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Only for medical professionals to read for reference.
After all the difficulties of "fever, diarrhea, weight loss", the doctor and patient made a decision and finally reached the end of happiness.
In 2019, young talent Xiao Zhang went to the UK to study alone.
He was full of enthusiasm and ideals.
Unexpectedly, in 2020, Xiao Zhang gradually developed abdominal pain, increased defecation frequency and intermittent fever in a foreign country in 2020.
He went to the local pharmacy to purchase medicine by himself, and his condition did not relieve after symptomatic treatment.
In March 2020, Xiao Zhang's intermittent body temperature can reach 38 degrees Celsius.
He has 4-5 defecation times a day.
He has worsened abdominal pain and is losing weight.
During the global COVID-19 pandemic, Xiao Zhang hesitated and finally decided to return to China for diagnosis and treatment.
Xiao Zhang recalled: At such a special moment, it was extremely difficult for a fever patient like him to transfer to an overseas airport.
After returning to China, Xiao Zhang's diarrhea and fever continued to worsen, and he began to develop edema in both lower limbs, so he rushed to Ruijin Hospital for treatment.
In April 2020, the weak Zhang was admitted to the Gastroenterology Department of Ruijin Hospital.
After detailed medical history, physical examination and preliminary examination, the report suggested that Xiao Zhang’s ileum and colon may have lesions, and he also developed anemia and low protein.
Hyperemia and inflammation indicators are abnormally increased.
After discussing with the physicians of Gastroenterology, Gastrointestinal Surgery, Radiography, and Nutrition, it is recommended that Xiao Zhang be further performed enteroscopy to determine the root cause of the disease of the ileocolon.
Endoscope results on April 17, 2020 showed that there were multiple, skipping, longitudinal ulcers in Xiao Zhang's intestines (Figure 1-3).
These ulcers are the "culprit"-Crohn's disease that causes diarrhea, abdominal pain, fever, weight loss and edema of both lower extremities.
Fig.
1 Fig.
2 Fig.
3 Fig.
1-3 shows the prompts of enteroscopy on April 17, 2020: multiple longitudinal deep ulcers in the sigmoid colon, transverse colon, and ileocecal area, intestinal mucosal edema, endoscopic diagnosis of "Crohn's disease" "Afterwards, the Ruijin Hospital's Inflammatory Bowel Disease Multidisciplinary Diagnosis and Treatment Team (IBD-MDT) and Xiao Zhang discussed together, and formulated a precise treatment plan for Xiao Zhang.
Taking into account Xiao Zhang’s need to continue studying abroad in the future, the continuity of drug treatment, the availability of drugs at home and abroad, and the convenience of medical treatment, he chose subcutaneous injection of Humira (adalimumab) combined with enteral nutrition therapy.
.
During the treatment, Xiao Zhang actively cooperated, and after 14 weeks of treatment, his symptoms were completely relieved; after 26 weeks of treatment, re-examination of the endoscopy showed that the longitudinal ulcers in the ileocolon had completely disappeared (Figure 4-6), and Xiao Zhang's weight increased from 60kg Increase to 80kg.
Figure 4 Figure 5 Figure 6 Figure 4-6 shows the reexamination of enteroscopy on October 28, 2020: the ulcers of the sigmoid colon, transverse colon and ileum disappeared, scars formed, and complete mucosal healing was achieved.
Now, Xiao Zhang has reached the remission stage of Crohn's disease , He told us: He is ready to go overseas again to regain his dream of studying.
Let us look forward to the painless and heatless youth who returned to Heathrow Airport to arrive at his happy terminal.
1What is balloon assisted enteroscopy? The small intestine is 5-7 meters in length, and it is difficult to enter and observe through endoscopy.
Due to the limitation of examination methods, the whole small intestine examination was once in the "blind spot" of the digestive tract diagnosis and treatment.
Balloon-assisted enteroscopy refers to the inspection method of the distal duodenum, jejunum, ileum and colon by endoscopy.
Enteroscopy can be used for microscopic biopsy, which is the gold standard for the diagnosis of intestinal diseases, especially small bowel diseases (Figure 7).
Enteroscopy indications include: potential small bowel bleeding, suspected Crohn’s disease, small bowel obstruction of unknown cause, etc.
