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PubMed1979

Chronic immune colitis in rabbits.

A chronic colitis has been induced in rabbits having many of the histological features of human ulcerative colitis. Animals were first immunised with the common enterobacterial antigen of Kunin and haemagglutinating antibodies demonstrated in high titre. An immune complex colitis was then established by the injection of soluble immune complexes following mild irritation of the rectum with dilute formalin as previously described. The rabbits developed an acute colitis within the first week but, in contrast with unsensitised rabbits, the inflammation persisted and was still present at six months as assessed by proctoscopy and rectal biopsy. Kunin-sensitised rabbits receiving intravenous saline, antigen, or antibody alone did not develop a chronic colitis. It is suggested that hypersensitivity to colonic bacterial antigens may be one mechanism whereby an acute colitis becomes chronic.

Animals↗
PubMed1975

Colonic epithelial cells and polymorphonuclear leukocytes in ulcerative colitis. An electron-microscopic study.

The following study cinfirms previously reported electron-microscopic findings in ulcerative colitis and agrees with the nonspecific nature of those findings. The study extends these observations in regard to relationship of PMN leukocytes, eosinophil leukocytes, and mast cells to colonic epithelial cells. Strong, though not conclusive, data that PMN and eosinophil leukocytes extensively invade epithelial cells in ulcerative colitis is presented. This finding also is not specific to ulcerative colitis and was found with much less frequency in Crohn's disease of the colon and in salmonella colitis. The presence of intravascular degranulation of PMN leukocytes in ulcerative colitis is confirmed. This study adds additional support to the concept that the major abnormality in ulcerative colitis resides within the colonic epithelial cell.

Animals↗
PubMed1979

Bowel wall thickness as a differentiating feature between ulcerative colitis and Crohn's disease of the colon.

The colonic wall thickness was assessed from the plain abdominal radiograph and double contrast barium enema in 33 patients with ulcerative colitis, 28 with Crohn's colitis and 20 with neoplasia. The maximum wall thickness in the control group with neoplasia measured in non-diseased colon, was 2 mm. Accurate measurement was possible from only 34% of the plain films, owing to inadequate gas in the lumen. Measurement was possible in 84% of barium enemas, mainly in the descending colon. The maximum wall thickness associated with ulcerative colitis was 5 mm. In 50% of Crohn's colitis the wall thickness was above 5 mm. Estimation of the wall thickness was a slightly less sensitive index of the presence of colitis than the mucosal changes on double contrast enema. Distinction between the types of colitis was usually possible from the mucosal lesions. Where these could be similar, such as with confluent shallow ulceration, the tendency of Crohn's disease to be associated with a wall thickness in excess of 5 mm was valuable diagnostically.

Barium Sulfate↗
PubMed1977

The leucocyte chemotactic function in patients with ulcerative colitis.

The intermittent course of ulcerative colitis could hypothetically be be caused by fluctuations of the patients' natural systems of resistance. To evaluate this hypothesis the chemotactic function of leucocytes in ulcerative colitis patients has been investigated. The patient group comprised 59 patients, 24 men and 35 women. All activity stages were represented. The control group comprised 25 normal subjects, 10 men and 15 women. The chemotactic reaction was investigated in a double chamber with a cellulose-ester-micropore filter with a pore size of 3 mum as a diaphragm in which the migration takes place. The variable applied was the ratio between the number of cells 50 mum down in the filter and at the surface, calculated as a chemotactic Index. Casein was used as chemotactic agents. The corrected chemotactic was defined as the difference between stimulated and unstimulated Chemotactic Index. The chemotactic as well as the corrected chemotactic response of leucocytes from ulcerative colitis patients was significantly lower than in control subjects. The subgroup, active ulcerative colitis,showed the lowest corrected Chemotactic Index, whereas the unstimulated Control Index was significantly higher than in normal subjects. The results did not correlate with treatment. The investigation has shown that leucocytes in active ulcerative colitis cases have a high spontaneous mobility, whereas their chemotactic function after stimulation is significantly subnormal. Further investigation is needed to demonstrate whether this phenomenon plays a major role in the pathogenesis of ulcerative colitis.

Adolescent↗
PubMed1979

Cancer in universal and left-sided ulcerative colitis: factors determining risk.

