乳糖酶缺乏与乳糖不耐受症状的临床特点分析

目的 探讨乳糖酶缺乏及乳糖不耐受症状的临床特点.方法 回顾性分析了84例于广东省人民医院门诊就诊的以腹痛、腹泻、腹胀、肠鸣为主要症状的患者,并接受胃肠镜、腹部CT、抽血及氢呼气试验等检查评估,根据患者的主要诊断,氢呼气试验结果及乳糖不耐受症状进行分组,比较各组的临床指标,包括年龄、性别、体质量指数、血常规、过敏原检测、...     

Ileitis in Ulcerative Colitis: Is It a Backwash?

PURPOSE This study aims to determine the incidence, demography, pathologic nature, and clinical significance of ileitis in ulcerative colitis patients who underwent restorative proctocolectomy. METHODS A prospectively collected pouch database and the case notes of 100 consecutive patients who underwent restorative proctocolectomy for ulcerative colitis, under the care of a single surgeon, between 1988 and 2003 were reviewed. The original proctocolectomy specimens and pouch biopsies were reexamined and regraded blind, using the current diagnostic criteria. Patients were divided into two groups, those who had ileitis and those who had not. The demographic, clinical, and pathologic characteristics and the incidence of pouchitis of both groups were compared. RESULTS Twenty-two patients had ileitis (22 percent). Compared with those with noninflamed ileum, patients with ileitis had a significantly shorter disease duration (P < 0.005), many of them presented or progressed to a fulminant state requiring acute surgical intervention (P < 0.01), had strong association with pancolitis and primary sclerosing cholangitis (P < 0.001), and had a higher incidence of subsequent development of pouchitis (P < 0.001). There was no correlation between the presence of ileitis and colitis severity. CONCLUSIONS Ileitis in ulcerative colitis is not rare and does influence the prognosis, and the term “backwash” is a misnomer. Ulcerative colitis with ileitis represents a distinct disease-specific subset of patients. Its true incidence and clinical significance can be determined only if detailed microscopic characterization of the terminal ileum is performed routinely in every patient with ulcerative colitis and the clinical outcome of these patients is audited prospectively. Presented in part at the meetings of the British Society of Academic and Research Surgery (SARS), Newcastle, United Kingdom, January 12 to 14, 2005, the American Gastroenterological Association (DDW), New Orleans, Louisiana, May 15 to 20, 2004, and the Association of Surgeons of Great Britain and Ireland, Harrogate, United Kingdom, April 28 to 30, 2004. Reprints are not available.     

Incidence and clinical significance of lactose malabsorption in ulcerative colitis and Crohn's disease

The incidence of lactose malabsorption was investigated in 85 patients with ulcerative colitis and 71 patients with Crohn's disease by means of lactose tolerance tests and disaccharidase determinations in small intestinal mucosa. Eight patients with ulcerative colitis (9%) and four with Crohn's disease (6%) had lactose malabsorption. A control group displayed a similar incidence. It is concluded that lactose malabsorption is not particularly common in ulcerative colitis and Crohn's disease. If it is present, its aetiology seems to be unrelated to the intestinal disease.Transitional lactose malabsorption was detected in two cases during a relapse of ulcerative colitis.Institution of a lactose-free (or lactose-poor) diet was an important supporting measure in seven patients who were unaware of their milk intolerance, in particular in two with ileostomy. Therefore, it is recommended that a lactose tolerance test should always be performed in patients with ulcerative colitis or Crohn's disease.Twenty-one patients with ulcerative colitis and nine with Crohn's disease, none of whom had lactose malabsorption, were placed on milk-free diets. A beneficial effect was noticed in five of the patients with ulcerative colitis, and in three of those with Crohn's disease. The mechanism is unknown.Evidence is presented that milk allergy is not responsible for the beneficial effect of a lactosefree diet in patients with associated lactose malabsorption.     

Familial empirical risks for inflammatory bowel disease: differences between Jews and non-Jews.

