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PubMedDate not supplied

[Ischemic colitis in patients submitted to aortic replacement surgery. Risk factors].

UNLABELLED: Ischemic colitis (IC) is an important clinical problem, and may present after aortic surgical procedures. The aim of this work was to establish risk factors for IC presentation in aortic surgical replacement patients. MATERIAL AND METHODS: A retrospective study of patients with aortic surgical replacement in a 3-year period was carried out. Patients were divided into two groups: patients without IC and patients with IC, the later group subdivided into patients with gangrenous ischemic colitis and without gangrenous ischemic colitis. Multiple logistic regressions was used to obtain the variables for possible risk factor for IC. RESULTS: We included 101 patients in the study; ischemic colitis was present in 16.8% of all cases, with 47.1% of gangrenous type. Metabolic acidosis was the most frequent alteration. Diagnosis was made by endoscopy in 94.1%. Mortality in IC group was 18.2% with an increase in the gangrenous group to 62.5%. Identified risk factors were disrupted aneurysm, previous colonic surgery, emergency surgery, and hemodynamic instability. CONCLUSIONS: Ischemic colitis is most frequent in emergency surgery for disrupted aneurysm in the hemodynamically unstable patient with retroperitoneal hematoma. We must entertain a high suspicion index for IC in all patients with aortic surgical procedures for early detection and adequate treatment.

Acidosis↗
PubMed2003

[Autoimmune hemolytic anemia: a rare complication of ulcerative colitis].

Anaemia is a common problem in patients with ulcerative colitis, and its etiology is usually multifactorial. It can be produced by chronic blood loss, nutritional deficiencies, drugs such as salazopyrine, or it can be related to those chronic disease. However, ulcerative colitis is known to be associated with several immune disorders, as autoimmune haemolytic anaemia. Nevertheless, this rare complication can be found in 0.2 to 0.7% of patients affected by ulcerative colitis, and although 1.82% of patients with ulcerative colitis have a positive direct Coombs test without evidence of hemolysis. We report one new case of ulcerative colitis associated with autoimmune anaemia haemolytic, and a review the literature.

Aged↗
PubMedDate not supplied

Coexistence of hyperthyroidism and ulcerative colitis: report of 4 cases and a review of the literature.

Four cases of coexisting hyperthyroidism and ulcerative colitis are presented. In two patients the diseases appeared simultaneously, in one the diagnosis of ulcerative colitis preceded the diagnosis of hyperthyroidism, while in the fourth the diagnosis of hyperthyroidism preceded the diagnosis of ulcerative colitis. Hyperthyroidism intensifies the symptoms of ulcerative colitis and impairs response to therapy. Treatment of both diseases should be conservative. There is no clear explanation for the concurrent existence of the two diseases, although immunological mechanisms seem to play the most significant role. The clinician must bear in mind that coexistence of hyperthyroidism and ulcerative colitis in some patients, although infrequent, nevertheless is a reality, which obviously is very important for the patient's outcome.

Adult↗
PubMed1992

[Concentration of selenium in serum of patients with ulcerative colitis].

Selenium deficiency may be implicated in the pathogenesis of some human diseases, including colon cancer. The incidence of carcinoma of the colon is increased in patients with ulcerative colitis. We measured the serum concentration of selenium in 22 patients with ulcerative colitis and 22 sex-, age-, height and weight-matched controls. Although no significant difference was found in mean serum selenium between patients and controls (patients: 0.92 mumol/l, controls: 0.79 mumol/l), the serum selenium level decreased with increasing extension of the disease. The differences between serum selenium concentrations in patients with proctitis-sigmoiditis, left-sided colitis and pan-colitis were statistically significant. No correlation was found between serum selenium concentrations and the sex, age, height, or weight of the patients. The inverse correlation between serum selenium concentration and the extension of the disease may be caused by a decreased absorption of selenium from the diseased colon in ulcerative colitis.

Adult↗
PubMed1992

[Severe psychiatric disorders associated with severe acute colitis].

