Crohn Disease: Zheng JJ

Anonymous00018, Anonymous00019, Ouyang Q, Hu PJ, Qian JM, Zheng JJ, Hu RW. · Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China. · J Dig Dis. · Pubmed #18251795 No free full text.

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Zheng JJ. · Suzhou Municipal Hospital and Suzhou Institute for Digestive Disease and Nutrition, Suzhou, China. · Chin J Dig Dis. · Pubmed #16643333 No free full text.

Abstract: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is reported to be increasing in incidence and prevalence in provinces and cities in mainland China. This article specifically reviews clinical features, extra-intestinal manifestations, complications, diagnosis and differential diagnosis, and medical treatment of UC. Compared to patients in Western countries, more mild to moderate and left-sided colitis cases were observed in a nation-wide study in China. Complications included anal fistula, anal abscess, anal fissure, severe bleeding, intestinal perforation, intestinal obstruction and colonic carcinoma. The extra-intestinal manifestations were arthritis/arthralgia, eye and skin disorders and oral ulcers. The high specificity of antineutrophil cytoplasmic antibody may useful for distinguishing UC from infectious colitis; in addition, serum levels of anti-saccharomyces cerevisiae antibody may be helpful for distinguishing between UC and CD. Oral sulfasalazine and 5-aminosalicylic acid (ASA) remain the mainstays for the management of mild to moderate UC in China. Corticosteroids and immunosuppressive agents are also widely used in severe or refractory UC.

Zheng JJ, Zhu XS, Huangfu Z, Gao ZX, Guo ZR, Wang Z. · Suzhou Institute for Digestive Disease and Nutrition, Suzhou University, Suzhou, China. · Chin J Dig Dis. · Pubmed #16246226 No free full text.

Abstract: BACKGROUND: Crohn's disease appears to be increasing in frequency in many areas of the world. However, little information with regard to disease incidence, prevalence and temporal trends has been published in China. OBJECTIVE: The aim of this review is to better understand the occurrence of Crohn's disease in mainland China, and to give an overview of the current status of the disease. METHODS: We used a computer-based literature search using 50-years of records from the Chinese Database of Biology and Medicine (CBM, 1979-2002), combined with a manual year-by-year search of the literature from 1950 to 1979. Each article was double-reviewed, and all descriptive epidemiological data were recorded, pooled and statistically analyzed. RESULTS: In total, 1526 cases of Crohn's disease since 1950 have been reported by more than 50 hospitals from 22 provinces and cities in mainland China, comprising 884 male and 642 female patients, with a 1.38:1 male predominance. More than 70% of patients were aged 20 to 50 years old, with a mean age of 37.2 +/- 2.68 (ranging from 1 to 83) years. The extrapolated disease incidence and prevalence rates are 0.28/100,000 person years and 1.38/100,000 persons, respectively. CONCLUSIONS: The incidence and prevalence rates of Crohn's disease are still lower than those in Western and other Asian countries, but these rates have been increasing rapidly, and the disease is no longer uncommon. An underestimation may occur because the patients who were misdiagnosed or did not seek medical advice could not be included in the study. A future population-based survey is warranted.

Zheng JJ, Chu XQ, Shi XH, Zhou CL, Seng BW. · Department of Internal Medicine, Suzhou Municipal Hospital, Suzhou, China. · J Dig Dis. · Pubmed #18419641 No free full text.

Abstract: OBJECTIVE: To evaluate the efficacy and the safety of long-term azathioprine maintenance therapy in a group of Chinese patients with Crohn's disease. METHODS: The efficacy of azathioprine (2.0 mg/kg/day) in controlling the disease relapse in 13 patients with Crohn's disease following clinical remission by prednisone or surgery were investigated. The Crohn's disease activity index (CDAI) and the Harvey-Bradshaw index, the reduction of steroid dosage and side-effects for an average of 18 months follow up were analyzed. RESULTS: Azathioprine was effective in controlling the disease relapse in 10 (by CDAI scores) or 11 (by Harvey -Bradshaw index) of 13 patients (76.9% and 84.6%, respectively) for at least 6 months. Azathioprine was not discontinued in a patient who experienced a temporary and mild elevation of aminotransferases 14 months after the initiation of therapy. However one patient who was co-administered with azathioprine and mesalamine (Pentasa) developed an episode of bone marrow suppression that ultimately required the withdrawal of both medications. CONCLUSION: Azathioprine is an effective agent which controls the relapse of Crohn's disease in most patients. Long-term remission can be achieved. Side-effects, including severe leukopenia, myelo-suppression and the mild elevation of hepatic enzymes, may occur in a small number of patients.

Zheng JJ, Cu XQ, Shi XH, Wang YM, Jia LM, Zhou XL, Wang FM. · Department of Gastroenterology, Suzhou Municipal Hospital, Suzhou, China. · J Dig Dis. · Pubmed #17261133 No free full text.

