Progress and Clinical Applications of Crohn’s Disease Exclusion Diet in Crohn’s Disease

( Duo Xu ),( Ziheng Peng ),( Yong Li ),( Qian Hou ),( Yu Peng ),( Xiaowei Liu ) 대한소화기기능성질환·운동학회 2024 Gut and Liver Vol.18 No.3

Crohn’s disease is a chronic intestinal inflammatory disorder of unknown etiology. Although the pharmacotherapies for Crohn’s disease are constantly updating, nutritional support and adjuvant therapies have recently gained more attention. Due to advancements in clinical nutrition, various clinical nutritional therapies are used to treat Crohn’s disease. Doctors treating inflammatory bowel disease can now offer several diets with more flexibility than ever. The Crohn’s disease exclusion diet is a widely used diet for patients with active Crohn’s disease. The Crohn’s disease exclusion diet requires both exclusion and inclusion. Periodic exclusion of harmful foods and inclusion of wholesome foods gradually improves a patient’s nutritional status. This article reviews the Crohn’s disease exclusion diet, including its structure, mechanisms, research findings, and clinical applications. (Gut Liver 2024;18:404-413)

Crohn병의 진단과 질병 활성도, 합병증 평가에 있어서 CT 소장조영술의 횡단영상과 관상영상의 유용성 비교

안성은,박성진,문성경,임주원,이동호,고영태,김효종 대한영상의학회 2013 대한영상의학회지 Vol.68 No.2

Purpose: To retrospectively compare the accuracy of axial and coronal planes of CT enterography for detection of pathologic findings of Crohn disease. Materials and Methods: 168 patients who were suspected of having Crohn disease underwent CT enterography. 66 patients who were diagnosed Crohn disease were retrospectively evaluated (endoscopic biopsy of terminal ileum: 12 patients, segmental resection of small bowel: 6 patients, diagnosed based on a combination of clinical, histopathological and imaging findings: 48 patients). 2 radiologists reviewed axial planes of CT enterography and one month later reviewed coronal planes. CT enterography findings of active phase, chronic phase and complications of Crohn disease were evaluated and then compared with axial and coronal planes by using chi-square test. Results: Mucosal hyperenhancement, wall thickening, and mesenteric fat stranding were more detected on axial planes, which were CT findings of active Crohn disease. Pseudosacculation, fibrotic strictures, fistulas, abscesses were more detected on coronal planes, which were CT findings of chronic Crohn disease or complications. In particular, pseudosacculation and fibrotic strictures were significantly more detected on coronal planes. Conclusion: When evaluating CT enterography in Crohn disease, coronal planes provide more useful diagnostic information of pseudosacculation and fibrotic strictures. 목적: Crohn병 환자에서 CT 소장조영술의 횡단영상과 관상영상을 비교하여, 질환의 진단과 합병증 평가에 있어서 차이점이 있는지 알아보고자 하였다. 대상과 방법: 소장의 Crohn병이 의심되어 CT 소장조영술을 시행한 환자 168명 중, Crohn병으로 진단된 66명의 환자를 대상으로 하였다(말단회장에서 내시경 생검: 12명, 소장이나 말단회장의 수술: 6명, 말단회장의 내시경 생검소견, 임상증상, 영상의학적 소견을 종합하여 판단: 48명). 2명의 영상의학과 의사가, CT 소장조영술의 횡단영상과 관상영상을 각각 1개월의 간격을 두고 분석하였다. CT 소견은 Crohn병의 급성기 소견, 만성기 소견, 합병증 동반여부를 분석하였고, 이 중 횡단영상과 관상영상에서 더 잘 관찰되는 소견을 카이제곱 검정을 이용하여 서로 비교하였다. 결과: CT 소장조영술의 횡단영상에서는 점막의 과다조영증강, 장벽 비후, 장간막 지방 침착이 잘 관찰되는 경향을 보였고, 관상영상에서는 거짓주머니, 섬유성 협착, 누공, 봉소직염이 잘 관찰되었다. 특히, 만성기 소견인 가성수포와 섬유성 협착은 관상영상에서 통계적으로 유의하게 더 잘 관찰되었다(p = 0.0423, p = 0.0329). 결론: Crohn병의 CT 소장조영술의 소견은 횡단영상과 관상영상에서 대부분 유의한 차이를 보이지 않았으나, 만성기 소견인 가성수포와 섬유성 협착은 관상영상에서 유의하게 높은 빈도로 관찰되었다.

