Acute Pancreatitis in Patients with Ulcerative Colitis

Twenty-two patients (13 men and 9 women; median age, 34 years; range, 15–64 years) with ulcerative colitis (UC) were evaluated to determine the incidence of acute pancreatitis with UC at the First Department of Internal Medicine, Mie University School of Medicine, during 1989–2001. Among these, three patients (14%) were diagnosed as having had episodes of acute pancreatitis during the mean follow-up period of 6 years. One patient presented with acute pancreatitis and UC simultaneously. Two patients had drug-induced pancreatitis (one due to azathioprine and the other due to 5-ASA). In conclusion, acute pancreatitis is not a frequent, but an occasional extraintestinal manifestation of UC.     

重症溃疡性结肠炎的诊断、评估与治疗

近年来,溃疡性结肠炎(ulcerative colitis,UC)已成为我国消化系统常见疾病和慢性腹泻的主要病因。全国20余家大型医院回顾性研究发现,UC住院病例逐年增多,其中重症病例占21.7%,并发症又占其中60%,危重病例相应增多,值得临床医师重视。重症溃疡性结肠炎的诊断与评估1.首先根据临     

Acute Severe Ulcerative Colitis: Optimal Strategies for Drug Therapy

Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency with considerable morbidity (30% to 40%). Patients with ASUC require hospitalization for prompt medical treatment, and colectomy is considered if medical therapy fails. Corticosteroids remain the primary initial therapy, although one-third of patients do not respond to treatment. Clinical data have indicated that cyclosporine, tacrolimus, and infliximab can be used to treat patients with ASUC who do not respond to intravenous corticosteroids. The effectiveness and safety of sequential therapy have recently been reported; however, the data are not convincing. Importantly, timely decision-making with rescue therapy or surgical treatment is critical to manage ASUC without compromising the health or safety of the patients. In addition, risk stratification and the use of predictive clinical parameters have improved the clinical outcome.of ASUC. Multidisciplinary teams that include inflammatory bowel disease experts, colorectal surgeons, and other medical staff contribute to the better management of patients with ASUC. In this review, we introduce current evidence and present a clinical approach to manage ASUC. (Gut Liver, Published online November 14, 2022)     

Enteral versus Parenteral Nutrition as Adjunct Therapy in Acute Ulcerative Colitis

To ascertain the role of total enteral nutrition, compared with total parenteral nutrition, as adjunct therapy to steroids in patients with severe acute ulcerative colitis, a prospective randomized trial was conducted in 42 of such patients. Inclusion criteria were the persistence of a moderate or severe attack of the disease (Truelove's index) after 48 h on full steroid treatment (prednisone 1 mg/kg/day). Patients were randomized to receive polymeric total enteral nutrition or isocaloric, isonitrogenous total parenteral nutrition as the sole nutritional support. Remission rate and need for colectomy were similar in both groups. No significant changes in anthropometric parameters were observed in either nutritional group at the end of the study. Median increase in serum albumin was 16.7% (−0.5% to +30.4%) in the enteral feeding group, and only 4.6% (−12.0% to +13.7%) in the parenteral nutrition patients ( p = 0.019). Adverse effects related to artificial nutritional support were less frequent (9% vs. 35%, p = 0.046) and milder in enterally fed patients. Postoperative infections occurred more often with parenteral nutrition ( p = 0.028). These results suggest that total enteral nutrition is safe and nutritionally effective in severe attacks of ulcerative colitis. It is also cheaper and associated with fewer complications than parenteral nutrition. Total enteral nutrition should be regarded as the most suitable type of nutritional support in these patient     

Ulcerative Colitis in Infancy

Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100 000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter started with immunosuppressive drugs. After initial induction therapy with parenteral steroid and infliximab, the patient is now on remission with azathioprine and mesalamine. UC is rare in Bangladesh, especially in children, and it is rarer during infancy. Several conditions like infective colitis, allergic colitis, Meckel''s diverticulitis, Crohn''s disease, etc. may mimic the features of UC. So, if a child presents with recurrent bloody diarrhea, UC should be considered as differential diagnosis.     

