OBJECTIVETo enhance our understanding of pediatric Crohn's disease and improve diagnostic accuracy and therapeutic efficacy by characterizing the clinical picture and reviewing 10 years' clinical experience in diagnosis and treatment.

METHODSNine cases with active Crohn's disease diagnosed between 1996 and 2005, including 8 males and 1 female, aged 6 - 13 years, were reviewed. Clinical, radiologic, endoscopic and histological data as well as therapeutic results were analized.

RESULTSThe mean interval from the onset of symptoms to the diagnosis was 10 months. The sites of involvement were both the small intestine and colon in 6, small intestine only in 3. Abdominal pain and diarrhea were the two most common gastrointestinal symptoms. The main extraintestinal manifestations were weight loss in 7, hypoalbuminemia in 5, mild anemia in 5, fever in 4 and hypocalcemia in 2. All the patients had undergone colonoscopy, and the findings included ulcerations, segmental lesions, cobblestone appearance, pseudopolyps and perianal abnormalities. Capsule endoscopic examination in one patient demonstrated the segmental distribution with typical longitudinal cleft-like ulcers and cobblestone appearance. Gastrointestinal barium meal X-ray examination was performed in 7 patients, the main findings were segmental strictures and abnormal mucosa. Histological examination of biopsy specimens mainly showed nonspecific chronic inflammation. Non-caseating granulomas were identifiable in 2 cases. Although there were many macroscopic and microscopic features supporting the diagnosis of Crohn's disease, no epithelioid granuloma could be found in surgical specimens of two patients. Treatment was given up by parents of 2 patients after the diagnosis was established. All the other 7 patients were treated with 5-acetylsalicylic acid, antibiotics and nutritional support during the acute phase. Corticosteroids were used in two patients. Long-term remission was achieved and maintained in 3 children, and in one of them medication could be discontinued and had no signs of disease activity at the end of the follow-up.

CONCLUSIONSChildren and adolescents presenting with Crohn's disease commonly have weight loss and nutritional impairment, which may provide clues to the diagnosis. Appropriate formulation and higher dosage of 5-acetylsalicylic acid [30-50 mg/(kg x d)] may be effective in inducing and maintaining remission in pediatric Crohn's disease.

Adolescent ; Child ; Colon ; pathology ; Colonoscopy ; Crohn Disease ; diagnosis ; pathology ; therapy ; Female ; Humans ; Intestinal Mucosa ; pathology ; Male ; Malnutrition ; etiology ; Weight Loss

Crohn's disease and ulcerative colitis are well known risk factors of intestinal cancer in relation to the extent and duration of disease. Rarely, small bowel cancer can develop after a longstanding inflammation of Crohn's disease with a relatively higher incidence than the general population. Signet ring cell carcinoma is a rare condition among intestinal cancers, and the diagnosis or detection is more difficult if the cancer originates from the small bowel. We report a case of a 30-year old female in whom signet ring cell carcinoma of ileum was diagnosed after a 15-year history of Crohn's disease.
Adult ; Carcinoma, Signet Ring Cell/*diagnosis/etiology/pathology ; Colonoscopy ; Crohn Disease/*complications/diagnosis/pathology ; Female ; Humans ; Ileal Neoplasms/*diagnosis/etiology/pathology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Focally enhanced gastritis (FEG) has been suggested as a specific diagnostic marker for patients with Crohn's disease (CD). However, the usefulness of FEG for distinguishing CD from ulcerative colitis (UC) is uncertain and the incidence or prevalence of FEG for inflammatory bowel disease (IBD) patients in Korea has not been defined yet. In this study, we investigated the frequency of FEG and other gastric histological abnormalities in Korean patients with CD and UC. METHODS: We evaluated 37 patients with known CD, 43 patients with UC and 41 non-IBD control group; all underwent upper gastrointestinal endoscopy followed by biopsy from the antrum and the body. The pathology of the gastric biopsy specimens and the presence of Helicobacter pylori (H. pylori) were evaluated. FEG was characterized by a focal perifoveolar or periglandular inflammatory cell infiltrates. RESULTS: H. pylori positive gastritis was found in 10 of 37 (27.0%) of CD patients, in 16 of 43 (37.2%) of UC patients, and in 22 of 41 (53.7%) of non-IBD control group (p=0.054). In H. pylori-negative patients, FEG was found in 8 of 27 patients (29.6%) of CD patients, 6 of 27 (22.2%) patients with UC, and 2 of 9 (10.5%) of non-IBD control group (p=0.324). CONCLUSIONS: In H. pylori-negative patients, there was no statistically significant difference in the occurrence of FEG among CD, UC and control groups in Korea.
Adult ; Colitis, Ulcerative/*diagnosis/etiology/pathology ; Crohn Disease/*diagnosis/etiology/pathology ; Female ; Gastritis/epidemiology/*pathology ; Gastroscopy ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Upper Gastrointestinal Tract/pathology