A retrospective study of 267 patients with ulcerative colitis admitted to The Mount Sinai Hospital during the period 1960--1976 revealed 26 (9.7%) with adenocarcinoma of the colon. Twenty-one cases of colorectal cancer were observed among 158 patients with universal colitis (13%), and 5 occurred among 109 patients with left-sided disease (5%). Patients with left-sided disease tended to develop cancer at least a decade later than patients with universal disease. The median duration from onset of colitis to diagnosis of cancer was 20 yr for those with universal colitis, and 32 yr for those with left-sided colitis. The decade incidence of colorectal carcinoma increased from 0.4% in the first decade to 7.4% in the second, 15.9% in the third, and 52.6% in the fourth decade of follow-up. The estimated cumulative probability of developing cancer reached 34% at 30 yr and 64% at 40 yr. Cancer risk was positively correlated with duration and anatomic extent of colitis, but did not appear to be increased by early age at onset of disease.

Adenocarcinoma↗
PubMed1977

Radiology in the current assessment of ulcerative colitis.

Plain abdominal radiography in acute ulcerative colitis is essential to detect acute colonic complications, such as acute dilatation and free perforation. Sealed perforations may not be detected. Useful information can be gained as to the extent and severity of the mucosal lesions, but can be unreliable so that a contrast examination is required. The double contrast barium enema is more accurate than the single contrast study in revealing the early mucosal lesions of colitis. It is the examination of choice to show the extent and severity of disease, and is of considerable value in the differential diagnosis of colitis. In active colitis, the unprepared double contrast barium enema is recommended. The success of the examination relies on the absence of fecal residue adjacent to an active mucosa. The technique, uses, and limitations of this type of examination are described. In the long-term management of colitis, the role of radiology is to show the presence of extensive disease, which indicates an increased risk of malignancy. Lesions such as strictures or polyps may be found and are more likely to be benign than malignant, but confirmation often requires endoscopic biopsy. In the search for malignancy regular barium enema examination is not recommended, as this can only reveal an overt tumor, whereas premalignancy can be detected histologically from an endoscopic biopsy.

Colitis, Ulcerative↗
PubMed1977

Spontaneous ischemic colitis.

Eighteen cases of spontaneous ischemic colitis are reviewed. The diagnosis was established according to the following criteria: 1) clinical background, 2) clinical characteristics, 3) morphologic characteristics, and 4) clinical and morphologic course. The last three constituted the diagnostic criteria. The cases were divided into mild-to-moderate, moderate-to-severe, and gangrenous categories. Although data on clinical background did not establish the diagnosis of spontaneous ischemic colitis, they were essential in strict diagnosis. Patients who had histories of Crohn's disease, chronic ulcerative colitis, and recent antibiotic administration were excluded from consideration. Appropriate stool examinations obtained in all of the mild-to-moderate and all except two of the moderate-to-severe cases excluded colitis due to pathogenic bacterial organisms or parasites. Spontaneous ischemic colitis generally occurs in older individuals; the average age in our patients was 60 years. Twelve of the 18 patients had at least some evidence of major cardiovascular disease.

Adult↗
PubMed1978

Studies on the subpopulation and function of peripheral lymphocytes, and lymphocyte reactivity to colonic mucosal antigen and bacterial antigen in patients with ulcerative colitis and Crohn's disease.

Immunological studies were carried out in fifteen cases of ulcerative colitis, three cases of tuberculous colitis, four cases of Crohn's disease and one case of Behcet's disease diagnosed by X-ray, endoscopy or biopsy mainly from the standpoint of cellular immunity. In patients with ulcerative colitis the T-cell population and PHA responsiveness of peripheral lymphocytes were both depressed more than in the control group. At different stages of the disease, the deviation of the values of PHA responsiveness of lymphocytes showed a rather wide range in the active stage and there was also immunological instability. However, when the disease entered remission, the immunological conditions settled down and the pathological condition appeared stable. In contrast to the nonspecific immunological conditions mentioned above, characteristically, there were many examples of a positive lymphocyte response to colonic mucosal and bacterial antigens. In all cases of Crohn's disease the lesions are in the small intestine and there was a reduced response to PHA lymphocytic stimulation which was more pronounced than that in patients with ulcerative colitis. PHA response was also high in tuberculous colitis cases.

Adult↗
PubMed1977

[Pregnancy in ulcerative colitis and Crohn's disease (author's transl)].

Between 1967 and 1973 15 women with ulcerative colitis had 20 pregnancies. 14 ended with normal deliveries, 4 with spontaneous abortions, and 2 with therapeutic abortions. Fertility was normal. Malformations in the children were not observed. In the case of conception during remission or a latent phase of the disease in general a normal pregnancy is to be expected (12 out of 14). On the other hand conception during an active phase can lead to an unpredictable threat to the life of mother and child. Therapeutic abortion should be seriously considered when ulcerative colitis and pregnancy begin simultaneously. In the same period of time in 15 comparable patients with Crohn's disease (12 with ileo-colitis and 3 with terminal ileitis) who were not taking ovulation inhibitors 4 pregnancies were observed. Fertility is not significantly reduced in terminal ileitis whereas in ileo-colitis it is highly significantly reduced (bilateral tubal irritation). As in ulcerative colitis a normal pregnancy can be expected after conception in an inactive phase (2 out of 4).

