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1.
Journal of Integrative Medicine ; (12): 194-204, 2023.
Article in English | WPRIM | ID: wpr-971652

ABSTRACT

OBJECTIVE@#This study was conducted to explore the mechanism of intestinal inflammation and barrier repair in Crohn's disease (CD) regulated by moxibustion through bile acid (BA) enterohepatic circulation and intestinal farnesoid X receptor (FXR).@*METHODS@#Sprague-Dawley rats were randomly divided into control group, CD model group, mild moxibustion group and herb-partitioned moxibustion group. CD model rats induced by 2,4,6-trinitrobenzene sulfonic acid were treated with mild moxibustion or herb-partitioned moxibustion at Tianshu (ST25) and Qihai (CV6). The changes in CD symptoms were rated according to the disease activity index score, the serum and colon tissues of rats were collected, and the pathological changes in colon tissues were observed via histopathology. Western blot, immunohistochemistry (IHC) and immunofluorescence were used to evaluate the improvement of moxibustion on intestinal inflammation and mucosal barrier in CD by the BA-FXR pathway.@*RESULTS@#Mild moxibustion and herb-partitioned moxibustion improved the symptoms of CD, inhibited inflammation and repaired mucosal damage to the colon in CD rats. Meanwhile, moxibustion could improve the abnormal expression of BA in the colon, liver and serum, downregulate the expression of interferon-γ and upregulate the expression of FXR mRNA, and inhibit Toll-like receptor 4 (TLR4) and myeloid differentiation factor 88 (MyD88) mRNA. The IHC results showed that moxibustion could upregulate the expression of FXR and mucin2 and inhibit TLR4 expression. Western blot showed that moxibustion inhibited the protein expression of TLR4 and MyD88 and upregulated the expression of FXR. Immunofluorescence image analysis showed that moxibustion increased the colocalization sites and intensity of FXR with TLR4 or nuclear factor-κB p65. In particular, herb-partitioned moxibustion has more advantages in improving BA and upregulating FXR and TLR4 in the colon.@*CONCLUSION@#Mild moxibustion and herb-partitioned moxibustion can improve CD by regulating the enterohepatic circulation stability of BA, activating colonic FXR, regulating the TLR4/MyD88 pathway, inhibiting intestinal inflammation and repairing the intestinal mucosal barrier. Herb-partitioned moxibustion seems to have more advantages in regulating BA enterohepatic circulation and FXR activation. Please cite this article as: Shen JC, Qi Q, Han D, Lu Y, Huang R, Zhu Y, Zhang LS, Qin XD, Zhang F, Wu HG, Liu HR. Moxibustion improves experimental colitis in rats with Crohn's disease by regulating bile acid enterohepatic circulation and intestinal farnesoid X receptor. J Integr Med. 2023; 21(2): 194-204.


Subject(s)
Rats , Animals , Crohn Disease/pathology , Moxibustion/methods , Toll-Like Receptor 4/metabolism , Rats, Sprague-Dawley , Myeloid Differentiation Factor 88/metabolism , Colitis , Inflammation , Enterohepatic Circulation , RNA, Messenger/metabolism
2.
São Paulo; s.n; s.n; 2021. 95 p. tab, graf, ilus.
Thesis in Portuguese | LILACS | ID: biblio-1415542

ABSTRACT

As doenças inflamatórias intestinais (DIIs) são enfermidades crônicas desencadeadas por grave inflamação no trato gastrointestinal. Entre os mediadores imunes envolvidos na patogênese das DIIs, o fator de necrose tumoral alfa (TNF-α) e sugerido como citocina primordial. Assim, ferramentas de inativação da via do TNF-α, como o infliximabe (IFX), tem sido amplamente aplicadas no tratamento destas doenças. Embora o IFX seja eficaz na indução/manutenção de remissão das DIIs, ainda há relatos de efeitos adversos ou pacientes refratários a imunoterapia. Por esse motivo, e emergente a necessidade de identificar biomarcadores associados ao sucesso das terapias biológicas. Estudos prévios em pacientes com Doença de Crohn (DC) mostraram que a expressão da proteína anti-inflamatória anexina A1 (AnxA1) sistêmica e na mucosa intestinal e aumentada após IFX e correlacionada com a melhora da qualidade de vida. A AnxA1 e o seu peptídeo N-terminal, Ac2-26, desempenham suas funções na resolução da inflamação via receptores para peptídeo formilado (FPRs). No presente estudo, nós investigamos de que maneira os FPRs e a AnxA1 participam dos mecanismos do IFX. No modelo de colite experimental induzida por dextran sulfato de sódio (DSS) em camundongos selvagens (WT) e deficientes para AnxA1 endógena (AnxA1-/-), o IFX atenuou as manifestações clínicas da doença apenas em animais WT. O bloqueio dos FPRs com o antagonista Boc-2 reverteu a melhora observada nos animais tratados, enquanto a ausência da AnxA1 endógena revogou completamente a eficácia do tratamento. Ainda, a resposta inflamatória da colite foi exacerbada nos animais AnxA1-/- após IFX, que apresentaram redução de células T regulatórias e aumento da MMP9 no colon, encurtamento do intestino grosso, ausência de melhora histológica e mortalidade de 50%. Nos animais WT, por sua vez, o bloqueio dos FPRs impediu a melhora clínica e a regeneração das criptas mucosas, com desorganização da ß-actina e da borda em escova. Nas células epiteliais do intestino da linhagem Caco-2 estimuladas por TNF-α in vitro, confirmamos que os efeitos protetivos do IFX nas junções celulares são perdidos após bloqueio do FPR1 e do FPR2, comprometendo a integridade desta barreira. No colon, o IFX induziu a expressão e secreção da AnxA1 em células da lamina própria após colite, e essa secreção foi dose-dependente em células da lamina própria tratadas ex vivo, demonstrando que a secreção da AnxA1 por células do tecido conjuntivo pode constituir um dos mecanismos resolutivos desta terapia. Em humanos, o tratamento com IFX na DC não modificou as expressões de FPR1 e FPR2 nos leucócitos circulantes ou da AnxA1 plasmática, não permitindo a diferenciação de pacientes responsivos ou não. No entanto, a AnxA1 tecidual estava aumentada em pacientes que respondem ao IFX, e os níveis de AnxA1 e FPR1 foram negativamente correlacionados a remissão histológica. Por fim, análises de bioinformática revelaram expressões diferenciais dos mRNAs de FPR1, FPR2 e AnxA1 no colon entre pacientes remissivos ou refratários mesmo antes do início das infusões, mas esse mesmo padrão não foi observado nos PBMCs do sangue. Em conclusão, sugerimos que a indução da AnxA1 pode ser um dos mecanismos de resolução do IFX, e que é complementado pela ativação de FPRs. Ainda, estes marcadores podem apresentar valor preditivo da eficácia do IFX, contribuindo para o alcance da remissão da DC de maneira mais rápida e permanente


