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PubMed2006

Pathological analysis of lesions within intestines resected due to ulcerative colitis.

INTRODUCTION: Ulcerative colitis (UC) and Lesniowski-Crohn's disease together constitute a type of intestinal pathology known as Inflammatory Bowel Disease. The etiology of UC still remains unknown, however some epidemiological data suggest the role of bacteria and viruses and also some habitual as well as environmental factors like smoking, diet, drugs, geographical and social status, as well as stress. The genetic predisposition is also suggested. UC affects young people in 2nd - 4th decades of life. Exacerbations of the disease may result in the necessity of surgical treatment, typically in the form of total proctocolectomy accompanied by the subsequent formation of ileo-pouch-anal anastomosis. The aim of our study was to analyze morphological pictures of resected specimens. MATERIAL AND METHODS: We analyzed 67 cases (40 women and 27 men) of UC with the special interest being focused at macro- as well as microscopic features of the intestines resected. We reviewed macroscopic characteristics of intestines (i.e. the length of resected fragments, localization, shape and diameter of the ulcers, polyps, number of resected lymph nodes), as well as microscopic descriptions concerning, among others the character and localization of inflammatory infiltrate, the architecture of glands, the presence of crypt abscesses and Paneth's metaplasia. Special attention was paid to the morphology of intestinal wall vasculature. RESULTS: In 42% of the cases macroscopically the inflammation covered the whole length of the resected colon. In 58% macroscopically detected inflammatory changes were segmental in distribution. In four cases the disease had clinically the fulminant course and the inflammation was transmural. There were 3 cases, in which histological assessment revealed the presence of malignancy (2 cases of mucus producing adenocarcinoma and one case of carcinoma in situ situated in the anal canal). Generally, microscopic findings were typical for the active phase of UC. We found intensive vascularization and hyperemia of the intestinal wall to be the common features accompanying the inflammation. CONCLUSIONS: Young people in the 3rd and 4th decades of life constitute the group being relatively commonly affected by the UC, and undergo the surgical proctocolectomy. Some of the cases present with the fulminant course of the disease. A rich vascular network is a common finding in the inflamed intestinal wall. We hypothesize, that intensive vascularization may play a significant role in the pathogenesis of UC.

Adolescent↗
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↗
PubMed1988

Mucin profiles in ulcerative colitis with dysplasia and carcinoma.

Mucin secretion was assessed in Crohn's colitis, in ulcerative colitis with regeneration, dysplasia and carcinoma and in non-colitic adenocarcinoma. The high iron diamine-alcian blue (HID-AB) and periodate borohydride-saponification periodic acid Schiff (PB-KOH-PAS) techniques were used to demonstrate sulphomucins and sialomucins, and O-acylated sialomucins respectively. There was mucosal hyperplasia and increased sialomucin secretion in Crohn's disease, quiescent and active ulcerative colitis. In colitis with carcinoma inflamed mucosa away from the tumour had increased sialomucins as had colitis with dysplasia. They did not differ statistically from each other or from colitic controls without cancer. Dysplastic crypts frequently secreted sulphomucins and the increased sialomucins were in transitional-like glands in the surface fronds or adjacent to the dysplasia. A comparative study of the HID-AB technique gave total correct qualitative allocation of individual quantitatively assessed crypts. Routine HID-AB staining did not aid the recognition of dysplasia in ulcerative colitis. With the PB-KOH-PAS technique colorectal adenocarcinoma showed a significant diminution in O-acylated sialomucins compared with its adjacent mucosa. Mucosal dysplasia in ulcerative colitis displayed a similar trend in O-acylated sialic acid variants, differing with respect to age-and sex-matched colitic controls. The PB-KOH-PAS technique may be of help in assessing mucin secretion in ulcerative colitis as a guide to the evolution of malignancy.

Adenocarcinoma↗
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↗
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↗
PubMed1987

[An experiment of acute fulminant severe ulcerative colitis in a 75- year-old male--a case report and a consideration of the surgical treatment of elderly patients with severe ulcerative colitis].

