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Confusing endoscopic findings of ulcerative colitis. A 22-year-old male had colonoscopy with complaints of loose stool. At initial diagnosis, diffuse erythema with friable and granular mucosal change was noted from the rectum to the descending colon without involvement of the right colon (A, B, C). He was diagnosed as ulcerative colitis and had been treated for 1 year, and complete remission was achieved (D, E, F). Four years after the diagnosis, during the follow-up colonoscopy, multiple longitudinal ulcers without involvement of rectum were noted which could have been confused with Crohn's disese if the patient did not have colonoscopy previously (G, H, I). Colonoscopic findings were more compatible with ulcerative colitis 8 months later compared with the latest exam (J, K, L).
Source publication
Colonoscopy plays a crucial role in the diagnosis, treatment and follow-up monitoring of inflammatory bowel disease (IBD). Practitioners should be well informed of the colonoscopic findings of IBD to prevent the misdiagnosis, overtreatment or delayed treatment. Distinguishing between Crohn's disease and ulcerative colitis is essential in terms of p...
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Inflammatory bowel disease and gastroenteritis secondary to Salmonella infection may manifest with overlaping clinical, endoscopic and histologic features. The case reported is of a 70-year-old woman who was admitted to hospital due to fever and diarrhea. Colonoscopic findings were suggestive of Crohn's disease, however pathologic examination when...
Objectives
Surveillance colonoscopy is thought to prevent colorectal cancer (CRC) in patients with long-standing colonic IBD, but data regarding the frequency of surveillance and the findings thereof are lacking. Our aim was to determine whether consecutive negative surveillance colonoscopies adequately predict low neoplastic risk.
Design
A multic...
Subjects affected by ulcerative colitis and Crohn’s disease with colonic localization have an increased risk of colorectal cancer (CRC). Surveillance colonoscopy is recommended by international guidelines as it can detect early-stage CRC. Based on previous evidence, in 2015 the Surveillance for Colorectal Endoscopic Neoplasia Detection and Manageme...
Background
Inflammatory bowel disease (IBD) is usually diagnosed in subjects with gastrointestinal symptoms, but may also be asymptomatic and diagnosed incidentally.
Aims
to determine the prevalence of IBD in asymptomatic adults.
Methods
we identified subjects who underwent colonoscopy between 1 September 2013 and 31 August 2019 in a regional col...
IL-17 antagonism is among the most potent treatments for psoriasis. Generally
safe, new onset and exacerbations of inflammatory bowel disease (IBD) may occur in
association with IL-17 therapy.1 We describe a patient with longstanding history of
psoriasis and psoriatic arthritis in whom asymptomatic Crohn’s disease (CD) was
identified during treatme...
Citations
... Patients with UC often experience abdominal pain, diarrhea, and rectal bleeding during disease exacerbations, symptoms that can be mirrored in CMV colitis [6]. Endoscopic features such as mucosal edema, ulcerations, and pseudopolypoid formations in both conditions further complicate the distinction [7]. ...
This case report presents a 24-year-old female with a history of ulcerative colitis (UC) who sought care for symptoms initially suggestive of the disease exacerbation but was later diagnosed as acute cytomegalovirus (CMV) colitis. The patient's clinical course, marked by watery diarrhea, blood in stools, vomiting, and fever, raised suspicion of a UC flare. However, a nuanced diagnostic approach revealed CMV superinfection, including computed tomography, colonoscopy, and tissue polymerase chain reaction (PCR). The patient's immunosuppressive history, with prior treatment, including intravenous infliximab and azathioprine, contributed to CMV infection. Treatment involved initiation of tofacitinib and antiviral therapy with valganciclovir. This case underscores the diagnostic challenges in distinguishing between infectious complications and UC exacerbations, necessitating a tailored, multidisciplinary approach for optimal management. It highlights the delicate balance required when managing UC patients on immunosuppressive regimens, emphasizing the importance of timely diagnosis and individualized treatment strategies in complex clinical scenarios.
