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ABSTRACT: Fistulae or leakages of anastomotic junctions of the gastrointestinal tract used to be an indication for surgery. However, patients often are severely ill and endoscopic therapeutic options have been suggested to avoid surgical intervention.
This is a retrospective analysis of fibrin glue application in the treatment of gastrointestinal fistulae or anastomotic leakages.
The aim of this study was to investigate the value of fibrin glue in the treatment of gastrointestinal fistulae and leakages.
From September 1996 to November 2002, 52 patients with gastrointestinal fistulae or insufficiencies have been treated endoscopically including the use of fibrin glue (Tissucol Duo S®, Baxter, Unterschleissheim, Germany). Clinical data comprising concomitant therapies and results were analysed by chart review.
Twenty-six lesions were located in the oesophagus or gastroesophageal junction, 4 in the stomach, 7 in the small intestine, 13 colorectal and 2 in the pancreas. The duration of treatment ranged from 12 to 1,765 days. Two to 81 ml fibrin glue (median 8.5) was used in 1-40 sessions (median 4). All patients received antibiotics; additional endoscopic options were frequently applied. Endoscopic therapy cured 55.7% patients (n = 29); 36.5% (n = 19) were cured with fibrin glue as sole endoscopic option. In 23.1% (n = 12), surgical intervention became necessary. Patients without major infectious complications tended to have a higher cure rate without surgery (87.5% vs. 50%). Eleven patients died (21.1%).
Endoscopic therapy is a valuable option in the treatment of fistulae and anastomotic insufficiencies of the gastrointestinal tract. It usually is applied repeatedly. Fibrin glue is a mainstay of this procedure. Major infectious complications seem to define a subgroup of patients with poorer outcome.
International Journal of Colorectal Disease 03/2011; 26(3):303-11. · 2.38 Impact Factor
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ABSTRACT: Peroxisome proliferator-activated receptor-gamma and cyclooxygenase-2 are frequently overexpressed on cholangiocarcinoma
(CC) cells and adjacent stroma cells, and might be potential therapeutic targets. A pilot phase II trial was started to analyze
the activity of angiostatically scheduled chemotherapy, capecitabine 2 × 1 g/m2from day 15 to 28 every 3 weeks combined with an antiinflammatory/angiostatic therapy, daily 45 mg oral pioglitazone and 25
mg oral rofecoxib day 1+ in advanced CC. All 21 consecutively included patients (mean age 64 years) suffered from non-resectable
far-advanced CC, 62% were pretreated. The median dose of capecitabine per cycle was 76% of that planned; the median duration
of treatment was 6.8 months (range 2 to 30+). Only three patients suffered from grade 3 toxicity (hand-foot syndrome n = 2,
edema n = 1). Therapy continuation was refused in one patient with HFS grade 3. Objective response was achieved in 29% of
the cases including one cCR, 29% achieved SD >6 months. Median overall survival was 8 months. The median overall survival
in this unselected, partially pretreated patient population compares to that observed in selected patient populations receiving
second generation combination chemotherapies which were shown to be accompanied with considerable hematotoxicity. The present
completely oral therapy approach combines convenience, low toxicity and efficacy, and fits to the general patients characteristics:
elderly patients with tumor-associated comorbidity. Randomized trials will definitely clarify the impact of antiinflammatory
treatment strategies on survival.
KeywordsHepatobiliary carcinoma-Metronomic chemotherapy-Pioglitazone-Coxib
12/2009: pages 341-352;
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ABSTRACT: Gastrointestinal (GI) tract involvement has been observed in the majority of patients with SSc. This has been attributed to an accumulation of extracellular matrix within the GI walls. We visualized the walls of the oesophagus, stomach and duodenum with its layers and measured the thickness in SSc patients and control patients utilizing endoscopic ultrasound (EUS).
Twenty-five SSc patients and 25 controls were evaluated. In addition to analysis of clinical symptoms, endoscopy and EUS (20-MHz miniprobe) were performed. The thickness of the complete wall was measured, and the mucosa, submucosa and muscularis were evaluated separately.
