SEARCH · PubMed Health

Results for “Colitis, Ulcerative”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,783 records · Page 99Linked to original sources

PubMed1994

Psychological stress and disease activity in ulcerative colitis: a multidimensional cross-sectional study.

OBJECTIVES: It is not known whether any link exists between life stress and disease activity in ulcerative colitis; attempts to demonstrate one have been complicated by recall bias, distressing psychological consequences of disease, psychogenic symptom exaggeration, and an irritable bowel component of inflammatory bowel disease symptoms. We therefore studied the relationship between psychological measures and two different aspects of ulcerative colitis activity. METHODS: The relation of perceived stress, depression, state anxiety, trait anxiety, and life events with endoscopic appearance of the rectal mucosa was studied "blind" in 46 asymptomatic outpatients with known ulcerative colitis. The same measures were then examined in relation to subjective activity, comparing the group in clinical remission with 32 ulcerative colitis outpatients who reported symptoms. RESULTS: Among asymptomatic patients, the level of stress over the past 2 yr on the General Perceived Stress Questionnaire was higher in the 11 with mucosal abnormalities than in the 35 with a normal rectal mucosa (p = 0.004). Among the entire population, symptomatic patients were more likely to recall major life events in the previous 6 months than the asymptomatic group (p = .02). Adjustment for smoking and for duration of remission did not substantially alter these findings. CONCLUSIONS: Life stress is associated with both objective and subjective aspects of activity in ulcerative colitis. Although the association of life events with reported symptoms may be subject to recall bias, the association of perceived stress with rectal mucosal abnormalities in asymptomatic patients is strongly suggestive of a true link between psychological factors and ulcerative colitis activity.

Adult↗

PubMed1999

Low molecular weight heparin as adjuvant therapy in active ulcerative colitis.

BACKGROUND: Heparin given intravenously has shown beneficial effects in the treatment of refractory ulcerative colitis in open trials. Low molecular weight heparin (LMWH) offers advantages in the method of administration but have not been evaluated in inflammatory bowel disease conditions. AIM: To assess the tolerability and safety of subcutaneous self-administered LMWH in outpatients with refractory ulcerative colitis and to evaluate any potential adjuvant therapeutic effect. PATIENTS AND METHODS: Twelve patients with mild to moderately active ulcerative colitis were included in the trial. The patients had either responded poorly to treatment with conventional therapy, including oral and/or rectal glucocorticosteroids, or had experienced a rapid relapse during or shortly after GCS therapy. Dalteparin sodium 5000 units s.c. injection was administered twice daily for 12 weeks. Patients were monitored for possible adverse events and changes in clinical symptoms, and endoscopic and histological scores were analysed. Leucocyte scanning was performed at inclusion and at the end of the study. RESULTS: Tolerability and compliance were excellent and no serious adverse events occurred. Eleven patients improved symptomatically and six (50%) attained complete remission after 12 weeks of treatment. Endoscopic, scintigraphic and histological scores were found to be significantly improved. CONCLUSION: Self-administered LMWH given s.c. may be a safe adjuvant therapy for patients with active, glucocorticosteroids-refractory ulcerative colitis. A controlled trial should be undertaken to confirm the positive effects found in this study.

Adult↗

PubMed2002

Anti-tumour necrosis factor alpha (infliximab) in the treatment of severe ulcerative colitis: result of an open study on 13 patients.

BACKGROUND: Conventional treatment options for patients with severe steroid-refractory ulcerative colitis include intravenous cyclosporine, which is frequently burdened by toxicity, or colectomy. Preliminary data suggest a benefit from anti-tumour necrosis factor alpha (Infliximab) therapy in patients with steroid refractory ulcerative colitis. AIM: To evaluate the efficacy of Infliximab in the treatment of severe ulcerative colitis refractory to conventional therapy PATIENTS AND METHODS: A series of 13 patients with severe ulcerative colitis, refractory to therapy with methyl-prednisolone, 60 mg daily for seven or more days, were treated with a single intravenous infusion of Infliximab 5 mg/kg. RESULTS AND CONCLUSIONS: Of these 13 patients, 10 (77%) had a clinical response to therapy defined by a clinical activity index 10 on two consecutive days. In 2 patients (15%) total colectomy was necessary on account of clinical worsening whilst one patient refused surgery and was lost to follow-up. All patients who responded showed very rapid clinical improvement, within 2 to 3 days of infusion. Infusion with Infliximab produced no significant adverse events. The mean time of follow-up was 10.1 months (range 5-12; during this time, 9 out of 10 patients (90%) maintained clinical remission and were able to discontinue corticosteroid therapy. Infliximab appears to be an effective agent for inducing long-standing remission in refractory patients with severe ulcerative colitis.

