Ulcerative colitis or Crohn’s disease?
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Cell proliferation kinetics of 30 patients affected by extensive ulcerative colitis in remission have been studied with autoradiography of rectal biopsies incubated with tritiated thymidine. The results have been compared with those of 20 control subjects without evidence of colonic diseases, and of 16 patients with multiple nonfamilial colonic adenomas. The labeling index was similar in the three groups (P = NS). On the contrary, the labeling frequency (SEM) in the upper 40% of the crypt (phi h value) was 0.04 +/- 0.01 in controls, 0.16 +/- 0.02 in ulcerative colitis, and 0.10 +/- 0.01 in adenoma patients (P less than 0.001 ulcerative colitis versus controls, P less than 0.01 adenomas versus controls, P = NS ulcerative colitis versus adenomas). The distribution of phi h values in ulcerative colitis showed a bimodal trend with 22 patients having mean phi h values similar to adenoma patients (0.10 +/- 0.01) and 8 with higher values (0.30 +/- 0.02). No relationship was found between phi h values and duration of colitis, age of patients, or age at onset of symptoms. These data show that cell kinetics studies can detect patients at particularly high risk of colon cancer, and that additional factors should determine colon cancer risk level in ulcerative colitis.
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The clinical course and endoscopic features of colitis associated with primary sclerosing cholangitis have not been well documented.Since 1980, a total of 485 patients with ulcerative colitis have been seen in our departments. During this period, we experienced 6 patients with primary sclerosing cholangitis, 4 of whom had ulcerative colitis concomitantly.Colitis preceded primary sclerosing cholangitis in 3 of the 4 patients. There were 2 males and 2 females. One patient had left-sided colitis while 3 had total colitis, 1 with a first attack and 3 with relapsing-remitting type. Two of the 4 patients had colonoscopically dominant inflammation in the proximal colon with continuous histological inflammation from the rectum to the proximal colon. Three colitic patients have been well controlled with oral sulfasalzine or mesalazine administration. Only 1 female patient had been hospitalized twice for moderately severe attacks of ulcerative colitis that required systemic prednisolone administration, however, this patient quickly responded to this treatment for each admission.Colitis associated with primary sclerosing cholangitis exhibited atypical colonoscopic findings and exhibited milder disease activity than ulcerative colitis without primary sclerosing cholangitis.
Primary Sclerosing Cholangitis
Mesalazine
Prednisolone
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To probe the relationship between location and extent of ulcerative colitis (UC) by analyzing its extra-intestinal manifestations.392 UC cases in Peking Union Medical College Hospital from 1976 to 2000 were reviewed retrospectively. Chi-square test was used to test the difference between groups.82 of 392 patients (20.9%) with UC had extra-intestinal manifestations, 34 (8.7%) of these patients had more than one extra-colonic organ involvement; It shows that the extensive colitis has highest incidence of extra-intestinal manifestations with UC than that of the left-sided colitis did, while the proctitis had the lowest incidence. There were no significant difference (P > 0.05) between the group of extensive colitis and that of left-side colitis; The incidence of extra-intestinal manifestations in severe cases was significantly greater than that in mild cases. There was a trend of increasing incidence from severe to moderate to mild type (P < 0.05); Most of the extra-intestinal manifestations were associated with active UC, except for AS, PSC, healed during SASP and/or steroid treatment.Extra-intestinal manifestations had a high incidence in UC. The most frequently involved organs were joints, hepatobiliary system, skin, mouth and eyes. The majority of them were associated with the active UC. The incidence of extra-intestinal manifestations with UC was closely related with the extent and severity of the lesions, and the most of the extra-intestinal manifestations occurred in the active phase of UC. But the incidence of extra-intestinal manifestations was not related to prognosis.