The Jewish population has an increased frequency of inflammatory bowel disease compared with their non-Jewish neighbours. Genetic factors have been implicated in the aetiology of this disorder and may contribute to ethnic differences. This study determined the familial empirical risks for inflammatory bowel disease in the first degree relatives of inflammatory bowel disease probands (for both Jews and non-Jews) for the purpose of accurate genetic counselling and genetic analysis. A total of 527 inflammatory bowel disease patients from Southern California (291 Jews and 236 non-Jews) were questioned about inflammatory bowel disease in their first degree relatives (a total of 2493 individuals). Since inflammatory bowel disease has a variable and late age of onset, age specific incidence data were used to estimate the life time risks and to make valid comparisons between the different groups. In the first degree relatives of non-Jewish probands, the life time risks for inflammatory bowel disease were 5.2% and 1.6% when probands had Crohn's disease and ulcerative colitis respectively. These values were consistently lower than the corresponding risks for relatives of Jewish patients -7.8% and 4.5% for Crohn's disease and ulcerative colitis probands respectively (p value for comparison between Jews and non-Jews: 0.028; between ulcerative colitis and Crohn's disease: 0.005). These data provide the requisite basis for genetic counselling for these disorders in the white American population. In addition, these different empirical risks for relatives of Jewish and non-Jewish probands allow rejection of single Mendelian gene models for inflammatory bowel disease, but are consistent with several alternative genetic models.     

Antineutrophil cytoplasmic antibodies in inflammatory bowel disease

PURPOSE: Perinuclear antineutrophil cytoplasmic antibodies have been found consistently in patients with ulcerative colitis; however, their pathogenetic and clinical role is still uncertain. In this study we tested the prevalence of perinuclear antineutrophil cytoplasmic antibodies in a large population of patients with ulcerative colitis and Crohn's disease, with particular attention to the possible correlation with clinical features. METHODS: Perinuclear antineutrophil cytoplasmic antibody reactivity was investigated with indirect immunofluorescence in 279 patients with ulcerative colitis, 110 patients with Crohn's disease, and 252 unrelated healthy subjects. RESULTS: Perinuclear antineutrophil cytoplasmic antibodies were found in 84 of 279 patients with ulcerative colitis (30 percent), 10 of 110 patients with Crohn's disease (9 percent), and 2 of 252 healthy subjects (<1 percent;P<0.001), respectively. Perinuclear antineutrophil cytoplasmic antibodies were significantly more frequent in patients with ulcerative colitis with higher relapse rate (43vs. 27 percent;P<0.002), and patients with Crohn's disease with colitis (27vs. 2.5 percent;P<0.0003). Perinuclear antineutrophil cytoplasmic antibodies were also significantly less frequent in patients with ulcerative colitis in remission (18vs. 34 percent;P<0.0025). CONCLUSIONS: In this study we confirm the relative specific of perinuclear antineutrophil cytoplasmic antibodies, either for ulcerative colitis or for Crohn's disease involving the colon. Perinuclear antineutrophil cytoplasmic antibodies were more frequently found in patients with ulcerative colitis with a more aggressive clinical behavior; however, their presence had a limited value in identifying homogeneous subgroups of patients in our population.Presented in part at the Digestive Disease Week Meeting, San Francisco, California, May 19 to 22, 1996.     

Genetic polymorphism of methylenetetrahydrofolate reductase G1793A,hyperhomocysteinemia, and folate deficiency correlate with ulcerative colitis in central China