Adolescent↗

PubMed1991

Rectal irrigation with short-chain fatty acids for distal ulcerative colitis. Preliminary report.

Colon cells from patients with ulcerative colitis utilize short-chain fatty acids inefficiently and may be exposed to decreased concentrations of these compounds. To test whether irrigation of the inflamed mucosa with short-chain fatty acids is useful, we conducted a six-week preliminary trial in 12 patients with distal colitis. Each patient used twice daily rectal irrigations with 100 ml of a solution containing acetate (80 mM), propionate (30 mM), and butyrate (40 mM). Two patients stopped at three weeks, one because of no improvement and the other because of complete resolution of symptoms. Of the 10 who completed the trial, nine were judged to be at least much improved and showed a change in a mean disease activity index score from 7.9 +/- 0.3 (SE) to 1.8 +/- 0.6 (SE) (P less than or equal to 0.002) and in a mucosal histology score from 7.7 +/- 0.7 (SE) to 2.6 +/- 0.7 (SE) (P less than or equal to 0.002). Thus, ulcerative colitis patients appear to benefit from increased contact with or higher than usual levels of these critical energy substrates.

Acetates↗

PubMed1996

Management of severe ulcerative colitis with the help of high resolution ultrasonography.

OBJECTIVES: The prognosis of attacks of ulcerative colitis is clearly linked to the extent and activity of the disease. The aim of this study was to investigate the value of high resolution ultrasonography in assessing both the extent and activity of severe ulcerative colitis and its response to medical treatment. METHODS: Fifty-seven consecutive patients affected by a severe (32 patients) or moderately severe (25 patients) attack of ulcerative colitis underwent ultrasonographic examination. The ultrasonographic extent of the disease was evaluated in 32 patients by comparing ultrasonography and scintigraphy. RESULTS: Compared with scintigraphy, sensitivity, specificity, and overall accuracy of ultrasonographic extent were 89%, 100%, and 91%, respectively. These results were also confirmed in a subgroup of patients submitted to surgery, comparing ultrasonographic and scintigraphic data versus specimens. Using the ultrasonographic score of activity, it was possible to discriminate severe and moderately severe attacks with a specificity, sensitivity, and diagnostic accuracy of 96%, 90.3%, and 92.9% respectively. A close correlation was also found between ultrasonographic and scintigraphic activity (r = 0.78; p < 0.001). After 10 days of intensive treatment, the ultrasonographic activity significantly decreased in severe and moderate groups (p < 0.001) and in both subgroups of nonoperated patients (p < 0.001) but not in operated patients (p = NS). CONCLUSIONS: High resolution ultrasonography can be useful in assessing both extent and activity of severe ulcerative colitis, in monitoring the patient's condition, and in objectively evaluating the response to medical therapy.

Adult↗

PubMed1990

Dysplasia and cancer complicating strictures in ulcerative colitis.