Clinical symptoms of SSc patients were dysphagia (14/25) and heartburn (19/25). Endoscopic findings were hiatal hernia (16/25), oesophagitis (6/25), amotility (19/25) and a dehiscent pylorus (15/25). In comparison with controls, SSc patients had significantly thicker oesophageal [SSc 1.619 (0.454) mm, control 1.392 (0.333) mm; P = 0.025], antral [SSc 1.876 (0.635) mm, control 1.599 (0.291) mm; P = 0.029] and duodenal [SSc 1.730 (0.522) mm, control 1.525 (0.222) mm; P = 0.039] walls. Predominantly, submucosa and muscularis were significantly thicker in SSc patients. The presence of dysphagia or amotility was significantly associated with the thickening of the GI walls.
The EUS revealed a significant thickening of the walls of the upper GI tract in SSc patients. Predominantly, the submucosa and muscularis are enlarged. These results strengthen the hypothesis that increased matrix deposition is an important aspect in the pathogenesis of GI involvement in SSc.
Rheumatology (Oxford, England) 12/2009; 49(2):368-72. · 4.24 Impact Factor
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ABSTRACT: Performance of endoscopic retrograde cholangiography (ERC) depends mainly on the skills of the examiner, but also on anatomical variants. The aim of the study was to investigate patient- and papilla-related factors for the successful selective cannulation of the common bile duct (CBD).
50 patients with a papilla with no prior sphincterotomy needing an ERC were enrolled. From a standardized description given by the endoscopist, criteria to characterize the papilla were analyzed.
Success was achieved in 92%. Cannulation time was 460 +/- 561 seconds on average. 70% of the papillae were mastered in 300 seconds or less. Concordance between endoscopists concerning descriptive variables was between 86% and 100%. The judgment of the endoscopist concerning expected difficulty was not significantly related to success, demonstrating the necessity of predictive parameters. Typical position of the duodenoscope and performance of precut were significantly related to success. The joint presence of a visible orifice and a typical position of the duodenoscope had a positive predictive value (PPV) of 96%.
Endoscopists can rely on the joint presence of a visible orifice of the papilla and a typical position of the duodenoscope in X-ray to predict the success of ERC.
North American journal of medical sciences. 07/2009; 1(2):66-73.
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ABSTRACT: The aim of our study was to develop a system to grade the risk of the procedures summarized under the term endoscopic retrograde cholangiopancreatography (ERCP).
In a controlled prospective study, we evaluated the early complications of ERCP in 526 consecutive patients at a single endoscopy center in a defined period. The relation between endoscopic procedures and related complications was analyzed for significance. A grading system based on significant risk factors and clinical implications was developed.
Of the ERCP procedures, 29% were diagnostic and 71% therapeutic. A total of 45 complications occurred in 42 patients: pancreatitis (2%), perforation (1%), cardiorespiratory problems (0.6%), stent-related complications (0.5%), leakages (1.5%), and bleeding (3%). A native papilla was a significant risk factor for the development of complications (P = 0.046). On the basis of these findings, we defined five groups of ERCP-related complications: nonnative papillae with either diagnostic (A) or therapeutic interventions (B); native papillae with diagnostic (C) or therapeutic (D) interventions; and special therapeutic interventions (E). Complication rates differed significantly between individual groups, A versus D (P = 0.013), A versus E (P = 0.010), B versus D (P = 0.005), and B versus E (P = 0.003), as well as between A/B and C/D (P = 0.003).
A grading system based on differentiating between native and nonnative papillae and diagnostic versus therapeutic procedures demonstrated significantly different complication rates. This grading system has the potential to predict the risk of ERCP-related complications.
Journal of Gastroenterology 02/2009; 44(2):160-5. · 4.16 Impact Factor
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Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 12/2007; 5(11):e45. · 5.64 Impact Factor
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ABSTRACT: Sclerosing cholangitis in critically ill patients (SC-CIP) is a newly described entity of severe biliary disease with progression to liver cirrhosis. The mechanisms leading to this form of cholangiopathy with stricture formation and complete obliteration of bile ducts are unknown.
