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PubMed1998

Familial predisposition for colorectal cancer in chronic ulcerative colitis: a case-control study.

BACKGROUND & AIMS: Familial predisposition as a risk for colorectal cancer in ulcerative colitis has not been rigorously explored. The aim of this study was to compare colorectal cancer frequency among kindreds of patients who had ulcerative colitis and colorectal cancer with that of control patients who had ulcerative colitis but no cancer. METHODS: Questionnaires were mailed to subjects to assess cancer occurrence among relatives. Eligible cases included 174 ulcerative colitis patients with colorectal cancer seen at Mayo Clinic in 1976-1994; 174 contemporaneous ulcerative colitis controls without cancer were matched on birth year, sex, and extent and duration of colitis. RESULTS: The responding 147 case and 150 control subjects reported on 1044 and 1090 first-degree relatives, respectively. Colorectal cancer occurred in 14.3% case kindreds and 6.7% control kindreds (P = 0.03). By logistic regression, a family history of sporadic colorectal cancer was an independent risk factor for cancer in ulcerative colitis (odds ratio, 2.33; 95% confidence interval, 1.06-5.14; P = 0.03). CONCLUSIONS: A familial association exists between colorectal cancers occurring with ulcerative colitis and those in the general population. Colorectal cancer in persons with ulcerative colitis represents a risk factor for colorectal cancer in their noncolitic relatives. Likewise, a family history of sporadic colorectal cancer increases the risk of colorectal cancer with ulcerative colitis.

Adult↗
PubMed2002

Collagenous and lymphocytic colitis in Iceland.

The aim of this study was to determine the nationwide incidence of collagenous and lymphocytic colitis in Iceland and the location of histopathological changes in the large bowel. All pathology reports of patients diagnosed with or suspected of having collagenous colitis or lymphocytic colitis in the period 1995-1999 were identified. All pathology samples were reevaluated using strict diagnostic criteria. After reevaluation 125 patients fulfilled our diagnostic criteria, 71 as collagenous colitis and 54 as lymphocytic colitis. The mean annual incidence for collagenous colitis was 5.2/100,000 inhabitants, and the mean age at diagnosis was 66.1 years. The mean annual incidence for lymphocytic colitis was 4.0/100,000 inhabitants, the mean age at diagnosis was 68.7 years. Both diseases more commonly involved the colon than the rectum. The incidence of collagenous colitis and lymphocytic colitis is high in Iceland. The mean annual incidence of collagenous colitis is much higher in Iceland than hitherto reported elsewhere.

Adult↗
PubMed1998

Colitis and colon cancer in cotton-top tamarins (Saguinus oedipus oedipus) living wild in their natural habitat.

The cotton-top tamarin is a nonhuman primate noted for susceptibility to juvenile onset colitis and subsequent colon cancer. About 80% develop colitis in captive environments outside the tropics. The aim was to determine the prevalence of colitis and colorectal cancer in tamarins living wild in their tropical habitat. Endoscopic biopsy was used to compare severity of colitis, inflammatory/immune cell densities, mucosal dysplasia, and occurrence of cancer in wild tamarins in a tropical habitat with tamarins living captive in a temperate climate. Six colon biopsies from each of 69 captives showed severe colitis in 64.5% of biopsies and moderate colitis in 19.5%. Severe colitis was not found in 88 wild tamarins; 13% had moderate colitis. Densities of polymorphonuclear leukocytes, plasma cells, and mononuclear cells in the lamina propria were related directly to the severity of four grades of colitis (normal, mild, moderate, and severe). Histologic or gross signs of carcinoma were detected in 12 captives and low- or high-grade dysplasia in 15. Neither cancer nor dysplasia was found in any of the wild tamarins. The observations suggest that colitis and cancer in the tamarin model are linked to environmental factors.

Animals↗
PubMed1996

Polyunsaturated phosphatidylcholine prevents stricture formation in a rat model of colitis.

