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PubMed1982

Argyrophilic cell hyperplasia and an atypical carcinoid tumor in chronic ulcerative colitis.

An unusual case of chronic ulcerative colitis, is presented in which an atypical carcinoid tumor was seen. Many areas of the mucosa showed glandular changes of chronic injury and dysplasia, and in these areas, argyrophilic cell hyperplasia was identified. Data is presented describing the evolution of argyrophilic cell hyperplasia as a reaction to injury, the evolution of carcinoid tumors in argyrophilic cell hyperplasia, and the relationship of the proliferating argyrophilic cells to the proliferating glandular cells in ulcerative colitis.

Adult↗

PubMed1985

Intraarterial prednisolone infusion therapy in ulcerative colitis.

Thirty-seven patients with ulcerative colitis who had shown inadequate response to conventional medical therapies were given intraarterial infusions of prednisolone via the superior and inferior mesenteric arteries. The therapy was effective in 31 (57%) of 54 infusions, including three of five cases of toxic megacolon. The effectiveness of the therapy correlated well with the clinical assessment of disease activity. There was also a positive correlation between the caliber of the inferior mesenteric artery and the effectiveness of the therapy. Intraarterial infusion of prednisolone can lead to improvement of ulcerative colitis, and this mode of therapy should be considered particularly in severe cases.

Adolescent↗

PubMed2003

Intractable ulcerative colitis caused by cytomegalovirus infection: a prospective study on prevalence, diagnosis, and treatment.

PURPOSE: Cytomegalovirus infection has been known to complicate ulcerative colitis. This study was designed to elucidate the prevalence and clinical features of ulcerative colitis that might point efficiently to the diagnosis of complicating cytomegalovirus infection in cases of ulcerative colitis. METHODS: The study included 47 consecutive patients diagnosed to have moderate-to-severe ulcerative colitis who were treated on an inpatient basis at our department during a two-year period. A prospective examination for cytomegalovirus antigenemia was conducted in all patients with moderate-to-severe ulcerative colitis to determine the prevalence of cytomegalovirus infection among these patients. Then, the characteristic clinical and endoscopic features of ulcerative colitis complicated by cytomegalovirus infection were investigated by comparison of the cytomegalovirus-infected group with the non-cytomegalovirus-infected group. The therapeutic effects of antiviral drugs also were assessed. RESULTS: Cytomegalovirus infection was detected in 16 of 47 patients (34 percent). Proportion of female patients, age at the time of determination, and proportion of patients showing corticosteroid resistance was significantly higher in the cytomegalovirus-infected group (59.1 percent) than in the non-cytomegalovirus-infected group (13.6 percent). The prevalence of endoscopically severe ulcerative colitis was higher in patients with cytomegalovirus antigenemia than in those without cytomegalovirus antigenemia (P = 0.016). Ganciclovir was administered to 12 of 16 ulcerative colitis patients with complicating cytomegalovirus infection, and was found to be effective in 8 (66.7 percent). CONCLUSIONS: It is not easy to make a diagnosis of cytomegalovirus infection complicating ulcerative colitis based on clinical features, including endoscopic biopsy. On the other hand, blood examination for the detection of cytomegalovirus antigenemia in corticosteroid-resistant patients, particularly in relatively elderly patients, may enable diagnosis of cytomegalovirus infection with a high sensitivity and allow effective treatment to be administered in these patients.

Adult↗

PubMed1964

THE SURGICAL MANAGEMENT OF CHRONIC ULCERATIVE COLITIS.

For many years patients with chronic ulcerative colitis were subjected to operation as a last resort, but now, owing to improved surgical techniques and adequate preoperative preparation of the patient, mortality associated with operation has decreased and better-risk patients are being operated upon electively. The experience of the University of Alberta Hospital during the past 10 years in respect of the surgical management of chronic ulcerative colitis is reviewed, on the basis of 105 patients, 36 of whom underwent operation. The indications for surgery include obstruction, suspected carcinoma, hemorrhage, perforation, acute fulminating disease with toxic megacolon, and intractability. A variety of surgical procedures were used during this period, reflecting changing views in surgical management. Surgical complications include wound infections, bowel obstruction with ileostomy malfunction, skin excoriation, and electrolyte imbalance. In this series three of the 36 died, a mortality rate of 8%. One death was from liver failure and two were from peritonitis.

Acute Disease↗

PubMed1980

Clinical course of ulcerative colitis in Italy.

The prognosis of ulcerative colitis has been studied in 122 patients with this disease who had been referred to Bolgna from various parts of Italy and were then followed up. The overall mortality rate was 4.9% and the percentage of patients who were treated by total colectomy was 15.5%. Postoperative mortality was 10.5%, and the percentage of patients who developed carcinoma of the colon was 0.8%. All these figures fall within the range of values for the relevant variables quoted by previous authors from different countries. It is concluded that the prognosis of ulcerative colitis in the 122 Italian patients in the present study was similar to that reported previously in patients of other nationalities.

Animals↗

PubMed1974

Rectal biopsy and precancer in ulcerative colitis.

Forty-seven patients with ulcerative colitis subjected to elective proctocolectomy were investigated with regard to the occurrence of precancerous changes in the rectal biopsy and the operation specimen. In the rectal biopsy from seven patients precancerous lesions were found and in the operation specimens from these patients precancer was also found in other parts of the colon. In five of these patients the precancer was associated with carcinoma and in four of the patients the tumour had not been detected before operation. It is concluded that rectal biopsy is of great value in patients with ulcerative colitis for detection of early cancer and patients at risk of developing a colitis carcinoma.

Adolescent↗

PubMed1995

Molecularly defined HLA-DR2 alleles in ulcerative colitis and an antineutrophil cytoplasmic antibody-positive subgroup.

BACKGROUND/AIMS: Although HLA-DR2 is associated with Japanese ulcerative colitis, data regarding an HLA-DR2 association in other populations are conflicting. A recent study suggests that HLA-DR2 is only associated with antineutrophil cytoplasmic antibody-positive ulcerative colitis. The aim of this study was to determine whether HLA-DR2 or the molecularly defined alleles within the HLA-DR2 group are associated with ulcerative colitis or a perinuclear antineutrophil cytoplasmic antibody-positive subgroup. METHODS: Unrelated white patients with a history of ulcerative colitis (n = 97) and control subjects matched to patients for Jewish ethnicity and sex (n = 149) were studied. An immunofluorescence assay was used to detect perinuclear antineutrophil cytoplasmic antibodies. A molecular, DNA-based method was used to perform HLA-DR2 typing. RESULTS: HLA-DRB1*1601 was present in 11 of 149 controls and 1 of 97 patients (P = 0.031, corrected P, not significant; Fisher's Exact Test). There were no other significant differences between ulcerative colitis or ulcerative colitis stratified by perinuclear antineutrophil cytoplasmic antibody status and controls. CONCLUSIONS: The HLA-DR2 group of alleles is not associated with ulcerative colitis or a perinuclear antineutrophil cytoplasmic antibody-positive subgroup. The unexpected finding of a decreased frequency of HLA-DRB1*1601 in ulcerative colitis should be further investigated.

Alleles↗

PubMed1978

Serial carcinoembryonic antigen (CEA) blood levels in patients with ulcerative colitis.

Fifty-seven patients with ulcerative colitis were folloued 1-49 months (mean, 18 months) with serial CEA determinations during periods of remission, mild relapses, and severe relapses. Elevated CEA titers correlated with activity and possibly extent of disease: 12% of patients with proctitis, 47% of patients with left-sided colitis, and 60% of patients with transverse or universal colitis had elevated CEA titers during a flare. Moreover, 24% of patients with mild flares and 86% of patients with severe flares had elevated CEA titers. Ninety-two percent of patients with extensive disease and severe flares had elevated CEA titers. Elevated CEA titers were correlated with histologic findings in three patients. Inflammation of mucosa was demonstrated by colonoscopy and confirmed by biopsy in one patient with persistently elevated CEA titers during clinical remission. In two other patients with active disease whose CEA titers fell prior to colectomy, marked denudation of colonic mucosa was noted. In this study, a transiently elevated CEA titer indicated either clinically active ulcerative colitis or active inflammation of colonic mucosa.

Carcinoembryonic Antigen↗

PubMed1997

Assessment and management of ulcerative colitis in children.

