Research For The Diagnosis And Treatment Of Crohn's Disease

Part one Clinical Significance of Food Intolerance in Patients with Crohn's Disease in Suzhou,Jiangsu ProvinceBackground Inflammatory bowel disease(IBD)is a group of chronic and non-specific intestinal inflammatory diseases of undetermined origin.It has been reported that food intolerance is associated with the occurrence of IBD.Aims To investigate the prevalence and clinical significance of food intolerance in patients with Crohn's disease(CD)in Suzhou,Jiangsu Province.Methods A total of 100 IBD patients,including 50 CD and 50 ulcerative colitis(UC),from Mar.2007 to Aug.2015 at the First Affiliated Hospital of Soochow University were enrolled.Serum specific Ig G for 14 kinds of food were tested by Allerquant Ig G Food Allergy Screening ELISA Kit to evaluate the food intolerance and its severity.Correlation of food intolerance with clinical characteristics of CD was analyzed.Results Food intolerance was more prevalent(98.0% vs.72.0%)and severe in patients with CD than those with UC(P=0.000 1).Intolerance to food rich in carbohydrates or proteins was commonly seen in patients with CD.Statistical analysis showed that food intolerance was correlated with age at diagnosis,location of disease,disease behavior,perianal disease and active disease(P<0.05).Patients intolerant to carbohydrates or proteins were prone to have the disease located at terminal ileum,and patients with active disease were prone to manifest multiple food intolerance.Conclusions Compared with UC,food intolerance,mainly carbohydrates and proteins intolerance,is more prevalent in patients with CD,especially the terminal ileum type in Suzhou,Jiangsu Province.Food intolerance is closely associated with active,progressive and perianal disease.Part two Clinical Significance of Serum Antibodies in Inflammatory Bowel DiseaseBackground There is no gold standard for the diagnosis and monitoring of inflammatory bowel disease(IBD).As immune system plays crucial role in the pathogenesis of IBD,some immune-specific serum antibodies are considered to be useful tools for the diagnosis and differential diagnosis of the disease.Aims To investigate the clinical significance of serum antibodies,including anti-Saccharomyces cerevisiae antibody(ASCA)and perinuclear anti-neutrophil cytoplasmic antibody(p ANCA)in IBD.Methods Serum samples were obtained from 91 consecutive IBD patients from Feb.2015 to May 2016 at the Affiliated Hospital of Soochow University.Among them,52 were Crohn's disease(CD)and 39 were ulcerative colitis(UC).Serum samples of 36 non-IBD patients were served as controls.ASCA-Ig A and ASCA-Ig G were detected by ELISA,and p ANCA by indirect immunofluorescence assay.Using clinical diagnosis as gold standard,crosstabs statistics was performed to measure the diagnostic accuracy of ASCA and p ANCA,and ROC curve,Pearson Chi-Square test and Fisher's exact test were employed for analyzing the correlations of these two serum antibodies with IBD,CD,UC,and the location of the disease.Results Both serum ASCA-Ig G and Ig A were correlated with CD(AUC=0.626 and 0.614),while UC was correlated with ASCA-Ig A only(AUC=0.486).Serum p ANCA had relevance to IBD(r=0.342),CD(r=-0.262)and UC(r=0.614);its sensitivity and specificity for IBD and UC were superior to those for CD(P<0.05).In CD patients,ASCA-Ig G was associated with terminal ileal disease(P<0.05),and p ANCA was associated with colonic involvement(P<0.05).In UC patients,both ASCA-Ig G and Ig A were correlated with terminal ileal disease(P<0.05).Conclusions Serum ASCA and p ANCA may be helpful for discrimination between CD and UC when the diagnosis of IBD is established.Furthermore,they are closely associated with the involved intestinal segment,ASCA is related with the terminal ileal disease and p ANCA is related with colonic involvement.Part three Clinical analysis for enteral Tube Feeding nutrition treatment of the complications of Crohn's diseaseBackground Inflammatory bowel disease(IBD)is a group of chronic and non-specific intestinal inflammatory diseases of undetermined origin including UC and CD.The prevalence of malnutrition in patients with CD is very high.Enteral nutrition has certain significance on reducing disease.Objective To investigate the value of EN to reduce the severity of disease,to improve patients' nutritional status,to treat complications.Methods 64 patients were selected in the study to receive based treatment and enteral nutrition.before and after nutritional therapy WBC,RBC,Hb,PLT,TP,ABL,ESR and CRP were monitored;CDAI was calculated;CT/ abdominal ultrasound and anus MRI were taken to assess complications.Paired t test was performed to compare the effect of enteral nutrition on reducing the severity of disease.Mc Nemar test were respectively performed to analyze the effect of enteral nutrition on treat complications.P<0.05 considered statistically significant.Results After 3 month enteral nutrition,the level of CDAI,ESR,CRP,PLT and WBC had been significantly decreased(P<0.05)and the level of RBC,Hb,TP,ALB had been prominently increased(P<0.05).The remission rate of crissum diseases was 100%(28/28),the remission rate of abdominal pelvic diseases was 72.2%(13/18),the remission rate of strictures was 62.1%(18/29).Conclusions Enteral nutrition treatment could help patients with CD achieve clinical remmisions.The dose of drugs had been reduced,while the side effects of immune modulators had been reduced and the side effects of glucocorticoids had been completely eradicated.Enteral nutrition can prevent and treat malnutrition among the patients with CD.After poor conditioned patients with complications(crissum lesions,abdominal pelvic diseases and strictures)went through 3 month enteral nutrition treatment,crissum diseases had been totally cured,abdominal pelvic lesions and strictures were getting better.Enteral nutrition should be the first therapeutic approach in all mild to moderate acute attacks in patients with CD.A further advantage of this approach is that it is a safer way of starting the treatment in patients with abdominal pelvic lesions or strictures.