AIM： To investigate the sonographic features at time of diagnosis and follow-up in patients with neutropenic enterocolitis. METHODS： The sonographic findings in 14 patients with neutropenic enterocolitis were descri...AIM： To investigate the sonographic features at time of diagnosis and follow-up in patients with neutropenic enterocolitis. METHODS： The sonographic findings in 14 patients with neutropenic enterocolitis were described and evaluated regarding symptoms and clinical outcome. RESULTS： In all patients with neutropenic enterocolitis, the ileocoecal region was involved with wall thickening 〉10 mm. A transmural inflammatory pattern, hypervascularity of the thickened bowel wall and free abdominal fluid were the common findings. The sonographically revealed thickness of the bowel wall was associated with lethal outcome （P〈0.03）. In the 11 surviving patients, the improvement of clinical symptoms was accompanied by progressive reduction of intestinal wall thickness. CONCLUSION： High-end sonography of the bowel is a helpful tool for diagnosis, assessment of prognosis and follow-up of patients with neutropenic enterocolitis. The ultrasonographically revealed bowel thickness reflects the severity and the course of the disease, and seems to be predictive for the clinical outcome.展开更多
Misconceptions are common in the care of patients with inflammatory bowel disease(IBD).In this paper,we state the most commonly found misconceptions in clinical practice and deal with the use of 5-aminosalicylates and...Misconceptions are common in the care of patients with inflammatory bowel disease(IBD).In this paper,we state the most commonly found misconceptions in clinical practice and deal with the use of 5-aminosalicylates and thiopurines,to review the related scientificevidence,and make appropriate recommendations.Prevention of errors needs knowledge to avoid making such errors through ignorance.However,the amount of knowledge is increasing so quickly that one new danger is an overabundance of information.IBD is a model of a very complex disease and our goal with this review is to summarize the key evidence for the most common daily clinical problems.With regard to the use of 5-aminosalicylates,the best practice may to be consider abandoning the use of these drugs in patients withsmall bowel Crohn's disease.The combined approach with oral plus topical 5-aminosalicylates should be the first-line therapy in patients with active ulcerative colitis;once-daily treatment should be offered as a first choice regimen due to its better compliance and higher efficacy.With regard to thiopurines,they seem to be as effective in ulcerative colitis as in Crohn's disease.Underdosing of thiopurines is a form of undertreatment.Thiopurines should probably be continued indefinitely because their withdrawal is associated with a high risk of relapse.Mercaptopurine is a safe alternative in patients with digestive intolerance or hepatotoxicity due to azathioprine.Finally,thiopurine methyltransferase(TPMT)screening cannot substitute for regular monitoring because the majority of cases of myelotoxicity are not TPMT-related.展开更多
Crohn’s disease(CD)and ulcerative colitis(UC)constitute the twomost common phenotypes of inflammatory bowel disease(IBD).Ileocolonoscopy with biopsy has been considered the gold standard for the diagnosis of IBD.Diff...Crohn’s disease(CD)and ulcerative colitis(UC)constitute the twomost common phenotypes of inflammatory bowel disease(IBD).Ileocolonoscopy with biopsy has been considered the gold standard for the diagnosis of IBD.Differential diagnosis of CD and UC is important,as theirmedical and surgical treatmentmodalities and prognoses can be different.However,approximately 15%of patients with IBD aremisdiagnosed as IBD unclassified due to the lack of diagnostic certainty of CD or UC.Recently,there has been increased recognition of the role of the therapeutic endoscopist in the field of IBD.Newer imaging techniques have been developed to aid in the differentiation of UC vs CD.Furthermore,endoscopic balloon dilation and stenting have become an integral part of the therapeutic armamentariumof CD stricturemanagement.Endoscopic ultrasound has been recognized as beingmore accurate thanmagnetic resonance imaging in detecting perianal fistulae in patientswith CD.Additionally,chromoendoscopymay help to detect dysplasia earlier compared with white-light colonoscopy.Hence,interventional endoscopy has become a cornerstone in the diagnosis,treatment andmanagement of IBD complications.The role of endoscopy in the field of IBD has significantly evolved in recent years fromsmall-bowel imaging to endoscopic balloon dilation and use of chormoendoscopy in dysplasia surveillance.In this reviewarticle,we discuss the current evidence on interventional endoscopy in the diagnosis,treatment andmanagement of IBD compications.展开更多
