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PubMed1992

Protein kinase C activity of colonic mucosa in ulcerative colitis.

Protein kinase C (PKC) activity was measured in the inflamed colonic mucosa of 24 patients with ulcerative colitis and in the normal colonic mucosa of 10 patients with other benign diseases. The particulate fraction activity in ulcerative colitis mucosa was significantly increased compared with that of normal mucosa (320 +/- 47 versus 200 +/- 30 pmol/min/mg protein; p less than 0.05). Inflamed ulcerative colitis mucosa also showed significantly increased total PKC activity in the particulate fractions compared with normal mucosa (147 +/- 26 versus 37 +/- 8 pmol/min/mg tissue; p less than 0.05). Mucosal samples from ulcerative colitis patients were divided into 12 with mild and 12 with severe inflammation by histologic examination. The particulate PKC activity of severely inflamed mucosa was significantly lower than that of mildly inflamed mucosa (p less than 0.05). These results indicate that colonic inflammation in ulcerative colitis may be associated with altered cellular PKC activity.

Adult↗
PubMed1980

Hyperthyroidism and ulcerative colitis: report of two cases and a review of the literature.

Two cases of coexisting ulcerative colitis and hyperthyroidism are discussed. In both patients, thyrotoxicosis preceded the development of the ulcerative colitis. Exacerbations of the thyroid disease led to exacerbations of ulcerative colitis and consequent difficulty in the management of the patients. Although a review of the literature reveals a possible connection with abnormalities of iodine metabolism in the ulcerative colitis patient, no definite conclusions are drawn.

Adolescent↗
PubMed1999

Mesenteric blood flow is related to disease activity and risk of relapse in ulcerative colitis: a prospective follow up study.

BACKGROUND: The diagnostic significance of increased splanchnic blood flow in ulcerative colitis is unclear. This prospective study was therefore undertaken to define the role of Doppler sonography in the assessment of disease activity and in the prediction of early relapse. SUBJECTS/METHODS: Splanchnic flowmetry was performed in 76 patients with ulcerative colitis (47 with active disease and 29 in remission), six with infectious colitis, and 13 healthy controls during fasting and 30 minutes after ingestion of a standardised meal. Twenty seven of the patients with ulcerative colitis and all patients with infectious colitis were investigated during the active state as well as in clinical remission and followed up for six months. Flow velocity and pulsatility index (PI) of the superior (SMA) and inferior (IMA) mesenteric arteries and the portal vein were related to clinical (Truelove index), laboratory (C-reactive protein), and endoscopic (Sutherland index) parameters of disease activity. RESULTS: The mean flow velocity of the IMA correlated closest with clinical activity (Truelove, r = 0.41, p<0.005), the PI with C-reactive protein (r = 0.30, p<0.05), and endoscopic activity (r = 0.45, p<0.001). All patients in remission after six months (14/14) or with infectious colitis (6/6) showed an increase in PI of the IMA compared with the initial measurement during active disease (mean increase for ulcerative colitis +36% and for infectious colitis +77%). In contrast, most patients with later relapse or surgery (11/13) had decreased PI during initial remission (mean decrease -12%). The positive predictive value of this index for maintenance of remission was 0.77. Flow variables of the SMA and portal vein displayed weaker correlations. CONCLUSIONS: Flow measurements in the IMA are closely related to clinical and endoscopic disease activity in patients with ulcerative colitis. Repeated measurement of the PI allows estimation of the risk of recurrence.

Adolescent↗
PubMed2000

Fracture risk is increased in Crohn's disease, but not in ulcerative colitis.

AIMS: To study fracture rates and risk factors for fractures in patients with Crohn's disease and ulcerative colitis. METHODS: 998 self administered questionnaires were issued to members of the Danish Colitis/Crohn Association, and 1000 questionnaires were issued to randomly selected control subjects. 845 patients (84.5%) and 645 controls (65.4%) returned the questionnaire (p<0.01). 817 patients and 635 controls could be analysed. RESULTS: Analysis was performed on 383 patients with Crohn's disease (median age 39, range 8-82 years; median age at diagnosis 26, range 1-75 years), 434 patients with ulcerative colitis (median age 39, range 11-86 years; median age at diagnosis 29, range 10-78 years), and 635 controls (median age 43, range 19-93 years, p<0.01). The fracture risk was increased in female patients with Crohn's disease (relative risk (RR) = 2.5, 95% confidence interval (CI) 1.7-3.6), but not in male patients with Crohn's disease (RR = 0.6, 95% CI 0.3-1.3) or in patients with ulcerative colitis (RR = 1.1, 95% CI 0.8-1.6). An increased proportion of low energy fractures was observed in patients with Crohn's disease (15.7% versus 1.4 % in controls, 2p<0. 01), but not in patients with ulcerative colitis (5.4%, 2p=0.30). The increased fracture frequency in Crohn's disease was present for fractures of the spine, feet, and toes and fractures of the ribs and pelvis. Fracture risk increased with increasing duration of systemic corticosteroid use in Crohn's disease (2p=0.028), but not in ulcerative colitis (2p=0.50). CONCLUSIONS: An increased risk of low energy fractures was observed in female patients with Crohn's disease, but not in male patients with Crohn's disease or in patients with ulcerative colitis.