Previous studies have found a widely variable prevalence of dysplasia and cancer in colonic strictures in patients with ulcerative colitis. Consequently, therapeutic recommendations are conflicting. To better assess the prevalence, we reviewed the clinical and pathological findings in all 27 patients with ulcerative colitis complicated by stricture who were entered into our Inflammatory Bowel Disease Registry. A true stricture was defined as a persistent localized narrowing of the colon found on air-contrast barium enema or on colonoscopy. Upon careful review, 12 of 27 patients were found to have transient colonic spasm, not a stricture, and were excluded. The remaining 15 patients with true strictures represented 3.2% of all ulcerative colitis patients in the registry. Strictures were identified at 13.3 +/- 9.9 years following the diagnosis of ulcerative colitis. Eleven patients had multiple strictures that were principally located in the left colon. Of the 15 patients, 11 had dysplasia and two had cancer found on colonoscopic biopsy. Ultimately, six patients had carcinoma found at colonoscopy or colectomy (three modified Dukes' stage A, one stage B, and two stage D). All cancers were at the site of a stricture. These findings indicate that a true colonic stricture in ulcerative colitis is frequently associated with dysplasia and cancer, which can be diagnosed with colonoscopic biopsy. A stricture should be considered a strong risk factor for cancer, requiring intensive colonoscopic surveillance. If dysplasia is discovered, or if the stricture cannot be adequately biopsied, consideration should be given to total colectomy.

Adult↗

PubMed1994

Dietary and other risk factors of ulcerative colitis. A case-control study in Japan. Epidemiology Group of the Research Committee of Inflammatory Bowel Disease in Japan.

A multisite, hospital-based, case-control study examined the risk of ulcerative colitis in relation to dietary factors, smoking and drinking habits, past history of diseases, and childhood factors. Information was obtained from self-administered patient questionnaires. Study subjects included 101 ulcerative colitis patients who were 10-39 years old at the time of disease onset, which was within the previous 3 years, and 143 control subjects. Combined consumption of Western foods (bread for breakfast, butter, margarine, cheese, meats, and ham and sausage) was significantly related to an increased risk of ulcerative colitis (trend, p = 0.04). Margarine (as an individual Western food item) was positively associated with ulcerative colitis (trend, p = 0.005). There was also a tendency toward positive association of bread for breakfast with ulcerative colitis (trend, p = 0.07). The risk did not measurably vary with the consumption of typical Japanese foods, vegetables and fruits, confectioneries, or soft drinks. As compared with lifelong nonsmokers, current smokers tended to have a decreased risk of ulcerative colitis and former smokers had an increased risk. There was no association between breastfeeding in infancy and the risk of ulcerative colitis.

Adolescent↗

PubMed1999

Validation of the spanish version of the inflammatory bowel disease questionnaire on ulcerative colitis and Crohn's disease.

The objective of this study is to validate the Spanish translation of the Inflammatory Bowel Disease Questionnaire (SIBDQ) on ulcerative colitis and Crohn's disease by assessing its convergence validity, discriminatory power, reliability and sensitivity to change. For that purpose, 211 patients with inflammatory bowel disease (116 with ulcerative colitis and 95 with Crohn's disease) completed the SIBDQ, the Psychological General Well-Being Index and the EuroQol. SIBDQ was repeated in those patients who remained in stable remission and in those with changes in clinical activity. Clinical activity was assessed by the Rachmilewitz and Harvey-Bradshaw indices. Correlations among scores of SIBDQ, EuroQol, Psychological General Well-Being Index and clinical indices of activity were all positive and comparable for both diseases (r = -0. 50 to r = -0.70, p < 0.01). Analysis of variance showed that SIBDQ discriminates between different clinical degrees of activity. Cronbach's alpha was 0.96 in ulcerative colitis and Crohn's disease. SIBDQ was also highly reliable when it was repeated in clinically stable patients with ulcerative colitis (intraclass correlation coefficient = 0.82) and Crohn's disease (intraclass correlation coefficient = 0.86). SIBDQ was sensitive to clinical changes in ulcerative colitis and in Crohn's disease, whether patients entered remission (effect size -1.88 and -1.81, respectively) or relapsed (effect size 1.70 and 8.04, respectively). In conclusion, the Spanish version of the IBDQ has proven to be a valid, reliable and sensitive instrument to detect clinical changes in patients with ulcerative colitis and Crohn's disease.

Adolescent↗

PubMed2002

Two for one: coexisting ulcerative colitis and Crohn's disease.

