RESUMO
Introudction: Crohn's disease [CD] is a lifelong condition. Multiple imaging investigations are often performed during follow-up. This could cause overexposure to radiation. The aim of our study was to determine mean radiation dose in patients with at least a 5-year course of CD and to determine possible risk factors associated with exposure to high doses of radiation
Methods: We conducted a retrospective study including patients whose CD was diagnosed between 1998 and 2005. Epidemiologic features of patients, characteristics of the disease, types of imaging investigations that were performed during follow-up and cumulative radiation effective dose were determined. Risk factors associated with exposure to high doses of radiation were then determined
Results: One hundred sixty seven patients were included. There were 92 males [55.1%] and 75 females [44.9%] with mean age at dianosis of 31.4 +/- 12.3years. Global radiation dose was 18.8 +/- 18.9 mSv. Twenty seven patients [16,2%] were exposed to more than 35 mSv and 4 patients [2.4%] had an exposure of more than 75 mSv. Use of Infliximab, age at disease onset /= 8 were independent risk factors of radiation exposure more than 35 mSv with adjusted Odds ratios [OR]: 2.5 [2.1- 5.3]; 1.6 [1.2- 4.7] and 3.2 [2.1- 7.8] respectively. Similarly, use of Infliximab and number of flares >/= 8 were independent risk factors of radiation exposure more than 75 mSv with adjusted OR: 4.3 [2.8-9.5] and 7 [3.2-11.2] respectively
Conclusion: Radiation risk seems to be increased with severe course of CD. Both referring physicians and radiologists have the responsibility to minimise radiation exposure. Entero-magnetic resonance imaging [Entero-MRI] may reduce this risk
RESUMO
Crohn's disease is a chronic relapsing- remitting affection. It has a strong immunologic component which represent the target of standard therapies including immunosppressants and biological therapies. However, many patients remain refracory or intolerant to these therapies. The aim of this review is to determine the effects of stem cell transplantation in patients with refractory Crohn's disease. Systematic review of observational studies, clinical trials and case reports that focused on the effectiveness and safety of stem cell transplantation in patients with refractory Crohn's disease. Hematopoietic stem cell transplantation seems to be efficient in maintaining clinical and endoscopic remission in patients with Crohn's disease refractory or intolerant to current therapies. However, it has been associated to high morbidity and mortality due to chemotherapy. Mesenchymal stem cell transplantation could induce remission in patients with fistulising refractory Crohns disease with no severe side effects. Its impact on luminal Crohns disease is still controversial. Stem cell transplantation seems to hold promising in patients with refractory Crohn's disease. However, because of the high morbidity and mortality related to chemotherapy, hematopoietic stem cell transplantation should be used as last resort to control this disease. Effectiveness of mesenchymal stem cell transplantation in luminal Crohn's disease has yet to be proven