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PubMed1988

Chemical colitis due to endoscope cleaning solutions: a mimic of pseudomembranous colitis.

A unique form of colitis was observed during endoscopy of the lower gastrointestinal tract in 21 patients. The patients were prepared using either tap-water enemas or standard lavage solutions. Patients were found to have discrete or confluent white plaques adherent to the colonic mucosa, mild to severe erythema of the surrounding mucosa, and variable amounts of foamy liquid upon withdrawal of the endoscope. Stool assays for Clostridium difficile toxin and bacterial cultures were negative. Mucosal biopsies revealed vacuolar changes in the lamina propria, with slight to moderate vascular congestion and foci of intramucosal hemorrhage. Five patients developed rectal bleeding, tenesmus, and increased frequency of stools, lasting up to 12 days. We believe these cases were due to contamination of the endoscope's air-water channel with solutions used during endoscope cleaning. Recognition of this entity is important, as it is preventable and may mimic pseudomembranous colitis.

Colitis↗
PubMed1987

Chronic colitis with thickening of the subepithelial collagen layer (collagenous colitis): histopathologic findings in 15 patients.

The histopathologic features of collagenous colitis were studied in 14 women and one man. All but one patient presented with chronic watery diarrhea: 10 had a history of thyroid disease or unspecified arthritis. All 15 patients showed characteristic thickening of the subepithelial collagen layer (SCL) in colorectal biopsy specimens, but in the distal colorectum the thickening was sometimes absent or borderline. Patchy or diffuse injury to the surface epithelium was seen in all cases and was independent of SCL thickening. The injured surface epithelium was infiltrated by lymphocytes and variably by eosinophils and neutrophils, causing it to resemble the surface epithelial injury seen in the small intestine in celiac disease. Crypts were commonly infiltrated by lymphocytes but without associated epithelial injury. The lamina propria in all patients was expanded by lymphocytes, plasma cells, and eosinophils. Neutrophilic cryptitis was seen in seven patients but was usually sparse. Watery diarrhea abated in eight patients treated with corticosteroids or sulfasalazine and was often paralleled by restoration of surface epithelium, reduction in surface epithelial lymphocytes, diminished SCL thickening, and reduced lamina propria eosinophils. Therapy did not consistently alter other inflammatory changes. The possible role of autoimmunity in collagenous colitis should be investigated because of the following circumstantial evidence: the overwhelming female predominance; the frequent presence of possible immunologically mediated disorders such as thyroid and joint disease; the resemblance of surface epithelial changes to those in celiac disease; and the response to corticosteroids.

Adult↗
PubMed1997

The accessory cell populations in ulcerative colitis: a comparison between the colon and appendix in colitis and acute appendicitis.

We present an immunohistochemical study of accessory cells in acute appendicitis and ulcerative colitis (UC). By comparing these two diseases, it is possible to distinguish between changes associated with inflammatory bowel disease and those resulting from nonspecific intestinal inflammation. Nine total colectomy specimens from patients with UC, in which the appendix was also involved, were compared with nine cases of acute appendicitis. Accessory cells were stained for CD68 (PGMI), ACPI (acid cysteine proteinase inhibitor), S100 protein, MAC387 (calgranulin), CD1a, factor XIIIa, and WR18 (HLA class II). In ulcerative colitis, but not acute appendicitis, there was extension of a network of S100 positive dendritic cells into the crptal mucosa, and these S100-positive dendritic cells were closely aligned with the epithelium. The epithelium in UC, but not in acute appendicitis, showed intense upregulation of HLA class II, and this was particularly marked at the crypt bases. Dendritic, MAC387-positive cells were seen only in UC. In both diseases there were abundant ACPI-positive accessory cells in the cryptal areas, a population normally restricted to the dome areas. Factor XIIIa- and PGM1-positive cells, although abundant in both conditions, had distributions similar to those that we had previously shown in normal controls. No CD1a-positive cells were identified in either UC or acute appendicitis. We hypothesize that S100 identifies a subpopulation of activated macrophages. The concentration of this subpopulation, in close contact with the epithelium, which also shows altered expression of HLA class II antigens, suggests that a component of the immune response is targeting this area in UC. In addition, we also suggest that the identification of MAC387-positive dendritic cells in UC reflects increased macrophage turnover in inflammatory bowel disease.

Antigen-Presenting Cells↗
PubMed1999

The differentiation of true adenomas from colitis-associated dysplasia in ulcerative colitis: a comparative immunohistochemical study.

