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PubMed1990

Epithelial deposition of immunoglobulin G1 and activated complement (C3b and terminal complement complex) in ulcerative colitis.

The epithelial destruction seen in ulcerative colitis remains unexplained. Complement activation has been proposed to be involved, but no definite evidence has been available to this end. In the present study, we examined immunohistochemically ulcerative colitis lesions with monoclonal antibodies to activation neoepitopes in the complement component C3b and in the cytolytically active terminal complement complex. Colonic tissue specimens from 23 patients with ulcerative colitis were examined by indirect two-color immunofluorescence staining with monoclonal antibodies to the four human immunoglobulin G subclasses and to activated complement C3b or terminal complement complex. All except two patients had activated C3b deposited apically on the surface epithelium of involved mucosa. Immunoglobulin G1 was found on the epithelium in extensively prewashed specimens from 7 of 11 patients, and a striking colocalization of immunoglobulin G1, C3b, and terminal complement complex was observed in 4. Immune deposits were not observed in 31 noninflamed specimens from the same ulcerative colitis patients. Only 1 of 44 histologically normal mucosae from 17 controls and 1 of 10 colonic adenomas contained some epithelial complement deposits. It is concluded that activated complement is often deposited along the brush border of the surface epithelium in active ulcerative colitis lesions and may be associated with immunoglobulin G1 autoantibody.

Adolescent↗
PubMed1962

Demonstration of an epithelial antigen in colon by means of fluorescent antibodies from children with ulcerative colitis.

Thirteen sera from children with ulcerative colitis were examined for antibodies reacting with constituents of human colonic tissue by means of immunofluorescent methods. 3 out of 10 sera reacted positively when tested by the direct staining method while 6 out of 13 reacted positively when tested by the indirect method with conjugates of rabbit anti-human gamma globulin. The specificity of the reactions could be confirmed by inhibition tests. 16 sera from healthy children and adults yielded completely negative results. The staining capacity of various sera was correlated to their hemagglutinating titer when they were tested with sheep erythrocytes, coated with phenol-water extract of human colon. Absorption experiments indicated that the stainable antigen was also present in the extracts used for the hemagglutination experiments. In unfixed tissue sections, fluorescent antibodies were adsorbed onto the epithelial cells of the mucosa. Adsorption on epithelial basement membranes could not be demonstrated. Fluorescent H agglutinins, isolated from eel serum, were adsorbed onto the same mucosal structures of human colon (blood group O) as the antibodies in the sera of patients with ulcerative colitis. However, any immunological relationship between H substance and the colonic antigen of ulcerative colitis could be ruled out by cross-inhibition and hemagglutination inhibition experiments. Fluorescent serum from patients with rheumatoid arthritis also stained sections of human colon but the localization of the stainable antigens was different from that visualized with the ulcerative colitis sera. Inhibition experiments indicated that the rheumatoid arthritis serum contained antibodies staining colon antigens different from those reacting with antibodies in the ulcerative colitis sera. Sera from patients with systemic lupus erythematosus or with the nephrotic syndrome, which all hemagglutinated erythrocytes coated with colon extract, did not stain the sections of the colon tissue either because of suboptimal antibody concentration or because of a difference in type or localization of the antigen.

Adult↗
PubMed1997

[Bone changes in ulcerative colitis].

One of the complications of ulcerative colitis with frequent relapses is mineral deficiency (potassium, calcium, magnesium and phosphorus). The objective of the present work is to examine the bone density and laboratory parameters of bone metabolism in 25 patients with a medium severe and severe form of ulcerative colitis. In patients with ulcerative colitis a significantly reduced bone density was found in the era of neck of the femur (p < 0.05), a a non-significantly reduction of the bone density in the era of the lumbar vertebrae and an elevated level of osteocalcin (p < 0.05). These findings indicate a higher prevalence of bone changes in patients with ulcerative colitis. Early detection of bone changes makes adequate prevention and treatment of bone complications possible.

