ABSTRACT
The 1993 Milwaukee Cryptosporidium outbreak posed several questions regarding appropriate management and prognosis of inflammatory bowel disease patients acutely infected with this organism. We prospectively identified and monitored 12 patients with stable ulcerative colitis or Crohn's disease who suffered abrupt clinical decompensation during the outbreak. All recovered to baseline at < or = 60 days. In patients receiving immunosuppressive therapy, mean duration of symptoms was no longer than in patients without it. Antibiotics did not clearly reduce duration of illness. Two additional patients without a history of intestinal disease presented with ileitis and colitis, respectively, initially suggesting Crohn's disease. Both recovered completely without specific therapy. We conclude that cryptosporidiosis may present as an acute relapse of inflammatory bowel disease and responds to standard therapy; antibiotics confer no obvious benefit. Immunosuppressive therapy does not predispose to chronic or severe illness in these patients. Cryptosporidiosis may present with acute findings initially mimicking Crohn's disease.
Subject(s)
Cryptosporidiosis/complications , Inflammatory Bowel Diseases/complications , Adult , Aged , Cryptosporidiosis/diagnosis , Cryptosporidiosis/epidemiology , Cryptosporidiosis/therapy , Disease Outbreaks , Female , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/therapy , Male , Middle Aged , Wisconsin/epidemiologyABSTRACT
The determinants of the lower esophageal sphincter relaxation response to esophageal distension have not previously been systematically examined in humans. In this study, 14 healthy subjects were tested using a manometry catheter with a sleeve device and three balloons spaced 5 cm apart. Subjects had up to five distensions with each balloon at four different diameters and two different durations of inflation. The results indicated that 1,170 separate distensions were available for analysis. Sphincter relaxation occurred more frequently (P < 0.005) with larger balloon diameters, yet occurred in only 84% of inflations at the largest diameter. Sphincter relaxation was more often observed with the proximal balloon (P < 0.005) during longer distensions (P < 0.05) and when esophageal contractions occurred above the balloon (P < 0.005). Once sphincter relaxation occurred, its magnitude was essentially independent of balloon site and diameter, distension duration, and the presence of proximal contractions. In conclusion, even large balloon distensions do not uniformly produce or maintain lower esophageal sphincter relaxation. Sphincter relaxation is more likely with proximal esophageal distension. The association of sphincter relaxation with vagally mediated proximal contractions suggests vagal modulation of this response.
