[Dysproteinemic myocardosis in sprue, acute ulcerative colitis and related diseases].
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Blood Protein Disorders↗
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Results for “Colitis, Ulcerative”
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[Right hypertrophic ulcerative colitis; subocclusion revealed by radiographic examination of the small intestine].
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Colitis↗
[Ulcerative colitis in pregnancy and labor].
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Colitis↗
Seasonal variation in exacerbations of ulcerative colitis.
BACKGROUND/AIMS: The aim of this study was to determine whether there is seasonal variability in exacerbations of ulcerative colitis. METHODOLOGY: The timing of ulcerative colitis relapses was retrospectively studied in a group of consecutive patients with quiescent ulcerative colitis. Ninety-four patients were followed-up at least every three months for a mean of 29.3 (range: 12-67) months. RESULTS: In total, 248 relapses of ulcerative colitis were observed with a mean number of 2.6 (range: 0-9) per patient. The timing of the relapses was characterized by a clear monthly and seasonal pattern (p < 0.001). In particular, the occurrence of relapses peaked during October and November (observed/expected (O/E): 30/20 in both months) and showed three troughs: during July and August, during December, and during February (O/E: 13/21, 7/21, 8/20, and 15/21, respectively). Moreover, the relapse rate was high during autumn and spring (O/E: 84/62 and 72/61, respectively) and low during summer and winter (O/E: 45/61 and 47/64, respectively). CONCLUSIONS: These data support the premise that there is seasonal variability in terms of relapses in ulcerative colitis patients and suggest that the role of seasonal triggering factors must be further investigated.
Cohort Studies↗
Prophylactic colectomy or surveillance for chronic ulcerative colitis? A decision analysis.
BACKGROUND & AIMS: The treatment of patients with long-standing ulcerative colitis involving the entire colon is controversial. The aim of this study was to examine the effectiveness of surveillance colonoscopy or prophylactic colectomy on colon cancer mortality in patients with chronic ulcerative colitis. METHODS: Using decision analysis, computer cohort simulation of patients with ulcerative colitis was performed to evaluate 17 strategies including no colonoscopic surveillance, surveillance at varying intervals, and prophylactic proctocolectomy with ileal pouch-anal anastomosis. The model examined which biopsy results (low-grade dysplasia, high-grade dysplasia, or cancer) should lead to proctocolectomy and ileal pouch-anal anastomosis. Published data on the incidence of cancer with ulcerative colitis, the sensitivity and specificity of colonoscopy with biopsy, the risks of colonoscopy and surgery, and the prognosis with colon cancer were used. RESULTS: For a 30-year-old patient with pancolitis for 10 years, the model suggests that prophylactic colectomy would increase life expectancy by 2-10 months compared with surveillance and by 1.1-1.4 years compared with no surveillance. Surveillance would improve life expectancy by 7 months to 1.2 years compared with no surveillance. In sensitivity analysis, results were most affected by the cumulative incidence of cancer in patients with chronic ulcerative colitis. CONCLUSIONS: Either surveillance or prophylactic colectomy should increase life expectancy in patients with ulcerative colitis.
Adult↗
Incidence and clinical significance of lactose malabsorption in ulcerative colitis and Crohn's disease.
The incidence of lactose malabsorption was investigated in 85 patients with ulcerative colitis and 71 patients with Crohn's disease by means of lactose tolerance tests and disaccharidase determinations in small intestinal mucosa. Eight patients with ulcerative colitis (9%) and four with Crohn's disease (6%) had lactose malabsorption. A control group displayed a similar incidence. It is concluded that lactose malabsorption is not particularly common in ulcerative colitis and Crohn's disease. If it is present, its aetiology seems to be unrelated to the intestinal disease. Transitional lactose malabsorption was detected in two cases during a relapse of ulcerative colitis. Institution of a lactose-free (or lactose-poor) diet was an important supporting measure in seven patients who were unaware of their milk intolerance, in particular in two with ileostomy. Therefore, it is recommended that a lactose tolerance test should always be performed in patients with ulcerative colitis or Crohn's disease.Twenty-one patients with ulcerative colitis and nine with Crohn's disease, none of whom had lactose malabsorption, were placed on milk-free diets. A beneficial effect was noticed in five of the patients with ulcerative colitis, and in three of those with Crohn's disease. The mechanism is unknown. Evidence is presented that milk allergy is not responsible for the beneficial effect of a lactosefree diet in patients with associated lactose malabsorption.