Background and Aims: Methylenetetrahydrofolate reductase (MTHFR) encoding genes were associated with ulcerative colitis in Chinese in our previous study. We further studied association of a new polymorphism of MTHFR G1793A with ulcerative colitis and assessed relationship of this polymorphism with hyperhomocysteinemia (HHcy, ≥ 15 mmol/L) and deficiency of folate (≤ 7 nmol/L) and vitamin B₁₂ (≤ 150 pmol/L) in a cohort of patients with ulcerative colitis in central China. Methods: A total of 252 patients and 654 healthy controls were recruited. Polymorphism of MTHFR G1793A was examined using a polymerase chain reaction‐restriction fragment length polymorphism method. Plasma levels of homocysteine (Hcy), folate and vitamin B₁₂ were determined by enzymatic cycling assay and corpuscle immune chemiluminescence assay, respectively. Results: Frequencies of alleles and genotypes in MTHFR G1793A gene differed significantly between ulcerative colitis patients and the healthy controls (20.83% vs 10.47%, 95% confidence interval [CI]: 1.703–2.972, P = 0.0006; 40.48% vs 19.88%, 95% CI: 1.997–3.761, P = 0.0002, respectively). Plasma Hcy levels were higher and folate and vitamin B₁₂ concentrations were lower in the patients than in the healthy controls (21.72 ± 6.59 vs 12.47 ± 5.02, 95% CI: ?10.93–?7.58, P < 0.0001; 11.25 ± 6.19 vs 15.28 ± 7.72, 95% CI: 2.03–6.04; P < 0.001; 322.81 ± 128.47 vs 442.59 ± 129.36, 95% CI: 62.61–136.95, P < 0.0001, respectively). HHcy and folate deficiency were more prevalent in patients with ulcerative colitis (45.32% vs 26.17%, 95% CI: 1.285–4.378, P = 0.005; 30.68% vs 13.0%, 95% CI: 1.416–6.197, P = 0.003, respectively). Conclusions: MTHFR G1793A gene polymorphism, HHcy, folate deficiency and low vitamin B₁₂ concentration were associated with ulcerative colitis in central China. Our findings demonstrate that the Hcy‐related gene and metabolites are involved in pathogenesis of ulcerative colitis.     

A Comparison of Adverse Events and Functional Outcomes After Restorative Proctocolectomy for Familial Adenomatous Polyposis and Ulcerative Colitis

Purpose Restorative proctocolectomy is the procedure of choice for patients undergoing proctocolectomy for familial adenomatous polyposis or ulcerative colitis. This meta-analysis was designed to identify differences in adverse events and functional outcomes between these two groups. Methods Studies published between 1986 and 2003 that compared outcomes between patients with familial adenomatous polyposis and ulcerative colitis were included. Meta-analytical techniques using random effect models were used to compare short-term and long-term adverse events as well as functional outcomes between the groups. Results Nineteen studies comprising 5,199 patients (familial adenomatous polyposis, 782; ulcerative colitis, 4,417) were analyzed. There were no significant differences in immediate postoperative adverse events between the two groups. Pouch-related fistulation was significantly increased in the ulcerative colitis group (10.5 percent vs. familial adenomatous polyposis 4.8 percent; odds ratio 2.31; P < 0.001). There was no significant difference in pouch failure between the two groups (ulcerative colitis 5.8 percent vs. familial adenomatous polyposis 4.5 percent; odds ratio 1.22; P = 0.43). The incidence of pouchitis was significantly greater in the ulcerative colitis group (30.1 vs. 5.5 percent; odds ratio 6.44; P < 0.001). Patients with familial adenomatous polyposis had a significant advantage in stool frequency with one less motion per 24 hours (95 percent confidence interval, 0.21–1.76; P = 0.01). Conclusions In contrast to studies reporting similar outcomes for patients undergoing restorative proctocolectomy for familial adenomatous polyposis or ulcerative colitis, the present meta-analysis suggested that patients with ulcerative colitis are at greater risk of pouch-related fistulation and pouchitis. Although there was an increase in the 24-hour stool frequency in the ulcerative colitis group, this may be accounted for by the younger age at surgery in the familial adenomatous polyposis group. Henry S. Tilney is sponsored by a research grant from The Royal College of Surgeons of England. Read at the meeting of the Association of Surgeons of Great Britain and Ireland, Edinburgh, Scotland, May 3 to 5, 2006.     

Deficiency of Invariant NK T Cells in Crohn's Disease and Ulcerative Colitis

The aim of this study was to investigate whether immunoregulatory invariant NK T cells are deficient in Crohn's disease or ulcerative colitis. Blood was collected for flow cytometry from 106 Crohn's disease, 91 ulcerative colitis, and 155 control subjects. Invariant NK T cells were assessed by Vα24 and (α-galactosylceramide/CD1d tetramer markers. Intracellular cytokine was measured after in vitro anti-CD3 antibody stimulation. Vα24+ T cells were quantified in ileocolonic biopsies as mRNA by real-time PCR and by immunofluorescence. Circulating invariant NK T cells were 5.3% of the control levels in Crohn's (P < 0.001) and 7.9% of the control levels in ulcerative colitis (P < 0.001). Interleukin-4 production was impaired in Crohn's disease and ulcerative colitis. Intestinal Vα24 mRNA expression was 7% in Crohn's disease (P < 0.05) and 9% in ulcerative colitis (P < 0.05). Intestinal Vα24+ T cells were 23% in Crohn's disease but not reduced in ulcerative colitis. We conclude that invariant NK T cells are deficient in Crohn's disease and in ulcerative colitis.     

