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PubMed1982

Bullous pemphigoid and ulcerative colitis.

A 21-year-old white woman, who had ulcerative colitis for 14 years, developed generalized severe bullous pemphigoid. Following the resection of her colon, her skin showed marked clinical improvement, but this was only temporary. Direct immunofluorescence was performed on the surgical specimen and no antibodies (BMZ) to colonic mucosal cells were evident. Anti-basement membrane zone antibodies were found on direct and indirect immunofluorescent studies and have persisted. Sera from 15 patients with ulcerative colitis and 11 patients with Crohn's disease, evaluated for the presence of an anti-basement membrane zone antibody did not contain any demonstrable levels of anti-BMZ antibodies. The co-existence of ulcerative colitis and bullous pemphigoid is more likely incidental rather than etiopathologic.

Adult↗

PubMed2000

Inducible nitric oxide synthase activity in colon biopsies from inflammatory areas: correlation with inflammation intensity in patients with ulcerative colitis but not with Crohn's disease.

Nitric oxide synthase (NOS) activities are responsible for the enzymatic conversion of L-arginine into NO and L-citrulline. Relatively low amounts of NO are produced in intestinal epithelial cells or are released from nerve endings. The effects of NO production are related to the maintenance of epithelial integrity and permeability. A pathological role of an increased NO production has been suggested to play a role in models of experimental colitis. In humans, NOS activity in colon mucosa from patients with ulcerative colitis is clearly increased when compared with the activity of the control group. In contrast, an increase of NOS activity in the colon mucosa from patients with Crohn's disease remains controversial. In the present work, we have measured NOS activity in colon biopsies originating from the control group (n = 16), from patients with ulcerative colitis (n = 23) and Crohn's disease (n = 17) using the radiochemical method of the conversion of L-[guanido-14C] arginine into radioactive L-citrulline. In the control group, NOS activity was mainly of the inducible type (88% of total NOS activity) since it was characterised by its insensibility to the absence of calcium in the assay medium. In colon biopsies originating from patients with ulcerative colitis, inducible NOS activity was increased 3 fold (p < 0.005) and in patients with Crohn's disease, inducible NOS activity was increased 5 fold (p < 0.005). Correlations between NOS activity in colon biopsies and the intensity parameters of the disease i.e. Truelove index, endoscopic score and histological parameters were evidenced in patients with ulcerative colitis. In contrast, in patients with Crohn's disease, the high inducible NOS activity was not correlated with any intensity parameters of the disease. From these data, we concluded that although inducible NOS activity was increased several fold in colon biopsies originating from patients with both ulcerative colitis and Crohn's disease, a correlation between this activity and the severity of bowel inflammation was not found in either cases.

Adult↗

PubMed1992

Treatment of the mucosa with local anaesthetics in ulcerative colitis.

A new paradigm for the treatment of ulcerative colitis has recently been presented: Treatment of the mucosa with lidocaine (2%) enemas for prolonged periods. This therapy was introduced based on the hypothesis that hyperreactive autonomic nerves may play a pathogenetic role in the disease. One hundred consecutive patients have now been treated and the results presented. The proctitis patients all responded to the treatment, despite previous therapeutic failures in more than two-thirds of the cases. They were treated for 3-12 weeks, but 68% had a relapse (observation period 20 months). Of the 49 patients with proctosigmoiditis, two-thirds had chronic symptoms resistant to previous therapy. One of these patients did not respond to lidocaine, but developed fulminant total colitis. The other patient had therapeutic failure with lidocaine but responded well to subsequent cortisone enemas. The patients were treated until the subsets of T-lymphocytes (OKT4+ and OKT8+) disappeared from the mucosa. This occurred in parallel with symptomatic relief and eventual healing in 83% of the patients after treatment for 6-34 weeks. Of all the patients with proctosigmoiditis, 42% presented with recurrent symptoms (observation period 16 months). Of the 17 patients with left-sided colitis, all went primarily into remission within 2-4 months, but 23% had a relapse (observation period 13 months). The 6 patients with total colitis had symptomatic relief and improvement of histology when treated over 3-8 months. One patient had recurrence after 12 months. Treatment with a local anaesthetic in ulcerative colitis is a new approach to mucosal inflammation. The beneficial effects may be due to blockade of certain neural effects, such as epithelial proliferation and shedding and congestion of the mucosal vasculature, with actions on cells of the immune system.

Adult↗

PubMed1995

Butyrate absorption and lactate secretion in ulcerative colitis.