In the last 2 yr, sclerosing cholangitis was diagnosed in 26 patients during or after their stay on the intensive care unit by ERCP and/or liver histology. Complete patient records were available for 17 patients. Histological evaluations of liver biopsies and of four explanted livers, parameters of cardiovascular and respiratory conditions, treatment modalities, and accompanying infections were analyzed to find further hints for the pathomechanisms leading to SC-CIP.
With the beginning of cholestasis, the earliest endoscopic findings were intrahepatic biliary casts with impairment of the biliary flow and subsequent biliary infection, in most cases with Enterococcus faecium. Liver biopsy confirmed cholangitis and histology of explanted livers revealed ulcerated biliary epithelium with hemorrhagic exudates in the bile ducts. In the further course, progressive sclerosis with formation of multiple strictures of the bile ducts was observed. All patients suffered severe respiratory insufficiency with the need for mechanical ventilation (40.7+/-32.9 days). The PaO2/FiO2 ratio until beginning of cholestasis was 150.5+/-43.1. Half of the patients (9/17) were treated with high-frequency oscillatory ventilation and 12/17 patients by intermittent prone positioning. All patients required catecholamines for hemodynamic stabilization.
SC-CIP is a severe and in most cases rapidly progressive complication of intensive care patients. Ischemic injury of the biliary tree with the formation of biliary casts and subsequent ongoing biliary infection due to multiresistant bacteria seem to be major pathogenic mechanisms in the development of this new entity of sclerosing cholangitis.
The American Journal of Gastroenterology 07/2007; 102(6):1221-9. · 7.28 Impact Factor
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ABSTRACT: The aim of our study was to determine whether chromoendoscopy with indigo carmine significantly improves the detection of adenomas in the distal colon and rectum and therefore could become routine in flexible sigmoidoscopy screening.
Between 2001- 2003, two sigmoidoscopies, the first conventional, the second with chromoendoscopy, were performed in a "back-to-back" design by two experienced endoscopists in a series of 55 patients. All lesions were classified with regard to position and size before and after staining, then endoscopically removed and referred to two experienced pathologists.
55 patients, mean age 60 +/- 9.8 (42-79) years, 34 (61.8%) men and 21 (38.2%) women were enrolled. After staining, 47 patients had 373 visible lesions, 306 (82%) < 3mm, 47 (12.6%) 3- 5 mm and 20 (5.4%) > 5 mm. Histologically, 215 (57.7%) were hyperplastic polyps, 27 (7.2%) adenomas and 131 (35.1%) other lesions. With chromoendoscopy, in 17 of the 47 patients (36.2%) 27 adenomas (15 <or= 5 mm and 12 > 5 mm) were detected. Chromoendoscopy significantly improved the detection of adenomas <or= 5 mm (p<0.01). Regarding the detection of adenomas larger than 5 mm, there was no significant difference between conventional sigmoidoscopy and chromoendoscopy. The chi-square test was performed for comparisons between the number of lesions detected by standard sigmoidoscopy and chromoendoscopy.
Chromoendoscopy with indigo carmine allows the detection of significantly more adenomas <or= 5 mm in the distal colon and rectum. Thus, flexible sigmoidoscopy with routine chromoendoscopy could become an option in colorectal cancer screening when colonoscopy is unavailable or not accepted by the patient.
Journal of gastrointestinal and liver diseases: JGLD 06/2007; 16(2):153-6. · 1.81 Impact Factor
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ABSTRACT: To identify genes that are differentially expressed in systemic sclerosis (SSc) fibroblasts of clinically involved and noninvolved skin compared to normal dermal fibroblasts, using RNA arbitrarily primed-polymerase chain reaction (RAP-PCR) for differential display.
We examined 12 fibroblast cultures derived from clinically involved skin, 3 fibroblast cultures from noninvolved skin, and 4 fibroblast cultures from healthy skin. After extraction of total RNA, the first step of RAP-PCR was performed using different arbitrary 10-12-base primers for first-strand cDNA synthesis. Second-strand synthesis was achieved by cycling using different arbitrary 10-base primers, followed by sequence analysis of the amplified fingerprint products. The resulting sequences were aligned to the GenBank database using Blast Search. Confirmation of differential expression was performed with specific primers using real-time PCR.
