伴有慢性便秘的老年缺血性结肠炎的临床特点

目的对伴有便秘的老年缺血性结肠炎（IC）患者的临床特点进行总结,旨在更好地指导临床工作,减少误诊、漏诊。方法回顾性地分析复旦大学附属华东医院消化内科2008年至2013年收治的160例老年IC患者,其中男35例,女125例,根据有无便秘分为便秘组和非便秘组,比较两组IC患者的基础疾病、临床表现、误诊情况、实验室检查、内镜和病理组织学检查结果,以及诊治经过及疾病转归等。结果160例IC患者中,便秘患者占57．5％;便秘组发病年龄低于非便秘组;临床表现不典型;误诊率高（48．8％）;病变程度较重;治疗2周后黏膜完全愈合率63.0％低于非便秘组79．9％。便秘组中78．3％的患者病变位于左半结肠与非便秘组75．0％相仿。结论慢性便秘在老年IC中常见,是老年IC发病的重要危险因素。伴有慢性便秘的老年IC患者临床表现不典型,当慢性便秘患者存在其他危险因素如高血压、冠心病、糖尿病等,一旦出现腹痛或便血时应高度警惕IC发生,应尽早行肠镜检查,明确诊断。     

老年缺血性结肠炎的内镜及临床特点

目的总结老年缺血性结肠炎患者的内镜及临床特点,探讨其早期诊断方法。方法收集分析2000年1月～2007年12月,经临床、结肠镜确诊的老年缺血性结肠炎患者的相关资料,89例患者均在腹痛等症状出现后10天内行全结肠镜检查,部分病例取病变黏膜活检,观察其内镜下表现及病理组织学特点。结果经临床、结肠镜确诊为老年缺血性结肠炎者90例,其中男25例、女65例,男女之比为1：2．6,年龄为60～90岁,平均年龄（73．31±6．63）岁,多伴有相关基础疾病。临床主要表现为腹痛和血便,病变多数位于左半结肠。一过型者86例,狭窄型4例,无坏疽型。病理学表现无特异性。结论老年病人出现急性腹痛、便血时,及时结肠镜检查对明确缺血性结肠炎诊断,了解病变范围和分犁具有重要意义。     

Ischemic Colitis Caused by Strict Dieting in an 18-Year-Old Female

Ischemic colitis is typically limited to elderly patients who have concomitant disorders such as cardiovascular disease and chronic renal failure, but rarely affects a young person. The patient was an 18-year-old Japanese female who started dieting to obtain a slim figure three months before admission and presented with a two-month history of constipation and a sudden onset of lower abdominal pain and bloody diarrhea. She underwent colonoscopy, which revealed edema, hemorrhages, and several longitudinal shallow ulcers in the descending colon. Stool and blood culture results were negative for pathogens. She improved rapidly within five days without any specific therapies except intravenous hydration and anticholinergic agents, under the diagnosis of ischemic colitis. In this case constipation and dehydration associated with dieting seemed to be responsible for the development of ischemic colitis. We recommend that ischemic colitis should be included in the differential diagnosis of colitis with bleeding, even in patients younger than age 20 who do not have any predisposing factors.     

Clinical features in young adult patients with ischaemic colitis

The clinical, radiographic and endoscopic findings in 16 patients with ischaemic colitis, all of whom were <45 years of age, were analysed. The clinical features were characterized by an acute onset of abdominal pain and rectal bleeding, and persistent constipation prior to the onset of symptoms. Twelve of the 16 patients did not have any known predisposing factors. Barium enema examination and colonoscopy revealed longitudinal ulcers and oedema of the left side of the colon of these patients. These features were then compared with those found in patients with ischaemic colitis, who were > 70 years of age. Although the clinical symptoms, the site of involvement and the initial radiographic or endoscopic findings were similar between the two groups, the transient form of ischaemic colitis and constipation prior to the onset of symptoms were more frequently present in the young patients than in the old patients. These findings suggest that ischaemic colitis, which is not a rare condition even in young adults, is less severe in young patients than in old patients, and that constipation may be related to the pathogenesis of this disease in young adults.     

