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Crohn′s disease (CD) is a chronic, progressive and destructive inflammatory disease affecting the entire digestive tract. Changes in the intestinal microbiota, particularly a decrease in gut microbiome diversity, are thought to be associated with chronic intestinal inflammation of CD. As for the mechanism of antibiotics in CD treatment, some scholars believe that antibiotics can affect the course of disease by reducing the concentration of intestinal bacteria and changing the composition of intestinal microbiota. Different antibiotics, including ciprofloxacin, metronidazole and rifaximin, have been proved to have certain therapeutic effect on some patients with CD in clinical practice, but there are still limitations in the use of antibiotics.In this review, the relationship between intestinal flora and the incidence of CD and the application of antibiotics in CD were reviewed, providing reference and help for the standardized application of antibiotics in CD.
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Objective To explore the changes and their clinical significance of peripheral blood myeloid-derived suppressor cells (MDSC)and their subtypes in patients with inflammatory bowel disease (IBD).Methods From April 2016 to April 2017,99 hospitalized IBD patients in 2nd Xiangya Hospital of Central South University were enrolled as observation group one,which included 84 Crohn's disease (CD) (70 in active phase and 14 in remission phase)and 15 patients with ulcerative colitis(UC).At the same period,32 healthy controls were enrolled as healthy control group one.The proportion of peripheral blood MDSC and subtypes of CD patients,UC patients and healthy controls were examined.Observation group two including 62 IBD patients (47 CD and 15 UC)were selected from observation group one and 21 healthy individuals were selected from healthy control group one as healthy control.The serum levels of tumor necrosis factorα(TNF-α)and interleukin 8 (IL-8)were detected.Chi square test,t test and one-way analysis of variance were performed for statistical analysis.Pearson correlation was performed for correlation analysis.Results The proportion of MDSC in peripheral blood mononuclear cells of CD and UC patients of observation group one were both higher than that of healthy control group one ((6 .30 ± 3.97)% and (7.50±3.12)% vs.(3.94±2.25)%,respectively),and the differences were statistically significant (t＝-3.22 and -3.21,both P＜0.01).The proportion of granulocytic MDSC in peripheral blood mononuclear cells of CD patients was higher than that of UC patients and healthy control group one ((65.69±20.45)% vs.(50.93±13.56)% and (51.50±11.61)%,respectively),and the differences were statistically significant (t＝2 .93 and 3 .79 ,both P＜0 .01 ).The proportion of monocytic MDSC in peripheral blood mononuclear cells of UC patients was higher than that of CD patients and healthy control group one ((28.41±18.33)% vs.(18.38±17.43)% and (28.17±10.22)%,respectively),and the differences were statistically significant (t＝2.22 and 2.93,both P＜0.05 ).The proportion of granulocytic MDSC was higher and the proportion of monocytic MDSC was lower in peripheral blood mononuclear cells of CD patients in active phase than those of CD patients in remission phase ((67 .36 ± 2.27)% vs.(46.49±6.32)%,and (17.19±2.02)% vs.(34.33±6.12)%),and the differences were statistically significant (t＝3.60 and 3.26,both P＜0.01).The serum level of TNF-αof CD patients of observation group two was higher than that of UC patients and healthy control group two ((7.83± 6.54)ng/L vs.(4.77±2.12)ng/L and (4.40±2.05)ng/L),and the differences were statistically significant (t＝2.01 and 2.53,both P＜0.05).The serum level of IL-8 of UC patients of observation group two was higher than that of CD patients and healthy control group two ((65.80±45.14)ng/L vs. (25.80±22.32)ng/L and (26.40±22.37)ng/L),and the differences were statistically significant (t＝4.87 and 4.21,both P＜0.01).Granulocytic MDSC was positively correlated with TNF-α(r＝0.319, P＝0 .0 1 1 )and was negatively correlated with IL-8 (r＝-0 .2 9 6 ,P＝0 .0 1 9 ).Monocytic MDSC was negatively correlated with TNF-α(r＝-0.260,P＝0.040)and was positively correlated with IL-8 (r＝0.306,P＝0.016).Conclusions The proportion of granulocytic MDSC in peripheral blood mononuclear cells significantly increases in active CD patients,while the proportion of monocytic MDSC significantly increases in UC and CD patients in remission phase.Detection of MDSC and their subtypes maybe helpful in the differentiation of CD and UC as well as the diagnosis and treatment of CD.
