Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) of unknown etiology. The main pathological feature of IBD is transmural infiltration of polymorphonuclear neutrophils (PMN) and mononuclear cells associated with smooth muscle cell proliferation, accumulation of collagen, thickening and stenosis. While the etiology of Crohn's disease remains unknown, increased levels of proinflammatory cytokines, such as IL-1, IL-6, IL-8 and TNF in the inflamed bowel probably play a major role in the tissue injury and fibrosis that ensue. PMNs infiltrate into tissue in response to chemotactic signals produced by the tissue, such as a-chemokines (IL-8). Although, the initial infiltration of neutrophils is beneficial to kill foreign particles and bacteria, persistent infiltration causes tissue damage. This review shows some evidence of neutrophil expression in Crohn's bowel and the process of neutrophil infiltration into the inflamed tissue

Background: The effectiveness of partial posterior wrap (Toupet procedure) in patients with defective esophageal body motility is controversial. Aim of the study: To evaluate the effect of Toupet procedure upon the outcome of laparoscopic (LF) and open (OF) fundoplications in gastroesophageal reflux disease (GERD) patients with defective esophageal body motility. Patients and Methods: This study included 32 patients with severe GERD who underwent Toupet procedure; 18 (56.25%) OF 'and 14 (43.75%) LF. Outcome measures included assessment of relief of the symptoms, results of repeated endoscopy, barium study, manometry and pH metry; both early (within six months) and late (two years at least). Results: Relief of heartburn was achieved in 26 patients (81.3%). These include 14 (77.7%) and 12 (85.7%) patients who underwent OF and LF respectively. Occasional dysphagia developed in six patients (18.7%) early, and three (9.4%) late; all were managed conservatively. Endoscopic esophagitis healed in 26 patients (81.3%); 14 (77.7%) OF and 12 (85.7%) LF. Mean LES and body pressures improved (10.5 to 17.7 and 29.0 to 41.0 mmHg respectively). Persistent acid reflux was detected in six patients (18.7%); two (22.3%) OF and two (14.3%) LF. Conclusion: Toupet fundoplication is an effective procedure for reflux control except in patients with severe GERD

The aim: The study aims to evaluate the clinical presentation and surgical management of small bowel Crohn's disease (CD) at a tertiary referral center in the Kingdom of Saudi Arabia (KSA). Patients and methods: A retrospective review of the medical records of all patients with the diagnosis of small bowel CD from March 1999 up to December 2003. The records of 28 patients were reviewed for demographic data, clinical presentation, preoperative investigations, indications of surgery, surgical procedures, postoperative complications and follow-up. The final diagnosis of CD was based on paraffin section histopathology reports. Results: The mean age was 34 years, female to male ratio was 1:2.1. The medical treatment was offered to 22 patients in whom the diagnosis of CD was established after investigations or they were known to have CD before admission. Thirteen patients (46.4%) responded to medical treatment, whereas 15 patients (53.6%) required surgery. The indications for surgery were intestinal obstruction (seven patients), right iliac fossa mass lesion of uncertain nature (three patients), enterocutaneous fistula and pelvic collection (one patient), failure of medical treatment (two patients), and acute abdomen (two patients). The surgical procedures carried out were limited right hemicolectomy in ten patients, segmental bowel resection (two patients) and stricturoplasty of the stenosed segment (three patients). Conclusion: Crohn's disease is not uncommon in KSA. It is a disease of young patients, half of patients needed surgery at some stage. Intestinal obstruction remains the most common indication of surgery. The surgery of CD needs a good cooperation between the surgeon, radiologist and gastroenterologist