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PubMed1989

Effectiveness and absorption of rectal hydrocortisone acetate foam in nonspecific proctocolitis.

A 3-week open trial of rectal hydrocortisone acetate foam (Colifoam, Stafford Miller, UK) was conducted in 19 patients with active, nonspecific distal proctocolitis. Complete or near complete remission was observed in nine patients (47.4%). Absorption of hydrocortisone acetate from Colifoam was evaluated in 13 patients by measuring early morning serum cortisol before treatment and 12 and 36 h after the final dose. Normal cortisol values were observed in every instance, suggesting that the steroid component of Colifoam was not significantly absorbed. Colifoam seems to be an effective remedy for distal proctocolitis. Its specific advantages include ease of retention and apparent nonabsorption of the active component.

Administration, Rectal↗
PubMed2004

The risk of dysplasia and cancer in the ileal pouch mucosa after restorative proctocolectomy for ulcerative proctocolitis is low: a long-term term follow-up study.

AIM: Some of the rare complications reported in patients with an ileopouch anal anastomosis (IPAA) after coloectomy for chronic ulcerative colitis are dysplasia and carcinoma. The supposed pathway is for the ileal pouch mucosa to go through adaptational changes then is to progress through the phases of chronic pouchitis, dysplasia and subsequently to adenocarcinoma. In many of these studies however, the dysplasia-cancer sequence is inconclusive since the carcinoma might have developed from the ileal mucosa itself or from residual viable rectal mucosa left behind. The purpose of this study was therefore to study the long-term ileal mucosal adaptation patterns and the incidence and grading of dysplasia in the ileal pouch mucosa in patients previously operated on for ulcerative proctocolitis. PATIENTS AND METHODS: Forty-five patients who had been operated on with an IPAA (25 males/20 females), with a median age of 54 years (range 34-76), were invited for clinical examination and pouch endoscopy including mucosal biopsies. The duration of their colitis until surgery was median 6 years (range 1-28) and the time median interval from start of disease until time of follow up 24.8 years (range 17-46). Three independent pathologists from two different centres reviewed sequential mucosal biopsies taken from separate sites of the pouch for dysplasia and mucosal adaptation patterns. RESULTS: The type C pattern with a severe inflammation in lamina propria together with severe atrophy of villi, sometimes with ulceration and granulation tissue, was observed by the two pathologists from one centre in 15 of 45 (33.3%) patients and in 11 (24.4%) of 45 by the third pathologist, respectively. As regards dysplasia one pathologist group evaluated 2/45 (4.4%) cases as low-grade dysplasia while the third pathologist considered one of these cases as indefinite for dysplasia and one as reactive. There was in this respect full agreement between the two centres in 43 (95.6%) of 45 cases. Neither high-grade dysplasia nor invasive carcinoma was diagnosed. CONCLUSION: Dysplastic transformation within the ileal pouch mucosa in patients operated for ulcerative proctocolitis is rare even after a long follow-up. These results are reassuring for both patients and surgeons. There seem to be no solid grounds to support routine surveillance for dysplasia in the ileal pouch mucosa in these patients. The surveillance for neoplastic changes in the remaining muscular/epithelial cuff is a separate issue however.

Adult↗
PubMed1979

Eosinophils in the rectal mucosa. A simple method of predicting the outcome of ulcerative proctocolitis?

One-hundred-and-thirteen rectal biopsies and 17 total colectomy specimens from 50 patients with ulcerative proctocolitis were examined. These patients had been followed for periods up to 220 months, mean 70 months. The histological changes were compared with the clinical features of the disease. Patients with relatively benign disease which responded to treatment had significantly raised eosinophil counts in the mucosa examined, compared with patients who had aggressive disease which failed to respond to medical treatment (P less than 0.001). Tissue eosinophilia in the rectal mucosa may provide a simple method for predicting the clinical course of patients with ulcerative proctocolitis.

Adult↗
PubMed1988

Polymorphonuclear leucocytes in Crohn's disease and ulcerative proctocolitis: association between enhanced adherence to nylon fibre and disease variables.

The adherence of polymorphonuclear leucocytes (PMN) to nylon fibre was investigated in patients with Crohn's disease, ulcerative proctocolitis, and anorexia nervosa, and compared with changes of circulating PMNs, C reactive protein concentrations, erythrocyte sedimentation rates, and clinical assessment of disease activity. PMN adherence was in excess of the maximum value detected for healthy subjects in 14 of 25 patients with Crohn's disease and two of 10 with proctocolitis, but it was within the normal range for all eight with anorexia nervosa. High adherence in Crohn's disease, however, was not associated with quantitative or qualitative changes of PMN populations, absolute concentrations of C reactive protein, erythrocyte sedimentation rates, disease severity, drug regimens, malnutrition, or zinc deficiency. High PMN adherence in Crohn's disease may therefore reflect the activation in vivo of normal PMN by humoral factors.

