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Ileal Disease (ileal + disease)
Selected AbstractsDefining complex contributions of NOD2/CARD15 gene mutations, age at onset, and tobacco use on Crohn's disease phenotypesINFLAMMATORY BOWEL DISEASES, Issue 5 2003Dr. Steven R. Brant Abstract Background Multiple factors, particularly IBD family history, tobacco use, age at diagnosis and recently, NOD2 mutant genotypes may influence Crohn's disease (CD) heterogeneity. Methods We performed a multicenter retrospective record analysis of 275 unrelated patients with CD. Age at diagnosis, IBD family history, Jewish ethnicity, tobacco use at diagnosis, surgical history, disease site and clinical behavior were correlated with genotypes for NOD2 mutations, and all risk factors were assessed for independent influence on outcomes of disease site, behavior and surgery free survival. Results Risk of ileal disease was increased for CD patients with two NOD2 mutations (Odds Ratio, O.R. 10.1), a smoking history (O.R. 2.25 per pack per day at diagnosis) or a younger age at diagnosis (O.R. 0.97 per each increased year). Presence of ileal disease (O.R. 4.8) and carrying one or two NOD2 mutations (O.R. 1.9 and 3.5, respectively) were independent risk factors for stricturing or non-perianal fistulizing behavior. Ileal disease, youthful onset and smoking at diagnosis (but not NOD2 mutations) were risk factors for early surgery. Conclusions Carrying two NOD2 mutations predicts youthful onset, ileal disease involvement, and development of stricturing or non-perianal fistulizing complications. Smoking and early onset independently influence ileal site and time to surgery. [source] Susceptibility loci reported in genome-wide association studies are associated with Crohn's disease in Canadian childrenALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2010D. K. AMRE Aliment Pharmacol Ther,31, 1186,1191 Summary Background, Recent genome-wide association studies based on adult and paediatric populations have implicated >30 genes/loci as susceptibility loci for Crohn's disease (CD). Aims, To investigate whether reported genes/loci were also associated with CD in Canadian children. Design and Methods, A case-control design was implemented at three paediatric gastroenterology clinics in Canada. Children ,18 years of age with a confirmed diagnosis of CD were recruited along with controls. Single nucleotide polymorphisms (SNPs) in five genome-wide association studies reported genes/loci were genotyped. Associations between individual SNPs and CD were examined. Results, A total of 406 cases and 415 controls were studied. The mean (±s.d.) age of the cases was 12.3 (±3.2) years. Most cases were male (56.6%), had ileo-colonic disease (L3 ± L4, 52.0%) and inflammatory behaviour (B1 ± p, 86.9%) at diagnosis. Allelic association analysis (two-tailed) showed that three of the five targeted SNPs were significantly associated with overall susceptibility for CD (ZNF365, r10995271, P = 0.001; PTPN2, rs1893217, P = 0.005; STAT3, rs744166, P = 0.01). Associations with SNP rs4613763 in the PTGER4 locus were marginally nonsignificant (P = 0.07). The ZNF365 and STAT3 SNPs were predominantly associated with ileal disease with or without colonic involvement. Conclusion, The identified susceptibility genes/loci for adult-onset CD also confer risk for paediatric-onset CD. [source] The use of exclusive enteral nutrition for induction of remission in children with Crohn's disease demonstrates that disease phenotype does not influence clinical remissionALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009E. BUCHANAN Summary Background, Exclusive enteral nutrition (EEN) achieves variable remission rates in patients with Crohn's disease (CD). Aim, To describe our experience of treating CD with an 8-week course of primary EEN and to study factors affecting treatment outcome. Methods, All CD patients treated with EEN in our centre between 2004 and 2007 were included in the study. Remission was determined by a combination of clinical parameters. Disease phenotype was assigned using published classifications. Inflammatory markers and anthropometry (Z -scores) were calculated before and after treatment. Results, A total of 114 children were treated (four were excluded). Median age at diagnosis was 11.6 years. Fifty-seven (51.8%) were fed orally whilst 53 (48.2%) were fed by tube. Eighty-eight (80%) achieved remission with consequent reductions in erythrocyte sedimentation rate and C-reactive protein (P < 0.001). Patients in remission had comparative improvements in weight (,1.04 cf. ,0.40) and BMI Z -scores (,0.98 cf. ,0.03) by the end of treatment (P < 0.001). Individuals with isolated terminal ileal disease (n = 4) had lower remission rates than other locations (P = 0.02). No other significant differences in remission rates for any other disease locations were found. Conclusions, Exclusive enteral nutrition induces clinical remission, normalization of inflammatory markers and improves weight/BMI Z -scores in most patients. This study demonstrates that disease phenotype should not influence clinicians when commencing patients on EEN. [source] The incidence of Crohn's disease in Cardiff over the last 75 years: an update for 1996,2005ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2008S. GUNESH Summary Background The incidence of Crohn's disease rose rapidly in industralized countries over the past 50 years, but it is unclear whether the incidence is still rising or has reached a plateau. Aims, To update the long-term incidence study of Crohn's disease in Cardiff for 1996,2005, to investigate whether incidence is still rising and to study changes in disease characteristics over time. Method, Crohn's cases identified by retrospective analysis of hospital records as in previous studies in Cardiff. Results, Two hundred and twelve cases were identified. Corrected incidence for this decade was 66 × 106 per year (95% confidence interval: 58,76), showing a continuing rise compared to previous decades. The proportion with colonic disease at presentation continues to rise (43%) with a corresponding fall in those with terminal ileal disease. There remains a strong female preponderance (F:M 1.6:1) as in previous studies. The incidence in children under age 16 continues to rise, and the median age at diagnosis has fallen slightly. Conclusion, Crohn's disease incidence continues to rise slowly in Cardiff with a continuing increase in those presenting with colonic disease, which is now the commonest disease pattern. [source] Combined type-1 plasminogen activator inhibitor and NOD2/CARD15 genotyping predicts complicated Crohn's disease behaviourALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2007M. ALVAREZ-LOBOS Summary Background NOD2/CARD15 gene variants have not been universally associated with stricturing behaviour in Crohn's disease. Other behaviour modifying genes could explain these results. Aim To study the combined influence of NOD2/CARD15 variants and 4G/4G genotype of type-1 plasminogen activator inhibitor (PAI-1) gene on Crohn's disease behaviour. Methods One hundred and seventy Crohn's disease patients were studied prospectively, with a mean follow-up of 7± 6 years. Disease behaviour was registered by using two criteria: the Vienna classification and a non-hierarchical classification based on the behavioural Vienna categories. Results In the multivariate analysis for stricturing behaviour according to the Vienna categories, only absence of colonic disease (OR, 4.0; 95% CI: 1.49,11.1; P = 0.006) was an independent predictive factor. However, in the multivariate analysis for stricturing disease applying a non-hierarchical criteria, ileal disease (OR, 4.19; 95% CI: 1.30,13.5; P = 0.01), and carrying both NOD2/CARD15 variants and the 4G/4G PAI-1 genotype (OR, 5.02; 95% CI: 1.44,17.48; P = 0.01) were independent predictive factors. In the multivariate analysis for penetrating behaviour, the 4G/4G PAI-1 (OR, 3.10; 95% CI: 1.54,6.23; P = 0.001) and male sex (OR, 2.44; 95% CI: 1.30,4.60; P = 0.005) were independent predictive factors irrespective of criteria applied. Conclusions Combined PAI-1 and NOD2/CARD15 genotyping predict complicated Crohn's disease. Patients with these variants could benefit from early interventions. [source] | ||||||||||