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In the first study 62 patients with ulcerative colitis and 20 healthy controls were fed a test meal of mashed potatoes and baked beans containing transit markers. Mouth-to-caecum transit was significantly slower in the patients than in controls; gastric emptying, however, was similar. Patients with active colitis had proximal colonic stasis, with rapid transit through the rectosigmoid region. In the patients with quiescent colitis the colonic distribution of markers was normal. Stool weight and frequency were significantly higher in the patients with active colitis. In the second study anorectal function was assessed in 29 patients with ulcerative colitis and in 12 healthy controls by measuring interluminal pressures at multiple sites in the anus and rectum before and during serial distention of a rectal balloon. Overall, resting and maximum squeeze sphincter pressures did not differ in patients with active or quiescent colitis and controls; however, in six patients with moderately severe colitis and incontinence, maximum squeeze pressure was significantly lower than in controls. The rectal volumes required to induce sensations of wind, a desire to defaecate, and pain were significantly lower in the patients with active colitis than patients with quiescent colitis and controls. Rectal pressures in response to rectal distention were higher in patients with active colitis. During disease remission rectal sensitivity decreased and rectal compliance increased. In the third study integrated pressure activity of the sigmoid colon, rectum, and anus was studied in patients with ulcerative colitis and healthy controls before and during provocation by rectal infusion of 1500 ml of warm saline. Resting motor activity was significantly lower in the patients with active colitis than in patients with quiescent colitis and controls. No anorectal contractions during the 1-h study were recorded in 7 of 18 patients with active colitis, 1 of 17 with quiescent colitis, and 1 of 18 controls. The volume of saline infused before leakage and total volume retained were significantly lower in the patients than in controls. The amplitude of regular contractions after rectal infusion of saline Was significantly higher in patients with active colitis than in patients with quiescent colitis and controls. Thus, the rectum in active colitis is tense and quiescent but responds to stimulation by generating large contractions.
Anus
Enema
Anorectal manometry
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Apoptosis plays a role in epithelial and mucosal injury, which is 1 of the mechanisms in the pathogenesis of ulcerative colitis. Apoptotic cells increase as a result of injured mucosa in ulcerative colitis and serum M 30 levels increase in epithelial cell apoptosis. In this study, we aimed to evaluate the relation between M 30 serum levels and ulcerative colitis activity.Eighty patients with ulcerative colitis and 40 healthy controls were enrolled into the study. The patient group consisted of 31 extensive colitis, 30 left-sided colitis, and 19 proctitis. The activity of ulcerative colitis was determined with clinical and endoscopic findings. Serum M 30 levels, acute phase reactants, and biochemical tests were analyzed in all subjects.Serum M 30 levels in patients with active ulcerative colitis were significantly higher when compared with the healthy controls (165.6 ± 60.6 and 129.6 ± 37.4; P = 0.003). Serum M 30 levels in active left-sided colitis patients was significantly higher when compared with patients in remission phase (180.6 ± 58.5, 141.5 ± 35.4; P = 0.044). When we exclude patients with ulcerative proctitis, M 30 levels in active ulcerative colitis patients were significantly higher than that the patients in remission phase (174.0 ± 63.5, 135.0 ± 29.9; P = 0.017).We found that M 30 levels increase in patients with active ulcerative colitis. Our findings support the role of apoptosis demonstrated by serum M 30 levels in the pathogenesis of active ulcerative colitis.
Pathogenesis
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Thirty five adult patients with precirrhotic primary sclerosing cholangitis were randomly allocated to treatment for at least one year with low dose (4.1 mg/kg/day) cyclosporin or placebo in a double blind trial. Thirty patients had coexisting ulcerative colitis, including three who had previously undergone colectomy and one who discontinued treatment after three months. Of the remaining 26 patients, 16 received cyclosporin and 10 received placebo. Endoscopy was performed at entry to confirm the diagnosis of inflammatory bowel disease. The ulcerative colitis disease activity was prospectively classified annually as remission/mild, moderate, or severe using the Truelove and Witt9s criteria. Before treatment there were no differences between the cyclosporin and placebo groups in the number of patients with remission/mild colitis, 14/16 (88%) v 9/10 (90%), and moderate colitis, 2/16 (12%) v 1/10 (10%). During treatment, a remission/mild disease course was present in 15/16 (94%) v 6/10 (60%), p = 0.05 and a moderate disease course in 1/16 (6%) v 4/10 (40%), p = 0.05. It is concluded that patients treated with cyclosporin for primary sclerosing cholangitis who have coexisting ulcerative colitis have a more benign course of colitis resulting both from improvement of moderately active colitis and from fewer flares of remission/mildly active colitis. These findings suggest that cyclosporin may be of benefit to the colon in patients with ulcerative colitis who are being treated with cyclosporin for primary sclerosing cholangitis.
Primary Sclerosing Cholangitis
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Background: Sequence variants in the autophagy gene IRGM and NKX2–3 has been reported to contribute to Crohn's disease (CD) Susceptibility while ECM1 to ulcerative colitis (UC) in genome-wide association scans in North America and Western Europe. The aim of this study was to investigate variants of the above genes and examine genotype-phenotype relationships in a independent Eastern European IBD cohorts.
