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1、InfliximabMaintenanceTherapyforFistulatingCrohn`sDiseaseNewEnglandjournalofMedicineFeb.26,2004Directedby:Dr.A.HAMAMPresentedBy:Dr.Y.Abu-ZanounaCrohn`sDiseaseItisanidiopathic,chronic,transmuralinflammatoryprocessofthebowel,thatcanaffectanypartoftheGItract,mostcasesinvolveterm
2、inalileum.Itisbelievedtobearesultofanimbalancebetweenproinflammatoryandanti-inflammatorymediators.Unpredictableflares&remissions.PathophysiologyTheexactcauseremainsunknownTheories:geneticmicrobial,immunologic,environmental,dietary,vascular,psychosocial.Microscopically:inflam
3、mationaroundthecrypts,ulceration,granuloma,mesentery&lymphnodes.Macroscopically:Hyperemia&edema,ulcers“cobblestone“,segmentallesionsGenetics1stdegreerelativeshavea5-25%higherriskthannormalpopulation.FamilymembersofpatientswithCrohn`sDiseasehaveincreasedriskforbothCD&UC.Offsp
4、ringhavean8.9%&siblingsan8.6%riskfordevelopingIBDSusceptibilityregionsdetectedondifferentchromosomes(6,12,16)EpidemiologyIncidencerateinchildren3.5/100,000inNA10–19yrolds.Morethan1/3ofpatientspresentinchildhoodoradolescence.Familyhistoryispresentin30%,youngerthan30.Males=Fem
5、alesinadulthood,Males>femalesinchildhood.HighestincidenceinCaucasians.ClinicalPresentationWeightloss85%Diarrhea80%Abdominalpain85%Rectalbleeding50%Growthfailure35%Fever40%Rectaldisease25%Extraintestinalsigns25%Perianaldisease25%Nausea&vomiting25%ClinicalpresentationPhysicale
6、xamination:GrowthDelay,wtloss,delayedpubertyRLQmass&tendernessPalpablethickenedloopofintestineHyperactivebowelsoundsPerianal&rectalexamination:skintag,fissure,fistula,hemorrhoidsorabscess.LaboratoryAidsAnemia:ChronicinflammationMalabsorption(B12&folate)ChronicbloodlossLeukoc
7、ytosis:ChronicinflammationAbscessSteroidtreatmentLab`sHypoalbuminemiaHypocholestrolemiaHypocalcaemiaHypomagnesaemiaHighCRP&ESRP-ANCA:CD19%vs.UC80%ASCA:Anti–SaccharomycesCrevisiaeAntibdy;CD60%ImagingStudiesPlainAbdominalradiographBariumcontraststudiesCTscanMRIU/SRadionucleoti
8、deScansProceduresColonoscopy:Obtainingmultiplebiopsies:diagnosticDilatation