Adult↗
PubMed1996

Ulcerative colitis in children.

Chronic nonspecific ulcerative colitis remains a disease of unknown etiology, although much new information continues to be gleaned from basic research and clinical trials. In most instances, ulcerative colitis responds to medical therapy. Selecting appropriate drug therapy for a specific child depends on the extent and severity of the colitis. This article summarizes the clinical information, diagnostic studies, and approaches to management that should be considered when evaluating a child for ulcerative colitis.

Adolescent↗
PubMed2004

Ulcerative colitis--diagnosis and surgical treatment.

Ulcerative colitis is a serious illness affecting the colon. Extracolonic manifestations include sclerosing cholangitis, arthritis, eye diseases, ankylosing spondylitis, and sacroiliitis. Ulcerative colitis may increase a patient's risk of cancer, depending on the duration and extent of the disease. Surgery is the only definitive way to remove the disease in its entirety. It may be possible for patients who do not wish to have a permanent stoma to undergo a restorative proctocolectomy with ileal pouch-anal anastomosis. Normal bowel physiology, pathophysiology of ulcerative colitis, medical and surgical treatments, and postoperative complications are discussed.

Adult↗
PubMed2004

Resolving microcarcinoids in ulcerative colitis: report of a case.

Ulcerative colitis is known to predispose to the development of neoplasia, especially adenocarcinoma. Microcarcinoids represent small nests of gut endocrine cells located in the mucosa and submucosa of the bowel. Such lesions have been identified in association with chronic inflammation and the concern is that they may represent a precursor lesion for invasive carcinoid tumors. Yet carcinoid tumors are rarely reported in patients with ulcerative colitis. This case report documents a 56-year-old male with ulcerative colitis who was found on random biopsies to have microcarcinoids in his rectal submucosa. Following treatment of his colitis, there was complete resolution of both the inflammation and the microcarcinoids. However, on subsequent follow-up at six months, the patient's colitis has returned and so have the microcarcinoids. We explore the issue of whether these lesions represent true neoplasias that should be resected, or whether they represent cellular hyperplasia in response to the inflammatory stimulus.

Carcinoid Tumor↗
PubMed1992

Do technetium-99m hexamethylpropylene amine oxime-labeled leukocytes truly reflect the mucosal inflammation in patients with ulcerative colitis?

Twenty-five patients with ulcerative colitis and nine controls with macroscopically non-inflamed colon were investigated with technetium-99m hexamethylpropylene amine oxime-labeled leukocyte scintigraphy and colonoscopy with biopsies. The interval between leukocyte scintigraphy and colonoscopy was < or = 14 days in all patients with ulcerative colitis and < or = 30 days in eight of nine controls. Scintigrams were obtained at approximately 45 min and 4 h after injection of labeled leukocytes. One nuclear physician, one internist, and one pathologist graded blindly and independently of each other the degree of active inflammation in seven different colonic segments for each patient, using 4-grade scales for scans and macroscopically and histologically viewed inflammation, respectively. A positive correlation between endoscopic and histologic grading of all colonic segments and scan gradings for all subjects and for ulcerative colitis patients separately was found (all, p < 0.001). By means of kappa statistics, the inter-observer agreement between scintigraphic grading at 45 min and endoscopy was, for all subjects, 0.32 (95% confidence interval (CI), 0.20-0.44; p < 0.001) and, for patients with ulcerative colitis, 0.19 (CI, 0.07-0.31; p < 0.001). When 17 patients who had complete colonoscopies were divided into those with total, extensive, or distal colitis, leukocyte scintigraphy underestimated the extension of active inflammation. A simple scintigraphic scoring system reflects the colonic inflammation viewed endoscopically and histologically in patients with ulcerative colitis but underestimates the presence of active inflammation in individual colonic segments.

Adolescent↗
PubMed1975

Inhibition of leucocyte migration by antigens from human colon and E. coli O 14 in patients with ulcerative colitis.