... Because colonoscopy plays an important role in the differential diagnosis of IBD and is effective in assessing the response to treatment, patients with IBD frequently undergo colonoscopy. 41, 42 In addition, IBD is associated with a high risk of dysplasia or malignancy and requires periodic surveillance colonoscopies. 43 The American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy recommend that surveillance colonoscopy be performed 8-10 years after the onset of IBD. ...
Background:
Consistent uptake of colorectal cancer (CRC) screening is important to reduce the incidence and mortality from advanced-stage CRC and increase the survival rate of the patients. We conducted a longitudinal study to determine the factors affecting CRC screening compliance in Korean adults using individual-level linked data from the Korean National Health and Nutrition Examination Survey, Korean National Health Insurance Service, and Korean Health Insurance Review and Assessment Service.
Methods:
We selected 3,464 adults aged 50-79 years as the study population and followed them for 12 years (January 2007-December 2018). The outcome variable was the level of adherence to CRC screening, categorized as nonadherent, intermittently adherent, and consistently adherent. An ordinal logistic regression model was designed to determine the socioeconomic factors, family history of CRC, and medical conditions that could facilitate the consistent uptake of CRC screening.
Results:
The results showed a significant and positive association between consistent uptake of CRC screening and the 100-150% income category (odds ratio [OR], 1.710; 95% confidence interval [CI], 1.401-2.088); clerical, sales and service job category (OR, 1.962; 95% CI, 1.582-2.433); residency at medium-sized cities (OR, 1.295; 95% CI, 1.094-1.532); high-school graduation (OR, 1.440; 95% CI, 1.210-1.713); married status (OR, 2.281; 95% CI, 1.946-2.674); use of employment-based national health insurance (OR, 1.820; 95% CI, 1.261-2.626); use of private insurance (OR, 2.259; 95% CI, 1.970-2.589); no disability (OR, 1.428; 95% CI, 1.175-1.737); family history of CRC (OR, 2.027; 95% CI, 1.514-2.714); and history of colorectal neoplasm (OR, 1.216; 95% CI; 1.039-1.422).
Conclusion:
The lack of regular participation in CRC screening programs in the Republic of Korea was found to be an issue that requires attention. Policies on CRC screening must place increased emphasis on strengthening educational and public relations initiatives.
... Crohn's disease can affect any region of the intestine in a discontinuous pattern involving the terminal ileum, cecum, perianal area, and colon. In contradiction, ulcerative colitis can affect part of the colon or the entire colon and the rectum in a continuous pattern 4 . A thickened submucosa, transmural inflammation, fissuring ulceration, and granulomas were exhibited histologically in Crohn's disease, whereas in ulcerative colitis the inflammation is limited to the mucosa, submucosa with cryptitis and crypt abscesses 5 . ...
Background
Objectives
The pivotal of the study was to compare the effectiveness of education in disease-associated knowledge of Inflammatory Bowel Disease (IBD) patients between pre-test and post-test using the IBD-KNOW questionnaire and patient educational resources.
Methods
This study used a patient proforma and IBD- KNOW questionnaire to perform the study prospectively by interviewing method. The patient selection was based on inclusion and exclusion criteria by convenient sampling technique from November 2018 to July 2019 at a multispecialty hospital. Knowledge scores and inter-item correlation were calculated between the pre-test and post-test by R Programming software with p<0.05.
Results
Among 40 patients with IBD diagnosis, the baseline sociodemographic characteristics were recorded. The response rate of IBD knowledge between the pre-test and post-test resulted in significant differences with varying scales but the response rate was lesser in the domains of management and pregnancy-based questions in the pre-test and post-test.
Conclusions
Recently there was a swift in IBD incidence, this may be improved by affording suitable patient education and counseling for further knowledge level in managing the disease by coping strategy. On comparison between the pre-test and post-test, this study recommends innovative educational methods to enable continuing education for chronic disease which can be easily accessible and reliable for IBD patients.
