Lichen planus and ulcerative colitis.
Three patients with ulcerative colitis and lichen planus are reported and similar cases in the literature discussed. Similarities in the pathology of the two conditions are outlined.
Adult↗
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Review: the surgical management of ulcerative colitis.
The treatment of ulcerative colitis requires careful review of the medical and surgical options. The surgical procedure of choice is proctocolectomy with ileal pouch-anal anastomosis. This procedure removes the diseased mucosa, effectively curing the disease whilst maintaining the normal route of defecation and continence. Other surgical options that may be considered in selected patients include proctocolectomy with either a Brooke ileostomy or a Kock pouch, and abdominal colectomy with ileorectal anastomosis. The choice of operation requires consideration of the advantages and disadvantages of a particular procedure and must be tailored to an individual patient's needs and circumstances.
Colectomy↗
Analysis of cytotoxic T lymphocyte associated antigen 4 gene polymorphisms in patients with ulcerative colitis.
BACKGROUND AND AIM: Ulcerative colitis (UC) is a multifactorial disease associated with dysregulated immunity. Recently, cytotoxic T lymphocyte associated antigen 4 (CTLA-4) gene polymorphisms have been reported in association with several autoimmune diseases in several populations. In the present study, the possible implication of the CTLA-4 gene as a risk factor for UC in the Iranian population was investigated. METHODS: One hundred UC patients and 100 healthy subjects were studied. CTLA-4 exon 1 position 49 (A/G: codon 17: Thr/Ala) polymorphisms were investigated by polymerase chain reaction single strand confirmation polymorphism method. Four of the patients and one of the healthy controls were excluded from the study because of incomplete DNA extraction. RESULTS: The allele frequencies of A and G in 96 patients (A: 66.1%; G: 33.9%) were not significantly different from the 99 control subjects (A: 63.1%; G: 36.9%, P > 0.05). No significant differences in the distribution of genotype frequencies were observed between A + 49G gene polymorphisms and UC in the Iranian population (P > 0.05). CONCLUSION: CTLA-4 polymorphism is not associated with UC in the Iranian population.
Adolescent↗
Takayasu's arteritis associated with idiopathic ulcerative colitis.
Two patients with ulcerative colitis associated with Takayasu's arteritis are described. Gangrene of a limb was the presenting feature in one patient and renovascular disease in the other. Angiography showed vascular occlusions affecting several medium or large sized vessels in both patients.
Adolescent↗
Clinical and prognostic features of rectal sparing in ulcerative colitis.
Thirty patients with ulcerative colitis who had been followed clinically for more than 5 years were studied. Patients with total or left-sided colitis were investigated to evaluate the significance of rectal sparing in the prognosis of the disease. Patients were divided into two groups, one with complete or relative sparing of the rectum and the other with homogeneous lesions ranging from the rectum to the proximal colon based on endoscopic findings. The administration of topical corticosteroids seemed to have little effect on rectal sparing. However, the relapse index was significantly higher in patients with rectal sparing. The intractability index, representing the ratio of the duration of the active stage to the investigation period, was also higher, though not significantly so, in this group. The results suggest that rectal sparing may give information about intractability or a tendency to relapse.
Administration, Topical↗
Substitution of factor XIII: a therapeutic approach to ulcerative colitis.
Three patients with ulcerative colitis in the active stage demonstrated reduced levels of F XIII activity and F XIII subunit A (61 and 80.3%, respectively). Because of the lack of clinical improvement during conservative therapy, the patients were treated additionally with F XIII concentrate (Fibrogammin HS, Behring, FRG) for 10 days. The substitution resulted in an increase in F XIII activity (144.3%) and F XIII subunit A (238%) as well as in a marked improvement in symptoms.
Adrenal Cortex Hormones↗
Isolation and characterization of a colonic autoantigen specifically recognized by colon tissue-bound immunoglobulin G from idiopathic ulcerative colitis.
Patients with idiopathic ulcerative colitis (UC) have a colonbound antibody (CCA-IgG) that reacts with colon tissue extracts. We have partially characterized a colonic protein that is specifically recognized by CCA-IgG. CCA-IgG was eluted from operative colon specimens from 10 patients with UC. A colon tissue-bound IgG was similarly eluted from six patients with Crohn's colitis, two with ischemic colitis, and one with diverticulitis. Purified serum IgG from patients with Crohn's disease, from normal subjects and a patient with myeloma were also used as additional controls. For detection of antigen(s), tissue extracts were prepared from 26 specimens of colon (UC, 12; Crohn's disease, 6; normal, 4; other controls, 4), 8 specimens of human normal stomach, duodenum, ileum, and liver (2 each). Tissue extracts were also prepared from rats and mice, including germ-free rat colons and rat's fetal colons. Immunorecognition of CCA-IgG to the tissue extracts was examined by affinity-column chromatography and by transblot analysis. Tissue-extracted proteins were electrophoresed in SDS-polyacrylamide gel, transferred to nitrocellulose sheet, and probed with iodinated CCA-IgG, colonic IgG from other inflammatory bowel disease patients, UC serum IgG, and control serum IgG. Although many proteins were present in colon tissue extracts, 9 of 10 CCA-IgG consistently recognized a protein of 40 kD. None of the nine IgG preparations from colon specimens of patients with Crohn's colitis and other colonic inflammatory diseases reacted with the 40-kD protein. Five of six symptomatic UC serum IgG and none of eight control serum IgG reacted with the 40-kD protein. The 40-kD protein was present in all colon specimens and it appeared to be organ specific. It was absent in mouse and rat tissues, including colon. The 40-kD protein is not actin and nor a part of the Ig molecule. These results suggest that the 40-kD protein is a colonic "autoantigen" that may initiate a specific IgG antibody response in UC.
