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PubMed2004

Blood flow alterations in TNBS-induced colitis: role of endothelin receptors.

OBJECTIVES: The aim of the present study was to investigate the time dependent changes in hemodynamic parameters and to assess the role of endothelin (ET) receptors in trinitrobenzene sulfonic acid (TNBS) induced colitis. MATERIALS: Inferior mesenteric artery (IMA) hemodynamics, myeloperoxidase activity (MPO) and damage scores were measured immediately or 1, 3, 5 and 14 days after colitis. TREATMENTS: Another group of rats received a nonselective ET receptor antagonist bosentan (30 mg/kg/day), ET-A receptor antagonist BQ485 (60 microg/rat/day) or ET-B receptor antagonist BQ788 (60 microg/rat/day) prior to and on the 1st, 2nd and 3rd days after TNBS administration. RESULTS: IMA flow significantly increased at 90 min followed by a substantial decrease through days 1-5. Tissue MPO activity and macroscopic damage score increased on 1st day after the induction of colitis and remained elevated 3, 5 and 14 days following colitis. Treatment with bosentan or ET-A receptor antagonist largely prevented the colitis-induced reduction in blood flow and tissue injury whereas ET-B receptor antagonist did not attenuate tissue injury or reductions in blood flow. CONCLUSIONS: Our results demonstrate that time-dependent abnormalities occur in IMA hemodynamics following TNBS administration. Our findings also indicate that ET-A receptors but not ET-B receptors play an important role in the colonic inflammation following TNBS administration.

Animals↗
PubMed2005

The COX-2 inhibitor, rofecoxib, ameliorates dextran sulphate sodium induced colitis in mice.

OBJECTIVE: We have evaluated the efficacy of the selective cyclo-oxygenase (COX)-2 inhibitor, rofecoxib, for the prevention of experimental colitis. MATERIAL AND METHODS: To induce colitis BALB/c mice received 5% dextran sulphate sodium (DSS) in their drinking water continuously for 7 days. Rofecoxib (2.5-10 mg/kg body weight, p.o.) was administered throughout the treatment period with DSS. Colitis was quantified by a clinical damage score, colon length, weight loss, stool consistency and rectal bleeding. Inflammatory response was assessed by neutrophil infiltration, determined by histology and myeloperoxidase (MPO) activity. Interleukin (IL)-1beta, prostaglandin (PG)E2 and PGD2 levels in colon mucosa and the immunohistochemical expression of COX-1 and -2 were also studied. RESULTS: The COX-2 inhibitor ameliorated severe colitis, reduced the degree of inflammation through reduction of neutrophil infiltration and IL-1beta levels. PGE2, and PGD2 synthesis were significantly reduced in DSS-treated groups. Indeed, treatment with rofecoxib diminished the lost of COX-1 caused by DSS in the crypt epithelium whereas expression of COX-2 remained unaffected. CONCLUSIONS: Rofecoxib is protective in acute DSS-induced colitis, probably by reducing neutrophil infiltration, inhibiting up-regulation of IL-1beta and returning to normal COX-1 expression in the inflamed colonic mucosa.

Animals↗
PubMed2006

[Cerebral vein thrombosis as a complication of a florid ulcerative colitis].

BACKGROUND: Thromboembolic episode, especially cerebral vein thrombosis, is a rare extraintestinal complication of ulcerative colitis. In world literature less than 100 cases are reported. Although the existence of coagulation alterations and fibrinolysis have been suggested, the exact mechanism of hypercoagulability in patients with ulcerative colitis is still unknown. CASE REPORT: The authors report of a 35-year-old female patient with ulcerative colitis, that has existed for several years. She developed strong cephalgias without further neurologic symptoms in an acute attack of her disease. Magnetic resonance imaging led to the diagnosis of an extensive acute cerebral vein thrombosis. Other possible reasons for a coagulopathy were excluded. CONCLUSION: Cerebral vein thrombosis is a rare, but severe complication of ulcerative colitis. Thus, the presence of neurologic symptoms in a patient with known ulcerative colitis should lead to immediate diagnosis and treatment.

Adult↗
PubMed2004

5-Aminoisoquinolinone reduces colon injury by experimental colitis.