Three cases of coexisting ulcerative colitis and Crohn's disease are presented. In the first case, the patient had a long-standing history of ulcerative proctitis before developing Crohn's colitis. In the two remaining cases, the patients presented initially with Crohn's disease of the ileum and, subsequent to resection, developed ulcerative colitis. Well-documented cases of patients diagnosed with both ulcerative colitis and Crohn's disease are rare. The literature on such cases is reviewed, and the controversy over whether ulcerative colitis and Crohn's disease are two distinct diseases is explored.

Adult↗

PubMed2002

Appendectomy protects against the development of ulcerative colitis but does not affect its course.

OBJECTIVES: Appendectomy has been shown to protect against the development of ulcerative colitis. The objective of this study was to examine the effect of appendectomy on the clinical features and natural history of colitis. METHODS: A total of 259 consecutive adults patients with ulcerative colitis were studied. Of the patients, 20 had undergone appendectomy (12 before onset of colitis and eight after diagnosis). RESULTS: The frequency of appendectomy was significantly less than in a group of 280 controls, which comprised partners of the patients and a group from the community (OR = 0.25; 95% CI = 0.14-0.44). This was even more significant if only the 12 patients who underwent surgery before the onset of colitis were considered (OR = 0.15; 95% CI = 0.07-0.28). Patients with prior appendectomy developed symptoms of ulcerative colitis for the first time at a significantly later age than those without appendectomy (42.5 +/- 6.5 vs 32.1 +/- 0.8 yr; p < 0.01) or those who had appendectomy after the onset of colitis (24.6 +/- 3.4 yr; p < 0.05). Appendectomy did not influence disease extent, need for immunosuppressive treatment with azathioprine or 6-mercaptopurine (as a marker of resistant disease), or the likelihood of colectomy. Five patients in the appendectomy group had clinical evidence of primary sclerosing cholangitis (25%). This was more common than in those without appendectomy (8%; OR = 4.09; 95% CI = 1.04-13.60). CONCLUSIONS: These results indicate that although appendectomy may delay onset of colitis, it does not influence its course. However, it is associated with the development of primary sclerosing cholangitis. Appendectomy is unlikely to be of benefit in established ulcerative colitis.

Adolescent↗

PubMed2005

Ulcerative colitis: factors affecting difficulties of life and psychological well being of patients in remission.

BACKGROUND: Ulcerative colitis is a chronic disease of unknown aetiology characterized by alternating periods of remission and relapses. The difficulties in the patients with ulcerative colitis daily life mostly arise from symptoms associated with bowel inflammation but there are many patients who have difficulties despite being in the remission phase. This study was conducted to elucidate factors that influence perception of difficulties of life and psychological well being of patients with ulcerative colitis in remission. METHODS: A questionnaire survey was carried out in 72 outpatients with ulcerative colitis in remission. The perception of difficulties of life was assessed using the scale developed by Tanaka et al. Psychological well being was assessed using the Japanese version of the 'profile of mood states'. Physical condition, demographic attributes and psychosociological states were also investigated as related factors. RESULTS: There was no outstanding aspect of psychological well being, but a relatively large number of patients perceived a 'decline of vitality or vigour' despite being in the remission phase. In the presence of irritable bowel syndrome-like symptoms, the scores for 'difficulties of life in society' or 'difficulties concerned with bowel movements' were high. Scores for 'decline of vitality or vigour' were high when the emotive coping scores were high, social support was lower, disease durations were short and relapses occurred more than once. When the emotive coping scores were high, psychological well being was not fine. RELEVANCE TO CLINICAL PRACTICE: Strategies need to be developed to allow patients to recover and maintain their strength in the remission phase. Further, the strategies should take the above factors into consideration.

Activities of Daily Living↗

PubMed1989

Status of the endorectal ileal pullthrough procedure for ulcerative colitis and polyposis.