BACKGROUND & AIMS: Polyunsaturated phosphatidylcholine stimulates collagen breakdown in experimental models of liver cirrhosis. Bowel strictures are characterized by excess deposition of collagen in the intestinal wall. The aim of this study was to investigate the effect of polyunsaturated phosphatidylcholine in the prevention of bowel strictures. METHODS: Colitis was induced by trinitrobenzenesulfonic acid. On day 21, the presence of strictures was assessed in control rats, rats with colitis, and phosphatidylcholine-fed (100 mg/day) rats with colitis. Furthermore, serum transforming growth factor beta1, collagen deposition, and collagenase activity in colonic tissue were measured in all groups. RESULTS: None of the control rats but 12 of 16 rats with colitis developed colonic strictures. In contrast, only 2 of 15 phosphatidylcholine-fed rats with colitis showed strictures. Collagen content was much higher in rats with colitis than in phosphatidylcholine-fed rats with colitis and control rats. Phosphatidylcholine-fed rats showed significantly higher collagenase activity in colonic tissue than rats with colitis and control rats. In an ancillary study, free linoleic acid-fed rats showed no differences when compared with rats with colitis. Stimulation of transforming growth factor beta1 was similar in all rats with colitis. CONCLUSIONS: Oral supplementation with polyunsaturated phosphatidylcholine prevents the accumulation of collagen in inflamed intestinal tissue and the formation of strictures. This effect is associated with an enhanced collagen catabolism.

Analysis of Variance↗
PubMed2002

Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis.

BACKGROUND: Published data on the risk of colorectal neoplasia in patients with ulcerative colitis with and without primary sclerosing cholangitis are conflicting. A meta-analysis was performed to synthesize available publications and to compare the risk of colorectal neoplasia in patients with ulcerative colitis with and without primary sclerosing cholangitis. METHODS: By using MEDLINE and manual search methods, studies were identified that compared the risk of colorectal neoplasia (dysplasia and carcinoma) in patients with ulcerative colitis with and without primary sclerosing cholangitis. In addition, citations were reviewed in relevant articles and proceedings from gastroenterology meetings, and investigators were contacted when data were incomplete. The summary odds ratio (OR) was then calculated for the risk for patients with ulcerative colitis and primary sclerosing cholangitis of having colorectal neoplasia develop compared with that of patients with ulcerative colitis without primary sclerosing cholangitis. RESULTS: Eleven studies met all eligibility criteria for the meta-analysis. Patients with ulcerative colitis and primary sclerosing cholangitis are at increased risk of colorectal dysplasia and carcinoma compared with patients with ulcerative colitis alone; OR 4.79: 95% CI [3.58, 6.41] with the Mantel-Haenszel method, and OR 5.11: 95% CI [3.15, 8.29] with the Der Simonian and Laird method. This increased risk is present even when the risk of colorectal carcinoma alone is considered; OR 4.09: 95% CI [2.89, 5.76] and OR 4.26: 95% CI [2.80, 6.48] by using, respectively, the Mantel-Haenszel and the Der Simonian and Laird methods. CONCLUSIONS: Patients with ulcerative colitis and primary sclerosing cholangitis have a significantly higher risk for the development of colorectal neoplasia than patients with ulcerative colitis but not primary sclerosing cholangitis. More intensive colonoscopic surveillance should be considered for patients with ulcerative colitis and primary sclerosing cholangitis.

Cholangitis, Sclerosing↗
PubMed1999

Biopsy diagnosis of colitis: possibilities and pitfalls.

The histopathologic diagnosis of inflammation is common in colorectal biopsies but is of limited value, if not further specified. We reviewed 280 endoscopic colorectal biopsy specimens for nonneoplastic disease from 100 consecutive patients in order to assess (a) the frequency of inflammation in excess of the physiologic infiltrate, (b) the frequency with which the cause of the inflammation could be specified, and (c) the interobserver variability in diagnosing inflammation. Based on the reviewers' impression, each case was classified into one of three categories: (I) normal or nonspecific change, (II) nonspecific inflammation, and (III) inflammation suggestive or diagnostic of specific cause. Inflammation was diagnosed in 68% of cases. The majority of these cases (75%) showed features typically associated with specific types of colitis, including Crohn's disease (n = 16), ulcerative colitis (n = 13), inflammatory bowel disease not otherwise specified (n = 5), infectious colitis (n = 6), ischemic colitis (n = 4), solitary rectal ulcer syndrome (n = 3), radiation colitis (n = 2), and lymphocytic colitis (n = 2). Interobserver variability was greatest in biopsy specimens interpreted by the reviewers as normal or showing nonspecific changes, most of which had been diagnosed as mild inflammation by the original pathologists. Etiologic classification of colitis was lacking in 59% of the cases interpreted by the reviewers as suggestive or diagnostic of a specific cause. We conclude that (a) the majority of colorectal biopsy specimens from patients with nonneoplastic disease in this series show inflammation, (b) the majority of such cases allow a specific cause of colitis to be suggested or firmly diagnosed, and (c) pathologists tend to overdiagnose the physiologic inflammatory infiltrate as evidence of colitis and underdiagnose specific etiologic types of colitis.

