SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Ulcerative colitis has a number of associated skin lesions. We report the case of a patient with active ulcerative disease presenting with rapidly progressive necrotic skin lesions, identified as thrombotic and requiring skin grafting. Thrombotic cutaneous gangrene is a rare but potentially serious manifestation of uncontrolled ulcerative colitis.
BACKGROUND & AIMS: The pathogenesis of ulcerative colitis and Crohn's disease is still unclear. Vascular injury has been suggested as a potential pathogenetic mechanism. Serum thrombomodulin is a marker of endothelial cell injury. The aim of this study was to determine the relevance of increased serum thrombomodulin levels for assessing disease activity in inflammatory bowel disease. As a potential cause of serum thrombomodulin level increase, the loss of local vascular thrombomodulin expression was investigated immunohistochemically. METHODS: Thrombomodulin levels were determined by enzyme-linked immunosorbent assay in sera from patients with ulcerative colitis, Crohn's disease, Schistosoma mansoni infection, and infectious diarrhea and controls. The vascular expression of thrombomodulin was investigated immunohistochemically in fresh frozen transmural specimens of normal, Crohn's, and ulcerative colitis bowel samples. RESULTS: Significantly elevated serum thrombomodulin levels were only detected in active ulcerative colitis and infectious diarrhea complicated by septicemia. A marked and general loss of vascular endothelial cell thrombomodulin expression was found immunohistochemically in inflamed bowel tissues. Graded by a newly established thrombomodulin staining index, this was significantly more marked in ulcerative colitis than Crohn's disease. CONCLUSIONS: Serum thrombomodulin proved to be a novel marker of disease activity in ulcerative colitis closely related to local vascular endothelial cell damage, which might be a relevant pathophysiological feature of ulcerative colitis.
Thrombophlebitis migrans complicating ulcerative colitis has been reported only once previously when it occurred in a patient with chronic and extensive bowel disease. This report describes the occurrence of thrombophlebitis before any bowel upset in a patient who proved to have only a mild colitis, and no laboratory evidence of hypercoagulability. It seems that thrombophlebitis migrans is a further systemic complication of ulcerative colitis, and that its occurrence may precede overt bowel disease.
Patients with ulcerative colitis (UC) have a less frequent prior history of appendectomy than the general population. The aim of the present investigation was to elucidate histological and immunological characteristics of the appendix in UC and to assess the effect of appendectomy on the disease. Nine subjects with mildly active UC were treated by surgical appendectomy. In four subjects, the histological findings of the appendix were compatible with ulcerative appendicitis. CD3+CD4+CD25+, CD3+CD4+CD45RO+, and CD3+CD8+CD45RO+ appendiceal mononuclear cells were significantly higher in UC than in acute appendicitis and in normal appendix. There was a trend towards higher mRNA transcripts of IFN-gamma in the appendix of UC than those in other two groups. Clinical activity index decreased significantly four weeks after the appendectomy, although the effect was transient. The appendix is a site of involvement in UC, where mononuclear cells are presumed to be at a state of basal activation.
BACKGROUND: Patients with active ulcerative colitis are treated with corticosteroids. We compared the efficacy and safety of intramuscular depot preparation of methylprednisolone acetate with oral prednisolone in the treatment of moderately active ulcerative colitis. DESIGN: Open labeled, randomized, prospective, four-month study. METHODS: 40 patients with moderately active ulcerative colitis (activity index 150-220) were randomized into two groups. Group A (n=21) received methylprednisolone acetate (80 mg intramuscularly once weekly for 6 weeks). Group B (n=19) received oral prednisolone (40 mg/day) in a 'tailing-off' regimen. In addition, patients in both the groups received sulfasalazine. Patients were followed up at 1, 2, 3, 4, 8, 12 and 16 weeks. The primary measure of therapeutic response was activity index. An index of <150 was considered as clinical remission. Secondary efficacy was assessed by subjective evaluation of acceptability of treatment by the patient. RESULTS: After one week of treatment, the decrease in mean activity index was significantly more with oral prednisolone (p<0.05), and five 5 patients (23.8%) in Group A and 12 (63.2%) in Group B were in clinical remission (p<0.05). However, after 2 weeks and beyond, the mean activity index and the number of patients with clinical remission were comparable in the two treatment groups. CONCLUSIONS: Methylprednisolone acetate as a depot preparation and oral prednisolone are equally effective in inducing remission in patients with moderately active ulcerative colitis. Though symptomatic improvement is quicker with oral prednisolone, the remission rate with the two drugs was similar after 2 weeks of treatment.