文摘AIM： To investigate the sonographic features at time of diagnosis and follow-up in patients with neutropenic enterocolitis. METHODS： The sonographic findings in 14 patients with neutropenic enterocolitis were described and evaluated regarding symptoms and clinical outcome. RESULTS： In all patients with neutropenic enterocolitis, the ileocoecal region was involved with wall thickening 〉10 mm. A transmural inflammatory pattern, hypervascularity of the thickened bowel wall and free abdominal fluid were the common findings. The sonographically revealed thickness of the bowel wall was associated with lethal outcome （P〈0.03）. In the 11 surviving patients, the improvement of clinical symptoms was accompanied by progressive reduction of intestinal wall thickness. CONCLUSION： High-end sonography of the bowel is a helpful tool for diagnosis, assessment of prognosis and follow-up of patients with neutropenic enterocolitis. The ultrasonographically revealed bowel thickness reflects the severity and the course of the disease, and seems to be predictive for the clinical outcome.
文摘Misconceptions are common in the care of patients with inflammatory bowel disease(IBD).In this paper,we state the most commonly found misconceptions in clinical practice and deal with the use of 5-aminosalicylates and thiopurines,to review the related scientificevidence,and make appropriate recommendations.Prevention of errors needs knowledge to avoid making such errors through ignorance.However,the amount of knowledge is increasing so quickly that one new danger is an overabundance of information.IBD is a model of a very complex disease and our goal with this review is to summarize the key evidence for the most common daily clinical problems.With regard to the use of 5-aminosalicylates,the best practice may to be consider abandoning the use of these drugs in patients withsmall bowel Crohn's disease.The combined approach with oral plus topical 5-aminosalicylates should be the first-line therapy in patients with active ulcerative colitis;once-daily treatment should be offered as a first choice regimen due to its better compliance and higher efficacy.With regard to thiopurines,they seem to be as effective in ulcerative colitis as in Crohn's disease.Underdosing of thiopurines is a form of undertreatment.Thiopurines should probably be continued indefinitely because their withdrawal is associated with a high risk of relapse.Mercaptopurine is a safe alternative in patients with digestive intolerance or hepatotoxicity due to azathioprine.Finally,thiopurine methyltransferase(TPMT)screening cannot substitute for regular monitoring because the majority of cases of myelotoxicity are not TPMT-related.
文摘Crohn’s disease(CD)and ulcerative colitis(UC)constitute the twomost common phenotypes of inflammatory bowel disease(IBD).Ileocolonoscopy with biopsy has been considered the gold standard for the diagnosis of IBD.Differential diagnosis of CD and UC is important,as theirmedical and surgical treatmentmodalities and prognoses can be different.However,approximately 15%of patients with IBD aremisdiagnosed as IBD unclassified due to the lack of diagnostic certainty of CD or UC.Recently,there has been increased recognition of the role of the therapeutic endoscopist in the field of IBD.Newer imaging techniques have been developed to aid in the differentiation of UC vs CD.Furthermore,endoscopic balloon dilation and stenting have become an integral part of the therapeutic armamentariumof CD stricturemanagement.Endoscopic ultrasound has been recognized as beingmore accurate thanmagnetic resonance imaging in detecting perianal fistulae in patientswith CD.Additionally,chromoendoscopymay help to detect dysplasia earlier compared with white-light colonoscopy.Hence,interventional endoscopy has become a cornerstone in the diagnosis,treatment andmanagement of IBD complications.The role of endoscopy in the field of IBD has significantly evolved in recent years fromsmall-bowel imaging to endoscopic balloon dilation and use of chormoendoscopy in dysplasia surveillance.In this reviewarticle,we discuss the current evidence on interventional endoscopy in the diagnosis,treatment andmanagement of IBD compications.