PURPOSE: Fecal electrolytes and organic anion concentrations are altered in ulcerative colitis, presumably reflecting changes in colon epithelial transport. Information of mucosal absorption of butyrate in active ulcerative proctosigmoiditis is not available. METHODS: Dialysis bags containing 70 mmol/liter of butyrate in an isotonic electrolyte solution were placed in the rectum for 30 minutes. Net absorption or secretion rates of butyrate, lactate, and electrolytes were determined in the rectum of 12 patients with active ulcerative colitis (UC) and in 10 patients with quiescent UC and then compared with 10 healthy controls. RESULTS: Net flux rates demonstrated a considerable absorption of butyrate in patients with active inflammation of 7.5 +/- 0.4 mumol/cm2/h and quiescent colitis of 6.6 +/- 0.4 mumol/cm2/h, equal to absorption in healthy controls of 6.3 +/- 0.5 mumol/cm2/h, P = 0.12. Despite normal butyrate absorption, sodium absorption was compromised in active ulcerative colitis (11.5 +/- 1.4 mumol/cm2/h) compared with quiescent (15.4 +/- 1.0 mumol/cm2/h) and controls (18.7 +/- 0.8 mumol/cm2/h) (P = 0.0006). Mucosal secretion of L-lactate was minimal in both healthy controls and quiescent UC but significantly increased in patients with proctosigmoiditis (0.2 +/- 0.1 mumol/cm2/h, 0.2 +/- 0.1 mumol/cm2/h vs. 0.9 +/- 0.2 mumol/cm2/h; P = 0.0001). Appearance of D-lactate was negligible in all three groups. CONCLUSIONS: This study demonstrates that rectal butyrate absorption is normal in UC, and it follows that butyrate supplied in enemas can be expected to be absorbed. The inflamed colonic mucosa secretes L-lactate, and the increased fecal lactate concentrations can be explained by mucosal origin of lactate.

Adult↗

PubMed2003

Infliximab in moderately severe glucocorticoid resistant ulcerative colitis: a randomised controlled trial.

BACKGROUND: Tumour necrosis factor production is increased in the mucosa of patients with active ulcerative colitis. The benefits of infliximab in Crohn's disease are established. We investigated its efficacy in ulcerative colitis. METHODS: We conducted a randomised placebo controlled trial of infliximab (5 mg/kg) in the treatment of glucocorticoid resistant ulcerative colitis. Infusions were given at weeks 0 and 2. Disease activity and quality of life were recorded over eight weeks of follow up. Remission was defined as an ulcerative colitis symptom score (UCSS) of < or =2 and/or Baron score of 0 at week 6. Patients not in remission were offered open label infliximab 10 mg/kg and reviewed two weeks later. RESULTS: After two weeks, there was no statistically significant difference between the infliximab and placebo groups in the proportion of patients with a Baron score of 0 (13% (3/23) v 5% (1/19) (95% confidence interval (CI) -9% to 24%); p=0.74). After six weeks, remission (UCSS < or =2) rates were 39% (9/23) versus 30% (6/20) (95% CI -19 to 34%; p=0.76). The median improvement in UCSS was 3 for the infliximab group and 2.5 for the placebo group (p=0.82, Mann-Whitney U test). A Baron score of 0 was likely in either group (26% (6/23) v 30% (6/20) (95% CI -30% to 23%); p=0.96). Improvement in the IBDQ and EuroQol was not significantly different between the groups (p=0.22 and 0.3, respectively, Mann-Whitney U test). Twenty eligible patients were given open labelled infusions. Remission was achieved in 3/11 (27%) patients initially treated with infliximab and in 1/9 (11%) patients treated with placebo. CONCLUSION: These data do not support the use of infliximab in the management of moderately active glucocorticoid resistant ulcerative colitis.

Adult↗

PubMedDate not supplied

Epidemiological features of ulcerative colitis in Trakya, Turkey.

To determine the epidemiological features of ulcerative colitis in the Trakya region of Turkey, southeast Europe, we conducted a descriptive, cross-sectional, hospital-based study. All subjects were followed, and age, sex, place of residence, family history, educational status, tobacco consumption and use of oral contraceptives were recorded. The study included 49 cases of ulcerative colitis. The incidence of the disease was 0.59 per 100,000 in 1998, 0.89 per 100,000 in 1999, 0.89 per 100,000 in 2000 and 0.69 per 100,000 in 2001. The overall prevalence of the disease was 4.9 per 100,000; it was 2.18 per 100,000 in rural areas and 5.87 per 100,000 in urban areas. As in the Mediterranean countries, both the incidence and the prevalence of ulcerative colitis were found to be low. The incidence was significantly higher in urban areas than in rural areas.

Adolescent↗

PubMed1987

Risk of ulcerative colitis among former and current cigarette smokers.