Inflammatory bowel diseases (IBDs) are chronic debilitating illnesses triggered by severe inflammation of the gastrointestinal tract. The tumor necrosis factor alpha (TNF-α) is pointed out as a primordial mediator of IBD pathogenesis; thus, inactivating tools targeting this cytokine have been widely used to treat these diseases. Although IFX is very efficient in inducing/maintaining remission in patients with IBD, side effects and unresponsiveness are still reported, emerging the need for the identification of biomarkers linked to therapeutical efficacy. In the Crohns disease (CD), systemic and tissue expressions of the anti-inflammatory protein, annexin A1 (AnxA1), are increased after IFX treatment and correlate with life quality improvement according to previous reports. AnxA1 and its N-terminal peptide, Ac2-26, act via formyl peptide receptors (FPRs); therefore, the present investigation aimed to understand how FPRs and AnxA1 participate in IFX mechanisms. In the experimental colitis model induced by dextran sulphate sodium (DSS) in wild-type (WT) and AnxA1-deficient mice (AnxA1-/-), IFX attenuated the clinical manifestations only in the WT group. FPRs blockade using the antagonist, Boc-2, impaired IFX effects in WT mice, while AnxA1 absence completely abrogated its efficacy. Furthermore, the inflammatory response was exacerbated after IFX in AnxA1-/- mice, with reduced T regulatory cells, increased tissue MMP9, large intestine shortening, lack of histological remission and 50% mortality. In WT mice, FPR blockade reverted the clinical recovery and mucosal crypts regeneration, with b-actina and brush border disorganization. Using the intestinal epithelial cell line Caco-2 stimulated with TNF-α in vitro, we confirmed that IFX protective effects on tight junctions are lost after FPR1 and FPR2 blockade, compromising the barrier integrity. In the colonic tissue, the expression and secretion of AnxA1 were induced by IFX after colitis. This secretion was shown to be dose-dependent in cells from the intestinal lamina propria treated ex vivo, demonstrating that secreted AnxA1 could constitute one of the resolutive mechanisms of that therapy. In humans with CD, IFX did not modify the expressions of FPR1 and FPR2 in circulating leukocytes or the plasma AnxA1 levels, not differentiating patients responsive or not. However, tissue AnxA1 expression was augmented in responsive patients, and AnxA1/FPR1 levels were negatively correlated with histological remission. Finally, bioinformatic analyses revealed differential expression of FPR1, FPR2 and AnxA1 mRNAs in the colon among remittent or refractory patients even before the beginning of infusions, which was not observed for samples of blood PBCM. In conclusion, we suggest that inducing tissue AnxA1 might be one of the resolution mechanisms of IFX, which is complemented by the activation of FPRs. Moreover, these markers could present predictive value of IFX efficacy, contributing to reaching an early and more permanent remission in IBD


Subject(s)
Animals , Male , Mice , Inflammatory Bowel Diseases/pathology , Annexin A1/adverse effects , Infliximab/administration & dosage , Infliximab/adverse effects , Crohn Disease/pathology , Drug-Related Side Effects and Adverse Reactions
3.
J. coloproctol. (Rio J., Impr.) ; 40(4): 421-424, Oct.-Dec. 2020.
Article in English | LILACS | ID: biblio-1143175

ABSTRACT

ABSTRACT Perianal fistulizing Crohn's disease (PFCD) is one of the most complex challenges in the colorectal surgery nowadays, because, even with combined clinical and surgical treatment, the rate of healing of the fistulas is approximately 50%. In this context, the monitoring of serum levels of anti-Tumor Necrosis Factor (anti-TNF) drugs appears as a crucial tool for the optimization of treatment, since there is a probable correlation between higher serum levels of infliximab and adalimumab with better outcomes of the disease, higher healing rates and lower recurrence rates. This review describes evidence on the use of serum anti-TNF levels and their relationship to clinical and radiological efficacy.


RESUMO A Doença de Crohn Perianal Fistulizante (DCPF) configura-se como um dos desafios mais complexos da cirurgia colorretal atualmente, isso porque, mesmo com tratamento clínico e cirúrgico combinados, a taxa de cicatrização das fistulas é de aproximadamente 50%. Nesse contexto, a monitorização de níveis séricos de drogas anti-Fator de Necrose Tumoral (anti-TNF) surge como ferramenta crucial para a otimização do tratamento, uma vez há provável correlação entre maiores níveis séricos de infliximabe e adalimumabe com melhores desfechos da doença, maiores taxas de cicatrização e menores índices de recorrência. Nesta revisão são descritas evidências sobre o uso dos níveis séricos de anti-TNF e sua relação com a eficácia clínica e radiológica.


Subject(s)
Humans , Crohn Disease/pathology , Tumor Necrosis Factor-alpha/therapeutic use , Fistula/complications
4.
J. coloproctol. (Rio J., Impr.) ; 39(4): 373-380, Oct.-Dec. 2019.
Article in English | LILACS | ID: biblio-1056641

ABSTRACT

Abstract Introduction Crohn's Disease is a chronic and idiopathic inflammatory process with transmural invasion that can affect the entire gastrointestinal tract. The etiopathogenesis of this pathology is not fully understood and studies have been carried out to understand the influence of different kind of factors on its development, including appendectomy. This monograph aims to address the possible existence of a link between appendectomy and Crohn's Disease, and the possible causes and clinical consequences of this association. Methods This monograph was based on the research of original scientific articles in MEDLINE database via PubMed, restricted to articles in Portuguese and English during the period between 1991 and 2017. Results Appendectomy seems positively associated with the development of Crohn's Disease, especially in the first years of surgery, regardless of whether or not there is inflammation of the appendix. In fact, the appendix plays important roles in gastrointestinal integrity, acting in the development of an adequate immune response, maintaining and regulating the intestinal flora. Conclusion The appendix is important for intestinal homeostasis, preventing the development of certain pathologies. Its resection, regardless of whether or not there is an inflammation after surgery, increases the risk of Crohn's Disease and worsens the prognosis of this pathology, so appendectomy should be avoided in the absence of appendicitis.