Abortion, Spontaneous↗
PubMed1979

Pathology of salmonella colitis.

Salmonella colitis was encountered in eight patients. In seven, the disorder simulated ulcerative colitis both clinically and radiologically. The salmonella infection in the eighth patient was superimposed upon hitherto unrecognized ulcerative colitis. In mild cases the histological appearances of rectal biopsies were nonspecific, consisting of edema of the mucosa with focal inflammatory cell infiltration. More severe cases were characterized by neutrophils infiltrating the walls of degenerating crypts, and in one case there were microthrombi in the mucosa. One patient who was thought to have fulminant ulcerative colitis had a hemicolectomy. The resected specimen exhibited marked hemorrhage and ulceration. There were crypt abscesses in unulcerated areas but there was also extensive necrosis of the mucosa, hemorrhage in the mucosa and submucosa, and microthrombi extending from small vessels in the mucosa into venules in the submucosa similar to the picture seen in acute ischemic colitis. In this case there was intense edema and inflammation in the submucosa as well as in the mucosa.

Abscess↗
PubMed1976

Salmonella typhimurium colitis.

A patient in whom Salmonella typhimurium infection caused a localised colitis is described. Colitis has been demonstrated in experimental animals infected with S. typhimurium and noted at post mortem in patients dying from S. typhimurium infection. However colitis is an infrequently recognised feature of this infection in man, the usual diagnosis being one of gastroenteritis. There have been four other cases reported with radiological evidence of colonic involvement due to salmonella infection. Colitis probably occurs more frequently than is usually recognised in this condition and must be distinguished from ulcerative colitis.

Adult↗
PubMed1979

Campylobacter colitis.

Eleven consecutive patients with diarrhoea from whose stools campylobacter were isolated were investigated by sigmoidoscopy and rectal biopsy. Eight had definite proctitis, and in seven biopsy specimens were abnormal with histological changes ranging from non-specific colitis to gross colitis with goblet-cell depletion and crypt-abscess formation. Nine of the patients passed blood in their stools, and in all but one abdominal pain was a feature of the illness. Severe campylobacter colitis may be clinically, sigmoidoscopically, and histologically difficult to differentiate from ulcerative colitis and is a differential diagnosis in acute colitis.

Adolescent↗
PubMed1979

Light and electron microscopic studies of antibiotic associated colitis in the hamster.

Lincomycin and its analogue, clindamycin, are capable of producing mild to severe colonic mucosal injury in humans (antibiotic associated colitis). Patients with the disorder may have severe diarrhoea, pseudomembranous plaques, confluent pseudomembranes, and/or a frank, diffuse haemorrhagic colitis. The present study was designed to assess the Golden Syrian hamster as an animal model for antibiotic associated colitis and to describe lesions seen in the animal model by light, transmission electron, and scanning electron microscopy. A colitis was produced in Golden Syrian hamsters by oral or parenteral administration of lincomycin, clindamycin, or N-demethyl clindamycin. Animals were killed at intervals and microscopic studies made of sequential morphological changes in the ileum, caecum, and colon. The microscopic lesions in the early stages of the disorder were abnormalities within the brush border, cellular oedema, and hyperaemia. Changes in the intracellular organelles were observed in more severely damaged epithelial cells. Epithelial hyperplasia resulted in the piling up of cells on the mucosal surfaces. In specimens with the most severe damage, complete loss of epithelium from the mucosal surface was observed. Pseudomembranous plaques were occasionally seen. Comparison of the clinical, gross, and histological features of the animal disease with the human disorder suggest that, although minor differences are present, the hamster model is suitable for experimental studies of antibiotic associated colitis.

Animals↗
PubMed1975

Growth retardation in children with ulcerative colitis: the effect of medical and surgical therapy.

