18 research outputs found

    Controversial role of laparoscopic appendicectomy vs steroids in a patient with provisional diagnosis of crohnÔÇÖs disease: A case report

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    CrohnÔÇÖs disease can originate in and be confined to the appendix, yet manifest clinical symptoms leading to the emergency laparoscopy. Preoperative radiologic findings can be similar to those of suppurative appendicitis. Here, we report the case of a 28-year-old female who had a provisional diagnosis of CrohnÔÇÖs disease based on radiological finding but later on, diagnosed to have a perforated appendix

    Determinants of Weight Loss prior to Diagnosis in Inflammatory Bowel Disease: A Retrospective Observational Study

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    Aims. To identify prevalence, severity, and environmental determinants of weight loss in inflammatory bowel disease (IBD) patients just prior to time of formal diagnosis. Methodology. IBD patients attending outpatient clinic were questioned about weight loss prior to diagnosis and other environmental and demographic variables. The percentage BMI loss was calculated for each subject and factors associated with weight loss were determined. Results. Four hundred and ninety-four subjects were recruited (237 cases of CrohnÔÇÖs disease (CD) and 257 cases of ulcerative colitis (UC)). Overall, 57% of subjects with CD and 51% of subjects with UC experienced significant weight loss prior to diagnosis (>5% BMI loss). Younger age at diagnosis and history of previous IBD surgery were significantly associated with both lower BMI at diagnosis and increased weight loss prior to diagnosis. In CD patients, increasing age at diagnosis was inversely associated with weight loss prior to diagnosis. Ileal disease was a risk factor of weight loss, whereas prior appendectomy was associated with reduced risk of weight loss. Conclusions. Weight loss is a significant problem for many IBD patients at presentation, especially in younger age and CD with ileal involvement. Appendectomy is associated with diminished weight loss

    Adipokines in the pathogenesis of idiopathic inflammatory bowel disease

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    Choroba Crona (CD) i wrzodziej─ůce zapalenie jelit s─ů najcz─Ö┼Ťciej wyst─Öpuj─ůcymi postaciami nieswoistych zapale┼ä jelit. Ich etiologia i patogeneza dotychczas nie zosta┼éy wyja┼Ťnione. Sugeruje si─Ö, ┼╝e przewlek┼éy stan zapalny jelit jest wynikiem predyspozycji genetycznych i indywidualnej nadmiernej reakcji uk┼éadu immunologicznego na antygeny fizjologicznej mikroflory jelitowej. Uwa┼╝a si─Ö, ┼╝e naruszenie r├│wnowagi jelitowego uk┼éadu immunologicznego jest spowodowane infekcj─ů jelitow─ů, kt├│ra prowadzi do zmian w sk┼éadzie fizjologicznej mikroflory jelitowej. Bierze si─Ö tak┼╝e pod uwag─Ö takie czynniki, jak pochodzenie geograficzne i etniczne oraz styl ┼╝ycia. W ostatnich latach liczne badania ocenia┼éy rol─Ö cytokin prozapalnych i hormon├│w tkanki t┼éuszczowej nazywanych adipokinami w patogenezie nieswoistych zapale┼ä jelit. Adipokiny wykazuj─ů zar├│wno pro-, jak i przeciw- zapalne dzia┼éania i mog─ů uczestniczy─ç w regulacji odpowiedzi immunologicznej. Wykazano tak┼╝e, ┼╝e oty┼éo┼Ť─ç wi─ů┼╝e si─Ö z przewlek┼éym uk┼éadowym stanem zapalnym. Z drugiej strony wyniki bada┼ä eksperymentalnych ujawni┼éy zwi─ůzek mi─Ödzy st─Ö┼╝eniem kr─ů┼╝─ůcych adipokin a nasileniem procesu zapalnego w jelicie niezale┼╝nie od masy cia┼éa. Wydaje si─Ö, ┼╝e istotn─ů rol─Ö w wytwarzaniu adipokin uczestnicz─ůcych w patogenezie nieswoistego zapalenia jelita odgrywa depozyt t┼éuszczu zlokalizowany w krezce jelita i bezpo┼Ťrednio je otaczaj─ůcy. Celem prezentowanej pracy by┼é przegl─ůd aktualnej literatury dotycz─ůcej roli adipokin w patogenezie nieswoistych zapale┼ä jelit, takich jak choroba Crona i wrzodziej─ůce zapalenie jelita grubego. (Endokrynol Pol 2013; 64 (3): 226–231)Crohn’s disease (CD) and ulcerative colitis (UC) are the two common forms of idiopathic inflammatory bowel disease (IBD). The aetiology and pathogenesis of IBD are not yet known. Genetic predisposition has been suggested as playing a role in the improper immune response to commensal microbiota. The main link of IBD pathogenesis is an intestinal immune system disability after enteric infection, resulting in an uncontrolled and chronic inflammatory state. Recently, numerous studies have been focused on the role of proinflammatory cytokines as well as hormones of adipose tissue named adipokines in the pathogenesis of IBD. Adipokines have pro- and anti-inflammatory properties and can modulate the immune response. It has been shown that obesity is associated with systemic microinflammation. On the other hand, experimental studies have revealed a link between levels of some adipokines and the severity of inflammation in IBD independent of body mass. The fat deposits called ‘wrapping’ or ‘creeping’ fat envelop the intestine, and adipokines produced by this tissue play an important role in the pathogenesis of IBD. The aim of this manuscript was to review the current literature concerning the role of adipokines in the pathogenesis of IBD. (Endokrynol Pol 2013; 64 (3): 226–231

