Medicine of the Future in America

Tag Archives: Granulomatous colitis

Long-term prognosis of early-onset Crohn’s disease: DISCUSSION (Part 3)

The data here indicate that an intestinal resection, if required, will usually be performed within two years of the initial diagnosis. Moreover, if a second resection is required, this is also frequently done within two years following the first resection. While it was not possible to evaluate the effects of therapy on the natural history of Crohn’s disease before resection in the present study, future investigations focused on new therapeutic drugs and biological agents should distinguish early-onset from adult onset disease. Continue reading

Long-term prognosis of early-onset Crohn’s disease: DISCUSSION (Part 2)

Epithelial dysplasia in Crohn’s disease has been recorded elsewhere in the small and large intestine, leading others to hypothesize that the so-called ‘dysplasia-carcinoma sequence’ may occur in Crohn’s disease. Although very logical, data to support an endoscopic surveillance approach are limited in Crohn’s disease, and are largely based on a single study conducted in an older adult population. Indeed, most cases of carcinoma in adults with Crohn’s disease, even from large tertiary care settings, were detected only incidentally during surgical treatment. Evidence providing support for routine endoscopic surveillance in pediatric Crohn’s disease is lacking and should not be recommended based on the limited data from adult populations. Continue reading

Long-term prognosis of early-onset Crohn’s disease: DISCUSSION (Part 1)

intestinal resectionThe present study focused on an exploration of specific disease end points traditionally used as clinical indicators of long-term prognosis in Crohn’s disease, but applied to early-onset disease diagnosed during childhood or adolescence. These included malignancy and mortality as well as the requirement for intestinal resection. As anticipated, the results show that both early malignancy and mortality are rare, each being noted only in single patients (eg, rectal cancer, suicidal drug overdose), around 40 years of age and beyond. Continue reading

Long-term prognosis of early-onset Crohn’s disease: Intestinal resections (Part 2)

Table 4 compares disease location in males and females who did not require an intestinal resection with those who required one or multiple intestinal resections. For both males and females, most early-onset Crohn’s disease with ileocolonic involvement required at least one, and usually multiple intestinal resections, while both males and females with only localized colonic disease were less likely to require an intestinal resection (P<0.05). Table 5 shows the data redistributed using the modern Vienna system. Continue reading

Long-term prognosis of early-onset Crohn’s disease: Intestinal resections (Part 1)

early-onset Crohn’s diseaseAfter diagnosis of early-onset Crohn’s disease, mean time to the first intestinal resection was 4.2 years (range to 20 years). For males, mean time to the first resection was 4.2 years (range to 20 years), and for females, 4.1 years (range to 19 years). After the first resection, mean time to the second resection was 6.6 years (range to 25 years). For males, mean time to the second resection was 6.7 years (range to 23 years), and for females, 6.6 years (range to 25 years). Continue reading

Long-term prognosis of early-onset Crohn’s disease: Malignancy and mortality (Part 2)

These findings contrast with earlier reported results on myeloid, lymphoid or intestinal malignancies in adults with Crohn’s disease from the University of British Columbia hospital with a similar duration of follow-up . In that report, the estimated overall rate for myeloid and lymphoid malignancies was 0.5% and the estimated overall rate for intestinal malignancies was 1% . In addition, one patient with Hodgkin’s disease, initially diagnosed at 10 years of age, was not included in the present evaluation of early-onset disease because her diagnosis of Crohn’s disease was only established after 20 years of age. Continue reading

Long-term prognosis of early-onset Crohn’s disease: Malignancy and mortality (Part 1)

intestinal malignancyOnly a single male with early-onset disease among these 224 patients developed an intestinal malignancy. He was initially diagnosed with Crohn’s disease at 17 years of age in 1977. Endoscopic and radiological studies defined ileocolonic involvement. He was subsequently treated with different 5-aminosalicylate preparations, including sulfasalazine and eventually metronidazole, but no corticosteroids or immunosuppressive agents. He required an ileocolonic resection in 1980 for a localized ileal perforation proximal to a strictured ileal segment. Continue reading

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