We performed a case-control study of the effect of tobacco smoking on the risk of acquiring ulcerative colitis among the 304,000 members of a health maintenance organization. Smoking histories before the date of the onset of ulcerative colitis were compared in 212 cases and an equal number of controls matched for age and sex who were selected from the enrollment file of the health maintenance organization. The relative risk of ulcerative colitis among current cigarette smokers as compared with nonsmokers was 0.6 (95 percent confidence interval, 0.4 to 1.0); however, among former cigarette smokers it was 2.0 (95 percent confidence interval, 1.1 to 3.7). These values remained after adjustment for socioeconomic factors and for coffee and alcohol consumption. The higher risk among former smokers could not be explained by postulating that smokers gave up tobacco near the time of disease onset because of early symptoms of ulcerative colitis. The relative risk of ulcerative colitis among former smokers increased in proportion to the cumulative number of cigarettes smoked before the onset of disease, suggesting a causal relationship between this exposure and disease occurrence. No difference in risk was observed among current smokers according to cumulative amount smoked. We conclude that former and current tobacco use may have opposite effects on the risk of acquiring ulcerative colitis.

Adolescent↗

PubMed2000

[Generalized intestinal CMV infection with protein-losing syndrome in ulcerative colitis].

Infection by cytomegalovirus (CMV) in immunocompetent patients is rare, and if it occurs it is most often associated with ulcerative colitis. This case illustrates a CMV infection in a patient with an ulcerative colitis combined with CMV-induced protein losing enteropathy, a condition reported in immunocompetent individuals in only a very few cases worldwide. It demonstrates the importance of differentiating between a flare-up of ulcerative colitis and CMV colitis. The indication for antiviral therapy is discussed. A 76-years-old patient with a 23-year history of leftsided ulcerative colitis presented with acute pancolitis sparing the rectum. He showed no evidence of impaired host defence, nor has he ever had taken immunosuppressive drugs. Disseminated primary CMV infection involving of the colon, the oesophagus and the small intestine with protein losing enteropathy was diagnosed on the basis of histology, culture and serology. In view of the long duration of the illness and the highly active infection, antiviral therapy with ganciclovir was given and led to a dramatical improvement of all disease manifestations. The patient subsequently remained in remission from ulcerative colitis for three years.

Aged↗

PubMed1979

Long-term prognosis of ulcerative colitis with onset in childhood or adolescence.

From 1955 through 1974, 336 patients with ulcerative colitis diagnosed before age 21 years were studied. In 93 patients (29%), a blood relative had ulcerative colitis, one case of Crohn's disease being found. The total colon was involved in 63% of patients; the entire colon or all but the rectal stump was removed in 35%. Eighteen patients died, nine of carcinoma of the colon. Sixty-five percent of patients had symptoms for longer than 6 months before the diagnosis of ulcerative colitis. If the diagnosis was delayed more than 24 months, there was a statistically significant correlation with increased rate of operations and complications and less good quality of life. When the 20-year study period was divided into two 10-year periods, the operative and complication rates were significantly different. Early diagnosis and treatment appear to improve the long-term prognosis of young patients with ulcerative colitis.

Acute Disease↗

PubMed1972

Urinary calculi and ulcerative colitis.

A survey of 458 patients treated for ulcerative colitis either medically or surgically by colectomy and the establishment of an ileostomy has provided further evidence that in Australia at least there is a significant association between ulcerative colitis and urinary calculi. The actual risk to the unoperated patient is not particularly high but is in the vicinity of 4%. The survey further confirms that the risk continues after colectomy and ileostomy, when the overall incidence of stones is roughly doubled. Finally, suggestive though admittedly somewhat inconclusive evidence supports the proposition that uric acid stones are more common in this group of patients.

Australia↗

PubMed1978

Strokes and ulcerative colitis.

One adolescent and two young adults had ulcerative colitis and cerebral thrombosis. All survived with neurologic deficit. These patients had no other predisposing factor for cerebrovascular disease. Systemic arterial and venous thromboembolic complications occur often in ulcerative colitis, but stroke is uncommon. Abnormalities in the early stages of clotting may be responsible, and the risk of thromboembolic phenomena in young patients seems to increase with exacerbations of this form of chronic inflammatory bowel disease, and possibly with regional enteritis as well.

Adolescent↗

PubMed1988

Does ulcerative colitis behave differently in the elderly?

The clinical course of all new patients with ulcerative colitis or indeterminate colitis aged 65 years or older diagnosed in one health district (population 274,000) between 1 January 1975 and 31 December 1984 has been compared with that of all new patients 55 years or younger diagnosed in the same period. Elderly patients were admitted more often in a first attack and were more likely to receive systemic steroids. No elderly patient required urgent surgery and no patient in either group died of ulcerative colitis or its complications. The mortality amongst elderly patients with ulcerative colitis was no greater than expected in a population of the same age. The prognosis for ulcerative colitis in elderly patients is the same as for younger patients.

Age Factors↗

PubMed1998

Pyoderma gangrenosum complicating ulcerative colitis: Successful treatment with methylprednisolone pulse therapy and cyclosporine.

A 32-year-old woman with ulcerative colitis had a relapsed of pyoderma gangrenosum during puerperium. Both the pyoderma gangrenosum and ulcerative colitis had been well controlled with oral prednisolone, but ulcerative colitis relapsed in pregnancy, and pyoderma gangrenosum relapsed in the puerperium. The pyoderma gangrenosum responded to methylprednisolone pulse therapy initially, but relapsed when prednisolone was tapered. A second trial of pulse therapy combined with cyclosporine resulted in complete remission of the pyoderma gangrenosum, and no recurrence was recognized after prednisolone was tapered. This is a very rare case of successful treatment with methylprednisolone pulse therapy combined with cyclosporine for pyoderma gangrenosum complicating ulcerative colitis.

Adult↗

PubMed2000

Acute cholecystitis after colectomy for ulcerative colitis.

OBJECTIVE: Many different hepatobiliary diseases have been related with ulcerative colitis. In this retrospective study we tried to determine whether colectomy involves a greater risk of postoperative cholecystitis in these patients than in other patients who undergo colectomy. METHODS: From 1990 to 1998 a total of 53 subtotal or total colectomies were carried out in our hospital. 35.8% of the operations were done for ulcerative colitis (group I), 58% for cancer, 1.8% for aganglionic megacolon, and 3.6% for volvular disorders (group II). RESULTS: In group I, 21% of the patients required reoperation because of postoperative acute cholecystitis. In group II there were no cases of acute cholecystitis. Neither parenteral nutrition nor diabetes were influential factors. 94.5% of the patients in group I had emergency surgery, while emergency surgery was necessary in only 38.2% of the patients in group II. CONCLUSIONS: Acute cholecystitis after colectomy for ulcerative colitis, especially when the latter arises in an emergency situation, is a common complication. Although the sample was small, the results show that in view of the mortality from cholecystitis, prophylactic cholecystectomy may be necessary.

Acute Disease↗

PubMed1995

[Autoimmune hemolytic anemia and ulcerative colitis].

Although several associations of autoimmune disorders with ulcerative colitis have been reported, autoimmune hemolytic anemia is extremely rare. We report a case of a 35 year-old white woman with a twelve-year history of mild ulcerative colitis treated in the last 5 years with 5-amino-salycilic acid who developed a severe autoimmune hemolytic anemia. We discuss some particular aspects of the association of these two immunologically mediated disorders as well as the controversial aspects of autoimmune hemolytic anemia therapy in this context.

Adult↗

PubMed1970

A case of ulcerative colitis and pyostomatitis vegetans in an African.

A case of pyostomatitis vegetans and ulcerative colitis in a 26-year-old African is described. The colitis, confirmed clinically and radiologically, antedated the development of pyostomatitis. Systemic corticosteroids apparently cured the pyostomatitis but only caused an improvement in the ulcerative colitis. The rarity of ulcerative colitis amongst the Nigerian population and of pyostomatitis vegetans as a complication makes the occurrence of these two diseases in a Nigerian an extraordinary event.

Adult↗

PubMed1977

Mortality from ulcerative colitis in Denmark 1960-1969.

The mortality from ulcerative colitis in Denmark, calculated on the basis of the mortality statistics, was 0.5/100,000/year for the period 1960-69. The total material consists of 110 females and 108 males with ulcerative colitis. The mortality showed a decreasing tendency during the study period, but the fall was not significant. The distribution of the deaths between rural and urban areas corresponded to the distribution of the general population. 93% of the deaths took place in hospital, the greater part in the surgical departments.

Colitis, Ulcerative↗

PubMed1991

[Conservative therapy of ulcerative colitis and Crohn disease].

Basis treatment of severe ulcerative colitis and Crohn's disease comprises the systemic administration of corticosteroids. If the conditions are less severe, treatment with oral sulfasalazine or 5-aminosalicylic acid (5-ASA) can be attempted. Distal ulcerative colitis may respond to topical corticosteroids of enemas with sulfasalazine or 5-ASA. In long-term treatment with high-dose corticosteroids, azathioprine and 6-mercaptopurine may be employed to reduce the corticosteroid requirement. There ist no known generally applicable diet for the treatment or prophylaxis of these conditions.

Adrenal Cortex Hormones↗