Biopsies of the endoscopically normal rectum and colon: a necessity. Incidence of collagen colitis and microscopic colitis

Collagenous colitis and microscopic colitis are histologic entities which do not have corresponding endoscopic features. Their precise incidence and role in the development of intestinal symptoms are poorly known. The aim of this study was to determine the frequency of these histologic abnormalities in patients with endoscopically normal colon and to correlate these findings with abdominal symptoms. Total colonoscopy was performed in 132 consecutive patients, 81 females and 51 males, aged 19 to 83 years (mean: 47.8 years). Patients complained of abdominal pain and/or diarrhea (66 cases), normal bowel transit or constipation (66 cases). Subjects were prepared for colonoscopy with polyethylene glycol 4,000. Three to 8 biopsies were taken from the rectum and the different parts of the colon. Histologic abnormalities were found in 36 patients (27.2 p. 100): collagenous colitis (7 cases), microscopic colitis (21 cases), and melanosis coli (8 cases). The frequency of diarrhea was significantly higher in patients with collagenous colitis and microscopic colitis than in those with melanosis coli or normal colonic mucosa. These results clearly demonstrate that routine biopsies of the rectum and colon are useful in patients with abdominal symptoms, particularly diarrhea, and normal endoscopy.     

缺血性结肠炎的结肠镜及影像学检查特征分析

[目的]分析缺血性结肠炎的结肠镜及影像学检查特征。[方法]回顾性分析96例缺血性结肠炎患者的临床资料。[结果]结肠镜检查以脾曲、降结肠及乙状结肠为最易受累部位,大多表现为一过型。腹部CT检查以病变肠段的肠管壁增厚为主要表现,腹主动脉或肠系膜动脉硬化及斑块形成检出率(14.3%)远低于腹部血管B超检查(73.3%),二者比较差异有统计学意义(χ²=51.3,P<0.01);右半结肠缺血患者住院日[(13.3±5.7)d]较无右半结肠缺血患者住院日[(9.5±3.4)d]更长,二者比较差异有统计学意义(t=-3.1,P<0.001)。[结论]临床工作中,尽早进行结肠镜、腹部CT及腹部B超等相关检查有助于早期诊断和治疗缺血性结肠炎,改善预后。     

缺血性结肠炎诊治现状

缺血性结肠炎(ischemic colitis,IC)是缺血性肠病中最常见的类型,也是下消化道出血的常见原因之一,由于肠道血流不能满足代谢需要导致大肠的特定肠段非感染性的炎症。IC病因多样,小血管病变、休克导致的全身血流灌注不足、缩血管药物的使用、腹部血管手术、便秘等可导致IC。老年人高发,临床表现无特异性,多数患者表现为急性的痉挛性腹痛、腹泻、排便急迫感和便血。结肠镜及活检病理检查在早期诊断中具有重要地位。大多数患者为一过性的非坏疽型的缺血,经内科保守治疗即可痊愈。但部分患者重度缺血出现结肠全层坏死、穿孔甚至多脏器功能衰竭。     

缺血性结肠炎临床特点分析

目的 探讨缺血性结肠炎的临床表现及内镜下特点以提高对本病的诊治水平.方法 回顾分析我院收治的37例缺血性结肠炎患者的临床资料及内镜下表现.结果 31例患者年龄大于50岁,29例伴有高血压病、心血管疾病、糖尿病、便秘、腹部手术等基础疾病.临床上主要表现为急性起病、腹痛、腹泻及便血.结肠镜下表现为黏膜充血、水肿、糜烂、溃...     