Adolescent↗
Granulocyte chemotaxis in ulcerative colitis.
The chemotactic responsiveness of granulocytes obtained from patients with ulcerative colitis was compared to granulocytes from healthy individuals, using the LMAT (Leukocyte Migration Under Agarose Technique). A depression of chemotaxis found in ulcerative colitis patients was seen to be related to the disease activity. This reduction in granulocyte migration could not be corrected by preincubation of cell suspensions with tinidazole. The pattern observed for granulocyte chemotaxis in ulcerative colitis was discussed with reference to use as an aid in the differential diagnosis of ulcerative colitis and Crohn's disease.
Adult↗
Peptidergic nerves in the colon of patients with ulcerative colitis.
BACKGROUND/AIMS: The cause of impaired motility, such as diarrhea and toxic megacolon, in patients with ulcerative colitis is unknown. Neuropeptides have recently been shown to be a neurotransmitter in the non-adrenergic non-cholinergic inhibitory and excitatory nerves in the human gut. To clarify the physiological significance of vasoactive intestinal polypeptide, substance P and neurotensin in the colon of patients with ulcerative colitis, we investigated the enteric nerve responses on lesional and normal bowel segments derived from patients with ulcerative colitis and patients who underwent colon resection for colonic cancers. METHODOLOGY: Twenty-four specimens were obtained from the lesional colon of 6 patients with ulcerative colitis (4 male, 2 female; ages 14-51 years, mean: 40.3 years). The patients with ulcerative colitis had chronic disease (4 with moderate disease, 2 with severe disease). Seventy-two specimens were obtained from the normal colon of 10 patients with colonic cancer (8 men and 2 women; ages 40-56 years, mean: 51.2 years). A mechanographic technique was used to evaluate in vitro muscle responses to these peptides of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers. RESULTS: (1) Peptidergic nerves such as vasoactive intestinal polypeptide, substance P, and neurotensin nerves were found to act on both normal colon and ulcerative colitis colon; (2) the colon with ulcerative colitis was more strongly innervated by vasoactive intestinal polypeptide nerves than the normal colon; (3) Substance P and neurotensin nerves act more weakly in the UC colon that the normal colon. CONCLUSIONS: These findings suggest that peptidergic nerves play an important role in the impaired motility observed in patients with UC.
Adolescent↗
Cellular hypersensitivity to components of intestinal mucosa in ulcerative colitis and Crohn's disease.
The migration of peripheral leucocytes in vitro is examined in 36 patients with ulcerative colitis, in 34 patients with Crohn's disease, in 12 patients with ulcerative colitis or Crohn's disease, and in 31 patients with other gastrointestinal disorders. In a majority of the patients with ulcerative colitis extracts of foetal, colonic, and jejunoileal mucosa inhibit migration of leucocytes. A similar reactivity is seldom seen in Crohn's disease. Extracts of liver, kidney, and adrenal gland do not inhibit the migration. The reactivity of the ulcerative colitis group was found to be significantly different from that in controls and in the Crohn group, whereas the Crohn group did not differ significantly from the controls. The examination thus reveals a biological difference between ulcerative colitis and Crohn's disease, which are otherwise separable mainly on nosological criteria. The finding of a similar inhibition of leucocyte migration in five out of 31 patients with miscellaneous gastrointestinal disorders unrelated to ulcerative colitis and Crohn's disease was inconclusive. An antigen-induced inhibition of leucocyte migration has been shown in vitro to be a correlate of cellular hypersensitivity. The immunological mechanisms behind the present system are discussed, and it is concluded that the reactivity observed probably indicates the existence in ulcerative colitis of a state of cellular hypersensitivity to components of normal foetal, colonic, and jejunoileal mucosa.
Adolescent↗
Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis.
Fish oil omega-3 fatty acids exert antiinflammatory effects on patients with ulcerative colitis. However, a comparative study in patients with mild to moderate ulcerative colitis receiving only sulfasalazine or omega-3 fatty acids has not been performed. We sought to detect changes in the inflammatory disease activity with the use of either fish oil omega-3 fatty acids or sulfasalazine in patients with ulcerative colitis. Ten patients (five male, five female; mean age = 48 +/- 12 y) with mild to moderate active ulcerative colitis were investigated in a randomized cross-over design. They received either sulfasalazine (2 g/d) or omega-3 fatty acids (5.4 g/d) for 2 m.o. Disease activity was assessed by clinical and laboratory indicators, sigmoidoscopy, histology, and whole-body protein turnover (with 15N-glycine). Treatment with omega-3 fatty acids resulted in greater disease activity as detected by a significant increase in platelet count, erythrocyte sedimentation rate, C-reactive protein, and total fecal nitrogen excretion. No major changes in protein synthesis and breakdown were observed during either treatment. In conclusion, treatment with sulfasalazine is superior to treatment with omega-3 fatty acids in patients with mild to moderate active ulcerative colitis.
Adult↗
Ulcerative colitis: a cyclothymic disorder?
While psychogenic aspects in ulcerative colitis have been comprehensively studied, much less attention has been given to sequence and interaction of psychic and somatic factors in psychopathological description. Onset of schizoaffective and cyclothymic symptomatology in 20 ulcerative colitis patients proved to occur only after somatic manifestation. As later on organic and psychic relapse never occurred simultaneously, further discussion should be centered on two points: Does schizoaffective cyclothymic axial syndrome occur separately from ulcerative colitis manifestation? Or is there a common etiological, pathogenic base for both somatic and psychic symptoms?
Colitis, Ulcerative↗
A prospective randomized controlled trial of intravenous ciprofloxacin as an adjunct to corticosteroids in acute, severe ulcerative colitis.
BACKGROUND: The role of antibiotics in the treatment of ulcerative colitis is controversial. This study aims at assessing the therapeutic role of ciprofloxacin as an adjunct to corticosteroids in acute severe ulcerative colitis. METHODS: In this prospective, randomized, double-blind, placebo-controlled trial, 55 consecutive patients fulfilling the criteria of Truelove and Witts for severe ulcerative colitis were randomized on admission to the hospital to receive intravenously ciprofloxacin (400 mg b.i.d.) (n = 29) or placebo (n = 27). All patients received parenteral nutrition, intravenous hydrocortisone (100 mg q.i.d.) and hydrocortisone enemas (100 mg b.i.d.). Patients were assessed after 10 days of continuous treatment, or at any time a severe complication occurred. RESULTS: At study entry, there were no significant differences between treatment groups in any patient or disease-related parameter. Twenty-three of 29 patients (79.3%) treated with ciprofloxacin and 20 of 26 patients (77%) treated with placebo showed substantial improvement and were given oral steroids (P > 0.1). Six patients in each group did not improve (n = 10) or developed complications (n = 2). Nine of these 12 patients underwent emergency colectomy; three patients consented to receive intravenous cyclosporin but did not achieve remission of colitis and they underwent elective colectomy. There were no perioperative or late deaths. CONCLUSIONS: A short course of intravenous ciprofloxacin does not seem to augment the effect of corticosteroids for patients with acute, severe ulcerative colitis.
Acute Disease↗
5-Aminosalicylates, sulfasalazine, steroid use, and complications in patients with ulcerative colitis.
OBJECTIVES: The choice between sulfasalazine and 5-aminosalicylate (5-ASA) drugs in the management of patients with ulcerative colitis often depends on idiosyncrasies of drug tolerance and control of the disease in individual patients. We sought to evaluate whether there were population differences in the effect of 5-ASA and sulfasalazine on the occurrence of clinically recognized adverse events. We also attempted to determine whether there were differences in the use of concomitant steroids and in the rates of hospitalization. METHODS: We reviewed a large computerized database drawn from general practices in the United Kingdom. There we found records of 2894 patients in whom general practitioners had diagnosed ulcerative colitis, and who were receiving ongoing medical therapy specific to ulcerative colitis. The period of data availability ran from the beginning of 1990 to the latter part of 1993. The average duration of observation was 2.1 yr per patient. Patient histories were categorized into distinct periods according to the dose of 5-ASAs and sulfasalazine, steroids, and immunosuppressants, and were further separated according to the activity of ulcerative colitis. Within these categories, we examined the initiation and discontinuation of steroids, incidence of new hospitalizations for ulcerative colitis, and clinical mention of adverse events. RESULTS: New clinical mentions of hepatic, pancreatic, renal, and hematological events other than anemia were similar among the 5-ASAs and were very infrequent overall. Hospitalizations for ulcerative colitis occurred with similar frequency (about 15 hospitalizations per 100 patients per year) among users of those drugs. Patients receiving sulfasalazine had lower rates of initiation of prednisolone than did patients receiving 5-ASA, but sulfasalazine was used proportionately less often in patients who had been recently hospitalized, and it may be that sulfasalazine patients were somewhat less sick, overall, than were 5-ASA-using patients. The choice of drug did not affect discontinuation rates for prednisolone among established users. CONCLUSIONS: In the United Kingdom, during the period of this study, serious adverse reactions to drugs were not an important aspect of the management of patients with ulcerative colitis. Renal and pancreatic complications of sulfasalazine and 5-ASA therapy were extremely rare. Sulfasalazine and 5-ASA drugs have similar steroid-sparing properties. Disease-specific hospitalizations are approximately 100 times more common in ulcerative colitis patients than are serious adverse drug effects. Considerations of drug efficacy should therefore dominate the choice between therapeutic agents.
Adolescent↗
Takayasu's disease associated with ulcerative colitis.
A 14-year-old female with ulcerative colitis developed right anterior cervical pain and high fever. Cervical contrast-enhanced computed tomography (CE-CT) showed a wall thickness of the right common carotid artery which suggested aortitis. Her pulmonary angiography demonstrated a narrowing of the pulmonary arteries and she was diagnosed as having Takayasu's disease associated with ulcerative colitis. HLA analysis showed Bw52 and DR2 haplotype, which is frequently found in patients with Takayasu's disease associated with ulcerative colitis.
Adolescent↗
Chronic polyneuropathy and ulcerative colitis.
A case of chronic polyneuropathy associated with ulcerative colitis was reported. The patient was 57-year-old man who developed sensory disturbances and muscle weakness in four extremities along with the digestive symptoms of ulcerative colitis. Neurological examination revealed that sensory impairment in all modalities, muscular atrophy and weakness in the distal portions of all extremities and decreased or absent muscle stretch reflexes. Laboratory data included sedimentation rate 119mm/hour, CRP 4+, increased IgG and IgM. Lumbar puncture revealed normal CSF pressures, increased protein and IgG content with almost normal cell count. Nerve conduction velocity was delayed dominantly in sensory nerves. Sural nerve biopsy demonstrated degeneration of myelin sheath and decreased number of large fibers. Teased nerve study showed shortened internodal distances with myelin ovoids. These data together with the clinical course of this patient suggested that this peripheral neuropathy might be resulted from the common pathogenesis for ulcerative colitis which is considered as autoimmune disease.
Colitis, Ulcerative↗
[Secondary amyloidosis complicating ulcerative colitis].
We report a case of amyloidosis secondary to ulcerative colitis. A 33-year-old man with total ulcerative colitis was treated by proctocolectomy 3 years and 5 months after the onset of the disease. One year later, a nephrotic syndrome revealed a secondary amyloidosis that led to end-stage renal failure 14 years later. Colectomy could have delayed renal failure. During the 27-year time of follow-up, ulcerative colitis was the only detected disease possibly responsible for secondary amyloidosis.
Adult↗
TCM differential treatment of 57 cases of chronic gastritis complicated by ulcerative colitis.
57 cases of chronic gastritis complicated by ulcerative colitis were clinically observed. According to the TCM theory of differentiation of symptoms and signs, 4 types of the disease were divided and treated: 1) stagnation of qi in the liver, 2) dampness and heat in gastrointestinal tract, 3) asthenic cold in the spleen and stomach, and 4) coexistence of cold and heat. The therapeutic effects of chronic gastritis and ulcerative colitis were evaluated: 23 cases (40.3%) of chronic gastritis were cured and 28 cases (49.1%) improved; 25 cases (43.8%) of ulcerative colitis were cured and 28 cases (49.1%) improved. The effective rates were 89.5% and 93.0% respectively. The correlation between the therapeutic effects for these two diseases further demonstrates that their pathological mechanisms are closely interrelated, indicating that it is important to have these two diseases treated simultaneously.
Adult↗
Hepatobiliary complications of ulcerative colitis.
The records of 202 patients with chronic ulcerative colitis seen over a 12 year period were reviewed. Over one half (55 percent) were found to have liver function test abnormalities. These abnormalities correlated with the extent and severity of ulcerative colitis but not with the duration of the disease. Eight patients (4 percent) developed cirrhosis and four required portasystemic decompression for bleeding varices. Four patients (2 percent) developed biliary tract complications. Two patients were diagnosed as having sclerosing cholangitis, and two patients developed carcinoma of the extrahepatic biliary tree. Three of these four patients had whole colon involvement, but all four had mild clinical disease. It is concluded that the hepatobiliary complications of ulcerative colitis are the most frequent and serious extracolonic manifestations of the disease.
Adolescent↗