Using 8 different primer combinations, in total 48 cDNA were differentially expressed between SSc and healthy dermal fibroblasts. Sequence analysis identified distinct PCR products, which were overexpressed in SSc as highly homologous to gene segments of gremlin protein, lysyl oxidase, c-cbl proto-oncogene, an estrogen-responsive element, fibronectin, and collagen type XIIa1 precursor.
Our results show that RAP-PCR is a suitable method to identify differentially expressed genes in SSc fibroblasts. Further, we identified genes that have not yet been described in the pathophysiology of SSc and that may be involved in matrix synthesis and cellular interaction.
The Journal of Rheumatology 05/2007; 34(4):747-53. · 3.69 Impact Factor
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Gastrointestinal Endoscopy 07/2006; 63(7):1068-9; discussion 1069. · 4.88 Impact Factor
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ABSTRACT: HISTORY AND FINDINGS ON ADMISSION: A 63-year-old female patient was admitted to the authors' hospital for further diagnostic work-up for suspected reactivation of a previously successfully treated lymph node tuberculosis, which had been diagnosed 1 year prior to the current admission. The clinical signs consisted of worsening of the patient's general condition, negacervical lymphadenopathy, night sweats, dyspnea, and superficial inflammation of the right mamma. FINDINGS: A contrast-enhanced CT scan of the neck, thorax and abdomen revealed a generalized enlargement of the cervical, axillar, mediastinal and retroperitoneal lymph nodes, multiple intrapulmonary nodular lesions with a diameter of up to 6 mm, and a substantial right-sided pleural effusion. COURSE OF DISEASE: Under the assumption of reactivation of a lymph node tuberculosis, the patient was initially treated with an extended tuberculostatic therapy. Because of disease progression another lymph node biopsy was performed revealing Hodgkin's disease of mixed-cellularity type with a partly histiocytic necrotizing, partly tuberculoid reaction. The biopsy was negative for acid-fast bacilli. Thereupon initiated chemotherapy according to the ABVD protocol led to a rapid amelioration of the clinical symptoms. CONCLUSION: In the clinical setting of suspected or confirmed lymph node tuberculosis malignant lymphoma should always be considered. This consideration is particular important since Hodgkin's disease is typically associated with a cellular immunosuppression predisposing the subject to tuberculosis.
Medizinische Klinik 07/2006; 101(6):500-4. · 0.34 Impact Factor
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ABSTRACT: Small bowel MR enteroclysis and wireless capsule endoscopy (WCE) are new diagnostic tools for the investigation of the small bowel. The aim of this study was to compare the diagnostic yield of WCE with MR enteroclysis in the detection of small bowel pathologies.
A total of 36 patients were included in the study. Indications for imaging of the small bowel were proven or suspected small bowel Crohn's disease (CD; n=18), obscure gastrointestinal (GI) bleeding (n=14) and tumour surveillance (n=4).
In patients with Crohn's disease WCE detected significantly more inflammatory lesions in the first two segments of the small bowel compared with MR enteroclysis (12 patients vs. 1 patient, p=0.016). In 5 out of 14 (36%) patients with GI bleeding, angiodysplasia was detected as a possible bleeding source. Three of these patients had active bleeding sites detected by WCE. One patient had scattered inflammation of the mucosa. MR enteroclysis did not reveal any intestinal abnormalities in this patient group. MR enteroclysis provided extraintestinal pathologies in 10 out of 36 (28%) patients.
In patients with Crohn's disease WCE revealed significantly more inflammatory lesions in the proximal and middle part of the small bowel in comparison to MR enteroclysis, whereas in patients with obscure GI bleeding WCE was superior to MR enteroclysis.