Differential diagnosis of dysplasia-associated lesion or mass and coincidental adenoma in ulcerative colitis

PURPOSE: This study was undertaken to investigate factors that influenced differential diagnosis of dysplasia-associated lesion or mass and coincidental adenoma in patients with ulcerative colitis. METHODS: Among 346 patients with ulcerative colitis who underwent colonoscopy between 1979 and 1995, 27 patients had macroscopic neoplastic lesions and were divided into two groups: those with dysplasia-associated lesion or mass (16 patients) and those with adenoma (11 patients), each being categorized by the presence and absence of dysplasia in the flat mucosa adjacent to the elevated lesions, respectively. RESULTS: Thirteen of 27 patients had dysplasia-associated lesion or mass detected by colonoscopic biopsy; 10 of these patients underwent colectomy, and all had dysplasia-associated lesion or mass in the colectomy specimens. Two patients whose biopsy findings were adenoma had an unsuspected dysplasia-associated lesion or mass in the operative specimens. In the remaining 12 patients, the macroscopic lesions were excised during colonoscopy because of clinical and colonoscopic evidence of adenoma. One of them was proved to have dysplasia-associated lesion or mass, and the other 11 were confirmed as having adenoma in the polypectomy specimens. Patients with dysplasia-associated lesion or mass were significantly younger (P<0.05), had longer duration of ulcerative colitis (P<0.01), and had more extensive disease (P<0.005) than those with adenoma. The colonoscopic appearance was plaque-like in 13, sessile in 13, and pedunculated in 2 of the 28 lesions with dysplasia-associated lesion or mass, whereas it was plaque-like in only 1 and sessile or pedunculated in 15 of the 16 lesions with adenoma (P<0.001). The mean size of the lesions that were considered to be dysplasia-associated lesions or mass and adenoma was 1.8 and 0.5 cm, respectively (P<0.0001). CONCLUSIONS: Colonoscopic biopsy for detection of dysplasia in the flat mucosa adjacent to macroscopic neoplastic lesions is an appropriate preoperative approach to distinguish dysplasia-associated lesions or mass from adenomas in patients with ulcerative colitis. The statistically significant variables that influenced the differential diagnosis were age, duration of disease, extent, tumor size, and tumor colonoscopic appearance.Read in part at the meeting of The Japan Society of Coloproctology, Tokyo, Japan, October 20 to 21, 1995.     

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.     

Deficient lactose digestion and intolerance in a group of patients with chronic nonspecific ulcerative colitis: a controlled, double-blind, cross-over clinical trial

Introduction: Despite the fact that the frequency of hypolactasia and lactose intolerance is similar in both chronic idiopathic ulcerative colitis patients and the general population, the elimination of dairy products from the patient's diet is a habitual recommendation. Hypolactasia is common in Mexico, but its relation to chronic idiopathic ulcerative colitis has not been established. Aims: To evaluate lactose digestion and lactose intolerance in persons with chronic idiopathic ulcerative colitis. Material and methods: Thirty-nine patients with confirmed chronic idiopathic ulcerative colitis diagnosis were included in the study (mean: 31 years, range: 15 to 38). Twenty-two patients presented with rectosigmoid involvement and the remaining patients with pancolitis. No patient showed inflammatory activity according to the Truelove-Witts criteria and all consumed dairy products before diagnosis. A prospective, controlled, double-blind, cross-over study was designed. Patients randomly received 12.5 g of lactose or maltose in 250 cc water- each test 72 hours apart - and ydrogen was measured in exhaled air before disaccharide ingestion and then every 30 minutes for 3 hours. Digestion was considered deficient when there was an increase in hydrogen of at least 20 ppm. Symptom intensities were evaluated by Visual Analog Scales before, during, and after the hydrogen test. Differences between the groups were contrasted with the Mann-Whitney U and the Wilcoxon tests. Results: Eighteen patients (46%) presented with deficient lactose digestion. No significant differences were found in the symptoms, extension, or progression of chronic idiopathic ulcerative colitis between patients that could digest and those that could not digest lactose. No patient had symptom exacerbation with the disaccharides used. Conclusions: Lactose digestion deficiency frequency is similar in subjects with chronic idiopathic ulcerative colitis and in healthy individuals in Mexico. We do not know whether higher doses could have some effect, but symptoms in patients with inactive chronic idiopathic ulcerative colitis were not modified using 12.5 g of lactose/day.     