Genome-wide Association Study
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BACKGROUND
Luminal anionic sulphide may contribute to epithelial damage in ulcerative colitis. Thiol methyltransferase (TMT) governs sulphide detoxification by the colonic mucosa and circulating erythrocytes.AIMS
To measure levels of TMT activity in erythrocytes of surgically treated cases of colitis or in rectal biopsies of defined groups of colitis.PATIENTS
Venepuncture blood was obtained from 37 blood donors and 27 subjects who had previously undergone a proctocolectomy for colitis: 18 for ulcerative colitis and nine for Crohn9s colitis. Rectal biopsies from 122 cases were obtained: 47 without mucosal disease, 33 post-colon resection for cancer, 14 with moderate to severe ulcerative colitis, 15 with quiescent ulcerative colitis, seven with acute Crohn9s colitis, and six with radiation proctitis.METHODS
TMT activity was measured by high performance liquid chromatography with radioactive detection to measure 14C methylmercaptoethanol formation, the reaction product of cell extracts incubated with mercaptoethanol and 14C S-adenosylmethionine.RESULTS
Erythrocyte TMT activity of surgically treated cases of colitis was significantly elevated (p<0.001) compared with control cases. TMT activity of rectal biopsies was significantly decreased (p<0.02) in acute but not quiescent ulcerative colitis, Crohn9s colitis, or radiation colitis.CONCLUSIONS
Erythrocyte TMT activity was persistently elevated after proctocolectomy for Crohn9s disease and ulcerative colitis. No primary defect of TMT activity was found in any case of unoperated colitis but mucosal activity was diminished with disease progression of ulcerative colitis. Studies of genetic control of TMT activity of erythrocytes in inflammatory bowel disease appear worthwhile.Proctocolectomy
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Background and aims: Serum β-2 microglobulin levels increase in all chronic inflammatory and autoimmune diseases. This incease is linked to the severity and extant of inflammation. The aim of our study was to evaluate value of serum β-2 microglobulin levels to determine Crohn disease activity. Material and methods: A total of 116 subjects (46 ulcerative colitis, 25 Crohn's disease, 55 Healthy controls) were included in the study. Ulcerative colitis and Crohn's disease patients were divided into three groups according to disease activity: Active, partial remission, complete remission. Chron's disease subjects were classified according to their treatment response as: responsive (complete or+ partial remission) and unresponsive (active). Subjects were divided into three groups according to the extent of disease: Distal, Left and Pancolitis for ulcerative colitis; ileitis, ileocolitis and colitis for Crohn's disease. All groups were compared for the mean Serum β-2 Microglobulin levels. Results: In both Crohn's disease and ulceratice colitis groups mean β-2 microglobulin levels were significantly higher than healthy (control) group (p
Pancolitis
Ileitis
Beta-2 microglobulin
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The aim of this study was to examine the relationship between a new activity index and the endoscopic severity assessed by sigmoidoscopy in patients with ulcerative colitis.We evaluated the sigmoidoscopic severity and Activity Index (AI) in 37 patients with distal colitis, 23 with left-sided colitis, and 36 with total colitis, in which the severity was divided into three categories: grade 1 = mildly active, grade 2 = moderately active, and grade 3 = severely active. We examined the relationship between the AI or clinical parameters and the endoscopic severity in all 96 cases.The AI was found to be significantly correlated with the degree of sigmoidoscopic activity in all cases, as well as in those with distal colitis, left-sided colitis, or total colitis. When patients with both grade 1 sigmoidoscopic activity and AI values of less than 150 were regarded to have mild colitis and patients with either grade 2 or grade 3 sigmoidoscopic activity and AI values of more than 150 were regarded to have moderate or severe colitis, 10 of 37 (27%) in the distal colitis, one of 23 (4.3%) in the left-sided colitis, and four of 36 (11.1%) in the total colitis groups were thus misclassified regarding the distinction between mild colitis and moderate or severe colitis. Three of four patients with severity of grade 1, indicating AI values of more than 150, had total colitis, whereas the remaining one had left-sided colitis. On the other hand, 10 of 11 patients with severity of grades 2 or 3 with AI values of less than 150 had distal colonic involvement. When the endoscopic activity was equivalent, the highest mean AI values occurred in total colitis whereas the lowest mean AI values were found in distal colitis.The AI well reflects the sigmoidoscopic activity. High AI values with a low sigmoidoscopic severity are thus considered to reflect extensive involvement, whereas a high sigmoidoscopic severity with low AI values is thought to indicate the involvement of the distal colon.
Sigmoidoscopy
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