    Identification of environmental risk factors associated with the development of Inflammatory Bowel Disease

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    BACKGROUND AND AIMS: Multiple genetic and environmental factors are involved in the etiology of inflammatory bowel disease (IBD), consisting of Crohn's disease (CD) and ulcerative colitis (UC) but data on these exposome factors are difficult to identify . Several exposome factors as smoking have been shown to be involved, as for other environmental factors, i.e. stress, results have been conflicting. METHODS: We performed a case-control study including 674 IBD patients of the 1000IBD cohort frequency-matched based on sex and age to 1,348 controls from population based Lifelines Cohort Study. Exposome data was obtained using the validated Groningen IBD Environmental Questionnaire (GIEQ), capturing exposome factors through different stages of life using 844 items, of which 454 applicable to study the role of 93 exposome factors in disease etiology. Logistic regression modeling with Bonferroni correction for multiple testing was applied to estimate the multivariable-adjusted effect of each exposome factor. RESULTS: For IBD, we identified four novel factors; stressful life-events (CD OR2.61/UC OR 2.92), high perceived stress (2.29/2.67), alcohol use (0.40/0.43), and bronchial hyperreactivity (3.04/2.36). Four novel factors were associated with only CD; prenatal smoke exposure (1.89), having a bedpartner (0.53), allergies (2.66) and cowmilk-hypersensitivity (5.87), two solely with UC; carpet flooring (0.57) and neuroticism (1.32). Nine factors were replicated. CONCLUSION: In this study we identified ten novel and replicated nine previous reported exposome factors associated with IBD. Identifying these factors is important for both understanding disease etiology and future prevention strategies to decrease the development of IBD in genetically susceptible persons

    Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark

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    Objective To determine whether the repeatedly observed low risk of ulcerative colitis after appendicectomy is related to the appendicectomy itself or the underlying morbidity, notably appendicitis or mesenteric lymphadenitis

    Surgery and me: the experience of surgery as a transition in young adults with inflammatory bowel disease

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    The peak incidence of Inflammatory Bowel Disease is between 15 ÔÇô 25 years. A significant number of young people whose disease is not controlled by medication undergo surgery. However, the experiences of young adults with Inflammatory Bowel Disease have not been well researched. The aim of this two phase exploratory mixed methods sequential study was to investigate the process of transition in young adults aged 18 ÔÇô 25 years with Inflammatory Bowel Disease who faced the prospect of, or had undergone, surgery. SchlossbergÔÇÖs Transition Theory (Goodman et al, 2006) was used to identify the important factors that influenced their experience. Phase1 was qualitative and exploratory and obtained narratives from semi structured interviews with 24 young adults. Phase 2 was a survey. In order to establish whether findings from Phase 1 could be generalised a questionnaire developed from the Phase 1 findings was developed and sent to 158 young adults randomly sampled from seven NHS centres in England,. One hundred and twenty people responded (76%). Key findings from Phase 1 were that preoperatively most young people knew that their disease was out of control. Afterwards they perceived that surgery had improved their physical health and positively changed their lives. The key findings from Phase 2 were that 72 (60%) young people had a positive perception of their surgery. Participants also experienced an improvement in physical health and made a good psychological recovery. The majority of participants (n=106, 84%) received appropriate support and used positive coping strategies such as acceptance and positive reframing. Fear, worry, uncertainty, negative experiences of surgery and body image concerns hindered the process of transition. The specialist Inflammatory Bowel Disease or stoma nurse had a key role in facilitating a positive transition. The study findings will enable health care practitioners to provide appropriate information, care and support for young adult patients with Inflammatory Bowel Disease facing surgery

    Die Rolle der Gene CXCL9 und NR1I2 bei chronisch entz├╝ndlichen Darmerkrankungen im Kindesalter

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    Chronisch entz├╝ndliche Darmerkrankungen haben einen multifaktoriellen Ursprung. Dabei scheinen genetische Faktoren eine entscheidende Rolle zu spielen und Einfluss auf den Krankheitsverlauf und unterschiedliche Erkrankungsmuster zu haben. Insbesondere bei Kindern ist eine genetische Disposition in der Pathogenese von chronisch entz├╝ndlichen Darmerkrankungen anzunehmen. Die vorliegende Dissertation ist die erste Untersuchung zur Expression der Gene CXCL9 und NR1I2 im Kolongewebe bei M. Crohn und C. ulcerosa im Kindesalter. Auch die Allelvarianten rs2276886 und rs3814055 in beiden Genen wurden erstmals bei Kindern mit chronisch entz├╝ndlichen Darmerkrankungen untersucht. Ein Zusammenhang zwischen M. Crohn und C. ulcerosa im Kindesalter und der Expression des Gens NR1I2 im Kolongewebe und dem SNP rs3814055 konnte in dieser Studie nicht gefunden werden. Eine deutliche ├ťberexpression des Gens CXCL9 und die signifikante Assoziation des SNP rs2276886 mit M. Crohn lassen jedoch eine Rolle dieses Gens in der Pathogenese chronisch entz├╝ndlicher Darmerkrankungen im Kindesalter vermuten
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