... CD mainly shows segmental involvement, aphthous ulcers, serpentious, longitudinal ulcers, large deep ulcers, rectal sparing, anal or perianal disease, and a cobble stone appearance. Conversely, UC shows a continuous lesion, loss of vascular pattern, granular mucosa, erosion, and rectal involvement [65,66]. Generally, CD can involve the entire GI tract, and UC affects only the colorectum. ...
... However, inflammation of the terminal ileum, i.e., backwash ileitis, is found in 10% of patients with diffuse active UC [67]. Since CD often invades the terminal ileum, it is essential to observe the terminal ileum during colonoscopy [66]. Histopathological evaluation through colonoscopic biopsy, especially the identification of granuloma specific to CD, helps to differentiate IBD [68]. ...
... However, not all tissue samples of CD show granuloma on histopathological examination. The rate of confirmation of granuloma through endoscopic biopsy in CD is as low as 15% to 36% [66]. ...
Since the development of the fiberoptic colonoscope in the late 1960s, colonoscopy has been a useful tool to diagnose and treat various intestinal diseases. This article reviews the clinical use of colonoscopy for various intestinal diseases based on present and future perspectives. Intestinal diseases include infectious diseases, inflammatory bowel disease (IBD), neoplasms, functional bowel disorders, and others. In cases of infectious diseases, colonoscopy is helpful in making the differential diagnosis, revealing endoscopic gross findings, and obtaining the specimens for pathology. Additionally, colonoscopy provides clues for distinguishing between infectious disease and IBD, and aids in the post-treatment monitoring of IBD. Colonoscopy is essential for the diagnosis of neoplasms that are diagnosed through only pathological confirmation. At present, malignant tumors are commonly being treated using endoscopy because of the advancement of endoscopic resection procedures. Moreover, the characteristics of tumors can be described in more detail by image-enhanced endoscopy and magnifying endoscopy. Colonoscopy can be helpful for the endoscopic decompression of colonic volvulus in large bowel obstruction, balloon dilatation as a treatment for benign stricture, and colon stenting as a treatment for malignant obstruction. In the diagnosis of functional bowel disorder, colonoscopy is used to investigate other organic causes of the symptom.
... Ulcerative colitis is a frequent emerging risk factor for inflammations that affects the colon and rectum mucosa. Inflammation affects continuous areas of the mucosa, and inflammation will be more pronounced in nearby areas of ulcerations (Jung 2012). The two key manifestations that have a diverse effect on the patient's performance in life are abdominal pain and diarrhea (Ahluwalia et al. 2018). ...
Inflammation’s impact on inflammatory bowel diseases is mostly due to altered non-coding RNA expression. This study aimed to explore the rs2107425 polymorphism in the long non-coding RNA gene H19 (lncRNA H-19) and emphasize the involvement of miR-200a and lncRNA H-19 expression in ulcerative colitis (UC) and Crohn’s disease (CD). One hundred and ten participants, ranging in age from 22 to 58 years, participated in the current investigation study. Study participants were classified into forty healthy participants, thirty-four patients with UC, and thirty-six patients with CD. Participants with ulcerative colitis and Crohn’s disease experienced a considerable elevation in C-reactive protein, total leucocyte count (TLC), platelets, and erythrocyte sedimentation rate (ESR), whereas a noticeable decrease in hemoglobin. Additionally, ulcerative colitis and Crohn’s disease both have markedly increased expression of lncRNA H-19 and miR-200a. The frequency of the CT + TT genotype of the rs2170425 lncRNAH-19 SNP was linked to susceptibility to IBDs. lncRNA H-19 and miR-200a can be used as non-invasive diagnostic biomarkers for follow-up patients with ulcerative colitis and Crohn’s disease.
... Patients are diagnosed with UC or CD based on endoscopic, histological, clinical, and radiological criteria (11,12). Colonoscopy plays a crucial role in the diagnosis, treatment, and follow-up monitoring of patients with IBD (13,14). Digestive endoscopies have been widely used in medical institutions worldwide, and the overall lack of high-level endoscopists and uneven distribution of resources have led primary medical institutions to face certain difficulties in the diagnosis of IBD (5,15). ...
