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Salt-losing diarrhoea in idiopathic proctocolitis.

The faecal output of chloride, sodium and potassium was studied in 14 patients with active idiopathic proctocolitis, in an attempt to establish a relationship between faecal electrolyte output and acid-base balance data. 7 patients with ileostomy and 8 healthy volunteers were used as controls. The daily faecal excretion of chloride and sodium in proctocolitis was significantly in excess of normal, whereas that of potassium was within the normal range. From the comparison with the results in patients with ileostomy it is concluded that colitic colon has an impaired capacity to absorb chloride and sodium but retains the ability to secrete potassium. The intestinal loss of chloride in addition to that of sodium and water may be regarded as a salt-losing diarrhoea and may account for the metabolic alkalosis commonly found in proctocolitis.

Acid-Base Equilibrium

Epidemiology of proctocolitis in the region of Leiden, The Netherlands. A population study from 1979 to 1983.

An epidemiologic study of proctocolitis in the Leiden Health Care Region was conducted between 1979 and 1983. One hundred and seven cases were diagnosed before 1979 and 150 between 1979 and 1983. Most of the patients had proctocolitis (42%), and only 11% had pancolitis. The incidence was 6.8/10(5)/year and was similar in men and women. There was no specific age group at additional risk of developing the disease. The prevalence was 58.4/10(5). Patients with proctocolitis tended to live in country or city areas; people living in dormitory suburbs were at a reduced risk (chi-square test, p less than 0.001). However, there was a significant difference in incidence between Leiden (10.8/10(5)/year) and Alphen (4.1/10(5)/year) (corrected chi-square = 7.3; p less than 0.001). This was also true for the prevalence in these two cities. The prevalence of the disease in migrants (85.3/10(5)) was not significantly different from that in the indigenous population (58/10(5)).

Adolescent

[The prevalence of idiopathic proctocolitis].

During screening of colorectal cancer by the Haemoccult test (Röhm Pharma Co.) the authors investigated the incidence of idiopathic proctocolitis in the population of the Bruntál district. The group of tested subjects comprises 16.642 of the population aged 45 to 86 years. After examination of 380 positive subjects (2.28%) twelve cases of idiopathic proctocolitis were detected. Of these twelve seven were identified previously and a new diagnosis was made in five subjects. At twelve cases were identified from a population of 16.642, the assumed prevalence in 1989 in the given age group is 72/100.000. This suggests considerable underestimation of the prevalence of idiopathic proctocolitis in current epidemiological surveys.

Aged

The effect of luminal pH on large intestinal absorption in ulcerative proctocolitis.

The sensitivity of large intestinal absorption to pH and the absorption of short-chain fatty acids were measured in ulcerative proctocolitis by a dialysis bag method. Lowering luminal pH from 7 to 5.5 significantly reduced absorption of salt and water in proctocolitis, but not in normal controls. Short-chain fatty acid absorption was not affected by inflammation or change in pH when patients with ulcerative proctocolitis were compared with controls.

Adult

Crohn's disease, non-specific ulcers of the small intestine, and idiopathic proctocolitis in a Japanese university hospital from 1954 to 1974.

Most of the cases of Crohn's disease reported in Japan were originally treated surgically as acute appendicitis and, after appendectomy, they were diagnosed as acute terminal ileitis or acute Crohn's disease, which should belong to a category different from typical Crohn's disease, according to the international nomenclature by the Council for International Organization of Medical Sciences in 1973. Reviewing our university hospital records from 1954 to 1974, the incidence of typical Crohn's disease and idiopathic proctocolitis has been increasing, while the patients with intestinal tuberculosis have been decreasing. Clinical and histopathological features of operated three groups of our patients with Crohn's disease of the small intestine, non-specific ulcers of the small intestine and prestomal ileitis were comparatively studied. Furthermore, 9 cases of operated Crohn's disease of the colon and 23 cases of operated idiopathic proctocolitis were similarly evaluated. The importance of diagnosing Crohn's disease as a whole from both clinical and histopathological stand points of view was emphasized, and main differential diagnostic criteria between Crohn's disease and idiopathic proctocolitis were discussed.

Colitis, Ulcerative

A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis.

Forty mg has been shown to be the optimal daily dosage of prednisone for outpatients requiring oral steroids for active proctocolitis. Although daily doses of oral steroids are commonly divided, a single dose each morning causes less adrenal suppression and is more convenient to take. A randomized controlled trial has been performed on patients with proctocolitis, in which 23 received 40 mg prednisolone each morning as one dose, and 22 received 10 mg four times a day, over two weeks. Physicians unaware of the dosage schedule scored the disease activity and assessed the steroid side-effects when the patient entered the trial, at day 7 and at day 14. Of those taking the divided dose the disease improved in 17 and failed to improve in five. No side-effects were observed in ten patients. Of those receiving a once daily regimen, 17 improved and six did not. Nine patients had no side-effects. Further assessment showed no difference between the two groups either in response rate or side-effects produced. When oral steroids are indicated for active proctocolitis, 40 mg prednisolone, as a single dose each morning can be recommended.