Acute colitis occurring in patients suffering from psychiatric illnesses is believed to be linked to the intake of psychotropes. From 1983 to 1989, the authors observed, in three Hepato-gastroenterology units, 10 cases of acute colitis in patients suffering from serious psychiatric disorders, most of them inpatients of mental hospitals. The detailed study of 7 of these cases emphasized a certain number of common features: there was no previous history of digestive disease, the psychiatric illness was serious and longstanding, acute colitis was severe, and there was no recurrence during clinical and endoscopic follow-up averaging 4.3 years. Of these 7 patients, 2 were not taking psychotropes at the time of colitis or after, 2 had discontinued their treatment for a few days, and 2 had not stopped taking psychotropes. One patient died. The short-term and long-term evolution in these cases was not influenced by the intake or not of psychotropes. The pathogeny of this colitis is yet to be determined: infection is the most likely origin.

Acute Disease↗
PubMed1992

Use of bacitracin in the prevention and treatment of experimentally-induced idiopathic colitis in horses.

Ten healthy ponies from a single herd were found by repeated fecal culture to be free of Salmonella species and Clostridium cadaveris. In a preliminary study, four ponies administered a single oral dose of 10 mg/kg lincomycin did not develop idiopathic colitis when the drug was administered alone. Four other ponies were administered 10 mg/kg lincomycin by stomach tube together with 0.45 L of colonic content from a horse with idiopathic colitis induced earlier by lincomycin alone. Two of the four ponies were treated with 25 g oral zinc bacitracin premix (110 g/kg active ingredient) 24 h later. Forty-two hours after inoculation the two untreated ponies had severe signs of idiopathic colitis and were euthanized. Postmortem findings were typical of idiopathic colitis. The two treated ponies had milder illness but the more severely affected was also euthanized; the other was retreated at 42 h with bacitracin pre-mix and again 12 h later. Its illness and diarrhea resolved over the next 24 h. Clostridium cadaveris was isolated in large numbers from the cecum of the euthanized ponies and their cecal content contained mouse lethal and guinea pig dermonecrotic, but not cytotoxic, activity. Enterotoxins of Clostridium perfringens and Clostridium difficile could not be demonstrated. No toxin could be demonstrated in culture supernatants of C. cadaveris or in supernatants of cecal contents treated with ethanol prior to culturing in anaerobically incubated broth. No Salmonella spp. were isolated. A further two ponies were administered 10 mg/kg lincomycin orally with 0.45 L colonic content from a horse with idiopathic colitis, as described.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Treatment of the mucosa with local anaesthetics in ulcerative colitis.

A new paradigm for the treatment of ulcerative colitis has recently been presented: Treatment of the mucosa with lidocaine (2%) enemas for prolonged periods. This therapy was introduced based on the hypothesis that hyperreactive autonomic nerves may play a pathogenetic role in the disease. One hundred consecutive patients have now been treated and the results presented. The proctitis patients all responded to the treatment, despite previous therapeutic failures in more than two-thirds of the cases. They were treated for 3-12 weeks, but 68% had a relapse (observation period 20 months). Of the 49 patients with proctosigmoiditis, two-thirds had chronic symptoms resistant to previous therapy. One of these patients did not respond to lidocaine, but developed fulminant total colitis. The other patient had therapeutic failure with lidocaine but responded well to subsequent cortisone enemas. The patients were treated until the subsets of T-lymphocytes (OKT4+ and OKT8+) disappeared from the mucosa. This occurred in parallel with symptomatic relief and eventual healing in 83% of the patients after treatment for 6-34 weeks. Of all the patients with proctosigmoiditis, 42% presented with recurrent symptoms (observation period 16 months). Of the 17 patients with left-sided colitis, all went primarily into remission within 2-4 months, but 23% had a relapse (observation period 13 months). The 6 patients with total colitis had symptomatic relief and improvement of histology when treated over 3-8 months. One patient had recurrence after 12 months. Treatment with a local anaesthetic in ulcerative colitis is a new approach to mucosal inflammation. The beneficial effects may be due to blockade of certain neural effects, such as epithelial proliferation and shedding and congestion of the mucosal vasculature, with actions on cells of the immune system.

