Angiotensin-converting enzyme in Crohn's disease and ulcerative colitis.

The relationship between serum angiotensin-converting enzyme activity and inflammatory bowel disease was investigated in 37 patients who had Crohn's disease, 31 patients who had ulcerative colitis, and 104 control subjects. The enzyme activity tended to be depressed in Crohn's ileitis (P less than 0.05) and colitis, but not in Crohn's ileocolitis and ulcerative colitis. No increase in enzyme activity was observed in Crohn's disease ileum or colon or in ulcerative colitis colon. The granulomatous inflammation in Crohn's disease differs from that in sarcoidosis, in which striking elevation of angiotensin-converting enzyme is present in granulomatous tissue and frequently in serum.

Crohn's disease.

Crohn's disease is manifested by fissure ulcers, transmural inflammation with lymphocytes, and granulomata affecting any part of the gastrointestinal tract. There seems to be a genetic predisposition, conditioned perhaps by environmental factors and possibly a virus. The disease is characterized by spontaneous fistulae, internal and external, anal lesions, stricture formation, and healing by fibrosis. The presenting symptoms are intestinal and systemic (Table 2). Systemic manifestations, such as arthritis, skin lesions, episcleritis and uveitis, pericholangitis, hydronephrosis, renal stones, amyloidosis, arrested maturation, fever, and anemia occur as complications of the intestinal disease. Medical treatment is empirical and supportive. Surgical treatment is reserved for complications. The incidence of Crohn's disease seems to be increasing because our diagnostic techniques are improving, but our treatment is unsatisfactory.