Poly (ADP-ribose) polymerase (PARP), a nuclear enzyme activated by strand breaks in DNA, plays an important role in the colon injury associated with experimental colitis. The aim of the present study was to examine the effects of 5-aminoisoquinolinone (5-AIQ), a novel and potent inhibitor of PARP activity, in the development of experimental colitis. To address this question, we used an experimental model of colitis, induced by dinitrobenzene sulfonic acid (DNBS). Compared with DNBS-treated mice, mice treated with 5-AIQ (3 mg/kg i.p.) or 3-aminobenzamide (3-AB; 10 mg/kg i.p. twice a day) and subjected to DNBS-induced colitis experienced a significantly lower rate in the extent and severity of the histological signs of colon injury. DNBS-treated mice experienced diarrhea and weight loss. Four days after administration of DNBS, the mucosa of the colon exhibited large areas of necrosis. Neutrophil infiltration (determined by histology as well as an increase in myeloperoxidase [MPO] activity in the mucosa) was associated with an up-regulation of intercellular adhesion molecule-1 (ICAM-1). Immunohistochemistry for PAR showed an intense staining in the inflamed colon. On the contrary, the treatment of DNBS-treated mice with 5-AIQ or with 3-AB significantly reduced the degree of hemorrhagic diarrhea and weight loss caused by administration of DNBS. 5-AIQ also caused a substantial reduction in the degree of colon injury, in the rise in MPO activity (mucosa), in the increase in staining (immunohistochemistry) for PAR, as well as in the up-regulation of ICAM-1 caused by DNBS in the colon. Thus, 5-AIQ treatment reduces the degree of colitis caused by DNBS. We propose that 5-AIQ treatment may be useful in the treatment of inflammatory bowel disease.

Animals↗
PubMed2005

Serum antibodies to EpCAM in healthy donors but not ulcerative colitis patients.

PURPOSE: The gastrointestinal carcinoma-associated antigen epithelial cell adhesion molecule (EpCAM) has been a target for passive and active immunotherapy of gastrointestinal carcinoma patients. The antigen is expressed by both tumor and normal tissues. The immunogenicity of EpCAM in colorectal cancer patients has been described previously. The purpose of this study was to evaluate humoral and cellular immune responses of healthy individuals and ulcerative colitis patients to EpCAM and to relate immune responses to colonic tissue expression of EpCAM. METHODS: An inhibition radioimmunoassay was used to detect anti-EpCAM serum antibodies. Anti-EpCAM antibodies of a healthy donor were expressed by phages and sequenced. (3)H-thymidine incorporation assay was used for detection of lymphoproliferative responses to stimulation with EpCAM. EpCAM tissue expression was determined by immunohistochemistry. RESULTS: We detected anti-EpCAM serum antibodies in 4 of 10, and EpCAM-specific lymphoproliferation responses in 1 of 10 healthy volunteers. The majority of anti-EpCAM antibodies derived from a healthy donor were germline-encoded. In contrast, none of the 23 patients with ulcerative colitis showed serum antibodies to EpCAM (P=0.005). Antigen expression was greatly reduced and altered in ulcerative colitis patients, whereas colon from healthy individuals and uninvolved colon of colorectal cancer patients expressed high levels of EpCAM. CONCLUSION: The results of these studies suggest an association between EpCAM antibody production and colonic EpCAM expression in healthy individuals and patients with ulcerative colitis. Decreased and altered colonic EpCAM expression in ulcerative colitis patients may be related to the disease induction, based on the previously demonstrated adhesion function of this molecule. Healthy individuals with anti-EpCAM immune responses and high risk for developing colorectal carcinoma are prime candidates for prophylactic immunization against EpCAM.

Adult↗
PubMed2004

Effects of iron deprivation or chelation on DNA damage in experimental colitis.