Adolescent↗
PubMed1988

Mucin abnormality of colonic mucosa in ulcerative colitis associated with carcinoma and/or dysplasia.

Twenty cases of resected specimens of carcinoma and/or dysplasia complicating ulcerative colitis were histochemically investigated by the periodic acid-thionein Schiff/potassium hydroxide/periodic acid-Schiff (PAT/KOH/PAS) staining method to see mucin characteristics of carcinoma, dysplasia, and the background mucosa of these lesions. As a control, 11 resected specimens of ulcerative colitis without dysplastic changes and 26 specimens of colonic carcinoma were examined also. All dysplasia and carcinoma in ulcerative colitis stained blue, whereas normal colonic mucin stained red in 65 percent. In 14 of 20 specimens with carcinoma and/or dysplasia, the background mucosa appeared normal with hematoxylin and eosin staining, but showed a mosaic staining pattern with PAT/KOH/PAS. However, only two of 11 specimens of ulcerative colitis without dysplasia and none of 26 specimens of flat mucosa with colorectal carcinoma showed a mosaic staining pattern. From these observations it was concluded that the PAT/KOH/PAS staining method could be useful as a histochemical marker of premalignant change in longstanding ulcerative colitis.

Colitis, Ulcerative↗
PubMed1997

In vitro release of eosinophil cationic protein from peripheral eosinophils reflects disease activity in childhood Crohn disease and ulcerative colitis.

UNLABELLED: The aim of this study was to compare in vitro release of eosinophil cationic protein (ECP) from peripheral blood eosinophils during active phases of childhood Crohn disease (CD) and ulcerative colitis with phases of remission. Ten children with CD and nine children with ulcerative colitis were investigated during 55 and 56 clinical visits, respectively. Each patient was investigated during at least one phase of clinically active disease and one phase of remission. Disease activity was assessed by means of the Paediatric Crohn Disease Activity Index (PCDAI) in Crohn disease and according to the clinical activity index of Rachmilewitz in ulcerative colitis. On an intra-individual basis, in vitro ECP release was significantly higher (P < 0.001) during active phases of CD and ulcerative colitis than in phases of remission (CD:median: 24.5 microg/l, range 16.0-61.2 versus median: 5.7 microg/l, range 2.0-16.7; ulcerative colitis: 14.8 microg/l, 8.3-39.8 versus 4.9 microg/l, 2.0-9.9). On an inte-individual basis, in CD and ulcerative colitis a strong and highly significant correlation was observed between disease activity indices and in vitro release of ECP from peripheral eosinophils (r = 0.89, P < 0.0001 and r = 0.82, P < 0.0001, respectively). CONCLUSION: These results show that in vitro ECP release from peripheral eosinophils reflects disease activity in both CD and ulcerative colitis and therefore can be used as a new appropriate laboratory parameter for assessment of disease activity in chronic inflammatory bowel disease.

Adolescent↗
PubMed2001

Primary biliary cirrhosis associated with ulcerative colitis.

A rare case of concurrent primary biliary cirrhosis and ulcerative colitis is described in a 61 year-old Japanese male. Primary biliary cirrhosis was diagnosed on the basis of characteristic histologic findings and a positive serum mitochondrial antibody test. Ulcerative colitis was diagnosed from typical findings on colonoscopy and the histologic features of a sigmoid colon biopsy specimen. This is the 12th report of a patient presenting with the combination of primary biliary cirrhosis and ulcerative colitis. The potential autoimmune relationships on the basis of these conditions are discussed.

Colitis, Ulcerative↗
PubMed1975

Growth retardation in children with ulcerative colitis: the effect of medical and surgical therapy.

The growth of 37 children with ulcerative colitis have been analyzed. While conventional growth charts showed only percentile changes in height, height data plotted on Tanner et al.'s growth charts showed increases and decreases in growth velocity. Growth retardation is a prominent complication of ulcerative colitis with onset on bowel symptoms. Both ulcerative colitis and "high-dose" steroid therapy (greater than 12 mg/sq m/day of cortisol) can hinder growth but in some instances there is a growth spurt after high-dose steroid therapy. "Low-dose" steroid therapy does not retard growth. Colectomy is more effective than high-dose steroid therapy in reversing the growth retardation caused by ulcerative colitis and is of greatest value if not delayed too long. Growth following subtotal colectomy with ileorectal anastomosis (Aylett procedure) is not likely to be as much as that after subtotal colectomy with ileostomy. Growth retardation is infrequently the only indication for surgical intervention but ileostomy and colectomy are appropriate for this complication of ulcertive colitis in itself when not improved by adequate medical treatment.

Adolescent↗
PubMedDate not supplied

Association of hyperthyroidism and ulcerative colitis. Report of two cases.

The association of hyperthyroidism and ulcerative colitis (UC) is presented in two cases: a 61-year-old man and a 54-year-old woman. In the first case the onset of hyperthyroidism was detected at the age of 25, and the onset of ulcerative colitis at the age of 36. The second case presented severe hyperthyroidism started at the age of 51. In the latter case ulcerative colitis had been detected ten year earlier. To our knowledge this report seems to be the first one considering this association from the endocrinological standpoint. The association of these two diseases might suggest that the disturbance of even one organ specific immune lesion implies a wider disorder. Thus one might assume that the association of multiple organ-specific immune diseases represents an unsuccessful attempt to equilibrate the repertoire of idiotypes and anti-idiotypes belonging to the immune network.

Autoimmune Diseases↗
PubMed1985

Pulmonary vasculitis complicating ulcerative colitis.

Pulmonary vasculitis is an infrequent complication of ulcerative colitis. The patient reported herein had biopsy-proven pulmonary vasculitis on two occasions, associated with flares in ulcerative colitis. The diagnosis of this entity is best made by open lung biopsy. Corticosteroid therapy appears to be a rational first step in the management of this condition.

Adolescent↗
PubMedDate not supplied

Central retinal vein occlusion during remission of ulcerative colitis.

BACKGROUND: Retinal vascular disease is a rare complication of ulcerative colitis. CASE: We report a patient who developed unilateral nonischemic central retinal vein occlusion (CRVO) (papillophlebitis) without any other retinal vascular disease during remission of ulcerative colitis. OBSERVATIONS: The best-corrected visual acuities were 1.5 OD and 0.7 OS. Dilated and tortuous retinal veins and retinal bleeding were seen in the left eye. Macular edema and leakage from the papilla and the retinal veins of the left eye were evident on fluorescein angiography. After increased dosage of systemic prednisolone was prescribed, the retinal vascular changes resulting from CRVO (papillophlebitis) in the left eye gradually abated. CONCLUSIONS: Retinal vascular diseases should be monitored during both remission and activation of intestinal symptoms of ulcerative colitis.

Adult↗
PubMed2004

Patterns of inflammation in mucosal biopsies of ulcerative colitis: perceived differences in pediatric populations are limited to children younger than 10 years.

The histologic criteria used to diagnose ulcerative colitis in colonic mucosal biopsies have been established for many years and include crypt architectural distortion, plasmacellular infiltrates, and neutrophils in the crypt epithelium and lumen. In several recent studies, it has been noted that colonic mucosal biopsies from children presenting with ulcerative colitis show fewer histologic abnormalities at initial presentation, especially less architectural distortion, than do biopsies from adults. In this study, colonic mucosal biopsies taken at the time of presentation of ulcerative colitis in 15 adults and 25 children were examined blindly by two pathologists. All biopsies were taken prior to the initiation of therapy. Twelve children were between 1 and 10 years of age, and 13 children were between the ages of 11 and 17 years. All patients had at least 1 year of follow-up, with clinical and pathologic confirmation of the diagnosis of ulcerative colitis. Five separate histologic features that are characteristic of ulcerative colitis were scored on mucosal biopsies. Children < or = 10 years of age had significantly less crypt branching, plasma cells in the lamina propria, cryptitis, crypt abscesses, and epithelial injury than adults (P values ranging from < 0.0001 to 0.0032). Children between the ages of 11 and 17 years had less cryptitis, crypt abscesses, and epithelial injury than adults (P values ranging from 0.0001 to 0.007) but similar degrees of crypt architectural distortion and plasma cell infiltrates. For all histologic features examined except epithelial injury, the significant findings were due to differences in biopsies taken proximal to the rectum. No significant differences in histology scores were found in rectal biopsies between any age group, except for epithelial injury, which was significantly less in children < or = 10 years. The findings show for the first time that the perceived differences between adults and children with ulcerative colitis are largely due to a decrease in histologic features of colitis in children less than 10 years of age. As children approach adulthood, the degree of inflammation and architectural distortion seen is similar to that found in adults. However, rectal biopsies show similar degrees of colitis in all age groups.

Adolescent↗
PubMed1994

[A case of cerebral venous sinus thrombosis occurring in ulcerative colitis].

A 33-year-old man with a 13-year history of ulcerative colitis developed generalized clonic convulsions after transient right hemiparesis. A computed tomographic scan revealed a hemorrhagic lesion in the left frontal lobe and contrast tomography demonstrated delta-sign in the occipital area. A sagittal gadolinium-contrast magnetic resonance imaging scan demonstrated a low signal intensity area in the superior sagittal sinus. The venous phase of his carotid angiogram showed a lack of filling of the superior sagittal sinus. Coagulation studies revealed abnormal findings, elevated fibrinogen and increased aggregation of platelets. Cerebral venous or sagittal thrombosis occurring in ulcerative colitis is very rare in Japan. But thromboembolism is known as one of the extraintestinal complications of ulcerative colitis, and a hypercoagulable state may occur even in the inactive state. Ulcerative colitis should be considered as one of the etiologies of thromboembolism in addition to the results of coagulation studies for the prevention of cerebrovascular diseases.

Adult↗
PubMed2001

Excision of an invasive thymoma: a cure for ulcerative colitis?

Thymoma is often associated with other diseases, including autoimmune diseases and endocrine disorders. Ulcerative colitis is a nonspecific inflammatory disease and is thought to be an immune-mediated disorder; however, coincidence of thymoma and ulcerative colitis is rare. We treated a 51-year-old woman with invasive thymoma and ulcerative colitis. After excision of the invasive thymoma with partial resections of pericardium, left lung, brachiocephalic vein, and left phrenic nerve, the ulcerative colitis was cured.

Colitis, Ulcerative↗
PubMed1997

Guidelines for the treatment of ulcerative colitis in remission.

The role is reviewed of sulphasalazine, 5-aminosalicylic acid (5-ASA), immunosuppressive agents and corticosteroids in the maintenance treatment of ulcerative colitis in remission. Sulphasalazine and oral 5-ASA are the drugs of first choice in preventing relapses for patients suffering from intermittent chronic ulcerative colitis. Rectally administered 5-ASA may be a valid alternative for treating patients with proctitis and left-sided ulcerative colitis. The optimal dosage of oral 5-ASA in the maintenance therapy of ulcerative colitis in remission is not clear. However, there is evidence that a higher dose of 5-ASA is more effective than low dosage in preventing relapses in patients in remission. For patients with chronically active or steroid-dependent ulcerative colitis who have achieved remission while taking immunosuppressants, continuing azathioprine or 6-mercaptopurine is indicated. Existing data cast doubts as to whether or not continuous maintenance is still necessary in patients suffering from intermittent chronic ulcerative colitis with prolonged endoscopic, clinical and histological remission.

Adrenal Cortex Hormones↗
PubMed2001

Surveillance issues in inflammatory bowel disease: ulcerative colitis.

This review article on the surveillance of patients with ulcerative colitis provides an overview of the criteria for evaluating screening and surveillance programs and applies the criteria to the available evidence to determine the effectiveness of the surveillance of patients with ulcerative colitis. We examine the clinical outcomes associated with surveillance, the additional clinical time required to confirm the diagnosis of dysplasia and cancer, compliance with surveillance and follow-up, and the effectiveness of the individual components of a surveillance program, including colonoscopy and pathologist's interpretation. The disability associated with colectomy is considered, as are the cost and acceptability of surveillance programs. Patients with long-standing ulcerative colitis are at risk for developing colorectal cancer. Recommended surveillance colonoscopy should be supported. New endoscopic and histopathologic techniques to improve the identification of high-risk patients may enhance the effectiveness and cost-effectiveness of surveillance practices.

Adult↗
PubMed1998

Observer agreement in endoscopic assessment of ulcerative colitis.

BACKGROUND: Colonoscopy is the investigation of choice to evaluate ulcerative colitis, but the reliability of the assessment of endoscopic signs is not clear. AIMS: The aim of this study was to evaluate interobserver agreement for the identification of endoscopic lesions typical of ulcerative colitis, and the influence of training. MATERIAL AND METHODS: Four experienced observers and 11 endoscopists under training assessed 49 still images selected from endoscopic video recordings. RESULTS: The agreement rate between experienced observers was excellent or good (k > 0.39) for recognition of 10 out of 14 signs or patterns (loss of vascular pattern, erythema, oedema, granular mucosa, blood, pseudopolyp, erosion, ulcer, normal pattern, severe activity), and was poor for pus, stricture, mild activity, moderate activity. The rates between endoscopists under training were excellent or good for 6 items (loss of vascular pattern, erythema, oedema, pseudopolyp, normal pattern, severe activity). CONCLUSIONS: Trained observers can reproducibly record most endoscopic signs of ulcerative colitis. A reliable overall scoring of severity should be based on a simple three-grading scale, i.e. normal pattern, moderate activity, severe activity. Acceptable agreement rates can be obtained by endoscopists under training on some well-defined endoscopic appearances.

Colitis, Ulcerative↗