Effect of the stellate ganglion block on symptoms of ulcerative colitis: A case report

Rationale:Chronic ulcerative colitis is an autoimmune disease in which epithelial injury continuously occurs in the colonic mucosa. While mesalazine (5-aminosalicylic acid) is used to treat ulcerative colitis, it can also cause liver failure, headaches, and abdominal pain; therefore, an alternative treatment is required. The purpose of this study was to evaluate the effectiveness of 80 stellate ganglion blocks in reducing pain and other symptoms in a patient with chronic ulcerative colitis.Patient concerns:A 54-year-old female patient with a history of ulcerative colitis was concerned with worsening symptoms, such as abdominal discomfort and bloody-mucous stools, over the past 3 years.Diagnoses:Oozing mucosal bleeding and a small amount of exudate were observed on colonoscopy; a diagnosis of ulcerative colitis was made upon histologic examination.Interventions and outcomes:A total of 80 stellate ganglion blocks were administered, after which the patient''s symptom and pain level was decreased from 6 to 4 points on the numeric rating scale (11-point, 0 = no pain, 10 = worst pain imaginable). Improved clinical signs were observed on colonoscopy at a follow-up assessment.Lessons:The stellate ganglion block may be effective for the reduction of pain and other symptoms in patients with chronic ulcerative colitis.     

Evaluation of clinical features of ischemic colitis: Comparison between young and elderly

Background: It has been thought that ischemic colitis is caused by vascular and intestinal factors. Although elderly patients with arteriosclerosis are more susceptible to ischemic colitis, many young patients suffering ischemic colitis are also reported. The present study aimed to clarify the relationship between arteriosclerosis and ischemic colitis, and to evaluate various risk factors for ischemic colitis. Methods: We compared the clinical features of patients with ischemic colitis (54 cases) and control patients without ischemic colitis (86 cases), all diagnosed by colonoscopy. Subjects were classified into a young group (60 cases) under 60 years of age, and an elderly group (80 cases) of over 60 years. The degree of arteriosclerosis was measured by pulse wave velocity (PWV) level, and the effects of vascular and intestinal factors in the development of ischemic colitis were evaluated using multivariate analytical models. Results: In the elderly group, the PWV level was significantly higher in ischemic colitis patients than in the controls. By analyzing with multivariate analytical models, a high level of PWV and underlying diseases related to arteriosclerosis were thought to be risk factors for ischemic colitis in the elderly group. In the young group, intestinal factors such as irregular bowel movement, which is often seen in irritable bowel syndrome, habitual constipation, and prior history of an abdominal operation, were thought to be contributors to ischemic colitis. Conclusion: These findings suggest that intestinal factors in younger patients and vascular factors in more elderly patients are the primary contributors in the development of ischemic colitis.     

以腹泻为主要表现的缺血性结肠炎12例诊治分析

目的 对缺乏典型临床表现的老年性缺血性结肠炎的诊治进行探讨。方法回顾分析1992年5月至2004年2月间共12例以腹泻为主要临床表现的缺血性结肠炎病人的临床经过、内镜表现及诊治。结果本组病人年龄均〉60岁，且多数伴有可能相关的基础疾病，包括心脑血管疾病、高血脂或腹腔手术史。初步诊断仅有4例考虑为缺血性结肠炎，其余拟诊为急性肠炎等疾病。10例（83．3％）依赖结肠镜检查确诊，其中早期肠镜检查6例。早期内镜表现主要为病变结肠黏膜充血、水肿、淤斑、糜烂、出血，严重者出现溃疡。病变黏膜与正常黏膜界限清楚。本组-过型11例（91．7％），经内科治疗后症状消失，狭窄型1例（8．3％）手术后恢复良好。结论老年性缺血性结肠炎可缺乏典型的临床表现，而仅以腹泻表现为主，此时容易发生漏诊，延误治疗。早期结肠镜检查对于正确诊断和及时治疗有重要价值。     

Colonoscopy in elderly Asians: a prospective evaluation in routine clinical practice