BACKGROUND AND AIMS: In inflammatory bowel diseases iron contributes to the formation of DNA adducts through the production of hydroxyl radicals. The aim of our study was to evaluate the effects of dietary or pharmacological iron deprivation in an experimental model of colitis in the rat and its potential protective effect against DNA damage. METHODS: Colitis was induced in rats by intracolonic instillation of dinitrobenzene sulphonic acid. Rats were assigned to an iron-deprived diet or to desferrioxamine preceding the induction of colitis. The severity of colitis was assessed by the presence of bloody diarrhea, colonic macroscopic damage score, body-weight variations and the amount of DNA colonic adducts. Hepatic and colonic iron concentrations were measured. RESULTS: Treated rats experienced less diarrhea and did not lose weight in comparison to untreated animals. The macroscopic damage score was significantly reduced in the iron-deprived diet for the 5-week group (P=0.03). Liver and colonic iron levels were significantly more reduced in the iron-deprived groups than in the standard diet group (P<0.03 and P<0.01 after a 3- and 5-week iron-deprived diet, respectively). DNA adduct formation was significantly reduced in the groups deprived of iron for 5 weeks (P<0.001) or treated with desferrioxamine (P<0.01). CONCLUSIONS: The degree of colitis caused by DNBS is macroscopically improved by dietary iron deprivation and to a lesser extent by pharmacological chelation; genomic damage is reduced by dietary iron deprivation or chelation, and this may have clinical implications on cancer prevention.

Animals↗
PubMed2004

The spectrum of segmental colitis associated with diverticulosis.

BACKGROUND: Segmental colitis associated with diverticulosis (SCAD) has been defined as chronic colonic inflammation surrounding diverticula with rectal sparing. Distinguishing this condition from inflammatory bowel disease may be difficult. Our aim was to evaluate the epidemiological and clinical characteristics of SCAD in our area. METHODS: Retrospective case identification with prospective follow-up was done. Patients with endoscopic findings suggestive of SCAD were enrolled. The epidemiological, clinical, and histological characteristics of these patients were analyzed. RESULTS: Out of 605 patients with diverticulosis, 23 cases of SCAD were identified (3.8%). Four patients had histological characteristics suggestive of ulcerative colitis, in 1 case the histology was suggestive of ischemic colitis, 6 patients had histology compatible with SCAD, and the remaining patients had either transitional mucosa or minimal lesions. Four cases were refractory to conservative treatment (mesalamine and antibiotics) and surgery was required. No cases of extension of colonic inflammation in diverticula-free areas were found. CONCLUSIONS: Segmental colitis associated with diverticulosis is not a rare disorder. It may occur with a spectrum of clinical and histologic features and may be confused with ulcerative colitis. The majority of the cases respond to medical therapy with antibiotics and/or mesalamine, whereas few cases are refractory and need surgery. No evolution to inflammatory bowel disease was observed.

Adult↗
PubMed2005

Exacerbation of dextran sulfate sodium-induced colitis by dietary iron supplementation: role of NF-kappaB.

BACKGROUND: In colitis, iron therapy may be given to treat anemia, but it may also be detrimental based on our previous studies using a rat model with colitis where iron supplementation increased disease activity and oxidative stress. This effect was partially reduced by an antioxidant. AIMS: The aim of this study was to further evaluate, in rats with dextran sulfate sodium (DSS)-induced colitis, the effect of iron on neutrophilic infiltration, cytokines and nuclear factor kappa-B (NF-kappaB)-associated inflammation and to determine whether the addition of vitamin E would be beneficial. METHODS: Colitis was induced with DSS at 50 g/l in drinking water for 7 days. DSS rats were randomized to the following: DSS, receiving a control, non-purified diet (iron, 270 mg and DL-alpha-tocopherol acetate, 49 mg/kg); DSS+iron (diet+iron, 3,000 mg/kg); DSS+vitamin E (diet+DL-alpha-tocopherol acetate, 2,000 mg/kg); or the DSS+iron+vitamin E. Colonic inflammation, myeloperoxidase activity (MPO), lipid peroxides (LPO), proinflammatory cytokines [tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL-6] and NF-kappaB binding activity were measured. RESULTS: The DSS+iron group showed a significant increase in inflammatory scores, MPO, TNF-alpha, IL-1, LPO and NF-kappaB activity compared to DSS or DSS+vitamin E. The addition of vitamin E to iron (DSS+iron+vitamin E group) significantly reduced the inflammatory scores, TNF-alpha and IL-6. None of the other parameters were affected. CONCLUSION: Iron increases disease activity in colitis, and this is associated with oxidative stress, neutrophilic infiltration, increased cytokines and activation of NF-kappaB. This detrimental effect was partially reduced by vitamin E.

Animals↗
PubMed2000

Deficiency of epithelial basement membrane laminin in ulcerative colitis affected human colonic mucosa.