Adult↗
PubMedDate not supplied

Quality of life in patients with ileal pouch for ulcerative colitis.

The improvement of surgery in the treatment of ulcerative colitis prompts us to consider its impact on the quality of life of the patients. Obviously, it is mandatory that the results after surgery should be better than the symptoms which elective surgery is designed to treat. A review of the literature was carried out on the current status of quality of life in patients with ulcerative colitis before and after surgery using a PubMed source. The rate of success after restorative proctocolectomy for ulcerative colitis is 95%. The quality of life after restorative proctocolectomy compared with other procedures is better, especially in the long term. About 90% of patients would undergo pouch surgery again after restorative proctocolectomy, while 53% of patients submitted to other procedures would have a restorative proctocolectomy. Restorative proctocolectomy is the gold standard for patients with ulcerative colitis who are suitable for surgical treatment, though future prospective trials are needed in order to establish when elective surgery for ulcerative colitis is indicated.

Colitis, Ulcerative↗
PubMed2004

Electroacupuncture ameliorates experimental colitis induced by acetic acid in rat.

The effect of electroacupuncture (EA) on experimental colitis was investigated in Sprague-Dawley rats. Colitis was induced by intracolonic instillation of 4% acetic acid. EA (2 Hz, 0.05 ms, 2 V for 20 min) was applied to bilateral Hoku (LI-4) and Zusanli (ST-36) on 12 hrs and 36 hrs after induction of colitis. EA-treatment significantly reduced the macroscopic damage and the myeloperoxidase activity of colonic samples at 3 days post-induction of colitis. Colitic colon showed a decreased in vitro motility. However, colonic motility of EA-treated group was not significantly different from that of normal group. The anti-inflammatory effect of EA was not inhibited by a glucocorticoid receptor antagonist, RU-486, but suppressed by a beta-adrenoceptor antagonist, propranonol. These results suggest that EA-treatment has a beneficial effect on colitis, and its anti-inflammatory effect is mediated by beta-adrenoceptor activation but not by endogenous glucocorticoiddependent mechanism.

Acetic Acid↗
PubMed2004

Salmonellosis and ulcerative colitis. A causal relationship or just a coincidence.

Coincidence of salmonellosis and ulcerative colitis is a rare clinical problem. Salmonella infection was reported to complicate the ulcerative colitis, as either facilitating its occurrence or activation. In this article, we present a case with salmonellosis whose clinicopathological findings also suggested ulcerative colitis. The patient improved rapidly after taking additional mesalazine to norfloxacin treatment. We conclude that salmonella infection might have either been coincidentally present or might have triggered an early ulcerative colitis in this patient who did not have history of inflammatory bowel diseases. In case of persistent severe diarrhea despite appropriate treatment, the possibility of a coincident inflammatory bowel disease such as ulcerative colitis should always be considered, especially in endemic regions for salmonellosis.

Abdomen, Acute↗
PubMed2004

Cytomegalovirus colitis in an immunocompetent patient with amebiasis: case report and review of the literature.

Most cases of cytomegalovirus colitis occur in adults with severe immune deficiency. Only a few cases involving immunocompetent patients have been reported. We describe the first case reported in English, of cytomegalovirus colitis in an immunocompetent patient with preceding amebiasis. Eight previous cases have been reported of cytomegalovirus colitis occurring after colonic mucosal injury in immunocompetent patients. Similar to our case, all eight of these cases resolved without the use of antiviral therapy. This suggests that disruption of colonic mucosa may predispose immunocompetent patients to cytomegalovirus colitis, and that the colitis may become self-limited once the preceding intestinal damage resolves.

Adult↗
PubMed1992

[Immunohistochemical analysis of colonic mucosa with ulcerative colitis--activation of lymphocytes and expression of ICAM-1 by lamina propria dendritic cells and macrophages].