In 55 patients with ulcerative colitis and in 25 controls the leucocyte migration inhibition test was performed. As antigens the extract from human fetal colon and the lipopolysaccharide antigen from E. coli O 14 were used. The leucocyte migration in patients with ulcerative colitis was significantly inhibited in the presence of the antigens mentioned. In patients with an active form of ulcerative colitis the leucocyte migration was significantly inhibited as compared to the leucocyte migration in patients with a nonactive form of the disease.

Adult↗
PubMed2000

Poor outcome of a defunctioning stoma after pouch construction for ulcerative colitis.

BACKGROUND: Restorative proctocolectomy for ulcerative colitis can have complications necessitating a later defunctioning ileostomy with uncertain outcome. This analysis was undertaken to assess the outcome in patients needing a later defunctioning ileostomy after pouch construction in patients with ulcerative colitis. METHOD: The notes of our series of 154 patients who underwent restorative proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis were reviewed and 28 patients identified who needed a later defunctioning ileostomy to deal with complications. RESULTS: A later defunctioning ileostomy was necessary in 28 patients to deal with the following complications: sepsis in 11 patients (5 pouches failed), fistulas in 7 (5 pouches failed), poor function including ileoanal stenosis in 5 (all 5 failed), postoperative intraabdominal bleeding in 2 (both saved), pouchitis in 2 (1 excised) and small bowel obstruction in 1 (saved). 16 pouches were eventually excised or permanently defunctioned (59%). CONCLUSION: Complications necessitating a later defunctioning stoma after pouch construction carry a poor prognosis, especially when used for ileoanal stenosis and fistulae.

Colitis, Ulcerative↗
PubMed1990

New directions in the aetiology of ulcerative colitis.

The causative factors of ulcerative colitis remain unknown. Cellular biochemistry has revealed altered oxidative metabolism, membrane function and synthesis of mucus in colonic epithelial cells in the early stages of ulcerative colitis. Immune studies have highlighted more precise changes in neutrophil and macrophage function in cells of the lamina propria while microbiological evidence has shown a dysbiosis of colonic bacteria related to entero-adhesion, release of bacterial peptides and formation of secondary bacterial metabolites (mercapto fatty acids). A precise sequence of pathological events still needs to be established to account for an acute attack of ulcerative colitis.

Bacterial Physiological Phenomena↗
PubMed2002

Ulcerative colitis in children: medical management.

Ulcerative colitis is a chronic relapsing inflammatory disorder of the colonic mucosa of unknown etiology. The inflammatory process involves the mucosa and submucosa in a continuous segment of bowel with rectal involvement in almost all cases. Since its etiology is unknown, therapy is directed at modulating the inflammatory response in order to control symptoms and to prevent relapses. 5-aminosalicylates and corticosteroids have been the most widely used therapeutic agents for treatment of ulcerative colitis. Recently, experience has been gained with the use of other immunomodulators, such as mercaptopurine, azathioprine, methotrexate, cyclosporine, and tacrolimus, in pediatric patients. Colectomy is indicated in patients with severe colitis who do not respond to intensive medical therapy. The care of children with ulcerative colitis not only involves control of symptoms from gastrointestinal and extraintestinal manifestations, but also optimizing growth and development. The complications of chronic inflammation and long-term medical therapy must be weighed against the risks and benefits of surgery for children and adolescents with this condition.

Adolescent↗
PubMed1991

Apparent change of Rhesus blood group typing in a case of ulcerative colitis.

An interesting case of ulcerative colitis with an apparent change of Rhesus blood group typing is described. To our knowledge, this has not been reported before. We postulate that during the initial active phase of ulcerative colitis, an unknown D-like antigen, possibly bacterial in origin, could temporarily give rise to a Rhesus D-positive blood group typing in a patient with Rhesus D-negative blood type. Interestingly, with continuous immunosuppressive therapy for ulcerative colitis, the patient did not develop anti-D antibodies despite multiple transfusions with D-positive blood.