The incidence of ulcerative colitis in school-age children in most parts of Europe has been steady at 1.5-2.0 per 100,000 children per year for the last 20-30 years. In comparison to adults, abdominal pain is a relatively frequent presenting symptom in children in addition to rectal bleeding, bloody diarrhoea or diarrhoea. Distribution of disease in children is generally more extensive (ratio rectal:left sided:extensive 25:30:45). There are remarkably few clinical trials of therapy in children and reasons for this are discussed. Subjective indices of disease severity and activity are unreliable in children. Objective measures such as endoscopy are of value to define the extent of ulceration and histopathological features; a test of gut protein loss using whole gut lavage gives an objective index of disease activity. Principles of medical management in children are generally the same as in adults with the additional need for scrupulous attention to nutrition and growth, and psychological factors. Reassuring results of a review of the health status of young adults who had developed ulcerative colitis in childhood are presented. Twenty-four of 27 considered themselves fully fit although nine of the patients had a permanent ileostomy.

Adolescent↗

PubMed1996

Absence of antineutrophil cytoplasmic antibodies in relatives of UK patients with primary sclerosing cholangitis and ulcerative colitis.

OBJECTIVE: Perinuclear antineutrophil cytoplasmic antibodies (ANCA) have been reported in patients and relatives of patients with ulcerative colitis and primary sclerosing cholangitis, suggesting that ANCA may be a genetic marker of disease susceptibility. The reported frequency of ANCA in relatives has varied greatly, between 0 and 30%. We therefore studied the prevalence of ANCA in unaffected first-degree relatives of British patients with primary sclerosing cholangitis and ulcerative colitis. DESIGN: Thirty-six patients with ulcerative colitis, 33 with primary sclerosing cholangitis and 187 relatives were studied. Ninety-seven relatives were from the primary sclerosing cholangitis proband and 90 were from the ulcerative colitis proband. As an environmental control, 32 spouses were included: 14 from the primary sclerosing cholangitis group and 18 from the ulcerative colitis group. Eighteen healthy volunteers were additional controls. METHODS: ANCA was detected using immunoalkaline phosphatase method. RESULTS: Only 3 of 97 (3%) of the primary sclerosing cholangitis proband relatives had ANCA. One of these had ulcerative colitis, one had rheumatoid arthritis and the third systemic lupus erythematosus. Both rheumatoid arthritis and system lupus erythematosus are known to exhibit ANCA. All other sera were negative. CONCLUSION: ANCA was found only in patients with primary cholangitis and ulcerative colitis and not in their healthy first-degree relatives. ANCA is therefore not a genetic marker for increased disease susceptibility to primary sclerosing cholangitis or ulcerative colitis in the British population.

Adult↗

PubMed1990

Management of severe hemorrhage in ulcerative colitis.

Twenty-five patients with ulcerative colitis were treated between 1959 and 1986 at the Mount Sinai Hospital, with severe gastrointestinal hemorrhage as their major complaint. Twenty-two patients required operation, while three patients were treated medically. Total proctocolectomy with ileostomy was carried out in 5 patients, and subtotal colectomy accompanied by mucous fistula (14), Hartmann closure (2), or ileosigmoidostomy (1) was performed in 17 patients. Eleven of the patients who underwent operation had emergency colectomies, while the remaining 11 had semielective procedures. Subtotal colectomy was performed in 10 of the 11 emergency cases. Indications for emergency surgery were massive hemorrhage alone in seven patients and severe hemorrhage complicated by toxic megacolon in four patients. One patient died postoperatively of a perforated duodenal ulcer following emergency subtotal colectomy. There were two late deaths from leukemia in one surgically treated patient and one medically treated patient at 9 and 18 months, respectively. All 4 of the 25 patients with remaining intact rectums were alive and well at 3- to 12-year follow-up. Subtotal colectomy can be undertaken in patients with massive hemorrhage from ulcerative colitis for whom subsequent ileoanal anastomosis is planned, provided that one recognizes and is prepared for the approximately 12% risk of continued rectal hemorrhage.

Adolescent↗

PubMed2001

[Common bile duct tumor in a young woman with ulcerative colitis].

Bile duct carcinoma is a rare complication of ulcerative colitis. In most of the cases it tends to occur together with primary sclerosing cholangitis predominantly in older males. The authors report a case of a 25 year old woman presenting with jaundice, 6 years after the diagnosis of colitis was made. The cause of the extreme extra- and intrahepatic bile duct dilation was revealed by endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography showing polypoid tumor in the common bile duct. The histological result taken during the surgical exploration proved the diagnosis of adenocarcinoma. Radical pylorus preserving pancreato-duodenectomy was performed. Subsequently adjuvant chemotherapy was instituted according to the PAV protocol. This rare case proves, that a malignant bile duct tumor may develop in a young patient with ulcerative colitis without the presence of primary sclerosing cholangitis. The authors emphasise the connection between ulcerative colitis and bile duct carcinoma and the importance of the close follow-up of every patient with ulcerative colitis.

Adenocarcinoma↗

PubMed1989

Conservative proctocolectomy: a dubious option in ulcerative colitis.

Conservative proctocolectomy was performed for ulcerative colitis in 19 patients, Crohn's disease in three and familial adenomatous polyposis in one. Healing was uncomplicated in only three patients (13 per cent). Eleven developed an anal discharge and nine an infected pelvic haematoma despite peranal drainage. Fourteen patients developed pelvic sepsis and, despite surgical curettage in 11, none healed. Six of these patients have had the anal sphincter divided, with healing in only one, and the anal canal has been excised in two. Eleven patients have ultimately healed at a median time of 28 months and eight have persistent sepsis after a median period of 45 months. Two patients with sepsis have had a successful ileoanal anastomosis. Conservative proctocolectomy cannot be recommended as a definitive operation for ulcerative colitis even though it may permit a subsequent restorative procedure.

Adult↗

PubMed1998

Glutathione content of colonic mucosa: evidence for oxidative damage in active ulcerative colitis.

Oxidative stress appears to play a role in the tissue damage of active ulcerative colitis, and it has been suggested that a defect in mucosal antioxidant defenses is a etiological factor in the disease. This study was undertaken to investigate the mucosal content and oxidation state of glutathione in ulcerative colitis in the active and inactive states and to examine the relationship between glutathione content and disease activity in this patient population. Endoscopic biopsies of colon mucosa were collected from normal subjects, from macroscopically normal tissue of patients with inactive and active ulcerative colitis, and from inflamed tissue of patients with active ulcerative colitis. The mucosal contents of GSH and GSSG were determined by liquid chromatography. We found no significant differences in tissue contents of reduced glutathione among the four groups. The median tissue level of oxidized glutathione in inflamed mucosa from patients with active ulcerative colitis was increased 1.7-fold (P = 0.017) over that of patients with inactive disease. The oxidized glutathione content of the mucosa also showed significant positive correlations with clinical and histological indices of disease severity among ulcerative colitis patients. In conclusion, a change in the redox status of mucosal glutathione is associated with inflammation and disease activity in ulcerative colitis. This change appears to be a consequence of inflammation rather than a pathogenic factor for the disease.

Colitis, Ulcerative↗

PubMed1986

Serum autoantibodies, ulcerative colitis and primary sclerosing cholangitis.

The aetiology of primary sclerosing cholangitis is unknown, but it is closely associated with ulcerative colitis. Serum anticolon antibodies, crossreacting with portal tracts, have been reported in patients with ulcerative colitis but no studies have been carried out in primary sclerosing cholangitis. The frequency of serum anticolon antibodies and portal tract antibodies have been measured in 24 patients with primary sclerosing cholangitis and ulcerative colitis; 15 patients with primary sclerosing cholangitis without ulcerative colitis; 77 patients without primary sclerosing cholangitis: 25 patients with Crohn's colitis; 10 patients with primary biliary cirrhosis; 22 patients with extrahepatic biliary obstruction and 20 normal controls. Serum anticolon and portal tract antibodies were detected using immunoperoxidase techniques on normal colon and obstructed human liver. Tissue typing was undertaken using a standard microcytotoxicity technique. The frequency of anticolon antibodies was markedly increased in primary sclerosing cholangitis patients with ulcerative colitis (62.5%) compared with patients with ulcerative colitis (17%) and Crohn's colitis (16%) (chi 2 = 17.9; p less than 0.001). The antibodies were almost entirely of IgG and IgA classes in all groups. Anticolon antibodies were not found in sera from any other group. Sera from eight of 15 patients with primary sclerosing cholangitis, ulcerative colitis and anticolon antibody reacted with portal tracts of human obstructed liver. This reaction was also seen in four of nine patients with ulcerative colitis and primary sclerosing cholangitis and in three of 15 patients with primary sclerosing cholangitis alone. Portal tract antibody was of IgG class and was not present in sera from any other groups. Unlike anticolon antibody, there was a close relationship between HLA-B8 phenotype and the portal tract antibody (p<0.02; chi 2 = 6.04). Absorption studies confirmed that the anticolon antibody is distinct from portal tract antibody.

Autoantibodies↗

PubMed2004

Clinical evaluation of granulocyte/monocyte apheresis therapy for active ulcerative colitis.

BACKGROUND: Recent evidence suggests that peripheral blood granulocytes and monocytes/macrophages have a major role in the exacerbation of ulcerative colitis. AIMS: Our objective was to investigate if selective granulocyte and monocyte adsorptive apheresis with Adacolumn promotes remission of active ulcerative colitis and spares corticosteroid. SUBJECTS: Sixty patients with active ulcerative colitis were studied, of whom 39 had relapsing-remitting ulcerative colitis, 15 had chronic continuous and 6 had their first episode of ulcerative colitis. METHODS: Granulocytapheresis was done with an Adacolumn filled with cellulose acetate beads as apheresis carriers that adsorb FcgammaR and complement receptors bearing leucocytes (granulocytes, monocytes and a small fraction of lymphocytes). Patients received up to 10 Adacolumn sessions over 12 weeks, one session was 60-90 min at 30 mL/min. No additional medication was given. Efficacy was assessed with Seo's activity index (AI) [Seo M, Okada M, Yao T. An index of disease activity in patients with ulcerative colitis. Am J Gastroenterol 1992;87:971-6]. The mean AL was 197.5 and range 154.4-277.7. AI < 150 was considered significant improvement and AI < 100 was considered clinical remission. RESULTS: Of 60 patients, 50 (83.3 %) improved, 14 achieved remission, granulocytapheresis was most effective in steroid-dependent patients. At entry, the mean dose of prednisolone was 15.3 mg/day per patient and was reduced to 3.6 mg/day after 10 sessions. Granulocytapheresis was well tolerated and no serious side-effects were observed. CONCLUSION: Based on our experience in patients with diverse ulcerative colitis disease expression and long-term exposure to conventional drug therapy, we believe that granulocytapheresis is an effective adjunct to conventional medication for promoting remission and sparing steroids in patients with active ulcerative colitis.

Adolescent↗

PubMed1988

Double-blind comparison of olsalazine and sulphasalazine in active ulcerative colitis.

Fifty-six patients with ulcerative colitis of mild to moderate severity were entered into a randomized, double-dummy comparison of sulphasalazine, 3 g/day, with olsalazine, 3 g/day. Patients were assessed clinically, and by sigmoidoscopy and biopsy, on entry and at 5 weeks. Both agents produced a similar reduction in stool frequency and in the passage of blood and mucus. Improvements in sigmoidoscopic and histological appearances of the rectal mucosa were observed to a similar extent in both groups of patients. Two patients treated with olsalazine were withdrawn because of increased diarrhoea attributable to the medication. Two patients given sulphasalazine for the first time developed a skin rash. Other side-effects seen during the trial were mild. In this small short-term study, oral olsalazine appeared to be as effective as sulphasalazine in the treatment of mild to moderate ulcerative colitis.

Adult↗

PubMed1990

Gastrointestinal motility in patients with ulcerative colitis.

In the first study 62 patients with ulcerative colitis and 20 healthy controls were fed a test meal of mashed potatoes and baked beans containing transit markers. Mouth-to-caecum transit was significantly slower in the patients than in controls; gastric emptying, however, was similar. Patients with active colitis had proximal colonic stasis, with rapid transit through the rectosigmoid region. In the patients with quiescent colitis the colonic distribution of markers was normal. Stool weight and frequency were significantly higher in the patients with active colitis. In the second study anorectal function was assessed in 29 patients with ulcerative colitis and in 12 healthy controls by measuring interluminal pressures at multiple sites in the anus and rectum before and during serial distention of a rectal balloon. Overall, resting and maximum squeeze sphincter pressures did not differ in patients with active or quiescent colitis and controls; however, in six patients with moderately severe colitis and incontinence, maximum squeeze pressure was significantly lower than in controls. The rectal volumes required to induce sensations of wind, a desire to defaecate, and pain were significantly lower in the patients with active colitis than patients with quiescent colitis and controls. Rectal pressures in response to rectal distention were higher in patients with active colitis. During disease remission rectal sensitivity decreased and rectal compliance increased. In the third study integrated pressure activity of the sigmoid colon, rectum, and anus was studied in patients with ulcerative colitis and healthy controls before and during provocation by rectal infusion of 1500 ml of warm saline.(ABSTRACT TRUNCATED AT 250 WORDS)

Colitis, Ulcerative↗