Hugh-James Freeman

....

..A widely available, reproducible and quantitative anti-enterocyte antibody assay is needed that could be applied in small bowel disorders that have the histological appearance of celiac disease, but fail to respond to a gluten-free diet...

..Recurrent myopericarditis with ulcerative colitis appears to be rare, but responsive to steroids. It may occur more often than is currently appreciated and may lead to fatal arrhythmias or cardiac failure...

..These studies raise the possibility that there may be separate stem cell lines or different states of stem cell activation involved in the renewal of normal mammalian intestinal tract...

..Osteopenia may also be associated with an increased risk of fractures. Finally, elderly celiacs have an increased risk of malignant intestinal disease, especially lymphoma...

..Future evaluation and treatment of EGE may depend on precise serological biomarkers to aid in definition of the long-term natural history of the disorder and its response to pharmacological or biological forms of therapy...

....

..Further studies are needed, however, to determine if a gluten-free diet will lead to improvement in the associated neurological disorder...

..If detected, removal and further histopathologic analysis of the polyp may be facilitated...

..Physicians caring for patients should be concerned about the positive results in clinical trials that are sponsored by industry, even if the trials involve respected centers and the results appear in highly ranked medical journals...

....

..Therefore, recognition of this entity is exceedingly important for the clinician involved in diagnosis and further evaluation of a potentially curable form of pancreatic cancer...

..Finally, refractory or treatment-resistant pouchitis may occur with CD infection...

..Finally, some with 'sprue-like intestinal disease' cannot be classified because a diet response fails to occur. This may be a heterogeneous group, although some are eventually found to have a malignant lymphoma...

..Future research should focus on development of molecular or other bio-markers that might predict future dysplasia or cancer development in Crohn's disease...

..Similar changes may result from increased intraluminal pressure during barium enema contrast studies. Finally, malignant disorders have also been reported, including carcinoma and lymphoproliferative disease...

....

..Long-term studies on the natural history have also suggested that discrete events (or agents) may precipitate this granulomatous inflammatory process...

....

..Although rare, it is a systemic infection that may mimic a wide spectrum of clinical disorders and may have a fatal outcome. If recognized, prolonged antibiotic therapy may be a very successful form of treatment...

..Reports noting activation during pregnancy or the puerperium may be important, and suggest that celiac disease may also be hypothetically precipitated by maternal exposure to one or more fetal antigens...

..Although the clinical challenge posed to even the most experienced clinicians remains significant, evolving methods of endoscopic imaging may facilitate better evaluation of this highly select group of patients...

..Modern abdominal imaging modalities may permit earlier detection in celiac disease so that earlier diagnosis and improved understanding of its pathogenesis may result...

..These have a sprue-like intestinal disorder, also labeled unclassified sprue. This represents a small, but likely, heterogeneous group, and in these, intractable symptoms may be present and, in some, lymphoma is eventually diagnosed...

..Identification of celiac disease is important since recent long-term studies have shown that the mortality of celiac disease is increased, if it is unrecognized and untreated...

....

..Studies showing either gastric or colonic involvement (or both) with this unusual collagenous inflammatory mucosal process may also reflect a far more extensive and heterogeneous process than previously appreciated...

..This likely reflects the dynamic nature of this evolving and individualized inflammatory process that tends to be focused, but not limited, to the mucosa of the intestinal tract...

..With the development of newer imaging modalities to visualize the small-intestinal mucosa, such as double-balloon enteroscopy, improved understanding of the long-term natural history of this apparently distinctive disorder should emerge...

..Celiac disease and myasthenia gravis may occur together more often than is currently appreciated. The presence of motor weakness in celiac disease may be a clue to occult myasthenia gravis, even in the absence of intestinal symptoms...

..In the future, treatment of EGE may involve monoclonal antibody agents that target the specific biological effects of the eosinophil, apparently central to this unusual inflammatory process...

..The dramatic findings here may reflect an underlying or early molecular event in the eventual clinical appearance of overt T-cell lymphoma...

....

..Although endoscopic removal of the appendix has been reported, treatment of these localized appendiceal lesions requires a wide surgical excision...

..While temporarily reassuring, ongoing vigilance, particularly in those genetically predisposed to colon cancer, is still warranted...