Autoantigens↗
Bronchopulmonary disease in ulcerative colitis.
Two cases of ulcerative colitis are described: a 33-year-old woman who developed widespread bronchiectasis 7 months after undergoing colectomy, and a 72-year-old man whose colonic disease began coincidentally with the appearance of diffuse interstitial pulmonary infiltrates. In both cases, clinical correlation and common patterns of response of lung and bowel diseases suggested that the co-existence of these two pathologies might not be merely a casual relation.
Adult↗
A pilot study on the endoscopic surveillance of colorectal dysplasia and cancer in long-standing ulcerative colitis.
INTRODUCTION: Patients with ulcerative colitis (UC) have a greater risk of developing colorectal cancer (CRC) when compared to the general population. Epithelial dysplasia comes before this neoplasm, and thus endoscopic surveillance is recommended to these patients. This pilot study aims at establishing the incidence of dysplasia and CRC in patients with long-standing UC in our hospital. MATERIAL AND METHODS: This is a prospective observational study performed in patients with a definite diagnosis of UC for more than 8 years. These patients were encouraged to enroll in an endoscopic surveillance program for CRC. All patients underwent colonoscopy and multiple biopsies every 18 to 24 months in order to detect epithelial dysplasia. RESULTS: Thirty-nine patients were included from January 1994 to December 2003. Half of them were males. Mean age was 52 +/- 13 years. Mean duration of UC was 15 +/- 8 years. Thirteen (35%) patients had left colitis, and 26 (65%) had pancolitis or extensive colitis. The presence of mild dysplasia was detected in four patients, on two occasions in one of them (13%; 95% CI: 6.1-33.5); the incidence of mild dysplasia was 1.3% patients per surveillance year. No severe dysplasia or CRCs were identified. CONCLUSION: The incidence of dysplasia in our area is lower than expected, and does not support surveillance programs for these patients. However, no definite conclusions may be drawn from such a small number of patients.
Adult↗
[Neurological complications of ulcerative colitis].
Extraintestinal complications of ulcerative colitis(UC) affect various organ systems. However, there is a notable sparing of the nervous system. In this review, we describe the complications of nervous system dividing into some categories. Most frequently reported is cerebrovascular disease(CVD), which occurs in hypercoagulable state or vasculitis. Young patient with active UC seems to be a risk of CVD. Some authors suggest that the familial concurrence of multiple sclerosis and UC. However, there is only one report in Japan. Myopathy and neuropathy are rare diseases in a group of this review. The former are considered an overlapping occurrence of UC. The latter have various areas in peripheral nervous system. A detailed investigation of immunological back-ground is required to define the nature of their association.
Cerebrovascular Disorders↗
[Colon cancer associated with ulcerative colitis and early diagnosis].
Ulcerative colitis(UC) is known to be associated with colon cancer. The risk factors of cancer incidence are total colitis type and over 10 years clinical course. The macroscopic appearance of cancer with UC mainly consist of type 3, 4 and dominant histological type is mucinous adenocarcinoma or poorly differentiated adenocarcinoma. Most of cancer is considered to raise from dysplasia. The dysplasia is difficult for diagnosis macroscopically, but it has characters of DNA aneuploidy and positive p53. For early diagnosis of cancer, surveillance is very important. The surveillance program is recommended to perform colonoscopy every year to UC patients with over 10 years course and take biopsies from every 10 cm of colon. If high-grade dysplasia is discovered by surveillance colonoscopy, a resection of total colon should be performed.
Adenocarcinoma↗
[The role of cytokines in pathogenesis of nonspecific ulcerative colitis].
Etiology of nonspecific ulcerous colitis (NSUC) as well as its pathogenetic mechanisms remain obscure. Cytokines are presently shown to play an essential role in development of inflammation. Cytokines are produced by the cells in the inflammatory infiltrate in NSUC, therefore, changes of their level in the blood and biopsies from colon mucosa is naturally determined. Current investigations register various changes in the levels of both proinflammatory and antiinflammatory cytokines. Further studies of unknown mechanisms of cytokines action may contribute to design of new methods of NSUC management.
Colitis, Ulcerative↗
[Evidence-based guideline for the diagnosis and treatment of ulcerative colitis].