Adult↗
PubMed1991

The plain abdominal film accurately estimates extent of active ulcerative colitis.

The aim of our study was to establish whether plain abdominal film can accurately assess the extent of active ulcerative colitis. Ninety-seven ulcerative colitis patients were studied, in whom the extent of the macroscopic lesion was established either by colonoscopy (n = 75) or by resection (n = 22). Of these, 42 had proctosigmoiditis, 12 left-sided colitis, 12 subtotal colitis, and 31 total colitis. Nine well-tested features were used for the radiological classification of lesion extent. The radiologists were not given any clinical information. Seventy-eight patients (80.4%) were correctly classified by plain abdominal film (r = 0.86); the best concordance was achieved for proctosigmoiditis and total colitis (80.9 and 90.3%, respectively). In total colitis the most reliable radiological features were "irregularity of the mucosal edge" and "increased thickness of the colon wall, " which were present in 74.2 and 67.7%, respectively, of the correctly classified patients. The fourfold combination of these two features with "loss of haustral clefts" and "empty right colon" was present only in patients with total colitis, and at least one of these features was present in all but one of them. Conversely, all nine abnormalities were absent in 73.8% of patients with proctosigmoiditis. In conclusion, plain abdominal film is a reliable tool for judging the extent of lesion in active ulcerative colitis. It seems particularly accurate in total colitis, where, in the acute phases, it is most important to avoid invasive examinations.

Adult↗
PubMed1998

Antineutrophil cytoplasmic antibody subtypes in children and adolescents after ileal pouch-anal anastomosis for ulcerative colitis.

BACKGROUND: Perinuclear antineutrophil cytoplasmic antibodies occur frequently in adult patients with chronic pouchitis after colectomy and ileal pouch-anal anastomosis for ulcerative colitis. The purpose of the study was to determine the prevalence of perinuclear antineutrophil cytoplasmic antibodies and cytoplasmic antineutrophil cytoplasmic antibody in children and adolescents who undergo colectomy and ileal pouch-anal anastomosis for ulcerative colitis and familial adenomatous polyposis. METHODS: Five groups of children and adolescents (age, <20 years) were studied, with the following histories: acute pouchitis and history of ulcerative colitis; chronic pouchitis and history of ulcerative colitis; pouchitis with Crohn's disease features and a history of ulcerative colitis; no pouchitis and a history of ulcerative colitis; and familial adenomatous polyposis, with or without pouchitis. Antineutrophil cytoplasmic antibody levels and titers were detected in postoperative sera by enzyme-linked immunosorbent assay, and positive results were subtyped by indirect immunofluorescence. RESULTS: The frequency of perinuclear antineutrophil cytoplasmic antibodies and cytoplasmic antineutrophil cytoplasmic antibody in patients with a history of ulcerative colitis were 67% and 15%, compared with a 0% presence in patients with familial adenomatous polyposis (p < 0.001). There was no significant correlation between the frequency of perinuclear antineutrophil cytoplasmic antibodies and ulcerative colitis patient subgroups (patients with and without pouchitis, 66% and 75%). Similarly, there was no significant correlation between the frequency of cytoplasmic antineutrophil cytoplasmic antibodies among ulcerative colitis patient subgroups (patients with and without pouchitis, 19% and 8%). The frequency of cytoplasmic antineutrophil cytoplasmic antibody in patients with Crohn's disease features (50%), was increased, but this difference was not significant. CONCLUSIONS: There is a high frequency of perinuclear antineutrophil cytoplasmic antibodies in children and adolescents who undergo ileal pouch-anal anastomosis for ulcerative colitis, whether or not they have pouchitis. The frequency of cytoplasmic antineutrophil cytoplasmic antibody is lower in this patient population. Additional studies will be required to determine whether the presence of cytoplasmic antineutrophil cytoplasmic antibody is associated with the postoperative development of features of Crohn's disease.

Adenomatous Polyposis Coli↗
PubMed2003

Gross versus microscopic pancolitis and the occurrence of neoplasia in ulcerative colitis.

OBJECTIVE: The gross extent of ulcerative colitis (UC) is a recognized risk factor for the development of colitis-related dysplasia and colorectal cancer (CRC). The risk of neoplasia associated with the microscopic extent of colitis is unknown. The aim of this study was to describe the gross and microscopic extent of colitis in patients with UC-related dysplasia/CRC. METHODS: All patients who underwent colectomy at our institution between 1992-2001 with colitis-related dysplasia/CRC were identified. Histological sections from each colectomy specimen were reviewed for the microscopic extent of colitis and the location of all lesions with dysplasia/CRC. RESULTS: Thirty-six patients with colitis-related dysplasia/CRC were identified of whom 30 had slides available for review. Gross pancolitis was identified in 19 patients, though microscopic pancolitis was evident in all 30 patients. Among the 11 patients with only distal gross colitis, 4/15 neoplastic lesions were proximal to the area of gross involvement. CONCLUSIONS: UC-related neoplasia can occur in areas of the colon not grossly involved with colitis, though it did not occur in any patients without microscopic pancolitis. To devise rational cancer surveillance guidelines, further studies are needed to determine the risk of colitis-related neoplasia in patients with microscopic pancolitis but limited gross disease.

Adolescent↗
PubMed2004

Does appendectomy reduce the risk of ulcerative colitis?

BACKGROUND: Persons who have had an appendectomy are less prone to develop ulcerative colitis than those who have not. The underlying mechanism and the clinical use of this finding are unknown. METHODS: Two competing hypotheses were examined: (1) the inverse association between appendectomy and ulcerative colitis is conferred by a mutual determinant such as genes, and (2) the appendix itself has biologic effects that promote the development of ulcerative colitis. We performed a population-based cohort study of all 234,559 persons who had an appendectomy performed in Denmark 1977 through 1999. We used a bidirectional cohort design, calculating the standardized incidence rate of ulcerative colitis both before and after the appendectomy. If the hypothesis of a constant, confounding factor were true, incidence rates of ulcerative colitis would be equal before and after appendectomy. If the incidence of ulcerative colitis were lower after appendectomy than before, it would support the second hypothesis and a true protective effect of the appendectomy. We controlled confounding by age and sex using direct standardization. RESULTS: Of 234,559 persons who had an appendectomy, 559 developed ulcerative colitis during a mean follow up of 17.5 years. The standardized incidence rate of ulcerative colitis was lower in the postappendectomy period than in the preappendectomy period (incidence rate ratio = 0.74; 95% confidence interval = 0.62-0.88). CONCLUSIONS: The inverse association between appendectomy and ulcerative colitis is not explained by time-stable factors such as genes. Appendectomy might have a genuine protective effect toward development of ulcerative colitis.

Adolescent↗
PubMed2004

Adenomatous colonic polyps are rare in ulcerative colitis.