Ruijin Hospital is the first medical institution in China to implement double-balloon enteroscopy.
It has nearly 20 years of experience in clinical diagnosis and treatment, and has brought great help to patients with difficult small bowel diseases. Figure 7 Indications for enteroscopy 2 What is Crohn's disease? Inflammatory Bowel Disease (Inflammatory Bowel Disease, IBD) mainly includes Ulcerative Colitis (UC) and Crohn's disease (CD).
Crohn's disease is a lifelong autoimmune gastrointestinal disease that can affect the entire digestive tract.
It usually occurs in the lower ileum and the right colon, but the entire digestive tract can be affected.
The typical endoscopic manifestations of Crohn's disease include: multiple, jumping longitudinal ulcers; paving stone sign; intestinal stenosis.
In view of the complex natural course of Crohn's disease, considerable complications, hospitalization and operation rates, it has become one of the most important diseases of digestive system at home and abroad.
Current treatment goals for Crohn’s disease include: symptom relief, C-reactive protein normalization, decline in fecal calprotectin, unaffected growth and development of children, endoscopic mucosal healing, unaffected quality of life and no disability due to disease .
The diagnosis and treatment of Crohn's disease are relatively complicated, and the clinical work requires the participation of multiple departments.
3Why do we need a multidisciplinary diagnosis and treatment team? In the current international and domestic IBD guidelines, it is proposed that there is no gold standard for the diagnosis of IBD.
The diagnosis process must be combined with medical history, laboratory examinations, endoscopy, imaging and pathological examinations, and at the same time, other diseases need to be ruled out.
Confirmed.
Due to the complex diagnosis steps and the changeable treatment plan, the application of the Multidisciplinary Team (MDT) concept to IBD will help improve the precision diagnosis and treatment of the disease.
Secondly, with the passage of time, the course of some patients with IBD in my country has gradually entered the intestinal comorbidity stage from the early stage; this change means that disease treatment decisions need to be led by a single department of gastroenterology and gradually evolve into the need for gastroenterology, gastrointestinal surgery, and clinical The nutrition department and other disciplines participate together.
Multidisciplinary collaboration can provide a good solution for the difficult and severe IBD comorbidity.
The Inflammatory Bowel Disease Multidisciplinary Treatment Team (IBD-MDT) of Ruijin Hospital was established on November 5, 2015, and discusses the diagnosis and treatment of inflammatory bowel disease at 15:30-17:30 every Wednesday.
Since IBD-MDT was founded, IBD-MDT has completed the diagnosis and treatment of thousands of outpatients and inpatients, and has gained good social and industry influence.
The successful diagnosis and treatment model has made Ruijin's IBD-MDT team enjoy an international reputation.
In 2016, Professor Zhong Jie, the head of our hospital's IBD-MDT team, was invited by the Korean Association for the Study of Intestinal Disease (KASIDs) to go to Seoul for Ruijin.
IBD-MDT treatment strategy for fistula Crohn’s disease made relevant academic reports and won international praise; In 2017, he was invited by the European Crohn’s Colitis Organisation (ECCO) to go to Barcelona and adopted the IBD-MDT model.
The differential diagnosis of Crohn's disease, intestinal Behcet's disease and intestinal tuberculosis has received extensive attention from scholars in Western countries.
In 2019, I was again invited by the Asian Organization for Crohn's and Colitis (AOCC) to give a special report on the introduction of the MDT treatment plan for CD bleeding, which won the attention of Asian countries.
Ruijin IBD-MDT's efficient and rigorous diagnosis and treatment capabilities have earned it a good reputation among patients.
In 2018, IBD-MDT was awarded the title of Ruijin Hospital's MDT brand team.
We look forward to providing more help to more patients in the future.
Team Introduction Ruijin IBD-MDT Multidisciplinary Diagnosis and Treatment Team of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine Guidance Time: Every Wednesday 3:30-5:30 Venue: Meeting Room, 4th Floor, Building 2, Ruijin Hospital Appointment method: The appointment statement of the Multidisciplinary Consultation Center, Room 1102, Area C, 11th Floor, Ruijin Hospital Outpatient Clinic:
After all the difficulties of "fever, diarrhea, weight loss", the doctor and patient made a decision and finally reached the end of happiness.
