SEARCH · PubMed Health

Results for “Colitis, Ulcerative”

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.

At least 721 records · Page 40Linked to original sources

PubMedDate not supplied

Nodular duodenitis involving CD8+ cell infiltration in patients with ulcerative colitis.

BACKGROUND/AIMS: Limited efforts have been made to determine changes in the upper gastrointestinal tract in ulcerative colitis. The aim of this study was to analyze gastroduodenal lesions in patients with ulcerative colitis. METHODOLOGY: The endoscopical appearance of lesions in the duodenum and stomach was first examined. Biopsy specimens taken from 25 patients with ulcerative colitis, as well as 21 with Crohn's disease and 16 with nonspecific gastroduodenitis who had no Helicobacter pylori infection, were then evaluated by histology and immunohistochemistry for CD8, CD68 and HLA-DR. In ulcerative colitis patients, the HLA-phenotype was also analyzed by the standard NIH complement-dependent microlymphocyte toxicity assay. RESULTS: Endoscopically evident alteration of nodularity in the descending part of duodenum was prominent in ulcerative colitis and Crohn's disease, but not gastroduodenitis. Histological inflammatory change of the duodenal bulb in ulcerative colitis and Crohn's disease was mild as compared to gastroduodenitis cases. Endoscopic and histological change (redness and deformity of villi) in the duodenum were more prominent in ulcerative colitis patients with pancolitis than those with left-sided/proctitis. CD8+ cells infiltrating both the duodenum and stomach were increased in ulcerative colitis and Crohn's disease as compared to gastroduodenitis whereas focal perifoveolar accumulation of CD68+ cells and enhanced epithelial expression of HLA-DR were characteristic of Crohn's disease. Histopathological alteration in the duodenum was particularly prevalent in ulcerative colitis patients with HLA-DR4 and Cw1. CONCLUSIONS: Nodular, histologically mild duodenitis involving CD8+ cell infiltration, the severity of which positively correlates with the extent of colitis, is characteristic of ulcerative colitis.

Adolescent↗

PubMed2004

Appendicectomy has no beneficial effect on admission rates in patients with ulcerative colitis.

BACKGROUND AND AIMS: Those who have had an appendicectomy have a reduced risk of developing ulcerative colitis. However, the effect of appendicectomy on disease activity in patients with ulcerative colitis has not been established. METHODS: We used the Danish National Patient Registry to identify all incident cases of ulcerative colitis in Denmark during the period 1981 to 1999. Of these, 202 had an appendicectomy after their first admission with ulcerative colitis. In these patients, we compared the incidence rate of hospitalisations with ulcerative colitis as first diagnosis during the period between the onset of ulcerative colitis and appendicectomy, with the rate of such hospitalisations after appendicectomy. To adjust for the clinical course of ulcerative colitis unrelated to appendicectomy, we extracted a reference cohort (n = 808), matched to the index subjects with respect to age, sex, and year of first admission, but with an intact appendix. RESULTS: The rate of admission with ulcerative colitis as first diagnosis decreased by 47% after appendicectomy (rate ratio 0.53 (95% confidence interval (CI) 0.36-0.80)). However, the reference cohort showed a similar decline in admission rate (rate ratio 0.51). Thus appendicectomy had no apparent beneficial effect on admission rate after adjustment for the clinical course of disease unrelated to appendicectomy (adjusted rate ratio 1.05 (95% CI 0.67-1.67)). CONCLUSIONS: Appendicectomy had no significant beneficial effect on admission rates in patients with ulcerative colitis.

Adult↗

PubMed1999

Exposure to risk factors for ulcerative colitis occurs during an early period of life.