Background and Aim
The identification of ulcerative colitis (UC) and Crohn's disease (CD) is a key element interfering with therapeutic response, but it is often difficult for less experienced endoscopists to identify UC and CD. Therefore, we aimed to develop and validate a deep learning diagnostic system trained on a large number of colonoscopy images to distinguish UC and CD.
Methods
This multicenter, diagnostic study was performed in 5 hospitals in China. Normal individuals and active patients with inflammatory bowel disease (IBD) were enrolled. A dataset of 1,772 participants with 49,154 colonoscopy images was obtained between January 2018 and November 2020. We developed a deep learning model based on a deep convolutional neural network (CNN) in the examination. To generalize the applicability of the deep learning model in clinical practice, we compared the deep model with 10 endoscopists and applied it in 3 hospitals across China.
Results
The identification accuracy obtained by the deep model was superior to that of experienced endoscopists per patient (deep model vs. trainee endoscopist, 99.1% vs. 78.0%; deep model vs. competent endoscopist, 99.1% vs. 92.2%, P < 0.001) and per lesion (deep model vs. trainee endoscopist, 90.4% vs. 59.7%; deep model vs. competent endoscopist 90.4% vs. 69.9%, P < 0.001). In addition, the mean reading time was reduced by the deep model (deep model vs. endoscopists, 6.20 s vs. 2,425.00 s, P < 0.001).
Conclusion
We developed a deep model to assist with the clinical diagnosis of IBD. This provides a diagnostic device for medical education and clinicians to improve the efficiency of diagnosis and treatment.
... 2,3 CS is recommended for the assessment of lower gastrointestinal system diseases such as colorectal cancer screenings, colorectal polyps, colorectal cancer, and inflammatory bowel disease. 4,5,6 The purpose of a CS is to examine the entire colon to the caecum. A successful CS provides precise imaging of the mucosal surface of the colon. ...
Amaç: Kolonoskopi kolorektal hastalıkların tanısında sıklıkla kullanılan bir işlemdir. Bu çalışmamızda endoskopi ünitemizde kolonoskopi yapılan Türk ve Suriyeli hastaların demografik, endoskopik ve histopatolojik özelliklerini, inkomplet kolonoskopi sıklığını ve inkomplet kolonoskopi nedenlerini sunmayı amaçladık. Yöntem: Ağustos 2017-Mart 2020 tarihleri arasında hastanemizde kolonoskopi yapılan Türk ve Suriyeli hastaların demografik, klinik ve histopatolojik özellikleri karşılaştırıldı. İnkomplet kolonoskopi nedenleri ve inkomplet kolonoskopiye etki eden faktörler incelendi. Bulgular: Çalışmaya dahil edilen 2.285 hastanın 1.175'i (%51,4) kadın, 1.110'u (%48,6) erkek olup, yaş ortalaması 46,30±15,33 idi. İnkomplet kolonoskopi oranı %18,3 idi. Erkek cinsiyetin, inkomplet kolonoskopi oranının, yetersiz barsak temizliği oranının ve Boston barsak temizliği skoru 0 ve 1 olan hastaların Suriyeli hasta grubunda daha yüksek olduğu görüldü (p<0,001). Polip saptanma oranı Türk hasta grubunda %14,6, Suriyeli hasta grubunda ise %8,8 idi (p=0,035). İleri yaş (p=0,002), etnik köken (p<0,001) ve yetersiz barsak temizliği (p<0,001) inkomplet kolonoskopi lehine anlamlı bulundu. Sonuç: Çalışmamızda Suriyeli hasta grubunda yüksek inkomplet kolonoskopi ve yetersiz barsak temizliği oranı ile düşük polip saptama oranı güncel literatür önerilerinin altında kalmıştır. Bu durumun bölgemizdeki mevcut sosyoekonomik şartlar ve iletişim probleminden (dil engeli) dolayı işlem öncesi barsak temizliği hazırlık bilgilendirmelerine uyumsuzluktan kaynaklandığını düşünmekteyiz. Anahtar Kelimeler: Kolonoskopi, inkomplet kolonoskopi, Suriyeli hastalar ÖZ ABSTRACT Aim: Colonoscopy is a frequently used procedure for the diagnosis of the colorectal diseases. In this study, we aimed to present demographic, endoscopic, and histopathological characteristics, the frequency