Montreal Classification에 따른 한국 크론병의 특징

김범,박순도,최성일,이석환,이길연 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.5

Purpose: Crohn’s disease is an inflammatory bowel disease with various symptoms and progressions. For effective identification of various causes and follow up of patients, we used the Vienna Classification from 1998, but we started applying the Montreal Classification in 2005. In this study, our aim was to identify the clinical characteristics of Korean patients with Crohn’s disease by using the Montreal Classification. Methods: A retrospective study was carried out among 111 patients who were evaluated at KyungHee Medical Center from March 1986 through February 2008 as having Crohn’s disease. Results: The male-to-female ratio was 1.8:1, and the average age was 27.2±9.6 yr. Abdominal pain was the major symptom, and extraintestinal manifestations were seen in 16 cases. Of the Crohn’s disease patients, 25.2% were initially misdiagnosed as having tuberculosis. Concerning age at diagnosis, A2 (patients 17 to 40 yr of age) was the largest group. The most common disease location was the ileocolon (L3), and a combined upper gastrointestinal lesion (L4) was most commonly seen in L3. The most common disease behaviors were nonstricturing and nonpenetrating (B1), and although perianal lesions were most common in B1, there were no statistical correlations (P=0.061). Surgical treatments were performed in 46 cases, especially in cases involving complex disease (stricturing & penetrating) (P<0.005) and ileal disease (L1) (P=0.024). Conclusion: According to the Montreal Classification of Korean Crohn’s disease patients, a more stable manifestation was seen in the group with lower age at diagnosis. Perianal lesions did not have any correlation with the form in which the disease manifested itself. Complex disease and ileal disease required a surgical procedure the most. Purpose: Crohn’s disease is an inflammatory bowel disease with various symptoms and progressions. For effective identification of various causes and follow up of patients, we used the Vienna Classification from 1998, but we started applying the Montreal Classification in 2005. In this study, our aim was to identify the clinical characteristics of Korean patients with Crohn’s disease by using the Montreal Classification. Methods: A retrospective study was carried out among 111 patients who were evaluated at KyungHee Medical Center from March 1986 through February 2008 as having Crohn’s disease. Results: The male-to-female ratio was 1.8:1, and the average age was 27.2±9.6 yr. Abdominal pain was the major symptom, and extraintestinal manifestations were seen in 16 cases. Of the Crohn’s disease patients, 25.2% were initially misdiagnosed as having tuberculosis. Concerning age at diagnosis, A2 (patients 17 to 40 yr of age) was the largest group. The most common disease location was the ileocolon (L3), and a combined upper gastrointestinal lesion (L4) was most commonly seen in L3. The most common disease behaviors were nonstricturing and nonpenetrating (B1), and although perianal lesions were most common in B1, there were no statistical correlations (P=0.061). Surgical treatments were performed in 46 cases, especially in cases involving complex disease (stricturing & penetrating) (P<0.005) and ileal disease (L1) (P=0.024). Conclusion: According to the Montreal Classification of Korean Crohn’s disease patients, a more stable manifestation was seen in the group with lower age at diagnosis. Perianal lesions did not have any correlation with the form in which the disease manifested itself. Complex disease and ileal disease required a surgical procedure the most.

크론병 치루

임석원,이철호,이광렬,유정준,박세영,김현식,전정열,이종균 대한대장항문학회 1997 Annals of Coloproctolgy Vol.13 No.1

수술적 처치를 요한 염증성 장질환

정병옥,김형록,김동의,김영진,김신곤 대한대장항문학회 1998 Annals of Coloproctolgy Vol.14 No.3

Crohn`s disease initially presenting as vulvar swelling

( Kyoung Geun Lee ),( Byoung Yong Koh ),( Eun Sun Kwon ),( Ki Bum Myung ),( Seung Hyun Cheong ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Crohn’s disease is a chronic granulomatous disease, involving any part of gastrointestinal tract. The skin is a common site of extraintestinal involvement in Crohn’s disease. The most common site of cutaneous involvement in Crohn’s disease is the perineal and perianal areas. Cutaneous Crohn’s disease is relatively common in those previously diagnosed with gastrointestinal Crohn’s disease. A 22-year-old woman has been presented with longer than several months history of erythematous swelling on vulva, right side predominant. She has no previous medical history including Crohn’s disease. Histopathologic examination on the right side of labium majus shows upper dermal edema and granulomatous non-caseating necrosis composed of multinucleated giant cells, perivascular and interstitial lymphoplasmocytic infiltration in dermis. Under gastroenterology consultation, endosopic examination was done. Colon biopsy revealed chronic inflammation with lymphoplasmocytic infiltration consistent with active stage of Crohn’s disease. Herein we report a rare case of Crohn’s disease initially presenting as vulvar swelling.