OBJECTIVE: It has been speculated that environmental factors play a role in the etiology of ulcerative colitis. A previous analysis revealed that the time trends of ulcerative colitis in England were shaped by an underlying birth-cohort pattern. We undertook this study to test whether the birth-cohort pattern was a unique feature of the English vital statistics or whether a similar phenomenon could also be ascertained in the mortality statistics from a different country, such as Switzerland. Besides comparing the data of ulcerative colitis from Switzerland and England, the trends of ulcerative colitis were compared with those of gastric and duodenal ulcer. METHODS: Death rates from ulcerative colitis, gastric ulcer, and duodenal ulcer were plotted against the period of death and period of birth. An age-standardized cohort mortality ratio was calculated as a summary statistic of the overall mortality associated with each consecutive birth-cohort. RESULTS: Mortality from ulcerative colitis increased among successive generations born throughout the 19th century. It peaked in individuals born around 1890 and has declined since then. Strikingly similar patterns were found in Switzerland and England. The birth-cohort pattern underlying the time trends of ulcerative colitis applied equally to the data for women and men. In comparison with peptic ulcer, the birth-cohort pattern of ulcerative colitis was almost identical to that of duodenal ulcer. It peaked in both countries 10-20 yr later than gastric ulcer. CONCLUSIONS: The birth-cohort pattern indicates that acquisition of ulcerative colitis is strongly influenced by environmental risk factors and that the exposure to these factors occurs during an early period of life. The similarity in the birth-cohort patterns of duodenal ulcer and ulcerative colitis could hint at a childhood infection or a related mode of transmission in both diseases.

Adult↗

PubMed2001

Lymph folliculitis in ulcerative colitis.

Preferential involvement of the appendix has recently been confirmed in ulcerative colitis. Since the appendix is an aggregate of lymph follicles, this new observation implies a critical role of the lymph follicles, of both the large bowel and the appendix, in an etiopathogenesis of ulcerative colitis. This report presents two cases of ulcerative colitis in which lymph folliculitis and lymphoid hyperplasia were observed. Lymph folliculitis was observed endoscopically in a border between an established lesion and an uninvolved area. Case 1, proctitis type, relapsing remitting, mild in severity, showed lymph folliculitis in a proximal border of an established rectal lesion. Case 2, with left-sided colitis, mild in severity, had a skip appendiceal orifice inflammation. Lymph folliculitis was observed in the cecum surrounding established appendiceal orifice inflammation. In both cases, lymphoid hyperplasia was observed in an uninvolved area with clear vascular patterns. These two cases clearly demonstrate the involvement of gut lymph follicles in ulcerative colitis. Lymph folliculitis and/or lymphoid hyperplasia was proposed to be early lesions in ulcerative colitis. In addition, the need for microbiology targeting lymph follicles of the large bowel and appendix is stressed in order to disclose the casual microbial agents in ulcerative colitis.

Adult↗

PubMedDate not supplied

Reticuloendothelial system Fc receptor-mediated clearance of IgG-tagged erythrocytes from the circulation of patients with idiopathic ulcerative colitis and chronic liver disease.

Immune complexes may be important in the pathogenesis of the liver disease associated with idiopathic ulcerative colitis. In the present study, we documented Fc receptor-mediated clearance by the reticuloendothelial system of immune complex-like material from the systemic circulation of 25 healthy control subjects, 19 patients with ulcerative colitis alone, 9 patients with ulcerative colitis and elevated liver enzyme tests and 8 patients with various other forms of chronic liver disease. Following an intravenous infusion of IgG-tagged 51Cr-labeled autologous erythrocytes, serial blood samples were drawn over a 2-hr period of time, and computer-generated clearance curves were obtained. The time required for clearance of 50% of infused erythrocytes (T1/2) was then calculated. Serum immunoglobulin (IgA, IgG and IgM), complement (C3 and C4) and immune complex-like activity (IgG and IgM types) were also determined. Sixteen of 19 (84%) ulcerative colitis patients and 7 of 8 (88%) chronic liver disease patients had normal clearance T1/2's (when compared to 25 healthy controls). Conversely, only 1 of 9 (11%) ulcerative colitis + chronic liver disease patients demonstrated normal clearance function. Aside from serum IgM levels, the results of serum immunoglobulin, complement and immune complex-like determinations were similar in ulcerative colitis and ulcerative colitis + chronic liver disease patients. Serum IgM levels, however, were significantly decreased in ulcerative colitis patients and increased in ulcerative colitis + chronic liver disease patients (p less than 0.001). The results indicate that the reticuloendothelial system of patients with ulcerative colitis and chronic liver disease is impaired in its ability to dear immune complex-like material from the systemic circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Circulating neutrophils from patients with ulcerative colitis have a normal respiratory burst.

