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PubMed1994

Current surgical therapy for mucosal ulcerative colitis.

PURPOSE: There are numerous surgical options for the treatment of mucosal ulcerative colitis. METHODS: This article reviews the currently available options for the treatment of mucosal ulcerative colitis. Separate discussions will explore both the options in the emergency and elective settings. RESULTS: Patients with mucosal ulcerative colitis may undergo surgery either as an emergency or in the elective setting. Emergency surgery is usually performed for one of the life-threatening complications of ulcerative colitis: fulminant colitis, toxic megacolon, or massive hemorrhage. The most commonly performed procedure under these conditions is a subtotal colectomy with end ileostomy. The rectal stump may be handled in a variety of ways. This procedure avoids proctectomy or anastomosis. Thus, patients will still have all necessary anatomic structures to allow for any of the definitive elective procedures. Elective surgery is performed for intractable disease, complications of medical therapy, dysplasia, or, occasionally, extraintestinal manifestations. In the elective setting, a definitive operation can be done to remove most or all of the disease-bearing colorectum and leave the patient with a means to control fecal elimination. Total abdominal colectomy with ileorectal anastomosis leaves the patient with diseased bowel but obviates the need for pelvic dissection. Although total proctocolectomy removes all potentially diseased mucosa, these patients have a permanent ileostomy. The stoma can either be a standard Brooke's ileostomy or a continent Kock pouch. The most common definitive procedure currently performed is the near-total proctocolectomy with ileal pouch-anal anastomosis. This option can be completed either with a rectal mucosectomy and hand-sewn anastomosis or with a double-stapled anastomosis, preserving the anal transition zone. This procedure is successful in eradicating almost all diseased mucosa while allowing the patient per anal defecation. Bowel movement frequency, degree of anal continence, and return to social and professional commitments have met with a great deal of satisfaction in most patients. A newer alternative to this procedure employs laparoscopy to facilitate a smaller incision. A one-stage procedure which omits the protective ileostomy and thus saves the patient one operation has also been used with some success in selected cases. CONCLUSION: There are several surgical options for the treatment of mucosal ulcerative colitis. Each one has a role and should be discussed with the patient.

Colitis, Ulcerative↗

PubMed1990

Liver histology and follow up of 68 patients with ulcerative colitis and normal liver function tests.

Hepatobiliary disorders are well known complications in patients with ulcerative colitis but it is not possible to predict those patients with ulcerative colitis who will eventually develop liver disease. In this study, liver biopsies from 74 patients with ulcerative colitis have been reevaluated. None of the patients showed clinical or biochemical signs of liver disease at the time of biopsy. Thirty seven (50%) had a completely normal liver biopsy. The others showed minimal portal inflammation or fatty infiltration. The biopsies of three patients displayed concentric, periductular fibrosis, or so called 'onion skin' lesions. None showed other signs of fibrosis or cirrhosis. The histological findings were unrelated to either activity or extent of colitis, except for the onion skin lesions which were seen exclusively in biopsies of patients with involvement of the total colon. Sixty eight of the 74 patients were reviewed after a mean interval of 18 years. The majority had no symptoms of hepatobiliary disorders and only two had developed liver disease; one suffered from cryptogenic cirrhosis, possibly due to non-A, non-B hepatitis and the other of an autoimmune liver disease and later developed a bile duct carcinoma. Both were women with total colonic involvement. At the time of the first liver biopsy one showed no histological abnormalities and the other only minor fatty infiltration. Thus, minor abnormalities in liver tissue are common in patients with ulcerative colitis without biochemical evidence of liver disease. The morphological changes are of little help in predicting the future risk of a patient with ulcerative colitis developing a clinically relevant hepatobiliary complication. The absence of biochemical parameters for liver disease during the early years of ulcerative colitis predict a favourable longterm diagnosis as regards hepatobiliary complications.

Adolescent↗

PubMedDate not supplied

Colonic mucosal antioxidant enzymes and lipid peroxide levels in normal subjects and patients with ulcerative colitis.

Oxygen-derived free radicals have been implicated in the pathogenesis of ulcerative colitis. Mammalian tissues contain antioxidant systems that offer protection from the damaging effect of these active species. In the present study, the activity of the antioxidant enzymes catalase, glutathione peroxidase, glutathione transferase and glutathione reductase were measured in rectal biopsies from patients with ulcerative colitis and compared with that obtained from normal subjects. A significant decrease in the activity of glutathione transferase was observed in ulcerative colitis (48.32 +/- 6.73 units/mg protein, mean +/- s.e.) compared to normal (68.20 +/- 6.83; P = 0.015). There was no difference in the activity of other antioxidant enzymes between controls and ulcerative colitis. Myeloperoxidase, a marker for neutrophil infiltration, was considerably increased in ulcerative colitis while malonaldehyde, the end product of lipid peroxidation, was not increased. The reduced activity of glutathione transferase in ulcerative colitis may be an additional factor in the pathogenesis of mucosal damage in this disease.

Adult↗

PubMed1998

[Interleukin-6 and interferon-gamma release from blood mononuclear cells and colonic mucosa from patients with ulcerative colitis].

BACKGROUND: Cytokines are involved in the pathogenesis of inflammatory bowel diseases such as ulcerative colitis and Crohn disease. AIM: To measure cytokine release by mononuclear cells of patients with ulcerative colitis. PATIENTS AND METHODS: Twelve patients subjected to a diagnostic colonoscopy were studied. Six had an ulcerative colitis and six did not have inflammatory changes in the colonic mucosa and were considered as control. Mononuclear cells were isolated from biopsies of colonic mucosa and from peripheral blood cultivated during 48 hours with pokeweed mitogen, and Interleukin 6 and interferon-gamma were measured in their supernatants. RESULTS: In patients with ulcerative colitis, interleukin 6 secretion by peripheral blood mononuclear cells was higher than in control subjects in the basal period (2212 +/- 424 and 443 +/- 174 pg/ml respectively p = 0.03) and after stimulation with pokeweed mitogen (16,328 +/- 1275 and 5462 +/- 322 pg/ml respectively p = 0.03). No differences in interleukin 6 secretion by colonic mucosa mononuclear cells were observed. Unstimulated cells did not liberate interferon-gamma. The secretion of this lymphokine by stimulated colonic mucosa cells was lower in patients with ulcerative colitis than in controls (1571 +/- 216 and 7953 +/- 389 pg/ml respectively p = 0.03). CONCLUSIONS: Local and systemic changes in interleukin 6 and interferon-gamma secretion occur in patients with ulcerative colitis. These changes could be related to the development of the disease.

Adult↗

PubMed1995

Phenotypic and functional characterization of T-cell lines generated from colonoscopic biopsy specimens in patients with ulcerative colitis.

Intestinal T-cell lines were generated from lamina propria mononuclear cells isolated from colonoscopic biopsies in ulcerative colitis patients and controls. In both ulcerative colitis and controls, expanded cells were constituted largely by T-cell receptor alpha beta+, CD4+, CD45RA- (helper), and CD8+, CD11b- (cytotoxic) phenotypes. T-cell receptor V beta gene usage was not significantly changed after cell expansion and no difference was observed between ulcerative colitis and controls. Ulcerative colitis cells, especially those derived from the patients with long-standing disease, showed significantly higher levels of cytotoxicity against the target cells, including those of colonic epithelial origin, and enhanced production of tumor necrosis factor-alpha and interferon-gamma after short incubation with anti-CD3 antibody. Generation of T-cell lines from colonoscopic biopsy specimens may be useful for detailed functional characterization of locally infiltrating T cells in ulcerative colitis patients.

Adolescent↗

PubMed1950

Chronic ulcerative colitis--psychosomatic factors.

In six cases of idiopathic ulcerative colitis here reported, close correlation with emotional stress was shown. Psychosomatic relationship seemed definite. Experience with 85 patients with ulcerative colitis has led to the suggestion that emotional stress may be causative or a predisposing factor in some, perhaps all, such cases.

Colitis, Ulcerative↗

PubMed1950