Does fecal calprotectin equally and accurately measure disease activity in small bowel and large bowel Crohn’s disease?: a systematic review

( Ebby George Simon ),( Richard Wardle ),( Aye Aye Thi ),( Jeanette Eldridge ),( Sunil Samuel ),( Gordon William Moran ) 대한장연구학회 2019 Intestinal Research Vol.17 No.2

Fecal calprotectin (FC) is a highly sensitive disease activity biomarker in inflammatory bowel disease. However, there are conflicting reports on whether the diagnostic accuracy in Crohn’s disease is influenced by disease location. The aim of this study was to undertake a systematic review of the published literature. Relevant databases were searched from inception to November 8, 2016 for cohort and case control studies which had data on FC in patients with isolated small bowel (SB) and large bowel (LB) Crohn’s disease. Reference standards for disease activity were endoscopy, magnetic resonance imaging, computed tomography or a combination of these. The QUADAS-2 research tool was used to assess the risk of bias. There were 5,619 records identified at initial search. The 2,098 duplicates were removed and 3,521 records screened. Sixty-one full text articles were assessed for eligibility and 16 studies were included in the final review with sensitivities and specificities per disease location available from 8 studies. Sensitivities of FC at SB and LB locations ranged from 42.9% to 100% and 66.7% to 100% respectively while corresponding specificities were 50% to 100% and 28.6% to 100% respectively. The sensitivities and specificities of FC to accurately measure disease activity in Crohn’s disease at different disease locations are diverse and no firm conclusion can be made. Better studies need to be undertaken to categorically answer the effect of disease location on the diagnostic accuracy of FC. (Intest Res 2019;17:160-170.)

크론병의 임상적 고찰

정희원,박재갑,이건욱,최국진,김진복 대한대장항문학회 1992 Annals of Coloproctolgy Vol.8 No.2

감별 규칙을 이용한 온톨로지 기반 크론병 진단 프로세스 정의

유동연,박예슬,이정원 한국정보처리학회 2018 정보처리학회논문지. 소프트웨어 및 데이터 공학 Vol.7 No.11

Crohn's disease, which is recently increasing in Korea, may be seen throughout the gastrointestinal tract and cause various symptoms. In particular, Crohn's disease is especially difficult to diagnose with several symptoms similar to other ulcerative colonic diseases. Thus, some studies are underway to distinguish two or more similar diseases. However, the previous studies have not described the procedural diagnosis process of it, which may lead to over-examination in the process. Therefore, we propose a diagnosis process of Crohn's disease based on the analysis of redundancy, sequential linkage and decision point in the diagnosis of Crohn’s disease, so that it enables to identify ulcerative colonic diseases with symptoms similar to Crohn's disease. Finally, we can distinguish the colon diseases that have symptoms similar to Crohn's disease and help diagnose Crohn's disease effectively by defining the proposed process-oriented association as an ontology. Applying the proposed ontology to 5 cases showed that more accurate diagnosis was possible and in one case it could be diagnosed even with fewer tests. 최근 국내에서도 발병률이 증가하고 있는 크론병은 위장관의 모든 부위에서 발병할 수 있으며, 나타나는 증상도 다양하다. 특히, 크론병은 다른 궤양성 대장질환과 유사한 증상을 보일 수 있어 크론병을 진단하는데 어려움을 겪는다. 이로 인해 크론병 진단 가이드라인이나 크론병과 유사한 증상을 보이는 질병의 감별에 대한 연구가 진행되고 있다. 하지만 기존 연구에는 크론병에 대한 순차적인 진단 과정이 기술되지 않아, 크론병 진단을 위한 검사 과정에서 과다한 검사가 시행될 우려가 있다. 따라서 본 논문에서는 크론병과 유사한 증상을 보이는 궤양성 대장 질환을 감별하기 위해 중복성 및 순차적인 연관성, 질병의 진단 조건을 분석하여 감별 규칙으로 정의하고, 이를 기반으로 크론병 진단 프로세스를 제안한다. 또한, 제안하는 프로세스 중심의 연관성을 온톨로지로 정의함으로써 크론병과 유사한 증상을 보이는 대장 질환을 감별하고, 효과적으로 크론병을 진단하는데 도움을 줄 수 있다. 제안한 온톨로지를 5개의 사례에 적용해 본 결과, 모두 올바른 진단을 내렸으며 1개의 사례에서 더 적은 수의 검사로 진단할 수 있었다.