Resumo Introdução A Doença de Crohn é um processo inflamatório crónico e idiopático com atingimento transmural que pode afetar todo o trato gastrointestinal. A etiopatogenia desta patologia não está completamente esclarecida pelo que se tem vindo a realizar estudos para perceber a influência de diferentes fatores no seu desenvolvimento, entre os quais a apendicectomia. Esta monografia visa abordar a existência de uma possível relação entre apendicectomia e Doença de Crohn e as possíveis causas e consequências clínicas desta associação. Métodos Esta monografia foi elaborada com base em artigos científicos originais pesquisados na base de dados MEDLINE via PubMed, com restrição a artigos em português e inglês com limite temporal de 1991 a 2017. Resultados A apendicectomia parece associar-se positivamente ao desenvolvimento da Doença de Crohn, principalmente nos primeiros anos após a cirurgia, independentemente de haver ou não inflamação do apêndice. De facto, o apêndice desempenha importantes funções na integridade gastrointestinal, com influência no desenvolvimento de uma resposta imunológica adequada e na manutenção e regulação da flora intestinal. Conclusão O apêndice é importante na homeostasia intestinal, prevenido o desenvolvimento de determinadas patologias. A sua ressecção, independentemente do facto de haver ou não inflamação aquando da cirurgia, aumenta o risco de Doença de Crohn e piora o prognóstico desta patologia, pelo que a apendicectomia deve ser evitada na ausência da doença.


Subject(s)
Appendectomy , Appendix , Crohn Disease , Appendix/surgery , Crohn Disease/pathology , Cecal Diseases
6.
J. coloproctol. (Rio J., Impr.) ; 38(3): 240-245, July-Sept. 2018.
Article in English | LILACS | ID: biblio-954604

ABSTRACT

ABSTRACT Crohn's disease has an ever-increasing prevalence and incidence, with about 20% of patients developing perianal fistula with significant impact on their quality of life. Despite the medical and surgical treatments currently used, Crohn's-related fistula treatment continues to pose a challenge due to the low rates of efficacy associated with high recurrence rates. Recent clinical trials have shown promising results regarding safety and efficacy of local treatment of this condition with the use of adipose tissue-derived mesenchymal stem cells. Besides being pluripotent and poorly immunogenic, they have immunomodulatory and anti-inflammatory properties, which combined, may accelerate healing. Our main objective is to summarize the clinical trials we found, highlighting the efficacy rates of this therapy and the main limitations we found in the analysis of the results. We conclude that, in perianal fistulas refractory to conventional therapies, the treatment with adipose tissue-derived mesenchymal cells is safe with promising results that may change the current paradigm of Crohn's related fistula treatment.


RESUMO A incidência e a prevalência da doença de Crohn têm aumentado e, ao longo do decurso da doença, cerca de 20% dos doentes irão desenvolver fístulas perianais com impacto significativo na sua qualidade de vida. Apesar dos tratamentos médicos e cirúrgicos utilizados atualmente, o tratamento destas fístulas continua a constituir um desafio com baixas taxas de eficácia e com elevadas taxas de recorrência. Ensaios clínicos recentes têm demonstrado resultados promissores em termos de segurança e eficácia de tratamentos locais destas fístulas com o recurso a células estaminais mesenquimatosas derivadas do tecido adiposo que, além de pluripotentes e pouco imunogênicas, têm capacidades imunomoduladoras e anti-inflamatórias capazes de promover o processo de cicatrização. O objetivo desta revisão sistemática é sumarizar os ensaios clínicos encontrados, realçando as taxas de eficácia desta terapêutica e as principais limitações na análise dos resultados. Concluímos que, nas fístulas perianais refratárias ás terapias convencionais, o tratamento com com celulas estaminais mesenquimatosas derivadas do tecido adiposo é seguro e com resultados promissores que podem mudar o paradigma atual do tratamento das fistulas complexas associadas à Doença de Crohn.


Subject(s)
Humans , Male , Female , Crohn Disease/pathology , Rectal Fistula/therapy , Mesenchymal Stem Cells/cytology , Adipose Tissue/cytology , Treatment Outcome
7.
Arq. gastroenterol ; 55(3): 290-295, July-Sept. 2018. tab
Article in English | LILACS | ID: biblio-973896

ABSTRACT

ABSTRACT BACKGROUND: The diagnosis of inflammatory bowel disease is often delayed because of the lack of an ability to recognize its major clinical manifestations. OBJECTIVE: Our study aimed to describe the onset of clinical manifestations in inflammatory bowel disease patients. METHODS: A cross-sectional study. Investigators obtained data from interviews and the medical records of inflammatory bowel disease patients from a reference centre located in Brazil. RESULTS: A total of 306 patients were included. The mean time between onset of symptoms and diagnosis was 28 months for Crohn's disease and 19 months for ulcerative colitis. The main clinical manifestations in Crohn's disease patients were weight loss, abdominal pain, diarrhoea and asthenia. The most relevant symptoms in ulcerative colitis patients were blood in the stool, faecal urgency, diarrhoea, mucus in the stool, weight loss, abdominal pain and asthenia. It was observed that weight loss, abdominal pain and distension, asthenia, appetite loss, anaemia, insomnia, fever, nausea, perianal disease, extraintestinal manifestation, oral thrush, vomiting and abdominal mass were more frequent in Crohn's patients than in ulcerative colitis patients. The frequencies of urgency, faecal incontinence, faeces with mucus and blood, tenesmus and constipation were higher in ulcerative colitis patients than in Crohn's disease patients. The mean time from the onset of clinical symptoms to the diagnosis of Crohn's disease was 37 months for patients with ileocolonic location, 26 months for patients with ileum location and 18 months for patients with colon location. In ulcerative colitis patients, the mean time from the onset of symptoms to diagnosis was 52 months for proctitis, 12 months for left-sided colitis and 12 months for extensive colitis. CONCLUSION: Ulcerative colitis presented a high frequency of intestinal symptoms, and Crohn's disease showed a high frequency of systemic manifestations at the onset of manifestation. There was a long delay in diagnosis, but individuals with more extensive disease and more obvious symptoms showed a shorter delay.