Administration, Oral

Proctocolitis unresponsive to conventional therapy. Response to 5-aminosalicylic acid enemas.

We report results of a prospective study of daily 5-ASA enema therapy in patients with proctocolitis that was unresponsive to conventional therapy. Forty-seven patients with active colonic inflammation distal to the splenic flexure have been followed for three months to three years. Rapid improvement was noted within three months in 41 of 47 (87%) patients, while six failed therapy. Of the 41 patients responding to therapy, 39 achieved complete remission. Nineteen patients have relapsed at least once following discontinuation of 5-ASA, but 23 of 25 (92%) relapse episodes responded to a course of 5-ASA therapy. Complications of 5-ASA therapy were limited to hemorrhoidal irritation and local perianal injury. We conclude that 5-ASA enema is effective in inducing remission in patients with proctocolitis unresponsive to conventional therapy.

Adult

Allergy-related proctocolitis in infants: diagnostic usefulness of rectal biopsy.

To evaluate the diagnostic utility of rectal mucosal biopsies in infants with proctocolitis, we compared the clinical and histologic features of an allergy-related group (N = 36) with those of normal (N = 12) and inflammatory (N = 8) controls. Clinical features were nondiscriminatory among the three groups of patients, except for an increased absolute peripheral eosinophil count in the allergic group. Similarly, morphologic evidence of proctitis (cryptitis and crypt abscesses) and small or moderate numbers of eosinophils (less than or equal to 60 per ten high power fields) in the lamina propria of the biopsies did not discriminate among the three groups. However, large numbers of eosinophils (greater than 60 per ten high power fields) and eosinophils located in the muscularis mucosae or as the predominant cell in crypt abscesses were significantly associated with allergy-related disease. No histologic features of chronic colitis were noted in the allergy-related group. Thus, in tandem with the remainder of the clinical data, rectal mucosal biopsy is a useful adjunct in the diagnosis of allergic proctocolitis.

Biopsy

Effectiveness and absorption of rectal hydrocortisone acetate foam in nonspecific proctocolitis.

A 3-week open trial of rectal hydrocortisone acetate foam (Colifoam, Stafford Miller, UK) was conducted in 19 patients with active, nonspecific distal proctocolitis. Complete or near complete remission was observed in nine patients (47.4%). Absorption of hydrocortisone acetate from Colifoam was evaluated in 13 patients by measuring early morning serum cortisol before treatment and 12 and 36 h after the final dose. Normal cortisol values were observed in every instance, suggesting that the steroid component of Colifoam was not significantly absorbed. Colifoam seems to be an effective remedy for distal proctocolitis. Its specific advantages include ease of retention and apparent nonabsorption of the active component.

Administration, Rectal

Eosinophils in the rectal mucosa. A simple method of predicting the outcome of ulcerative proctocolitis?

One-hundred-and-thirteen rectal biopsies and 17 total colectomy specimens from 50 patients with ulcerative proctocolitis were examined. These patients had been followed for periods up to 220 months, mean 70 months. The histological changes were compared with the clinical features of the disease. Patients with relatively benign disease which responded to treatment had significantly raised eosinophil counts in the mucosa examined, compared with patients who had aggressive disease which failed to respond to medical treatment (P less than 0.001). Tissue eosinophilia in the rectal mucosa may provide a simple method for predicting the clinical course of patients with ulcerative proctocolitis.

Adult

Polymorphonuclear leucocytes in Crohn's disease and ulcerative proctocolitis: association between enhanced adherence to nylon fibre and disease variables.

The adherence of polymorphonuclear leucocytes (PMN) to nylon fibre was investigated in patients with Crohn's disease, ulcerative proctocolitis, and anorexia nervosa, and compared with changes of circulating PMNs, C reactive protein concentrations, erythrocyte sedimentation rates, and clinical assessment of disease activity. PMN adherence was in excess of the maximum value detected for healthy subjects in 14 of 25 patients with Crohn's disease and two of 10 with proctocolitis, but it was within the normal range for all eight with anorexia nervosa. High adherence in Crohn's disease, however, was not associated with quantitative or qualitative changes of PMN populations, absolute concentrations of C reactive protein, erythrocyte sedimentation rates, disease severity, drug regimens, malnutrition, or zinc deficiency. High PMN adherence in Crohn's disease may therefore reflect the activation in vivo of normal PMN by humoral factors.

Adolescent

A controlled comparison of corticotropin and hydrocortisone in the treatment of severe proctocolitis.