The hallmark of ulcerative colitis is a diffuse infiltration of neutrophils from the circulation into the colonic mucosa. The underlying mechanism for neutrophil tissue infiltration is unknown. One possible hypothesis is abnormal circulating neutrophils. This hypothesis has been previously tested with conflicting results. The aim of our study was to re-evaluate circulating neutrophil function in the absence of several possible confounding factors. To this end, we measured the respiratory burst of circulating neutrophils in response to two different stimuli by chemiluminescence in patients with active and inactive ulcerative colitis being off all medications. Our results show no significant difference between ulcerative colitis patients and controls in peak chemiluminescence, area-under-the-curve and time to peak comparisons. However, 27% of patients with active ulcerative colitis had an abnormally elevated chemiluminescence to stimuli. In addition, no correlations were seen between disease activity and peak chemiluminescence. Thus circulating neutrophils in the majority of patients with ulcerative colitis do not appear to be either "primed" or hyperactive. This may suggest the presence of local colonic factors that lead to neutrophil tissue infiltration and activation.

Adult↗

PubMed1995

Changes in substance P-immunoreactive innervation of human colon associated with ulcerative colitis.

The amount of colonic substance P and substance P-receptors is increased in ulcerative colitis, which may denote that substance-P is involved as a neurogenic mediator in the inflammatory process of ulcerative colitis. We studied the anatomical distribution of elevated colonic substance P in ulcerative colitis and assessed morphometrically whether the changes in substance P correlate with alterations in colonic innervation. Full-thickness specimens of colonic wall were obtained from normal human colons (N = 9) and the most and least affected regions of ulcerative colitis colons (N = 10) and immunostained for substance P. Substance P immunoreactivity index was calculated by multiplying each intensity value by the number of pixels exhibiting this intensity value. The numbers of substance P-immunoreactive nerve fibers in the lamina propria were markedly increased, and their fluorescence intensity was enhanced in ulcerative colitis. The longitudinal muscle layer contained substance P-immunoreactive nerve fibers in ulcerative colitis, but not in the controls. The substance P-immunoreactive index (= number x intensity of nerve fibers) was 3.42 +/- 1.49 in controls, 21.19 +/- 7.79 in mild ulcerative colitis regions (P < 0.05), and 29.68 +/- 9.81 in severe ulcerative colitis regions (P < 0.01). Increase in the number of substance P nerve fibers is in accordance with the hypothesis that substance P contributes to neurogenic mediation of inflammation in ulcerative colitis.

Aged↗

PubMed2003

Surgical management of ulcerative colitis in the presence of primary sclerosing cholangitis.