RESUMO CONTEXTO: O diagnóstico da doença inflamatória intestinal é frequentemente retardado pela falta de capacidade para reconhecer as suas principais manifestações clínicas. OBJETIVO: Nosso estudo teve como objetivo descrever as manifestações clínicas iniciais em pacientes com doença inflamatória intestinal. MÉTODOS: Estudo transversal. Os pesquisadores obtiveram dados por entrevistas e registros médicos de pacientes com doença inflamatória intestinal em um centro de referência localizado na Bahia. RESULTADOS: Foram incluídos 306 pacientes. O tempo entre o início dos sintomas e o diagnóstico foi de 28 (±48) meses para doença de Crohn e 19 (±46) meses para colite ulcerativa. O tempo médio desde o início dos sintomas clínicos até o diagnóstico de doença de Crohn foi de 37 meses para pacientes com localização do ileocolon, 26 meses para a localização do íleo e 18 meses para a localização do cólon. Nos doentes com colite ulcerativa, o tempo médio desde o início dos sintomas até ao diagnóstico foi de 52 meses para proctite, 12 meses para colite no lado esquerdo e 12 meses para colite extensa. As principais manifestações clínicas em pacientes com doença de Crohn foram perda de peso, dor abdominal, diarreia e astenia. Os sintomas mais relevantes da colite ulcerativa foram sangue nas fezes, urgência fecal, diarreia, muco nas fezes, perda de peso, dor abdominal e astenia. Observou-se que a perda de peso, dor abdominal e distensão, astenia, perda de apetite, anemia, insônia, febre, náusea, doença perianal, manifestação extraintestinal, afta oral, vômitos e massa abdominal foram mais frequentes na doença de Crohn. A frequência de urgência e incontinência fecal, fezes com muco e sangue, tenesmo e constipação foram maiores na colite ulcerativa. CONCLUSÃO: A colite ulcerativa apresentou alta frequência de sintomas intestinais e a doença de Crohn mostrou alta frequência de manifestações sistêmicas. Houve um grande atraso no diagnóstico, mas indivíduos com doença mais extensa e sintomas mais exuberantes mostraram um atraso menor.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/pathology , Crohn Disease/diagnosis , Crohn Disease/pathology , Brazil , Colitis, Ulcerative/physiopathology , Crohn Disease/physiopathology , Cross-Sectional Studies , Age of Onset , Early Diagnosis , Delayed Diagnosis , Middle Aged
8.
Rev. Col. Bras. Cir ; 45(6): e1840, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-976939

ABSTRACT

RESUMO Objetivo: determinar o papel da ultrassonografia endoscópica (UE) em relação à ressonância magnética nuclear (RMN) e ao exame sob anestesia (ESA) no manejo de pacientes com doença de Crohn fistulizante perianal. Métodos: estudo observacional transversal com pacientes com doença de Crohn perianal, avaliados em um centro terciário de Curitiba, Paraná, Brasil, de fevereiro de 2016 a março de 2017. Todos os pacientes foram submetidos à UE, RMN e ESA. O grau de concordância entre os três métodos foi avaliado através da obtenção do coeficiente de Kappa. Um valor de Kappa de 0,7 ou maior indicou boa concordância. O teste não paramétrico de Friedman foi utilizado para comparar o número de trajetos fistulosos detectados em cada modalidade. Considerou-se o nível de significância estatística como p<0,05. Resultados: vinte pacientes foram incluídos. Houve concordância entre os três exames em 11 pacientes. O nível de concordância de Kappa entre os três exames foi 0,53 (moderado) (p<0,001). Não houve diferença estatisticamente significativa em relação ao número de trajetos fistulosos detectados nos três exames (p=0,641). Houve falha na identificação de um trajeto fistuloso em três pacientes com a UE, em três pacientes com a RMN e em dois pacientes com o ESA. Conclusão: a UE foi comparável à RMN e ao ESA para avaliação da doença de Crohn fistulizante perianal, e pode ser considerada um exame válido para investigação pré-operatória desses pacientes.


ABSTRACT Objective: to determine the role of endoscopic ultrasonography (EU) in comparison with nuclear magnetic resonance imaging (MRI) and examination under anesthesia (EUA) in the management of patients with perianal fistulizing Crohn's disease. Methods: we conducted a cross-sectional, observational study with patients with perianal Crohn's disease evaluated at a tertiary center in Curitiba, Paraná, Brazil, from February 2016 to March 2017. All patients underwent EU, MRI and EUA. We evaluated the degree of agreement between the three methods by obtaining the Kappa coefficient. A Kappa value of 0.7 or greater indicated good agreement. We used the Friedman's non-parametric test to compare the number of fistulous paths detected in each modality. We set the level of statistical significance at p<0.05. Results: we included 20 patients. There was agreement between the three exams in 11 patients. The level of Kappa agreement between the three exams was 0.53 (moderate - p<0.001). There was no statistically significant difference in relation to the number of fistulous trajectories detected in the three exams (p=0.641). EU failed to identify a fistulous pathway in three patients; MRI failed in three; and EUA failed in two. Conclusion: EU was comparable to MRI and EUA for the evaluation of perianal fistulizing Crohn's disease, and can be considered a valid exam for preoperative investigation of such patients.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Magnetic Resonance Imaging/methods , Crohn Disease/pathology , Crohn Disease/diagnostic imaging , Rectal Fistula/pathology , Rectal Fistula/diagnostic imaging , Endosonography/methods , Reference Values , Cross-Sectional Studies , Reproducibility of Results , Rectal Fistula/classification , Anesthesia/methods , Middle Aged
9.
An. bras. dermatol ; 92(2): 263-265, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-838065

ABSTRACT

Abstract: Sweet's syndrome is an uncommon benign skin disorder, whose pathogenesis remains unknown. Its classic form is more common in women and presents itself as papular-nodular, painful and erythematous or violaceous lesions. It mainly affects the face, neck, and upper limbs. Fever and neutrophilic leukocytosis are also common features. Although it is considered a systemic disease marker in more than half of patients, the association of this condition with Crohn's disease is rare, with few cases reported in the literature, of which, none in Brazil. We report the case of a patient with Crohn's disease who developed the classical features of Sweet's syndrome.


