Urgent Subtotal Colectomy for Severe Inflammatory Bowel Disease

PURPOSE The purpose of this study was to assess the safety of subtotal colectomy and outcomes after this procedure in the modern era of immunosuppressive agents and primary pelvic pouch surgery.METHODS All patients undergoing subtotal colectomy with ileostomy for ulcerative colitis or Crohns colitis from July 1, 1990 to June 30, 2003 were identified from a prospective database. Only patients who were operated on while hospitalized for disease exacerbation were included in the analysis. Age at colectomy, preoperative days in the hospital, postoperative length of stay, and complications were recorded. The medical records were then reviewed for duration of disease, preoperative diagnosis, use of steroids and immunomodulators, parenteral nutrition, endoscopy findings, albumin level, postoperative diagnosis, and ultimate disposition.RESULTS One hundred one patients underwent subtotal colectomy for inflammatory bowel disease during the study period. Seventy-four patients met all the inclusion criteria. The mean age was 35.9 (range, 18–86) years. Median duration of disease was 36 (0–240) months, but 28 patients had colitis for less than 1 year, whereas 10 patients had disease of greater than 10 years duration at the time of colectomy. Median preoperative hospital stay was 7 (range, 0–43) days and median postoperative length of stay was 6.5 (range, 4–37) days. Sixty-six patients underwent surgery for refractory exacerbation, 5 for free perforation, 2 for abscess, and 1 patient for hemorrhage. Twenty-seven patients (36.5 percent) had a change in diagnosis after surgery. Complications occurred in 17 patients (23 percent), including 8 cases of central venous catheter–associated thrombosis; 7 of these occurred in patients who had been hospitalized for more than a week before surgery. In the ulcerative colitis patients, 31 of 52 ultimately underwent ileal pouch–anal anastomosis, but 20 (39 percent) chose either completion proctectomy or no further surgery.CONCLUSIONS Subtotal colectomy with ileostomy remains a safe and effective treatment for patients requiring urgent surgery for severe inflammatory bowel disease. Because of the substantial incidence of change in diagnosis and satisfaction in many patients with an ileostomy, subtotal colectomy with ileostomy may be preferable to primary ileal pouch–anal anastomosis, even when a pouch is considered safe.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004Reprints are not available.     

炎症性肠病急危重症的诊断治疗

炎症性肠病( Inflammatory bowel disease,IBD)包括溃疡性结肠炎(ulcerative colitis, UC)与克罗恩病(Crohn′s disease,CD),为一种病因尚不十分清楚的结肠粘膜和粘膜下炎症疾病。在西方国家相当常见,患病率分别为 100~200/100 000和 50~100/100 000。近年国内报告亦渐增多。据不完全统计,仅从15年3 千余篇文章报告中已超过 14 万例次,是消化系统常见疾病和慢性腹泻的主要病因。而全国20余家大型医院近 14 年回顾性研究发现,住院病例逐年增多。其中重症病例在 30%以上,并发症发生率约60%,说明病例增多、病情复杂,危重病症相应增多…     

RDW as an Additional Marker in Inflammatory Bowel Disease/Undifferentiated Colitis

BACKGROUND: Anemia is a common complication in inflammatory bowel disease patients. We postulate that the distribution of lesions in Crohn's disease is more likely than ulcerative colitis to lead to malabsorption as an additional cause of anemia. RDW, a simple and inexpensive test could be an additional differentiating test. METHODS AND RESULTS: Retrospective review of 284 cases of which 156 cases were diagnosed with Crohn's disease and 128 cases were diagnosed with ulcerative colitis. There was a significant difference in the mean RDW between the Crohn's and the ulcerative colitis cases (14.9 vs. 14.3, P = .027). CONCLUSIONS: We conclude there is a statistical significance between the two groups though this may not represent a clinically significant difference. From our analysis we conclude that RDW is statistically significant and with the implementation of a more rigorous study design and analysis of further data RDW may prove to be a clinically effective marker in differentiating Crohn's disease from ulcerative colitis.     

粪便钙卫蛋白对炎症性肠病和肠易激综合征的鉴别诊断价值研究

目的粪便钙卫蛋白（FCP）被认为是判断炎症性肠病（IBD）的肠道炎症的非侵入性标志物。本研究旨在探讨FCP对IBD和肠易激综合征（IBS）的鉴别诊断价值,并比较FCP与C-反应蛋白（CRP）和红细胞沉降率（ESR）诊断IBD的临床价值。方法应用FCP酶联免疫试剂盒检测正常对照组42例,炎症性肠病组50例,包括16例溃疡性结肠炎（UC）,34例克罗恩病（CD）患者的FCP浓度;同时检测36例IBS患者的FCP浓度。其中39例IBD患者在留取FCP标本的同期进行了ESR和CRP的检测。绘制受检者操作特征曲线（ROC曲线）,确定FCP鉴别诊断IBD和IBS的诊断临界点。结果 IBD组FCP浓度的中位数和四分位间距分别为131.1μg/g（72.64～518.37μg/g）,显著高于IBS组的39.43μg/g（20.58～56.18μg/g）,和正常对照组的27.7μg/g（10.87～44.01μg/g）,FCP浓度比较,P〈0.001。IBS组与正常对照组FCP浓度无统计学差异,P〉0.05。FCP检测IBD的阳性率分别为87.5%和88.2%,显著高于ESR和CRP的阳性率,P〈0.05。以68.76μg/g作为最佳的诊断临界点,此时FCP鉴别诊断IBD和IBS的敏感性为84.0%,特异性为88.89%。结论检测FCP是一种简单易行且无创的检查方法,对于IBD和IBS鉴别诊断具有较高的临床价值。     

Osteoporosis in Inflammatory Bowel Disease

Osteoporosis commonly afflicts patients with inflammatory bowel disease, and many factors link the 2 states together. A literature review was conducted about the pathophysiology of osteoporosis in relation to inflammatory bowel disease. Screening guidelines for osteoporosis in general as well as those directed at patients with inflammatory bowel disease are reviewed, as are currently available treatment options. The purpose of this article is to increase physician awareness about osteopenia and osteoporosis occurring in patients with inflammatory bowel disease and to provide basic, clinically relevant information about the pathophysiology and guidelines to help them treat these patients in a cost-effective manner.