Adenocarcinoma of the large intestine associated with chronic ulcerative colitis; clinical and pathologic features of 73 cases.
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Adenocarcinoma↗
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The treatment of gastroduodenal ulcerative disease and ulcerative colitis with detergent complexes.
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Colitis↗
Intercurrent cytomegalovirus colitis in a patient with ulcerative colitis.
Acute intercurrent CMV colitis developed in a patient with UC who was receiving prednisone. CMV infection was suggested by light and electron microscopic study of a rectal biopsy taken during the acute episode and was confirmed by serology done nine months later. The microscopic studies of plastic-embedded tissues demonstrated that infected cells were concentrated in a subendothelial location and were presumably macrophages. Epithelial and endothelial cells were not involved. Steroid therapy and the inflammation and repair process (granulartion tissue) of active UC may have predisposed the present patient to CMV colitis. CMV infection has been reported to be more common in patients with UC than in the general population. Detection of CMV colitis in patients with UC could be of special importance since alteration of immunosuppressive therapy may be indicated.
Acute Disease↗
Transdermal nicotine for mildly to moderately active ulcerative colitis. A randomized, double-blind, placebo-controlled trial.
BACKGROUND: Ulcerative colitis is predominantly a disease of nonsmokers. Transdermal nicotine may help control clinical manifestations of this condition. OBJECTIVE: To determine the efficacy of transdermal nicotine for controlling clinical disease activity in active ulcerative colitis. DESIGN: Randomized, double-blind, placebo-controlled, single-center clinical trial. SETTING: Multispecialty group serving as an academic tertiary referral center. PATIENTS: 64 nonsmoking patients with mildly to moderately active ulcerative colitis despite the use of medication. INTERVENTION: Patients were stratified on the basis of smoking history, extent of disease, and concomitant medical therapy. After stratification, patients were randomly assigned to daily treatment with transdermal nicotine (n = 31) at the highest tolerated dose (11 mg for 1 week and then < or = 22 mg for 3 weeks) or placebo (n = 33). MEASUREMENTS: Clinical features were assessed at baseline and 4 weeks by endoscopy, physician assessment, and a patient diary of daily symptoms. Serum concentrations of nicotine were determined by using gas chromatography and mass spectrometry, and plasma concentrations of cotinine were measured by using high-performance liquid chromatography. RESULTS: At 4 weeks, 12 of 31 patients (39%) who received nicotine showed clinical improvement compared with 3 of 33 patients (9%) who received placebo (P = 0.007). Four patients receiving nicotine discontinued therapy because of side effects (contact dermatitis [n = 2], nausea [n = 1], and acute pancreatitis [n = 1]). At week 4, the nicotine group had a mean (+/-SD) trough serum nicotine concentration of 11.3 +/- 8.4 ng/mL and a mean trough plasma cotinine concentration of 192 +/- 95 ng/mL. CONCLUSIONS: Transdermal nicotine administered at the highest tolerated dosage (< or = 22 mg/d) for 4 weeks is efficacious for controlling clinical manifestations of mildly to moderately active ulcerative colitis.
Administration, Cutaneous↗
Quantification of distinct molecular species of platelet activating factor in ulcerative colitis.
The aim of this study was to characterize the synthesis and metabolism of platelet activating factor (PAF, 1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine) by colonic mucosa from patients with ulcerative colitis and healthy individuals. Tissue was obtained by endoscopic biopsy and by scraping the mucosa from surgical resections. Tissue was assayed for the various molecular species of PAF and its biologically inactive metabolite lyso-PAF using gas chromatography/mass spectrometry. Mucosa from surgical resections for ulcerative colitis contained C16:0 PAF (mean = 156 ng/g of mucosa), but not C18:0 PAF, PAF was not identified in mucosa from normal surgical resections or in endoscopic biopsies from either patients with ulcerative colitis or normal individuals. Both C16:0 lyso-PAF and C18:0 lyso-PAF were found in mucosa from normal and ulcerative colitis surgical resections and in endoscopic biopsies from ulcerative colitis and normal tissue. Levels of lyso-PAF were similar in ulcerative colitis and normal mucosa. Incubation of mucosa from areas of active inflammation in ulcerative colitis with the calcium ionophore A23187 increased the levels of C16:0 PAF by 2-3 fold and also increased the levels of C16:0 lyso-PAF. Addition of 3H-PAF to endoscopic biopsies from either normal individuals or patients with ulcerative colitis resulted in hydrolysis to 3H-lyso-PAF. The data on colonic mucosal levels of PAF are consistent with the results of earlier studies measuring PAF in patients with ulcerative colitis by bioassay. This study examines the synthesis and metabolism of specific molecular species of PAF in ulcerative colitis for the first time.