Since 1977, 174 patients with ulcerative colitis and 16 with polyposis underwent colectomy with endorectal ileal pullthrough in two stages with a temporary ileostomy. Five had an S, three a J, and 15 had no reservoir (NR); 97 had a lateral reservoir (LR) constructed at the second, and 70 at the first operation. Ten patients with NR and one with JR were converted to LR because of unacceptable stool frequency. Three patients with SR and seven of 178 LR patients (3.9 per cent) returned to a permanent ileostomy or Kock pouch. More than 65 per cent of complications occurred in the first 50 patients. Late reservoir shortening was necessary in 36 patients. Of the last 115 patients, 112 are functioning well with a mean of six bowel movements per 24 hours. The endorectal ileal pullthrough with reservoir provides a good option to the standard proctocolectomy for patients with ulcerative colitis or polyposis. In our experience, a short rectal muscle cuff (less than 5 cm), removal of all rectal mucosa to the dentate line, and construction of a short LR (less than 15 cm) at the first operation produces the fewest complications and the best results. The majority of complications, including pouchitis, can be either avoided or corrected surgically.

Adenomatous Polyposis Coli↗

PubMed2000

Identification of a prodromal period in Crohn's disease but not ulcerative colitis.

OBJECTIVES: Irritable bowel syndrome, a common gastrointestinal diagnosis, has not been clearly studied in inflammatory bowel disease. Some of the residual symptoms in subjects treated with Crohn's disease and ulcerative colitis are thought to be related to irritable bowel syndrome. The aims of this study were 1) to describe the duration and nature of complaints before the diagnosis of Crohn's disease and ulcerative colitis (prodromal period), and 2) to determine the role of IBS in this prodromal period. METHODS: A total of 66 patients with confirmed inflammatory bowel disease were enrolled in the study. The subjects received a questionnaire to ascertain the nature and duration of symptoms preceding the diagnosis of Crohn's disease or ulcerative colitis, including features described under the Rome criteria for irritable bowel syndrome. RESULTS: Of the 66 subjects analyzed, 45 had Crohn's disease and 21 had ulcerative colitis. The prodromal period was 7.7 +/- 10.7 yr for Crohn's disease and 1.2 +/- 1.8 yr for ulcerative colitis (p < 0.05). Once patients meeting the Rome criteria for irritable bowel syndrome during the prodrome were excluded, the duration of the prodromal period (non-IBS) for ulcerative colitis dropped to 0.8 +/- 1.3 yr compared to 6.9 +/- 9.8 yr in the Crohn's disease group (p < 0.05). The symptoms of the non-IBS prodrome in subjects with Crohn's disease were bloating, diarrhea, stomach pain, heartburn, fever, weight loss, and fatigue. Further analysis demonstrated that subjects whose Crohn's disease initially began as colonic disease had a longer prodrome than with small bowel. In the non-IBS Crohn's group, there was also a correlation between the age at the time of diagnosis and the duration of prodrome (r = 0.67, p < 0.0001). CONCLUSIONS: There is a significant prodromal period before the time of diagnosis of Crohn's disease that is not found in ulcerative colitis even after exclusion of subjects with IBS.

Adult↗

PubMed1987

A controlled randomized trial of budesonide versus prednisolone retention enemas in active distal ulcerative colitis.

Sixty-four patients with active distal ulcerative colitis participated in a multicentre, randomized, investigator-blind trial to compare the effect of budesonide enema, 2 mg/100 ml, with prednisolone disodium phosphate enema, 31.25 mg/100 ml. Budesonide is a new potent corticosteroid with a rapid first-pass elimination. The patients were treated for 4 weeks, and the efficacy of the drugs were evaluated by sigmoidoscopy, histology, and subjective symptoms after 2 and 4 weeks. After 4 weeks of treatment 16 of 31 patients (52%) receiving budesonide enema had healed endoscopically, compared with 8 of 33 (24%) (p = 0.045) receiving prednisolone enema. Budesonide was superior to prednisolone in terms of both significantly improved sigmoidoscopic and histologic scores and subjective symptoms evaluated by visual analogue scales. The patients receiving prednisolone had a significant depression of endogenous cortisol levels during the treatment period, but not the patients receiving budesonide. Budesonide enema seems to be a promising therapy for active distal ulcerative colitis and causes no adverse reactions.

Adolescent↗

PubMed1977

Fecal bile acids and cholesterol metabolites of patients with ulcerative colitis, a high-risk group for development of colon cancer.