In 2019, young talent Xiao Zhang went to the UK to study alone.
He was full of enthusiasm and ideals.
Unexpectedly, in 2020, Xiao Zhang gradually developed abdominal pain, increased defecation frequency and intermittent fever in a foreign country in 2020.
He went to the local pharmacy to purchase medicine by himself, and his condition did not relieve after symptomatic treatment.
In March 2020, Xiao Zhang's intermittent body temperature can reach 38 degrees Celsius.
He has 4-5 defecation times a day.
He has worsened abdominal pain and is losing weight.
During the global COVID-19 pandemic, Xiao Zhang hesitated and finally decided to return to China for diagnosis and treatment.
Xiao Zhang recalled: At such a special moment, it was extremely difficult for a fever patient like him to transfer to an overseas airport.
After returning to China, Xiao Zhang's diarrhea and fever continued to worsen, and he began to develop edema in both lower limbs, so he rushed to Ruijin Hospital for treatment.
In April 2020, the weak Zhang was admitted to the Gastroenterology Department of Ruijin Hospital.
After detailed medical history, physical examination and preliminary examination, the report suggested that Xiao Zhang’s ileum and colon may have lesions, and he also developed anemia and low protein.
Hyperemia and inflammation indicators are abnormally increased.
After discussing with the physicians of Gastroenterology, Gastrointestinal Surgery, Radiography, and Nutrition, it is recommended that Xiao Zhang be further performed enteroscopy to determine the root cause of the disease of the ileocolon.
Endoscope results on April 17, 2020 showed that there were multiple, skipping, longitudinal ulcers in Xiao Zhang's intestines (Figure 1-3).
These ulcers are the "culprit"-Crohn's disease that causes diarrhea, abdominal pain, fever, weight loss and edema of both lower extremities.
Fig.
1 Fig.
2 Fig.
3 Fig.
1-3 shows the prompts of enteroscopy on April 17, 2020: multiple longitudinal deep ulcers in the sigmoid colon, transverse colon, and ileocecal area, intestinal mucosal edema, endoscopic diagnosis of "Crohn's disease" "Afterwards, the Ruijin Hospital's Inflammatory Bowel Disease Multidisciplinary Diagnosis and Treatment Team (IBD-MDT) and Xiao Zhang discussed together, and formulated a precise treatment plan for Xiao Zhang.
Taking into account Xiao Zhang’s need to continue studying abroad in the future, the continuity of drug treatment, the availability of drugs at home and abroad, and the convenience of medical treatment, he chose subcutaneous injection of Humira (adalimumab) combined with enteral nutrition therapy.
.
During the treatment, Xiao Zhang actively cooperated, and after 14 weeks of treatment, his symptoms were completely relieved; after 26 weeks of treatment, re-examination of the endoscopy showed that the longitudinal ulcers in the ileocolon had completely disappeared (Figure 4-6), and Xiao Zhang's weight increased from 60kg Increase to 80kg.
Figure 4 Figure 5 Figure 6 Figure 4-6 shows the reexamination of enteroscopy on October 28, 2020: the ulcers of the sigmoid colon, transverse colon and ileum disappeared, scars formed, and complete mucosal healing was achieved.
Now, Xiao Zhang has reached the remission stage of Crohn's disease , He told us: He is ready to go overseas again to regain his dream of studying.
Let us look forward to the painless and heatless youth who returned to Heathrow Airport to arrive at his happy terminal.
1What is balloon assisted enteroscopy? The small intestine is 5-7 meters in length, and it is difficult to enter and observe through endoscopy.
Due to the limitation of examination methods, the whole small intestine examination was once in the "blind spot" of the digestive tract diagnosis and treatment.
Balloon-assisted enteroscopy refers to the inspection method of the distal duodenum, jejunum, ileum and colon by endoscopy.
Enteroscopy can be used for microscopic biopsy, which is the gold standard for the diagnosis of intestinal diseases, especially small bowel diseases (Figure 7).
Enteroscopy indications include: potential small bowel bleeding, suspected Crohn’s disease, small bowel obstruction of unknown cause, etc.
