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  1. Pangolin

    Proposed Crohn's model and treatment approach

    Crohn's is characterized by inflammation in the intestines. The immune system is responding to some antigen in the region, and, since no autoimmunity has been discovered, it is probably the result of foreign material reaching areas that expose it to the immune response. Theories of causation...
  2. Pangolin

    Thinking about Crohn's wrong has set patients back decades

    The near-exclusive focus on Crohn's as an immune disorder has clouded the judgment of doctors and has set back the research on Crohn's by at least a decade. Even today, many if not most doctors consider Crohn's to be an autoimmune disorder, although little evidence in favor of that theory has...
  3. Pangolin

    Anti-TNFs associated with eosinophilic esophagitis

    Recent paper finding an association of eosinophilic esophagitis with anti-TNFs in pediatric IBD patients: https://www.jacionline.org/article/S0091-6749(20)32109-6/fulltext
  4. Pangolin

    Stelara is working

    Just a little update on my son's case. He's 13, and he had surgery last year to remove a stricture at the terminal ileum. Prior to that he was on Remicade and then Entyvio as well as long-term EEN. Nothing we tried worked enough to allow him to go off the EEN, and none of this was able to get...
  5. Pangolin

    Post-surgery update and the problem of food

    My son had surgery in September to remove a stricture at the end of the small intestine. He's had a difficult case that's never reached a full remission, and the stricture had most likely been there for years. All of the obviously inflamed part was removed, and he recovered quickly from the...
  6. Pangolin

    Resection and some history

    My son, now 12, had an ileocecal resection last week to remove a stubborn, inflamed stricture at the ileocecal valve. Recovery has been surprisingly fast so far, and he's feeling pretty good. The surgery went very smoothly, and less than 6 inches was removed. The rest of the intestines looked...
  7. Pangolin

    Any tips for a resection?

    My 12 year old son is going to have the end of his small intestine and a bit of the large intestine chopped out to remove a stubbornly inflamed and strictured region. I think this surgery will be very helpful to him, but i wonder if anyone here has any tips for surgery and recovery? What should...
  8. Pangolin

    New vaccine possibility (not MAP)

    https://presse.inserm.fr/en/un-vaccin-contre-les-maladies-inflammatoires-chroniques/37598/ This reminds me of the Qu Biologics approach, which is based on an immune deficiency model of Crohn's. In this study, the researchers injected mice with flagellin in order to promote anti-flagellin...
  9. Pangolin

    Why does inflammation happen?

    Inflammation is an immue response to material that the body has identified as foreign. The elements necessary for inflammation to happen are: 1. Molecules which may be identified by the immune system as foreign, 2. The movement of those molecules into regions accessible to the immune system...
  10. Pangolin

    Higher doses of Humira *not* better for induction

    This is important. Higher doses of adalimumab (Humira) were not more effective for INDUCTION of remission of #UC (and similarly presented this week, #Crohns) despite higher serum concentrations of drug. Maintenance study is ongoing. #UEGW2019 We will discuss further at #ACG2019...
  11. Pangolin

    Update on long-term EEN, switching from Remicade

    My son was diagnosed 2 years ago at age 10. Perianal abscess, colonic inflammation, too much inflammation at the small/large intestine junction to see into the opening during colonoscopy. I'll skip most of the intervening details for now, but due to substantial perianal inflammation we ended up...
  12. Pangolin

    Oral Vancomycin study

    Anyone tried this? Due to the lack of absorption, this seems like it might be a safe option. Check out the graphs in the study--impressive reduction of pain, blood, and anemia. https://academic.oup.com/crohnscolitis360/article/1/2/otz015/5532749 Objective To study the efficacy of oral...
  13. Pangolin

    Bacteriophage therapy targeting adherent invasive ecoli

    https://academic.oup.com/ecco-jcc/article/11/7/840/2895107 Background and Aims: Adherent invasive Escherichia coli [AIEC] are abnormally predominant on the ileal mucosa of Crohn’s disease [CD] patients. They bind to the CEACAM6 receptor expressed on the surface of epithelial cells. We aimed to...
  14. Pangolin

    Perianal Crohn's: keeping an eye on the anus

    This might seem a little weird at first, but consider that in a case of Crohn's with perianal involvement, your most current and objective data on how things are going is a visual inspection. There is no better way to tell what the current level of inflammation in that region is than taking a...
  15. Pangolin

    Elevated ALT (liver enzyme)

    Son is 11 and currently on EEN and a rather high dose of infliximab 400mg (which is about 14 mg/kg now) every 6 weeks. Obvious Crohn's symptoms have been minimal lately and improving over time, but blood tests have been trending in the wrong direction: Sed rate up. Last three measurements...
  16. Pangolin

    66% pediatric remission with Azithromycin plus Metronidazole

    https://academic.oup.com/ecco-jcc/article/5/3/222/468526 Results: Thirty two patients (mean age 13.1 ± 3.9, mean duration of disease 0.65 years) were included, of whom 21 (66%) entered clinical remission (PCDAI < 10) after 8 weeks of treatment. The mean age at treatment and duration of disease...
  17. Pangolin

    EEN: not just for kids

    Not only does it have excellent remission and mucosal healing rates in pediatric patients, but also adult results are looking promising. Here's a recent study in adults: https://www.tandfonline.com/doi/full/10.1080/00365521.2017.1335770 Forty-one patients with CD and with intestinal...
  18. Pangolin

    EEN seems to be working

    First, a little background: 10 y/o son developed an abscess last October Diagnosed with Crohn's after scope Abscess drained in hospital IV antibiotics including flagyl given Feeding tube started to improve iron and protein levels, told diet could be unrestricted otherwise Remicade started @ 10...
  19. Pangolin

    Long-term maintenance EEN?

    I've been reading about the success of EEN in inducing remission, but I haven't heard much about people staying on it for months or years. Does anyone have experience with this? Why do people transition off EEN if it's working? More detailed version: My 10 year old son was diagnosed with...
  20. Pangolin

    Newly Diagnosed 10 yr Old with Crohn's

    Hi everyone. I'm the mom of a little boy (10 yrs old) who just got diagnosed with Crohn's. I'm not sure when the Crohn's started. Our trouble began the day he came home from the hospital: he wouldn't nurse. He had colic; he was diagnosed with GERD and put on anti-reflux medication. I made a...
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