ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The increasing application of monoclonal antibody technology and FACScan analysis to the phenotyping of immunocytesin situor after isolation from tissues is having a considerable impact on understanding of intestinal mucosal immunity. Cells can be classified as to type and state of activation. So far, however, we have no really acceptable hypothesis for the immunopathogenesis of inflammatory bowel disease. These techniques may need to be applied to clinical situations, such as pouchitis following pelvic ileal pouch operation for ulcerative colitis and recurrence in the neoterminal ileum following ileocolonic resection for Crohn's disease. In these situations, clinical researchers are perhaps defining for the first time the real natural history of ulcerative colitis and Crohn's disease. In the area of autoimmunity and inflammatory bowel disease, the main priority is cloning and identifying putative autoantigens.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

New molecular biologic techniques have opened a new era of pursuit of an infectious cause of Crohn's disease. Early data, however, are negative for the presence of DNA from mycobacteria andChlamydiain Crohn's disease tissue. The role of the fecal stream in Crohn's disease has again been highlighted by excellent clinical observations in the pathogenesis of recurrent ileal disease following “curative” resection and requires more detailed appraisal. The elegant demonstration of the intimate involvement of vascular endothelium in granulomas in Crohn's disease emphasizes the much-ignored role of endothelium in inflammatory events. More information on abnormalities of some key cytokines in the intestinal mucosa still leaves the question of “cause versus effect” unanswered. A role for the “impotent” neutrophil in Crohn's disease has again been supported by studies of postphagocytic activities. For ulcerative colitis, a study of monozygotic twins has confirmed that abnormalities of mucin glycoproteins in large bowel epithelium found in affected patients is unlikely to be a consequence of mucosal inflammation but, by itself, is not responsible for the development of such inflammation. The impressive disease specificity of perinuclear antineutrophil cytoplasmic antibodies to ulcerative colitis and to primary sclerosing cholangitis offers the exciting prospect of defining a putative autoantigen that would considerably expand our investigational capabilities, and provides a link between the two diseases. Pouchitis, a condition of ileoanal reservoirs that appears specific for patients with ulcerative colitis, may also offer clues to the cause of ulcerative colitis and recent studies have begun to examine roles of the lumen, the epithelium, and immunoinflammatory events in its pathogenesis. The void in our understanding of the pathogenesis of diarrhea in colitis has been narrowed by studies in experimental animals and humans on muscle, nerve and epithelial function, and on factors influencing them.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Descriptive epidemiologic studies from a high-incidence area like Sweden indicate a stable annual incidence rate for both ulcerative colitis and Crohn's disease since the 1970s. Differences in the prevalence of ulcerative colitis in different ethnic groups in Israel, studies of perinatal events in Sweden and Canada, and cohort phenomena reported from Sweden indicate that events in the perinatal period are important in the causation of inflammatory bowel disease. Studies of the familial occurrence of inflammatory bowel disease in Denmark, Sweden, Israel, and the United States consistently show that there also is a strong genetic component in the etiology of the diseases.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

New clinical advances in inflammatory bowel disease are highlighted. Conditions that mimic the presentation of either ulcerative colitis or Crohn's disease are discussed along with the role that endoscopy, radiography, and histology play in establishing the correct diagnosis of each respective disorder. Assessment of Crohn's disease activity has progressed, with evaluation of soluble interleukin-2 receptor, serum tumor necrosis factor-α, fecal αarantitrypsin clearance, erythrocyte sedimentation rate, IgG content of gut lavage fluid, andIIIIn scintigraphy. Systemic complications associated with inflammatory bowel disease are reviewed, with particular attention to oral complication of Crohn's disease, complications resulting from a hypercoagulable state, bronchopulmonary manifestations, hematologic malignancies, and factors associated with intestinal perforation. Although the etiologic agents responsible for Crohn's disease and ulcerative colitis remain elusive we still continue to advance our knowledge base, making significant strides toward better understanding the pathophysiology of these two disorders, thus enabling us to better treat afflicted patients. These advances are established with hopes that we will soon unearth the cause and cure of both Crohn's disease and ulcerative colitis.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Medical treatment of ulcerative colitis and Crohn's disease is based on the results of clinical trials. For treatment of ulcerative colitis, in addition to the use of corticosteroids at different dosages and routes according to severity of attacks, there is now a place for high dosage of oral mesalamines or, even better, for topical treatment using suppositories or rectal enemas; the use of mesalamine colonic foams seems promising. Enemas with corticosteroids, which are topically active and have no systemic effects, are providing good results. Long-term treatment has been done with sulfasalazine; now new oral mesalamine or diazoderivative compounds are available and rectal mesalamine preparations have shown a prophylactic effect. Treatment of pouchitis, usually with metronidazole, might benefit also by a topical approach—either with mesalamine or steroids. Crohn's disease patients might be more safely treated using new corticosteroids along with traditional steroids, which can avoid systemic side effects, but high dosages of oral mesalamines are also useful to induce remission. The antibacterial agent metronidazole appears to be beneficial, whereas the role of antimycobacterial agents needs further clinical investigation. For prevention of relapse, low or intermittent dosage of steroids seems to offer some benefit and possibly oral mesalamine. In refractory or steroid-dependent Crohn's disease, patients on azathioprine or 6-mercaptopurine usually have a better outcome, whereas cyclosporine is effective in a short, but not long-term, period. Methotrexate should be cautiously used in patients in whom immunosuppressive agents have failed. New selectively acting agents, such as lipoxygenase inhibitors, eicosapentanoic acid, free-radical scavengers, and interleukin-1 receptor antagonists, are now under clinical investigation.