Adult↗
In-situ and invasive carcinoma of the colon in patients with ulcerative colitis.
Four cases are described in which ulcerative colitis was complicated by carcinoma and in which the extent of the accompanying in-situ carcinoma (precancer) was determined. The extent of the in-situ carcinoma was very variable and in all cases the rectum was spared in whole or part. Search for in-situ carcinoma in rectal biopsies will fail to indicate the development of malignancy in some patients with ulcerative colitis. Alternative methods of cancer detection in this group are discussed.
Adenocarcinoma↗
Uveitis occurring after colectomy and ileal-rectal sleeve anastomosis for ulcerative colitis.
Uveitis is an extraintestinal complication of ulcerative colitis and Crohn's disease. In most cases, its course parallels that of the underlying bowel disease and improves with its therapy. Occasionally, the two processes are not synchronous. In either case, the uveitis has usually been considered to be dependent on the presence of the colon. This report describes a patient who developed uveitis shortly after colectomy and ileal-rectal sleeve anastomosis for ulcerative colitis, indicating that the continuing presence of the colonic mucosa is not necessary for development of the associated ocular inflammation.
Adult↗
Trends in incidence rates of ulcerative colitis and Crohn's disease.
Between 1960 and 1979, three studies were conducted in the Baltimore Standard Metropolitan Statistical Area to ascertain the incidence rates of first hospitalizations for ulcerative colitis and Crohn's disease. The age-adjusted rates per 100,000 population for the 1977-1979 survey for ulcerative colitis in white and nonwhite males and females were 2.92, 1.79, 1.29, and 2.90, respectively; the Crohn's disease rates were 3.39, 3.54, 1.29, and 4.08, respectively. In Baltimore the age-adjusted rate for Crohn's disease has increased to exceed the ulcerative colitis rate for whites of both sexes and nonwhite females. The ulcerative colitis and Crohn's disease rates for nonwhite males are similar. The rate for white males exceeds that for nonwhite males for both ulcerative colitis and Crohn's disease, but the converse is true for females. Females have higher rates than males for Crohn's disease in both color groups and for ulcerative colitis among nonwhites. White ulcerative colitis rates are higher for males than for females. From the first to the second surveys, the white male and female rates for ulcerative colitis converge with increasing male and decreasing female rates, but then both decline from the second to the third surveys. For Crohn's disease, the age-adjusted rates increased for whites of both sexes and nonwhite females from the first to second surveys. The Crohn's disease rates appeared to stabilize for whites of both sexes between the second and present surveys, but they increased for nonwhites of both sexes. Trends in age-adjusted rates for other areas are also discussed.
Adolescent↗
Increased presence of cells containing transforming growth factor alpha (TGF-alpha) in ulcerative colitis, both during active inflammation and in remission.
OBJECTIVE: Patients with extensive and long-standing ulcerative colitis have an increased risk of developing colorectal cancer and sub-epithelial fibrosis. The polypeptide transforming growth factor alpha (TGF-alpha) has mitogenic effects and it is believed that local overproduction may result in tumour formation and fibrosis. DESIGN: In the present study, we correlated the presence of TGF-alpha in ulcerative colitis with the degree of inflammation and with dysplasia. METHODS: Sixty two patients were investigated, 46 with ulcerative colitis (16 with active inflammation and 20 in remission, 10 with dysplasia of the colon), and 16 controls with normal colonoscopy and without a history of colitis. There were no overlaps between the subgroups. Tissue sections from colonic biopsies were examined and TGF-alpha was detected by immunohistochemistry. TGF-alpha-containing cells were characterized by double-staining with antibodies to eosinophil cationic protein (ECP). An antibody (EG2) recognizing eosinophils with an activated phenotype was also used. RESULTS: The median number of TGF-alpha-containing cells in the mucosa was 24 per mm2 (inter-quartile range 10-51) in controls, 186 per mm2 (73-245) in ulcerative colitis with active inflammation, 76 per mm2 (52-198) in remission, and 130 per mm2 (66-203) in areas of dysplasia. Double-staining for TGF-alpha and ECP revealed that most of the TGF-alpha-containing cells were eosinophils, and most had an activated phenotype as judged by staining with EG2. CONCLUSIONS: The presence of TGF-alpha-containing cells in colonic mucosa is increased both in active inflammation and during remission in ulcerative colitis. Dysplasia is not associated with any significant increase in TGF-alpha-containing cells. The majority of TGF-alpha-containing cells are eosinophils with an activated phenotype. TGF-alpha released from these cells could be important for the development of complications seen in ulcerative colitis, such as cancer and fibrosis.
Adult↗
Nicotine tartrate liquid enemas for mildly to moderately active left-sided ulcerative colitis unresponsive to first-line therapy: a pilot study.
BACKGROUND: Ulcerative colitis is predominantly a disease of non-smokers, and transdermal nicotine is therapeutic but often results in side-effects. Administration of nicotine as a liquid rectal enema results in less systemic nicotine absorption. AIM: To determine the safety and clinical response of nicotine tartrate liquid enemas for active left-side ulcerative colitis in a pilot study. METHODS: Ten non-smoking patients with mildly to moderately active left-sided ulcerative colitis unresponsive to first-line therapy were treated in an open protocol with nightly nicotine tartrate liquid enemas at a dose of 3 mg nicotine base for 1 week then 6 mg for 3 weeks. Clinical assessments were determined at baseline and 4 weeks by endoscopy, physician assessment and a patient diary of daily symptoms. Peak and trough serum nicotine and trough plasma cotinine were determined by gas chromatography/mass spectrometry and high performance liquid chromatography, respectively. RESULTS: After 4 weeks of treatment, 5/7 patients (71%) showed clinical and sigmoidoscopic improvement (per protocol analysis). The other three patients discontinued therapy within 7 days because of inability to retain the liquid enemas. No patients showed histologic improvement. Six of the patients who completed the 4-week study had peak and trough serum nicotine concentration determined, only 1 of 6 patients had a detectable peak nicotine concentration (value 2.3 ng/mL), and all six patients had undetectable trough nicotine concentrations. The mean trough plasma cotinine concentration was 13 +/- 10 ng/mL. Transient and mild adverse events occurred in 4/10 patients (nausea, lightheadedness, tremor, sleep disturbance). Given the low or undetectable serum nicotine concentrations, these adverse events are not likely to be related to the nicotine enemas. CONCLUSIONS: Nicotine tartrate liquid enemas administrated at a dose of 3 mg nicotine base/day for 1 week and then 6 mg/day for 3 weeks are safe and appear to result in clinical improvement in some patients with mildly to moderately active, left-sided ulcerative colitis unresponsive to first-line therapy. Placebo-controlled trials are warranted to confirm these preliminary findings.
Adult↗
A novel method in the induction of reliable experimental acute and chronic ulcerative colitis in mice.
Acute and chronic experimental ulcerative colitis models were produced in mice by providing them with drinking water containing synthetic dextran sulfate sodium. Mice that developed acute colitis showed signs of diarrhea, gross rectal bleeding, and weight loss within 6-10 days after ingesting 3%-10% dextran sulfate sodium. On postmortem examination, multiple erosions and inflammatory changes including crypt abscesses were found on the left side of the large intestine. Mice that developed chronic colitis showed signs of erosions, prominent regenerations of the colonic mucosa including dysplasia, shortening of the large intestine, and frequent formation of lymphoid follicles after 5 administration cycles, where each cycle was composed of 7 days' consumption of drinking water containing 5% dextran sulfate sodium followed by 10 days' consumption of distilled water. The population of intestinal microflora, Bacteroides distasonis and Clostridium spp., increased significantly in mice with acute and chronic ulcerative colitis. Further, morphological studies suggest that the administered dextran sulfate sodium was partially phagocytized by macrophages in the colonic mucosa.
Acute Disease↗
[Study on differentially expressed genes of ulcerative colitis in the rat treated by herbs-partitioned moxibustion].
OBJECTIVE: To probe the mechanism of herbs-partitioned moxibustion for treatment of ulcerative colitis. METHODS: The rats with ulcerative colitis were randomly divided into 3 groups, normal control group, model group, and herbs-partitioned moxibustion group. The rats in the herbs-partitioned moxibustion group were treated by herbs-partitioned moxibustion at bilateral Tianshu (ST 25). BiostarR-40s gene chip was applied to detect the differentially expressed gene of their colonic tissues and fluorescence quantitative polymerase chain reaction was employed to confirm the results of the microarray analysis with interleukin-1 beta messenger RNA (IL-1beta mRNA) expression. RESULTS: Of 174 differential expression genes identified, 28 genes (including 7 known genes) elevated in rats of ulcerative colitis were down-regulated and 146 genes (including 42 known genes) reduced in the rat of ulcerative colitis were up-regulated after herbs-partitioned moxibustion treatment. CONCLUSION: Many abnormally expressed genes are involved in occurrence of ulcerative colitis and herbs-partitioned moxibustion can regulate expression of IL-1beta and other genes to exert therapeutic effect.
Animals↗
Seasonal variation in exacerbations of ulcerative colitis.
The monthly distribution of relapses in ulcerative colitis was analysed retrospectively to assess seasonal variation. In 338 patients who were regularly followed up at the colitis clinic, 1013 relapses occurred during the period 1977 to 1988. A peak of relapses occurred in the spring and autumn, with a decrease in the summer; the ratio of the observed to expected number of relapses was 201:255.3 for the summer, 289:252.6 for the autumn, 243:249.8 for the winter, and 280:255.3 for the spring. In contrast, month of diagnosis was evenly distributed without seasonality. The data support the concept that exacerbations in ulcerative colitis are influenced by seasonal factors.
Colitis, Ulcerative↗
[Ulcerative colitis and granulomatous enteritis (author's transl)].
Radical operative treatment of ulcerative colitis and regional granulomatous enteritis leads to satisfactory short-term results. The high mortality of one-stage proctocolectomy in the acute case can be markedly reduced by a staged operation. The same applies for surgery in toxic megacolon. Preservation of continence in ulcerative colitis is rarely possible without endangering long-term results. Chances of evading life-long ileostoma in granulomatous enteritis are very much better. The prominent ileostoma represents a great step forwards. Conservatively treated patients with ulcerative colitis are by no means free from the risk of dangerous complications. 10% had to undergo surgery in the end and only 36% were symptom-free according to their own evaluation. Out of patients with ulcerative colitis treated with procto-colectomy and ileostoma 75% were completely symptom-free. Patients with symptoms had not obtained a prominent ileostoma or it was unsuccessful. Acute ileitis should not be treated operatively. Surgical treatment of chronic granulomatous enteritis need seldom be urgently performed and should be carefully evaluated. Late mortality in operated patients occurs only in the young, in a small percentage due to relapse.
Colectomy↗
Appendectomy protects against ulcerative colitis.
We conducted a case-control study of the protective effect of appendectomy on the development of ulcerative colitis. We calculated the risk of ulcerative colitis in 716 incident cases of ulcerative colitis and 2,747 controls according to appendectomy status, using data from the United Kingdom General Practice Research Database. We also studied a random sample of 100 cases and 100 controls to validate the subject's history of appendectomy. Fifteen cases (2%) and 109 (4%) controls had a computer-recorded history of appendectomy [odds ratio (OR) = 0.5; 95% confidence interval (CI) = 0.3-0.9]. In the sample, the OR was 0.3 (95% CI = 0.1-0.9). Appendectomy appears to protect against ulcerative colitis.
Adult↗
Intracolonic release in vivo of interleukin-1 beta in chronic ulcerative colitis.
1. To investigate the role of interleukin-1 beta in chronic ulcerative colitis, we quantified interleukin-1 beta steady-state release into the colonic lumen. 2. We studied 26 patients with untreated chronic ulcerative colitis and seven patients with irritable bowel syndrome who served as disease controls. In seven ulcerative colitis patients, the disease was inactive and in 19 it was mild to moderately active, according to clinical and colonoscopic criteria. Seven patients with active colitis were studied before and after 4 weeks of treatment with oral 5-aminosalicylic acid. 3. Colonic perfusions were performed using a double-lumen technique. An isotonic solution was continuously infused 50 cm from the anal verge at 5 ml/min, and was recovered 30 cm distally by siphonage. Interleukin-1 beta was measured by ELISA, polymorphonuclear elastase by immunoactivation and leukotriene B4 by specific RIA. 4. All control patients and five out of seven patients with inactive colitis had undetectable interleukin-1 beta release. In active colitis, the release of interleukin-1 beta was detected in 17 out of 19 patients (median 500 pg/min, interquartiles 270-1582 pg/min, P < 0.01 compared with control subjects and patients with inactive colitis). Elastase and leukotriene B4 release were also significantly increased in active colitis compared with inactive colitis and controls. Leukotriene B4 release was similar in inactive colitis and controls, whereas elastase release was higher in inactive colitis than in controls. Five out of seven patients with colitis improved after treatment with 5-aminosalicylic acid. In all responder patients, interleukin-1 beta became undetectable or declined. 5. Our results demonstrate under conditions in vivo that active colitis is associated with enhanced interleukin-1 beta release into the colonic lumen whereas such release does not occur in remission, supporting the concept that ulcerative colitis flare-ups involve increased interleukin-1 beta production.
Adolescent↗
An index of disease activity in patients with ulcerative colitis.
Quantification of disease severity was studied in 72 patients with ulcerative colitis, who had undergone total 85 clinical courses. We performed a multiple stepwise regression analysis, according to Truelove and Witts' classification, with disease severity as a dependent variable, and with 18 clinical, laboratory, and endoscopic parameters as independent variables. Results showed that disease severity in patients with ulcerative colitis is significantly influenced by five factors, namely, bloody stool, bowel movements, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), and serum albumin. The activity index (AI) developed for ulcerative colitis is expressed as follows: AI = 60 x blood stool + 13 x bowel movements + 0.5 x ESR - 4 x HB - 15 x albumin + 200. Index values below 150, values between 150 and 220, and values above 220 nearly corresponded to mild, moderate, and severe disease, respectively, in Truelove and Witts' classification. We believe that the activity index is useful in evaluation of the effect of medical treatment in patients with ulcerative colitis. Its most important value will be in therapeutic trials.
Adolescent↗
[Cerebral sinus thrombosis and ulcerative colitis: two cases].
Inflammatory bowel diseases (IBD)--ulcerative colitis and Crohn's disease--are associated with increased risk for thrombotic complications both in the arterial and venous system. Cerebral sinus thrombosis is a rare but potentially fatal consequence of these diseases. Modern imaging methods made this uncommon complication of IBD more frequently recognized. The link between IBDs and thrombosis has been extensively studied. Inherited coagulation disorders (APC resistance, antithrombin III and protein-S deficiency), acquired diseases (antiphospholipid syndrome), and the frequent use of corticosteroids were suspected. Two cases of ulcerative colitis associated with cerebral sinus thrombosis successfully treated are reported. The connection between IBD and thrombotic complications and the therapeutic risks are discussed as well.
Adult↗