INTRODUCTION: The surgical management of ulcerative colitis in the patient with primary sclerosing cholangitis is controversial. METHODS: This study was designed as a retrospective chart review of all patients with primary sclerosing cholangitis who were surgically treated for ulcerative colitis. RESULTS: Sixteen patients with primary sclerosing cholangitis and ulcerative colitis were identified. The indication for ulcerative colitis surgery was dysplasia in 7 patients (44 percent), cancer in 2 (13 percent), intractability in 4 (25 percent), and unknown in 1. Final colon pathology demonstrated cancer in three patients and dysplasia in four. Two patients had biliary cancer discovered at the time of orthotopic liver transplantation. Thirteen patients were known to have primary sclerosing cholangitis when they underwent surgery for ulcerative colitis; two patients with severe primary sclerosing cholangitis underwent simultaneous orthotopic liver transplantation/total abdominal colectomy and did well with subsequent ileal pouch reconstruction. Two patients had orthotopic liver transplantation first and then ileal pouch-anal anastomosis (1 patient) or total abdominal colectomy (1 patient) and did well. Seven patients had well-controlled primary sclerosing cholangitis on medication and underwent ileal pouch-anal anastomosis or total abdominal proctocolectomy without significant hepatic compromise. One patient with moderate primary sclerosing cholangitis underwent ileorectal anastomosis and had severe liver failure postoperatively but survived. Another patient with worsening primary sclerosing cholangitis after total abdominal colectomy has since developed persistent bleeding from peristomal varices. CONCLUSIONS: The overall cancer/premalignant lesion rate was high (50 percent in this study) in patients with primary sclerosing cholangitis and ulcerative colitis. Complications associated with the surgical management of ulcerative colitis are largely dictated by the degree of liver disease present at the time of surgery. Patients with significant primary sclerosing cholangitis that requires colectomy can undergo simultaneous orthotopic liver transplantation/total abdominal colectomy and then be candidates for subsequent ileal pouch-anal anastomosis reconstruction once liver function has improved. Patients with well-controlled primary sclerosing cholangitis can undergo ileal pouch-anal anastomosis surgery safely.

Adult↗

PubMedDate not supplied

Quality of life in patients with ileal pouch for ulcerative colitis.

The improvement of surgery in the treatment of ulcerative colitis prompts us to consider its impact on the quality of life of the patients. Obviously, it is mandatory that the results after surgery should be better than the symptoms which elective surgery is designed to treat. A review of the literature was carried out on the current status of quality of life in patients with ulcerative colitis before and after surgery using a PubMed source. The rate of success after restorative proctocolectomy for ulcerative colitis is 95%. The quality of life after restorative proctocolectomy compared with other procedures is better, especially in the long term. About 90% of patients would undergo pouch surgery again after restorative proctocolectomy, while 53% of patients submitted to other procedures would have a restorative proctocolectomy. Restorative proctocolectomy is the gold standard for patients with ulcerative colitis who are suitable for surgical treatment, though future prospective trials are needed in order to establish when elective surgery for ulcerative colitis is indicated.

Colitis, Ulcerative↗

PubMed1997

South Asians with ulcerative colitis exhibit altered lectin binding compared with matched European cases.

Ulcerative colitis is associated with abnormalities of mucin synthesis and secretion, features that may also be associated with malignant change. It has been shown that South Asians in Britain have a high incidence of ulcerative colitis but a low incidence of colorectal carcinoma compared with their European counterparts. Previous studies have demonstrated changes in colonic mucin sialylation and sulphation in both South Asian and European cases with ulcerative colitis. This was related to disease severity, but changes were also found in quiescent disease. The aim of the present study was to determine glycoconjugate expression in the colon from South Asian cases and to compare results with those from a group of affected Europeans. Glycans were identified in formalin-fixed, paraffin-embedded tissue from 17 South Asian patients with ulcerative colitis and from 11 European patients with a similar degree of colitis, by the application of 10 biotinylated lectins. These were directed against a range of sialyl, fucosyl and 2-deoxy, 2-acetamido-galactosyl sequences, using an avidin-peroxidase revealing system and semiquantitative assessment. The South Asian group showed a reduction in the binding of agglutinins from Sambucus nigra in the apical-membranous region of enterocytes, and a decrease in apical Maackia amurensis agglutinin binding. These results suggest that South Asians with ulcerative colitis show a different distribution of terminal N-acetyl neuraminyl residues, either in their alpha-2,6 or alpha-2,3 linkage, compared with their European counterparts. The changes in sialylation observed in European cases compared with normal disease-free control subjects were present in quiescent disease, but were also related to disease activity. Their absence in Asians with ulcerative colitis may imply an inherent, genetically determined variation in this group, which may also play a part in their reduced risk of subsequent malignancy.

Asia, Southeastern↗

PubMed1987

Significance of eosinophil and mast cell counts in rectal mucosa in ulcerative colitis. A prospective controlled study.