No abstract available.
Adult ; Constriction, Pathologic ; Crohn Disease/*complications ; Endoscopy, Gastrointestinal ; Humans ; Ileal Diseases/*diagnosis/etiology/pathology ; Ileum/pathology ; Male

Crohn's disease is characterized by its chronic course and transmural inflammation of gastrointestinal tract. The accompanying fibrous reaction and adhesion to adjacent viscera appears to limit the complication of free perforation. The true incidence of free bowel perforation is difficult to assess, however, the anticipated occurrence rate is 1-2% during the course of illness. Moreover, portal venous gas is also an uncommon event in the natural history of Crohn's disease. Portal venous gas occurs when intraluminal gas from the gastrointestinal tract or gas-forming bacteria enters the portal venous circulation. The finding of portal venous gas associated with Crohn's disease does not always mandate surgical intervention. We experienced a case of Crohn's disease presenting with free perforation and portal venous gas. The literatures on the cases with perforation and portal venous gas associated with Crohn's disease were reviewed.
Adult ; Colonoscopy ; Crohn Disease/complications/drug therapy/*pathology ; Diagnosis, Differential ; Embolism, Air/*diagnosis/etiology ; Humans ; Intestinal Perforation/*diagnosis/etiology ; Male ; *Portal Vein ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Ascites that can be induced by various causes is not a rare finding in Crohn's disease. The clinical implication of ascites in Crohn's disease remains unknown in the cases without any specific cause of ascites except Crohn's disease itself. The purpose of this study was to investigate the clinical implication and characteristics of ascites in Crohn's disease. METHODS: We reviewed the medical records of the patients with Crohn's disease who underwent abdominal CT scan. Patients were categorized into two groups: patients with ascites (22 cases) and without ascites (23 cases). We compared clinical features, disease activities and clinical courses of the two groups. RESULTS: Serum albumin level was significantly lower and the C-reactive protein level was significantly higher in the ascites group than in the control group. Harvey and Bradshaw index was significantly higher in the ascites group (8.32 +/- 2.51) than in the control group (6.09 +/- 2.07) (p=0.002). The average dose of prednisolone was higher in the ascites group. On the other hand, there was no significant difference in the number of cases requiring surgery due to complication between two groups. CONCLUSIONS: Our results suggest that the presence of ascites in Crohn's disease is associated with increased disease activity and inflammations requiring more aggressive treatment.
Adolescent ; Adult ; Ascites/diagnosis/*etiology ; Biological Markers/blood ; C-Reactive Protein/analysis ; Crohn Disease/*complications/diagnosis/pathology ; Female ; Humans ; Male ; Serum Albumin/analysis

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by multiple gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. Peutz-Jeghers syndrome has an incidence of approximately 1 in 25,000 to 300,000 births. Crohn's disease is a chronic inflammatory bowel disease that typically manifests as regional enteritis with its incidence ranging from 3.1 to 14.6 cases per 100,000 person-years in North America. Herein, we report a case of a 30-year-old male patient who had both Peutz-Jeghers syndrome and Crohn's disease. We believe that this is the first case in Korea and the second report in the English literatures on Peutz-Jeghers syndrome coincidentally accompanied by Crohn's disease.
Adult ; Crohn Disease/complications/*diagnosis/pathology ; Endoscopy, Gastrointestinal ; Humans ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Intestinal Polyps/pathology/surgery ; Male ; Peutz-Jeghers Syndrome/complications/*diagnosis/genetics ; Protein-Serine-Threonine Kinases/genetics