OBJECTIVE: Colonoscopy is believed to be more complicated in elderly patients in Western countries. It is uncertain if the situation holds true among Asians. This study is to determine differences in colonoscopy performance and sedation complications between patients aged <65 years and those ≥65 years of age in an Asian population. METHODS: A prospective, cross‐sectional study of adults attending outpatient colonoscopy at a tertiary institution. Clinical and endoscopic data were obtained from all consenting adults. RESULTS: Two hundred and one patients (70 elderly and 131 aged <65 years) were enrolled. Compared to the patients aged <65 years, the elderly patients had similar levels of good (42.9%vs 45.8%), satisfactory (42.9%vs 33.6%) and poor (14.3%vs 20.6%) bowel preparations (P = NS). Cecal intubation was achieved in 60 (85.7%) of the elderly patients and 116 (88.5%) of the younger adults (P = NS). The differences in mean total colonoscopy duration was not significant (30 ± 13 vs 27 ± 11 min). Although the elderly patients received lower mean sedation doses of midazolam (4.7 vs 5.1 mg) and pethidine (37.8 vs 46.4 mg) compared to the younger adults, the hypotension rates were significantly higher in the elderly patients (7.1%vs 0.8%, P = 0.01). The elderly patients had in additional one or more co‐morbid illnesses (P = 0.001), with significantly higher rates of diabetes (P = 0.004), ischemic heart disease (P = 0.03), hypertension (P = 0.001) and stroke disease (P = 0.004). CONCLUSION: Colonoscopy performance in elderly Asians is similar to that in younger adults. However, the conscious sedation of these patients results in a higher rate of cardio‐vascular complications.     

The value of colonoscopy in schistosomal,tuberculous, and amebic colitis

Forty-six patients were diagnosed as having schistosomal, tuberculous, or amebic colitis over a two-year period using colonoscopy and biopsy. Both schistosomal and tuberculous colitis could be diagnosed by characteristic endoscopic and histologic features in the majority of cases. Colonoscopy provided the added advantage of endoscopic polypectomy at the diagnostic session itsell. The yield of granulomas in tuberculous lesions was 100 percent, although acid-fast bacilli could not be recovered from any. The endoscopic picture of amebic colitis often resembles that of inflammatory bowel disease; hence endoscopic biopsies are of paramount importance in establishing a correct diagnosis, especially in developing countries where both diseases exist with considerable frequency.     

Multiple food hypersensitivity as a cause of refractory chronic constipation in adults

Chronic constipation that is unresponsive to laxative treatment is a severe illness, but children unresponsive to laxatives have been successfully treated with an elimination diet. We report the first cases of refractory chronic constipation caused by food hypersensitivity in adults. Four patients with refractory constipation who were unresponsive to high doses of laxatives were put on an oligo-antigenic diet and underwent successive double-blind, placebo-controlled, food challenges (DBPFC). Routine laboratory tests, immunological assays, colonoscopy, esophago-gastroduodenoscopy and rectal and duodenal histology were performed. While on an elimination diet, bowel habits normalized in all patients and a DBPFC challenge triggered the reappearance of constipation. In comparison with another 13 patients with refractory constipation unresponsive to the elimination diet, observed over the same period, the patients with food-hypersensitivity-related constipation had the following characteristics: longer duration of illness (p<0.03), lower body mass index (p<0.03), higher frequency of self-reported food intolerance (p<0.01), higher frequency of nocturnal abdominal pain and anal itching (p<0.01). In patients with food hypersensitivity, hemoglobin concentrations and peripheral leukocytes were lower than those in controls (p<0.03). The duodenal and rectal mucosa histology showed lymphocyte and eosinophil infiltration, and the duodenal villi were flattened in two cases. In adult patients, refractory chronic constipation may be caused by food hypersensitivity and an elimination diet is effective in these subjects.     

