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- Title
CHALLENGES IN MANAGING EARLY-ONSET CROHN'S DISEASE.
- Authors
Mustea, Teodora Ioana; Morar, Maria Melisa; Muntean, Ada Mihaela; Nistor, Şerban; Pop, Andrei Vasile
- Abstract
Introduction: Crohn's disease is a chronic inflammatory bowel disease which might result from a complex interaction between the following: genetic susceptibility, impaired immune response and environmental triggers. It is delineated by a transmural, granulomatous inflammation that can affect the entire gastrointestinal tract, illustrating a discontinuous pattern. It involves periods of activity and remission, with the presenting symptoms: colicky pain, low-grade fever and weight loss due to diarrhea, anorexia and fear of eating. Case Report: We report a case of a 41-year-old male with a history of ileocaecal Crohn's disease who is non-responsive at both immunosuppressive drugs (Azathioprine) and anti-inflammatory drugs (Mesalazine). The patient had undergone ileocolonic anastomosis after right hemicolectomy due to an acute episode in 2010 and has been under immunosuppressive and anti-inflammatory therapy since. He is also known with erosive antral gastritis as well as with an old myocardial infarction for which he follows a therapy with Clopidogrelum and Bisoprololum. Total colonoscopy performed in 2010 illustrated the hemicolectomy as well as grade 1 internal hemorrhoids with small lesions. However, the one performed in 2022 showed an upper rectal sessile polyp, which has been endoscopically excised. An upper GI endoscopy performed in 2022 confirmed the erosive antral gastritis. Discussions : Since the classical treatment was non-effective for this patient, the biological therapy was implemented. It has to be taken into consideration the fact that the most common indications for surgery are represented by fistula, abscess, obstruction and in this particular case, surgical management was necessary due to the unfavorable evolution. Moreover, patients with elderly onset are associated with a less progressive course of the disease and a better outcome. Conclusions: To conclude, the presented case displays the situation of a patient that suffered a major complication during the standard therapy, so that the surgical intervention was necessary. The alternative treatment established in this case was the biological one. Currently, the patient has been recommended the new implemented treatment and he is expected for a follow up in order to initiate the proper therapy with Adalimumab.
- Subjects
ROMANIA; CROHN'S disease; CONFERENCES &; conventions; BIOTHERAPY; ADALIMUMAB; COLECTOMY
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p188
- ISSN
2668-7755
- Publication type
Article