Adenomas in areas involved by ulcerative colitis (UCA) are difficult to identify because of their morphological similarity to ulcerative colitis-associated dysplasia (UCD) and have an uncertain biology. Recently, a set of morphopathologic criteria were published for the diagnosis of UCA versus UCD. As a first step to analyze these criteria, we studied p53 and bcl-2 expression in groups of UCA and UCD along with a sporadic adenoma control group. Ninety lesions from UC areas (62 patients) were examined, including 24 UCA without high-grade dysplasia (HGD) and 66 UCD consisting of 43 polypoid and 23 flat dysplastic lesions (29 with HGD). Immunohistochemical p53 and bcl-2 expression were evaluated semiquantitatively. P53-positive cases were significantly less frequent in the UCA (4%) versus the UCD group (30%, P = .01) and the polypoid UCD subgroup (35%, P = .005). Moderate or strong bcl-2 expression was significantly more frequent in the UCA than in the UCD group (96% v 70%, P = .01) and in the UCA versus both polypoid and flat UCD subgroups. Comparison of UCA with low-grade dysplastic polypoid UCD cases alone showed a difference just below significance for p53 (P = .07). p53 and bcl-2 expression rates were very similar in the UCA group and the sporadic adenoma (n = 25) control group. These results show that UCA has phenotypic features more similar to sporadic adenomas than UCD and supports the concept that adenomas in UC have a biology different from UC-associated dysplasia.

Adenoma↗
PubMed1988

Differentiating Crohn's colitis from ulcerative colitis. A rundown of likenesses and dissimilarities.

Crohn's colitis and ulcerative colitis are two distinct clinical entities with differing clinical, pathologic, endoscopic, and radiographic findings. Because of distinct differences in their response to surgical and, in some instances, medical management, clinical separation of these two unique disease states is important. Although at times diagnostic confusion may persist, thorough clinical evaluation, including the judicious use of mucosal biopsy, yields the correct diagnosis in the majority of patients.

Colitis, Ulcerative↗
PubMed1979

The outlook after total colectomy in patients with Crohn's colitis and ulcerative colitis.

The postoperative recurrence rates for Crohn's colitis (CC) and ulcerative colitis (UC) have varied markedly in different medical centers. We have reviewed the reasons for this variation and present our own series of patients in a manner which allows comparison with previous studies. In our study: 1) Patients with CC had an overall recurrence rate of 38% after total colectomy. By actuarial statistics, this recurrence rate computes to 48% by 12 years after operation. 2) Patients with ileal disease, even if totally removed at operation, had a recurrence rate of 48% whereas those with no obvious ileal involvement had a recurrence rate of 18%. 3) When nonspecific criteria are used for recurrence, which we call "complication," as has been the case in several previous studies of CC, even patients with UC had a complication rate of 33%. Such complications both in UC and CC represent postoperative occurrence rather than ileal recurrence of the inflammatory process. 4) Patients with CC develop more postoperative complications than patients with UC, but for most of the time they were asymptomatic. In this series there were no patients with disease originally or almost entirely limited to the colon who became "intestinal cripples" as a result of recurrent disease. 5) Patients with short preoperative intervals had the highest recurrence rate, whereas patients with disease of the terminal ileum had the highest postoperative complication rate. 6) Patients with "superficial" CC had a low recurrence rate, probably because of a shorter follow-up than the other patients. There were no true recurrences in patients with UC.

Adult↗
PubMedDate not supplied

The thyroid in ulverative colitis and Crohn's disease. II. Thyroid enlargement and hyperthyroidism in ulcerative colitis.

The frequency of thyroid disease has been surveyed in 300 patients with ulcerative colitis (UC) and 600 controls. The controls were drawn from visitors to the general medical wards of the Radcliffe Infirmary and were matched for age and sex with the UC patients. Two observers independently assessed all these subjects for thyroid enlargement of the simple goitre type. Although there were minor variations between the results obtained by the two observers, they found simple goitre in 8.7-6.3 percent among the UC patients compared with 4.3-3.3% percent among the controls; a difference which is significant. A history of thyrotoxicosis was obtained in 3.7 percent of the UC patients compared with 0.8 percent of the controls (p greater than 0.01). In more than half of the UC patients with a history of hyperthyroidism, the hyperthyroidism occurred years before the onset of the colitis. It is therefore highly unlikely that hyperthyroidism is a complication of the colitismpossible reasons for the association of the two diseases are discussed but it is concluded that no satisfactory explanation exists at present.