Subject(s)
Humans , Female , Adult , Crohn Disease/complications , Sweet Syndrome/complications , Skin Diseases/pathology , Crohn Disease/pathology , Sweet Syndrome/pathology
10.
An. bras. dermatol ; 92(5,supl.1): 104-106, 2017. graf
Article in English | LILACS | ID: biblio-887087

ABSTRACT

Abstract Metastatic Crohn's disease is a rare extraintestinal manifestation of Crohn's disease. It is characterized by polymorphic skin lesions formed by non-caseating granulomas located on anatomical sites distant from the gastrointestinal tract. We report a rare case of metastatic Crohn's disease, simultaneously displaying multiple clinically heterogeneous cutaneous lesions, in a patient with previously diagnosed Crohn's disease in remission due to anti-TNF-α use. This case highlights the need for high clinical suspicion and early biopsy in the setting of a patient with Crohn's disease and persistent skin lesions, even under biologic therapy. Furthermore, it reinforces the need of monitoring of the serum level of infliximab, increasing the dose in case it is low or undetectable.


Subject(s)
Humans , Female , Adult , Gastrointestinal Agents/therapeutic use , Crohn Disease/complications , Crohn Disease/drug therapy , Erythema/etiology , Infliximab/therapeutic use , Skin/pathology , Biopsy , Crohn Disease/pathology , Erythema/pathology
11.
An. bras. dermatol ; 91(4): 531-533, July-Aug. 2016. graf
Article in English | LILACS | ID: lil-792437

ABSTRACT

Abstract: Metastatic Crohn's disease is a rare skin manifestation, defined by granulomatous skin lesions that are discontinuous to the affected gastrointestinal tract and histopathologically resembling inflammatory bowel lesions. Up to 44% of patients with Crohn's disease have cutaneous manifestations, of which metastatic lesions are the least common. We present a case of an adolescent with refractory Crohn's disease and persistent papules and plaques on the skin.


Subject(s)
Humans , Female , Adolescent , Crohn Disease/complications , Crohn Disease/pathology , Erythema/etiology , Erythema/pathology , Skin/pathology , Biopsy
12.
J. coloproctol. (Rio J., Impr.) ; 36(1): 21-26, Jan.-Mar. 2016. tab, graf
Article in English | LILACS | ID: lil-780061

ABSTRACT

BACKGROUND: Colonoscopy is part of the current diagnostic armamentarium. However, in some patients with chronic diarrhea, a colonoscopy may show normal mucosa; in these cases, serial biopsies can provide important information for the diagnosis and treatment of patients. AIM: To analyze patients with chronic diarrhea having a macroscopically normal colonoscopy, by evaluating histological changes. METHODS: 30 patients with chronic diarrhea and normal colonoscopy were prospectively evaluated and submitted to serial biopsies of the terminal ileum, ascending colon and rectum. RESULTS: The sample of 30 patients showed a ratio of 18 men (60%) and 12 women (40%). On histological types, it was found that 13 patients (43.3%) had lymphoid hyperplasia, eosinophilic inflammation in 4 (13.3%), nonspecific inflammation in 4 (13.3%), regenerative changes in 3 (10%), lymphocytic colitis in 2 (6.6%) and changes consistent with Crohn's disease in 1 (3.3%). CONCLUSIONS: One can observe that even chronic diarrhea patients, without other associated factors, benefited from colonoscopy with biopsy, because it held the etiologic diagnosis in some cases as also excluded by histopathology. It was noticed that the frequency of patients with altered biopsy and less dragged diarrheal episodes (84.2%) was large, should consider their achievement.


INTRODUÇÃO: A colonoscopia faz parte do arsenal de diagnóstico atual. Porém, em alguns pacientes com diarreia crônica, a colonoscopia pode evidenciar mucosa normal; nesses casos biópsias seriadas podem trazer informações importantes para o diagnóstico e tratamento dos pacientes. OBJETIVO: Analisar pacientes com diarreia crônica submetidos à colonoscopia macroscopicamente normal, avaliando assim histologicamente as alterações. MÉTODOS: Análise prospectiva da histologia 30 pacientes com diarreia crônica e colonoscopias normais, submetidos a biópsias seriadas de íleo terminal, cólon ascendente e reto. RESULTADOS: A amostra de 30 pacientes mostrou uma proporção de 18 homens (60%) e 12 mulheres (40%). Sobre os tipos de alterações histológicas, foi verificado que 13 pacientes (43,3%) apresentaram hiperplasia linfóide, inflamação eosinofílica em 4 (13,3%), inflamação inespecífica em 4 (13,3%), alterações regenerativas em 3 (10%), colite linfocítica em 2 (6,6%) e alterações compatíveis com Doença de Crohn em 1 (3,3%). CONCLUSÕES: Observou-se que mesmo pacientes com diarreia crônica, sem outros fatores associados, beneficiaram-se da colonoscopia com biópsia, pois a mesma realizou o diagnóstico etiológico em alguns casos como também o excluiu através da histopatologia. Verificou-se que a frequência de pacientes com biópsia alterada e quadros diarreicos menos arrastados (84,2%) foi grande, devendo-se considerar a realização do exame.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Rectum/surgery , Crohn Disease/surgery , Pseudolymphoma , Colon, Ascending/surgery , Diarrhea/diagnosis , Diarrhea/pathology , Rectum/pathology , Crohn Disease/pathology , Colonoscopy , Colon, Ascending/pathology , Colitis, Lymphocytic , Diarrhea/microbiology , Inflammation
13.
Rev. argent. ultrason ; 14(1): 28-30, mar. 2015. ilus
Article in Spanish | LILACS | ID: lil-763809

ABSTRACT

Se presenta el caso de una hembra canina de raza indefinida con síntomas de diarrea crónica a la que se le diagnosticó una enteritis granulomatosa crónica por medio de histopatología. Este estudio describe los hallazgos ecográficos observados.