Imbalances in epithelium-matrix interactions have been discussed as a pathomechanism in ulcerative colitis, causing a colonic mucosal barrier dysfunction. Laminin, the major noncollagenous component of the basement membrane, plays a role in epithelial basal lamina formation and promotes differentiation of human enterocytes. We therefore investigated the distribution of laminin in ulcerative colitis affected colonic tissues. Tissue specimens from both affected and nonaffected colonic regions were obtained from ten patients with ulcerative colitis during colonoscopies or operations. Healthy tissue from five patients with colorectal cancer was used as control. After histological classification, the localization and distribution of the basement membrane associated extracellular matrix proteins were determined by immunohistochemistry. Paraffin-embedded sections were incubated with antibodies against laminin and type IV and V collagen. No positive immunoreactivity against laminin was found in most of the epithelial basement membranes surrounding the crypts in affected colonic tissues, without involvement of the subendothelial structures. In contrast, a type IV and V collagen accumulation occurred in all these tissue samples. The lack of laminin in combination with an overexpression of type IV and V collagen, as reported for the first time in this paper, leads to changes in basement membrane structure. These findings indicate that the three-dimensional network of the colonic epithelial basement membrane and its function are seriously disturbed in exacerbating ulcerative colitis. This provides new insights into the importance of cell-matrix interactions for physiological and pathological mechanisms in the etiology of ulcerative colitis.

Adolescent↗
PubMed2004

5-ASA and lycopene decrease the oxidative stress and inflammation induced by iron in rats with colitis.

BACKGROUND: Supplementation of 5-aminosalicylic acid (5-ASA) and of iron are among the principal therapies in patients with inflammatory bowel disease. Therapeutic iron, as well as heme iron from chronic mucosal bleeding, can increase iron-mediated oxidative stress in colitis. This study was designed to examine the influence of iron supplementation on histological expression and oxidative status relative to 5-ASA treatment and antioxidant treatment. METHODS: Colitis was induced using the iodoacetamide rat model, and rats were divided into different dietary groups of 6 rats each: 1, normal chow diet (control); 2, diet supplemented with iron; 3, iron supplementation and lycopene; 4, iron and Beta-carotene; 5, 5-ASA; 6, 5-ASA and lycopene; 7, 5-ASA and iron; 8, 5-ASA, iron, and lycopene. The animals were killed after 3 days and the weight of the ulcerated area recorded. Mucosal specimens were histologically evaluated. Myeloperoxidase (MPO) was measured to evaluate inflammatory status (U/g). Malondialdehyde (MDA) was measured in colonic tissue ( micro mol/g) and superoxide dismutase (SOD) in erythrocytes to assess the degree of tissue oxidative stress. RESULTS: Significantly more severe colitis, including necrosis, ulceration, and hemorrhage, was seen in colonic biopsies of rats with colitis when iron was supplemented. This pathology was attenuated when iron was given in combination with 5-ASA and/or lycopene. There was no significant benefit from adding Beta-carotene. CONCLUSIONS: Iron supplementation can amplify the inflammatory response and subsequent mucosal damage in a rat model of colitis. We suggest that the resultant oxidative stress generated by iron supplementation leads to the extension and propagation of crypt abscesses, either through direct membrane disruption by lipid peroxidation or through the generation of secondary toxic oxidants. Simultaneous treatment with 5-ASA and/or lycopene minimizes the potential hazard of iron. Therefore, we suggest giving iron supplementation with 5-ASA or lycopene or both.

Animals↗
PubMed1998

Steroid complications and surgery in intractable ulcerative colitis.

The major operative indication for ulcerative colitis is intractability. Although steroid side effects appear to be closely associated with surgical indications for intractable ulcerative colitis, this relationship has yet to be analyzed in detail. To elucidate this relationship, we investigated 39 surgical patients with intractable ulcerative colitis, as defined by the Research Committee for Intractable Diseases of the Ministry of Health and welfare of Japan, and 66 conservatively treated patients with ulcerative colitis, of whom 6 had intractable disease. All patients with major steroid side effects and 17/24 (71%) patients with minor side effects underwent surgery. The median number of admissions was higher in patients with major side effects than in those with less severe or no side effects in the operative series, while this value was lower in the non-operative series than in the operative series. This tendency was similar for the total duration of hospitalization and the number of relapses. In the operative series, markedly higher steroid doses were administered to patients with side effects than to those without, and lower doses were given in the non-operative series. On multivariate regression analysis, the presence of steroid side effects, disease extent, and disease duration were significantly associated with surgery. Patients without side effects had a higher postoperative complication rate than those with minor side effects. We conclude that major side effects are a surgical indication for patients with intractable ulcerative colitis, and that even minor side effects should be taken as a surgical indication in view of the patient's quality of life.