The therapy of ulcerative colitis is still not causal but is directed unspecifically at mucosal inflammation. The treatment of the uncomplicated remitting course is tailored to the activity and location of the disease. In the case of mild to moderate activity aminosalicylates are recommended, in the absence of a response systemic steroids are the treatment of choice. However, when administered locally, aminosalicylates have proven superior to steroids. Chronic active disease should be treated with azathioprine. A steroid-refractory course often responds to ciclosporine or tacrolimus: A course refractory to conservative measures is an indication for a proctocolectomy with ileoanal anastomosis.
Colitis, Ulcerative↗
Requirements for the use of intestinal action antibiotics in the treatment of ulcerative colitis.
The causes of ulcerative colitis are still unknown and above all the circumstances which can lead to inflammatory episodes are unclear. Antibiotic therapy has not provided encouraging results so far but it is possible that the pathogenesis of this disease may involve bacterial species which have not yet been identified. The use of an antibiotic with specific colic activity therefore seems to be justified.
Colitis, Ulcerative↗
Significance of increased proliferation of immature plasma cells in the appendix of patients with ulcerative colitis.
The etiology of ulcerative colitis (UC) is not known. Recent studies support a primary role of the appendix in the pathogenesis of UC, however phenotypical studies of proliferating cells in the appendix have not been reported. We report phenotypical studies of lymphocytes and of proliferating subpopulations in the appendix of patients with inflammatory bowel disease and of controls. Surgical samples of the appendix were obtained from 5 patients with colon cancer, 5 with acute appendicitis, 12 with UC and 7 with Crohn's disease (CD). Frozen sections were cut from fixed samples, and immunostained with lymphocyte markers and anti-Ki-67 antibodies. The number of Ki-67(+) proliferating cells, CD19, and CD138 cells was significantly higher in the appendix of patients with UC than in controls, patients with acute appendicitis, and patients with CD. Immunohistological double staining revealed significant proliferation of CD3, CD19, and CD138 cells in the appendix of patients with UC. The proportions of Ki-67(+) cells in CD3, CD19, and CD138 cells were significantly higher in both total UC patients and patients in remission-stage UC, than in controls, patients with acute appendicitis, and patients with CD. Lamina propria cells in the appendix of patients with UC showed augmented proliferation with increased numbers of CD19 and CD138 cells. The number of CD3 cells was not significantly increased, but the proportion of proliferating CD3 cells was increased. An increased proportion of Ki-67(+) cells in CD19 and CD138 cells represents proliferation of immature plasma cells in the appendix of patients with UC, and proliferation of such immature plasma cells was seen in both active- and remission-stage UC. Proliferation of immature plasma cells in the appendix of patients with UC suggests a primary role of humoral immune responses in the pathogenesis of UC.
Adolescent↗
[Radiological diagnosis of ulcerative colitis].
In cases with ulcerative colitis, barium enema is valuable in objectively determining the stage (active, inactive) and defining the extent and aggressiveness of the disease that often varies during the course. The preparation, findings, and differential diagnosis of the technique are reviewed.
Barium Sulfate↗
Pathogenesis and management of ulcerative colitis.
The etiopathogenesis of ulcerative colitis (UC) is still largely unknown, although the role of genetic influences now seems to be fairly clear. Diagnosis is based on clinical, endoscopic and histological findings. The most important differential diagnosis of UC is Crohn's disease (CD). UC always first arises in the rectum and can spread continuously to upper parts of the colon. One of the severest complications consists in the development of toxic megacolon, which is seen in 1.6%-8% of cases. Another point is the occurrence of carcinoma in longstanding and extensive UC. The risk of this complication may have been overestimated in earlier studies: A realistic rate could be 0.5%-1% per person and year of pancolitis. However, carcinoma may occur even in less extensive cases. The conclusions which have to be drawn are still controversial. Some authors recommended regular endoscopy with serial biopsies, but others do not. The standard oral therapy is based on sulfasalazine (SASP) and corticosteroids. For topical treatment, 5(4)-amino-salicylic acid has proven to be effective in distal colitis, as has cortisone. Also, oral treatment with 5-ASA preparations seems to be beneficial, even if some of the published studies are open to criticism. Presumably, the drug is more clearly effective at higher doses than those commonly used.
Colitis, Ulcerative↗
[Surgical treatment of acute conditions of ulcerative colitis].
Acute complications of ulcerative colitis that require surgery are rare (toxic megacolon, 5-8%, perforation, 2-3%, massive hemorrhage less than 1%), but pose a high risk. Surgery within 48 h after the failure of intensive conservative treatment is decisive for success. Turnbull's procedure is still less risky than colectomy for toxic megacolon. In case of perforation colectomy is considered the standard procedure. Massive hemorrhage (greater than 2000 ml blood/24 h) always requires colectomy. Preservation of the rectal stump shortens the operation, lessens the trauma and allows reconstruction of the continence function by pouch-ileoanostomy.
Acute Disease↗