Subject(s)
Animals , Dogs , Crohn Disease/diagnosis , Crohn Disease/pathology , Crohn Disease , Crohn Disease/veterinary , Dog Diseases/diagnosis , Dog Diseases , Ultrasonography
14.
Arq. gastroenterol ; 51(4): 276-282, Oct-Dec/2014. tab, graf
Article in English | LILACS | ID: lil-732203

ABSTRACT

Context and Objectives Focally enhanced gastritis and macrophage microaggregates are found in the upper gastrointestinal involvement of Crohn’s disease, and may reflect an underlying defective innate immunity. These features, however, are also described in patients with Helicobacter pylori infection. The role of these gastric abnormalities in the diagnosis of Crohn’s disease was assessed in a population with high prevalence of H. pylori infection. Methods Thirty-seven Crohn’s disease, 26 ulcerative colitis, and 30 control patients were included. The H. pylori status was evaluated by the rapid urease test and histology. The presence of focally enhanced gastritis and macrophage microaggregates was recorded. Results Focally enhanced gastritis was present in 24% of Crohn’s disease patients, 4% of ulcerative colitis patients and 11.5% of controls, presenting an overall sensitivity and specificity for Crohn’s disease of 24% and 88%, respectively. Macrophage microaggregates were found in all groups, but were only detected in ulcerative colitis and controls in association with H. pylori infection, with an overall sensitivity and specificity for Crohn’s disease of 61% and 69%, respectively. In the absence of H. pylori infection, focally enhanced gastritis and macrophage microaggregates were significantly associated with Crohn’s disease (P<0.02 and P = 0.001 respectively). Conclusions Focally gastritis and macrophage microaggregates are suggestive of Crohn’s disease only in H. pylori-negative specimens. HEADINGS - Crohn’s disease. Ulcerative colitis. Gastritis. Macrophages. Helicobacter pylori. .


Contexto e objetivos Gastrite focal e microagregados de macrófagos são encontradas no acometimento gástrico da doença de Crohn, e podem refletir um defeito subjacente na imunidade inata. Estas características, no entanto, são também descritas em pacientes com infecção por Helicobacter pylori. O papel destas anormalidades gástricas no diagnóstico da doença de Crohn foi avaliada em uma população com alta prevalência de infecção por H. pylori. Métodos Trinta e sete pacientes com doença de Crohn, 26 pacientes com colite ulcerativa e 30 pacientes-controle foram incluídos. O status de infecção por H. pylori foi avaliado pelo teste da urease e histologia. A presença de gastrite focal e microagregados de macrófagos foi avaliada. Resultados Gastrite focal estava presente em 24% dos pacientes com doença de Crohn, 4% dos indivíduos com colite ulcerativa e 11,5% dos controles, apresentando uma sensibilidade e especificidade para doença de Crohn de 24% e 88%, respectivamente. Microagregados de macrófagos foram encontrados em todos os grupos, mas foram apenas detectados em colite ulcerativa e controles em associação com infecção por H. pylori, com sensibilidade e especificidade para doença de Crohn de 61% e 69%, respectivamente. Na ausência da infecção por H. pylori comprovada, gastrite focal e microagregados de macrófagos foram significativamente associados com doença de Crohn (P<0,02 e P = 0,001, respectivamente). Conclusões Gastrite focal e microagregados de macrófagos são sugestivos de doença de Crohn apenas em pacientes com avaliação dignóstica negativa para H. pylori. .


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Colitis, Ulcerative/pathology , Crohn Disease/pathology , Gastric Mucosa/pathology , Gastritis/pathology , Macrophages/pathology , Case-Control Studies , Diagnosis, Differential , Immunohistochemistry , Predictive Value of Tests , Sensitivity and Specificity
15.
J. bras. patol. med. lab ; 50(3): 221-228, May-Jun/2014. tab, graf
Article in English | LILACS | ID: lil-715620

ABSTRACT

Introduction: Inflammatory bowel disease comprises two major categories: Crohn's disease and ulcerative rectocolitis, both with different clinical and histological aspects, causing sometimes significant morbidity. Objectives: Choose and apply standardized and quantified histopathological diagnosis method, and compare the results and quality index with the original diagnosis. Materials and methods: 43 histological colonoscopic biopsies of 37 patients were re-evaluated by standardized system. Results and discussion: The original diagnoses were more inconclusive (23.3%) than those standardized (2.3%). The agreement with gold standard (clinical, colonoscopical, and radiological diagnosis) was higher on standardized diagnoses (95.3%) than in original (74.4%), especially in relation to Crohn's disease, which percentages were 92.3% and 46.1%, respectively. The quality index was calculated in conclusive diagnosis of each method. For ulcerative rectocolitis, both methods showed sensitivity and negative predictive value of 100%; otherwise the original diagnosis demonstrated specificity of 85.7%, positive predictive value of 96.3% and accuracy of 97.0%, and the standardized diagnosis 92.3%, 96.7% and 97.6%, respectively. For Crohn's disease, there is specificity and positive predictive value of 100% in both methods; the original diagnosis showed sensitivity of 85.7%, negative predictive value of 96.3% and accuracy of 97%, while for the standardized diagnoses 92.3%, 96.7%, and 97.6%, respectively. Conclusion: The standardized diagnosis presented a higher percentage of correct and conclusive diagnoses than those presented in the original diagnosis, especially for Crohn's disease, as well as equal or slightly higher values in some quality index...


Introdução: Duas são as formas de manifestação da doença intestinal inflamatória: doença de Crohn e retocolite ulcerativa, ambas com evolução clínica, tratamento e aspectos histopatológicos diferentes, causando, por vezes, significativa morbidade. Objetivos: Escolher e aplicar método padronizado e quantificado de diagnóstico histopatológico e comparar os resultados e os índices de qualidade, com os dos diagnósticos originais. Materiais e métodos: Foram reavaliadas histologicamente 43 biópsias colonoscópicas seriadas de 37 pacientes por sistema padronizado. Resultado e discussão: Os diagnósticos originais foram mais inconclusivos (23,3%) do que os padronizados (2,3%). A concordância com o padrão-ouro (diagnóstico clínico, colonoscópico e radiológico) foi maior nos diagnósticos padronizados (95,3%) do que nos originais (74,4%), principalmente em relação à doença de Crohn, cujos percentuais foram de 92,3% e 46,1%, respectivamente. Para retocolite ulcerativa, ambos os métodos apresentaram sensibilidade e valor preditivo negativo de 100%; já nos diagnósticos originais, foram verificados especificidade de 85,7%, valor preditivo positivo de 96,3% e acurácia de 97%, e nos diagnósticos padronizados, 92,3%, 96,7% e 97,6%, respectivamente. Para doença de Crohn, verificaram-se especificidade e valor preditivo positivo de 100% nos dois métodos; nos diagnósticos originais, sensibilidade de 85,7%, valor preditivo negativo de 96,3% e acurácia de 97%, e nos diagnósticos padronizados, 92,3%, 96,7% e 97,6%, respectivamente. Conclusão: O diagnóstico padronizado apresentou maior percentual de diagnósticos corretos e conclusivos do que os apresentados no diagnóstico original, principalmente para doença...