Patients with chronic ulcerative colitis are at increased risk of developing carcinoma of the colon. It has been shown that the concentration of fecal bile acids and neutral sterols was higher in cancer patients than in the comparable healthy controls. Fecal neutral steroids and bile acids were measured in patients with ulcerative colitis, family controls who were immediate relatives of patients, patients with other digestive diseases, and healthy unrelated controls. The fecal excretion of cholesterol, coprostanol, and cholestane-3beta, 5alpha, 6beta-triol was higher in patients with ulcerative colitis than in other groups. Patients with other diseases, family controls, and unrelated controls excreted comparable levels of neutral sterols. Patients with ulcerative colitis excreted levels of bile acids in their feces comparable to those excreted by other groups. These findings suggest that possible interactions between cholesterol metabolites and colonic epithelial cells may be relevant in colon carcinogenesis.

Adult↗

PubMed1981

Imuran in the treatment of ulcerative colitis.

A retrospective study of 35 patients with ulcerative colitis is presented. The patients were treated with Imuran, alone or combined with corticosteroids, in single or repeated courses, over a period of 11 years. The usual indication for Imuran treatment was nonresponse to Azulfidine or corticosteroids. Criteria for response to treatment were: 1. decrease in stool frequency, 2. decrease in frequency and amount of rectal bleeding and 3. weight gain. Improvement was noted on the average two weeks after the start of Imuran therapy and 62% of the patients had complete remission afer 1.7 months. When patient-months of remission and activity were compared on different therapies. Imuran, both alone and combined with steroids, was clearly superior to nontreatment or steroid therapy. With the exception of two patients with fulminant disease, who developed fatal septicemia on Imuran therapy, there were no serious complications. Seven patients eventually underwent colectomy and one patient developed carcinoma of the colon. Our results indicate that there is a definite place for Imuran in the treatment of selected patients with ulcerative colitis.

Adolescent↗

PubMed1985

[Personality structure of patients with ulcerative colitis and Crohn disease, a psychological test study in disease remission].

30 patients with ulcerative colitis and 30 patients with Crohn's disease during remission were tested with the Freiburger Persönlichkeitsinventar (FPI) and standardized interview. There was no difference between both groups in the FPI, both were significantly less aggressive than controls. The patients with ulcerative colitis were more reserved and introverted, patients with Crohn's disease more self-confident, obliging and emotionally stable. Apart from two exceptions the answers in the standardized interview were similar in both groups. The patients with ulcerative colitis had a significantly better relationship with their mothers, the patients with Crohn's disease often called themselves "peacemaker". We couldn't confirm the clinical impression that there are important differences between patients with ulcerative colitis and Crohn's disease. A remarkable result, however, is that our study of patients during the remission didn't show any characteristics as nervousness, depression, emotional restraint and instability as it is described to be for the acute phase.

Adolescent↗

PubMed1994

Restorative proctocolectomy in elective and emergency cases of ulcerative colitis.

A consecutive series of restorative proctocolectomy for ulcerative colitis was reviewed to determine whether an emergency restorative proctocolectomy procedure leads to a higher morbidity, more especially anastomotic leakage. Severity of illness and nature of surgery were divided in two categories: (1) no acute disease and elective surgery (18 patients), (2) acute disease requiring emergency surgery either immediately or within one week of admission (12 patients). Morbidity after elective surgery was 27% and after emergency surgery 66% (P < 0.06). Pouch-anal leakage occurred in 11% and 41% respectively (P = 0.08). Five risk factors significantly influenced the leak rate including preoperative white blood cell count > 10,000/microliter (P < 0.02), urgent nature of surgery (P < 0.02), the combination of leucocytosis and urgent nature of surgery (P = 0.02), the combination of leucocytosis and preoperative corticosteroid dose equivalent to > or = 200 mg hydrocortisone/24 h (P = 0.006), postoperative pelvic haematoma (P < 0.05). In conclusion, restorative proctocolectomy is contraindicated in emergency circumstances, especially in patients with signs of sepsis on a high corticosteroid dose. To reduce operative risk and number of procedures required, patients with relapsing ulcerative colitis should be referred for restorative proctocolectomy while being in remission.

Adult↗