This is a case report of 75 year-old male patient with acute fulminant severe ulcerative colitis who underwent proctocolectomy after emergency ileostomy and decompression colostomy, and consideration of surgical treatment for elderly patients with severe ulcerative colitis are also discussed. A 75 year-old male was hospitalized as emergency case with complaints of high fever, severe abdominal pain and diarrhea. He was diagnosed as acute fulminant ulcerative total colitis by colonoscopy and barium enema examination. He had urgent operation of ileostomy and decompression cecostomy in the presence of severe disease after intensive medical treatment had failed. After a few days toxic signs gradually disappeared and general status was slightly improved. And then, radical operation of proctocolectomy and permanent ileostomy was successfully performed 3 weeks after the previous operation. We wish to emphasize in the elderly patients, namely 60 years and over with severe ulcerative colitis, that radical surgical treatment such as proctocolectomy or total colectomy should be performed after minimal laparotomy with decompression colostomy and ileostomy, because they do not survive so readily as the younger patients.

Acute Disease↗
PubMed1994

Mesalamine capsules enhance the quality of life for patients with ulcerative colitis.

Patients with ulcerative colitis tend to be young, potentially at peak lifetime productivity levels, and the disease can be devastating in its effects on the quality of life in these individuals. No treatment for ulcerative colitis can be comprehensively evaluated without careful attention to its impact on such psychosocial issues. The quality of life was evaluated in 374 ulcerative colitis patients using mesalamine capsules at 1 g, 2 g, and 4 g daily versus placebo in an 8-week, randomized, dose-response, placebo-controlled, double-blind, multicentre trial. Function-related quality of life parameters were assessed in this study, including five pertinent clinical symptoms and seven general life capabilities. These parameters have been previously shown to be valid, reliable, and responsive to the disease activity of ulcerative colitis. All of the parameters were recorded using a 10-cm visual analogue scale, except trips to the toilet which were recorded in patients' diaries. The mean change was calculated from baseline and endpoint data. Mesalamine at 2 g and 4 g daily was significantly superior to placebo in improving each of the 12 quality of life parameters (P < 0.05). These results indicate that controlled-release mesalamine significantly enhances the quality of life for patients with either left-sided ulcerative colitis or pancolitis.

Administration, Oral↗
PubMed1986

Ulcerative colitis and sarcoidosis.

Ulcerative colitis is not commonly associated with recognizable pulmonary disease and only four sporadic cases of sarcoidosis in association with ulcerative colitis have been previously reported. However, in a series of 680 patients with ulcerative colitis, pulmonary or extra-pulmonary sarcoidosis has at some stage been present in eight. These cases are reported in detail. The onset of either condition bore no relationship to the activity or the presence of recognized peripheral manifestations of the other, suggesting that the two diseases were independent. However, three of the patients had the HLA B8 DR3 phenotype which is a higher prevalence than seen in previous studies of either disease alone. Patients with ulcerative colitis who possess this HLA phenotype may possibly be more susceptible to developing sarcoidosis.

Adult↗
PubMed2004

Risk factors for carcinoma of the pelvic ileal pouch/anal canal in ulcerative colitis.

Patients with ulcerative colitis who undergo proctocolectomy and an ileal anal anastomosis (IPAA) require surveillance; dysplasia and carcinoma occur in both the small intestinal mucosa of the ileal pouch and the retained rectal mucosa as early as 2 yr after ileostomy closure. This study evaluated risk factors for carcinoma (eg, dysplasia, p53 overexpression, labeling index, and aneuploidy) in the small intestinal and rectal mucosa. Thirty patients (age 14-64 yr) with ulcerative colitis and IPAA were studied. The mean duration of ulcerative colitis prior to IPAA was 3 yr (range 6 mo-21 yr). Patients were followed by annual endoscopy and biopsies of the ileal pouch and rectal mucosa. Sections of small intestine and rectal mucosa were evaluated for inflammation and dysplasia, and by immunohistochemical stains Ki-67 (MIB-1) for a labeling index and for p53. Ploidy determination was performed by flow cytometry. Active inflammation of the small intestinal mucosa and the rectal mucosa was frequent and the labeling index of both the pouch and rectal mucosa was abnormal. Two patients had changes indefinite for dysplasia, one involving the small bowel mucosa of the pouch and the other the retained rectal mucosa. Fifteen of the 30 patients had overexpression of p53, 9 from the pouch, and 6 from the rectal mucosa. Overexpression of p53 was seen in both of the patients with indefinite dysplasia. Aneuploidy was noted in 3 patients: two from the pouch and one from the rectal mucosa. All aneuploidic specimens were p53-positive, but negative for dysplasia. In conclusion, most biopsies of the ileal pouch and rectal mucosa were inflamed. The labeling indexes of the small bowel and rectal mucosa were higher than normal. The risk factors for carcinoma (dysplasia, overexpression of p53, and aneuploidy) occurred in the small intestinal and the rectal mucosa. Overexpression of p53 was noted in 16 patients, dysplasia only in 2. Therefore, p53 overexpression and aneuploidy should be considered in the evaluation of surveillance biopsies of patients with ulcerative colitis with IPAA, whereas dysplasia is an insensitive marker.

