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Course and prognosis of idiopathic ulcerative proctosigmoiditis in young patients.

The course and prognosis of idiopathic ulcerative proctosigmoiditis were studied in 85 young patients whose symptoms had begun before the age of 21 (mean age at onset, 16 years), and the results were compared with those in adults with proctosigmoiditis. Data regarding extension of disease, available in 66 patients, allowed us to identify two groups of patients. Presenting symptoms were the same in both groups. In Group I (41 patients, 62%), the disease remained stable or did not extend beyond the descending colon. In Group II (25 patients, 38%), there was evidence of extension to the hepatic flexure or beyond. Extension was unpredictable in individual patients, but generally occurred within 5 years from the onset of symptoms (73%). The clinical course and prognosis were different in each group. In Group I, there were more females, the disease ran a milder course, and there were few complications. In Group II, there were relatively more males, the disease was more active and severe, and a high incidence of intestinal and extraintestinal complications was observed. Fifteen patients, all from Group II, required colectomy. The natural history of proctosigmoiditis in young patients is somewhat different from that in adults, being characterized by a greater tendency to proximal extension (38% vs. 10%). However, when the disease remains confined to the rectosigmoid region (or does not spread beyond the splenic flexure), the course and prognosis are no different than in adults.

Administration, Oral↗
PubMed1987

Topical 5-aminosalicylic acid versus prednisolone in ulcerative proctosigmoiditis. A randomized, double-blind multicenter trial. Danish 5-ASA Group.

The therapeutic efficacy of a slightly acidic, buffered suspension of 1000 mg 5-aminosalicylic acid (Pentasa) was compared with that of 25 mg prednisolone following daily rectal administration to outpatients with mild to moderate proctosigmoiditis. The study was carried out as a randomized, double-blind trial in seven gastroenterological departments. A total of 123 patients were included of whom 114 completed the study (53 5-aminosalicylic acid, 61 prednisolone). The patient population was representative for the disease as it ordinarily appears in medical outpatient clinics. After 14 days, patients in total remission discontinued the treatment, while the rest were treated for another two-week period. Improvement or remission was seen in 77% of the 5-aminosalicylic acid-treated patients and in 72% of the prednisolone-treated patients (P greater than 0.05). More than half the patients requiring prolonged treatment benefited from it, which points to an advantage of extended therapy. Side effects were few and mild. It is concluded that the applied suspension of 5-aminosalicylic acid is at least as efficient as prednisolone for topical treatment of patients with slightly to moderately active proctosigmoiditis.

Administration, Topical↗
PubMed1987

[Sigmoiditis with lower rectal and perirectal development].

Lesions of sigmoiditis do not extend beyond the recto-sigmoid junction and Douglas' pouch. However, in 9 out of 271 patients operated upon for sigmoiditis the lesions invaded the rectum either anteriorly by perforating Douglas' pouch, or around it and posteriorly through the meso-rectum. These cases of "lower" sigmoiditis have several features in common: a long history of infection, frequent haemorrhages and fistulae, pseudo-tumoral lesions, sometimes very large, detectable by rectal palpation. Surgery is indicated only in cases with serious complications, since many technical problems may be encountered. Wide resection of the rectum followed by low-sited anastomosis ensure stable results.

Aged↗
PubMed1986

[Acquired immunologic deficiency syndrome (AIDS) and other sexually transmissible diseases with gastrointestinal manifestations].

Various kinds of gastrointestinal symptoms are seen in connection with AIDS. Furthermore, because of special sexual practices, other sexually transmitted diseases are found, especially in the oral cavity, the oesophagus and the anorectum. Whereas in most of the cases infections can be treated successfully under a strict drug regimen, the treatment of malignant lymphomas or Kaposi's sarcoma is problematic. When the digestive tract is affected by the latter diseases, treatment is normally restricted to symptomatic measures. In the future, gastroenterologists will be faced with the above mentioned problems more frequently.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Colitis cystica profunda: an unusual surgical problem.

Colitis cystica profunda is a rare, benign, non-neoplastic condition which usually presents as a mass in the rectum associated with bloody, mucoid diarrhea. This clinical presentation associated with the microscopic finding of mucus cysts in the submucosa has led to the mistaken diagnosis of adenocarcinoma of the rectum and unnecessarily radical operative procedures. Attention to the completely normal cellular architecture provides the key to the correct diagnosis. Local excision is curative, and there is no propensity to develop malignancy in these patients. Experience with one case is reported, and the medical literature on the subject is reviewed.

Adenocarcinoma↗
PubMed1979

[Double contrast barium enema-colonoscopy. Comparative diagnostic value in 73 patients (author's transl)].

Double contrast barium enema and colonoscopy are great value in the diagnosis of lesions of the colon, especially polyps. This study involved 73 patients. The results were in agreement in 71,2% of cases and disagreed in 23,3%. In 5,5%, colonoscopy was technically inadequate. Classical barium enema remains indicated for the detection of carcinoma or in elderly or bedridden individuals. By contrast, barium enema should be replaced by double contrast study in the aetiological evaluation of rectal bleeding. In our own series, the diagnosis was positive in 92% of cases as long as both the radiological and endoscopic techniques were used.

Adolescent↗
PubMed1988

[Küss' syndrome].

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Chronic Disease↗
PubMed1988

Empirical therapy for the management of acute proctitis in homosexual men.

An effective empirical treatment regimen would provide a more rapid and less expensive approach to the management of homosexual men with acute proctitis. We conducted a randomized trial in 129 homosexual men who presented with acute proctitis, comparing treatment with an empirical regimen (4.8 million U of aqueous penicillin G procaine intramuscularly and 1.0 g of probenecid orally, followed by 100 mg of oral doxycycline twice daily for seven days) with specific therapy for each infection as it was recognized. Therapy with the empirical regimen resulted in more rapid resolution of the symptoms of proctitis, the objective signs of proctitis, and the infecting microorganisms. However, nearly one fourth of the patients, primarily those with unrecognized herpes simplex virus proctitis, did not respond to empirical therapy. We recommend empirical therapy coupled with appropriate pretreatment diagnostic testing for the initial management of acute proctitis in homosexual men with no clinical evidence of acquired immunodeficiency syndrome or AIDS-related complex.

Adolescent↗