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ABSTRACT: Concomitant diagnosis of Crohn's disease and juvenile or adult-onset idiopathic arthritis is rare. It is possible that both conditions share some genetic or immunological defects although sufficient data are lacking. We describe herein the first case of a patient with adult-onset Still's disease who was diagnosed on follow up with concomitant Crohn's disease. A 38-year-old man diagnosed with adult onset Still's disease from the age of 24 was admitted in our hospital because of bloody diarrhea. On admission physical examination was unremarkable and all routine laboratory tests were normal except of Hg at 11.3gr/dl, erythrocyte sedimentation rate at 27mm/h and C-reactive protein at 14mg/dl. Ileocolonoscopy revealed small aphthoid ulcers in the terminal ileum and capsule endoscopy revealed the source of bleeding and small aphthoid ulcers starting from the distal jejunum up to the terminal ileum. Terminal ileum biopsies were diagnostic of Crohn's disease and patient had started on therapy with mesalamine 2gr/day and azathioprine 2mg/kg and is currently on multidisciplinary follow up. We review all literature on co-existence of Crohn's disease with chronic idiopathic arthritis and we discuss the possible difficulties in diagnosis and therapy of those patients also in the view of the new biological agents.
Journal of Crohn s and Colitis 06/2012; · 2.57 Impact Factor
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ABSTRACT: To describe our 15-year experience on the patients' response and safety to the use of EPO in IBD patients with refractory anemia.
Single center retrospective chart analysis of all IBD patients receiving EPO for the period 1994-2009. Patients with resistant anemia not responding to I.V. iron therapy were enrolled. Concommitant medication, medical and laboratory data on short and long-term patients' responses and safety were recorded.
In total 820 IBD files were reviewed and among 78 patients treated with I.V. iron we identified 26 patients who received EPO in concordance to our inclusion criteria. Azathioprine or methotrexate was administered in 17 patients and 7 patients received concomitant Infliximab. After EPO, 22/26 patients (84.6%) responded and peripheral blood parameters were significantly improved and blood transfusions were significantly decreased (p<0.001). Erythropoietin dose was increased in three non-responders while two patients required emergency transfusions. No adverse events were recorded.
In anemic IBD patients who are refractory to I.V. iron monotherapy, administration of EPO significantly improved peripheral blood parameters with safety. Prospective controlled trials are needed to confirm positive patients' response to EPO and identify those patients who are more likely to benefit.
Journal of Crohn s and Colitis 02/2012; 6(1):56-61. · 2.57 Impact Factor
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ABSTRACT: To test the hypothesis that Helicobacter pylori infection is associated with a higher rate of documented cardiovascular disease (CVD) in subjects undergoing elective upper gastrointestinal endoscopy.
202 consecutive patients (median age 60 years, 101 men) were studied. H. pylori infection was established by a rapid urease test in a gastric tissue sample (CLO test) and by histological examination of gastric mucosa from the stomach antrum and body. CVD was documented by completion of the Rose questionnaire. The association of H. pylori infection with CVD was determined by multivariate logistic regression modelling after adjusting for potential confounding factors.
A total of 104 (51.5%) subjects were found H. pylori positive. Forty patients had a confirmed history of CVD. Multiple logistic regression analysis verified the strong associations of CVD with established risk factors of atherosclerotic disease but not with H. pylori infection.
Our findings suggest that there is no association of H. pylori infection with CVD. Eradication of H. pylori to prevent CVD is not warranted.
European Journal of Internal Medicine 04/2011; 22(2):191-4. · 2.00 Impact Factor
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ABSTRACT: Introduction An accumulating amount of evidence suggests a high incidence of colorectal cancer (CRC) in Europe and North America [1], with approximately 180,000 deaths in the 25 member states of the European Union in 2000 [2]. Although the disease may sometimes be very aggressive, CRC diagnosed at an early stage, either as a result of altered bowel symptoms or by screening has more chances of being cured and it is associated with an improved prognosis. Polyps have been reported in up to 30% of patients over 60 years of age [3]. Especially, the adenoma-carcinoma sequence has been well established previously [4,5]. Furthermore, Japanese authors have described flat adenomas and small depressed lesions, the latter with high rate of submucosal invasion [6,7], and these lesions have also been identified in western populations [8]. In addition, clinical and epidemiological data suggest that a timely colonoscopy and removal of colonic polyps may reduce the risk for CRC [9]. Endoscopic procedures of the large bowel reduce the risk for developing CRC by 50-90%, their protective influence lasting 6 years [10-12]. This fact has supported the removal of all adenomatous polyps detected at colonoscopy. The present article describes the efficacy and safety of endoscopic polypectomy in a population of patients in Northwestern Greece and the follow-up of those patients. a Abstract Background and Aims Primary aim of the present study was the evaluation of efficacy and safety of endoscopic polypectomy in a tertiary advanced endoscopic laboratory in Northwestern Greece. Additional aim was to estimate the effectiveness of endoscopic treatment of colorectal polyps and record the clinical course.
Annals of Gastroenterology 01/2011; 24:115-120.