Adult↗
PubMed1991

Is topical therapy necessary in acute distal colitis? Double-blind comparison of high-dose oral mesalazine versus steroid enemas in the treatment of active distal ulcerative colitis.

Thirty-seven patients suffering an attack of acute distal ulcerative colitis of mild or moderate severity were randomized in a double-blind, double-dummy fashion to receive either 800 mg oral mesalazine four times daily (18 patients) or steroid enemas twice daily (19 patients) for 4 weeks. Both treatments were well tolerated with no adverse effects. Three patients in each group were withdrawn because of clinical deterioration but both treatments produced significant clinical improvement with decreases in stool frequency and scores for urgency, bleeding and tenesmus. There were no significant differences between the treatments although there was a slight trend in favour of the enemas for reduction in rectal bleeding. Activity of the colitis as graded at sigmoidoscopy also decreased significantly with both treatments and there were corresponding improvements in histological parameters of inflammatory activity assessed with the aid of a computerized morphometric system. Little correlation was seen between clinical, sigmoidoscopic and histological changes.

Acute Disease↗
PubMed1992

Increased expression of c-myc proto-oncogene in biopsies of ulcerative colitis and Crohn's colitis.

The steady state levels of c-myc mRNA have been measured in RNA samples extracted from colonoscopic biopsies of inflammatory bowel disease patients obtained at routine endoscopy sessions. Biopsies were immediately frozen in liquid nitrogen limiting the ischaemic time to less than 15 seconds, and can be stored for up to 96 hours before separation of RNA. Yields of RNA using biopsies were 0.137 (0.041)% wet wt (mean (SD), n = 68), these are significantly better than those obtained from surgical material (0.064 (0.063)% wet wt (mean (SD), n = 21) where the tissue ischaemic time was 45 minutes to one hour 40 minutes. Functional activity of RNA extracted was demonstrated by the ability to direct in vitro protein translation in the rabbit reticulocyte system. We have used this technique to show that there is an increased ratio of steady state c-myc proto-oncogene expression in inflamed tissue from 18 patients with left sided ulcerative colitis and five patients with segmental Crohn's colitis, compared with an uninvolved region of the colon in each case. No difference in c-myc expression was seen in biopsies at least 30 cm apart in 11 control patients with no macroscopic or histological abnormalities. Increased expression of c-myc in inflammatory bowel disease is consistent with the activation of this proto-oncogene during altered cell cycle control resulting from the inflammatory process.

Adult↗
PubMed2003

Induction of experimental ulcerative colitis by Fusobacterium varium isolated from colonic mucosa of patients with ulcerative colitis.

BACKGROUND: Bacteria are implicated in certain forms of model chronic colitis but the identity and role of bacteria in human ulcerative colitis (UC) are uncertain. AIMS: To isolate pathogenic bacteria from inflamed mucosa of patients with UC, to examine whether the bacteria have a toxin to Vero cells, and to determine whether the toxin induces UC-like lesions in animals. METHODS: Bacteria were isolated from UC patients and supernatants from cultures were filtered and tested for cytotoxicity to Vero cells. Bacterial cells producing the cytotoxic supernatants were examined by polymerase chain reaction for verotoxin genes. Culture supernatants of cytotoxic strains were examined by high performance liquid chromatography for organic acid concentrations. Mice were given enemas containing organic acid at the mean concentration in the supernatants of cytotoxic strains to ascertain whether colonic lesions appear in UC. RESULTS: Only supernatants from cultures of Fusobacterium varium killed Vero cells. Bacterial cells lacked verotoxin genes. Bacterial culture supernatants contained high concentrations of n-butyric acid and the mean concentration (32 mmol/l) was cytotoxic to Vero cells. Twenty four hours after mice were given enemas containing either butyric acid or F varium culture supernatants, colonic ulcers with crypt abscesses, inflammatory cell infiltration, and apoptotic changes were observed. CONCLUSIONS: Butyric acid in culture supernatants from cultures of F varium caused UC-like lesions in mice. This study indicates that F varium may be one of the elusive pathogenic factors in UC.

Adult↗
PubMed1994

Collagenous colitis and lymphocytic colitis.

Collagenous and lymphocytic colitis are newly recognized causes of chronic watery diarrhea that typically affect middle-aged patients. Although endoscopic studies are normal, inflammatory changes and (in the case of collagenous colitis) collagen deposition occur histologically in the colonic mucosa. The pathogenesis of these disorders remains a mystery, but the possible causes are intriguing. Patients may experience spontaneous remissions and relapses, but treatment with sulfasalazine or prednisone is usually effective for patients with distressing symptoms.