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Objective To investigate the clinical features of small bowel Crohn's disease(CD).Methods From January 2009 to September 2012,a total of 138 patients diagnosed as CD who underwent examinations of colonoscopy,digestive tract radiography,capsule endoscopy,double-balloon enteroscopy and computed tomography (CT) enterography were enrolled.According to the Montreal Classification criteria,the disease was typed by the age at diagnosis,location of the lesions and behavior of the disease.The clinical symptoms,laboratory examinations,diagnostic methods and recurrence condition were also evaluated.Through the comparison of the clinical features of ileocolonic and colonic CD,the clinical features of small bowel CD were analyzed.Measurement data were analyzed with t-test,analysis of variance or non parametric test.Chi square test was performed for count data.Spearman's correlation analysis was used for correlation analysis and multivariate Logistic regression analysis was used for risk factors screening.Results A total of 62 (44.9％) cases were simple small bowel CD.Fifty-three patients (85.5％) were male,and the mean age at diagnosis was 35.3 years old.The age of 67.7％(42/62) of small bowel CD patients were less than 40 years old when diagnosed.The ratio of stricture in small bowel CD group (35.5％,22/62) was significantly higher than that of ileocolonic (18.8％,6/32) and colonic CD group (13.9％,5/36) (x2=6.594,P=0.037).Jejunal involvement was an independent risk factor for structure in CD (OR=3.481,95％ CI:1.250 to 9.693).The patients with obstructive symptoms as primary symptom in small bowel CD (38.7％,24/62) were more than those with colonic CD (16.7％,6/36) (x2 =5.210,P=0.022).However,patients with diarrhea as primary symptom in small bowel CD (21.0％,13/62) were less than those with ileocolonic (37.5％,12/32) and colonic CD (44.4％,16/36) (x2=6.512,P=0.039).Patients with two or more extraintestinal manifestations in small bowel CD (3.2％,2/62) were also significantly less than those with ileocolonic (15.6％,5/32) and colonic CD (19.4％,7/36) (x2=7.957,P=0.019).The score of CD activity index was generally low,and with no statistical correlation to serum inflammation markers such as C reaction protein.The average time duration between induction of remission and clinical recurrence of small bowel CD ((23.64 ± 17.08) months) was shorter than that of ileocolonic type ((35.07±29.84) months,t=-4.285,P=0.002) and colonic CD ((32.35 ± 28.46) months,t =-3.700,P =0.004).However,there was no significant difference in the rate of clinical recurrence between small bowel CD and ileocolonic,colonic CD.Conclusions Patients with small bowel CD account for a large proportion in patients with CD,especially in males.Stricture is more common in jejunum CD.The time duration between induction of remission and clinical recurrence of small bowel CD is short.
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ObjectiveTo unify the definitions of colonoscopic characteristics of Crohn disease (CD) and intestinal tuberculosis ( ITB),and to evaluate colonoscopic and clinical features in the differential diagnosis of CD and ITB.MethodsA collaborative group composed of 10 experts from 5 hospitals voted to identify and confirm the colonoscopic characteristics.Clinical and colonoscopic characteristics were analyzed,thereafter,characteristics were scored based on different diagnostic specificity.ROC curve was used for determining the cutoff point to differentiate CD from ITB.ResultsFirstly,standard endoscopic images and descriptions were determined.Secondly,colonoscopic parameters which were significantly different between the CD and ITB patients included the follows:involvement of more than four intestinal segments,anorectal involvement,longitudinal ulcers,cobblestone appearance and transverse ulcers.Clinical findings which were significantly different between the CD and ITB patients included active pulmonary tuberculosis,PPD-test strong positive,anal fistula/perianal abscess and extra-intestinal manifestations in CD.4.4％(6/136) patients were confirmed by histological evidence of caseating granulomas.By using our scoring system,39.7％ (54/136) confirmed diagnoses and 18.4％ (25/136) suspected diagnoses were made in patients without histological evidence.ConclusionIdentification of colonoscopic characteristics and unification of the colonscopic diagnostic criteria were helpful in the differential diagnosis between CD and ITB.The differential diagnosis rate could he improved by using the scoring system.Half cases could not be confirmed even with combined pathology and the scoring system,so a more comprhensive scoring system would be warranted.
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OBJECTIVE@#To understand the value of Child-Pugh (CP) classification and model of end-stage liver disease (MELD) score for patients with cirrhosis and their prognosis by retrospectively analyzing the two methods in hemorrhage death and non-hemorrhage death in patients with liver cirrhosis.@*METHODS@#A total of 72 patients who died of cirrhosis (the death group) were analyzed retrospectively, and the initial data in the hospital before death were collected. The initial information of the control group (88 patients) at the same time was also obtained. The death group was divided into two subgroups: esophagus varicosity burst massive hemorrhage death group and non-hemorrhage death group.@*RESULTS@#MELD score and CP score of the death group (22.230±13.451, 10.264±2.028) were significantly higher than those of the control group (15.370±6.201, 9.318±1.644; P<0.05). The MELD score and CP score for the massive bleeding death group were close to those of the control group. There was significant difference between the non-hemorrhage death group and the control group. The ratio of patients with CP grade A and MELD scores<20 died for massive bleeding in the death group was more than 70%, and that of CP grade C and MELD scores ≥ 30 in the death group was higher. ROC surve analysis found the accuracy of short-term predication of survival by MELD score and CP classification was improved after eliminating the risk factors of hemorrage.@*CONCLUSION@#MELD and CP play a role in evaluating the state and prognosis of patients with cirrhosis. MELD score and CP classification predict the short-term survival efficiently on the premise of excluding the risk factors of esophagus and/or stomach bottom varicosity burst massive bleeding. CP and MELD scores are deficiencies, especially for low MELD score (<20) and CP level A patients. The prognostic accuracy may be improved when combining esophageal gastric fundal varices.
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Humans , End Stage Liver Disease , Diagnosis , Mortality , Esophageal and Gastric Varices , Liver Cirrhosis , Diagnosis , Mortality , Prognosis , ROC Curve , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
OBJECTIVE@#To analyze the characteristics of intestinal flora in Crohn's disease (CD) and intestinal tuberculosis (ITb), and to find potential identification features to differentiate these 2 diseases.@*METHODS@#Fifteen CD patients, 23 ITb patients, and 21 healthy volunteers (controls) were enrolled from June 2007 to November 2009. Selective culturing was used for the enumeration of bacteria count.@*RESULTS@#The intestinal flora was mainly composed of Bifidobacteria, Bacteroids, Escherichia coli and Staphylococcus aureus both in CD and ITb patients. Lactobacillus and Bifidobacteria decreased obviously but Bacteroid increased in CD patients compared with the control (P0.05).@*CONCLUSION@#Intestinal flora disorder occurred in either CD or ITb patients. The alteration of Bacteroid and Escherichia coli can help differentiate the 2 diseases.