Postoperative recurrence of Crohn's disease: Pathophysiology and prevention

D’Haens, Geert R.; Rutgeerts, Paul

doi:10.1002/ibd.3780050411

Cited by 17 publications

(14 citation statements)

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“…In addition to altering the neural modulation of motility in Crohn's disease, immune cells may influence the natural history of the disease. Recent preliminary reports by D'Haens et al (15,16) showed a positive correlation between the perineural infiltration by immunocytes in the myenteric plexus of surgically resected Crohn's disease specimens and the subsequent development of disease recurrence postoperatively. Taken together, these observations indicate that while the focus of inflammation in Crohn's disease may be in the mucosa, the presence of T cells in the muscularis externa may be important not only in symptom generation by altering gut physiology, but also in determining the clinical course of the disease.…”

Section: Discussionmentioning

confidence: 95%

“…Traditionally, studies on the pathogenesis and pathophysiology of Crohn's disease have focused on the mucosal compartment, despite the fact that serious complications such as the development of strictures and fistulae emphasize the transmural nature of the inflammatory process. Recent evidence suggests that the presence of T cells in the deeper neuromuscular layers of the gut may more accurately predict postoperative recurrence of the disease than mucosal changes (15,16). Although medical treatment of Crohn's disease may improve mucosal lesions, it seldom prevents the development of strictures, and this may reflect differences in immune activity between the mucosal and subserosal compartments of the gut.…”

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confidence: 99%

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Interleukin-4- and -13-induced hypercontractility of human intestinal muscle cells-implication for motility changes in Crohn's disease

Akiho¹,

Lovato²,

Deng³

et al. 2005

American Journal of Physiology-Gastrointestinal and Liver Physi

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Interleukin-4- and -13-induced hypercontractility of human intestinal muscle cells-implication for motility changes in Crohn's disease

Akiho¹,

Lovato²,

Deng³

et al. 2005

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…An attempt to classify Crohn's disease on the basis of inflammatory patterns [172] has been compromised by the tendency towards the development of stenoses over time [173]. In contrast to the potential of curing ulcerative colitis with a colectomy, Crohn's disease is usually not cured by surgery; intestinal resection and anastomosis is almost inevitably followed by recurrence of the disease involving the anastomotic site and proximal intestine [174].…”

Section: Crohn's Diseasementioning

confidence: 99%

Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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In the US, H. pylori vacA shows allelic variation in the signal sequence (which may be type sla, slb or s2) and the mid-region (type ml or m2). Previous PCR-based vacA mid-region typing classified most, but not all, Asian and South American strains tested as ml or m2. We now sought to investigate vacA mid-region diversity further.MotlmodL We studied 13 Japanese, 6 Chinese, 9 Thai, and 8 Peruvian H. pylori isolates. cagA was identified by colony hybridisation (CH), vacA signal sequence was typed by PCR, and vacA mid-region was typed proximally by CH and distally by PCR. Sections of the vacA mid-region from 8 strains were PCR-amplified, sequenced, and compared with known sequences from 8 other strains.Rcuts Of the 36 Asian and South American strains studied, 35 were cagA+ (the cagA-was Peruvian) and 35 were vacA sla (1 cagA + Peruvian was slb). vacA mid-regions from the 13 Japanese strains were not PCR-amplified by ml or m2-specific primers, but hybridised weakly with an ml probe. Sequence analysis of vacA from 1 Japanese strain revealed 91% nucleotide identity with the ml probe but only 71% identity with the m2 probe. The previously equivocal Thai and Peruvian strains also had ml-like mid-region sequences. A Chinese strain was ml in the proximal mid-region and m2 distally, showing a clear crossover site. Final mid-region types were: Japanese, all 13 ml; Chinese, 1 ml, 1 ml/m2, 4 m2; Thai, 3 ml, 6 m2; Peruvian 4 ml, 4 m2. Distal mid-region sequences of 16 strains, compared over 294 bp, clustered into 2 groups, ml and m2. Nucleotide identity between ml and m2 strains ranged from 73-78%. Within groups, m2 strains were less diverse than ml strains (m2 range 94-99.7%, ml 88-99.3%, p<0.001). Sequence analysis of 7 ml and 3 m2 strains over 1.1kb proximally showed maintenance of clustering outside the 294bp region C duions These Asian and South American strains are similar in terms of cagA status and vacA sla genotype, but fall into 2 vacA midregion groups. ml sequences are more diverse than m2, and thus may be phylogenetically older. The vacA sequence of 1 Chinese strain suggests recombination in vivo between ml and m2 alleles. Introduction: H.pylori antimicrobial susceptibility is an important determinant ofthe efficacy of eradication therapies'. The prevalence of antimicrobial resistance varies within the UK and may increase given the increased use of eradication therapy. This multicentre study assesses the prevalence and possible associations ofH.pylon antimicrobial resistance. Methods: H.pylon was isolated from antral biopsies of patients undergoing routine endoscopy and cultured according to standard microbiological methods. Antimicrobial resistance was determined using "E-tests" or disc tests (tinidazole only) with breakpoints defined by previous studies. Results: H.pyloni was isolated from 32% (1222/3823) of patients and antimicrobial susceptibility determined in 90% (1077/1222) Previous case-control studies of IBD have used hospital or community derived controls. There are obvious inherent biases in both metho...

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“…After ileocolectomy with end ileostomy or fecal diverting ileostomy for refractory CD, management should include identification of high-risk patients and careful endoscopic evaluation for monitoring for CD recurrence. Endoscopic evaluation of the neoterminal ileum is recommended 6-12 months after surgery, given the fact that endoscopic recurrence typically precedes relapse of symptoms [10][11][12].…”

Section: Discussionmentioning

confidence: 99%