Adolescent↗
PubMed1999

Skip colonic ulceration in typhoid ileo-colitis.

Colonic skip lesions are typically described in Crohn's colitis, but this phenomenon has been recognized in ulcerative colitis (skipped appendiceal involvement), Behcet's colitis, cytomegaloviral colitis, and even in Aeromonas hydrophilia and Histoplasma capsulatum infection. However, skip lesions in typhoid ileo-colitis have not been reported in the English-language literature. We report herein a patient with skip ulcers due to typhoid fever.

Adult↗
PubMed2000

Preventive efficacy of butyrate enemas and oral administration of Clostridium butyricum M588 in dextran sodium sulfate-induced colitis in rats.

Butyrate enemas have been reported to be effective in ulcerative colitis. However, long-term use is difficult because of the troublesome procedure and the unpleasant smell. We therefore investigated the effects of the oral administration of Clostridium butyricum M588 (CBM588), an enterobacterium producing butyrate, in dextran sodium sulfate (DSS)-induced colitis in rats. First, we confirmed the effects of pre-treatment with a butyrate enema on DSS colitis. We then studied the efficacy of oral administration of CBM588 which was started 1 week prior to the induction of DSS colitis. In the CBM588 group, the ulcer index and myeloperoxidase (MPO) activity in the distal colon were significantly lower than in the control group. Proliferating cell nuclear antigen (PCNA) immuno-positive cells were increased around the ulcer in the CBM588 group. In regard to the contents of the cecum and colon, the proportions of Lactobacillus and Eubacterium were increased in the cecum in the CBM588 group. Further, there were significant increases of n-butyrate, propionate, and acetate concentrations in the cecum in the CBM588 group. These results indicated that the oral administration of CBM588 alleviated DSS-induced colitis, and may be useful instead of butyrate enema.

Acetates↗
PubMed2003

Germinated barley foodstuff, a prebiotic product, ameliorates inflammation of colitis through modulation of the enteric environment.

BACKGROUND: Germinated barley foodstuff (GBF), which contains glutamine-rich protein and hemicellulose-rich fiber, exhibits therapeutic effects in ulcerative colitis; however, its mechanism is still under investigation. The aim of this study was to evaluate the anti-inflammatory effects of GBF on colitis in terms of the epithelial inflammatory response. METHODS: Mice with dextran sulfate sodium-induced colitis were used. The effects of GBF on the colitis were evaluated by measuring the body weight; disease activity; mucosal damage (histology, mucosal inflammatory parameters, nuclear factor kappa B [NFkB] activation, and signal transducer and activator of transcription 3 [STAT3]); serum interleukin 6 (IL-6) level; cecal short-chain fatty acids (SCFAs); and bile acid contents. RESULTS: GBF significantly prevented disease activity and body weight loss after induction of colitis. Serum IL-6 level and mucosal STAT3 expression were also significantly attenuated, with a conspicuous reduction of mucosal damage; NFkB activity showed the same tendency. Cecal butyrate content was significantly higher and, interestingly, GBF mice had lower bile acid concentrations than the control group. CONCLUSIONS: GBF has the potential to reduce the epithelial inflammatory response by depressing STAT-3 expression and inhibiting NFkB binding activity. These effects may be brought about by an increase of butyrate production and adsorption of bile acids.

Animals↗
PubMed2004

Resolving microcarcinoids in ulcerative colitis: report of a case.

Ulcerative colitis is known to predispose to the development of neoplasia, especially adenocarcinoma. Microcarcinoids represent small nests of gut endocrine cells located in the mucosa and submucosa of the bowel. Such lesions have been identified in association with chronic inflammation and the concern is that they may represent a precursor lesion for invasive carcinoid tumors. Yet carcinoid tumors are rarely reported in patients with ulcerative colitis. This case report documents a 56-year-old male with ulcerative colitis who was found on random biopsies to have microcarcinoids in his rectal submucosa. Following treatment of his colitis, there was complete resolution of both the inflammation and the microcarcinoids. However, on subsequent follow-up at six months, the patient's colitis has returned and so have the microcarcinoids. We explore the issue of whether these lesions represent true neoplasias that should be resected, or whether they represent cellular hyperplasia in response to the inflammatory stimulus.

