Chronic ulcerative colitis in children

Summary Manifestations of chronic ulcerative colitis in children are the same as those in adults, except for growth retardation. The incidence of the disease appears to have become more widely recognized. Intractability is a recognized problem and is often an indication for surgery. Total colectomy and abdominoperineal resection with ileostomy is the treatment of choice for the acute fulminating type. It is suggested that if the patients are operated upon earlier in the course of the disease, the rectum may be saved and continuity of the bowel may be restored. While the etiology remains an enigma, in a high percentage of cases there is a strong psychosomatic overlay. Read at the meeting of the American Proctologic Society, Miami Beach, Florida, April 30 to May 3, 1962.     

Chronic ulcerative colitis

Summary Chronic ulcerative colitis has been observed in 220 patients at the Scott and White Clinic during the past 15 years. Our observations of the clinical features of the disease have been reviewed. The diarrhea associated with chronic ulcerative colitis tends to be chronic and recurrent and frequently occurs nocturally. Anorexia, weight loss, mild anxiety, tachycardia, fever, abdominal cramping, anemia, skin lesions, rectal complications, and joint involvement are the more common symptoms and signs. Important in the physical examination are auscultation and palpation of the abdomen and a careful digital examination of the rectum.The diagnosis of chronic ulcerative colitis is dependent upon sigmoidoscopic and roentgenologic examination of the rectum and colon. The characteristic sigmoidoscopic findings during various stages of the disease have been presented. Mucosal and luminal changes as observed radiologically have been depicted.The differential diagnosis has been discussed, and diseases occurring in association with chronic ulcerative colitis have been considered.     

Chronic ulcerative colitis

Diseases of the Colon & Rectum -     

Chronic idiopathic ulcerative colitis

Many frequently cited studies of the interaction of chronic idiopathic ulcerative colitis (CIUC) and pregnancy were performed in the 1950s before pharmacotherapy for this disease was common. We retrospectively reviewed obstetrical records at a large maternity facility to determine the effects of CIUC on pregnancy and on fetal outcome. We observed that the prevalence of CIUC in pregnant women was below that expected based on published data (P<0.01). The use of prednisone and sulfasalazine in pregnant women with CIUC was common; 85% of these patients received these medications. We found significantly greater (P<0.01) incidence of low-birth-weight in infants (<2500 g) of mothers with CIUC than in the control population. The delivery of infants of low birth weight occurred despite adequate maternal weight gain.This work was supported in part by a grant for David H. Van Thiel from the National Institutes of Health, 534875, and from the Gastrointestinal Medical Research Foundation of Southwestern Pennsylvania. David H. Van Thiel is the recipient of a career development award from the National Institutes of Mental Health, AA00016.     

Early ulcerative colitis in children and adolescents

Summary Roentgenologic changes in the early stages of ulcerative colitis in patients less than 20 years of age are described. Lesions appearing in patients below the age of puberty differed in distribution, and in the clinical course, from those appearing in adolescents. They also differed clearly from those of Crohn’s disease. Healing of extensive lesions was observed, and the prognosis was not found to be related to the initial extent of the disease.     

Chronic ulcerative colitis,colonic adenocarcinoma and hypoglycemia

Summary This report documents the association of metastatic colonic adenocarcinoma and hypoglycemia occurring in a 40-year-old female with long-standing ulcerative colitis. Although there was extensive replacement of liver parenchyma by metastases, minimal impairment of liver-cell function and the sequence of clinical events indicated that the hypoglycemia was primarily due to the widespread neoplasm and not to hepatic insufficiency. Tumor analysis by the radioimmunoassay method failed to identify the presence of insulin. To our knowledge, this is the first report of the association of chronic ulcerative colitis, colonic adenocarcinoma and hypoglycemia.The authors wish to thank Dr. D. H. Law for his helpful comments and criticism and Mrs. Mildred Hale for her secretarial assistance.     

Chronic pancreatitis in patients with sclerosing cholangitis and ulcerative colitis

In the 4-year period 1980-83 sclerosing cholangitis was demonstrated in 7 out of 151 patients with ulcerative colitis hospitalized in our department. Total ulcerative colitis was demonstrated in all patients with sclerosing cholangitis, whereas abnormal pancreatograms compatible with chronic pancreatitis were seen in four of these patients. According to the criteria of Kasugai, one had minimal, two moderate, and one advanced changes of chronic pancreatitis. Although three of four patients had been treated with drugs known to induce pancreatitis (sulfasalazine and corticosteroids), it is tempting to assume that ulcerative colitis, sclerosing cholangitis, and pancreatitis, when seen in combination, are manifestations of autoimmune diseases with a genetic predisposition. A mechanical mechanism for the development of chronic pancreatitis in sclerosing cholangitis must also be considered.