of incomplete colonoscopy, and causes of incomplete colonoscopy of Turkish and Syrian patients who had undergone colonoscopy in our hospital. Method: The demographic, clinical, and histopathological characteristics of Turkish and Syrian patients who had undergone colonoscopy in our hospital between August 2017 and March 2020 were compared. Results: A total of 2,285 patients were included in the study, of which 1,175 (51.4%) were female, 1,110 (48.6%) were male, and the mean age was 46.30±15.33 years. The rate of incomplete colonoscopy was 18.3%. It was observed that the male gender, incomplete colonoscopy rate, insufficient bowel cleansing rate, and patients with Boston bowel cleansing score of zero and one were higher in the Syrian patient group (p<0.001). The polyp detection rate was 14.6% in the Turkish patient group and 8.8% in the Syrian patient group (p=0.035). Advanced age (p=0.002), ethnicity (p<0.001), and insufficient bowel cleansing (p<0.001) were significant factors for incomplete colonoscopy. Conclusion: In our study, the higher rate of incomplete colonoscopy and insufficient bowel cleansing and the low rate of polyp detection in the Syrian patient group remained below the current literature recommendations. We think that insufficient information about bowel cleansing preparation is responsible for this finding due to the current socioeconomic conditions and communication problem (language disability) in our region.
... İBH tanısında klinik, laboratuvar, endoskopik ve radyolojik bulgular önemlidir. Ancak bütün bu uygulamalara rağmen İBH hastalarının %10'luk bir grubu iki ana grup içerisinde (ÜK ve CH) yanlış sınıflandırılmakta, diğer bir %10'luk grup ise sınıflandırılamayan İBH olarak kalmaktadır (2,3). Bu nedenle, ayırıcı tanıyı sağlayabilmek adına, çeşitli serolojik yöntemler kullanılmaktadır. ...
... The fifth one is rare toxicity known as idiosyncratic toxicity found in 1/10 3 to 1/10 4 individuals [122]. Detail mechanism of all the drug-induced toxicities is given below in table 5. [123], [124], [125], [126], [127], [128] 2. ...
Drug development is the backbone of modern medicine and the pharma industry. Identifying new drug targets and successful drug development is contributed by several techniques, methods, and protocols. Each method has its unique significance and limitations. This review work has addressed the opportunities, constraints and future perspectives of the current drug development process. Many general considerations, successful approaches, techniques, and examples in drug development are discussed.
... 23,24 Moreover, susceptibility to mucosal injury and other GI insults is observed, with neutrophils and eosinophils raiding in the lamina propria. 18,19,25 Initially, eosinophils are detected infiltrating the layers of the intestines with no discrepancy of disease state in IBD, [20][21][22] with minimal insight on their interactions with the ENS. Therefore, this review will address the current understanding of eosinophil roles in IBD. ...
Clinical investigations in inflammatory bowel disease (IBD) patients have provided increasing evidence that eosinophils contribute to chronic intestinal inflammation. Accumulation of eosinophils in the gastrointestinal tract correlates with the variations of eosinophil regulatory molecules; however, their role in gastrointestinal dysfunction in IBD has not been fully elucidated. This review will describe the development and characterization of gastrointestinal eosinophils, mechanisms of eosinophil recruitment to the gastrointestinal tract. Moreover, the eosinophil-induced changes to the enteric nervous system associated with disease severity and gastrointestinal dysfunction will be analyzed with suggestive molecular pathways for enteric neuronal injury. Current and potential therapeutic interventions targeting eosinophils will be discussed.