International Journal of Colorectal Disease 04/2006; 21(2):97-104. · 2.38 Impact Factor
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Gastrointestinal Endoscopy 03/2006; 63(2):358-9. · 4.88 Impact Factor
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ABSTRACT: Small bowel adenocarcinoma (SBA) is a very rare tumor entity but occurs in up to 5% of patients suffering from familiar adenomatous polyposis (FAP). Because of nonspecific symptoms, diagnosis is usually made with delay, which contributes to high rates of metastatic disease at the time of diagnosis. The overall prognosis of SBA is poor with 5-year survival rates of 15-35%. For localized disease, complete surgical resection is the treatment of choice, whereas systemic chemotherapy is deemed indicated in tumors with metastatic spread. The optimal regimen has not been defined as yet. In October 2001, a 51-year-old woman with attenuated FAP, that had total proctocolectomy in 1994 was diagnosed with a jejunal adenocarcinoma. She subsequently underwent small bowel resection. Because a computed tomography (CT) scan in April 2002 revealed multiple liver metastases, chemotherapy with nine cycles FOLFOX6 was initiated. Afterwards, a small residual lesion in segment VIII was seen in CT scan but could not be identified by PET and at laparotomy in November 2002. In December 2003, again, a lesion was detected in S VIII. This solitary residual liver metastasis was resected in January 2004. Postoperatively, the patient received adjuvant chemotherapy with three cycles (with six applications in each cycle) 5-fluorouracil/folinic acid/irinotecan according to the AIO protocol. To date, more than 3 years after liver resection, the patient is still in complete remission and undergoes regular restaging investigations. Resection of liver metastases from SBA combined with neoadjuvant and adjuvant chemotherapy can result in extended disease-free survival and should undergo further investigation.
International Journal of Gastrointestinal Cancer 02/2006; 37(2-3):94-7.
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ABSTRACT: Anamnese und klinischer Befund:Eine 63-jährige Patientin stellte sich mit Verdacht auf Reaktivierung einer Lymphknotentuberkulose (LK-Tbc) in der Klinik
der Autoren vor. Eine im Vorjahr diagnostizierte LK-Tbc war erfolgreich behandelt worden. Klinisch zeigten sich akut eine
Verschlechterung des Allgemeinzustands, zervikale Lymphknoten-(LK-)Schwellungen, Nachtschweiß, Dyspnoe und eine oberflächliche
Inflammation der rechten Brust.
Untersuchungen:Computertomographie von Hals, Thorax und Abdomen mit Kontrastmittel: ausgedehnte LK-Vergrößerung zervikal, axillär, mediastinal
und retroperitoneal. Multiple intrapulmonale noduläre Läsionen mit einem Durchmesser bis zu 6 mm. Ausgeprägter Pleuraerguss
rechts.
Therapie und Verlauf:Unter der Annahme einer Reaktivierung der vorbekannten LK-Tbc wurde die Patientin initial mit einer erweiterten antituberkulösen
Therapie behandelt. Nach klinischer Progredienz erfolgte eine erneute LK-Biopsie aus der linken Axilla, welche nunmehr den
Nachweis eines Morbus Hodgkin vom Mischtyp mit teils histiozytär nekrotisierender, teils tuberkuloider Begleitreaktion ohne
Nachweis säurefester Stäbchen erbrachte. Die daraufhin eingeleitete Chemotherapie nach dem ABVD-Schema führte zu einer raschen
Verbesserung der klinischen Beschwerdesymptomatik.
Schlussfolgerung:Sowohl bei dem Verdacht als auch bei gesicherter Diagnose einer LK-Tbc sollte differentialdiagnostisch ein Lymphom ausgeschlossen
werden. Dieser Abwägung kommt insofern eine besondere Bedeutung zu, als der Morbus Hodgkin charakteristischerweise mit einem
T-Zell-Defekt assoziiert ist, welcher zu einer Tbc prädestiniert.
History and Findings on Admission:A 63-year-old female patient was admitted to the authors’ hospital for further diagnostic work-up for suspected reactivation
of a previously successfully treated lymph node tuberculosis, which had been diagnosed 1 year prior to the current admission.
