Crohn's disease (CD), one of the major forms of idiopathic inflammatory bowel disease (IBD), is thought to be related to genetic susceptibility coupled with environmental factors. A positive family history is the strongest risk factor for the development of CD. The 10-fold increase in the familial risk of CD strongly suggests that these disorders have a genetic background. The prevalence of IBD in Asian populations is lower than in Western populations, which may be due to genetic influences, environmental factors, or a combination of both. In a Korean study, only 0.25% of parents had IBD in CD probands and all of them had ulcerative colitis. The term of familial CD was used only for those with one or more first-degree relatives with confirmed CD. There are few case reports about familial Crohn's disease in Korea. We report a case of familial CD that the father, the first degree relative was diagnosed as small bowel CD after confirming his son as having CD.
Child ; Colonoscopy ; Crohn Disease/*diagnosis/etiology/radiography ; Family ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; Pedigree

No abstract available
Adult ; Crohn Disease/*diagnosis/radiography ; Endoscopy, Gastrointestinal ; Female ; Humans ; Intestine, Small/pathology/radiography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: It remains uncertain which patients with stricturing-type Crohn's disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD. METHODS: We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up. RESULTS: Twenty-eight patients (53%) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5–14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4%, 41.0%, and 63.2%, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P<0.0001), and prestenotic dilation (P<0.0001) on radiography were associated with small bowel surgery, and immunomodulatory (P=0.037) and biological therapy (P=0.008) were significant factors during follow-up. Multivariate analysis revealed that long-segment stricture (hazard ratio [HR], 4.25; 95% confidence interval [CI], 1.78–10.53; P=0.001) and prestenotic dilation (HR, 3.41; 95% CI, 1.24–9.62; P=0.018) on radiography showed a positive correlation with small bowel surgery, and biological therapy (HR, 0.40; 95% CI, 0.15–0.99; P=0.048) showed a negative correlation. CONCLUSIONS: CD patients with long-segment stricture and prestenotic dilation on radiography seem to be at a higher risk of needing small bowel surgery. For such patients, early surgical intervention might be appropriate, even at initial diagnosis.
Biological Therapy ; Constriction, Pathologic ; Crohn Disease ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Intestine, Small ; Multivariate Analysis ; Radiography ; Retrospective Studies

No abstract availble.
Adult ; Crohn Disease/*complications ; Humans ; Intestinal Fistula/*diagnosis/*etiology ; Intestinal Perforation/*diagnosis/*etiology ; Male ; Tomography, X-Ray Computed ; Urinary Bladder/radiography

Plummer-Vinson syndrome manifests as cervical dysphagia, iron deficiency anemia, an upper esophageal web, and atrophic glossitis. The cause of the esophageal web is thought to be iron deficiency anemia; however, the cause of Plummer-Vinson syndrome has not been established. Crohn's disease is usually accompanied by malnutrition and iron deficiency anemia; however, no case of concomitant Crohn's disease and Plummer-Vinson syndrome with aggravated malnutrition and anemia has been previously reported. Here, we report on a rare case of Plummer-Vinson syndrome in a Crohn's disease patient, which caused malnutrition and constipation.
Adult ; Cobblestone Lissencephaly/diagnosis ; Colon, Sigmoid/surgery ; Crohn Disease/complications/*diagnosis ; Esophageal Sphincter, Upper/radiography ; Humans ; Male ; Plummer-Vinson Syndrome/*diagnosis/etiology ; Sigmoidoscopy ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed

No abstract available.
Adenocarcinoma, Mucinous/diagnosis ; Colonoscopy ; Crohn Disease/complications/*pathology ; Humans ; Intestinal Neoplasms/*diagnosis/pathology/radiography ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Positron-Emission Tomography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Several clinical risk factors for low bone mineral density (BMD) in the patients with inflammatory bowel disease (IBD) have been suggested. However, its prevalence and pathophysiology in Korean population have not been fully studied. The aim of this study was to investigate the prevalence and risk factors for low BMD in Korean IBD patient. METHODS: BMD of the lumbar spine and femur was evaluated using dual-energy X-ray absorptiometry in 30 patients with IBD. Biochemical parameters of bone metabolism, such as serum calcium, phosphorus, osteocalcin, and deoxypyridinoline were measured. The associations between low BMD and clinical parameters such as disease duration, disease activity, drug history, body mass index (BMI), and others were evaluated retrospectively using medical records. RESULTS: Low BMD at the lumbar spine or femur was observed in 63.3% of the patients, and there was no significant difference between the patients with Crohn's disease and ulcerative colitis. Clinical and biochemical parameters were irrelevant to BMD. In the patients without glucocorticoid treatment prior to BMD measurement, already 50.0% of patients had low BMD. CONCLUSIONS: Low BMD is a common feature in Korean IBD patients, even those who do not use glucocorticoid. The multiple factors may be involved in the pathogenesis of low BMD. Therefore, BMD should be examined in all IBD patients, irrespective of glucocorticoid treatment.
Absorptiometry, Photon ; Adolescent ; Adult ; Amino Acids/blood ; Body Mass Index ; *Bone Density ; Calcium/blood ; Colitis, Ulcerative/diagnosis/radiography ; Crohn Disease/diagnosis/radiography ; Female ; Glucocorticoids/therapeutic use ; Humans ; Inflammatory Bowel Diseases/diagnosis/drug therapy/*radiography ; Male ; Middle Aged ; Osteocalcin/blood ; Phosphorus/blood ; Prevalence ; Retrospective Studies ; Risk Factors

Mesalazine (5-aminosalicylic acid) and sulfasalazine are widely used in the treatment of inflammatory bowel disease. The pulmonary toxicity related to sulfasalazine was well-recognized complication and it was caused by sulfapyridine moiety in sulfasalazine. However, the lung injury related to mesalazine has rarely been reported. A thirty five-year-old man with Crohn's disease who was treated with mesalazine complained fever and dry cough. The finding of bilateral wandering pulmonary infiltration, peripheral eosinophilia and increased eosinophils in bronchoalvolar lavage were consistent with eosinophilic pneumonia. His symptoms and laboratory findings were markedly improved after the discontinuation of mesalazine. The mesalazine-induced eosinophilic pneumonia was diagnosed according to his clinical course. This report shows that the eosinophilic pneumonia should be considered in patients who develope pulmonary involvement with inflammatory bowel disease receiving mesalazine therapy.
Adult ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/therapeutic use ; Crohn Disease/*drug therapy ; Humans ; Lymphocyte Activation ; Male ; Mesalamine/*adverse effects/therapeutic use ; Pulmonary Eosinophilia/chemically induced/*diagnosis/radiography ; Tomography, X-Ray Computed

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.
Adolescent ; Anti-Bacterial Agents/therapeutic use ; Anticoagulants/therapeutic use ; Colonoscopy ; Crohn Disease/complications/*diagnosis ; Humans ; Male ; Phlebitis/complications/*diagnosis ; Portal Vein/radiography ; Sepsis/*diagnosis/microbiology ; Streptococcal Infections/diagnosis/drug therapy ; Thrombosis/drug therapy/radiography ; Tomography, X-Ray Computed ; Viridans Streptococci/isolation & purification