크론씨 병의 질병 활성도 평가에 있어서 CT의 유용성

하현권,김표년,이문규,Ha, Hyeon-Gwon,Kim, Pyo-Nyeon,Lee, Mun-Gyu 대한영상의학회 2001 대한영상의학회지 Vol.45 No.4

목적:크론씨 병 환자에서 질병 활성도를 반영하는 CT 소견을 알아보고,질병 활성도 평가에 있어서 CT의 유용성을 알아보고자 하였다. 대상과 방법:크론씨 병으로 진단된 36명의 환자에서 시행된 50예의 CT를 대상으로 하였다. 모든 환자에서 임상 소견을 바탕으로 Crohn ’s disease activity index (CDAI)를 구하였으며 아울러 C-reactive protein (CRP)수치를 조사하였다.CT는 임상적 질병 활성도를 모르는 상태로 분석하였으며,분석한 CT 소견은 침범 부위,과녁 징후의 유무,침범 된 장벽의 조영 증강 양상,침범 된 장벽의 증가된 조영 증강 유무,병변의 길이,장벽 비후의 두께,과혈관성의 유무,복수의 유무,임파절 비대 유무,지방섬유 증식의 유무,및 장 주변 침윤의 정도이었다. 각각의 CT 소견을 CDAI,CRP와 비교하였다. 결과:CDAI와 CRP 모두 유의하게 높았던 CT 소견은 과혈관성 (p=0.005,0.028),복수 (p=0.001,0.008),심한 장 주위 침윤 (p=0.009,0.003),40 cm 이상의 병변 길이 (p=0.001,0.001)였으며,CRP만 유의한 차이를 보였던 CT 소견은 비균질한 장벽의 조영 증강 (p=0.001),증가된 조영 증강 (p=0.042),과녁 징후 (p=0.031),심한 장벽 비후 (r=0.410,p=0.003)였다.그 외에 침범부위,임파절 비후,지방 섬유 증식의 유무는 CDAI와 CRP의 유의한 차이가 없었다. 결론:여러 CT 소견들이 크론씨 병의 활성도와 관련성이 있었으며,이러한 소견을 이용하면 CT가 크론씨 병의 활성도를 평가하는데 유용할 것으로 사료된다. Purpose: The purpose of this study is to determine the CT features indicating active disease as well as to evaluate the usefulness of CT in assessing disease activity in patients with Crohn's disease. Materials and Methods: Thirty-six patients with Crohn ’s disease underwent a total of 50 abdominal CT scans. To characterize clinical disease activity, the Crohn ’s disease activity index (CDAI) was calculated using clinical and laboratory patient data, and C-reactive protein (CRP), levels were also measured. Without knowledge of clinical disease activity, computed tomograms were evaluated in terms of site, target sign, degree of bowel wall enhancement, length, bowel wall thickness, extraluminal hypervascularity, ascites, lymphadenopathy, fibrofatty proliferation, and degree of pericolic or perienteric infiltration. Each finding was compared with the clinical parameters of disease activity. Results: Both CDAI and CRP were significantly higher in patients with hypervascularity (p=0.005 and 0.028,respectively), long length of involved bowel (p=0.001, 0.001), moderate to severe pericolic or perienteric infiltration (p=0.009, 0.003), or ascites (p=0.001, 0.008). Only CRP was significantly higher in those with heterogeneous bowel wall enhancement (p=0.001), marked bowel wall enhancement (p=0.042), target sign (p=0.031), or severe bowel wall thickening (r=0.410, p=0.003). For other CT findings such as the location, lymphadenopathy, and fibrofatty proliferation, there were no statistically significant differences in CDAI or CRP levels. Conclusion: A number of CT findings varied according to clinical disease activity. These findings are, therefore, useful for evaluating disease activity in patients with Crohn’s disease.