• All patients, regardless of extent of disease at initial diagnosis, should undergo a screening colonoscopy a maximum of 8 years after onset of symptoms, with multiple biopsy obtained throughout the…
Fig. 48.1 Inflammation (left panel) and fibrostenosis (right panel) The progression from early to late disease is accompanied by a change in mucosal cytokine profiles. Early CD is characterized by…
Fig. 50.1 CT image of isolated small bowel Crohn’s disease (arrows). This image clearly demonstrates the segmental nature CD and the hyper-enhancement of the mesenteric blood vessels and thickened bowel…
Possible causes for change over time • Before 1970 – Retrospective data – Hospital based – Cross-sectional studies – Unclear definitions – Pre-endoscopic period • After 1970 – Early endoscopic period – Defined populations – Prospective registration – GP/hospital based • After…
Gender Female +2 HLA DR3 or DR4 +1 AP:AST (or ALT) ratio >3 <1.5 −2 +2 Immune disease Thyroiditis, colitis, others +2 γ-Globulin or IgG level above normal >2.0 1.5–2.0…
Induction Maintenance Minimal evidence Investigational No role IFX or ADA IFX or ADA CZP Spherical carbon adsorbent Steroids aAntibiotics b6-MP Tacrolimus Stem cells Aminosalicylates – bAZA Cyclosporine – – –…
Fig. 38.1 Chemical structures of sulfasalazine and 5-ASA derivatives [2, 3] Mechanism of Action Sulfasalazine has been suggested to exert its clinical effects through anti-inflammatory, immunosuppressive, and bacteriostatic mechanisms. Downregulation…
Benefits of mucosal healing Unresolved issues of mucosal healing Decreased clinical relapse How much mucosal healing is required to impact outcomes? Decreased hospitalizations Can mucosal healing be achieved in most…
Fig. 45.1 Tc-99 m HMPAO WBC scintigraphy in a patient with ulcerative colitis (left) whole-body image and (right) a detail of the abdomen. Rapid migration of lymphocytes from the peripheral…
Drug Risk of Infection Comments Corticosteroids • Serious infections OR 2.21 (1.46–3.34) from TREAT registry of Crohn’s disease patients [7, 19] • Independently associated with serious infections [28] • Infections reported: fungal [10],…