Eosinophil and mast cell counts were done in 44 patients with active ulcerative colitis, 10 patients with ulcerative colitis in remission, and 44 matched subjects with functional bowel disorder. Mean (+/- SD) rectal eosinophil counts (EC) per unit area were significantly high (P less than 0.01) in active ulcerative colitis (5.80 +/- 5.49) as compared with inactive disease (2.81 +/- 2.19) or controls (3.01 +/- 1.67). Eosinophil count was not significantly different in the acute stage between responder (6.36 +/- 5.95) and nonresponders (5.1 +/- 5.84) to medical treatment and was thus of little discriminatory and prognostic value. Mean (+/- SD) EC was reduced from 6.36 +/- 5.95 to 3.91 +/- 3.19 in responders after four weeks of medical treatment. There was little change in the EC with treatment in nonresponders. No correlation was seen between tissue eosinophils and clinical severity of ulcerative colitis. Mast cell count was not significantly different between patients with active ulcerative colitis, inactive disease, and controls and thus had little diagnostic or prognostic value. It can be concluded therefore, that EC in the rectal mucosa indicated activity but not severity of ulcerative colitis. A reduction in EC possibly indicated remission. Rectal EC, however, cannot correctly prognosticate the treatment response and outcome of the disease.

Adult↗

PubMed1996

Ashkenazi Jews, sulfur gases, and ulcerative colitis.

Fecal pathogens have been suspected to cause ulcerative colitis, yet none have been identified. Meanwhile, the 400 species comprising normal colonic flora have received little attention as potential pathogens. Sulfate-reducing bacteria (SRB), a frequent colonic commensal, have been identified in greater numbers in people with ulcerative colitis. The bacteria produce hydrogen sulfide, a toxic compound with the potential to cause colonic injury and possibly ulcerative colitis. If these bacteria are pathogenic, high-risk populations may harbor greater numbers of these organisms in their colons. We compared a group with a high incidence of ulcerative colitis, Ashkenazi Jews, to a control population to assess carriage rates for SRB. Breath samples were collected to indirectly determine colonic conditions. No difference was found between the two groups studied.

Adolescent↗

PubMed1959

Autoantibodies in human ulcerative colitis.

Sera from 30 children, suffering from ulcerative colitis, were examined for the presence of antibodies capable of reacting with antigens of normal human tissue. It was possible to demonstrate that most of the sera contained a precipitating and hemagglutinating factor, reacting with a constituent of human colonic tissue. This constituent was obtained, within 1 hour after death, from colonic tissue of newborn babies who had died without feeding. It could also be prepared from fetal tissue. The antigen can be extracted with phenol-water at 65 degrees C. and seems to be a polysaccharide. The precipitating factor in the sera of the patients behaves electrophoretically as a gamma-globulin. Phenol-water extracts from liver and from kidney also reacted positively with the sera from certain patients. There are indications which suggest that the antigen obtained from these tissues is identical with that from colon. Sera from 38 healthy children did not give any reactions with the extracts used. In additional controls, the sera of 32 children with various diseases, all of suspected autoimmune origin, were also tested. A few of these reacted positively with the phenol-water extracts from the organs mentioned above. Most likely, the antigen reacting in these cases is different from that reacting with the antibodies in the sera from patients with ulcerative colitis. The possible role of the antibodies in the pathogenesis of ulcerative colitis and the mechanism of their formation are discussed.

Antigens↗

PubMed1987

Expression of HLA-DR antigens on colonic epithelium in ulcerative colitis.