Cytomegaloviral colitis in HIV positive patients: endoscopic findings

BACKGROUND: Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. AIM: To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. METHODS: Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. RESULTS: Total colonoscopy was possible in 98.03% and ileum intubation in 88.23% of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54%, an inflammatory process of the mucosa in 21.56% and 5.88% of the patients mucosa was endoscopically normal. CONCLUSION: Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea.     

缺血性结肠炎与溃疡性结肠炎临床诊断对比分析

目的对比分析缺血性结肠炎及溃疡性结肠炎临床特点与组织病理学的差异,为临床鉴别诊断提供依据。方法收集广西医科大学第一附属医院2010~2013年20例缺血性结肠炎及30例溃疡性结肠炎患者性别、病程、年龄、基础疾病史、临床表现,肠镜结果及病理特点等资料,并进行对比分析。结果缺血性结肠炎发病以60岁以上老年人为主,起病急,病程短,多伴有高血压、糖尿病等基础疾病,溃疡性结肠炎以中青年患者为主,病程长,伴随基础疾病较少见,前者临床表现以腹胀、呕吐多见,后者以黏液血便及里急后重症状较多见。缺血性结肠炎肠镜下病变较少累及直肠,多出现黏膜水肿,溃疡多呈纵行,溃疡性结肠炎常累及直肠,常合并炎性假息肉,溃疡以地图状为主,病变部位呈连续性。病理上,缺血性结肠炎以血管扩张充血、间质水肿及血管壁增厚多见,而炎性细胞浸润及隐窝脓肿较少见。结论结合年龄、既往病史、临床症状及内镜、组织病理学检查结果,有助于缺血性结肠炎与溃疡性结肠炎的鉴别诊断。     

La diverticulose colique à Dakar: aspects épidémiologiques, cliniques et endoscopiques chez 34 patients

Introduction

Colonic diverticulosis is a rare disorder among Africans and few studies have been carried out in Africa. Our objective was to report its epidemiological, clinical and endoscopic features in a centre for digestive endoscopy in Dakar.

Patients and method

This was a retrospective study of patients who had had a total colonoscopy in the Aristide-Le-Dantec Hospital in Dakar between January 2006 and December 2008. All patients who had at least one diverticula were included. Age, sex, indications and colonoscopy results were analysed.

Results

Of the 358 patients, 34 had diverticulosis (9.49%). The mean age was 67 years (extremes: 45 and 85 years) and the male to female ratio was 1:1. The colonoscopic examinations were indicated chiefly by rectal bleeding, constipation and abdominal pain. Most of the diverticula were on the left colon (76.47%). Diffuse colonic diverticulosis was present in 13 patients (38.23%). Associated lesions were found in 9 cases (26.47%).

Conclusion

Colonic diverticulosis has an endoscopical prevalence of 9.49% in the hospital Aristide-Le-Dantec in Dakar. It affects elderly subjects without distinction of sex and it is often revealed by rectal bleeding, constipation and abdominal pain. Localisation on the left colon is predominant.     

Plasma calprotectin is superior to serum calprotectin as a biomarker of intestinal inflammation in ulcerative Colitis

Abstract

Background and aims: Despite promising results, only a few studies have been published on serum calprotectin as a biomarker in IBD. Recently, plasma measurements of calprotectin have been shown to be more reliable than serum measurements. In this study, we aim to assess plasma and serum calprotectin measurements as biomarkers of disease activity in paediatric and adult ulcerative colitis.

Methods: Paediatric (5–18?years) and adult (>18?years) patients scheduled for colonoscopy due to suspected or confirmed ulcerative colitis were included prospectively. Stool and blood samples were collected at time of colonoscopy and patient symptom scores were recorded. At colonoscopy the Ulcerative Colitis Endoscopic Index of Severity was recorded. Histology was graded according to the Geboes score.