Adolescent↗
PubMed1992

Relapse-preventing effect and safety of sulfasalazine and olsalazine in patients with ulcerative colitis in remission: a prospective, double-blind, randomized multicenter study. The Ulcerative Colitis Multicenter Study Group.

Forty-nine patients with ulcerative colitis in remission were entered into a prospective, double-blind, multicenter trial comparing the relapse-preventing effect and safety of 4 g sulfasalazine and 2 g olsalazine daily during 48 wk. Of the 46 evaluable patients, 23 were assigned to sulfasalazine and 23 to olsalazine. Seven of 23 patients (30.4%) relapsed on sulfasalazine and six of 23 patients (26.1%) on olsalazine (95% confidence interval of the difference -22.0% to 30.3%). The relapse-free survival curves did not differ significantly at any time during the trial period. In both treatment groups, three patients dropped out because of adverse effects. Four patients on sulfasalazine and six patients on olsalazine experienced minor adverse effects. One patient on sulfasalazine had mild leukopenia, and four patients on sulfasalazine and one patient on olsalazine had decreased levels of haptoglobin. Thus, sulfasalazine and olsalazine are equally effective in maintaining remission of ulcerative colitis and are accompanied by a similar incidence of adverse effects.

Adolescent↗
PubMed1979

Colitis and pseudomembranous colitis associated with cephazolin prophylaxis.

Three patients suffering from colitis associated with cephalexin therapy are reported. All had undergone surgery and had previously suffered severe associated medical problems. Their presenting symptoms included profuse diarrhea, vague abdominal pain, fever and leukocytosis, but all stool cultures were negative. In one case, a pseudomembrane was present; in another only acute inflammatory changes, and in the third patient, no proctosigmoidoscopy or biopsy was done. Cephalosporin therapy was halted and bowel rest as well as intravenous hydration were instituted. All three patients survived. Inasmuch as four cases of colitis associated with cephalosporin therapy have now been treated at UCLA Hospital, the authors believe that this diagnosis should be strongly considered when patients on cephalosporin develop diarrhea.

Aged↗
PubMed1983

[Granulomatous colitis presenting as ischemic colitis].

The authors describe a case of granulomatous colitis mimicking a non gangrenous ischemic colitis. The radiological features are thumbprinting, ulcerations, then stenosis and sacculation. The resected specimen reveal some granuloma without necrosa.

Adult↗
PubMed1995

[Cytomegalovirus colitis in a patient carrying the human immunodeficiency virus: the endoscopic image similar to pseudomembranous colitis].

Endoscopically detected ulcers and submucous haemorrhage are common findings related to cytomegalovirus infection. We report a case of cytomegalovirus colitis in a patient seropositive for human immunodeficiency virus. Endoscopic findings showed elevated, white-yellowish, small size plaques with an erythematous central depression, resembling those found in pseudomembranous colitis.

AIDS-Related Opportunistic Infections↗
PubMed1993

["Microscopic colitis" and collagenous colitis. Unusual explanation of diarrhea of unknown origin].

The article describes two female patients with severe diarrhoea. Both patients were suspected of having an organic diarrhoea syndrome and underwent extensive investigations. No specific diagnoses such as inflammatory bowel disease, pancreatic cholera, malabsorption and surreptitous ingestion of laxatives could be established. Histologic examination of biopsy specimens from apparently normal colon revealed microscopic changes characteristic of "microscopic colitis" in one of the patients, and of collagenous colitis in the other. The authors discuss similarities between these two microscopic abnormalities in colonic mucosa and their close association with chronic watery diarrhoea.

Adult↗
PubMed1992

Joint manifestations in gastrointestinal diseases. 2. Whipple's disease, enteric infections, intestinal bypass operations, gluten-sensitive enteropathy, pseudomembranous colitis and collagenous colitis.

This review addresses the clinical picture of rheumatic diseases seen in Whipple's disease, gluten-sensitive enteropathy, pseudomembranous colitis, collagenous colitis and that developing after enteric infections and intestinal bypass operations for morbid obesity. These disorders exemplify the interplay between antigen entrance through the gastrointestinal canal, specific bacterial properties and genetic host factors such as HLA B27. In most cases such as interplay results in formation of circulating immune complexes causing the development of peripheral joint disease.

Bacterial Infections↗