Maintenance Therapy for Fistulating Crohns Disease英夫利昔单抗为fistulating克罗恩病维持治疗课件.ppt

Infliximab Maintenance Therapy for Fistulating Crohn`s Disease New England journal of Medicine Feb. 26,2004 Directed by: Dr. A. HAMAM Presented By:Dr.Y.Abu-Zanouna Crohn`s Disease It is an idiopathic ,chronic ,transmural inflammatory process of the bowel ,that can affect any part of the GI tract ,most cases involve terminal ileum. It is believed to be a result of an imbalance between pro inflammatory and anti-inflammatory mediators. Unpredictable flares remissions. Pathophysiology The exact cause remains unknown Theories: genetic microbial,immunologic, environmental, dietary, vascular ,psychosocial. Microscopically : inflammation around the crypts, ulceration ,granuloma , mesentery lymph nodes. Macroscopically : Hyperemia edema , ulcers “ cobble stone “ ,segmental lesions Genetics 1st degree relatives have a 5-25% higher risk than normal population. Family members of patients with Crohn`s Disease have increased risk for both CD UC. Offspring have an 8.9% siblings an 8.6% risk for developing IBD Susceptibility regions detected on different chromosomes (6 ,12 , 16 ) Epidemiology Incidence rate in children 3.5/100,000 in NA 10 – 19 yr olds. More than 1/3 of patients present in childhood or adolescence. Family history is present in 30% ,younger than 30. Males = Females in adulthood, Males females in childhood. Highest incidence in Caucasians. Clinical Presentation Weight loss 85% Diarrhea 80 % Abdominal pain 85% Rectal bleeding 50% Growth failure 35% Fever 40% Rectal disease 25% Extraintestinal signs 25% Perianal disease 25% Nausea vomiting25% Clinical presentation Physical examination: Growth Delay , wt loss , delayed puberty RLQ mass tenderness Palpable thickened loop of intestine Hyperactive bowel sounds Perianal rectal examination: skin tag ,fissure ,fistula, hemorrhoids or abscess. Laboratory Aids Anemia: Chronic inflammation Malabsorption ( B 12 folate ) Chronic blood loss Leukocytosis: Chronic inflammation Abscess Steroid treatment Lab`