Although the expression of HLA-DR antigens on colonic epithelium in ulcerative colitis has been observed by several groups, the results of the expression in remission have been conflicting and there has been virtually no study concerning the expression in non-inflamed area in active ulcerative colitis. We studied systematically HLA-DR expression on colonic epithelium in 37 patients with ulcerative colitis chronologically, namely in remission as well as in the active stage and inflamed and non-inflamed areas simultaneously in the active stage. HLA-DR antigens were detected by indirect peroxidase staining using anti-HLA-DR monoclonal antibody. We confirmed the previous observation that epithelium from control colon does not express HLA-DR antigens, while epithelium from ulcerative colitis expresses the antigens with high frequency (83.3 percent). In addition, we demonstrated that HLA-DR expression on colonic epithelium in active ulcerative colitis disappeared in remission. Our new finding was that there is no HLA-DR expression on colonic epithelium in non-inflamed mucosa in active ulcerative colitis. Namely HLA-DR antigens were expressed only on inflamed epithelium of ulcerative colitis. These results lead to the conclusion that the expression of HLA-DR antigens on colonic epithelium in ulcerative colitis is closely related to the inflammation of mucosa.

Colitis, Ulcerative↗

PubMed2002

[Changes in the proliferation and apoptosis of colonic epithelial cells in correlation with histologic activity of ulcerative colitis].

BACKGROUND: The imbalance of epithelial cell kinetics in ulcerative colitis can lead to several gastrointestinal disorders such as ulcers or neoplasias. The changes of epithelial cell kinetics caused by the inflammatory process have not been fully and uniformly described. Aim of the study was to compare the rate of epithelial cell apoptosis and proliferation within colonic crypts considering the histological activity of ulcerative colitis. MATERIALS AND METHODS: Formalin fixed paraffin embedded biopsy specimens from mild, moderate, and severe active inflammation of ulcerative colitis and from normal colonic tissue were observed. Number of cases (apoptosis/proliferation): normal: 8/10; mild UC: 8/10; moderate: 8/8; severe: 12/8. For detecting apoptosis the TUNEL-POD-DAB method, and for proliferation the PCNA (PC-10)-Biotin-Streptavidin-AEC method were used, constrained with haematoxylin. Using light microscope, at least 500 crypt epithelial cells were encountered axially in whole, well-orientated colonic crypts per each specimen. RESULTS: The number of TUNEL positive epithelial cells were significantly higher in moderate and severe active inflammation compared to each other and to normal (p < 0.0001). Between mild inflammation and normal significant alteration was not found. The number of PCNA positive cells were significantly higher in each groups of inflammation compared to normal or each other. CONCLUSION: These results demonstrate that there is a strong correlation between the histological activity of ulcerative colitis and elevated crypt epithelial cell turnover, although the alterations in proliferation develop in the earlier stages of inflammation.

Adult↗

PubMed1981

[Immunopathogenetic and ultrastructural aspects of ulcerative colitis].

The ultrastructural pathology and local immune response in ulcerative colitis are discussed. The local immune reaction in ulcerative colitis is characterized by distinct plasma cell multiplication with a striking deviation from the normal mucosal immunocyte class pattern resulting in a disproportionate increase of the IgG-cell number. The pronounced local IgG-cell response in the bowel mucosa of patients with ulcerative colitis should probably be regarded as an attempt to establish a "second line of defense" against exogenous and/or endogenous antigens. In cases with active disease IgG is found to be bound to the basement membrane of the surface epithelium. Activated complement (Clq and C3 fraction) can be demonstrated at this site as well. This association of IgG and activated complement at the same site in the mucosa suggests the possible involvement of fixed immune complexes in the production of mucosal damage. The immune complexes presumably bound to the epithelial basement membrane and the consequent activation of complement could explain the marked granulocytic activities at the surface epithelium in active ulcerative colitis. These polymorphonuclear leukocytes could have been attracted by components of the activated complement. Granulocytes are often seen in state of degranulation. The degranulation of granulocytes (and macrophages) may be result of "frustrated phagocytosis" by the granulocytes and macrophages of antigen-antibody complexes. This process could induce the release of lysosomal enzymes by granulocytes and macrophages. The detection of extracellular lysosomal enzymes (peroxidase, acid phosphatase) could be of pathogenetic significance in connection with the concept of Weissmann. Lysosomal enzymes damage cells, connective tissue and mucosal block. This implies exacerbation and perpetuation of the antigenic breach and therefore of the inflammatory process. A vicious circle is started.