The clinical signs consisted of worsening of the patient’s general condition, negacervical lymphadenopathy, night sweats,
dyspnea, and superficial inflammation of the right mamma.
Findings:A contrast-enhanced CT scan of the neck, thorax and abdomen revealed a generalized enlargement of the cervical, axillar, mediastinal
and retroperitoneal lymph nodes, multiple intrapulmonary nodular lesions with a diameter of up to 6 mm, and a substantial
right-sided pleural effusion.
Course of Disease:Under the assumption of reactivation of a lymph node tuberculosis, the patient was initially treated with an extended tuberculostatic
therapy. Because of disease progression another lymph node biopsy was performed revealing Hodgkin’s disease of mixed-cellularity
type with a partly histiocytic necrotizing, partly tuberculoid reaction. The biopsy was negative for acid-fast bacilli. Thereupon
initiated chemotherapy according to the ABVD protocol led to a rapid amelioration of the clinical symptoms.
Conclusion:In the clinical setting of suspected or confirmed lymph node tuberculosis malignant lymphoma should always be considered.
This consideration is particular important since Hodgkin’s disease is typically associated with a cellular immunosuppression
predisposing the subject to tuberculosis.
01/2006; 101(6):500-504.
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ABSTRACT: In recent years chromoendoscopy has become popular as a diagnostic enhancement tool in endoscopy. Using the macroscopic description of gastric ulcers, experienced endoscopists may be able to differentiate malignant and benign lesions. The aim of our study was to determine whether indigo carmine staining improves the ulcer differentiation by experienced and inexperienced endoscopists.
50 patients were enrolled, 7 with malignant gastric ulcers and 43 with benign gastric ulcers. Gastroscopy was initially videotaped native, then on a second tape after staining with 0.2% indigo carmine. Later on biopsies were taken for histology. Subsequently the tapes were randomly evaluated by three experienced (>2000 gastroscopies; group A) and by three inexperienced (<100 gastroscopies; group B) investigators blinded from any personal data of the patients. The investigators had to classify the ulcers, using published criteria, native as well as stained. The results were compared within each group and with the histology.
The endoscopic native diagnosis showed a sensitivity of 66.3%, a specificity of 86.3%, a positive predictive value of 48.1% and a negative predictive value of 94% for group A, respectively 66%, 62.5%, 22.7% and 92% for group B. After staining, the values of these parameters were reduced insignificantly to a sensitivity of 60.2%, a specificity of 78.5%, a positive predictive value of 36.1% and a negative predictive value of 92.8% for group A. Group B, on account of one investigator who demonstrated excellent skills, showed a significant better sensitivity (79.9%) and a slight improvement of the positive and negative predictive values to 25.7% respectively 94.8%, whereas the specificity very slightly decreased to 61.3%. The diagnostic accuracy before and after staining was 83.6%, respectively 76.5%, in group A and 63.2%, respectively 63.9% in group B. The correlation with the histology, determined by Cohen's kappa coefficient (median value), decreased from 0.46 for the native to 0.30 for the chromoendoscopic diagnosis in group A and remained unchanged (0.17) in group B.
We concluded that chromoendoscopy does not improve the classification of gastric ulcers with respect to malignant or benign origin. The role of endoscopic experience could only be proved in the native macroscopic diagnosis of the investigators. After staining, with the exception of one investigator, experienced as well as inexperienced endoscopists lost their diagnostic accuracy.
Romanian journal of gastroenterology 09/2005; 14(3):239-44.
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ABSTRACT: Based on a 15-year old hypothesis, it is believed that an adequate ingestion of folate vitamins decreases, whereas a nutritional depletion of folate increases the risk of colorectal cancer. The present article reviews the efforts to provide biochemical and epidemiological evidence for folate as a chemopreventive agent against colorectal carcinogenesis. BIOLOGICAL EVIDENCE: Tetrahydrofolates govern the intracellular one-carbon metabolism and account for proper DNA biosynthesis and macromolecular modification. Numerous experimental studies traced different molecular pathways and tried to link folate depletion with DNA instability and/or mutagenesis. However, none of the proposed underlying molecular mechanisms appear clearly defined. EPIDEMIOLOGICAL EVIDENCE: Numerous case-control and prospective studies have been conducted on folate and colorectal cancer, which all together miss a clinical bottom line. The recommendation of folate intake to prevent colorectal cancer is therefore not evidence-based.
