Rectal biopsy in Crohn's disease

Iliffe, Gerald D.; Owen, David A.

doi:10.1007/bf01308372

Cited by 11 publications

(2 citation statements)

References 7 publications

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“…(133,227,246) and in tuberculosis and other mycobacterial infections (125,203 All major texts on gastroenterology and mycobacteriology make reference to the possible mycobacterial etiology of Crohn's disease. This is surprising, particularly in older texts, since the data which suggested such an association were sparse when these texts were written ( (198,242), or even fewer (132). Based on epidemiologic data, it has been estimated that at least 20% of Crohn's disease diagnoses are misclassifications (36) 108 CHIODINI unique among the mycobacteria because the gastrointestinal tract is the only environment in which it can replicate in vivo.…”

Section: Epidemiologymentioning

confidence: 95%

Crohn's disease and the mycobacterioses: a review and comparison of two disease entities

1989

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Crohn's disease is a chronic granulomatous ileocolitis, of unknown etiology, which generally affects the patient during the prime of life. Medical treatment is supportive at best, and patients afflicted with this disorder generally live with chronic pain, in and out of hospitals, throughout their lives. The disease bears the name of the investigator who convincingly distinguished this disease from intestinal tuberculosis in 1932. This distinction was not universally accepted, and the notion of a mycobacterial etiology has never been fully dismissed. Nevertheless, it was 46 years after the distinction of Crohn's disease and intestinal tuberculosis before research attempting to reassociate mycobacteria and Crohn's disease was published. Recently, there has been a surge of interest in the possible association of mycobacteria and Crohn's disease due largely to the isolation of genetically identical pathogenic Mycobacterium paratuberculosis from several patients with Crohn's disease in the United States, the Netherlands, Australia, and France. These pathogenic organisms have been isolated from only a few patients, and direct evidence for their involvement in the disease process is not clear; however, M. paratuberculosis is an obligate intracellular organism and strict pathogen, which strongly suggests some etiologic role. Immunologic evidence of a mycobacterial etiology, as assessed by humoral immune determinations, has been conflicting, but evaluation of the more relevant cellular immunity has not been performed. Data from histochemical searches for mycobacteria in Crohn's disease tissues have been equally conflicting, with acid-fast bacilli detected in 0 to 35% of patients. Animal model studies have demonstrated the pathogenic potential of isolates as well as elucidated the complexity of mycobacterial-intestinal interactions. Treatment of Crohn's disease patients with antimycobacterial agent has not been fully assessed, although case reports suggest efficacy. The similarities in the pathology, epidemiology, and chemotherapy of Crohn's disease and the mycobacterioses are discussed. The issue is fraught with controversy, and the data generated on the association of mycobacteria and Crohn's disease are in their infantile stages so that a general conclusion on the legitimacy of this association cannot be made. While no firm evidence clearly implicates mycobacteria as an etiologic agent of Crohn's disease, the notion is supported by suggestive and circumstantial evidence and a remarkable similarity of Crohn's disease to known mycobacterial diseases.

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Section: Epidemiologymentioning

confidence: 95%

Crohn's disease and the mycobacterioses: a review and comparison of two disease entities

1989

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“…The other colitides that can have this histologic appearance and enter into diagnostic consideration are Crohn colitis and infectious-type colitis, the latter including antibiotic-associated colitis and so-called acute self-limited colitis. [56][57][58][59][60][61][62][63] We are not…”

Section: Discussionmentioning

confidence: 99%

The Histopathology of Nonsteroidal Anti-inflammatory Drug-Associated Colitis

Goldstein

Cinenza

1998

Am J Clin Pathol

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The influence of disease at the margin of resection on the outcome of Crohn's disease

Heuman¹,

Boeryd²,

Bolin³

et al. 1983

Journal of British Surgery

110

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Sixty-seven patients with Crohn's disease undergoing 81 resections followed by a restorative procedure were reviewed to evaluate the influence of microscopic disease at the margin of resection on the recurrence rate. The average follow-up after resection was 5.6 +/- 2.8 years. The resectional margins were classified into three groups depending on the microscopic appearance of the most involved margin. Recurrent disease developed in 36 per cent of the resections without microscopic evidence of Crohn's disease, while 38 per cent of the resections with signs of Crohn's disease developed a clinical recurrence. The recurrence rate increased with the follow-up time, but was independent of microscopical disease at the resectional margins. Therefore we recommend restricted resection of macroscopically diseased bowel. Microscopical involvement does not seem to increase the recurrence rate.

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Rectal biopsy in Crohn's disease

Cited by 11 publications

References 7 publications

Crohn's disease and the mycobacterioses: a review and comparison of two disease entities

Crohn's disease and the mycobacterioses: a review and comparison of two disease entities

The Histopathology of Nonsteroidal Anti-inflammatory Drug-Associated Colitis

The influence of disease at the margin of resection on the outcome of Crohn's disease

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