Adolescent↗
PubMed1977

A controlled comparison of corticotropin and hydrocortisone in the treatment of severe proctocolitis.

A randomized controlled trial has been made of corticotropin (ACTH) 80 units given intramuscularly daily and hydrocortisone 400 mg infused intravenously over 24 hours, in the treatment of in-patients with severe proctocolitis. Seven patients were treated with ACTH and nine with hydrocortisone over an initial seven days. Three patients in the ACTH group and six in the hydrocortisone group improved and were discharged on medical treatment. Four patients treated with ACTH and two with hydrocortisone required urgent colectomy during this admission. Plasma cortisol levels were measured, but there was no correlation between these and the observed therapeutic response. Sideeffects were troublesome in both groups but were more marked in those treated with hydrocortisone. It is concluded that ACTH is not intrinsically superior to hydrocortisone in these doses, in the treatment of severe proctocolitis.

Adrenocorticotropic Hormone↗
PubMed1999

Diagnosis and treatment of sexually acquired proctitis and proctocolitis: an update.

Sexually transmitted gastrointestinal syndromes include proctitis, proctocolitis, and enteritis. These syndromes can be caused by one or multiple pathogens. Routes of sexual transmission and acquisition include unprotected anal intercourse and oral-fecal contact. Evaluation should include appropriate diagnostic procedures such as anoscopy or sigmoidoscopy, stool examination, and culture. When laboratory diagnostic capabilities are sufficient, treatment should be based on specific diagnosis. Empirical therapy for acute proctitis in persons who have recently practiced receptive anal intercourse should be chosen to treat Neisseria gonorrhoeae and Chlamydia trachomatis infections. In individuals infected with human immunodeficiency virus (HIV), other infections that are not usually sexually acquired may occur, and recurrent herpes simplex virus infections are common. The approach to gastrointestinal syndromes among HIV-infected patients, therefore, can be more comprehensive and will not be discussed in this article.

Humans↗
PubMed2000

Food-induced eosinophilic proctocolitis.

Food-induced eosinophilic proctocolitis appears in the first 2 months of life with blood-tinged stools. Aside from occasional apparent pain on defecation and a few infants with moderate eczema, systemic features are absent. Indeed, aside from the diaper, the infant is generally described as well. Thus, in contrast to the infant with enterocolitis, features such as emesis, failure to thrive, significant anemia, and dramatic diarrhea are not seen. In contrast to infants with the other food-induced inflammatory diseases of the bowel, most symptomatic infants are exclusively breast fed. Proctoscopic examination reveals focal erythema, erosions, and/or the nodularity of lymphoid nodular hyperplasia of the rectosigmoid. Biopsies of the rectum and lower sigmoid reveal a characteristic infiltration of the mucosa and lamina propria with eosinophils, usually in excess of 6 to 10 per high powered field. Elimination of the offending protein from the diet of the infant, through use of an extensively hydrolyzed casein-based formula or the elimination of the protein from the diet of the mother of the breast-feeding infant, leads to clinical resolution of the bleeding within 72 to 96 hours. By 1 year of age the infants routinely tolerate an unrestricted diet, and the long term prognosis is excellent.

Biopsy↗
PubMed1976

Blood pH: a test for assessment of severity in proctocolitis.

Acid base balance was studied in 58 patients with active idiopathic proctocolitis; the condition of 10 of them was complicated by toxic megacolon. Arterial blood pH increased progressively with increased severity of the colitis and as the lesions became more widespread. Statistically significant differences were observed in pH values between the mild/moderate and severe forms and between the severe and complicated forms ('toxic megacolon'). A linear correlation was found between pH and the amount of intestinal gas, pulse rate, and plasma albumin.

Carbon Dioxide↗
PubMedDate not supplied

[Idiopathic proctocolitis. Follow-up (1-13 years) of 71 patients].

Follow-up was possible in 71 of 74 patients with idiopathic proctocolitis diagnosed and/or assisted at the Department of Gastroenterology of the Centro Policínico de Almada, between 1973 and 1985. The aim of the present study was to verify the natural history of the disease and if there were statistically significant differences depending on the extension of the disease (proctitis versus colitis). Complications were present in 22 patients (31%): peri-anal (10%), local or intestinal (24%) and extra-intestinal (28%). Fifteen patients (21% of the cases) had hospital admission at least once, and 2 of them (3%) were submitted to surgery. No cases of cancer of the colon and rectum were detected and mortality was nil. Forty-one patients (58%) were assymptomatic at the last observation (45% with colitis and 75% with proctitis). There were statistically significant differences between the group of patients with ulcerative colitis and that of proctitis concerning the total number of complications (p less than 0.001), local complications (p less than 0.01), extra-intestinal complications (p less than 0.05), need for hospital admission (p less than 0.001) and absence of symptoms at the time of last observation (p less than 0.05), thus confirming a better prognosis of the disease when only the rectum is involved.

