s disease

Aratari

Papi

Leandro

et al. 2007

Aliment Pharmacol Ther

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Summary Background Surgical resection is almost inevitable in Crohn’s disease. Surgery is usually performed for refractory or complicated disease: no studies appear to have been carried out, so far, to evaluate the potential benefits of performing surgery early in the course of the disease. Aim To compare the long‐term course of Crohn’s disease following ileo‐caecal resection performed at the time of diagnosis (early surgery) or during the course of the disease (late surgery). Patients and methods Overall 207 patients with ileo‐caecal Crohn’s disease at their first resection were reviewed: 83 patients underwent surgery at the time of diagnosis (early surgery), while 124 underwent surgery 54.2 months (range 1–438) after diagnosis (late surgery). The mean follow‐up after surgery was 147 months (range 12–534). The primary endpoint was clinical recurrence, defined as need for corticosteroids for symptomatic disease in the presence of endoscopic and/or radiologic recurrence. Secondary endpoints were need for immunosuppressants and surgical recurrence. Statistical analysis: Kaplan–Meier survival method and Cox proportional hazards regression model. Results Within 10 years after surgery, the cumulative probability of clinical recurrence was significantly lower in the early surgery group (Log Rank test P = 0.01). A trend was observed regarding the need for immunosuppressants (P = 0.05). No difference was observed regarding surgical recurrence. At multivariate analysis, early surgery was the only independent variable associated with a reduced risk of clinical recurrence (Hazard ratio, HR = 0.57; 95% CI 0.35 to 0.92, P = 0.02), but not with need for immunosuppressants and surgical recurrence (HR = 0.51; 95% CI 0.20 to 1.30, P = 0.15; HR = 0.66; 95% CI 0.33 to 1.35, P = 0.25, respectively). Conclusion Early surgery prolongs clinical remission compared to surgery performed during the course of the disease, but the natural history of disease is not modified.

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“…As immunosuppressive treatment may be associated with an increased risk of lymphoma, there may be some doubts as to why we preferred it over surgical resection. The timing of surgical resection in a CD patient is influenced by the risk of post‐surgical recurrence and the possibility of the development of short bowel syndrome 40; in our case, an earlier surgical resection may have detected the two coexisting conditions and allowed earlier neoplastic treatment.…”

Section: Discussionmentioning

confidence: 85%

Epstein-Barr Virus-Associated Lymphoma in Crohnʼs Disease

Losco

Gianelli²,

Cassani³

et al. 2004

Inflammatory Bowel Diseases

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Although no increased risk of developing lymphoproliferative disorders has been observed in population-based studies of patients with Crohn's disease, the possibility has been suggested in the subset of patients previously treated with thiopurine metabolites and suffering from concomitant Epstein-Barr virus infection. A few cases of lymphomas have occurred in patients with Crohn's disease treated with infliximab, only one of whom showed the presence of the Epstein-Barr virus genome. We here describe the case of a patient with steroid-dependent ileal Crohn's disease treated with azathioprine and a single infusion of infliximab, who developed a diffuse large B cell ileal lymphoma. Epstein-Barr virus genome was detected in the neoplastic cells by means of polymerase chain reaction. Epstein-Barr virus may be detected in the neoplastic tissues of lymphomas of patients with Crohn's disease treated with immunosuppressants and infliximab. The identification of such cases may help to define the frequency of this association and how to manage the lymphoproliferative disorder.

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Ileal Crohn's disease is best treated by surgery

Cited by 13 publications

References 21 publications

Between Celiac Disease and Irritable Bowel Syndrome: The “No Man's Land” of Gluten Sensitivity

Between Celiac Disease and Irritable Bowel Syndrome: The “No Man's Land” of Gluten Sensitivity

Early versus late surgery for ileo‐caecal Crohn’s disease

Epstein-Barr Virus-Associated Lymphoma in Crohnʼs Disease

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