The cotton-top tamarin (CTT; Saguinus oedipus) is an endangered New World primate that develops a highly prevalent idiopathic colitis resembling human ulcerative colitis. This study found that enteropathogenic Escherichia coli (EPEC) caused acute colitis in CTTs, which was associated with ulcerative colitis. EPEC clinical isolates revealed localized adherence patterns by HEp-2 assay and were devoid of Shiga-toxin production. Sequencing of the eae gene (GenBank accession no. AF319597) revealed 99.2% identity to sequences of human isolates (GenBank AF116899) and corresponded to the epsilon intimin gene subtype. Detection of intimin sequences by polymerase chain reaction on primary fecal cultures indicated widespread EPEC infection in the CTT colony. Prospective analysis revealed that animals with fecal cultures positive for intimin sequences had a higher frequency of active colitis (75.0% vs. 27.2%; P<.005, chi(2) test) and higher histological scores of colonic inflammation (0.875 vs. 0.455, respectively; P<.05, Mann-Whitney rank sum test).
Patients with pancolonic chronic ulcerative colitis are at increased risk to develop carcinoma of the colon. Controversy continues, however, as to whether this carcinoma is more "virulent" than "type ordinaire" carcinoma of the colon and as to the best way to manage these patients. This study reviews the characteristics and survival of 70 patients with cancer of the colon superimposed on chronic ulcerative colitis. Patients with carcinoma identified incidentally during prophylactic colectomy for chronic ulcerative colitis fared well (5-year survival of 72 per cent), while those with clinical symptoms or radiographic suggestion of cancer had a poor survival rate (5-year survival of 35 per cent). Patients with panproctocolitis, 10 years of disease, and early onset of disease are most likely to have cancer superimposed on chronic ulcerative colitis. This cancer is likely to have a poorer prognosis than type ordinaire cancer of the colon. Prophylactic proctocolectomy should be considered before evidence suggesting carcinoma develops.
Most patients with ulcerative colitis respond well to medical treatment, however surgical treatment may be required in cases with severe clinical symptoms. We treated eight patients with distal ulcerative colitis (DUC), limited to the rectum and distal sigmoid colon, who were treated at St. Mark's Hospital by excision of the rectum and sigmoid colon with permanent colostomy. Four who did not respond to medical treatment and had severe and intermittent symptoms of long-standing, three with no control of the distressing diarrhea with a shorter history, and those with a severe dysplasia evidenced by rectal biopsy were surgically treated. Two of eight had a recurrence at the proximal colon within 6 and 10 years respectively but responded well to conservative management. From these observations it concluded that the procedure for patients with DUC may be one of adequate operations. Histological features of the resected specimens did not relate to the postoperative outcome of these patients.
In patients with ulcerative colitis Proteus could be isolated from all the gastrointestinal portions studied: mouth cavity, stomach, small intestine, small intestinal mucous membrane, and mostly from faeces. In some patients with ulcerative colitis a decrease in membraneous hydrolysis of polysaccharides was noted. Severe Proteus dysbiosis was associated with a sharp decrease in absorption processes at the small intestinal mucous membrane. The Proteus strains obtained from the patients belonged mostly to 3 serogroups: OA, OB, OC. Studies in virulent properties of Proteus in experiments with white mice gave positive results in 96% cases. Enterotoxin could be found in no case. As the result of vaccinal therapy in most patients disappearance or decrease of signs of malabsorption, increase in weight, stool normalization, and better hematological indices was manifested.
Anorectal function in ulcerative colitis was assessed by measuring pressures at multiple sites in the anus and rectum under basal conditions and during balloon distention of the rectum in 29 patients with ulcerative colitis (12 active, 11 quiescent, and 6 during both phases) and in 12 normal controls. Resting and squeeze sphincter pressures were similar in the three groups. The lowest rectal volume that could be perceived, the volume required to induce a desire to defecate, and the maximum tolerable rectal volume were all lower in patients with active colitis than in patients with quiescent colitis (p less than 0.001) and controls (p less than 0.001). The rectal volume required to cause a sustained anal relaxation was lower in patients with active colitis (p less than 0.05) than in controls. Both peak and steady state rectal pressures in response to rectal distention were significantly higher in patients with active colitis than in patients with quiescent colitis (p less than 0.05) and controls (p less than 0.02). Paired studies showed that during remission of disease there was a decrease in rectal sensitivity (p less than 0.05) and an increase in rectal compliance (p less than 0.05). These results suggest that the frequent and urgent defecation, i.e., the predominant feature of active colitis, is related to a hypersensitive and poorly compliant rectum, which, upon distention, is more reactive and is more likely to induce prolonged sphincter relaxation.
Although histologically relapses in ulcerative colitis are characterized by an intense granulocyte infiltrate, there is evidence both from in vitro function tests and skin window migration studies in vivo that there is defective granulocyte function in ulcerative colitis. We have recently developed a method for non invasively monitoring granulocyte migration to sites of inflammation using indium-111-labelled granulocytes, and have used this technique in fifteen patients with ulcerative colitis. In all fifteen cases there was rapid migration of indium-111-labelled granulocytes to inflamed bowel within 10 min of return of the labelled cells. This study provides no support for a significant granulocyte migration defect in ulcerative colitis.