Ruijin Hospital is the first medical institution in China to implement double-balloon enteroscopy.
It has nearly 20 years of experience in clinical diagnosis and treatment, and has brought great help to patients with difficult small bowel diseases. Figure 7 Indications for enteroscopy 2 What is Crohn's disease? Inflammatory Bowel Disease (Inflammatory Bowel Disease, IBD) mainly includes Ulcerative Colitis (UC) and Crohn's disease (CD).
Crohn's disease is a lifelong autoimmune gastrointestinal disease that can affect the entire digestive tract.
It usually occurs in the lower ileum and the right colon, but the entire digestive tract can be affected.
The typical endoscopic manifestations of Crohn's disease include: multiple, jumping longitudinal ulcers; paving stone sign; intestinal stenosis.
In view of the complex natural course of Crohn's disease, considerable complications, hospitalization and operation rates, it has become one of the most important diseases of digestive system at home and abroad.
Current treatment goals for Crohn’s disease include: symptom relief, C-reactive protein normalization, decline in fecal calprotectin, unaffected growth and development of children, endoscopic mucosal healing, unaffected quality of life and no disability due to disease .
The diagnosis and treatment of Crohn's disease are relatively complicated, and the clinical work requires the participation of multiple departments.
3Why do we need a multidisciplinary diagnosis and treatment team? In the current international and domestic IBD guidelines, it is proposed that there is no gold standard for the diagnosis of IBD.
The diagnosis process must be combined with medical history, laboratory examinations, endoscopy, imaging and pathological examinations, and at the same time, other diseases need to be ruled out.
Confirmed.
Due to the complex diagnosis steps and the changeable treatment plan, the application of the Multidisciplinary Team (MDT) concept to IBD will help improve the precision diagnosis and treatment of the disease.
Secondly, with the passage of time, the course of some patients with IBD in my country has gradually entered the intestinal comorbidity stage from the early stage; this change means that disease treatment decisions need to be led by a single department of gastroenterology and gradually evolve into the need for gastroenterology, gastrointestinal surgery, and clinical The nutrition department and other disciplines participate together.
Multidisciplinary collaboration can provide a good solution for the difficult and severe IBD comorbidity.
The Inflammatory Bowel Disease Multidisciplinary Treatment Team (IBD-MDT) of Ruijin Hospital was established on November 5, 2015, and discusses the diagnosis and treatment of inflammatory bowel disease at 15:30-17:30 every Wednesday.
Since IBD-MDT was founded, IBD-MDT has completed the diagnosis and treatment of thousands of outpatients and inpatients, and has gained good social and industry influence.
The successful diagnosis and treatment model has made Ruijin's IBD-MDT team enjoy an international reputation.
In 2016, Professor Zhong Jie, the head of our hospital's IBD-MDT team, was invited by the Korean Association for the Study of Intestinal Disease (KASIDs) to go to Seoul for Ruijin.
IBD-MDT treatment strategy for fistula Crohn’s disease made relevant academic reports and won international praise; In 2017, he was invited by the European Crohn’s Colitis Organisation (ECCO) to go to Barcelona and adopted the IBD-MDT model.
The differential diagnosis of Crohn's disease, intestinal Behcet's disease and intestinal tuberculosis has received extensive attention from scholars in Western countries.
In 2019, I was again invited by the Asian Organization for Crohn's and Colitis (AOCC) to give a special report on the introduction of the MDT treatment plan for CD bleeding, which won the attention of Asian countries.
Ruijin IBD-MDT's efficient and rigorous diagnosis and treatment capabilities have earned it a good reputation among patients.
In 2018, IBD-MDT was awarded the title of Ruijin Hospital's MDT brand team.
We look forward to providing more help to more patients in the future.
Team Introduction Ruijin IBD-MDT Multidisciplinary Diagnosis and Treatment Team of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine Guidance Time: Every Wednesday 3:30-5:30 Venue: Meeting Room, 4th Floor, Building 2, Ruijin Hospital Appointment method: The appointment statement of the Multidisciplinary Consultation Center, Room 1102, Area C, 11th Floor, Ruijin Hospital Outpatient Clinic:
