• Title/Summary/Keyword: Crohn%27s disease

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Oral Symptoms Related to Vitamin B12 Deficiency in a Patient with Crohn's Disease

  • Lee, Joo-Hee;Park, Youn-Jung;Kwon, Jeong-Seung;Kim, Young-Gun;Ahn, Hyung-Joon
    • Journal of Oral Medicine and Pain
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    • v.42 no.1
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    • pp.25-27
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    • 2017
  • Crohn's disease is an inflammatory bowel disease which affects whole gastrointestinal tract from mouth to anus. Crohn's disease may present both oral manifestation and gastrointestinal symptom-abdominal pain, diarrhea, weight loss, anorexia, fever, and growth failure. The prevalence rate of oral manifestation is approximately between 0.5% and 20%. The oral lesion could be the first sign of Crohn's disease. We present a case of Crohn's disease in a patient who did not show typical oral manifestations but had nonspecific aphthous like ulceration and burning sensation for many years. Through this case, we suggest approaches for the diagnosis and treatment of the oral lesion of Crohn's disease.

Mucosal Immunity Related to FOXP3+ Regulatory T Cells, Th17 Cells and Cytokines in Pediatric Inflammatory Bowel Disease

  • Cho, Jinhee;Kim, Sorina;Yang, Da Hee;Lee, Juyeon;Park, Kyeong Won;Go, Junyong;Hyun, Chang-Lim;Jee, Youngheun;Kang, Ki Soo
    • Journal of Korean Medical Science
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    • v.33 no.52
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    • pp.336.1-336.12
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    • 2018
  • Background: We aimed to investigate mucosal immunity related to forkhead box P3 ($FOXP3^+$) regulatory T (Treg) cells, T helper 17 (Th17) cells and cytokines in pediatric inflammatory bowel disease (IBD). Methods: Mucosal tissues from terminal ileum and colon and serum samples were collected from twelve children with IBD and seven control children. Immunohistochemical staining was done using anti-human FOXP3 and anti-$ROR{\gamma}t$ antibodies. Serum levels of cytokines were analyzed using a multiplex assay covering interleukin $(IL)-1{\beta}$, IL-4, IL-6, IL-10, IL-17A/F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, interferon $(IFN)-{\gamma}$, soluble CD40L, and tumor necrosis factor-${\alpha}$. Results: $FOXP3^+$ Treg cells in the lamina propria (LP) of terminal ileum of patients with Crohn's disease were significantly (P < 0.05) higher than those in the healthy controls. $ROR{\gamma}t^+$ T cells of terminal ileum tended to be higher in Crohn's disease than those in the control. In the multiplex assay, serum concentrations (pg/mL) of IL-4 ($9.6{\pm}1.5$ vs. $12.7{\pm}3.0$), IL-21 ($14.9{\pm}1.5$ vs. $26.4{\pm}9.1$), IL-33 ($14.3{\pm}0.9$ vs. $19.1{\pm}5.3$), and $IFN-{\gamma}$ ($15.2{\pm}5.9$ vs. $50.2{\pm}42.4$) were significantly lower in Crohn's disease than those in the control group. However, serum concentration of IL-6 ($119.1{\pm}79.6$ vs. $52.9{\pm}39.1$) was higher in Crohn's disease than that in the control. Serum concentrations of IL-17A ($64.2{\pm}17.2$ vs. $28.3{\pm}10.0$) and IL-22 ($37.5{\pm}8.8$ vs. $27.2{\pm}3.7$) were significantly higher in ulcerative colitis than those in Crohn's disease. Conclusion: Mucosal immunity analysis showed increased $FOXP3^+$ T reg cells in the LP with Crohn's disease while Th17 cell polarizing and signature cytokines were decreased in the serum samples of Crohn's disease but increased in ulcerative colitis.