Abstract: OBJECTIVE: An attempt was made to provide a better insight into endoscopic and histological features and to enhance the understanding of the diagnostic value of colonoscopy combined with biopsy for colonic Crohn's disease. METHODS: As presented in our 27 cases of colonic Crohn's disease (Crohn's colitis), the endoscopic findings and histological changes of biopsy specimens were analyzed. As collated with correspondent results of biopsy and surgical specimens, the diagnostic accuracy of endoscopy was evaluated. RESULTS: Of these patients, 26 involvements of the colon (often combined with other sites of the bowel) were observed (96.3%). However, involvements limited to the colon alone were seen in only four cases (14.8%). Endoscopically, diverse patterns of multi-staged-segmental distributed and multi-sited inflammatory lesions, both destructive and proliferative/regenerative changes were observed in the bowel of the same patient. The diagnostic accuracy of colonoscopy, as confirmed by the histological examination of biopsy and resected specimens, was 66.7%. The major characteristic features of mucosal biopsy were the focal distribution of inflammatory infiltration and lymphoid aggregate. Otherwise, it may include edematous and widened submucosa, deep fissuring ulcers and hyperplasia, fibrosis and granulomas (detected in 30% of the group), among others. CONCLUSION: The colonic involvement of Crohn's disease was common. Colonoscopy may be valuable in establishing a diagnosis and in assessing the extent and severity of such colonic involvement. Biopsy is helpful to confirm a diagnosis conducted by colonoscopy. Colonoscopy combined with biopsy may replace radiology as the initial test of choice in many clinical situations.

Zheng JJ, Chu XQ, Shi XH, Wang YM, Jia LM, Zhou CL, Wang FM. · Department of Gastroenterology of the Third People's Hospital of Suzhou, Suzhou 215008, China. · Zhonghua Yi Xue Za Zhi. · Pubmed #16313774 No free full text.

Abstract: OBJECTIVE: An attempt was made to provide a better insight into endoscopic and histological features and/or problems encountered when establishing a diagnosis of colonic Crohn's disease (Crohn's colitis). METHODS: As presented in our 27 cases with Crohn's colitis, the endoscopic findings and histological changes of biopsy specimens were summarized. As collated with correspondent results of biopsy and surgical specimens, the diagnostic accuracy of endoscopy was evaluated. RESULTS: twenty-six involvements of the large intestine (combined with other sites of the intestine) was found (96.3%). However, involvement limited to the colon alone was seen in only 4 cases (14.8%). Endoscopically, overlapped lesions with multistaged-segmental distributed and multi-sited diverse patterns (destructive and proliferative/regenerative) of inflammatory changes were observed. Endoscopic accuracy was 66.7%. The characteristic features of mucosal biopsy include focal distribution of the lesions, a thickened and edematous submucosa, deep fissuring ulcers, lymphoid aggregate, and hyperplasia, fibrosis and granulomas (detected in 30% of the group), etc. CONCLUSIONS: Colonic involvement of Crohn's disease is common. Colonoscopy may be valuable in establishing the diagnosis and in assessing the extent and severity of colonic involvement, and CDEIS was value in the follow up of patients. Colonoscopic biopsies are helpful for verification of the diagnosis in difficult cases. Colonoscopy has replaced radiology as the initial test of choice in many clinical situations.

Zheng JJ, Shi XH, Chu XQ, Jia LM, Wang FM. · Department of Gastroenterology, the Third People's Hospital, Suzhou 215008, China. · Chin Med J (Engl). · Pubmed #14975199 links to  free full text

Abstract: BACKGROUND: An increasing incidence of Crohn's disease has been found in China in recent years. Our study has been focused on evaluating the diversity of the clinical manifestations of Crohn's disease in order to improve early diagnostic accuracy and therapeutic efficacy. METHODS: Thirty patients with active Crohn's disease were enrolled and their clinical data, including diagnostic and therapeutic results, were analyzed. Endoscopy combined with histological examination of biopsy specimens provided characteristic features of the disease. Transabdominal bowel sonography (TABS) was used for detecting intestinal complications. Nutritional supportive therapy was given to 20 subjects with active cases of the disease. RESULTS: Most patients were young adults with a higher proportion of females to males (ratio: 1.14:1). The disease affects any segment or a combination of segments along with the alimentary tract (from the mouth to the anus). In this study, the colon and small bowel were the major sites involved. Recurrent episodes of abdominal pain in the right lower quadrant and watery diarrhea were the most common symptoms. Granulomas were identifiable in nearly one-third (30.8%) of all biopsy specimens. In moderate cases of the disease, remission was achieved more quickly through the use of oral prednisone therapy than with SASP or 5-ASA. Beneficial effects on the host's nutritional status were observed. Immunosuppressives were used on an individual basis and showed variable therapeutic effects. Sixteen patients had surgery due to intestinal obstruction or failure to respond to drug therapies. Rapid improvement after surgery was reported. CONCLUSION: Endoscopy (with biopsy) and TABS were both crucial procedures for diagnosis. SASP (or 5-ASA) and prednisone were effective as inductive therapies. Azathioprine has demonstrable benefits after induction therapy with prednisone. Surgery, as an alternative treatment, provided another effective choice in selected patients.