BACKGROUND: Uncertainty exists as to whether dysplastic polyps in ulcerative colitis should always be managed as dysplasia-associated lesions/masses requiring colectomy, or whether some can be managed by polypectomy. The prevalence of non-inflammatory polyps in ulcerative colitis is unknown. AIM: To compare dysplastic polyp occurrence in patients with ulcerative colitis and in patients without inflammatory bowel disease. METHODS: The clinical, endoscopic and histological records of 150 ulcerative colitis patients (median disease duration, 10 years; 57% with pancolitis) undergoing colonoscopy were scrutinized for any polyp history. Two hundred and five patients undergoing colonoscopy for altered bowel habit, but without features suggestive of polyp presence, were used as a control group. Immunohistochemical staining of flat and polypoid mucosa for p16, beta-catenin, p53 and cyclo-oxygenase-2 was compared in the two groups. RESULTS: Only six (4%) ulcerative colitis patients had ever had dysplastic polyps. Two had single adenomatous polyps proximal to the colitis segment. Of the four patients with dysplastic polyps within colitic mucosa, two were treated endoscopically, but in two the lesions were considered to be dysplasia-associated lesions/masses and colectomy was advised. In contrast, 24 controls had at least one adenomatous polyp (chi(2) = 6.7, P < 0.01). Ten (6.7%) ulcerative colitis patients and 24 (12%) control patients had metaplastic polyps (N.S.). Immunohistochemical staining was not discriminatory. CONCLUSION: Despite the increased cancer risk in long-standing ulcerative colitis, adenomatous polyps arise less frequently in ulcerative colitis patients than in patients without ulcerative colitis.

Adenomatous Polyposis Coli↗
PubMed2005

Oral methotrexate in ulcerative colitis.

BACKGROUND: We performed an audit of methotrexate for ulcerative colitis, because efficacy is unclear. Aim : To investigate the role of methotrexate in the management of ulcerative colitis. METHODS: Patients with ulcerative colitis treated with oral methotrexate at the inflammatory bowel disease clinics of Oxford and Wycombe General Hospital, UK, were evaluated. Efficacy was defined by remission (complete steroid withdrawal for >3 months) and response (good, partial or nil, proportionate reduction of steroids). RESULTS: There were 50 patients (42 ulcerative colitis alone; eight had rheumatoid arthritis associated with ulcerative colitis and were analysed separately). Indications for methotrexate in ulcerative colitis alone were azathioprine intolerance (31 of 42) and lack of benefit from azathioprine (11 of 42). The mean dose of methotrexate in ulcerative colitis alone was 19.9 mg/week for a median of 30 weeks (range: 7-395). Remission occurred in 42%. The response was good in 54% and partial in 18%. Side-effects occurred in 23%; 10% stopped treatment because of side-effects. Of those treated with methotrexate because of treatment failure with azathioprine, three of 11 achieved remission, but four came to colectomy within 90 days of starting methotrexate. The colitis remained in remission in seven of eight of those with RA treated with methotrexate and ulcerative colitis (mean dose 15.0 mg/week). CONCLUSION: Oral methotrexate (approximately 20 mg/week) is well-tolerated and moderately effective in steroid-dependent or steroid-refractory patients with ulcerative colitis.

Adolescent↗
PubMed1999

Exposure to risk factors for ulcerative colitis occurs during an early period of life.

OBJECTIVE: It has been speculated that environmental factors play a role in the etiology of ulcerative colitis. A previous analysis revealed that the time trends of ulcerative colitis in England were shaped by an underlying birth-cohort pattern. We undertook this study to test whether the birth-cohort pattern was a unique feature of the English vital statistics or whether a similar phenomenon could also be ascertained in the mortality statistics from a different country, such as Switzerland. Besides comparing the data of ulcerative colitis from Switzerland and England, the trends of ulcerative colitis were compared with those of gastric and duodenal ulcer. METHODS: Death rates from ulcerative colitis, gastric ulcer, and duodenal ulcer were plotted against the period of death and period of birth. An age-standardized cohort mortality ratio was calculated as a summary statistic of the overall mortality associated with each consecutive birth-cohort. RESULTS: Mortality from ulcerative colitis increased among successive generations born throughout the 19th century. It peaked in individuals born around 1890 and has declined since then. Strikingly similar patterns were found in Switzerland and England. The birth-cohort pattern underlying the time trends of ulcerative colitis applied equally to the data for women and men. In comparison with peptic ulcer, the birth-cohort pattern of ulcerative colitis was almost identical to that of duodenal ulcer. It peaked in both countries 10-20 yr later than gastric ulcer. CONCLUSIONS: The birth-cohort pattern indicates that acquisition of ulcerative colitis is strongly influenced by environmental risk factors and that the exposure to these factors occurs during an early period of life. The similarity in the birth-cohort patterns of duodenal ulcer and ulcerative colitis could hint at a childhood infection or a related mode of transmission in both diseases.