The growth of 37 children with ulcerative colitis have been analyzed. While conventional growth charts showed only percentile changes in height, height data plotted on Tanner et al.'s growth charts showed increases and decreases in growth velocity. Growth retardation is a prominent complication of ulcerative colitis with onset on bowel symptoms. Both ulcerative colitis and "high-dose" steroid therapy (greater than 12 mg/sq m/day of cortisol) can hinder growth but in some instances there is a growth spurt after high-dose steroid therapy. "Low-dose" steroid therapy does not retard growth. Colectomy is more effective than high-dose steroid therapy in reversing the growth retardation caused by ulcerative colitis and is of greatest value if not delayed too long. Growth following subtotal colectomy with ileorectal anastomosis (Aylett procedure) is not likely to be as much as that after subtotal colectomy with ileostomy. Growth retardation is infrequently the only indication for surgical intervention but ileostomy and colectomy are appropriate for this complication of ulcertive colitis in itself when not improved by adequate medical treatment.

Adolescent↗
PubMed1978

Protective effect of metronidazole in experimental ulcerative colitis.

Administration of carrageenan to guinea pigs produces colonic lesions which are similar to those noted in idiopathic ulcerative colitis of human beings. This model was used to determine fecal flora changes and response to antimicrobial probes during the evolution of carrageenan-induced colitis. The results of fecal flora analysis showed that mean coliform concentrations increased from 10(2.7) to 10(7.4) per g during the initial stages of colonic ulceration. Pretreatment of carrageenan recipients with antimicrobials directed against coliforms reduced the concentrations of these organisms, but failed to attenuate the disease process. On the other hand, pretreatment with metronidazole, an antimicrobial primarily active against anaerobic bacteria, prevented carrageenan-induced colitis in a majority of animals. Delayed treatment with metronidazole until after colitis was established showed no salutory benefits. These results suggest that anaerobic bacteria play a role in the initial events of carrageenan-induced colitis in the guinea pig model.

Animals↗
PubMed1978

[Pathology of ulcerative colitis (author's transl)].

The macroscopic and histological appearance, and the local immune response in ulcerative colitis are discussed. The main criteria for the differentiation between ulcerative colitis and Crohn's disease of the large bowel are reviewed. The risk to develope carcinoma in the large bowel is greater in patients with total ulcerative colitis than in the general population. Precancerous changes in rectal and colonoscopical biopsies are a useful parameter in detecting early cancer in colitis. A description of the morphology of precancerous changes in ulcerative colitis is given.

Biopsy↗
PubMed1979

Prevention of clindamycin-induced colitis in hamsters by Clostridium sordellii antitoxin.

Toxins produced by Clostridium difficile have been implicated in the etiology of antibiotic-induced colitis. Clostridium difficile antitoxin is not available, but recent studies have shown that toxins present in the feces of patients with this disease are neutralized by Clostridium sordellii antitoxin. We found that C. sordellii antitoxin neutralized toxins produced in broth cultures of either C. sordellii or C. difficile and that passive immunization with C. sordellii antitoxin before challenge with clindamycin prevented colitis in hamsters. Significantly fewer antitoxin-treated animals than unimmunized controls developed diarrhea and died with hemorrhagic colitis. Administration of 300 U of antitoxin parenterally either on the day of challenge with clindamycin or 24 hr later provided significant protection (25% mortality vs. 100% mortality in controls, P less than 0.01). None of eight animals given antitoxin (300 U) both on the day of challenge and 24 hr later died. Filtrates prepared from cecal contents of dead or killed hamsters were tested for toxicity by intraperitoneal injection into hamsters and by addition to monolayers of monkey kidney cells. Fecal filtrates from antitoxin-protected animals were not toxic in these assays, but filtrates from control animals were uniformly toxic. Passive immunization against clostridial toxins was protective against clindamycin-associated colitis in this model. This finding further substantiates the importance of these toxins in the pathogenesis of antibiotic-induced colitis.

Animals↗
PubMedDate not supplied

Antibiotic-associated colitis: effects of antibiotics on Clostridium difficile and the disease in hamsters.

Fifteen isolates of Clostridium difficile from hamsters and human patients were inhibited or killed by low concentrations of metronidazole, vancomycin, penicillin, and ampicillin; the isolates were often reesistant to tetracycline, cephalosporins, trimethoprim-sulfamethoxazole, clindamycin, erythromycin, and aminoglycosides. Antibiotics to which C. difficile was susceptible were able to prevent or postpone the colitis caused by clindamycin in hamsters. Colitis could be produced by treatment of hamsters with any one of these antibiotics. Production of colitis not only involved selection of resistant variants, but in some instances seemed to result from the acquisition of organisms after treatment, their persistence despite treatment, or from subinhibitory cecal concentrations of antibiotic (explainable by either pharmacologic factors or enzymatic inactivation). As in humans, no organisms other than C. difficile have been implicated conclusively as etiologic agents of colitis in hamsters. Our results suggest it may be wise to use isolation precautions for patients with colitis caused by C. difficile.

Animals↗