The colonic mucosa of 30 patients with ulcerative colitis was analyzed by an immunohistochemical technique. A quantitative evaluation for lymphocyte subsets show significantly increased numbers of CD3+, CD4+, CD8+, and CD28+ cells in ulcerative colitis cases of histological grades 3, 4 and 5 by Matts' classification comparing to normal control cases. CD4/CD8 ratio in each histological grade of ulcerative colitis was not significantly different from those in normal controls and disease controls (infectious colitis cases). However, CD28/CD3 ratio was increased significantly in ulcerative colitis cases of histological grades 3, 4 and 5 comparing to control cases. Most of the lymphocytes were positive for lymphocyte function-associated antigen-1 alpha (LFA-1 alpha). There were increased numbers of S100-beta + dendritic cells and CD68+ macrophages in the luminal area of the lamina propria. Moreover double stainings revealed that most of the S100-beta + dendritic cells and CD68+ macrophages were intercellular adhesion molecule-1 (ICAM-1, a ligand for LFA-1) positive. These findings suggested that the expression of ICAM1 on S100-beta + dendritic cells and CD68+ macrophages is important by the interaction with T cells and T cell antigen recognition.

CD4-CD8 Ratio↗
PubMedDate not supplied

Infliximab in the treatment of steroid-dependent ulcerative colitis.

BACKGROUND AND OBJECTIVES: Infliximab has proven efficacious in the treatment of Crohn's disease. Limited and contrasting data are available on effectiveness of anti-TNF alpha therapy in ulcerative colitis. We evaluated the efficacy of infliximab in the management of steroid-dependent ulcerative colitis. METHODS: We report preliminary data from a randomized, open-label, methylprednisolone-controlled trial of infliximab in the induction and maintenance of remission of patients with moderate to severe steroid-dependent ulcerative colitis. Twenty patients received either three infusion of infliximab (5 mg/kg) at 0, 2 and 6 weeks and thereafter every 8 weeks (group A) or methylprednisolone (0,7-1 mg/kg) daily for one week followed by a tapering regimen up to the minimal dose to maintain a symptom-free condition (group B). Clinical remission was defined as a DAI score less than 3. RESULTS: Ten patients in group A (DAI: 8.9+/-1.4) achieved remission after the first infusion (DAI: 1.6+/-0,7; p = 0.005) and steroids were progressively discontinued. At present (mean follow-up: 9.8+/-1.1 months), 9 out of 10 patients maintain clinical remission, while one patient relapsed at 3 months. Ten patients in group B (DAI: 8.7+/-1.4) reached clinical remission at one week (DAI: 1.9+/-0.3; p = 0.005). Eight out of 10 patients were maintained at a minimal steroid dosage without any relapse at 9.7+/-1.0 months follow-up. Two patients relapsed at 6 and 8 months, respectively. CONCLUSIONS: Infliximab seems to be as effective as steroids in the management of moderate to severe steroid-dependent ulcerative colitis. These preliminary data suggest the potential efficacy of repeated treatment with infliximab for short-term maintenance of remission and steroid withdrawal in glucocorticoid-dependent ulcerative colitis.

Adult↗
PubMed1992

[Morphological and immunohistochemical quantitative analysis of dysplasia in ulcerative colitis. II. Immunohistochemical quantitative analysis].

Mapping specimens of 6 cases of ulcerative colitis included adenocarcinoma invaded into submucosa (invasive carcinoma) were made and immunohistochemical quantitative analysis of ras p21, an oncogene product and secretory component were examined in invasive carcinoma, severe and moderate dysplasia of ulcerative colitis. Large intestinal carcinoma invaded into submucosa, colonic adenoma and normal mucosa were examined as the control. Index values of Staining Density (ISD) and of Staining Gland (ISG) of ras p21 demonstrated significantly higher values in invasive carcinoma, severe and moderate dysplasia of ulcerative colitis than adenoma (P less than 0.01). ISG of secretory component in moderate dysplasia and adenoma showed significantly high value compared with severe dysplasia and invasive carcinoma of ulcerative colitis (P less than 0.05). The collective evidence indicates that severe dysplasia falls into the same category with invasive carcinoma of ulcerative colitis and may be defined as carcinoma in situ. Moderate dysplasia was also defined as carcinoma in situ or borderline lesion.