Network pharmacology and molecular docking reveal the mechanism of Qinghua Xiaoyong Formula in Crohn's disease

  • Chenyang Fang;Yanni Pei;Yunhua Peng;Hong Lu;Yin Qu;Chunsheng Luo;Yafeng Lu;Wei Yang
    • The Korean Journal of Physiology and Pharmacology
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    • v.27 no.4
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    • pp.365-374
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    • 2023
  • Crohn's disease (CD) is a chronic inflammatory illness of the digestive system with unknown etiology, and its incidence is increasing worldwide. However, there are currently no effective treatments or medications available for individuals with CD. Therefore, novel therapeutic strategies are urgently needed. The bioactive compounds and targets associated with compounds of Qinghua Xiaoyong Formula (QHXYF) were examined using The Traditional Chinese Medicine Systems Pharmacology database, and 5 disease target databases were also used to identify CD-related disease targets. A total of 166 overlapping targets were identified from QHXYF-related and CD-related disease targets and they were found to be enriched in oxidative stress-related pathways and the PI3K/AKT signaling pathway. Molecular docking was then used to predict how the bioactive compounds would bind to the hub targets. It was found that quercetin could be the core bioactive compound and had good binding affinity to the top 5 hub targets. Finally, animal experiments were performed to further validate the findings, and the results revealed that QHXYF or quercetin inhibited 2,4,6-trinitrobenzenesulfonic acid-induced inflammation and oxidative stress processes by inhibiting the PI3K/AKT pathway, thereby improving CD symptoms. These findings suggest that QHXYF and quercetin may be potential novel treatments for CD.

Interleukin-17 in the Inflammatory Bowel Disease (Interleukin-17의 발현이 염증성장질환의 발생과 진행에 끼치는 영향)

  • Lee, Cho-Rong;Park, Sung-Gyoo
    • Hanyang Medical Reviews
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    • v.33 no.1
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    • pp.27-32
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    • 2013
  • Inflammatory bowel diseases(IBD), including Crohn's disease and ulcerative colitis, are chronic inflammatory states of the intestinal tract. While the exact mechanisms inducing chronic inflammation are still unclear, it is hypothesized that the inflammation is caused in part by an inappropriate immune response to the intestinal microflora. Although inflammatory diseases are not directly linked to patient survival, symptoms of these diseases significantly decrease quality of life. The incidence rate is higher in western people than eastern people, but the incidence rate of IBD in eastern people, including Korean, is increasing. Recently, it has been reported that IL-17 is an important factor that appears to be involved in IBD induction and progression. This report reviews many recent papers reporting the relationship between IBD and IL-17, which may provide an understanding leading to new means of prevention and treatment for IBD.

Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding

  • Lee, Sunyoung;Ye, Byong Duk;Park, Seong Ho;Lee, Kyung Jin;Kim, Ah Young;Lee, Jong Seok;Kim, Hyun Jin;Yang, Suk-Kyun
    • Korean Journal of Radiology
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    • v.19 no.6
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    • pp.1089-1098
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    • 2018
  • Objective: To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding. Materials and Methods: A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis. Results: The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09-9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21-6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-${\alpha}$ therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07-0.95; p = 0.041). Conclusion: The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.

Characteristics of Upper Gastrointestinal Tract Involvement in Korean Pediatric Crohn's Disease: A Multicenter Study

  • Park, Ji Hyoung;Nam, Hye Na;Lee, Ji-Hyuk;Hong, Jeana;Yi, Dae Yong;Ryoo, Eell;Jeon, In Sang;Tchah, Hann
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.20 no.4
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    • pp.227-235
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    • 2017
  • Purpose: Crohn's disease (CD) can involve any site of the gastrointestinal tract (GIT). However, the characteristics of upper GIT involvement in CD are unclear, especially in the Eastern pediatric population. This study aimed to estimate the prevalence of upper GIT involvement and identify the clinical features of Korean children with CD. Methods: This was a retrospective multicenter cohort study that included 52 pediatric patients with CD who underwent esophagogastroduodenoscopy and biopsy. The clinical symptoms and endoscopic and histologic features of the upper GIT were identified according to the presence or absence of upper gastrointestinal symptoms. Results: Among the 52 patients, upper GIT involvement was noted in 50.0% (26/52). The mean age at CD diagnosis was $14.1{\pm}2.1$ years. Gastric ulcer was the most common lesion (19.2%) found on upper GIT endoscopy, followed by duodenal ulcers (15.4%). Chronic inflammation was the most common histopathologic feature (75.0%), followed by gastric erosion (17.3%). Granuloma was found in 9.6% of patients. Helicobacter pylori infection was identified in 5.8% of patients. Endoscopic and histologic findings were not significantly different, but the mean values of erythrocyte sedimentation rate ($60.7{\pm}27.1$ vs. $43.0{\pm}27.6mm/h$, p=0.037) and C-reactive protein ($16.5{\pm}28.2$ vs. $6.62{\pm}13.4mg/dL$, p=0.014) were significantly different between patients with and without upper gastrointestinal CD symptoms. Conclusion: Upper GIT involvement was relatively common in pediatric patients with CD irrespective of upper gastrointestinal symptoms, and H. pylori infection was relatively uncommon. The results of this study should aid the establishment of regional guidelines for upper GIT examination.

