Browse Inflammatory Bowel Disease
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Case Records of the Massachusetts General Hospital
Case 8-2012 — A 53-Year-Old Man with Crohn's Disease, Diarrhea, Fever, and Bacteremia
Presentation of Case. Dr. Jacob Soumerai (Internal Medicine): A 53-year-old man with Crohn's disease who was receiving immunosuppressive therapy was admitted to this hospital because of diarrhea, fever, and bacteremia. The patient had been in his usual state of health until 2 days before admission,…
- CME
Clinical Implications of Basic Research
Diet and Intestinal Immunity
"You are what you eat." A couple of recent studies underscore the relevance of this adage to the immune system. New studies by Kiss et al. and Li et al. show how certain dietary components derived from vegetables interact with intestinal immune receptors and thereby regulate the organogenesis of…
Review Article
Medical Progress: Ulcerative Colitis
Ulcerative colitis was first described in the mid-1800s, whereas Crohn's disease was first reported later, in 1932, as "regional ileitis." Because Crohn's disease can involve the colon and shares clinical manifestations with ulcerative colitis, these entities have often been conflated and diagnosed…
- CME
Original Article
Infliximab, Azathioprine, or Combination Therapy for Crohn's Disease
Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract that is defined by relapsing and remitting episodes, with progression over time to complications of stricture, fistulas, or abscesses. Symptoms of mild-to-moderate disease are treated with mesalamine, budesonide, or…
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Correspondence
Norovirus Gastroenteritis
To the Editor: As Glass et al. discuss in their review article (Oct. 29 issue), norovirus is the major cause of epidemic gastroenteritis and the most common cause of diarrhea in adults. Prospective studies have shown that 3 to 36% of enteric infections lead to a new diagnosis of the irritable bowel…
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Original Article
Effect of Human Rotavirus Vaccine on Severe Diarrhea in African Infants
Rotavirus is the most important cause of severe gastroenteritis among children worldwide. The World Health Organization (WHO) estimates that globally 527,000 deaths occur each year among children as a result of rotavirus infection; more than 230,000 of the deaths occur in sub-Saharan Africa. Six of…
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Rotavirus is the leading cause of gastroenteritis in children worldwide. In this report, the efficacy of the rotavirus vaccine among 4417 children in Malawi and South Africa was studied in a randomized trial. Severe rotavirus gastroenteritis occurred in 4.9% of the infants in the placebo group as compared with 1.9% of the infants in the pooled vaccine group; the vaccine efficacy was 61.2%.
Editorial
A Common Genetic Fingerprint in Leprosy and Crohn's Disease?
The cause-and-effect relationship between severe infections and death suggests that microbial pathogens are evolutionary sculptors of the genome. However, the genetic component of susceptibility to infections in the general population is complex and heterogeneous and is modulated by environmental…
Review Article
Mechanisms of Disease: Inflammatory Bowel Disease
The idiopathic inflammatory bowel diseases comprise two types of chronic intestinal disorders: Crohn's disease and ulcerative colitis. Accumulating evidence suggests that inflammatory bowel disease results from an inappropriate inflammatory response to intestinal microbes in a genetically…
This review gives an account of recent advances in our knowledge of the intestinal immune system and how it becomes perturbed in Crohn's disease and ulcerative colitis. The importance of genetic factors in these diseases has been increasingly recognized, and this article emphasizes their roles.
Original Article
Inflammatory Bowel Disease and Mutations Affecting the Interleukin-10 Receptor
Inflammatory bowel disease is a heterogeneous group of disorders, classified as Crohn's disease, ulcerative colitis, and indeterminate colitis. In most patients, these disorders are manifested in adolescence or adulthood; however, they may present in infancy and may be inherited as an autosomal…
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Genetic analyses showed that mutations affecting the interleukin-10 receptor are associated with early-onset colitis. Further molecular analyses showed that the mutations abrogated interleukin-10 signaling. Treatment of one of the affected children by means of allogeneic hematopoietic stem-cell transplantation was successful.
Editorial
Interleukin-10 in Inflammatory Bowel Disease
In this issue of the Journal, Glocker et al. provide the first substantial support for a functional role for the immunosuppressive cytokine interleukin-10 in the pathogenesis of inflammatory bowel disease in humans. By performing genetic-linkage and candidate-gene analysis of two unrelated…
Review Article
Current Concepts: Norovirus Gastroenteritis
The Norwalk agent was the first virus that was identified as causing gastroenteritis in humans, but recognition of its importance as a pathogen has been limited because of the lack of available, sensitive, and routine diagnostic methods. Recent advances in understanding the molecular biology of the…
Noroviruses are now recognized as the leading cause of epidemics of gastroenteritis and an important cause of sporadic gastroenteritis among both children and adults. In the United States, more than 90% of the outbreaks of gastroenteritis for which the cause could not previously be identified can now be attributed to this virus. Understanding the nature of immunity to the norovirus is a key determinant for future improvements in the control and prevention of this viral infection.
Clinical Problem-Solving
The Writing on the Wall
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 52-year-old man presented to the…
A 52-year-old man presented to the emergency department with a 5-week history of abdominal discomfort. The pain worsened after eating and was associated with nausea and bloating. Two weeks before presentation, the patient's pain localized more to the periumbilical area and was accompanied by early satiety and vomiting. He had no fever, diarrhea, tenesmus, melena, or hematochezia.
Clinical Implications of Basic Research
Inflammatory Bowel Disease, Stress, and the Endoplasmic Reticulum
The causes of Crohn's disease and ulcerative colitis are poorly understood, despite having been defined many decades ago on the basis of their clinical manifestations. Experiments involving transgenic mice and genomewide association studies involving patients have independently provided glimpses…
Case Records of the Massachusetts General Hospital
Case 33-2008 — A 63-Year-Old Woman with Dyspnea on Exertion
Presentation of Case. Dr. Andrew Tinsley (Medicine): A 63-year-old woman was admitted to this hospital because of dyspnea on exertion. The patient had been in her usual state of health until approximately 3 weeks before admission, when dyspnea developed. Approximately 1 week later, she began to…
A 63-year-old woman was admitted to the hospital because of a 3-week history of dyspnea on exertion, associated left subscapular burning pain, and a mild dry cough. She had a history of ulcerative colitis, which was most recently treated with azathioprine and infliximab. On examination, there were inspiratory wheezes and rales, without expiratory wheezes. Chest imaging showed ground-glass opacities in both lower lobes. A diagnostic procedure was performed.
Correspondence
Resolution of Non–Small-Cell Lung Cancer after Withdrawal of Anti-TNF Therapy
To the Editor: We report the development of locally advanced non–small-cell lung cancer (tumor–node–metastasis [TNM] stage T4N2M0) in a 69-year-old woman with Crohn's colitis. Her condition had been diagnosed in 2000 and had required treatment with methotrexate (from 2003 to the present),…
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Clinical Implications of Basic Research
Tumor Necrosis Factor α and Colitis-Associated Colon Cancer
Colon cancer is one of the most serious complications of chronic inflammatory bowel disease. The cumulative risk ranges from 2% among patients who have had colitis for 10 years to 18% among patients who have had colitis for 30 years. A clinical trial of infliximab, a humanized monoclonal antibody…
Clinical Implications of Basic Research
Inflammatory Bowel Disease — Live Transmission
Inflammatory bowel disease results from a dysregulated immunologic response to commensal microbial flora residing in the intestinal lumen. Although this response is probably due at least in part to a genetic predisposition, patients with inflammatory bowel disease have also been reported to house…