Adult↗
PubMed1990

[Late results of ileorectal anastomosis in proctocolitis].

In 1961-1986 at the Surgical Clinic of the Institute for Postgraduate Medicine in Prague 49 colectomies were performed with ileorectal anastomosis. The operations were usually made in several stages. The remote results were evaluated after an interval of 10 to 26 years in 33 patients and were good to satisfactory in 82%. Malignant degeneration in the rectum was not observed. The relatively favourable results can be ascribed to careful selection of patients and frequently also the multi-stage procedure. Ileorectal anastomoses are still justified in the surgical treatment of proctocolitis.

Adolescent↗
PubMed1987

[Radiation proctocolitis following gynecologic radiotherapy: an endoscopic study].

The prevalence of radiation injuries was assessed in 155 of 206 surviving patients who had had radiation therapy for carcinoma of the uterus or vagina. The patients were examined according to a standardized protocol. 51 (32.9%) exhibited endoscopic proctitis, and in 10 of them sigmoid colon was also affected. The prevalence of colitis was 31 of 66 (47%) in patients treated for carcinoma of cervix and 19 of 86 (47%) in those treated for carcinoma of corpus. 41 (80.4%) had clinical symptoms (bleeding and diarrhea in 53% each). The mean time lag between radiation therapy and beginning of symptoms was 9 months. Histology was positive in only 24 (47.1%) of 51 endoscopically documented cases of proctocolitis. There was no increase in the prevalence of radiation injury after previous surgery of any kind. Nor was higher risk found in patients with hypertension, diabetes, or congestive heart failure. However, patients with low body mass were at increased risk (p less than 0.01). There was a dose-response relationship between total dose and endoscopic proctitis (p less than 0.001). The incidence was 0% below 40 Gy, 20% at 60 Gy and 50% at 90 Gy.

Adult↗
PubMed1982

Sudden reversal of renal failure after take-down of a jejunoileal bypass. Report of a case involving hemorrhagic proctocolitis, and renal and hepatic failure late after jejunoileal bypass for obesity.

Hepatic and renal failure developed in association with severe enteritis and hemorrhagic proctocolitis in a patient who had had a jejunoileal bypass 8 yr previously for morbid obesity. Parenteral antibiotic treatment abolished the systemic manifestations of the enteritis, but did not change the course of the hepatic and renal failure, and prolonged hemodialysis was necessary. Liver function improved in response to hyperalimentation. Take-down of the jejunoileal bypass resulted in immediate improvement of renal function, and hemodialysis could be discontinued. Although there is no direct evidence supporting this theory, the course of this patient suggested that the renal failure was functional in origin, and was caused by a toxin generated as a result of the intestinal bypass. We suspect that the toxin originated from bacteria within the blind bowel loop. Its delivery to the renal circulation was probably facilitated by increased absorption from the ulcerated large intestine and by impaired clearance by the diseased liver. When the bacterial flora were returned toward normal by take-down of the bypassed intestine, the quantity of circulating toxins probably decreased, which allowed renal function to improve.

Acute Kidney Injury↗
PubMed1983

Nonspecific proctocolitis in northeastern Scotland: a community study.

An extensive retrospective survey of patients with onset of symptoms of nonspecific protocolitis arising in the decade 1967-1976 was carried out in northeastern Scotland, including the Grampian region, Orkney, and Shetland. Five hundred and thirty-seven cases were identified, and a 97% follow-up was achieved. One hundred and twenty nonhospitalized cases were included. The average annual incidence was 11.3 per 10(5) population, the highest recorded in Europe to date. Moreover, a striking rise in the incidence was noted. A bimodal age distribution and urban predominance was found. The frequency of both nonspecific proctocolitis and Crohn's disease in first-degree relatives was high. The disease was found to be less severe and extensive at onset than suggested by other surveys, 70% having only distal involvement and 68% having a mild first attack. The overall mortality and surgical resection rates in the first attack were both 3%. Severe first attacks carried a striking 23% mortality. The observed long-term mortality differed little from the expected, except in patients with extensive disease or severe first attacks, or both. The risk of relapse correlated with decreasing age at onset but not with the initial extent or severity of disease. The surgical resection rate after 5 yr was 8%. Twelve percent of patients extended their disease by 5 yr. Using the patient-year concept, 68% of patient years were remission years. The youngest age group had the highest percentage of attack years. The percentage of attack years for all patients correlated more closely with extent of disease in each patient year rather than extent of disease at diagnosis.

