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Duodenal Crohn's Disease


Presentation

  • This paper presents a summary of the published literature on duodenal Crohn's disease, including a review of the surgical approaches to this uncommon problem.[ncbi.nlm.nih.gov]
  • Obstruction was the presenting symptom in 33 of 34 patients, and all had strictures.[ncbi.nlm.nih.gov]
  • Contiguous disease of the gastric antrum and duodenum was present in 60% of patients. Endoscopic examination revealed abnormalities in 62 of 67 patients. Granulomas or granulomatous inflammation was found in 37 of 76 patients.[ncbi.nlm.nih.gov]
  • In our experience, strictureplasty is indicated when less than 2 strictures are present in the 2nd or 3rd duodenal portion. In cases with multiple strictures localized in the 1st or the distal duodenal portion, resection is preferable.[ncbi.nlm.nih.gov]
  • Data collected included demographics, clinical presentation, operative and hospital course, and postoperative followup. Thirty patients had surgical intervention for DCD during the selected period.[ncbi.nlm.nih.gov]
Pertussis
  • Vaccination against tetanus, diphtheria, and pertussis (Tdap); hepatitis A and B (HAV, HBV, respectively); and human papillomavirus (HPV) should be administered as per Advisory Committee on Immunization Practice (ACIP) guidelines.[emedicine.medscape.com]
Abdominal Pain
  • Common symptoms were upper abdominal pain and symptoms of gastroduodenal obstruction. Contiguous disease of the gastric antrum and duodenum was present in 60% of patients. Endoscopic examination revealed abnormalities in 62 of 67 patients.[ncbi.nlm.nih.gov]
  • Six months after the surgery, the patient had stopped antalgic treatment and did not have residual abdominal pain. He had gained 11 kg in weight and had no diarrhea with pancreatic enzymes.[karger.com]
  • Typical symptoms include: Loss of appetite Weight loss Nausea Vomiting Abdominal pain similar to indigestion Fatigue What are the treatments for gastroduodenal Crohn's disease? Treatments currently include medication and surgery .[ibdrelief.com]
  • A few of these symptoms may include abdominal pain that doesn’t go away or gets worse, swelling of the abdomen, nausea or vomiting, diarrhea, and constipation.[crohnsandcolitis.com]
Vomiting
  • The patient was admitted for a history of epigastric pain, recurrent vomiting, weight loss and low grade fever. He was evaluated with esophagogastroduodenoscopy and with radiological double-contrast technique.[ncbi.nlm.nih.gov]
  • This can result in food being unable to pass through and can cause vomiting Pancreatitis : This is where digestive enzymes attack the pancreas.[ibdrelief.com]
  • Sometimes patients experience vomiting, which is a sign that parts of the digestive system have become blocked. Patients with Crohn's disease that affects the stomach and small intestine may develop bleeding, which can lead to anemia.[livestrong.com]
  • Bleeding in the stomach or intestine may cause low red blood cell levels (anemia), bloody vomit, or black (tarry) bowel movements . 6 If your small intestine becomes blocked, you may feel nauseated or vomit. 6 Jejunoileitis Jejunoileitis is an inflammation[crohnsdisease.com]
  • Consultation with a physician for further investigations and more sophisticated treatments will be necessary if symptoms do not settle quickly, or if any vomit contains blood.[ddc.musc.edu]
Nausea
  • When symptoms are noted, according to the Crohn's and Colitis Foundation of America, patients may experience weight loss, nausea and a loss of appetite.[livestrong.com]
  • Typical symptoms include: Loss of appetite Weight loss Nausea Vomiting Abdominal pain similar to indigestion Fatigue What are the treatments for gastroduodenal Crohn's disease? Treatments currently include medication and surgery .[ibdrelief.com]
  • Other symptoms can include: nausea and vomiting bloating and gas weight loss and/or loss of appetite Chronic Gastritis Symptoms In the vast majority of cases, chronic gastritis causes no symptoms.[ddc.musc.edu]
  • Strictures can lead to nausea, vomiting, and intestinal obstructions. The ileum is the lower portion of the small intestine. It attaches the small intestine to the colon.[healthline.com]
  • (stomach and duodenum) and the jejunum (middle part of the small intestine) The disease may be associated with inflammation in other organs, such as the eyes, skin, joints, and liver Symptoms Abdominal pain Diarrhea Rectal bleeding Fever Weight loss Nausea[centerforibd.com]
Recurrent Vomiting
  • The patient was admitted for a history of epigastric pain, recurrent vomiting, weight loss and low grade fever. He was evaluated with esophagogastroduodenoscopy and with radiological double-contrast technique.[ncbi.nlm.nih.gov]

Workup

  • Provides all the necessary tools to make a comprehensive diagnostic workup including data from ancillary techniques and molecular findings whenever appropriate.[books.google.com]
  • Chronic bleeding from the diseased and strictured intestinal segment Setup Regular laparoscopic set-up Preoperative Workup Complete assessment of disease extension with MR and/or CT enterography for the small bowel and colonoscopy for the colon Anatomy[csurgeries.com]
  • Follow-up laboratory workup and diagnostic testing should be performed regularly as needed to monitor the safety and success of therapy.[emedicine.medscape.com]