Adult↗
PubMed2003

The colon single-stripe sign and its relationship to ischemic colitis.

OBJECTIVES: Endoscopic findings may assist in the clinical diagnosis of ischemic colitis but have not been systematically characterized. We noted that a single linear colonic ulcer could on occasion be found endoscopically after hypotension and proceeded to investigate its relationship to ischemic colitis. METHODS: Twenty-six patients (19 female and seven male, mean age 71 yr) with endoscopic evidence of a single linear ulcer running along the longitudinal axis of the colon (colon single-stripe sign (CSSS) were retrospectively studied. Colitis etiologies were determined in the CSSS patients and in 58 consecutive patients without a stripe forming a colitis comparison group; clinical course and outcome in CSSS patients subsequently were compared with those in 22 patients with circumferentially involved ischemic colitis. RESULTS: The CSSS was >/=5 cm in length in all instances and isolated to a segment of the left colon in 89%. Evidence of a preceding ischemic event was noted significantly more often in the CSSS (62%) patients than in the colitis comparison group (7%) (p < 0.0001). On blinded histopathological examination, 75% of CSSS cases had microscopic evidence of ischemic injury compared with 13% in the colitis comparison group (p < 0.0001). None of the CSSS patients required surgical intervention, whereas six (27%) patients from the circumferential ischemic colitis group underwent exploration (p < 0.05). Nine patients (41%) in the circumferential ischemic colitis group died, whereas there was one death in the CSSS group (4%) (p < 0.05). CONCLUSIONS: Ischemia can manifest endoscopically as the CSSS. This sign seems to characterize milder disease in the clinical spectrum of ischemic colitis.

Aged↗
PubMed2002

Association between anal furunculosis and colitis in the dog: preliminary observations.

Treatment of anal furunculosis in dogs is often unsatisfactory and may be associated with significant recurrence and complications. This may be compounded by the simultaneous presence of colitis in affected animals. Clinical signs associated with colitis and anal furunculosis may be similar, including faecal tenesmus, dyschezia and haematochezia. To examine the incidence of concurrent anal furunculosis and colitis, colonic biopsies were collected from 18 dogs referred for treatment of anal furunculosis. Nine dogs (50 per cent) had a histopathological diagnosis of colitis. Clinical signs more indicative of colitis than anal furunculosis (increased frequency of defecation, mucus in faeces and diarrhoea) were not observed more frequently in dogs with confirmed colitis compared with those with furunculosis alone. Therefore, while an association between colitis and anal furunculosis may exist, clinical signs alone cannot be used as an indicator of the presence of colitis in cases of anal furunculosis. The authors recommend that colonic biopsies should be undertaken in all dogs presented with anal furunculosis. Whether specific treatment of colitis in dogs with histopathological evidence of colitis improves the outcome of treatment for anal furunculosis awaits further study.

Animals↗
PubMed1973

Lymphoblastic response to autologous colon epithelial cells in ulcerative colitis in vitro.

The blastic transformation in vitro of peripheral blood lymphocytes was measured by the 72-hour uptake of tritiated thymidine ((3)H-6-thymidine) in 23 patients with mucosal ulcerative colitis, three patients with acute Crohn's colitis with rectal involvement, and seven normal subjects. The 23 patients with ulcerative colitis were subdivided into three groups, graded according to severity into seven with acute, severe, nine with active, chronic, and seven with quiescent disease. In the control cultures of lymphocytes without any added potential stimulant the uptake of (3)H-6-thymidine in the clinical subgroup of seven patients with acute, severe ulcerative colitis was significantly greater than in seven normal subjects (p<0.01). This contrasted with a reduced uptake of (3)H-6-thymidine by lymphocytes from seven patients with acute severe colitis when compared with seven normal subjects after stimulation with phytohaemagglutinin-P (PHA-P) (p<0.01). In further duplicate cultures of lymphocytes specifically stimulated by an equal number of viable autologous rectal epithelial cells, the uptake of (3)H-6-thymidine was significantly greater in seven patients with acute severe colitis when compared with seven normal subjects (p<0.01). The results in three patients with acute Crohn's colitis with rectal involvement showed no such evidence of lymphocyte sensitivity to autologous rectal epithelial cells and their uptake of (3)H-6-thymidine lay within the normal range.Evidence that the degree of lymphoblastic transformation was related to the clinical severity of ulcerative colitis was provided by the results obtained in the unstimulated and epithelial cell stimulant cultures. The uptake of (3)H-6-thymidine was directly related to the clinical severity of ulcerative colitis in the three subgroups studied. In addition, four of the seven patients with acute severe colitis were studied later in clinical remission. They were then found to have a significantly reduced uptake of (3)H-6-thymidine in response to autologous rectal epithelial cells (p < 0.01).