Acute Colonic Graft-versus-host Disease and Ulcerative Colitis with Respect to Cytokines

Colonic graft-versus-host disease (GVHD) occurring after allogeneic bone marrow transplantation (BMT) resembles ulcerative colitis (UC) with respect to pathological features. In addition, therapy for UC has been reported to be effective for the treatment of refractory GVHD. The relationship of these two conditions with respect to cytokines was investigated in the present study.

Among 27 patients who underwent allogeneic BMT during the previous two years, six developed GVHD of grade 3 or higher, and these six patients were compared with the other 21 patients.

In six patients, the levels of the following cytokines were significantly elevated at the onset of GVHD: tumor necrosis factor-α (p<0.05), interleukin-6 (p<0.05), interleukin-8 (p<0.01), interferon-γ (p<0.05), and interleukin-7 (p<0.0001).

These findings indicate that GVHD and UC are similar in terms of their cytokine profile.     

Acute CMV-Colitis in a Patient with a History of Ulcerative Colitis

A symptomatic cytomegalovirus (CMV) infection usually occurs in patients with debilitating diseases, immunosuppression, transplantations and acquired immunodeficiency syndrome (AIDS). Gastrointestinal infections with CMV, especially colitis, are usually found in immunocompromised patients and rarely affect immunocompetent subjects. Here we report the case of a young female patient with a history of ulcerative colitis (UC) who presented with an acute attack of colitis caused by CMV infection. This was documented by the presence of CMV early antigen, antibodies and evidence of CMV in the colonic mucosa. After combined anti-inflammatory and antiviral treatment the patient recovered completely. As most attention is given to CMV-pathogeneity in immunocompromised patients, here we discuss the relationship to inflammatory bowel diseases.     

溃疡性结肠炎的并发症

溃疡性结肠炎是慢性复发性疾病,其并发症直接影响该病的预后。本文以1993年全国慢性非感染肠道疾病学术研讨对本病会制定的诊断标准,对北京协和医院1974年1月至1995年1月溃疡性结肠炎住院和门诊病人483例进行了分析,着重探讨并发症的种类与疾病严重程度的关系以及对预后的影响。本组病人并发症的发生率为6.2％(30/483)。重症患者并发症的发生率为24.3％。并发症的种类,按其发生频率的多少依次排列如下:严重电解质紊乱(9.01％)、肠梗阻(8.11％)、人出血、菌群失调,肠穿孔(各3.60％)、败血症(2.70％)、肠瘘、癌变(各1.80％).中毒性肠扩张(0.90％)。本组溃疡性结肠炎早期并发症,除电解质紊乱外尚有大出血、中毒性肠扩张、败血症多见,随病程迁延则以肠梗阻、肠瘘、肠穿孔和癌变为主。并发症多发生于重度活动期(24.3％);其中病变累及全结肠为82％,左半结肠仅为18％。住院病人中该病病死率为6.08％,并发症组为23.08％,高于无并发症组(2％)。因此,对溃疡性结肠炎的并发症,要提请广大临床医师注意:需早期诊断,积极治疗,以减少病死率。     

溃疡性结肠炎的并发症

目的:探讨溃疡性结肠炎并发症的种类与疾病严重程度的关系以及对预后的影响.方法:以1993年全国慢性非感染肠道疾病学术研讨会制定的对本病的诊断标准,分析了北京协和医院1974年1月至1995年1月溃疡性结肠炎住院和门诊病人483例.结果:本组病人并发症的发生率为6.2%(30/483).重症患者并发症的发生率为24.3%.并发症的种类按其发生频率的多少依次为:严重的电解质紊乱(9.01%)、肠梗阻(8.11%)、大出血、菌群失调、肠穿孔(各3.6%)、败血症(2.70%)、肠瘘、癌变(各1.80%)、中毒性肠扩张(0.90%).本组溃疡性结肠炎早期并发症,除电解质紊乱外尚有大出血、中毒性肠扩张、败血症多见,随病程迁延则以肠梗阻、肠瘘、肠穿孔和癌变为主.并发症多发生于重度活动期(24.3%);其中病变累及全结肠为82%,左半结肠仅为18%.住院病人中该病病死率为6.08%,并发症组为23.08%,高于无并发症组(2%).结论:溃疡性结肠炎的并发症需早期诊断,积极治疗以减少病死率.