The courses of 38 patients with severe, uncomplicated acute colitis (16 with Crohn's colitis and 22 with ulcerative colitis) were analyzed retrospectively. The patients were placed on total parenteral nutrition and treated concomitantly with corticosteroids, antibiotics (often metronidazole), sulfasalazine, and/or azathioprine. Fifteen of the 16 Crohn's colitis patients were initially managed without surgery. Four patients subsequently relapsed, two responded to reinstituted medical therapy, and two underwent colon resection 2 and 4 years later. Of 22 ulcerative colitis patients, 16 required surgery during the initial hospitalization, one patient subsequently had surgery, and one died after refusing surgery. Three of the other four continue in remission on medical therapy. Thus, there were significant differences in this series between the clinical courses of severe ulcerative colitis and severe Crohn's colitis. While most of the ulcerative colitis patients with severe disease underwent colectomy, most of the patients with severe but uncomplicated Crohn's colitis responded to aggressive medical therapy, of which total parenteral nutrition and perhaps bowel rest seemed to be an important part. Afterwards, the majority remained in remission on long-term medical therapy.
Four patients with ulcerative colitis also had primary biliary cirrhosis, as judged by compatible liver histology, positive serum mitochondrial antibody tests, and normal cholangiography (in the 3 patients in whom it was performed). Primary biliary cirrhosis may be another hepatobiliary association of ulcerative colitis, and although less common than primary sclerosing cholangitis should be considered as a cause of cholestasis in these patients.
BACKGROUND & AIMS: Ulcerative colitis is a debilitating disease for which colectomy is curative. Racial disparities have been described for a wide spectrum of surgical procedures. The goal of this study was to characterize racial and geographic differences in colectomy rates among hospitalized ulcerative colitis (UC) patients. METHODS: We analyzed discharge records from the Nationwide Inpatient Sample, the largest representative sample of acute care hospitals throughout the United States. A total of 23,389 discharges with UC from 1998-2003 were included for analysis. Colectomy rates, in-hospital mortality, and length of stay were calculated for non-Hispanic whites, African Americans, and Hispanics. RESULTS: After adjustment for age, gender, health insurance, comorbidity, and hospital characteristics, the colectomy rate ratios for African Americans and Hispanics compared with whites were 0.46 (95% confidence interval, 0.35-0.60) and 0.74 (95% confidence interval, 0.59-0.93), respectively. African Americans experienced a longer interval between admission and colectomy than whites (8.8 vs 5.6 days, P=.02). There were also significant geographic variations in colectomy, with the West and Midwest regions yielding rates 3-fold higher than the Northeast. Although adjusted in-hospital mortality did not differ by race, Medicaid patients had 3.3-fold higher mortality than those with private insurance. Between 1998 and 2003, the colectomy rate decreased among whites but not African Americans and Hispanics. A temporal narrowing of geographic variation in colectomy was also observed. CONCLUSIONS: The rate of colectomy among hospitalized UC patients varies significantly by race and geographic location. Further studies are needed to elucidate the social and biologic underpinnings of these variations.
The association of ulcerative colitis with Takayasu's arteritis is rarely reported. The occurrence of the two together is possibly related to a common pathophysiology involving alteration in immune mechanisms. Takayasu's arteritis is more prevalent in Japan and South East Asia whereas Ulcerative Colitis is more in Western countries. The coexistence of these two diseases is uncommon and hence this report.
Relapsing polychondritis and Ulcerative Colitis is an uncommon association that has been described only ten times in medical literature. We report a new case of this association in which it was necessary to treat with azathriopine to stop disease progression. Relapsing Polichondritis is a disorder to be considered in patients with Ulcerative Colitis and inflammation of the cartilagenous structures.
The treatment of ulcerative colitis (UC) remains empiric because of undetermined etiology and pathogenesis and incomplete understanding of the underlying immunoinflammatory events. However, considerable progress has been made in the management of this disease with the availability and wider use of newer aminosalicylates and immunomodulating agents. The clinician confronted with a patient with chronic ulcerative colitis must weigh the advantages of continued medical therapy against the potential curability with improved surgical techniques. After a brief discussion of the current classes of medicines and their pathophysiological basis of action, we focus on standard approaches to the different clinical syndromes and their complications.
Endoscopic findings of ulcerative colitis are classified into three groups according to the degree of inflammation, i.e. mild, moderate and severe. 1)mild: Edema, erythema, yellow spots, fine granular appearance are conspicuous signs of early disease. The mucosal vascular pattern disappears. 2)moderate: Coarse mucosa with mucous, pus, blood are characteristic findings. Erosions or shallow ulcers are scattered. The erythematous mucosa is friable and bleeds easily. 3)severe: There are deep, widespread ulcers. Marked bleeding is seen from granulation tissue of ulcer base. We remind that inflammation often take a turn for the worse due to endoscopic examination. Total colonoscopy is not always necessary in the cases of ulcerative colitis.