Adenocarcinoma↗
PubMed2005

[Enema therapy for ulcerative colitis patients].

The therapeutic options for the treatment of mildly to moderately active distal colitis or distal flare up of total colitis have increased over the last decade. Many reports have documented the effectiveness of various compounds, such as 5-aminosalicylic acid, steroids, cytoprotective agents, lidocaine gel, short chain fatty acid, and cyclosporine when they are applied topically to the inflamed distal colon in patients with ulcerative colitis. These treatments have considerably attracted our attention because of their possible anti-inflammatory effects on ulcerative colitis with lower toxicity. Larger, controlled studies will be necessary to establish the roles of enema therapy in patients with distal colitis.

Abietanes↗
PubMed2005

Reproduction and ulcerative colitis: a review.

Ulcerative colitis is a chronic inflammatory bowel disease. The onset peaks at age 15-30 years and coincides with the reproductive period. We screened and summarized the relevant English-language publications (Entrez-PubMed) on ulcerative colitis, fertility and pregnancy. The presence of ulcerative colitis per se does not seem to significantly alterfertility in young women. However, associated conditions, such as active disease, surgical interventions and medication, may interfere with reproduction. It is difficult to draw conclusions regarding the effect of ulcerative colitis on pregnancy outcome in terms of pregnancy loss, intrauterine growth restriction, low birth weight, preterm labor, stillbirth and perinatal mortality. Nevertheless, it appears that major complications do not occur in ulcerative colitis patients more frequently than in healthy women. The rate of exacerbation is probably the same for pregnant and nonpregnant women. Disease control during pregnancy is of the utmost importance. Fortunately, most drugs can by used safely during pregnancy.

Adolescent↗
PubMedDate not supplied

Predictive factors of glucocorticosteroid treatment failure in severe acute idiopathic colitis.

INTRODUCTION: The purpose of our study was to determine clinical, biological or endoscopic factors that could predict glucocorticosteroid treatment failure in acute colitis. PATIENTS AND METHODS: Fifty-four Tunisian Caucasian patients with acute idiopathic colitis (ulcerative colitis in 53 patients, Crohn's colitis in 1 patient) have been evaluated. Non-therapeutic response was defined as over 6 bowel movements per day, blood visible to the naked eye in stools on the fifth day after admission or the development of a complication inducing a resort to surgery. Predictive factors were assessed using bivariate and multivariate analysis. RESULTS: Thirty-nine patients (72.2%) had no medical response. In univariate analysis, predictive factors of therapeutic failure were: male sex, tobacco, previous history of colitis attacks, bowel movements per day over seven at admission and on day three, and pulse rate over 90/mn, temperature over 38 degrees C, systolic blood pressure below 11 on day 3 and on day 5 after admission. In multivariate analysis, bowel movements over seven per day on day 3 of hospitalization and male sex independently predicted a failure of glucorticosteroid treatment. CONCLUSION: Bowel movements per day over seven on day 3 of hospitalization and male sex were the independently predictive factors of failure of glucocorticosteroid treatment.

Acute Disease↗
PubMedDate not supplied

Inflammatory bowel disease-like colitis in a young Turkish child with glycogen storage disease type 1b and elevated platelet count.

Inflammatory bowel disease (IBD)-like colitis is a known entity in glycogen storage disease (GSD) type 1b patients. The mean age of the reported cases with IBD-like colitis was 12 +/- 5 years, and all had absolute neutrophil count (ANC) less than 1,000 cells/microl. We report a three-year-old girl with GSD type 1b that was dignosed by mutation analysis. The patient was hospitalized with fever, diarrhea, and perioral and anal ulcers. Colonoscopy was performed and IBD-like colitis was diagnosed. The patient had elevated platelet count beyond the age of three months, but IBD-like colitis was diagnosed at three years of age. An elevated platelet count may be a warning sign for the IBD-like colitis in young patients with GSD type 1b.

Child, Preschool↗