Acute Disease↗
PubMed1986

Serum autoantibodies, ulcerative colitis and primary sclerosing cholangitis.

The aetiology of primary sclerosing cholangitis is unknown, but it is closely associated with ulcerative colitis. Serum anticolon antibodies, crossreacting with portal tracts, have been reported in patients with ulcerative colitis but no studies have been carried out in primary sclerosing cholangitis. The frequency of serum anticolon antibodies and portal tract antibodies have been measured in 24 patients with primary sclerosing cholangitis and ulcerative colitis; 15 patients with primary sclerosing cholangitis without ulcerative colitis; 77 patients without primary sclerosing cholangitis: 25 patients with Crohn's colitis; 10 patients with primary biliary cirrhosis; 22 patients with extrahepatic biliary obstruction and 20 normal controls. Serum anticolon and portal tract antibodies were detected using immunoperoxidase techniques on normal colon and obstructed human liver. Tissue typing was undertaken using a standard microcytotoxicity technique. The frequency of anticolon antibodies was markedly increased in primary sclerosing cholangitis patients with ulcerative colitis (62.5%) compared with patients with ulcerative colitis (17%) and Crohn's colitis (16%) (chi 2 = 17.9; p less than 0.001). The antibodies were almost entirely of IgG and IgA classes in all groups. Anticolon antibodies were not found in sera from any other group. Sera from eight of 15 patients with primary sclerosing cholangitis, ulcerative colitis and anticolon antibody reacted with portal tracts of human obstructed liver. This reaction was also seen in four of nine patients with ulcerative colitis and primary sclerosing cholangitis and in three of 15 patients with primary sclerosing cholangitis alone. Portal tract antibody was of IgG class and was not present in sera from any other groups. Unlike anticolon antibody, there was a close relationship between HLA-B8 phenotype and the portal tract antibody (p<0.02; chi 2 = 6.04). Absorption studies confirmed that the anticolon antibody is distinct from portal tract antibody.

Autoantibodies↗
PubMed1988

Anorectal contractility under basal conditions and during rectal infusion of saline in ulcerative colitis.

Pressure activity in the rectum and anal canal was measured with a multilumen probe in 29 patients with ulcerative colitis (12 active, 11 quiescent, six studied during both phases) and 18 normal controls under resting conditions and during rectal infusion of saline. Resting motor activity was significantly decreased in patients with active colitis compared with quiescent colitis (p less than 0.005) and normal controls (p less than 0.001). Forty per cent of active colitics showed a featureless record compared with only one patient with quiescent colitis and one normal subject. The volume of saline infused before leakage occurred, and the total volume retained were significantly lower (p less than 0.001) in patients with active and quiescent colitis compared with normal controls. Rectal infusion of saline provoked regular rectal contractions, of significantly higher (p less than 0.05) amplitude in patients with active colitis, than in quiescent colitis or controls. These rectal contractions were associated with simultaneous anal relaxations. During saline infusion, peak and pressures were lower in patients with ulcerative colitis than in normal subjects, but there were no significant differences in relaxation pressures. In normal subjects, the rectal pressures remained below the anal pressures throughout the saline infusion. Peak rectal pressures exceeded the anal relaxation pressures during the last five minutes of saline infusion in patients with ulcerative colitis and throughout the infusion in those patients who complained of incontinence. Results suggest that although the resting rectal motor activity is diminished in patients with ulcerative colitis, luminal distension causes the inflamed rectum to generate abnormally strong contractions that may threaten continence.

Adult↗