Carcinoid Tumor↗
PubMed2002

Takayasu's arteritis after total proctocolectomy for ulcerative colitis: report of a case.

PURPOSE: Although coexistence of Takayasu's arteritis with ulcerative colitis is often reported, all these cases have been in patients whose colons were in situ. The aim of the present study was to describe a patient who developed Takayasu's arteritis after total proctocolectomy for ulcerative colitis. METHODS: The clinical course of a 42-year-old female who developed Takayasu's arteritis after total proctocolectomy for ulcerative colitis is described and the literature reviewed. RESULTS: Symptomatic arteritis developed in the left carotid artery four months after total proctocolectomy with ileal J-pouch-anal anastomosis for ulcerative colitis. Peristomal pyoderma gangrenosum, multiple ulcers in the oral cavity, and leakage at the ileoanal anastomosis were observed simultaneously. High-dose therapy with steroids proved effective for the arteritis, pyoderma gangrenosum, and multiple oral ulcers. We finally excised the ileal pouch with anus because of the intractable leakage three years after the occurrence of Takayasu's arteritis. CONCLUSIONS: This patient illustrates the possibility that Takayasu's arteritis is an extraintestinal complication of ulcerative colitis even after surgical removal of the colon.

Adult↗
PubMed2002

Ischemic colitis caused by strict dieting in an 18-year-old female: report of a case.

Ischemic colitis is typically limited to elderly patients who have concomitant disorders such as cardiovascular disease and chronic renal failure, but rarely affects a young person. The patient was an 18-year-old Japanese female who started dieting to obtain a slim figure three months before admission and presented with a two-month history of constipation and a sudden onset of lower abdominal pain and bloody diarrhea. She underwent colonoscopy, which revealed edema, hemorrhages, and several longitudinal shallow ulcers in the descending colon. Stool and blood culture results were negative for pathogens. She improved rapidly within five days without any specific therapies except intravenous hydration and anticholinergic agents, under the diagnosis of ischemic colitis. In this case constipation and dehydration associated with dieting seemed to be responsible for the development of ischemic colitis. We recommend that ischemic colitis should be included in the differential diagnosis of colitis with bleeding, even in patients younger than age 20 who do not have any predisposing factors.

Adolescent↗
PubMed2003

Atrophy and neoplastic transformation of the ileal pouch mucosa in patients with ulcerative colitis and primary sclerosing cholangitis: a case control study.

INTRODUCTION: Patients with ulcerative colitis and primary sclerosing cholangitis have an increased risk of developing carcinoma both in the bile ducts and in the colon. PURPOSE: To investigate whether this patient group also has an increased risk of developing atrophy and neoplasia in the ileal pouch mucosa after construction of a pelvic pouch with an ileoanal anastomosis or a continent Kock ileostomy. METHODS: Flexible video endoscopic examinations of the ileal pouch were performed in 16 patients with ulcerative colitis and primary sclerosing cholangitis and in 16 matched patients with ulcerative colitis without sclerosing cholangitis. Biopsies were sampled from different locations in the pouch for histologic assessment of mucosal atrophy and dysplasia and for flow cytometric DNA analysis assessing chromosomal aberrations. RESULTS: The patients with sclerosing cholangitis developed moderate or severe atrophy in the pouch significantly more often (P < 0.01). Persistent severe mucosal atrophy was revealed in eight patients with sclerosing cholangitis and only in two controls. One patient with sclerosing cholangitis had high-grade dysplasia in multiple locations. Low-grade dysplasia was assessed in three patients with sclerosing cholangitis and in two of the controls. DNA aneuploidy was displayed in three patients, all with sclerosing cholangitis and dysplasia. All patients with neoplastic transformation had a pouch with ileoanal anastomosis and a long pouch duration (> 8 years). CONCLUSION: Patients with ulcerative colitis and primary sclerosing cholangitis with an ileal reservoir are more prone to developing mucosal atrophy in the pouch and seem to have a higher risk of neoplastic transformation in the pouch mucosa than patients with ulcerative colitis without sclerosing cholangitis.

Adult↗