Chapter 11 : Crohn's Disease

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Inflammatory bowel disease (IBD) refers to Crohn's disease (CD) and ulcerative colitis (UC). There are many similarities between CD and UC, and they may have some common genetic and environmental links. This chapter, however, focuses on CD. Although granulomas are the pathological signature of CD, they are discovered in only about 60% of biopsies and surgical resections. It is most likely that several genes impact on the risk for CD and affect its presentation, location, and intensity. There is susceptibility to an IBD-like illness in patients with Turner’s syndrome, Hermansky- Pudlak syndrome, glycogen storage disease type Ib, and various classic immunodeficiency illnesses. It has been proposed that a major environmental factor predisposing to IBD is underexposure to intestinal helminths, which promote strong Thelper 2 (Th2)-type inflammation. Helminths are multicellular worms with complex life cycles that can live within our gastrointestinal tracts and elsewhere. CD is associated with various immunological abnormalities. However, no discrete immunoregulatory defect has proven specific or etiologic for CD. Most of these observations simply reflect ongoing chronic inflammation. Mucus covers the apical surface of epithelial cells, affording protection. Neuropeptides modulate inflammation and can effect granulomatous inflammation. Sulfasalazine and aminosalicylates are commonly used therapeutic agents for CD. Sulfasalazine is sulfapyridine conjugated to 5-aminosalicylic acid (5-ASA, mesalamine).

Citation: Weinstock J. 2003. Crohn's Disease, p 293-320. In Boros D (ed), Granulomatous Infections and Inflammations. ASM Press, Washington, DC. doi: 10.1128/9781555817879.ch11
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Figure 1

Gastrointestinal X ray showing the radiographic features of CD of the terminal ileum. This is the classic "string sign" of CD, showing a narrowed terminal ileumresulting fromintestinal fibrosis. There also is cobblestoning of the mucosa caused by edema and ulceration. The diseased terminal ileum is extending upward and inserting into the ascending colon shown on the left.

Citation: Weinstock J. 2003. Crohn's Disease, p 293-320. In Boros D (ed), Granulomatous Infections and Inflammations. ASM Press, Washington, DC. doi: 10.1128/9781555817879.ch11
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Figure 2

This is a series of colonoscopic photos of progressively worsening CD of the terminal ileum. The photos show macroscopic progression of CD from a single 1-mm diameter aphthous ulcer (B) to confluent ulceration involving more than 30% of the ileal circumference (E). (A) A normal terminal ileum. (B) Aphthous ulcer of 1-mm diameter with surrounding inflammation. (C) Several linearly arranged aphthous ulcers. (D) Three ulcers of 4-mm diameter. (E) Confluent ulceration. The arrows point to the rim of the ulcers.

Citation: Weinstock J. 2003. Crohn's Disease, p 293-320. In Boros D (ed), Granulomatous Infections and Inflammations. ASM Press, Washington, DC. doi: 10.1128/9781555817879.ch11
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Figure 3

Granulomas in the intestine of patients with Crohn's disease can have various microscopic appearances. (A) A “microgranuloma” composed of a central core of epithelioid cells with an incomplete halo of lymphocytes (hematoxylin & eosin [H&E] staining; magnification, ×50). (B) Awell-developed submucosal granuloma. This large lesion has many epithelioid cells and lymphocytes. A thick rimof lymphocytes encircles it (H&E staining; magnification, ×35). (C) A loosely developed granulomatous aggregate in the muscularis propria containing histiocytes, lymphocytes, and an occasional giant cell (H&E staining; magnification, ×50).

Citation: Weinstock J. 2003. Crohn's Disease, p 293-320. In Boros D (ed), Granulomatous Infections and Inflammations. ASM Press, Washington, DC. doi: 10.1128/9781555817879.ch11
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