..These results demonstrate the phenomenon of age dependence in the phenotypic clinical expression of Crohn's disease...

..While prolapsing gastric antral polyps are usually benign and hyperplastic, inflammatory or regenerative in type, excisional snare polypectomy here led to complete resolution of his symptoms, but showed a malignant polyp...

..Some recent reports have documented treatment success but histopathologic reversal has been more difficult to substantiate owing to the focal, sometimes extensive nature, of this pathologic process...

..Development of new neuropsychiatric changes in Crohn's disease should be thoroughly evaluated to exclude a concomitant demyelinating process. Infliximab infusions should be terminated if demyelination is suspected...

..The observations presented here reflect a possible gene-based predisposition to Crohn's disease or, alternatively, disease clustering related to a commonly shared environmental factor...

....

..Information on long-term follow-up of early-onset Crohn's disease is crucial to avoid the direct extrapolation of adult data to children and adolescents...

..Finally, pharmacologic and surgical avenues available for treatment of obesity, including lipase inhibitors and gastric or jejuno-ileal bypass procedures may set the stage for subsequent gastric or intestinal tract cancer...

..Moreover, collagenous colitis may be a clinical signal that occult small intestinal disease is present. Finally, collagenous sprue may, in some instances, be a completely reversible small intestinal disorder...

..Finally, except for a single hypopharyngeal carcinoma in a celiac disease patient with a malignant lymphoma, other malignant disorders of esophagus, stomach, and colon were not detected...

..New treatments are required, possibly defined on the basis of their effectiveness in reducing the severity and extent of intestinal disease, rather than more conventional statistically driven reductions in disease activity indexes...

..This suggests that some components of the inflammatory process in Crohn's disease may be modulated by estrogen-mediated events, particularly in adolescents and young adults...

..Particular consideration should be given if there has been a prior thrombotic event, if hospitalization will require surgery, or if an underlying coagulation disorder is present...

..Precise definition will be critical in the future as an array of new treatments, including biological agents, may emerge...

..Conversely, tissue transglutaminase antibodies have been detected in autoimmune disorders, including systemic lupus erythematosus (SLE), but cases of celiac disease with SLE have been only rarely recorded...

..It is hoped that this series will gather expert commentaries on a range of issues critical to the subspecialty from fundamental science to clinical care so that future directions can be defined...

..Pancreatic exocrine alterations may also occur, and if severe, marked malnutrition with pancreatic failure and ductal calcification have been observed. Finally, other pancreatic disorders have been recorded with celiac disease...

..In some pathological classification schemes, the criteria for a definite, probable or possible diagnosis have been listed, with the epithelioid granuloma indicating definite Crohn's disease...

..Using the Montreal classification for Crohn's disease, these results define the clinical features in a large, single clinician database and demonstrate age dependence in the phenotypic clinical expression of Crohn's disease...

....

..This case underscores the ongoing need for additional evidence-based studies on evolving imaging modalities used in the diagnosis and management of colonic cancer...

..Collagenous enterocolitis is an inflammatory process that may represent a distinctive and reversible paraneoplastic phenomenon...

..Pediatric-onset disease is more extensive than adult-onset disease. When followed for an extended period of time, it has high rates of disease complexity, with strictures and penetrating complications similar to adult-onset disease...

....

..This report documents a high mortality for this serious complication in celiac disease, its lack of predictability and the potential for development even with strict compliance to a gluten-free diet...

..With improved treatment measures, including modern nutritional support, it is likely that there will be an increased opportunity in future for improved appreciation of the complications of collagenous sprue, specifically, lymphoma...

..The authors' experiences, and a review of the literature suggest that a diagnosis of SLE should be considered in young Asian women who present with significant but clinically enigmatic gastrointestinal illness...

..This percentage would be higher if only those having an intestinal resection were considered (0.68%). Additional studies are needed to further define this risk of appendiceal carcinoids in Crohn's disease...

..Future studies are needed to further explore the role of both genetic and environmental factors in the pathogenesis and phenotypic expression of familial CD...

..There have been no mortalities, and the subsequent clinical course of these patients has been limited to a minority requiring corticosteroid or immunosuppressive medications, or further surgical resections...