Adolescent↗
PubMed1994

[Activity of the antioxidant system in patients with idiopathic proctocolitis and the effect of 5-aminosalicylic acid (Salofalk)].

There is a close relationship between inflammation and reactive oxygen species (ROS). Primary source of ROS are activated leucocytes. Antioxidant system protects organism against the deleterious effect of ROS. The aim of the present study was to follow the activity of antioxidant system in blood and colonic mucosa of 17 patients with idiopathic proctocolitis. All patients were treated with 5-aminosalicylic acid (Salofalk), 7 patients with a combination of prednison. The following biochemical parameters were ascertained: malondialdehyde (MDA) and ceruloplasmin in serum, glutathione (GSH) and activities of superoxide dismutase, catalase and glutathione peroxidase in erythrocytes and colonic mucosa. Before treatment there was found: an increase of MDA and all antioxidant enzyme activities, an a decrease of GSH. After 3 weeks of therapy in 59% of patients, initial clinical remission was observed without serious improvement of biochemical parameters. After 10 weeks of therapy the clinical course improved in all patients, a significant decrease of MDA and activities of all antioxidant enzymes as well as an increase of GSH were stated. The authors assume that IP was positively affected by 5-ASA, and in some patients by its combination with prednisom. The effect of 5-ASA is based on its known antiinflammatory impact and its functioning as a "scavanger" of free radicals (or ROS). (Tab. 1, Fig. 3, Ref. 23.)

Adult↗
PubMed1987

Mucosal proctectomy and colo-anal anastomosis for distal ulcerative proctocolitis.

Four patients with long-standing symptomatic ulcerative colitis confined to the left colon and rectum were treated by resection, mucosal proctectomy and colo-anal sleeve anastomosis. There was no operative mortality or anastomotic leakage. Follow-up has ranged from 12 to 66 months (mean 52 months). Loose bowel motions with urgency and frequency of defaecation were troublesome postoperative symptoms. Recurrence of the colitis in the neorectum with extension into the proximal colon occurred in all patients within 3 to 11 months (mean 6 months) of operation. This necessitated total proctocolectomy with ileostomy in three patients (mean 18 months postoperatively). In the fourth patient the recurrence is medically controlled without a stoma more than 5 years after operation. This operation is unsuitable for the treatment of segmental ulcerative proctocolitis.

Adult↗
PubMed1975

Carcinoembryonic antigen in patients suffering from ulcerative proctocolitis.

Carcinoembryonic antigen (CEA) has been measured by radioimmunoassay in samples obtained from all patients suffering from ulcerative proctocolitis and seen within a four-month period. The characteristics of this group of patients have been compared with reported epidemiological studies in this disease, and have been found to have a similar sex ratio and age of onset, but a more limited disease. Among 59 patients, 11 were found to have elevated circulating CEA values. One of the 11 had a colonic carcinoma and another was pregnant. Excluding these two patients, an overall prevalence of elevated CEA levels of 17.5% was found. The prevelance in ulcerative proctitis was 7.1%, and in colitis was 19.9%. The patients in whom elelvated plasma CEA values were found were compared with the remaining patients in relation to factors known to be associated with an increased propensity for the development of colorectal carcinoma complicating ulcerative colitis. There was no difference in mean age of the patients at disease onset, nor was there any difference in disease duration, extent, and control. A significant correlation was found between elevated plasma CEA levels and the severity of the initial attack. One patient with premalignant changes in the rectal mucosa had consistently normal concentrations of plasma CEA. There was no significant correlation between elevated plasma CEA values and disease activity. The mean age of the two groups of patients was similar. No carcinoma has manifested in any patient during follow-up periods of at least 18 months.

Adult↗
PubMed1975

Double-blind comparison of the effectiveness of azathioprine and sulfasalazine in idiopathic proctocolitis. Preliminary report.

A double-blind therapeutic trial of azathioprine in 20 patients with acute proctocolitis was performed over a 3-month period. Azathioprine was compared with sulfasalazine in patients paired and treated in a sequential order. Clinical, laboratory, endoscopic, biopsy, and radiologic data were assessed by semiquantitative criteria. No significant difference in the effect of the drugs was observed. Both azathioprine and sulfasalazine produce significant improvement in clinical symptoms, some laboratory findings (ESR, serum iron), and endoscopic and biopsy findings (P smaller than 0.05). Radiologic improvement was less evident (P smaller than 0.10). On the overall final evaluation of the trial, 14 patients were improved, and 6 remained stationary or worsened (P smaller than 0.10). This short-term trial confirms previous uncontrolled experiences of one of the authors on larger series of patients.

Acute Disease↗