A randomized controlled trial has been made of corticotropin (ACTH) 80 units given intramuscularly daily and hydrocortisone 400 mg infused intravenously over 24 hours, in the treatment of in-patients with severe proctocolitis. Seven patients were treated with ACTH and nine with hydrocortisone over an initial seven days. Three patients in the ACTH group and six in the hydrocortisone group improved and were discharged on medical treatment. Four patients treated with ACTH and two with hydrocortisone required urgent colectomy during this admission. Plasma cortisol levels were measured, but there was no correlation between these and the observed therapeutic response. Sideeffects were troublesome in both groups but were more marked in those treated with hydrocortisone. It is concluded that ACTH is not intrinsically superior to hydrocortisone in these doses, in the treatment of severe proctocolitis.

Adrenocorticotropic Hormone

Blood pH: a test for assessment of severity in proctocolitis.

Acid base balance was studied in 58 patients with active idiopathic proctocolitis; the condition of 10 of them was complicated by toxic megacolon. Arterial blood pH increased progressively with increased severity of the colitis and as the lesions became more widespread. Statistically significant differences were observed in pH values between the mild/moderate and severe forms and between the severe and complicated forms ('toxic megacolon'). A linear correlation was found between pH and the amount of intestinal gas, pulse rate, and plasma albumin.

Carbon Dioxide

[Idiopathic proctocolitis. Follow-up (1-13 years) of 71 patients].

Follow-up was possible in 71 of 74 patients with idiopathic proctocolitis diagnosed and/or assisted at the Department of Gastroenterology of the Centro Policínico de Almada, between 1973 and 1985. The aim of the present study was to verify the natural history of the disease and if there were statistically significant differences depending on the extension of the disease (proctitis versus colitis). Complications were present in 22 patients (31%): peri-anal (10%), local or intestinal (24%) and extra-intestinal (28%). Fifteen patients (21% of the cases) had hospital admission at least once, and 2 of them (3%) were submitted to surgery. No cases of cancer of the colon and rectum were detected and mortality was nil. Forty-one patients (58%) were assymptomatic at the last observation (45% with colitis and 75% with proctitis). There were statistically significant differences between the group of patients with ulcerative colitis and that of proctitis concerning the total number of complications (p less than 0.001), local complications (p less than 0.01), extra-intestinal complications (p less than 0.05), need for hospital admission (p less than 0.001) and absence of symptoms at the time of last observation (p less than 0.05), thus confirming a better prognosis of the disease when only the rectum is involved.

Adult

[Late results of ileorectal anastomosis in proctocolitis].

In 1961-1986 at the Surgical Clinic of the Institute for Postgraduate Medicine in Prague 49 colectomies were performed with ileorectal anastomosis. The operations were usually made in several stages. The remote results were evaluated after an interval of 10 to 26 years in 33 patients and were good to satisfactory in 82%. Malignant degeneration in the rectum was not observed. The relatively favourable results can be ascribed to careful selection of patients and frequently also the multi-stage procedure. Ileorectal anastomoses are still justified in the surgical treatment of proctocolitis.

Adolescent

[Radiation proctocolitis following gynecologic radiotherapy: an endoscopic study].

The prevalence of radiation injuries was assessed in 155 of 206 surviving patients who had had radiation therapy for carcinoma of the uterus or vagina. The patients were examined according to a standardized protocol. 51 (32.9%) exhibited endoscopic proctitis, and in 10 of them sigmoid colon was also affected. The prevalence of colitis was 31 of 66 (47%) in patients treated for carcinoma of cervix and 19 of 86 (47%) in those treated for carcinoma of corpus. 41 (80.4%) had clinical symptoms (bleeding and diarrhea in 53% each). The mean time lag between radiation therapy and beginning of symptoms was 9 months. Histology was positive in only 24 (47.1%) of 51 endoscopically documented cases of proctocolitis. There was no increase in the prevalence of radiation injury after previous surgery of any kind. Nor was higher risk found in patients with hypertension, diabetes, or congestive heart failure. However, patients with low body mass were at increased risk (p less than 0.01). There was a dose-response relationship between total dose and endoscopic proctitis (p less than 0.001). The incidence was 0% below 40 Gy, 20% at 60 Gy and 50% at 90 Gy.

Adult

Mucosal proctectomy and colo-anal anastomosis for distal ulcerative proctocolitis.

Four patients with long-standing symptomatic ulcerative colitis confined to the left colon and rectum were treated by resection, mucosal proctectomy and colo-anal sleeve anastomosis. There was no operative mortality or anastomotic leakage. Follow-up has ranged from 12 to 66 months (mean 52 months). Loose bowel motions with urgency and frequency of defaecation were troublesome postoperative symptoms. Recurrence of the colitis in the neorectum with extension into the proximal colon occurred in all patients within 3 to 11 months (mean 6 months) of operation. This necessitated total proctocolectomy with ileostomy in three patients (mean 18 months postoperatively). In the fourth patient the recurrence is medically controlled without a stoma more than 5 years after operation. This operation is unsuitable for the treatment of segmental ulcerative proctocolitis.

Adult