Treatment

  • After the 2-wk treatment, her symptoms were very much improved, and endoscopically, the duodenal stricture and inflammation improved. The duodenal mucosal cytokine levels remarkably decreased compared with those before the treatment.[ncbi.nlm.nih.gov]
  • Then, due to these untreatable clinical manifestations, he underwents a surgical treatment.[ncbi.nlm.nih.gov]
  • Similar to other treatments for CD, the objective is to avoid surgical treatment as long as possible in order to prevent short bowel syndrome and other complications related to surgical resection.[healio.com]
  • Typical symptoms include: Loss of appetite Weight loss Nausea Vomiting Abdominal pain similar to indigestion Fatigue What are the treatments for gastroduodenal Crohn's disease? Treatments currently include medication and surgery .[ibdrelief.com]
  • In complicated gastroduodenal CD, medical treatments are often effective and surgery is only considered in exceptional cases.[karger.com]

Prognosis

  • Crohn's in the Small Bowel Direct visualization may lead to a better prognosis Direct visualization of the small bowel mucosa can detect abnormalities that a traditional endoscopy or colonoscopy procedure could miss.[pillcamcrohns.com]
  • Since biologicals at present seem to be able to induce mucosal healing, we might see a change in the prognosis of CD regarding surgery in the future, with the increasing use of biologics earlier in the disease course.[e-guide.ecco-ibd.eu]
  • […] fistula are iatrogenic and diverticulitis] • Intramural sinus tracts • Abscess formation [common] • Rarely, perforation • Toxic megacolon (dilated transverse colon with pseudopolyps in toxic person no BE) • Small bowel obstruction • Adenocarcinoma (rare) Prognosis[learningradiology.com]
  • What is the prognosis? The outlook (prognosis) is variable. It depends on which part or parts of the gut (gastrointestinal tract) are affected and how often and how severe the flare-ups are.[patient.info]
  • Standard MRI Standard MRI can also give valuable information: perianal disease hepatobiliary disease sacroiliac joints, spine and large joints Treatment and prognosis Management is complex as the condition is chronic with a relapsing-remitting course.[radiopaedia.org]

Etiology

  • […] new chapters on the many advances in understanding and treatment options, this set of volumes represents the definitive reference on inflammatory bowel disease, a spectrum of diseases that is receiving increasing attention as our understanding of the etiological[books.google.com]
  • AP may also be an extra-intestinal manifestation of CD with etiological association with CD.[pancreas.imedpub.com]
  • 100,000, peaks in teens / twenties and 50s / 60s RR: Whites 2 - 5:1, Jews 3:1 Associated with smoking Monozygotic twins have 30 - 50% concordance Sites Small bowel only (particularly terminal ileum) in 40%, colon only in 30% Rarely other sites in GI tract Etiology[pathologyoutlines.com]
  • The etiology of growth failure is multifactorial, with nutritional, hormonal, and disease-related factors all contributing.[emedicine.medscape.com]
  • (Etiology) Currently, the exact cause and mechanism of Crohn’s Disease development is unknown. It is a chronic (long-standing) and relapsing (flaring up after symptom-free periods) condition.[dovemed.com]

Epidemiology

  • Curbside Consultation Linda Tang, MD Previous epidemiological studies have shown that Crohn’s disease (CD) is limited to the small bowel in 31% of patients. Most of the small bowel disease is located in the ileum.[healio.com]
  • Epidemiology Affects primarily Western populations, equal gender incidence 3 per 100,000, peaks in teens / twenties and 50s / 60s RR: Whites 2 - 5:1, Jews 3:1 Associated with smoking Monozygotic twins have 30 - 50% concordance Sites Small bowel only ([pathologyoutlines.com]
  • EPIDEMIOLOGY OF AP IN PATIENTS WITH CD The first association of IBD with AP was made in the 1950s by Ball et al. [ 2 ] who found in an autopsy series of patient with ulcerative colitis (UC), 53% of the cases had histological evidence of interstitial pancreatitis[pancreas.imedpub.com]
  • New trends in inflammatory bowel disease epidemiology and disease course in Eastern Europe. Dig Liver Dis . 2013 Apr. 45(4):269-76. [Medline] . Economou M, Zambeli E, Michopoulos S.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology: The exact cause of Crohn disease remains unknown. Current theories implicate the role of genetic, microbial, immunologic, environmental, dietary, vascular, and even psychosocial factors as potential causative agents.[gastrointestinalatlas.com]
  • Pathophysiology Crohn disease begins with crypt inflammation and abscesses, which progress to tiny focal aphthoid ulcers.[merckmanuals.com]
  • Pathophysiology: Implications for the Physical Therapist. 3rd ed. St. Louis, MO: Saunders-Elsevier; 2009. Susman E.. SONIC gives boost to infliximab for Crohn's. Medical Post [serial online]. November 2008;44:14. Available from: Health Module.[physio-pedia.com]
  • Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management . 6th ed. Philadelphia, Pa: WB Saunders Co; 1998. Vol 2: 1708-34. Panes J, Gomollon F, Taxonera C, et al.[emedicine.medscape.com]

Prevention

  • The management of this patient may serve as a guide possibly to delay or even prevent surgical intervention in similar cases of benign enteric strictures.[scholars.northwestern.edu]
  • Similar to other treatments for CD, the objective is to avoid surgical treatment as long as possible in order to prevent short bowel syndrome and other complications related to surgical resection.[healio.com]
  • How can Crohn’s Disease be Prevented? Currently, there are no known methods to prevent the occurrence of Crohn’s Disease.[dovemed.com]
  • This is because people with painful Crohn’s of the stomach may avoid eating or consume less food to prevent pain and other symptoms.[healthline.com]
  • For others, medication to prevent flare-ups can make a big difference to quality of life.[patient.info]

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