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PubMed1984

[Amebic colitis - differential diagnosis of ulcerative colitis and Crohn disease].

Amoebic colitis rarely develops in patients who had not stayed in a country where amoebiasis is endemic. "Crohn's colitis" was diagnosed in a 33 year old female patient who never had stayed in such an area. The dramatic deterioration of the disease led to revise the early diagnosis. The reported case indicates that the conventional laboratory, endoscopic, histologic, and radiologic examinations don't prove the anamnestically unsuspected amoebic colitis. Since the correct diagnosis was verified by stool and serologic examinations, these should be performed in any doubt of a specific colitis.

Adult↗
PubMed1994

Anti-neutrophil cytoplasmic antibodies in children with ulcerative colitis.

Tests that positively identify individuals with ulcerative colitis, distinguishing them from patients with Crohn disease or other causes of colitis, have not been reliable. Genetic predisposition to inflammatory bowel diseases and genetic influence on immune regulation resulted in the clinical evaluation of potential serologic markers. In adults the presence of anti-neutrophil cytoplasmic antibody (ANCA) in serum identifies patients with ulcerative colitis. In this study we demonstrated that high levels of ANCA are present in 83% of children and adolescents with ulcerative colitis. Furthermore, the majority of patients with ulcerative colitis had a perinuclear pattern of these antibodies by indirect immunofluorescence. The combination of a positive ANCA and perinuclear indirect immunofluorescence pattern was 97% specific for ulcerative colitis. We conclude that determination of ANCA is a sensitive and specific clinical test for identification of children and adolescents with ulcerative colitis.

Adolescent↗
PubMed1980

The rarity of ulcerative colitis in South African blacks.

Ulcerative colitis is rare in black populations of sub-Saharan African. Only 18 cases were reported up to 1975. Since then, in four years, an additional 13 patients have been diagnosed at Baragwanath Hospital, Johannesburg. This hospital, with 2,700 beds, serves a population of approximately 1 1/2 million blacks. The low frequency of ulcerative colitis is in accord with the uncommonness of other noninfective large bowel diseases and contrasts with their high prevalences in white populations. Reasons for the uncommonness of ulcerative colitis in blacks are not known but consumption of their still largely traditional diet, insufficient exposure to environmental changes linked with urbanization and genetic factors may be responsible. All patients in this series, save one, were females. They were urbanized, belonged to upper social and educational strata and consumed a Western, or partially Westernized diet.

Adult↗
PubMed1992

Steroid complications in patients with ulcerative colitis.

Physicians treating patients with ulcerative colitis are confronted with the difficult task of deciding whether medical or surgical treatment is best for their patients. There are no definitive criteria to indicate when medical therapy should be exchanged for definitive surgery. Even in patients who respond well to glucocorticoid treatment, the side effects of these drugs may necessitate surgery. We reviewed the steroid complications of our operative cases retrospectively. Although ulcerative colitis was usually in remission, severe steroid complications were no longer tolerable and definitive surgery was required. We also reviewed the literature regarding the adverse effects of steroid. Because of advances in sphincter-preserving surgery, re-evaluation of the treatment of ulcerative colitis is necessary. Although conservative treatment remains the first choice, tolerance of irreversible side effects (especially in children) no longer seems to be justified. In such patients, early definitive surgery may offer more than it appears to sacrifice.

Adult↗
PubMed2004

Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis.

BACKGROUND & AIMS: Patients with ulcerative colitis are at increased risk of colorectal cancer. It is widely believed that this is secondary to colonic inflammation. However, the severity of colonic inflammation has never been shown to be a risk factor. METHODS: We devised a case-control study of patients with long-standing extensive ulcerative colitis to examine various potential risk factors for neoplasia. All cases of colorectal neoplasia detected from our surveillance program between January 1, 1988, and January 1, 2002, were studied (n = 68). Each patient was matched with 2 control patients from the same surveillance population (n = 136). Matching was for sex, colitis extent, age at onset, duration of colitis, and year of index surveillance colonoscopy. Segmental colonoscopic and histological inflammation was recorded by using a simple score (0, normal; 1, quiescent/chronic inflammation; and 2, 3, and 4, mild, moderate, and severe active inflammation, respectively). Other data collected included history of primary sclerosing cholangitis, family history of colorectal cancer, and smoking and drug history (mesalamine 5-aminosalicylic acid, azathioprine, and folate). RESULTS: Univariate analysis showed a highly significant correlation between the colonoscopic (odds ratio, 2.5; P = 0.001) and histological (odds ratio, 5.1; P < 0.001) inflammation scores and the risk of colorectal neoplasia. No other factors reached statistical significance. On multivariate analysis, only the histological inflammation score remained significant (odds ratio, 4.7; P < 0.001). CONCLUSIONS: In long-standing extensive ulcerative colitis, the severity of colonic inflammation is an important determinant of the risk of colorectal neoplasia. Endoscopic and histological grading of inflammation could allow better risk stratification for surveillance programs.

Adolescent↗