pituitrin and Crohn-Disease

Topics: Abdomen; Aged; Crohn Disease; Duodenal Diseases; Duodenal Ulcer; Esophageal Achalasia; Esophagitis; Follow-Up Studies; Gastrectomy; Gastritis; Gastrointestinal Hemorrhage; Hematoma; Hernia, Diaphragmatic; Humans; Intestine, Small; Methods; Obesity; Peptic Ulcer Hemorrhage; Postoperative Complications; Stomach Neoplasms; Stomach Ulcer; Vagotomy; Vasopressins; Zollinger-Ellison Syndrome

In this article, we present a clinical case of refractory septic shock resulting from intestinal perforation treated with high doses of vasopressin and hydrocortisone during emergency surgery. The use of such high doses of vasopressin for this type of shock is not described in the literature.. A 49-year-old white woman with grade III obesity, Crohn's disease, and an intestinal perforation presented with refractory septic shock. Initially, a low dose of vasopressin was used. Then, the dosage was increased to 0.4 U/minute; in the literature, this is defined as "salvage therapy." This therapy consists of an initial load followed by a continuous infusion of hydrocortisone.. The significant increase in her cardiac index and stroke volume index resulted in an improvement in peripheral resistance, gas exchange, and urine output and a decrease in her heart rate, interleukin-6 level, and tumor necrosis factor-α level. The administration of high doses of vasopressin and corticosteroids was demonstrated to be safe for the immune system, to reduce the systemic inflammatory response, and to have direct cardiovascular effects. Further studies are required to examine the use of vasopressin as an initial vasopressor as well as its use in high dosages and in combination with corticosteroids.

Topics: Acute Disease; Anti-Inflammatory Agents; Crohn Disease; Drug Therapy, Combination; Female; Humans; Hydrocortisone; Ileocecal Valve; Intestinal Perforation; Middle Aged; Obesity, Morbid; Shock, Septic; Tomography, X-Ray Computed; Vasoconstrictor Agents; Vasopressins

Inflammatory bowel disease (IBD) is a chronic intestinal disorder, often leading to an impaired quality of life in affected patients. The importance of environmental factors in the pathogenesis of IBD, including their disease-modifying potential, is increasingly recognised. Hypoxia seems to be an important driver of inflammation, as has been reported by our group and others. The aim of the study is to evaluate if hypoxia can alter disease activity of IBD measured by Harvey-Bradshaw Activity Index in Crohn's disease (increase to ≥5 points) and the partial Mayo Score for ulcerative colitis (increase to ≥2 points). To test the effects of hypoxia under standardised conditions, we designed a prospective and controlled investigation in healthy controls and patients with IBD in stable remission.. This is a prospective, controlled and observational study. Participants undergo a 3-hour exposure to hypoxic conditions simulating an altitude of 4000 metres above sea level (m.a.s.l.) in a hypobaric pressure chamber. Clinical parameters, as well as blood and stool samples and biopsies from the sigmoid colon are collected at subsequent time points.. The study protocol was approved by the Ethics Committee of the Kanton Zurich (reference KEK-ZH-number 2013-0284). The results will be published in a peer-reviewed journal and shared with the worldwide medical community.. NCT02849821; Pre-results.

Topics: Adolescent; Adult; Altitude; Angiotensins; Biopsy; Blood Pressure; Colitis, Ulcerative; Colon, Sigmoid; Crohn Disease; Cytokines; Feces; Healthy Volunteers; Humans; Hypoxia; Hypoxia-Inducible Factor 1; Leukocyte L1 Antigen Complex; Middle Aged; Organ Size; Prospective Studies; Research Design; Severity of Illness Index; Sigmoidoscopy; Urinary Bladder; Vasopressins; Young Adult

Technological advances in the last couple of decades have led to a tremendous improvement in the safety and efficacy of embolization making it the therapeutic intervention of choice in angiogram positive lower gastrointestinal bleeding. Vasopressin has thus been forgotten and it is hardly ever used by the current generation of interventionists. However, coil embolization is technically challenging and requires greater expertise. Difficulty in super-selective catheterization and lack of adequate collateralization can also prevent successful delivery of coils. In this article we present the successful use of intra-arterial vasopressin in a patient with Crohn's disease with severe lower gastrointestinal bleeding. Despite not being the first choice, vasopressin can be safely and effectively used in selected patients who are not candidates for embolotherapy. The purpose of this article is to discuss the relative merits and demerits of vasopressin vis-à-vis embolization and to identify the role of vasopressin in the current era of super-selective embolization. Successful control of massive lower gastrointestinal bleeding by intra-arterial vasopressin infusion has previously been reported only once before in Crohn's disease. We suggest that this technique may be used in an attempt to avoid surgery in these patients.

Topics: Catheterization, Peripheral; Colonic Diseases; Crohn Disease; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Mesenteric Arteries; Mesenteric Artery, Superior; Middle Aged; Vasopressins

A case of massive lower gastrointestinal bleeding from Crohn's disease is reported. This is an uncommon complication of the disease and the literature is reviewed. Successful control of gastrointestinal bleeding by intra-arterial vasopressin infusion has not previously been reported in Crohn's disease. We suggest that this technique may be used in an attempt to avoid surgery.

Topics: Adult; Crohn Disease; Female; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Vasopressins

Topics: Acute Disease; Adolescent; Adult; Aged; Angiography; Arteriosclerosis; Celiac Artery; Crohn Disease; Duodenal Ulcer; Epinephrine; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hernia, Diaphragmatic; Humans; Injections, Intra-Arterial; Male; Mallory-Weiss Syndrome; Mesenteric Arteries; Middle Aged; Peptic Ulcer Hemorrhage; Propranolol; Vasoconstrictor Agents; Vasopressins

Topics: Adolescent; Adult; Age Factors; Angiography; Bradykinin; Cecal Diseases; Colectomy; Colitis, Ulcerative; Colon; Colon, Sigmoid; Colonic Diseases; Crohn Disease; Duodenal Diseases; Female; Humans; Intestines; Jejunum; Male; Mesenteric Arteries; Middle Aged; Phlebography; Rectal Diseases; Sex Factors; Vasodilator Agents; Vasopressins