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PubMed1996

Incidence of ulcerative colitis and indeterminate colitis in four counties of southeastern Norway, 1990-93. A prospective population-based study. The Inflammatory Bowel South-Eastern Norway (IBSEN) Study Group of Gastroenterologists.

BACKGROUND: The incidence of ulcerative colitis (UC) has been difficult to interpret because prospective studies have only been performed during the past 3 decades. Geographic variations may therefore be due to differences in study design. METHOD: From 1 January 1990 to 31 December 1993 all new cases of UC in four counties in southeastern Norway were prospectively registered. Cases diagnosed as indeterminate colitis (IND) when endoscopy and histopathology were inconclusive or diverged with regard to diagnosis of UC or Crohn's disease (CD) were also included in the study. RESULTS: A total of 525 cases of UC and 93 cases of IND yielded an mean annual incidence of 13.6/10(5) and 2.4/10(5), respectively. There were differences in incidence between counties, and a peak of 21.5/10(5) in the annual incidence was found for the age group 25 to 34 years in UC. The distribution was about equal for each of the groups proctitis and left-sided and extensive colitis. The time interval from onset of symptoms to diagnosis was 4 months. CONCLUSION: In this study one of the highest incidences of UC in the world has been found. The classification 'indeterminate colitis' seems reasonable to use in some of the cases to prevent misclassification at the initial stage of diagnosis.

Adolescent↗

PubMed2001

Evaluation of antigenicity of germinated barley foodstuff for the treatment of ulcerative colitis in a chronic murine colitis model.

Germinated barley foodstuff (GBF) contains insoluble protein and dietary fiber, and has the potential to attenuate diarrhea and colonic mucosal damage in colitis. Since GBF contains a poorly digested protein fraction, this protein may be transferred to and absorbed in the colon. It may therefore be possible to detect the GBF antigen in colitis patients with dysfunctional colonic mucosal barrier defense. In this study, the antigenic potency of GBF was examined in vivo and in vitro. Using the AOAC method, the indigestible fraction of GBF (dietary fiber) was obtained, and the poorly digested protein fraction in GBF was determined. Using Sprague Dawley rats with chronic colitis induced by dextran sulfate sodium (DSS, 2.5% in diet), a GBF and control diet were administered, and total and specific serum immunoglobulin E (IgE) against intestinal contents and the soluble GBF protein were determined. In addition, reactivity between serum and intestinal content were examined by gel electrophoresis mobility shift assay (EMSA). GBF showed relatively low protein digestibility (47%) because of its low solubility in neutral pH. Total serum IgE in both dietary groups was not significantly different, and specific IgE antibodies against intestinal contents and the soluble GBF protein were not significantly different. In addition, supershifts were not observed in either dietary group by EMSA. The possible antigenicity of oral GBF was considered to be low in this colitis model.

Animals↗

PubMed1980

[Ulcerative colitis and Crohn's colitis. Medical or surgical treatment].

Colectomy with ileorectal anastomosis was performed in 47 patients affected by ulcerative colitis and Crohn's colitis. These two forms of "aggressive idiopathic colitis" present the same problems of therapy from both the pharmacological and the surgical point of view. The topical employment of antiphlogistic steroids and sulphasalazine by daily retention enemas caused a regression of proctitis and allowed a safe ileorectal anastomosis. After the surgical procedure a protective treatment of the rectal mucosa was prosecuted with minimal dosages of the same antiphlogistic drug by daily minienemas. Betametasone in aqueous solution have proved, among the antiphlogistic steroids, to be very suitable for a topical action without side-effects in the long time. The association of topical treatment and surgery is particularly indicated for those patients who cannot recover with medical therapy alone, as it enables them to recover and return to a normal life. The opportunity for colectomy is so much greater as it is possible, as a rule, to spare the rectum and protect the ileorectal anastomosis by means of a topical therapy without limitations of time. Therefore the surgical indication should not be delayed whenever the medical treatment by systemic administration of steroids, sulphasalazine and immunosuppressors is unable to prevent the evolution of aggressive idiopathic colitis to a chronic and seriously invalidating disease.

Anti-Inflammatory Agents↗

PubMed1998

Lack of effectiveness of the platelet-activating factor antagonist SR27417A in patients with active ulcerative colitis: a randomized controlled trial. The Platelet Activating Factor Antagonist Study Group in Ulcerative Colitis.

BACKGROUND & AIMS: Platelet-activating factor (PAF) is increased during relapse of ulcerative colitis. In animal models of experimental colitis, specific inhibition of PAF has reduced inflammation. The aim of this study was to evaluate the efficacy and safety of the PAF antagonist SR27417A in moderately active UC. METHODS: A double-blind multicenter trial was conducted during a 28-day period in hospital outpatients with an exacerbation of ulcerative colitis. Patients were randomized to receive 10 mg/day SR27417A or placebo, and both groups were also given 2.4 g mesalazine. Patient classification at the end of the treatment period was based on sigmoidoscopy and clinical scores. RESULTS: One hundred fifty-one subjects entered the study (75 placebo and 76 SR27417A). The remission rate between placebo- and SR27417A-treated patients at 28 days was not significantly different (29.0% and 35.6% respectively; P = 0.44). Similarly, 49.2% treated with SR27417A had a definite or possible improvement of their symptom score compared with 48.3% of those treated with placebo (P = 0.43). Four subjects in the placebo group and 5 subjects in the SR27417A group discontinued the drug treatment because of adverse events. No significant adverse events were thought to be caused by SR27417A. CONCLUSIONS: Although the specific PAF antagonist SR27417A is safe in humans, there is no evidence of efficacy in the treatment of acute ulcerative colitis.

Adult↗

PubMed1999

Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis (GETECCU).

OBJECTIVE: Butyrate enemas may be effective in the treatment of active distal ulcerative colitis. Because colonic fermentation of Plantago ovata seeds (dietary fiber) yields butyrate, the aim of this study was to assess the efficacy and safety of Plantago ovata seeds as compared with mesalamine in maintaining remission in ulcerative colitis. METHODS: An open label, parallel-group, multicenter, randomized clinical trial was conducted. A total of 105 patients with ulcerative colitis who were in remission were randomized into groups to receive oral treatment with Plantago ovata seeds (10 g b.i.d.), mesalamine (500 mg t.i.d.), and Plantago ovata seeds plus mesalamine at the same doses. The primary efficacy outcome was maintenance of remission for 12 months. RESULTS: Of the 105 patients, 102 were included in the final analysis. After 12 months, treatment failure rate was 40% (14 of 35 patients) in the Plantago ovata seed group, 35% (13 of 37) in the mesalamine group, and 30% (nine of 30) in the Plantago ovata plus mesalamine group. Probability of continued remission was similar (Mantel-Cox test, p = 0.67; intent-to-treat analysis). Therapy effects remained unchanged after adjusting for potential confounding variables with a Cox's proportional hazards survival analysis. Three patients were withdrawn because of the development of adverse events consisting of constipation and/or flatulence (Plantago ovata seed group = 1 and Plantago ovata seed plus mesalamine group = 2). A significant increase in fecal butyrate levels (p = 0.018) was observed after Plantago ovata seed administration. CONCLUSIONS: Plantago ovata seeds (dietary fiber) might be as effective as mesalamine to maintain remission in ulcerative colitis.

Adult↗

PubMed1988

A method for reproducing fatal idiopathic colitis (colitis X) in ponies and isolation of a clostridium as a possible agent.

Severe colitis was induced in two ponies after oral pretreatment with clindamycin and lincomycin, followed by intestinal content from two horses which had died from naturally-occurring idiopathic colitis. Two ponies treated with antibiotic alone, and two ponies treated with intestinal content alone, were unaffected. In a further study, three ponies treated on separate occasions with lincomycin, administered orally, died or were destroyed 67 to 72 h after initial treatment. No established salmonella, yersinia or campylobacter pathogens were isolated from these ponies, but a clostridium closely resembling Clostridium cadaveris was isolated as the predominant clostridium from them all and from the colonic content of one of six horses which died from naturally-occurring idiopathic colitis. It was not isolated from six horses with non-fatal diarrhoea. This clostridium is a candidate as an agent of some cases of fatal colitis in horses.

Animals↗

PubMed1975

The pseudomembranous colitis associated with clindamycin therapy--a viral colitis.

Four patients are described who developed pseudomembranous colitis in association with clindamycin therapy. Rectal biopsies from two patients were studied with the electron microscope and compared with the ultrastructural appearance of the rectal mucosa from seven normal people. Ultrastructural evidence for a viral colitis was obtained. The significance of the clindamycin therapy to the viral colitis and the contribution of the viral colitis to the clinical state are discussed.

Adult↗

PubMed1977

Immunological studies in ulcerative colitis. VIII. Antibodies to colon antigen in patients with ulcerative colitis, Crohn's disease, and other diseases.

Sera from patients with ulcerative colitis or Crohn's disease had elevated titers to colon antigen from germ-free rats significantly more often than sera from patients with gastroenteritis, irritable colon, non-gastrointestinal diseases, and healthy controls. Elevated anticolon titers in significant frequency were also found in patients with liver cirrhosis, urinary tract infections, and in polyposis coli and their relatives. Females with ulcerative colitis had, on an average, higher titers than men especially in the age group 30 years and over. In Crohn's disease the antibody titers often increased with time--as opposed to those in ulcerative colitis and non-gastrointestinal diseases. In conjunction with results published earlier, the present work supports the assumption that the antibodies in ulcerative colitis patients react with antigenic determinants distinct from those recognized by the colon antibodies present in other groups, including patients with Crohn's disease and polyposis.

Adolescent↗

PubMed1995

Laboratory markers of colonoscopic activity in ulcerative colitis and Crohn's colitis.

BACKGROUND: Previous studies have not identified a convenient laboratory marker of colonoscopic activity in Crohn's colitis or ulcerative colitis. METHODS: Twenty-eight patients with either ulcerative colitis or Crohn's colitis undergoing colonoscopy by the same observed had laboratory measurements of serum albumin, orosomucoid, C-reactive protein, plasma viscosity, haemoglobin, leucocyte and platelet counts, and faecal alpha-1-antitrypsin from single non-lyophilized samples. Multiple linear regression was performed using each laboratory variable as the dependent variable and the lengths of each grade of endoscopic activity as the explanatory variables. RESULTS: Multiple regression analysis using all the endoscopic grades of acute activity showed significant correlations with faecal alpha-1-antitrypsin (p < 0.001), serum albumin (p < 0.001), C-reactive protein (p = 0.02), and plasma viscosity (p = 0.03). CONCLUSIONS: The highest multiple correlation coefficients were obtained with faecal alpha-1-antitrypsin (r = 0.82) and serum albumin (r = 0.80), and these measurements can be recommended as convenient markers of endoscopic activity in these diseases.

Adult↗

PubMed1999

Interferon-inducible gene family 1-8U expression in colitis-associated colon cancer and severely inflamed mucosa in ulcerative colitis.

Persistent severe inflammation in colonic mucosa is thought to cause the development of colon cancer in patients with ulcerative colitis (UC). However, predisposing genetic abnormalities have not been identified in this sequence. Using differential display PCR, we isolated cDNA fragments corresponding to mRNAs that were differentially expressed in colitis-associated cancer tissues and mucosa with mild inflammation in the colon of five UC patients. This molecular screening approach identified 60 cDNA fragments, and we sequenced 34 fragments. One cDNA fragment, which is identical to IFN-inducible gene family 1-8U, was strongly expressed in all five UC-associated cancers. 1-8U was also expressed in sporadic colon cancer tissues and colon cancer cell lines, but not in normal mucosa. This gene was strongly expressed in severely inflamed colonic mucosa of UC without colitis-associated colon cancer, although 1-8U expression was not related to the extent and duration of the disease. However, 1-8U was expressed in the colonic mucosa of all patients with chronic, continuously severe inflammation. These results indicated that IFN-inducible gene family 1-8U expression in inflamed colonic mucosa might be used as a preferential marker of colitis-associated colon cancer in UC.

Adenocarcinoma↗

PubMed2006

[Risk factors for ulcerative colitis associated colorectal cancers in a Hungarian cohort of ulcerative colitis patients].

BACKGROUND: There is an increased risk of colorectal cancer (CRC) in ulcerative colitis (UC). The prevalence of UC associated CRC is different in various geographical regions. The risk depends primarily on the duration and extent of disease. AIM: The aim of the study was to identify risk factors for and epidemiology of CRC in UC patients in Veszprem province. PATIENTS AND METHODS: From our thirty-year IBD database we retrospectively studied the relevant epidemiological and clinical data of all UC patients in Veszprem province. The data of 723 UC patients (m/f: 380/343) were evaluated. The rate of familial disease was 5.2%, the rate of non-CRC related colectomies was 3.7% in our UC patients. RESULTS: CRC was diagnosed in 13 patients (m/f: 6/7, 13/8564 person year duration) during follow-up. The onset of UC in the 13 patients with UC-CRC was 34.5 (13-61) years, 4.1 years younger compared to UC patients without CRC. Mean age of UC-CRC patients at diagnosis of CRC was 50.9 (27-70) years (duration of UC: 16.5 +/- 8.2 years), almost 15 years younger than the average in sporadic CRC population in Hungary. Eight patients are still alive (survival: 67.9 (10-163) months), four patients died because of CRC (survival: 8.0 months), one died due to unrelated cause after 10 years of the diagnosis of CRC. Longer disease duration, chronic continuous disease, more extensive colitis, the presence of iron deficiency or chronic anaemia, primary sclerosing cholangitis (PSC) and dysplasia in the biopsy were identified as risk factors for developing CRC. In a logistic regression model longer disease duration, extensive colitis, PSC and dysplasia were still associated with increased risk. The cumulative risk for developing CRC after a disease duration of 10 years was 0.6% (95% CI: 0.2-1.0%), at 20 years 5.4 % (95% CI: 3.7-7.1%) and at 32 years 12.6% (95% CI: 7.0-18.2%). CRC diagnosed at surveillance colonoscopy was associated with longer survival (p = 0.04). CONCLUSION: The cumulative risk of CRC was high in our UC patients, however it was lower compared to that reported in Western European and North American studies. CRC developed approximately fifteen years earlier compared to the sporadic CRC cases. Long disease duration, extensive colitis, the presence of iron deficiency or chronic anaemia, dysplasia and primary sclerosing cholangitis (PSC) seem to be important risk factor for developing CRC in UC patients.

Adult↗

PubMed2006

Dense eosinophilic infiltration of the mucosa preceding ulcerative colitis and mimicking eosinophilic colitis: report of two cases.

There is increasing evidence about the involvement of eosinophils in the pathogenesis of inflammatory bowel disease. We report here two patients with ulcerative colitis who were initially diagnosed as eosinophilic colitis based on histopathological examination during their first attacks. They had symptomatic improvement with ketotifen and metronidazole during their first attacks. However, subsequent attacks which were histopathologically diagnosed as ulcerative colitis did not resolve with the above-mentioned treatment and necessitated a treatment with 5-ASA agents plus corticosteroids. Azathioprine also had to be added in the treatment of the second patient. Dense eosinophilic infiltration in these cases may suggest a role of eosinophils in the initiation of attacks in some ulcerative colitis patients.

Adolescent↗

PubMed1991

Crohn's colitis complicated by superimposed invasive amebic colitis.

The clinical characteristics and endoscopic appearance of inflammatory bowel disease (IBD) may be very similar to those of amebic colitis. Physicians, especially in areas in which amebiasis is endemic, are familiar with this difficulty. Moreover, in individual cases, it may even be impossible to distinguish between the two conditions, since stool specimens, bowel biopsies, and serological studies may be negative for Entamoeba histolytica, even in the presence of invasive amebic colitis. Invasive amebiasis may rarely be superimposed on IBD, which further complicates the issue. We report here a young patient with a 7-yr history of Crohn's colitis proven histologically who developed invasive amebic colitis during steroid and 6-mercaptopurine treatment for active disease. Stool specimens, mucosal biopsies, and serological studies were negative for E. histolytica, and the diagnosis was established on pathological examination of a surgically resected bowel. Anti-amebic therapy should be considered in endemic areas in cases of persistent IBD.

Adult↗

PubMed1987

[An experiment of acute fulminant severe ulcerative colitis in a 75- year-old male--a case report and a consideration of the surgical treatment of elderly patients with severe ulcerative colitis].

This is a case report of 75 year-old male patient with acute fulminant severe ulcerative colitis who underwent proctocolectomy after emergency ileostomy and decompression colostomy, and consideration of surgical treatment for elderly patients with severe ulcerative colitis are also discussed. A 75 year-old male was hospitalized as emergency case with complaints of high fever, severe abdominal pain and diarrhea. He was diagnosed as acute fulminant ulcerative total colitis by colonoscopy and barium enema examination. He had urgent operation of ileostomy and decompression cecostomy in the presence of severe disease after intensive medical treatment had failed. After a few days toxic signs gradually disappeared and general status was slightly improved. And then, radical operation of proctocolectomy and permanent ileostomy was successfully performed 3 weeks after the previous operation. We wish to emphasize in the elderly patients, namely 60 years and over with severe ulcerative colitis, that radical surgical treatment such as proctocolectomy or total colectomy should be performed after minimal laparotomy with decompression colostomy and ileostomy, because they do not survive so readily as the younger patients.

Acute Disease↗

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↗

PubMed1981

Detection of colonic antigen(s) in tissues from ulcerative colitis using purified colitis colon tissue-bound IgG (CCA-IgG).

In our report of a disease-specific colonic tissue-bound antibody (CCA) from patients with ulcerative colitis (Proc Natl Acad Sci USA 1978;75:4528), crude CCA was largely fragmented, and the yield was small. We have modified the extraction procedure to increase the yield of intact IgG present in CCA by sequential elution, storage of tissues in presence of a protease inhibitor, 2 mM Phenylmethylsulfonyl Fluoride, and use of Phenylmethylsulfonyl Fluoride in extraction buffers. Intact CCA-IgG was purified using protein A-Sepharose 4B affinity chromatography. 125I-CCA-IgG formed immune complexes in vitro with the aqueous extracts of colonic mucosa from 5 patients with ulcerative colitis but not from 6 patients with Crohn's disease and 6 normal colons from patients with carcinoma (p less than 0.01). We also performed reverse experiments by iodination of the colonic mucosal extracts with Bolton-Hunter reagent and incubating them with several preparations of CCA-IgG. Mucosal extracts of colon from 3 patients with ulcerative colitis bound significantly with CCA-IgG when compared with the identical extracts from 3 patients with Crohn's disease, 3 with a normal colon (p less than 0.005), and with the control human IgG (p less than 0.025). These studies demonstrate a better method of extraction and purification of intact CCA-IgG. Intact CCA-IgG binds to a specific protein(s) present in the homogenates of colonic mucosa from patients with ulcerative colitis but not from patients with Crohn's disease and normal colon.

Antigen-Antibody Complex↗

PubMed1994

[Diarrhea due to rare forms of colitis: microscopic (lymphocytic, collagenous) colitis and spirochetosis].

Lymphocytic and collagenous colitis, uncommon entities that are identifiable by histopathologic examination only, and intestinal spirochetosis may cause chronic diarrhea. Data on incidence, histopathology, and diseases associated with these infrequent forms of colitis are reviewed. Etiology and pathogenesis of lymphocytic and collagenous colitis are still unknown, but immuno-inflammatory factors may be involved in both forms as well as, in collagenous colitis, primary disorders of collagen metabolism or drug-induced toxic effects. The significance of intestinal colonization by spirochetes is disputed; however, recent results indicate that these microorganisms are capable of inducing disease.

Adult↗

PubMed1993

[Simultaneous occurrence of lymphocytic gastritis and lymphocytic colitis with transition to collagenous colitis].

Lymphocytic gastritis and lymphocytic colitis are two rare disorders of unknown etiology, only diagnosable by histology. Simultaneous occurrence of lymphocytic colitis and lymphocytic gastritis has not been described up to now. A 69-year-old female patient was examined because of crampy abdominal pain and watery diarrhea. Laboratory tests did not reveal an etiology and in colonoscopy the colon and terminal ileum were normal. Histology disclosed lymphocytic colitis. Esophagogastroduodenoscopy showed erosive bulbitis. Biopsies of the stomach revealed lymphocytic gastritis. A second colonoscopy one year later showed the development of collagenous colitis.

Aged↗