Korean Children and Adolescents with Crohn's Disease Are More Likely to Present with Perianal Fistulizing Disease at Diagnosis Compared to Their European Counterparts

  • Kang, Ben;Kim, Jung Eun;Jung, Jae Hun;Choe, Jae Young;Kim, Mi Jin;Choe, Yon Ho;Kim, Seung;Koh, Hong;Lee, Yoo Min;Lee, Jee Hyun;Lee, Yoon;Lee, Ji-Hyuk;Lee, Hae Jeong;Jang, Hyo-Jeong;Choi, Youjin;Choi, So Yoon;Kim, Ju Young;Choe, Byung-Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.23 no.1
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    • pp.49-62
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    • 2020
  • Purpose: We aimed to investigate the disease phenotype of Korean pediatric Crohn's disease (CD) patients at diagnosis according to the Paris classification by comparison with patients from the European multicenter 5-years recruitment of children with newly developed IBD (EUROKIDS registry). Methods: Korean children and adolescents who had been newly diagnosed with CD at the age of <18 years during 2013-2016 were included in this multicenter retrospective study. Disease phenotype at diagnosis was classified according to the Paris classification, and compared with the published data from the EUROKIDS study. Results: A total of 255 patients were included. The median diagnosis age was 14.7 years (range, 0.8-17.9 years). No significant difference was observed in male-to-female ratio with EUROKIDS (1.9:1 vs. 1.45:1, p=0.062). The proportion of children aged <10 years was significantly lower in Koreans (7.1% vs. 19.6%, p<0.001). Colonic disease was less prominent (10.0% vs. 27.3%, p<0.001), while upper GI involvement was more prominent in Korean children (59.3% vs. 46.2%, p<0.001). The proportion with perianal fistulizing disease at diagnosis was significantly higher in Korean patients (44.8% vs. 8.2%, p<0.001). A separate analysis of Korean patients revealed that perianal fistulizing disease at diagnosis was positively associated with male sex and body mass index z-score (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.20-3.76, p=0.010; and OR=1.29, 95% CI=1.05-1.58, p=0.015, respectively). Conclusion: Approximately half of pediatric CD patients in Korea present with perianal fistulas and/or abscesses at diagnosis, which is a distinct feature of CD in Korean children and adolescents compared to their European counterparts. An underlying genetic difference between ethnicities may play a role in this expression of different phenotypes in pediatric CD.

Parent Perspectives of Diagnostic and Monitoring Tests Undertaken by Their Child with Inflammatory Bowel Disease

