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PubMed1993

Long-term evaluation of the endorectal Soave operation performed for ulcerative colitis or polyposis in the pediatric patient.

BACKGROUND: A follow-up study was conducted to evaluate the late results of the operation that we have performed for ulcerative colitis and polyposis during the past 25 years. METHODS: Sixty-seven consecutive patients less than 21 years of age who underwent a standard operation for ulcerative colitis or polyposis performed by or under direct supervision of one surgeon were included in the follow-up study 2 to 15 years after operation. RESULTS: The 11 patients with polyposis all had "excellent" results. Of the 56 patients with ulcerative colitis, results were "good" or excellent in 48. Of the eight patients with less than good results, one died of complications of preexisting muscular dystrophy; four, or possibly six, had Crohn's disease. Presumably the original disease was Crohn's colitis instead of ulcerative colitis. CONCLUSIONS: The results of the study suggested that this operation was not appropriate for Crohn's disease and underscored the importance and the difficulties of differentiating the two conditions, if they are indeed separate entities.

Adenomatous Polyposis Coli↗
PubMed1993

[Usefulness of subtotal colectomy with colorectal anastomosis for chronic ulcerative colitis].

Recently in Japan, most of surgeons have been performing restorative proctocolectomy with ileoanal anastomosis for ulcerative colitis, leaving unsolved problems with regard to postoperative complications. Analysis was made on subtotal colectomy with colorectal anastomosis with the following policies. Firstly, the inflammation of the remnant intestine could be easily and correctly controlled by medication in outpatient. Secondly, carcinomas associated with ulcerative colitis can be discovered by postoperative colonoscopic examinations. Operations were carried out to 26 cases of ulcerative colitis for the past 13 years. Subtotal colectomy with colorectal anastomosis were performed to 11 cases. Three cases of colorectal carcinomas associated with ulcerative colitis were experienced. One of the resected specimen was investigated using stereomicroscopy after alcian blue staining to formalin fixed one. As a result of this research, we have convinced that colorectal anastomosis should be favorable surgical potion to the cases of chronic ulcerative colitis because postoperative anal function and quality of life are excellent in our series, in addition, carcinomas in the remnant intestine can be probably easily found out at the early stage by annual colonoscopic examinations with dye staining.

Adolescent↗
PubMed1993

[Risk of development of colorectal carcinoma in patients with ulcerative colitis].

In patients with ulcerative colitis of prolonged duration and major extent there is according to the majority of investigations an increased risk of development of colorectal carcinoma; the magnitude of the risk which is of major importance for clinical practice, however, differs according to different authors. The present study comprises 189 patients with ulcerative colitis, 103 men and 86 women, perspectively followed up for a period of 12.5 years (8.0-24.5). In 60 patients the distal form was present, in 68 left-sided colitis and in 61 pancolitis. The patients were monitored systematically--clinically colonoscopically and endoscopically. The intervals between these check-ups were gradually shorter when the disease persisted for 10 or 12 years, i.e. the patients were checked once to twice a year. The endoscopic findings were focused in particular on evidence of dysplasia. The follow-up system was modified with regard to individual conditions. In the course of the follow-up colorectal carcinoma was detected in 9 patients (4.8%) with a persistence of the disease for 9-25 years (in one patient after 9 years, in 5 after 10-20 years and in 3 after longer periods). In three instances the left-sided form was involved, in 6 pancolitis. Dysplastic changes were mostly medium grade and were found at least once in all patients. The preoperative diagnosis of carcinoma was established for certain in three patients, there was major suspicion in four patients. In two patients the carcinoma was detected only on operation (in active forms of the disease). All carcinomas were resectable, 4 times DUKES A, 4 times B, once C. As to the remaining 180 patients, 32 were operated on account of colitis; in 28 at least once dysplasia was proved, with a rising trend as the disease had a prolonged duration. These results confirm the increased risk of carcinoma in ulcerative colitis with a long duration and with a major extent and justify systematic colonoscopic and endobioptic follow-up of these patients.

Adolescent↗
PubMed1993

[Salmonellosis and ulcerative colitis. A case report and review of the literature].

A propos of a case of intestinal infection due to Salmonella non typhi in a patient with ulcerative colitis, we have reviewed the disease and, therefore ran a search through the scientific literature in which we have found 16 cases of ulcerative colitis diagnosed in a clinical setting which began as an enterocolitis due to Salmonella. Bacteriological studies, clinical evolution and response to treatment, normally allow to differentiate between the two clinical entities. Colitis due to Salmonella and ulcerative colitis can coexist in the same patient. Duration of the clinical manifestations oven four weeks, previous history of diarrhea with blood, the sudden worsening of a mild prolonged diarrhea, non-response to specific antibiotic treatment and fast response to therapy with corticoids of a diarrhea positive isolation of Salmonella in stools, should make us immediately think in the coexistence of a subjacent ulcerative colitis. Treatment with steroids always must be associated with systemic antibiotics if Salmonella has been isolated just before or during their administration.

Adrenal Cortex Hormones↗
PubMed1993

Predictors and the rate of medical treatment failure in ulcerative colitis.

Eighty-nine admissions into Auckland Hospital with exacerbation of ulcerative colitis (between May 1985 and May 1991) were analyzed to determine the rate and any predictors of medical treatment failure. Twenty-five patients (28%) failed to respond to medical treatment and required surgery. Clinical information and laboratory indices available within 24 h of the admissions were compared between the patients requiring surgery and those who did not. There were no significant differences between the groups in sex distribution, age of onset of disease, duration of disease, hemoglobin concentration, or white cell count. However, "severe" diarrhea (chi 2 = 24.83, p = 0.0001), and lower albumin level (F1, 83 = 45.61, p = 0.0001) were noted in the surgical group. There was a tendency toward higher ESR (F1, 82 = 3.06, p = 0.08) and "extensive" colitis (chi 2 = 3.29, p = 0.07) in the patients requiring surgery. Univariate analysis confirmed albumin level and severity of diarrhea as significant discriminators. A discriminant function analysis showed that albumin level and severity of diarrhea would distinguish between surgical and nonsurgical outcome in 82% of cases. Distal colitis and mild to moderate diarrhea had negative predictive values of 80% and 91%, respectively, for nonsurgical outcome of acute ulcerative colitis. It is concluded that the above significant variables are good predictors of outcome of medical treatment for exacerbations of ulcerative colitis and that the proportion of patients needing surgery has not changed in the last 35 yr despite various management strategies.

Adult↗
PubMed1995

[Clinical manifestations and course of cytomegalovirus colitis in AIDS patients].

The clinical findings and course in 10 HIV-positive patients with cytomegalovirus (CMV) colitis were analyzed. Homosexuality was the main risk factor for HIV infection. All patients had markedly reduced CD4 counts (mean 25 x 10(9)/l). Symptoms at presentation were chronic diarrhea, weight loss, fever and abdominal pain. One of the patients had an abdominal mass in the ileocecal region due to inflammation as the leading symptom. Endoscopically the colitis was more often segmental than diffuse. In 2 out of 9 patients who underwent colonoscopy, only the right hemicolon was affected. Concurrent intestinal infections with up to 4 different pathogens were found in 7 patients. 5 patients had chorioretinitis as an extraintestinal CMV symptom (2 before, 3 after the occurrence of CMV-colitis). In only one patient was there a partial response of CMV-colitis to therapy with ganciclovir and foscarnet. Even under therapy CMV colitis was complicated in 2 patients by perforation and inflammatory stenosis respectively. Both needed surgical treatment. Most of the patients died of generalized CMV infection or wasting syndrome.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Immunological effect of immunoglobulin on experimental colitis induced by dextran sulfate].

To clarify the mechanism of action of immunoglobulin (IgG) in intravenous immunoglobulin therapy for ulcerative colitis (UC) patients, we studied the effect of IgG on the dynamics of immunocompetent cells in the colonic mucosa of experimental colitis induced by dextran sulfate sodium (DSS) in rats. The administration of the same species' IgG suppressed the mucosal infiltration of immunocompetent cells (activated T cells, macrophages and neutrophils), although the different species' IgG didn't. We have already shown that the same species' IgG, suppressed the production of inflammatory cytokines (TNF alpha, IL-1 alpha and IL-8) in the colonic mucosa of experimental colitis induced by DSS. In the present report, we demonstrated the different species' IgG, as well as same species' IgG, suppressed the production of inflammatory cytokines (TNF alpha and IL-1 alpha) from lamina propria mononuclear cells of rat large intestine in vitro. Therefore, it was considered that the suppression of cytokine production was a consequence of the decreased immunocompetent cells in colitis mucosa. Furthermore, we demonstrated that the DSS-treated antigen presenting cells (APCs) activated antigen-specific T cells as a possible mechanism underlying the colitis induced by DSS and the same species' IgG inhibited this activation of T cells.

Animals↗
PubMed1995

Adverse effects of sulfasalazine and treatment of ulcerative colitis with mesalazine.

We investigated the adverse effects of sulfasalazine in the treatment of inflammatory bowel disease in Japan. In our first survey, adverse effects were observed in 52 out of 751 patients with ulcerative colitis (6.9%) and in 8 out of 221 patients with Crohn's disease (3.6%); i.e., such effects were observed in 60 out of 972 patients with inflammatory bowel disease. In our second survey, we examined 94 adverse reactions in 64 patients with ulcerative colitis. The main adverse reactions were exanthema, fever, nausea and vomiting, angioedema, and liver damage, in decreasing order of frequency; these reactions accounted for about 80% of the adverse reactions. Most of the reactions (62%) occurred within 1 month after the beginning of sulfasalazine intake. Mesalazine is thought to effectively release the 5-ASA molecule in the colon and has already proven of value in patients with mild active ulcerative colitis. We evaluated the effect of mesalazine in patients intolerant to sulfasalazine. Effectiveness was observed in 14 out of 18 patients with active ulcerative colitis (78%) and in 3 out of 3 patients in the quiescent state. These results suggest that mesalazine is effective for the treatment of patients with ulcerative colitis who are intolerant to sulfasalazine; this drug could be a gleam of hope to those patients.

Adverse Drug Reaction Reporting Systems↗
PubMed1995

[Intestinal obstruction caused by ischemic colitis: description of 3 surgically treated cases].

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction who required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗
PubMed1996

Cytomegalovirus colitis in an immunocompetent old woman successfully treated with ganciclovir: a case report.

Cytomegalovirus (CMV) diseases occur almost exclusively in the immunocompromised hosts. Persons most commonly affected are patients with acquired immunodeficiency syndrome (AIDS). On rare occasions, however, CMV diseases can be seen in apparently immunocompetent persons. A CMV colitis in a 68-year old immunocompetent woman presenting with watery diarrhea, malaise, and body weight loss of about 5 kg over a three week period is reported. Colonoscopy and mucosal biopsy revealed CMV colitis involving the sigmoid colon. Treatment for two weeks with ganciclovir (10 gm/kg/day I.V. in 2 divided doses) resulted in resolution of colitis and clinical symptoms without any noticeable side-effects. There was no relapse of infection by six months of follow-up. The possibility of CMV colitis should be considered in any elderly person with watery diarrhea, general debilitation, marked body weight loss and with negative stool cultures. CMV colitis may be more frequent than is usually believed. It has a favorable response to ganciclovir without further relapse after the successful treatment in patients with normal immune function.

Aged↗
PubMed1995

[Treatment of diversion colitis with short-chain fatty acids. Bacteriological study].

OBJECTIVES: Bacterial imbalance may be involved in the pathogenesis of diversion colitis, via diminished production of short chain fatty acids. The aim of the study was to evaluate the effectiveness of short chain fatty acids on microbial flora of patients with diversion colitis and to compare this flora to the microbial flora of controls. METHODS: We prospectively evaluated the effectiveness of short chain fatty acids irrigation on bacterial flora of the excluded colon in 13 patients (8 males, 5 females; mean age: 43.7 years). The causes of diversion were inflammatory bowel disease (n = 4) colonic cancer (n = 2) sigmoid diverticulitis with perforation (n = 3) ischio-rectal abscess (n = 2) and miscellaneous (n = 2). Patients were given, twice a day for 14 days in a double blind manner, a 60 mL enema containing either short chain fatty acids (acetate: 60 mmol/L; propionate: 30 mmol/L; and n-butyrate: 40 mmol/L) (group 1; n = 7) or isotonic NaCl (group 2; n = 6). Bacteriological studies were carried on before starting the trial (D1) and 14 days later (D14). RESULTS: Before and after treatment, there was no difference between group 1 and group 2 concerning bacterial counts and species. Bacterial flora of patients with diversion colitis was characterized by: a) an increase of the count of aerobic bacteria; b) an increase of aerobic and aeroanaerobic species; c) the presence of black pigmented Gram negative anaerobic rods such as Prevotella intermedia and Porphyromonas asaccharolytica which were not found in rectal flora of the control group (16 volunteers, mean age: 27 years). CONCLUSIONS: These data suggest that: a) enema with short chain fatty acids does not induce significant changes in the composition of the microbial flora in patients with diversion colitis; b) bacterial dysbiosis may be involved in pathogenesis of diversion colitis without involving the action of short chain fatty acids.

Adult↗
PubMed1996

Concentrations of platelet activating factor in rectal mucosa in patients with ulcerative colitis.

OBJECTIVE: To find out if concentrations of platelet activating factor (PAF), which has been proposed as a mediator in the pathogenesis of ulcerative colitis and Crohn's disease, are increased in the rectal mucosa of patients with ulcerative colitis. DESIGN: Open study. SETTING: University hospital, Sweden. SUBJECTS: 45 Patients with ulcerative colitis (19 with active disease and 26 in remission), and 6 control patients and 11 healthy volunteers who acted as controls. INTERVENTIONS: Rectal biopsy. MAIN OUTCOME MEASURE: PAF content of rectal biopsy specimens. RESULTS: There were no differences between the PAF content of rectal mucosa in patients with active disease (median 47 pmol/g wet weight), patients in remission (47 pmol/g), and controls (51 pmol/g). There was no correlation between PAF content and inflammation seen endoscopically or histologically. 13 Patients who had active disease were investigated on a second occasion 9 weeks later (range 7-17), when in remission having received steroids but steroid-free at that time. There was a slight but not significant trend towards lower concentrations of PAF (median 33 pmol/g) compared with their previous results, possibly as a result of treatment. PAF concentrations were significantly lower than those of a group of patients in clinically stable remission of longer duration (p < 0.05). CONCLUSIONS: We did not find high concentrations of PAF in the rectal mucosa of patients with active ulcerative colitis compared with patients in remission or controls. We therefore have no evidence that PAF has an important role as a mediator in the inflammation of ulcerative colitis.

Adult↗
PubMed1996

Ulcerative colitis: pathogenesis, diagnosis, and current treatment.

Ulcerative colitis is a chronic inflammatory disease of the colon that affects the rectum and a variable length of contiguous colon. The disease is characterized by rectal bleeding and diarrhea during periods of exacerbation; these symptoms usually abate with treatment. The pathogenic mechanism of ulcerative colitis is believed to be an aberrant immune response in which antibodies are formed against colonic epithelial protein(s). The disease usually presents during the second and third decades of life, with a smaller peak after the age of 60 years. There is a genetic component to ulcerative colitis, with a higher incidence among family members and, particularly, first-degree relatives. Diagnosis depends on several factors, most notably symptoms, demonstration of uniformly inflamed mucosa beginning in the rectum, and exclusion of other causes of colitis, such as infection. There is no medical cure for ulcerative colitis, but medical therapy is effective and can improve or eliminate symptoms in more than 80% of patients. Surgery offers a cure but carries the high price of total colectomy. New surgical methods, such as ileoanal anastomosis, allow for maintenance of bowel continuity and better patient satisfaction.

Aminosalicylic Acids↗
PubMed1996

[Clinical evaluation of 99mTc-HMPAO labeled leukocyte imaging in ulcerative colitis].

Inflammatory imaging using 99mTc-HMPAO-labeled mixed leukocytes was assessed for use in treating 11 cases diagnosed as ulcerative colitis: 10 cases with total colitis and 1 with left-sided colitis. They consisted of 8 patients with relapse-remitting type and 3 with chronic continuous type. Radionuclide abdominal images were obtained at 1 hr, 4 hr and 24 hr after intravenous injection of 200 MBq prepared 99mTc leukocytes. Obvious colonic activity noted at 4 hr served as the basis for positive comparative criterion in the present study. The diagnostic efficacy of radionuclide imaging was compared with endoscopic findings (based on Matts' classification) and the clinical manifestations as reference. The sensitivity and specificity of this imaging were 83.3% and 85.7%, respectively, these values being consistent with endoscopic findings and clinical manifestations at sites of disease activity. All of positive images changed to negative after treatment by leukocyte apheresis or glucocorticoid. Based on these results, 99mTc leukocyte imaging can be used to accurately evaluate severity and treatment response in ulcerative colitis. Leukocytes may be closely related to the pathogenesis of ulcerative colitis.

Adolescent↗
PubMed1996

Four new cases of collagenous colitis with joint symptoms.

Collagenous colitis is characterized by chronic watery diarrhea and a greater than 10 micron-thick collagen deposit in the subepithelial layer of the colonic mucosa. Rheumatic and autoimmune diseases have been reported to occur in patients with collagenous colitis. In 1993, we managed four patients with collagenous colitis and joint diseases. One had rheumatoid arthritis, one had a spondylarthropathy and two had seronegative polyarthritis without joint destruction. Three patients had dryness of the eyes and/or mouth and two had Raynaud's phenomenon. These four cases and data from a literature review provide a basis for discussing possible links between collagenous colitis and a number of joint diseases. Although some anecdotal case-reports may reflect a chance association with inflammatory joint diseases, available evidence suggests that collagenous colitis may be a cause of enteropathic arthropathy. Recent data point to an abnormality in the differentiation of fibroblasts in the colonic mucosa, although the mechanism that initiates this abnormality remains unknown.

Adult↗
PubMed1997

Dysregulated intrathymic development in the IL-2-deficient mouse leads to colitis-inducing thymocytes.

Gene-targeted mice lacking the IL-2 gene (IL-2 -/- mice) develop various forms of autoimmunity as well as severe colitis, either spontaneously in a conventional environment or after immunization with 2,4,6-trinitrophenol (TNP)-conjugated keyhole limpet hemocyanin (KLH) in a specific pathogen-free environment. We show here that the induction of colitis with TNP-KLH induces a change in the thymocyte population characterized by decreased numbers of double positive (DP; CD4+CD8+) thymocytes (IL-2 +/+, 45.2 x 10(6) vs IL-2 -/-, 23.6 x 10(6)) and increased numbers of single positive (SP; CD4+CD8- or CD4-CD8+) thymocytes (IL-2 +/+, 5.3 x 10(6) vs IL-2 -/-, 20.9 x 10(6)). The latter also bear activation markers. In addition, thymocytes from TNP-KLH-immunized IL-2 -/- mice produce more IFN-gamma and less IL-4 than similarly immunized IL-2 +/+ mice. These defects in thymocyte maturation and lymphokine production are IL-12 driven, since they are prevented when immunized IL-2 -/- mice are coadministered with anti-lL-12. Furthermore, we demonstrate that IL-2 -/- mice exhibit decreased cortical apoptosis as determined by thymocyte numbers and detection of apoptotic cells in situ. Finally, we show that colitis-inducing thymocytes are generated in the immunized IL-2 -/- thymus, since IL-2 +/+ mice develop colitis following injection of small numbers of single positive thymocytes from immunized IL-2 -/- mice but not from IL-2 +/+ mice. Taken together, these data indicate that, in the absence of IL-2, thymocyte maturation is abnormally directed by IL-12 toward the generation of mature, activated Th1-type thymocytes that are capable of mediating colitis.