Adolescent↗
PubMed2000

Toxic pseudomembranous colitis in a patient with ulcerative colitis.

UNLABELLED: Toxic colitis is a severe disease that may be caused by several inflammatory and/or infectious diseases. Ulcerative colitis is one of the most frequent causes of toxic colitis in the United States. Toxic megacolon complicating Clostridium difficile colitis is a rare occurrence with significant morbidity and mortality. CASE REPORT: A 52-year-old male presented with rectal bleeding and tenesmus. He had been treated for amebiasis with metronidazole, and had improved. Two weeks later, symptoms recurred, and he was referred to our hospital. A sigmoidoscopy and biopsies demonstrated mucosal ulcerative colitis. He underwent treatment with systemic prednisone, mesalamine, and hydrocortisone enemas with adequate response. He was asymptomatic for 2 months, but later presented with a tender abdomen and rectal bleeding. Plain abdominal and thorax films showed colonic distention and free intraperitoneal air. Emergency laparotomy was performed, and an inflamed and distended colon, with free inflammatory liquid in the peritoneum, was found. A total abdominal colectomy with temporary ileostomy and Hartmann's pouch was performed. The histopathology analysis demonstrated a Clostridium difficile pseudomembranous colitis. CONCLUSION: The presence of toxic megacolon due to Clostridium difficile in patients with ulcerative colitis is a rare complication that may be suspected in patients with initial relapse who are on antibiotics.

Abdominal Pain↗
PubMed2004

Surgical Indications and Procedures in Ulcerative Colitis.

Chronic ulcerative colitis (CUC) is an inflammatory bowel disease limited to the mucosa of the rectum and colon. The inflammation begins in the rectum and progresses uninterrupted for variable distances. To date, no etiologic factor has been identified. However, population studies suggest there is both a genetic and environmental component contributing to the development of CUC. The natural history is one of a chronic inflammatory state, characterized by intermittent flares of disease activity. In a small number of patients, the initial presentation of CUC is of a fulminant nature. Medical therapy for the intestinal manifestations of CUC is directed at controlling symptoms through treatment of the underlying inflammatory process. Medical therapy is not curative for either the intestinal or extraintestinal manifestation of CUC. However, surgical removal of the colon and rectum cures the intestinal manifestations of the disease and eliminates or markedly reduces the associated risk of malignancy in longstanding CUC. The indications for surgical intervention are divided into two broad categories that influence the type of surgery performed: emergent and elective surgery. Emergency operations are directed at life-threatening complications of CUC and are not intended as definitive surgical treatment for CUC. Alternatively, elective surgery is intended as definitive treatment for the intestinal component of the disease. In appropriately selected patients, the best surgical treatment option is the total proctocolectomy with an ileal pouch-anal anastomosis (IPAA). The IPAA avoids the need for a permanent stoma and maintains the normal route of defecation. This is a technically demanding operation and should be performed by surgeons comfortable with the procedure. The severity and frequency of complications related to IPAA have decreased significantly since the introduction of the operations in the early 1980s. More importantly, long-term follow-up of IPAA patients has demonstrated that the functional results are durable and patient satisfaction remains high.

Journal Article↗
PubMedDate not supplied

Ulcerative colitis and malignancy.

Ulcerative colitis is associated with an increased risk for colorectal cancer. The increase is approximately six to ten times the expected in the general population. Disease duration and extension are the major risk factors. Concomitant primary sclerosing cholangitis is an additional independent risk factor. The relative risk is approximately 14.8 for patients with pancolitis while it is 1.7 for patients with disease restricted to the rectum. The risk increases rapidly after 20 years of disease evolution. Active treatment might decrease the risk. The increased cancer risk is a major problem for longterm management of patients with ulcerative colitis. It is the rationale for various surveillance programs and the search for dysplasia. Two major types of dysplasia must be distinguished in ulcerative colitis: sporadic adenomas and ulcerative colitis-associated dysplasia. Sporadic adenomas can be treated by simple polypectomy. The diagnosis of dypsplasia relies mainly on microscopic analysis of biopsy samples. Additional techniques, including flow cytometry and the search for DNA abnormalities and immunohistochemistry or molecular techniques looking for genetic defects can help to improve the diagnostic yield.

Colitis, Ulcerative↗