Adult↗
PubMed1975

The incidence of lactose malabsorption in ulcerative colitis.

120 Danish patients with ulcerative colitis, admitted consecutively to a Department of Gastroenterology, were investigated for lactose malabsorption. The prevalence was 9.2 percent, which is not significantly higher than that in a mixed Danish gastroenterological material, There was no difference in distribution according to age and sex, and the incidence was not correlated to the severity of the ulcerative colitis. The possible reasons for the wide variation in the incidence of lactose malabsorption in materials of patients with ulcerative colitis are discussed, and it is concluded that the main cause must be that the materials with the highest incidence include patients of races and ethnic groups in which lactose malabsorption is a common finding.

Adult↗
PubMed2003

Association between the C3435T MDR1 gene polymorphism and susceptibility for ulcerative colitis.

BACKGROUND & AIMS: The human multidrug resistance 1 (MDR1) gene product P-glycoprotein is highly expressed in intestinal epithelial cells, where it constitutes a barrier against xenobiotics. The finding that mdr1a knockout mice develop a form of colitis that is similar to ulcerative colitis, which can be prevented by antibiotics, indicates a barrier function for P-glycoprotein against the invasion of bacteria or toxins. Because the MDR1 single nucleotide polymorphism C3435T is associated with lower intestinal P-glycoprotein expression, we tested whether this polymorphism predisposes to development of ulcerative colitis. METHODS: Allele frequencies and genotype distributions of the C3435T single nucleotide polymorphism were investigated in 149 patients with ulcerative colitis, 126 patients with Crohn's disease, and sex-matched healthy controls. RESULTS: Significantly increased frequencies of the 3435T allele and the 3435TT genotype were observed in patients with ulcerative colitis compared with controls (3435T: P = 0.049; odds ratio, 1.4; 95% confidence interval, 1.02-1.94; 3435TT: P = 0.045; odds ratio, 2.03; 95% confidence interval, 1.04-3.95). In contrast, frequencies of the T allele and the TT genotype were the same in patients with Crohn's disease as in controls (P = 0.66 and P = 0.59, respectively). In comparison to 998 non-sex-matched controls, the effect for the TT genotype in ulcerative colitis patients was more pronounced (P = 0.0055; odds ratio, 2.1). CONCLUSIONS: The higher frequency of the 3435TT genotype in patients with ulcerative colitis corroborates the findings from the mdr1a knockout mice. The results support the notion that P-glycoprotein plays a major role in the defense against intestinal bacteria or toxins. Impairment of barrier function in 3435TT subjects could render this genotype more susceptible to the development of ulcerative colitis.

Adolescent↗
PubMed1982

A controlled study of the association between ulcerative colitis and psychiatric diagnoses.

Fifty consecutive patients with ulcerative colitis were personally examined to determine the lifetime prevalence of specific psychiatric diagnoses. A personality assessment and a tabulation of recently occurring stressful events were done. A matched control sample with chronic nongastrointestinal medical illnesses was evaluated in the same way. The two groups were compared so as to quantify the relative association and impact of psychiatric disorder in ulcerative colitis. We found no greater frequency of diagnosable psychiatric disorder in ulcerative colitis patients than in the control population. Those with ulcerative colitis and a psychiatric illness did not appear to have more serious gastrointestinal involvement, nor did severity of the ulcerative colitis predict more frequent or more serious psychiatric disorder. Personality profiles were similar in probands and controls, and there was no correlation between the frequency of potentially stressful life events within the six months prior to interview and severity of ulcerative colitis at the time of interview. We did find slightly higher levels of obsessional symptomatology in ulcerative colitis cases, but this association appeared to be weak and unrelated to the severity of the gastrointestinal disorder. Despite the fact that more than a quarter of the ulcerative colitis patients had some diagnosable psychiatric illness, the occurrence of psychiatric disorder was rarely documented in the medical charts.

Adult↗