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In the past year, there has been an increased emphasis on developing improved methods and assessment of inflammatory bowel disease. Although tumor necrosis factor-α may be useful in the evaluation of inflammatory bowel disease in children, some controversy remains. Other serum markers, such as procollagen type I and type III, appear to be useful as early indicators of growth or inhibition of growth with treatment and activity. The use of steroid-sparing drugs continues to be studied, with new reports of pediatric inflammatory bowel disease responding to cyclosporine, 6-mercaptopurine, azathioprine, and alternate-day prednisone. Long-term studies are reported on outcome and recurrence in children with Crohn's disease following surgery, the development of inflammatory bowel disease in the offspring of couples with inflammatory bowel disease, and the psychologic difficulties that arise in children and families of children with inflammatory bowel disease. Other diseases that may be confused with pediatric inflammatory bowel disease are also reviewed.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The most exciting development this year in the field of cancer in inflammatory bowel disease has been the use of flow cytometry to define genetic abnormalities in colonic biopsy specimens in patients with Crohn's colitis or ulcerative colitis. In the future, it appears that DNA aneuploidy will replace mucosal dysplasia as the best marker for identifying the patient at extremely high risk for developing cancer. Work continues, though, on confirming and identifying risk factors for cancer in ulcerative colitis patients and on further defining parameters for cancer surveillance that use mucosal dysplasia as the criterion for a positive screening test. Crohn's disease patients may be at increased risk for intestinal and extraintestinal cancer as judged by a flurry of such reports this year. The evidence for an increased risk of extraintestinal cancer in inflammatory bowel disease, though, is slim.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This review of the past year's literature shows continuing interest in the prevalence of nutritional problems in inflammatory bowel disease, especially Crohn's disease, and the occurrence of specific deficiencies such as zinc, copper, selenium, and calcium. There is also continuing interest in the correction of nutritional insufficiency in inflammatory bowel disease and in the use of nutrition, especially elemental diets, as possible primary therapy in Crohn's disease. A number of clinical trials have been reported on this subject in the past year and mixed results obtained. Although some studies suggest that elemental diets are no different from polymeric preparations in the management of Crohn's disease, the suspicion remains that there may be a specific effect of elemental diets in some patients. There is a case for further well-planned, prospective, well-controlled studies to investigate this whole area further. Other interesting work has looked at the effect of artificial nutritional support on abnormalities of liver function tests and an assessment of home artificial nutritional support in patients with inflammatory bowel disease.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Significant advances have occurred in the operative and perioperative treatment of patients with inflammatory bowel disease since this topic was last reviewed in this journal. The ileoanal pouch is the preferred operative treatment for most patients with ulcerative colitis and it continues to be the subject of the greatest investigative interest. Technical improvements in the construction of the ileoanal pouch continue to appear. However, with the many different types of pouch operations still being performed, it is concluded that the “ideal pouch” has yet to be developed. Controversy continues as to the necessity of anorectal mucosectomy. The benefits of completely eliminating premalignant and inflamed mucosa are contrasted with apparent increased postoperative morbidity with mucosectomy. Construction of a pouch in the presence of acute illness now appears feasible in selected patients and avoids a three-stage operative treatment. The increasing incidence of the iatrogenic disease “pouchitis” is enigmatic. Ongoing investigations of pouchitis may help elucidate the pathogenetic mechanisms of inflammatory bowel disease. Conservatism continues to be the underlying principle of operative treatment for patients with Crohn's disease. This principle is supported by increasing evidence of very early postoperative recurrence of Crohn's disease in many asymptomatic patients. The presence of initial disease at multiple intestinal sites and mucosal contact with the fecal stream are important determinants of postoperative recurrent disease. Published reports are beginning to appear concerning the inadvertent creation of ileoanal pouches in patients with Crohn's disease. Significant complications occur in these patients, underscoring the need for thorough preoperative evaluation and accurate diagnosis in all patients in whom pouches are being considered. Similar to other areas of surgery, advances in the perioperative treatment of patients with inflammatory bowel disease continue to be demonstrated. The efficacy for restrictive use of perioperative antibiotics in patients undergoing restorative proctocolectomy is now documented. Improved regimens to replete vitamin D losses following extensive ileal resections have been reported.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID