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PubMed1995

Surgical management of total ulcerative colitis and familial adenomatous polyposis.

Total ulcerative colitis (UC) and familial adenomatous polyposis (FAP) are two major diseases that require total removal of the colorectal mucosa. To provide a high quality of postoperative life, various surgical techniques have been used. However, results were far from ideal. Since 1978, we have worked on the ileoanal anastomosis (IAA) technique to achieve both radical removal of the mucosa and preservation of natural anal function. From 1979 to 1991, a total of 155 patients were treated by IAA. To evaluate the surgical results, these patients were divided into three groups: the Tokyo series (49 cases, 1979-1983), Hyogo I series (49 cases 1983-1988) and Hyogo II series (57 cases, 1989-1991). The success rates in terms of preservation of anal continence were: 58% (UC) and 78% (FAP) in the Tokyo series, 84% (UC) and 96% (FAP) in the Hyogo I series and 92% (UC) and 100% (FAP) in the Hyogo II series. The surgical time and blood loss were significantly reduced in the later series. Of the 82 patients followed up for 6 mo in the two Hyogo series, anal continence was normal or nearly normal in 54 patients, with only minor leakage at night in 22 patients. Septic complications in the pelvic caused the majority of surgical failures. We conclude that improved IAA techniques can achieve total removal of the colorectal mucosa and preserve anal function in more than 90% of patients with UC or FAP. However, the skill of an experienced surgeon is still required to achieve this goal. The long-term outcome of anal function after such procedures needs further evaluation.

Adenomatous Polyposis Coli↗

PubMed1993

New therapies for idiopathic ulcerative colitis.

Medical and surgical management of ulcerative colitis has advanced far in the last decade. New time-released ASA compounds and enemas have decreased the side effects of sulfasalazine and allowed delivery of higher doses of the active compound to the site of action. New steroid compounds have reduced the potential for systemic adrenal glucocorticoid suppression. However, therapy is still directed only against secondary immune and inflammatory responses. Until the cause of UC is discovered, well-designed and well-performed clinical trials must continue to try to identify agents that combine low toxicity with high therapeutic potential.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Long-term results of corticosteroid administration via appendicostomy in patients with ulcerative colitis involving the entire colon.

BACKGROUND: Ulcerative colitis (UC) of an unknown etiology frequently demonstrates repeated active and inactive stages. As a result, it is difficult to sustain long-term remission under conservative therapy. METHODS: Ten patients who presented suffering from UC involving the entire colon were treated. All patients had been previously treated at other hospitals usually with sulphasalazine and either corticosteroids or steroid enemas for the primary complaints of muco-bloody stool or frequent diarrhea. All patients underwent either an appendicostomy or cecostomy, and were injected with dexamethasone via an artificial fistula twice a day. RESULTS: This treatment led to remission, and, as a result, the symptoms of anal bleeding or muco-bloody stools disappeared in all patients. Radiological, endoscopic, and pathological studies revealed a dramatic response to steroid injection from the fistula. The mean follow-up period was 44.7 months (3-122 months). Eight patients remained free from any symptoms of UC. One underwent a proctocolectomy because of side effects due to steroid treatment. The other patient died suddenly of unknown causes. The mean symptom-free period after cecal injection was 39.5 months (1-119 months). The mean proportion of disease free period from UC, compared with the total follow-up period after surgery, was 88%. After remission, eight patients were able to return to a normal lifestyle at home using a peritoneal button. They could also take a bath and continue their school or social lives in almost the same way as healthy persons. CONCLUSIONS: We thus recommend this new, minimally-invasive therapy for patients with UC involving the entire colon who demonstrate resistance to conventional conservative therapy. As a result of such treatment, all patients were able to achieve a comfortable lifestyle after undergoing minimally-invasive surgery.

Adult↗

PubMedDate not supplied

Malignant lymphoma complicating ulcerative colitis.

Carcinoma of the colon as a complication of chronic ulcerative colitis is relatively common, whereas malignant lymphoma is apparently rare. We report two cases of patients with malignant lymphoma complicating ulcerative colitis, a CD 30 + T-cell lymphoma of the intestine and a low grade B-cell non-Hodgkin's lymphoma of MALT type. It is important to be aware of the possibility of malignant lymphoma in ulcerative colitis in order to evaluate correctly any lymphoid infiltrate seen in a biopsy, especially when anti-inflammatory treatment seems to be ineffective or when symptoms change.

Aged↗

PubMed1985

Ulcerative colitis in Iran: a review of 112 cases.

Despite claims of rarity, chronic ulcerative colitis is being encountered with increasing frequency in developing countries. We report our experience with 112 patients with chronic ulcerative colitis diagnosed during a 10-year period between 1973 and 1982 in Tehran, Iran, and compare the demographic and clinical features of chronic ulcerative colitis on our patients with those reported from other countries. Significant differences included the mild course of the disease, the absence of skin manifestations, and the rarity of colorectal cancer in our patients. The importance of changing socioeconomic status and cultural factors on the development of chronic ulcerative colitis is briefly discussed. The extreme rarity of Crohn's disease in Iran is noted.

Adolescent↗

PubMed2004

Efficacy and safety of thiopurinic immunomodulators (azathioprine and mercaptopurine) in steroid-dependent ulcerative colitis.

BACKGROUND: The efficacy of azathioprine in the management of steroid-dependent ulcerative colitis is taken for granted. However, study populations frequently include together steroid-dependent and refractory patients. AIM: To assess the efficacy and safety of thiopurinic immunomodulators in strictly defined steroid-dependent ulcerative colitis. METHODS: Survey of 34 patients with steroid-dependent ulcerative colitis, treated with azathioprine according to protocol. Therapeutical success: glucocorticoid withdrawal within 12 months, without steroid requirements during another year. RESULTS: Mean age was 39.1 +/- 17 years. Pancolitis and extensive colitis accounted for 50% of cases. Therapeutic success of immunomodulator treatment reached 70.6%, intention to treat analysis (confidence interval 95%: 52-84%) and 72.7%, as per protocol (confidence interval 95%: 54-86%). Mean time to steroid withdrawal was 4.6 months. In therapy successes, mean corpuscular volume and total serum bilirubin increased with treatment time (P = 0.0001). Fifteen adverse effects were observed in 13 patients (38%). Azathioprine was withdrawn in seven cases (20.6%); in four of them (with liver toxicity), treatment with mercaptopurine was indicated. CONCLUSIONS: Therapy with thiopurinic immunomodulators (azathioprine) represents the first option in the management of steroid-dependent ulcerative colitis. Its efficacy (70%) and its acceptable safety support this view. Increasing mean corpuscular volume and serum bilirubin values may be a surrogate marker of a beneficial effect.

Adult↗

PubMed1984

Survival of patients with colorectal cancer complicating ulcerative colitis.

The crude five year survival of patients with colorectal cancer complicating ulcerative colitis in a large series of patients under long term review has, for the first time, been compared with the survival of patients with colorectal cancer in the general population (West Midlands region) from which the colitic patients were drawn. Thirty five cases of colorectal cancer were diagnosed in 676 patients with ulcerative colitis between 1944 and 1976. An actuarial five year survival curve was computed for the colitic and non-colitic patients with colorectal cancer. In ulcerative colitis patients with cancer the five year survival was 33.5% (range 16.9-50.1%) compared with 32.6% (28.2-37.0%) in the non-colitic cancer patients drawn from the relevant general population. Overall the prognosis is much better than earlier reports suggest. It is perhaps disappointing that in a closely monitored group the outcome is only as good as that in the general population. Surveillance programmes should improve the outcome in those patients with ulcerative colitis who accept the need for regular review.

Adult↗

PubMed2002

Effects of topical ropivacaine on eicosanoids and neurotransmitters in the rectum of patients with distal ulcerative colitis.

BACKGROUND: Topical administration of lidocaine has been suggested to have beneficial clinical effects in patients with active ulcerative colitis, but the mechanism of action, if any, remains obscure. As local anaesthetics may exert anti-inflammatory actions through their inhibition of nervous reflexes, we have studied the local effects of a single rectal dose of ropivacaine gel on rectal concentrations of eicosanoids and neurotransmittors in patients with relapsing ulcerative colitis. METHODS: In a randomized, double-blind, placebo-controlled study, concentrations of leukotriene B4, thromboxane B2 and prostaglandin E2 in rectal dialysates and concentrations of substance P, neurokinin A, somatostatin, vasoactive intestinal polypeptide and calcitonin gene-related peptide in rectal biopsies from 19 patients with active, distally located, ulcerative colitis were measured before and after rectal administration of a 200-mg dose of ropivacaine- or placebo-gel by use of radioimmunoassays. For comparison with normal conditions, concentrations of neuropeptides were measured in another 19 patients with relapsing ulcerative colitis and 14 controls with non-inflamed colon. RESULTS: No significant changes in concentrations of eicosanoids or neuropeptides were observed after ropivacaine or placebo administration. Baseline concentrations of all neuropeptides, except somatostatin, were significantly lower in active ulcerative colitis than in controls with non-inflamed colon. CONCLUSIONS: These findings reveal no evidence of anti-inflammatory actions by ropivacaine in active ulcerative colitis and thus provide no rationale for topical treatment with local anaesthetics.

Administration, Rectal↗

PubMed1998

A practical guide to the management of distal ulcerative colitis.

This article reviews the role of corticosteroids, sulfasalazine and mesalazine (5-aminosalicylic acid, mesalamine), immunosuppressive agents and alternative novel drugs for the treatment of distal ulcerative colitis. Short cycles of traditional, rectally administered corticosteroids (methylprednisolone, betamethasone, hydrocortisone) are effective for the treatment of mild to moderately active distal ulcerative colitis. In this context, their systemic administration is limited to patients who are refractory to either oral 5-amino-salicylates, topical mesalazine or topical corticosteroids. Of no value in maintaining remission, the long term use of either or topical corticosteroids may be hazardous. A new class of topically acting corticosteroids [budesonide, fluticasone, beclomethasone dipropionate, prednisolone-21-methasulphobenzoate, tixocortol (tixocortol pivalate)] represents a valid alternative for the treatment of active ulcerative colitis, and may be useful in the treatment of refractory distal ulcerative colitis. Although there is controversy concerning dosage or duration of therapy, oral and topical mesalazine is effective in the treatment of mild to moderately active distal ulcerative colitis. Sulfasalazine and mesalazine remain the first-choice drugs for the maintenance therapy of distal ulcerative colitis. Evidence exists showing a trend to a higher remission rate with higher doses of oral mesalazine. Topical mesalazine (suppositories or enemas) also is effective in maintenance treatment. For patients with chronically active or corticosteroid-dependent disease, azathioprine and mercaptopurine are effective in reducing either the need for corticosteroids or clinical relapses. Moreover, they are effective for long term maintenance remission. Cyclosporin may be useful in inducing remission in patients with acutely severe disease who do not achieve remission with an intensive intravenous regimen. Existing data suggest that azathioprine and mercaptopurine may be effective in prolonging remission in these patients. The role of alternative drugs for the treatment of distal ulcerative colitis and its different forms is reviewed. In particular data are reported concerning the effectiveness of 5-lipoxygenase inhibitors, topical use of short chain fatty acids, nicotine, local anaesthetics, bismuth subsalicylate enema, sucralfate, clonidine, free radical scavengers, heparin and hydroxychloroquine.

Administration, Oral↗

PubMed2004

Comparison of a disease activity index and patients' self-reported symptom severity in ulcerative colitis.

BACKGROUND: A self-report instrument to measure disease activity in ulcerative colitis was compared with a full-scale measure of clinical and endoscopic activity, the St. Mark's index. We also tested the effects of symptom reporting style on both instruments. METHODS: Disease activity was measured in 94 patients with ulcerative colitis using the St. Mark's index and an instrument consisting of 7 self-reported symptoms. Reporting style was measured as health anxiety, measured with the Illness Behavior Questionnaire, and repressive coping, defined by scores on the Marlow-Crowne questionnaire and the State Anxiety Index. RESULTS: The St. Mark's index and the self-report index were highly correlated (R = 0.98, P < .001). Compared with the St. Mark's index, the self-report index categorized patients into inactive or active disease with a positive predictive value of 100% and negative predictive value of 100%. Reporting style was associated with differences in disease activity in both disease severity scales. CONCLUSIONS: A self-report measurement of ulcerative colitis disease activity is a valid alternative to complete clinical and endoscopic examination in subjects who do not have severe illness. Determination of disease severity in ulcerative colitis is vulnerable to individual biases in symptom reporting style, not only in self-report instruments, but also in an index that includes endoscopy and physical examination.

Adult↗

PubMed1980

Abnormal gastrocolonic response in patients with ulcerative colitis.

The purpose of these studies is to determine the colonic myoelectrical and contractile response after eating a 1000 calorie meal in patients with active ulcerative colitis. During fasting, slow waves are identifiable significantly more in patients with ulcerative colitis than in normal subjects (p < 0 . 01). The predominant slow wave frequency is 6 . 1 +/- 0 . 2 cycles/min, which is similar to the normal subjects. The slow waves are not altered by eating in either group. Minimal spike or contractile activity occurs during the fasting period both in patients with ulcerative colitis and in normal subjects. In patients with ulcerative colitis, spike activity increases rapidly after eating the 1000 calorie meal (P < 0 . 01), but the maximal response is decreased and shorter in duration than in normal subjects. There is no simultaneous increase in colonic contractility above fasting levels after the meal in patients with ulcerative colitis. This is strikingly different from the simultaneous increase in contractile and spike activity (P < 0 . 01) that occurs after eating in normal subjects. These studies suggest that in ulcerative colitis (1) the colonic smooth muscle slow wave activity is intact; and (2) a disturbance in the normal colonic contractile response to eating is present despite an adequate spike response. This lack of colonic contractility may contribute to the increase in diarrhoea that occurs in these patients after eating.

Adult↗

PubMed1984

[Autoantibodies against the exocrine pancreas and against intestinal goblet cells in the diagnosis of Crohn's disease and ulcerative colitis].

It was demonstrated by indirect immunofluorescence that Crohn's disease and ulcerative colitis are serologically distinct. In 59 patients with Crohn's disease, confirmed by endoscopy and histology, 23 (39%) had serum autoantibodies against exocrine pancreas; in 17 (29%) the titre was 1 : 100 or higher. In 46 patients with confirmed ulcerative colitis pancreas antibodies were demonstrated only twice, in 100 healthy control subjects only 3 times, with titres less than 1 : 100. Pancreas antibodies do not occur in high concentrations in pancreatitis; titres higher than 1 : 100 therefore suggest Crohn's disease. The pancreas antibodies of patients with Crohn's disease were predominantly immunoglobulins IgA and IgG, twice they were IgD and once IgM, never IgE. In 6 patients the pancreas antibodies fixed complement. Autoantibodies against intestinal goblet cells were found only in patients with ulcerative colitis (13 of 46 = 28%). The titres range was from 1 : 10 to 1 : 1000. The goblet-cell antibodies consisted only of IgA and IgG, never reacting with complement. These results indicate that determining pancreas and goblet-cell antibodies alone will make it possible to diagnose either Crohn's disease or ulcerative colitis in more than a quarter of patients with chronic inflammatory intestinal disease.

Adolescent↗

PubMed1993

[Usefulness of subtotal colectomy with colorectal anastomosis for chronic ulcerative colitis].

Recently in Japan, most of surgeons have been performing restorative proctocolectomy with ileoanal anastomosis for ulcerative colitis, leaving unsolved problems with regard to postoperative complications. Analysis was made on subtotal colectomy with colorectal anastomosis with the following policies. Firstly, the inflammation of the remnant intestine could be easily and correctly controlled by medication in outpatient. Secondly, carcinomas associated with ulcerative colitis can be discovered by postoperative colonoscopic examinations. Operations were carried out to 26 cases of ulcerative colitis for the past 13 years. Subtotal colectomy with colorectal anastomosis were performed to 11 cases. Three cases of colorectal carcinomas associated with ulcerative colitis were experienced. One of the resected specimen was investigated using stereomicroscopy after alcian blue staining to formalin fixed one. As a result of this research, we have convinced that colorectal anastomosis should be favorable surgical potion to the cases of chronic ulcerative colitis because postoperative anal function and quality of life are excellent in our series, in addition, carcinomas in the remnant intestine can be probably easily found out at the early stage by annual colonoscopic examinations with dye staining.

Adolescent↗

PubMed1983

Biochemical analysis of enzymic markers of inflammation in rectal biopsies from patients with ulcerative colitis and Crohn's disease.

Rectal biopsies were collected from control subjects, patients with ulcerative colitis both active and quiescent, and from patients with Crohn's disease, both with and without rectal involvement, as judged by histological assessment. Tissue homogenates were assayed for neutrophil (vitamin B12 binding protein, myeloperoxidase, lysozyme) and lymphocyte (5' nucleotidase) selective markers. Patients with acute but not those with quiescent colitis had striking increases of the neutrophil markers. Neither patient group with ulcerative colitis showed a change in the lymphocyte marker enzyme activity. Patients with Crohn's disease involving the rectum showed significant, but less marked, increases in the activity of the neutrophil markers that were found in active ulcerative colitis. Patients with Crohn's disease, not involving the rectum, showed normal or reduced levels of neutrophil markers. Patients with Crohn's disease, both those with and without rectal involvement, had increased activities of the lymphocyte selective marker. This distinguishes this inflammatory response from that of ulcerative colitis and provides further biochemical evidence of abnormalities in apparently uninvolved mucosa from Crohn's patients.

5'-Nucleotidase↗

PubMed1986

Quantification of disease activity in patients with ulcerative colitis.

To develop an efficient index for evaluating ulcerative colitis, we quantitatively assessed disease activity by multiple regression analysis. Thirty-two consecutive cases with ulcerative colitis were studied. These cases were divided by degree of severity into three groups: mild, moderate, and severe; this tripartite grouping was used as a dependent variable. As independent variables, 11 predictors were selected from among physical findings and laboratory data. By multiple regression analysis with stepwise deletion, six factors indispensable to the disease activity were selected: temperature, pulse rate, erythrocyte sedimentation rate, red blood cell count, alpha 2-globulin, and number of bowel movements per day. Disease activity is predicted by using the following equation: Y = -12.168 + 0.333X1 + 0.022X2 + 0.018X3 - 0.337X4 + 0.056X5 + 0.033X6, where X1, X2, X3, X4, X5, and X6 denote temperature, pulse rate, erythrocyte sedimentation rate, red blood cell count, alpha 2-globulin, and number of bowel movements per day, respectively. By applying this equation to each case, the range of activity indices is expressed as follows: mild, less than 1.52; moderate, between 1.52 and 2.44; and severe, more than 2.44.

Adult↗

PubMed1997

A pilot study of centrifugal leukocyte apheresis for corticosteroid-resistant active ulcerative colitis.

Corticosteroids are effective in bringing about a clinical remission in patients with ulcerative colitis. However, in severely relapsed cases, corticosteroids are not always effective even when a high dosage is administered. In addition, the long-term use of corticosteroids often causes serious side effects. Therefore, an alternative treatment for active ulcerative colitis is necessary in order to avoid these clinical problems. In the present pilot study, the efficacy of leukocytapheresis using a centrifugal procedure was evaluated for corticosteroid-resistant, active ulcerative colitis. Fourteen patients with corticosteroid-resistant severely active ulcerative colitis were treated by leukocytapheresis. Thirteen patients (92.9%) achieved clinical remission within 4 weeks after the apheresis, and remained in remission for 8 months on average without any additional corticosteroid therapy. In the remaining patient, in whom remission was not induced, a total colectomy was performed immediately after the fourth course of leukocytapheresis. No significant side effects were noticed throughout the therapy. Both colonoscopic and histological examinations confirmed the beneficial effect of this procedure in terms of the reduction of severe inflammation of the affected colon. We found that the expression of two adhesion molecules, L-selectin and VLA4a, on the surface of peripheral leukocytes was decreased after this new therapy.

Adrenal Cortex Hormones↗

PubMed1995

Intraluminal excretion of PAF, lysoPAF, and acetylhydrolase in patients with ulcerative colitis.

PAF-acether (PAF) is a phospholipid synthesized by numerous inflammatory cells. PAF can produce several pathological changes in various organs, especially in the colon. In animals PAF causes colonic ulceration and inflammation, which are similar to the anatomic lesions seen in human ulcerative colitis. The aim of this study was to measure in vivo colonic production of PAF in active ulcerative colitis using a modified colonic perfusion method. Ten patients with active ulcerative colitis and six control patients were investigated. A colonic segment was continuously perfused with a buffer and the liquid was recovered 20 cm distally, after a 45-min period of equilibration, at 20-min intervals. PAF, lysoPAF, and acetylhydrolase were measured in the colonic samples. PAF and lysoPAF outputs were significantly higher in patients with active ulcerative colitis compared to controls patients. There was a significant correlation between colonic PAF output and, respectively, macroscopic mucosal lesions and myeloperoxidase colonic output. We thus conclude: (1) the colonic perfusion method allows in vivo study of the metabolism of PAF during ulcerative colitis and could also be used to study the efficiency of PAF antagonists in UC; and (2) colonic production of PAF is increased during ulcerative colitis and correlated to local injury and inflammation. Whether or not PAF plays a role in the pathogenesis of ulcerative colitis remains open for further investigations.

1-Alkyl-2-acetylglycerophosphocholine Esterase↗

PubMed2005

Therapeutic effects of ecabet sodium, an antiulcer drug, on dextran sodium sulfate-induced ulcerative colitis in rats.

Ecabet, an antiulcer drug, is reported to be effective in patients with ulcerative colitis. We investigated the effect of ecabet enema on ulcerative colitis in rats and some mechanisms underlying this effect. In vivo ecabet enema showed a therapeutic effect in the rat ulcerative colitis model induced by dextran sodium sulfate in the drinking water. The amount of ecabet bound to damaged mucosa was higher than that bound to normal mucosa 30 min after intrarectal administration. In vitro ecabet accelerated the restitution of epithelial cells, which was not affected by a TGF-beta antibody. Ecabet inhibited the leukotriene B4 production and 5-lipoxygenase activity in human neutrophils. In conclusion, ecabet enema showed a therapeutic effect in rats with ulcerative colitis. This effect may be attributable to the high binding affinity for damaged mucosa, the acceleration of restitution, and the inhibition of leukotriene B4 production.

Abietanes↗