Results: 84 patients where included; 30 paediatric and 54 adult patients. Plasma calprotectin had a stronger correlation to all outcome variables than serum calprotectin. Plasma calprotectin correlated positively to disease extent (Rho?=?0.53, p?<?.0001), symptoms scores (Rho?=?0.54, p?=?.002, only in the paediatric cohort), endoscopic scores (Rho?=?0.39, p?=?.0003), histological scores (Rho 0.28, p?=?.01) and, when using endoscopic assessment of severity as reference, could discriminate active disease from patients in remission (p?=?.03).

Conclusions: While more studies are needed to assess if plasma calprotectin can discriminate healthy individuals from ulcerative colitis, this study indicates that plasma calprotectin can be used as a biomarker of disease activity, especially in cases where faecal calprotectin measurements are cumbersome either due to patient compliance or logistical requirements.     

Do Technetium-99m Hexamethylpropylene Amine Oxime-Labeled Leukocytes Truly Reflect the Mucosal Inflammation in Patients with Ulcerative Colitis?

Twenty-five patients with ulcerative colitis and nine controls with macroscopically non-inflamed colon were investigated with technetium-99m hexamethylpropylene amine oxime-labeled leukocyte scintigraphy and colonoscopy with biopsies. The interval between leukocyte scintigraphy and colonoscopy was 14 days in all patients with ulcerative colitis and 30 days in eight of nine controls. Scintigrams were obtained at approximately 45 min and 4 h after injection of labeled leukocytes. One nuclear physician, one internist, and one pathologist graded blindly and independently of each other the degree of active inflammation in seven different colonic segments for each patient, using 4-grade scales for scans and macroscopically and histologically viewed inflammation, respectively. A positive correlation between endoscopic and histologic grading of all colonic segments and scan gradings for all subjects and for ulcerative colitis patients separately was found (all, p < 0.001). By means of kappa statistics, the inter-observer agreement between scintigraphic grading at 45 min and endoscopy was, for all subjects, 0.32 (95% confidence interval (CI), 0.20–0.44; p < 0.001) and, for patients with ulcerative colitis, 0.19 (CI, 0.07–0.31; p < 0.001). When 17 patients who had complete colonoscopies were divided into those with total, extensive, or distal colitis, leukocyte scintigraphy underestimated the extension of active inflammation. A simple scintigraphic scoring system reflects the colonic inflammation viewed endo-scopically and histologically in patients with ulcerative colitis but underestimates the presence of active inflammation in individual colonic segments.     

PRELIMINARY STUDY ON BACTERIAL INFLUENCE IN ISCHEMIC COLITIS

Background: It is necessary to exclude infectious colitis by fecal culture for diagnosis of ischemic colitis. But even if pathogenic bacteria are excluded, it is expected that the population of normal bacterial flora of the lesion is probably changing. We have performed bacterial culture using colonoscopic sampling in order to detect more important bacteria, when we diagnose ischemic colitis on colonoscopy. Methods: The subject group comprised 81 patients diagnosed with ischemic colitis between January 1998 and July 2004. During initial colonoscopy, we sprayed 20 mL saline on the most severe site of the inflammatory lesion and collected the fluid by suction for culture (colonoscopic spraying wash culture). When only one species of bacteria was isolated, we registered the bacteria as the predominant organism. When two or more species of bacteria were isolated, we registered the bacteria that were isolated most superior in number. Results: Escherichia coli (48 patients), Klebsiella (22 patients), Enterococcus (22 patients), Enterobacter (12 patients) and others were registered. Generally, younger patients (under 50 years) had prominently E. coli, and elderly patients (above 70 years) had Klebsiella. Patients with baseline disease such as hypertension, diabetes mellitus, and hyperlipidemia generally had Enterococcus. Patients without baseline disease generally had E. coli. Sex and the length of period after onset were not significantly different. Colonoscopic features of the cases isolated only one species of bacteria by colonoscopic spraying wash culture that were different to each other. Conclusion: It is expected that age and baseline diseases contribute to the onset of ischemic colitis and to the disruption of normal flora. Meanwhile, it is supposed that the disruption of normal flora is related to the induction of various configurations of ischemic colitis.