  • Ho, Shaun Siong Chung;Keenan, Jacqueline Ilene;Day, Andrew Stewart
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.24 no.1
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    • pp.19-29
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    • 2021
  • Purpose: To assess parent perspectives of the current and potential future tests for their child with inflammatory bowel disease (IBD). Methods: New Zealand parents of a child with IBD were invited to complete an anonymous online survey. Experiences relating to their child's blood or faecal tests, medical imaging (abdominal ultrasound [US], abdominal computerised tomography [CT] and magnetic resonance enterography) and colonoscopy were collected. Perceived attitudes to potential future testing of urine, saliva, and breath, were sought. Results: Twenty-eight parents, 93% female completed the survey, and 86% were aged between 35 and 54 years. Baseline information was provided by parents for 27 of 28 children, 70.3% had Crohn's disease with a mean disease duration of 2.67 years. Blood tests were the most requested and completed tests, while CT was the least ordered and most refused test. Colonoscopy was rated as the least comfortable and generated the most worry. Explanation of test significantly improved parent's levels of understanding when their child had blood, faecal, imaging (US) or colonoscopy tests. Providing an explanation, test invasiveness and the impact of the blood results may have on their child's treatment significantly improved parents' comfort levels. However, explanation of colonoscopy generated a significant parental concerns. Saliva, urine and blood tests were chosen as the most preferred disease monitoring tests. Conclusion: Parents preferred any tests less invasive than colonoscopy for monitoring their child's IBD. Although providing explanation of their child's tests enhanced parents' understanding, it can also affect parents' levels of concern and comfort.

Agreement Level of Inflammatory Bowel Disease Symptom Reports between Children and Their Parents

  • Angharad Vernon-Roberts;Emma Rouse;Nerissa L Bowcock;Daniel A Lemberg;Andrew S Day
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.26 no.2
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    • pp.88-98
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    • 2023
  • Purpose: Children with inflammatory bowel disease (IBD) frequently undergo clinical assessments, involving triadic communication between clinician, parent, and child. During such encounters parents are traditionally the main communicator of information on their child's IBD, including subjective symptom reports. The level of agreement between children and their parents for IBD symptoms is poorly understood, and this study aimed to examine this factor. Methods: This was a cross-sectional study among children with IBD, and one parent. A validated paediatric IBD symptom report tool (IBDnow) enabled children and their parent to rate seven pain, well-being, and stool metrics, with dyads completing the tool concurrently. Results were assessed using: Individual agreement: proportion of identical symptom reports by each dyad (ideal score >0.7); Category agreement: percentage of identical reports for IBDnow metrics for the cohort; Inter-rater reliability: Gwet's AC1 coefficient with higher scores indicating better reliability (maximum=1). Results: Seventy-four parent/child dyads participated; child's mean age 12.2 years (standard deviation [SD] 2.9, range 6-16), mean time since diagnosis 2.8 years (SD 3), 54% female, 73% had Crohn's Disease. Mean individual agreement level was 0.6, with 27% of dyads agreeing on ≥6/7 IBDnow metrics. Category agreement was reported by 61% of dyads, 20% of parents overestimated, and 19% underestimated, their child's symptoms. Inter-rater reliability ranged from fair to good. Conclusion: These results should improve clinician awareness of how IBD symptom reports from parents may introduce bias. Children should be considered the most important source of symptom reports, and tools such as IBDnow utilised to enhance communication.

Web based Text-mining and Biological Network Analysis System (웹기반 문헌분석 및 생물학적 네트워크 분석시스템 개발)

  • Seo, Dongmin;Cho, Sung-Hoon;Ahn, Kwang-Sung;Yu, Seok Jong;Park, Dong-Il
    • Proceedings of the Korea Contents Association Conference
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    • 2017.05a
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    • pp.27-28
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    • 2017
  • 다양한 위상학적 관계(topological relation)를 분석하는 네트워크 분석은 복잡한 데이터에서 숨어있는 특성과 사실을 발견하는 기술로 최근 빅데이터 분야에서 데이터 분석 핵심 기술로 급부상하고 있다. 본 연구에서는 질병연구에 핵심적인 생물학적 네트워크의 생성 및 사용자 친화적인 네트워크 분석시스템을 개발하였다. 개발한 시스템은 PubMed에서 특정 질병과 관련있는 논문 요약 정보를 자동 수집후 텍스트마이닝을 통해 질병 관련 화합물, 유전자 그리고 상호작용 정보를 추출해 생물학적 네트워크를 생성하는 기능을 제공한다. 또한, 연구자가 손쉽게 생성된 네트워크에 대한 검색 및 다차원 분석을 수행할 수 있는 기능을 제공한다. 마지막으로 개발한 시스템의 우수성을 입증하기 위해 크론병(Crohn's Disease)에 대한 적용사례를 소개한다.

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