Subject(s)
Humans , Biopsy/standards , Crohn Disease/diagnosis , Proctocolitis/diagnosis , Diagnostic Techniques and Procedures/standards , Crohn Disease/pathology , Inflammatory Bowel Diseases/diagnosis , Predictive Value of Tests , Proctocolitis/pathology
16.
An. bras. dermatol ; 89(2): 361-362, Mar-Apr/2014. graf
Article in English | LILACS | ID: lil-706980

ABSTRACT

Multiple autoimmune syndrome is a rare condition, described by Humbert and Dupond in 1988. It is defined by the association of at least 3 autoimmune diseases in the same patient. Vitiligo is the most common skin condition in this syndrome. This article presents the case of a 31-year-old male with vitiligo, alopecia areata, Crohn's disease, psoriasis vulgaris and oral lichen planus. The rarity of this case is highlighted by the coexistence of four autoimmune skin diseases in association with Crohn's disease, never described in the literature.


Subject(s)
Humans , Male , Adult , Psoriasis/pathology , Autoimmune Diseases/pathology , Vitiligo/pathology , Crohn Disease/pathology , Lichen Planus, Oral/pathology , Alopecia Areata/pathology , Psoriasis/complications , Autoimmune Diseases/complications , Syndrome , Vitiligo/complications , Crohn Disease/complications , Lichen Planus, Oral/complications , Alopecia Areata/complications
17.
An. bras. dermatol ; 88(6,supl.1): 71-74, Nov-Dec/2013. graf
Article in English | LILACS | ID: lil-696821

ABSTRACT

Crohn's disease is a multisystem chronic granulomatous inflammatory disease that primarily affects the gastrointestinal tract. In the majority of the cases, the cutaneous manifestations follow the intestinal disease, but occasionally dermatological lesions are the inaugural event and may constitute the only sign of the disease. Vulvoperineal involvement is rare, may precede bowel symptoms by months to years and may go unrecognized. Due to the paucity of reports of Crohn's disease at this location and in the absence of randomized trials, there are no standard treatments for the cutaneous disease. We describe the case of a 47 year-old woman with vulvoperineal Crohn's disease without digestive involvement, that was successfully managed with metronidazole.


A doença de Crohn é uma doença granulomatosa multissistêmica inflamatória crónica que afecta primariamente o tracto gastrointestinal. Na maioria dos casos, as manifestações cutâneas sucedem a doença intestinal, mas, ocasionalmente, as lesões dermatológicas são o primeiro evento e podem constituir o único sinal da doença. O envolvimento vulvoperineal é raro, pode preceder os sintomas intestinais em meses ou anos, e pode passar despercebido. Devido à escassez de relatos de doença de Crohn com esta localização e na ausência de ensaios clínicos randomizados, não há nenhum tratamento padrão para a doença cutânea. Descrevemos um caso de uma mulher de 47 anos com doença de Crohn vulvoperineal sem envolvimento digestivo, que foi tratada com sucesso com metronidazol.


Subject(s)
Female , Humans , Male , Middle Aged , Anti-Infective Agents/therapeutic use , Crohn Disease/drug therapy , Metronidazole/therapeutic use , Perineum , Skin Diseases/drug therapy , Vulvar Diseases/drug therapy , Biopsy , Crohn Disease/pathology , Perineum/pathology , Skin Diseases/pathology , Treatment Outcome , Vulvar Diseases/pathology
18.
J. pediatr. (Rio J.) ; 89(2): 204-209, mar.-abr. 2013. tab
Article in Portuguese | LILACS | ID: lil-671457

ABSTRACT

OBJECTIVE: To evaluate the role of wireless capsule endoscopy in identifying small bowel lesions in pediatric patients with newly diagnosed colonic inflammatory bowel disease (IBD) type unclassified (IBDU), and to assess whether capsule endoscopy findings result in altered patient management. METHODS: Ten pediatric patients recently diagnosed with IBDU through standard investigations were recruited from the pediatric gastroenterology clinic at McMaster Children's Hospital to undergo capsule endoscopy using the Pillcam SB TM (Given Imaging) capsule. Findings consistent with a diagnosis of Crohn's disease required the identification of at least three ulcerations. RESULTS: Three out of ten patients had newly identified findings on capsule endoscopy that met criteria for Crohn's disease. Three more patients had findings suspicious for Crohn's disease, but failed to meet the diagnostic criteria. Three additional patients had findings most consistent with ulcerative colitis, and one had possible gastritis with a normal intestine. Findings from capsule endoscopy allowed for changes in the medical management of three patients. In all ten cases, capsule endoscopy allowed for a better characterization of the type and extent of disease. No adverse outcomes occurred in the present cohort. CONCLUSIONS: This prospective study reveals that wireless capsule endoscopy is feasible, valuable, and non-invasive, offering the ability to potentially better characterize newly diagnosed pediatric IBDU cases by identifying lesions in the small bowel and reclassifying these as Crohn's disease. Further investigation is warranted.


