Mario Vassallo

Incidence of inflammatory bowel disease in Malta between 1993 and 2005: A retrospective study

Background: The primary aim of the study was to estimate the incidence of Crohns disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), in Malta in a well‐defined population during a 13‐year study period. Methods: Diagnostic criteria for CD and UC were defined. A diagnosis of IBD was obtained from the histopathology reports at St. Lukes Hospital, Malta, between January 1993 and December 2005. The date of diagnosis was defined as the date of the first histopathology report revealing signs of IBD. Results: Incidence rates were standardized using the direct method on the European Standard Population. The mean incidence of UC in males was 8.16 per 100,000 per year and for females was 7.59 per 100,000 per year, while that for CD in males was 0.96 per 100,000 per year and for females 1.622 per 100,000 per year. Using linear regression, in UC there is an almost significant (P = 0.069) increasing trend with time but no difference by gender (P = 0.591). On the other hand, in CD there is no significant trend with time (P = 0.555) but almost a significant difference by gender (P = 0.078). Conclusions: This is the first Maltese study in which the incidence of IBD has been recorded. In Malta the incidence of UC is similar to the overall incidence of other European countries while the incidence of CD is lower. In fact, the incidence rates of CD are among the lowest in Europe, similar to other southern European countries.

Crohn's disease manifesting as an isolated cecal polyp and secondary appendiceal obstruction with histologically normal bowel.

Dear Editor:Inflammatory colonic polyps usually arise on a backgroundhistory of an inflamed colon such as Crohn’s disease orulcerative colitis [1]. Similar inflammatory bowel disease(IBD)-related inflammatory polyps, occurring in the absenceof background IBD, have manifested themselves as eitherfiliform polyposis [2] or localized giant inflammatory polyps[3]. We hereby report a case of an isolated sessile cecal poleinflammatory polyp, with histological features of Crohn’sdisease, without a history or current evidence of backgroundIBD. To our knowledge, our case is the first case of such amanifestation of a common condition. Moreover, this polypalso caused secondary appendiceal obstruction, another find-ing previously unreported.A 33-year-old male, nonsmoker, presented with a 6-monthhistory of intermittent colicky right iliac fossa (RIF) pain,which spontaneously resolves after 2 days of rest. He did notreport any change in bowel habit, rectal bleeding, fever, orweight loss. His past medical history, surgical history, familyhistory, and social history were unremarkable. Examinationrevealed normal findings. No tenderness or masses were elic-ited on palpation of the abdomen. Laboratory investigationsrevealeda normal fullblood count and inflammatory markersduring pain-free periods but an elevated C-reactive protein(95mg/l)andhyperferritinemia(681ng/ml)wheninpain.Hehad normal renal, liver, iron, folate, and vitamin B

Diarrhoeal episodes in travellers suffering from IBD

Background and aims There is limited data on the risk of developing diarrhoea in travelling patients with inflammatory bowel disease (IBD). We analysed the rate of developing diarrhoea among travellers suffering from IBD and their healthy controls. Methods We performed a retrospective case-controlled study among 78 patients with IBD and their healthy travelling companion controls, thus matching both groups to the same environmental conditions. Data was retrieved through a structured questionnaire, interview and clinical case notes review. Results Sixteen (20.5%) patients with IBD developed diarrhoea while abroad (p −0.0001) Statistical analysis using a χ2 test for independence (with Yates Continuity Correction). Prior to travelling, they were in clinical remission. Only one healthy control (1.3%) developed diarrhoea while abroad. In 11 patients (14.1%), the duration of diarrhoea was 3 days or less, and resolved on its own without antibiotics, any increase in their IBD medications and without a medical consultation. The other five patients had a flare-up of their disease and needed medications to put them back into remission. There was no statistically significant difference between patients having immunomodulator medications versus those having aminosalicylates only in developing diarrhoea when abroad. Conclusions Patients with IBD have a higher rate of developing diarrhoea compared with controls when travelling. Thus, such patients must always seek a pretravel medical consultation.

Recurrent urinary tract infections in a patient with Crohn's disease.

A 62-year-old male smoker was diagnosed with ileo-colonic Crohns disease 1 year previously, which was complicated by an asymptomatic terminal ileal stricture diagnosed on contrast radiology. Clinical and biochemical remission were induced initially by steroids and then maintained by mesalazine (1 g three times a day) and azathioprine (2 mg/kg daily). Six months following diagnosis, the patient complained of recurrent urinary tract infections and haematuria, and was found …

A difficult case of Crohn's disease?

A young lady with a long history of recurrent infections was referred to the gastroenterology department by an infectious disease consultant because of a long history of profuse diarrhoea. A nitroblue tetrazolium (NBT) test performed in her mid-teens had shown zero reduction of the dye. The clinical, biochemical, radiological and endoscopic findings were suggestive of possible underlying Crohns disease. However, the NBT test was more suggestive of a granulomatous colitis which frequently mimics Crohns disease in patients with Chronic granulomatous disease. Management with immunosuppressants is proving to be very difficult in this patient in view of recurrent sepsis on introducing these drugs.