Critical Reviews in Oncology/Hematology 08/2005; 55(1):13-36. · 4.41 Impact Factor
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ABSTRACT: Crohn's disease is a chronic inflammatory disease of the intestine potentially affecting all parts of the intestine with predilection sites in the terminal ileum and proximal colon. Its prevalence in Western Europe is 20-40/100,000 with equal affection of both sexes and familiar accumulation. Histopathologically, it is characterized by a discontinuous, segmental manifestation and implication of all intestinal layers. Celiac disease, on the other hand, is defined by histologically proven villous atrophy associated with hyperplasia of crypts, lymphocytic infiltration and clinical improvement after a gluten-free diet.
We report the case of a 52-year-old man presenting with long-term diarrhea and loss of weight associated with Crohn's disease. After interventional therapy for an unstable coronary artery syndrome and medical therapy for hyperthyroidism, the diarrhea stopped only after maintaining a gluten-free diet. A latent form of celiac disease (clinical symptoms, improvement after gluten-free diet, detection of anti-gliadin IgA antibodies, negative histology) was diagnosed.
To our knowledge, this is the first report on the association of Crohn's disease and the latent form of celiac disease in the same patient. Whereas in most cases, Crohn's disease develops secondary to a pre-existing celiac disease, in our patient, latent celiac disease was diagnosed years after the onset of and therapy for Crohn's disease.
International Journal of Colorectal Disease 08/2005; 20(4):376-80. · 2.38 Impact Factor
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ABSTRACT: A 79-year-old white woman presented with upper abdominal pain. She had a history of rheumatoid arthritis since she was 19 years old, which was treated with prednisolone, leflunomide, diclofenac and pantoprazole. She also had factor VII deficiency. The patient had been hospitalized 2 months previously with sepsis presumed to be due to urinary infection, and was treated with antibiotics. Sonography at this time revealed a gallbladder with a monstrous thick wall and stones, and the first differential diagnosis was cholecystitis. Cholecystectomy was planned after amelioration of the patient's general state, but her general state worsened.
Sonography, endoscopy of the upper and lower intestine, and CT scan.
Biliodigestive fistula and gallstone ileus.
Enterolithotomy, stenting, endoscopic retrograde cholangiopancreatography, and surgery.
Nature Clinical Practice Gastroenterology & Hepatology 08/2005; 2(7):331-5; quiz 336. · 5.33 Impact Factor
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ABSTRACT: BackgroundCrohns disease is a chronic inflammatory disease of the intestine potentially affecting all parts of the intestine with predilection sites in the terminal ileum and proximal colon. Its prevalence in Western Europe is 20–40/100,000 with equal affection of both sexes and familiar accumulation. Histopathologically, it is characterized by a discontinuous, segmental manifestation and implication of all intestinal layers. Celiac disease, on the other hand, is defined by histologically proven villous atrophy associated with hyperplasia of crypts, lymphocytic infiltration and clinical improvement after a gluten-free diet.Case reportWe report the case of a 52-year-old man presenting with long-term diarrhea and loss of weight associated with Crohns disease. After interventional therapy for an unstable coronary artery syndrome and medical therapy for hyperthyroidism, the diarrhea stopped only after maintaining a gluten-free diet. A latent form of celiac disease (clinical symptoms, improvement after gluten-free diet, detection of anti-gliadin IgA antibodies, negative histology) was diagnosed.ConclusionTo our knowledge, this is the first report on the association of Crohns disease and the latent form of celiac disease in the same patient. Whereas in most cases, Crohns disease develops secondary to a pre-existing celiac disease, in our patient, latent celiac disease was diagnosed years after the onset of and therapy for Crohns disease.
International Journal of Colorectal Disease 06/2005; 20(4):376-380. · 2.38 Impact Factor
