Richard S. Bloomfeld

MR Enterography in the Management of Patients with Crohn Disease

Crohn disease is a complex pathologic process with an unpredictable lifelong course that includes frequent relapses. It often affects young patients, who are most vulnerable to the potential adverse effects of repeated exposure to ionizing radiation from computed tomography performed for diagnosis and surgical planning. The small intestine is the bowel segment that is most frequently affected, but it is the least accessible with endoscopic techniques. Magnetic resonance (MR) enterography has the potential to safely and noninvasively meet the imaging needs of patients with Crohn disease without exposing them to ionizing radiation. Appropriate use of MR enterography requires a carefully crafted protocol to depict signs of active inflammation as well as complications such as bowel obstruction, fistulas, and abscesses. Interpretation of MR enterographic images requires familiarity with the imaging signs and mimics of active bowel inflammation and stenosis. Although MR enterography currently is helpful for management in individual patients, the standardization of acquisition protocols and interpretive methods would increase its usefulness for more rigorous, systematic assessments of Crohn disease treatment regimens.

Conjugated linoleic acid modulates immune responses in patients with mild to moderately active Crohn's disease

BACKGROUND & AIMS Conjugated linoleic acid (CLA) has demonstrated efficacy as an immune modulator and anti-inflammatory compound in mouse and pig models of colitis. We investigated the immunoregulatory efficacy of CLA in patients with mild to moderate Crohns disease (CD). METHODS Thirteen patients with mild to moderately active CD were enrolled in an open-label study of CLA (6 g/d orally) for 12 weeks. Peripheral blood was collected at baseline, 6 and 12 weeks after treatment initiation for isolation of peripheral blood mononuclear cells for functional analyses of lymphoproliferation and cytokine production. Disease activity was calculated using the CD activity index (CDAI) and quality of life was assessed using the Inflammatory Bowel Disease Questionnaire (IBDQ). RESULTS CLA significantly suppressed the ability of peripheral blood CD4+ and CD8+ T cell subsets to produce IFN-γ, TNF-α and IL-17 and lymphoproliferation at week 12. There was a statistically significant drop in CDAI from 245 to 187 (P = 0.013) and increase in IBDQ from 141 to 165 (P = 0.017) on week 12. CONCLUSION Oral CLA administration was well tolerated and suppressed the ability of peripheral blood T cells to produce pro-inflammatory cytokines, decreased disease activity and increased the quality of life of patients with CD.

Extracolonic Findings at Virtual Colonoscopy: An Important Consideration in Asymptomatic Colorectal Cancer Screening

BackgroundVirtual colonoscopy has been evaluated for use as a colorectal cancer screening tool, and in prior studies, it has been estimated that the evaluation of extra-colonic findings adds

An analysis of the placebo effect in Crohn’s disease over time

28-

Sensitivity of Upper Endoscopy in Diagnosing Esophageal Cancer

34 per patient studied.MethodsAs an ancillary study to a prospective cohort study comparing virtual colonoscopy to conventional colonoscopy for colorectal cancer detection, the investigators retrospectively determined the number and estimated costs of all clinic visits, imaging and laboratory studies, and medical procedures that were generated as a direct result of extra-colonic findings at virtual colonoscopy.ResultsWe enrolled 143 subjects who underwent CTC followed by conventional colonoscopy. Data were available for 136 subjects, and 134 (98%) had at least one extra-colonic finding on CT. Evaluation of extra-colonic findings was performed in 32 subjects (24%). These subjects underwent 73 imaging studies, 30 laboratory studies, 44 clinic visits, 6 medical procedures, and 44 new or return outpatient visits over a mean of 38 months following the CTC. The most common findings causing further evaluation were lung nodules and indeterminate kidney lesions. No extra-colonic malignancies were found in this study. A total of

Uvular Necrosis after Endoscopy

33,690 was spent in evaluating extra-colonic findings, which is

Preventive Health Care Among Postpartum Women With Inflammatory Bowel Disease: Results From the PIANO Registry

248 per patient enrolled.ConclusionsThe cost of the evaluation of extra-colonic findings following virtual colonoscopy may be much higher in actual practice than is suggested by prior studies. This will impact the cost-effectiveness of using virtual colonoscopy for asymptomatic colorectal cancer screening and underscores the importance of standardizing the reporting of extra-colonic findings to encourage appropriate follow-up.

Endoscopic deployment of video capsule endoscopy: does it guarantee a complete examination of the small bowel?

Background  Randomized, placebo controlled trials are used to assess the efficacy of therapies for Crohn’s disease. The placebo response and remission rates vary among studies.

Lymphomatoid papulosis in a patient with Crohn's disease treated with infliximab.

Esophageal cancer is a common cause of dysphagia and upper endoscopy is the accepted standard for making the diagnosis; however, the accuracy of endoscopy is not known. The purpose of this study is to determine the sensitivity of upper endoscopy in making the diagnosis of esophageal cancer in clinical practice. All patients with a new diagnosis of esophageal cancer from 1997 to 2001 in the Tumor Registry of Wake Forest University Baptist Medical Center were identified. The medical records were reviewed to identify all patients who had undergone a previous endoscopy within two years that failed to diagnose esophageal cancer. The reason for failure was recorded. One hundred ten new cases of esophageal carcinoma were identified, and ten patients had had a previous false-negative endoscopy within two years for a sensitivity of 90.9% in clinical practice. The reasons for the failure of endoscopy were (1) lesion not seen in seven patients, (2) lesion seen and biopsied with benign histology in two patients, and (3) lesion seen but felt to be benign and not biopsied in one patient. Given the uncertain natural history of esophageal cancer, the data were also analyzed using a one-year window; this resulted in a sensitivity of 94.5%. The sensitivity of upper endoscopy in the diagnosis of esophageal cancer in general clinical practice is 90.9% using a two-year window and 94.5% using a one-year window. Understanding the reasons for the failure of endoscopy may allow us to improve the practice of endoscopy.

Are COX‐2 inhibiotrs safe for anyone

A 28-year-old man presented with a sore throat 72 hours after undergoing upper endoscopy with dilation of a Schatzki ring. He noted a sore throat, starting 24 hours after the procedure.