OBJETIVO: Avaliar o papel da cápsula endoscópica na identificação de lesões no intestino delgado em pacientes pediátricos com DII inespecífica (DIII) diagnosticada recentemente e avaliar se os achados da cápsula endoscópica resultam em alterações no tratamento dos pacientes. MÉTODOS: Dez pacientes pediátricos recém-diagnosticados com DIII por meio de investigações padrão foram recrutados da clínica de gastroenterologia pediátrica no McMaster Children's Hospital, para serem submetidos a exame com a cápsula endoscópica Pillcam SB TM (Given Imaging). Achados compatíveis com o diagnóstico da doença de Crohn exigiram a identificação de pelo menos três ulcerações. RESULTADOS: De 10 pacientes, três apresentaram achados novos com a cápsula endoscópica que satisfizeram o critério para a doença de Crohn. Outros três apresentaram achados com suspeita de doença de Crohn, porém não atenderam nossos critérios de diagnóstico. Apresentaram achados mais compatíveis com colite ulcerativa outros três pacientes, e um apresentava possível gastrite com intestino normal. Os achados da cápsula endoscópica possibilitaram mudanças no tratamento médico de três pacientes. Em todos os dez casos, a cápsula endoscópica permitiu uma melhor caracterização do tipo e da extensão da doença. Não houve resultado adverso em nossa coorte. CONCLUSÃO: Este estudo prospectivo revela que a cápsula endoscópica é viável, útil e não invasiva, que oferece a possibilidade de melhor caracterização de casos de DIII pediátricos recém-diagnosticados ao identificar lesões no intestino delgado e reclassificá-las como doença de Crohn.


Subject(s)
Adolescent , Child , Female , Humans , Male , Capsule Endoscopy/methods , Inflammatory Bowel Diseases/pathology , Intestine, Small/pathology , Colitis, Ulcerative/pathology , Crohn Disease/pathology , Prospective Studies
19.
Arq. gastroenterol ; 50(2): 130-137, abr. 2013. tab
Article in English | LILACS | ID: lil-679161

ABSTRACT

Context The use of fecal markers to monitor Crohn's disease is crucial for assessing the response to treatment. Objective To assess the inflammatory activity of Crohn's disease by comparing fecal markers (calprotectin and lactoferrin), colonoscopy combined with biopsy, and the Crohn's disease activity index (CDAI), as well as serum markers, before treatment with infliximab, after the end of induction, and after the end of maintenance. Methods Seventeen patients were included who had been previously diagnosed with Crohn's disease and were using conventional treatment but required the introduction of biological therapy with infliximab. Each patient underwent a colonoscopy with biopsy, serum, and fecal (calprotectin and lactoferrin) tests to assess inflammatory activity, and CDAI assessments before treatment with infliximab, after induction (week 8), and after maintenance (week 32). Results The calprotectin levels exhibited significant reductions (P = 0.04) between the assessment before treatment with infliximab and the end of induction, which did not occur after the end of the maintenance phase. Lactoferrin remained positive throughout the three phases of the study. Regarding the histological assessment, a significant difference was found only between the assessment before treatment and after the end of maintenance (P = 0.036), and 60% of the patients exhibited histological improvements after the completion of the follow-up period. The CDAI exhibited a significant difference between the assessment before treatment with infliximab and after induction, as well as before treatment and after maintenance (P<0.01). Conclusion Calprotectin and lactoferrin are not useful for monitoring inflammatory activity in Crohn's disease patients who are subjected to biological therapy. .


Contexto O uso de marcadores fecais para a monitorização da doença de Crohn é muito importante para a avaliação da resposta ao tratamento instituído. Objetivo Avaliar a atividade inflamatória da doença de Crohn comparando os marcadores fecais (calprotectina e lactoferrina), colonoscopia com biópsias, Crohn's Disease Activity Index (CDAI) e marcadores séricos antes do uso do Infliximabe, após a fase de indução e após a fase de manutenção. Método Foram incluídos 17 pacientes com diagnóstico prévio de doença de Crohn, que faziam uso da terapia convencional, mas que necessitaram da introdução da terapia biológica: Infliximabe. Esses pacientes realizaram colonoscopias com biópsias, exames de atividade inflamatória sérica, fecal (calprotectina e lactoferrina) e análise do CDAI nas fases pré Infliximabe, pós indução (semana 8) e pós manutenção (semana 32). Resultados Houve queda significativa (P = 0,04) da calprotectina entre as fases pré Infliximabe e pós indução, o mesmo não ocorrendo após a fase de manutenção. A lactoferrina manteve-se positiva nas três fases do estudo. Na análise histológica, houve diferença significativa apenas entre as fases pré Infliximabe e pós manutenção (P = 0,036), com 60% dos pacientes apresentando melhora histológica após o período de acompanhamento. O CDAI apresentou diferença significativa entre as fases pré Infliximabe e pós indução e entre as fases pré Infliximabe e pós manutenção (P<0,01). Conclusão A calprotectina e a lactoferrina não foram capazes de monitorizar a atividade inflamatória ...


Subject(s)
Adult , Female , Humans , Male , Antibodies, Monoclonal/therapeutic use , C-Reactive Protein/analysis , Crohn Disease/drug therapy , Feces/chemistry , Gastrointestinal Agents/therapeutic use , Lactoferrin/analysis , Leukocyte L1 Antigen Complex/analysis , Biological Therapy , Biopsy , Biomarkers/analysis , Colonoscopy , Crohn Disease/pathology , Predictive Value of Tests , Prognosis , Severity of Illness Index , Treatment Outcome
20.
Journal of Korean Medical Science ; : 575-579, 2013.
Article in English | WPRIM | ID: wpr-194145

ABSTRACT

There are no previous large scale studies which have evaluated the phenotypes and clinical characteristics of Korean Crohn's disease patients who underwent intestinal resection. The purpose of this multicenter retrospective cohort study was to evaluate the clinical characteristics of Korean Crohn's disease patients who underwent intestinal resection during the study period. A total of 686 patients were enrolled in this study. The study period was over a 20-yr period (1990-2009). The patients were divided into the first-10-yr group and the second-10-yr group. The phenotypes and clinical characteristics were compared between the groups. The most common site of the disease was the ileal area (37.8%) and stricturing behavior was observed in 38.3% patients. The most common type of surgery was segmental resection of the small bowel (30.6%). These phenotypes showed a similar pattern in both the first and second study period groups and did not show any significant differences between the groups. The number of registered patients increased continuously. The phenotypes of Korean Crohn's disease patients who underwent intestinal resection are different compared with previously reported clinical characteristics of general Crohn's disease patients.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Asian People , Cohort Studies , Colon/surgery , Crohn Disease/pathology , Ileum/surgery , Phenotype , Republic of Korea , Retrospective Studies
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