Guidelines for the Management of Crohn's Disease / 대한소화기학회지

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) with uncertain etiopathogenesis. CD can involve any site of gastrointestinal tract from the mouth to anus and is associated with serious complications such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies are currently applied for diverse clinical situations of CD. However, a lot of decisions on the management of CD are made depending on the personal experiences and personal dicision of physicians. To suggest preferable approaches to diverse problems of CD and to minimize the variations according to physicians, guidelines for the management of CD are needed. Therefore, IBD Study Group of the Korean Association for the Study of the Intestinal Diseases has set out to develop the guidelines for the management of CD in Korea. These guidelines were developed using the adaptation methods and encompass the treatment of inflammatory disease, stricturing disease, and penetrating disease. The guidelines also cover the indication of surgery, prevention of recurrence after surgery, and CD in pregnancy and lactation. These are the first Korean guidelines for the management of CD and the update with further scientific data and evidences is needed.

Successful Primary Infliximab Treatment of Orofacial Crohn's Disease without Gastrointestinal Manifestation / 대한소화기학회지

Crohn's disease is a chronic inflammatory bowel disease that can involve the whole gastrointestinal tract. The orofacial manifestation of Crohn's disease, which is rare, can develop irrespective of intestinal involvement. These orofacial lesions are often misdiagnosed as simple oral ulcers. Corticosteroids are the mainstay of therapy for orofacial Crohn's disease. However, infliximab, the chimeric monoclonal antibody to tumor necrosis factor-alpha, is now considered as a primary treatment because of the disease's relatively high rate of steroid resistance. We present a case of deep oral ulcer and periorbital swelling in a 65-year-old woman. She was diagnosed with intestinal Crohn's disease 7 years ago, which was in remission after treatment with an immunosuppressive agent (azathioprine). The patient was given the diagnosed with orofacial Crohn's disease and successfully treated with infliximab.

A Case of Primary Colon Amyloidosis Presenting as Hematochezia / 대한소화기학회지

Amyloidosis is characterized by a deposition of insoluble fibrils in various organs and tissues. Amyloid deposition, in the gastrointestinal track, provokes a dysfunction of the organ, due to an accumulation of fibrils, and causes a variety of clinical symptoms and endoscopic findings. Primary amyloidosis in the gastrointestinal tract is rarely reported in Korea. We experienced a case of recurrent intestinal bleeding, in a 59-year-old female patient with primary amyloidosis. A colonoscopy revealed the presence of multiple large circular ulcers. In the entire colon, diffuse nodular lesions with edema and bleeding were found. A colonoscopic biopsy established the diagnosis of amyloidosis, to the exclusion of other disease components. We concluded that the patient had localized amyloidosis. Though a definitive therapeutic strategy has not been established for localized gastrointestinal amyloidosis, the patient has been successfully treated with a high-dose of steroids and azathioprine.

Wegener granulomatosis; diagnosis and management

To highlight the different clinical features, parameters of diagnosis and to see the effect of chemotherapy and steroids on this disease. Department of Otolaryngology Head and Neck Surgery Jinnah Hospital Lahore. From Dec 1998 to July 2001. Five cases of Wegener Granulomatosis were studied during the study period. Three patients had limited disease while two patients had generalized disease with renal involvement. All patients were started on azathiopurine [2mg/Kg/day] orcyclophoshamide [1-2mg/kg/day] along with steroids. After a months time the dose of steroid was reduced to alternate day. Weekly monitoring of white blood cell count with urine examination for RBCs or protein casts was done. Any patient with haematuria or TLC reduced to less than 3500 were immediately taken off from cyclophosphamide and azathiopurine was started. Patients having classic disease, dose of cyclophoshamide had to be increased from two to four milligram / per Kilogram per day to achieve a good response. The response to treatment was measured by noticing the resolution of pulmonary infiltrates reduced ESR and negative C-ANCA. We found nasal symptoms like nasal obstruction and epistaxis to be the most common symptom followed by fever, cough and deafness. Crusting, granulations and occasional perforation were usually found on nasal examination. Conductive deafness was most common ear finding. History, clinical examination, ESR, C-ANCA and a representative biopsy were all essential in diagnosing this condition. Azathiopurine and cyclophosphamide were the main chemotherapeutic agents used with prednisone to cause remission in all our patients except one who died two weeks after having been admitted in our institution. Surprisingly in contrast to the normal cause of high mortality reported in international literature in this disease to be renal failure, our patient died due to respiratory failure. Four out of five patients went into remission a year after regular treatment with this regime. The major complications occurring during hospital stay and their treatment were nausea, vomiting, sudden fall of TLC, and oral thrush. The common presentation of patient with Wegner's Granulomatosis is of upper respiratory tract symptoms like nasal obstruction and epistaxis followed by lower respiratory symptoms like cough, fever and Haemoptysis. A representative biopsy with positive C-ANCA and high ESR are hallmarks of diagnosing this condition. The most effective medical regime till today is cyclophosphamide and azathiopurine with alternate day prednisone for inducing remission