Crohn Disease: Katz J

Sands BE, Cuffari C, Katz J, Kugathasan S, Onken J, Vitek C, Orenstein W. · Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Inflamm Bowel Dis. · Pubmed #15472534 No free full text.

Abstract: During the past 2 decades, medical therapy for Crohn's disease (CD) and ulcerative colitis (UC) has grown to incorporate a variety of immunesuppressing agents. At the same time, basic insights into the aberrant mucosal immune response underlying inflammatory bowel disease (IBD) have expanded dramatically. The interplay of host susceptibility to infection and the safety and efficacy of immunization for vaccine-preventable diseases has been explored in other immune-mediated disease states but only rarely in IBD. The purpose of this review is to formulate best-practice recommendations for immunization in children and adults with IBD by considering the effects of the IBD disease state and its treatments on both the safety and efficacy of immunization. To do so, we first considered the routine recommendations for immunization of children, adults and distinct populations at increased risk for vaccine-preventable disease. Because it was rarely possible to examine direct data on safety and efficacy of immunization in IBD populations, we relied to a large extent upon extrapolation from similar populations and from knowledge of basic mechanisms. The literature suggests that efficacy of immunization may be diminished in some patients whose immune status is compromised by immune suppression. However, except for live agent vaccines, most immunizations may be safely administered to patients with IBD even when immune compromised. Conversely, protection against vaccine-preventable illness may be of even greater benefit to those at risk for morbid or lethal complications of infections because of an immune compromised state. We conclude that for most patients with IBD, recommendations for immunization do not deviate from recommended schedules for the general population.

Shenkman A, Katz J, Shenkman Z, Melzer E. · No affiliation provided · Harefuah. · Pubmed #10883191 No free full text.

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Ojha J, Cohen DM, Islam NM, Stewart CM, Katz J, Bhattacharyya I. · University of Nebraska, Lincoln, NE, USA. · J Am Dent Assoc. · Pubmed #18056101 links to  free full text

Abstract: BACKGROUND: Although the oral manifestations of Crohn disease are well-established, there is little specific documentation of the gingival involvement. CASE DESCRIPTION: The authors describe four patients with significant gingival involvement and identify clinical signs and symptoms of the disease involving the gingivae, along with other oral manifestations. Patients had persistent gingival lesions manifesting as pustular ulcerations, erythema, swelling and cobblestoning. The authors also discuss the differential diagnosis, treatment options and prognostic factors. CLINICAL IMPLICATIONS: Patients with gingival and/or other oral lesions with or without other constitutional symptoms should be evaluated for Crohn disease. Dentists can play a critical role in the early diagnosis, and they can help prevent complications and improve the prognosis.

Stavropoulos F, Katz J, Guelmann M, Bimstein E. · Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA. · Pediatr Dent. · Pubmed #15344631 No free full text.

Abstract: Crohn's disease is an inflammatory intestinal disease of unknown etiology. The disease primarily affects whites, with both sexes being affected equally. A genetic predisposition exists. Symptoms frequently present in the second to third decades of life, although they may present in the pediatric and/or geriatric populations. Oral lesions are significant as they are frequently reported to precede intestinal symptoms. Treatment of Crohn's disease is palliative, with a focus on remission. Pediatric and general dentists play a critical role in the early diagnosis of Crohn's disease. Evaluation of a pediatric patient with complaints of oral ulcerations, as well as gastrointestinal symptoms, fatigue, and/or weight loss requires prompt referral to a gastroenterologist for further evaluation for Crohn's disease.

Parsi MA, Achkar JP, Richardson S, Katz J, Hammel JP, Lashner BA, Brzezinski A. · Center for Inflammatory Bowel Disease, Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. · Gastroenterology. · Pubmed #12198696 No free full text.

Abstract: BACKGROUND & AIMS: Identifying predictors of response to infliximab in Crohn's disease may lead to better selection of patients for this therapy. METHODS: One hundred patients with either inflammatory or fistulous Crohn's disease and at least 3 months of follow-up after infliximab infusion were evaluated. Clinical response and duration of response were the primary outcome measures. RESULTS: For inflammatory disease, 73% of nonsmokers, compared with 22% of smokers, responded to infliximab (P < 0.001). Among patients taking concurrent immunosuppressives, 74% responded to infliximab compared with 39% not taking any immunosuppressives (P = 0.007). Prolonged response (duration >2 months) was achieved in 59% of nonsmokers compared with 6% of smokers (P < 0.001) and in 65% of patients on immunosuppressives compared with 18% not on immunosuppressives (P < 0.001). For fistulous disease, overall response rates were not different between nonsmokers and smokers, but nonsmokers had a longer duration of response (P = 0.046). Concurrent use of immunosuppressive medications had no effect on rate or duration of response. Multivariable logistic regression analysis confirmed the harmful effect of smoking and the beneficial effect of immunosuppressive use on response in patients with inflammatory disease. The same analysis for fistulous disease did not show an association between smoking or concurrent immunosuppressive use and response to infliximab. CONCLUSIONS: In patients with inflammatory disease, nonsmoking and concurrent immunosuppressive use are associated with higher rates of response and longer duration of response to infliximab. In patients with fistulous Crohn's disease, nonsmoking is associated with longer duration of response to infliximab.

Kachko L, Efrat R, Ami SB, Katz J, Mukamel M. · No affiliation provided · Paediatr Anaesth. · Pubmed #17897281 No free full text.

This publication has no abstract.