Cytomegalovirus (CMV) colitis is common among immunocompromised patients, and often diagnosed by pathologic confirmation because it is associated with a diverse spectrum of clinical and endoscopic features. However, Crohn's disease has no definitive diagnostic criteria, but longitudinal ulcers and cobble stone appearance are accepted as typical endoscopic features of Crohn's disease. An 83 year-old male with a history of radiotherapy for hypopharyngeal cancer visited our hospital with a complaint of melena for 1 week. His colonoscopic exam showed multiple longitudinal ulcers along the entire colon. Most of the ulcers were longer than 4 cm, these endoscopic findings were suspected as typical endoscopic features of Crohn's disease. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis, and received a 3 week-course of intravenous ganciclovir. A colonoscopic follow-up showed complete healing of the multiple longitudinal ulcers, and he is doing well now without further treatment.
Aged, 80 and over ; Antiviral Agents/therapeutic use ; Colitis/*diagnosis/etiology/pathology ; Colonoscopy ; Crohn Disease/diagnosis ; Cytomegalovirus Infections/*diagnosis/drug therapy/pathology ; Ganciclovir/therapeutic use ; Humans ; Immunohistochemistry ; Injections, Intravenous ; Male ; Tomography, X-Ray Computed

Urological complications are not uncommon in Crohn's disease (CD). The most common manifestations are renal stones, enterovesical fistulas, and ureteral obstruction, but renal parenchymal disease has rarely been reported. IgA nephropathy, the most common form of primary glomerulonephritis, is usually isolated, but can be sometimes associated with chronic extrarenal disorders such as inflammatory bowel disease. We describe a case of 36 year-old man with CD associated with IgA nephropathy. He was diagnosed as CD 6 years ago and at that time, isolated proteinuria was observed. He presented recurrent proteinuria and elevation of creatinine level while he had been managed well with mesalamine and azathioprine. The renal biopsy was performed and IgA nephropathy (type IV) was diagnosed. Strict blood pressure control with angiotensin converting enzyme inhibitor and calcium channel blocker resulted in clinical improvement and normalization of serum creatinine level.
Adult ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antimetabolites/therapeutic use ; Azathioprine/therapeutic use ; Blood Pressure ; Calcium Channel Blockers/therapeutic use ; Colonoscopy ; Crohn Disease/*diagnosis/drug therapy/etiology ; Glomerulonephritis, IGA/complications/*diagnosis/pathology ; Humans ; Male ; Mesalamine/therapeutic use ; Proteinuria/diagnosis/etiology

Sclerosing mesenteritis (SM) is a rare disease characterized by chronic nonspecific mesenteric inflammation and fibrosis of unknown etiology. Some tumefactive SM shows diffuse accumulation of IgG4-positive plasma cells and is considered as a part of the spectrum of IgG4-related disease. An association between inflammatory bowel disease and IgG4-related disease has been indicated. A 45-year-old woman visited our hospital due to weight loss with intermittent lower abdominal discomfort. Pelvic ultrasound revealed a mass-like lesion in the abdominal wall and pelvis MRI demonstrated a 5.9 cm sized wall-enhancing mass with heterogeneous signal intensity from right adnexa to the abdominal wall. Tumor resection and adhesiolysis was done because of severe adhesion with the small bowel, colon, bladder, uterus, and abdominal wall. Appendectomy was also performed due to adhesion and edematous change. Histological examination of the resected mass showed findings that were compatible with IgG4-related SM. The resected appendix showed chronic granulomatous inflammation without evidence of tuberculosis. She was diagnosed with Crohn's disease after undergoing colonoscopy and CT enterography. Herein, we report a rare case of IgG4-related SM that occurred in conjunction with Crohn's disease.
Anti-Inflammatory Agents/therapeutic use ; Appendix/pathology ; Azathioprine/therapeutic use ; Colonoscopy ; Crohn Disease/complications/*diagnosis/drug therapy ; Female ; Humans ; Immunoglobulin G/*blood ; Magnetic Resonance Imaging ; Mesalamine/therapeutic use ; Middle Aged ; Panniculitis, Peritoneal/*diagnosis/etiology/ultrasonography ; Prednisolone/therapeutic use ; Tomography, X-Ray Computed ; Urinary Bladder/pathology