Animals↗
PubMed1996

[Surgically treated severe acute inflammatory colitis. Immediate results and long-term outcome].

UNLABELLED: The goal of this study was to analyse the management and the long-term evolution of 40 patients surgically treated for acute colitis (AC) during a 10 year period. PATIENTS AND METHODS: From June 1985 to June 1995, 40 patients (22 males and 18 females, mean age: 33,5 y.o.) have been consecutively operated on for AC. Assessment of severity was based on clinico-biological, endoscopic and radiological criterias: AC was complicated in 3, failing to respond to medical therapy in 9, resisting to medical therapy in 28. Sub-total colectomy (STC) with ileostomy and sigmoidostomy was the most frequently performed procedure (27 cases-68%). RESULTS: 1) The preoperative diagnosis of colitis was modified 6 times (15%) after histological assessment of the specimen: the final diagnosis was ulcerative colitis, indeterminate colitis and Crohn colitis respectively in 36 (90%), 2, and 2 cases. The established diagnosis had to be modified 4 times during follow-up. 2) Postoperative complications occurred in 5 after STC (18%) and in 4 in the other procedures (31%), without mortality. 3) After a mean follow-up of 55 +/- 10 months of the all series, 7 patients (17,5%) had a stoma: 2 had ileo-anal anastomosis taken down and 2 returned to ileostomy for Crohn disease, 1 patient with protected ileo-rectal anastomosis stayed with an ileostomy, 1 patient refused ileo-anal anastomosis, and 1 with imperforate anus had terminal ileostomy. Respectively 25, 6 and 2 patients had a functional ileo-anal, ileo-rectal, and colo-rectal anastomosis and experienced good to excellent digestive comfort in 85% of the cases.

Acute Disease↗
PubMed1996

[Functional diarrheas are not, in most cases, minor clinical forms of lymphocytic or collagenous colitis].

AIM: The aim of the study was to test the hypothesis that some patients with functional diarrhea could actually suffer from a mild clinical pattern of collagenous or lymphocytic colitis. PATIENTS AND METHODS: Twenty consecutive patients with chronic diarrhea were included in the study if the colonic mucosa appeared normal during colonoscopy. From multiple colonic biopsies were established a conventional histological diagnosis and a quantitative histological diagnosis. This latter diagnosis was based on the semiquantitative evaluation of epithelial morphological alterations and lamina propria monocellular infiltration, and on the determination of both intraepithelial lymphocyte count and subepithelial collagen layer thickness. Multiple colonic biopsies from 12 control patients without diarrhea were analyzed according to the same protocol. RESULTS: Among the 20 patients with diarrhea, the quantitative diagnosis of collagenous colitis was made in 3 patients (thickness of the collagen band between 11 and 26 microns) and the diagnosis of lymphocytic colitis in one (21% of intraepithelial lymphocytes). The percentage of intraepithelial lymphocytes did not differ between the 16 remaining patients and the controls (12 +/- 5% and 9 +/- 4%, respectively). Similarly, the score of surface epithelial damage and the score of lamina propria infiltration in patients with diarrhea (1.2 +/- 1.0 et 1.7 +/- 1.5) were not different from the values in the control group (1.3 +/- 1.3 et 1.5 +/- 1.2). The mean fecal weight in patients with diarrhea but without colitis was 161 +/- 130 g/d. All the values of fecal weight were below 300 g/d, except in one patient with a past history of truncular vagotomy. CONCLUSIONS: These results suggest that most of the patients with functional diarrhea do not suffer from mild clinical patterns of collagenous or lymphocytic colitis.

Adult↗