Colitis, Ulcerative↗

PubMed2003

Colorectal cancer and high grade dysplasia complicating ulcerative colitis in Italy. A retrospective co-operative IG-IBD study.

BACKGROUND: Ulcerative colitis is a well-known risk factor for colorectal cancer. AIM: To take a census of the cases of colorectal cancer in ulcerative colitis patients observed in Italy and to evaluate the clinical presentation of neoplastic complication. PATIENTS AND METHODS: Experts from 28 Italian centres specialised in the management of inflammatory bowel disease or malignancies participated to the study. They were invited to send clinical data of patients with ulcerative colitis complicated by colorectal cancer or high-grade dysplasia consecutively observed between 1985 and 2000. One hundred and twelve patients (92 with cancer and 20 with high-grade dysplasia) were collected. Fourteen of them had undergone colectomy and ileo-rectal anastomosis for ulcerative colitis. Data of surgical patients were analysed separately. RESULTS: The mean age at diagnosis of ulcerative colitis and colorectal cancer patients was 39.3 and 53.2 years, respectively, and the mean duration between diagnosis of ulcerative colitis and cancer was 13.9 years (range 0-53). Inflammation was proximal to the splenic flexure in 71 cases (76.3%). One hundred and three colorectal cancers were registered (93 patients with single lesion and five patients with two synchronous cancers), with 76.7% of cancers being located in the left colon. As to the surgical patients, the mean age at diagnosis of ulcerative colitis and cancer was 28.9 and 47.0 years, respectively, and the mean diagnostic interval for ulcerative colitis and cancer was 18.1 years. Only 51 out of 112 patients were in follow-up. An early diagnosis of neoplasia (high grade dysplasia, stage A or B sec. Dukes) occurred in 72.5% of patients who were subjected to endoscopic surveillance and in 48.0% of patients who did not undergo endoscopic surveillance (p=0.02). CONCLUSIONS: These data show an earlier diagnosis of cancer in patients who had undergone endoscopic surveillance. The poor compliance to the follow-up program, however, reduces its effectiveness. Moreover, total colectomy allows an easier follow-up, with only the rectum being controlled. Colectomy with ileo-rectal anastomosis or proctocolectomy with ileo-anal anastomosis, could represent a valid alternative in patients at high risk of cancer who refuse endoscopic surveillance.

Adolescent↗

PubMed2005

Is endoscopy necessary for the measurement of disease activity in ulcerative colitis?

OBJECTIVES: Many disease activity indices are used to measure ulcerative colitis. Invasive indices incorporate an endoscopic score, while noninvasive indices do not require endoscopy. In clinical practice, many patients are treated based on their symptoms without endoscopic evaluation. However, invasive indices are commonly used in clinical research. Our objective was to determine whether endoscopy is necessary for the assessment of disease activity in patients with ulcerative colitis. METHODS: Sixty-six consecutive ulcerative colitis patients were evaluated with invasive indices: the St. Mark's index and the Ulcerative Colitis Disease Activity Index (UCDAI); and noninvasive indices: the Simple Clinical Colitis Activity Index (SCCAI) and the Seo index. The correlations between the indices were measured. The contribution of the endoscopic items was measured with linear regression modeling. The overlap of endoscopy with other items in the standard indices was determined through factor analysis. RESULTS: The two noninvasive indices correlated well with the invasive St. Mark's Index (SCCAI 0.86, Seo 0.70). After adjusting for the three noninvasive UCDAI items, the UCDAI endoscopy item predicted only 0.04% of the variance in the St. Mark's index. Factor analysis demonstrated that this is because the endoscopy items in the invasive indices correlate with stool frequency and stool blood items. CONCLUSIONS: Endoscopy items contribute little additional information to indices of disease activity in ulcerative colitis. The clinical practice of treating patients based on reported symptoms is appropriate. The use of noninvasive indices in clinical trials could lower study costs and may increase subjects' willingness to participate.

Adult↗