Ileal pouch-anal anastomosis in patients with indeterminate colitis

PURPOSE: Patients with chronic ulcerative colitis who undergo proctocolectomy and are found intraoperatively to harbor histologic signs suggesting Crohn's disease have indeterminate colitis; nonetheless, ileal pouch-anal anastomosis is usually performed. The aim of this study was to determine the long-term outcome of ileal pouch-anal anastomosis in patients with indeterminate colitis compared with a cohort of patients with chronic ulcerative colitis. METHOD: Review of an ileal pouch-anal anastomosis registry identified 1,437 patients with chronic ulcerative colitis and 82 patients with indeterminate colitis who underwent an ileal pouch-anal anastomosis between 1981 and 1995. The median follow-up was 83 (range, 1–192) months. Demographic data and functional outcomes were compared by chi-squared and Wilcoxon's rank-sum tests. Probabilities of complications and pouch failure were analyzed using Kaplan-Meier and log-rank techniques. Finally, Bonferroni adjustments were used for multiple comparisons. RESULTS: Patients with indeterminate colitis and chronic ulcerative colitis were comparable in terms of gender and length of follow-up. The mean age of the chronic ulcerative colitis group was higher (34vs. 31; P<0.01). At ten years patients with indeterminate colitis had significantly more episodes of pelvic sepsis (17 percent indeterminate colitisvs. 7 percent chronic ulcerative colitis; P<0.001), pouch fistula (31vs. 9 percent; P<0.001), and pouch failure (27vs. 11 percent; P<0.001). Importantly, during follow-up fully 15 percent of patients with indeterminate colitis, but only 2 percent of patients with chronic ulcerative colitis, had their original diagnosis changed to Crohn's disease (P<0.001). When the outcomes of these patients newly diagnosed with Crohn's disease were considered separately, the rate of complications for the remaining patients with indeterminate colitis was identical to that of patients with chronic ulcerative colitis. Functional outcomes were comparable among all three groups. CONCLUSION: After ileal pouch-anal anastomosis patients with indeterminate colitis who did not develop Crohn's disease subsequently experienced long-term outcomes nearly identical to patients with chronic ulcerative colitis. Crohn's disease, whether it develops after surgery for chronic ulcerative colitis or indeterminate colitis, is associated with poor long-term outcomes.Presented at the meeting of the American College of Surgeons, San Francisco, California, October 10 to 15, 1999.     

Ulcerative colitis in the Jewish population of southern Israel 1961-1985: epidemiological and clinical study.

The incidence of ulcerative colitis in the Jewish population of Southern Israel has increased in the period 1961-85 and is presently 5.8/10(5)/year. The mean annual incidence was significantly higher in European and American born (10.8/10(5)/year) than in Asian and African or Israeli born Jews. The disease was significantly more prevalent in women, who developed the illness at a younger age and had a milder course. The age adjusted prevalence rate in each population group was greater than the rates detected by earlier studies in other areas of the country (p less than 0.05). The prevalence rate in the total population now approximates the moderate to high prevalence rates of ulcerative colitis found in many other localities. The particularly high rates of ulcerative colitis in the European and American born population in Israel, in Jews residing in Western countries, and in certain non-Jewish populations in Great Britain and Northern Europe may imply the presence of a common aetiological mechanism.     

Intolerance to milk in ulcerative colitis

Summary Fifty-nine per cent of a series of patients with ulcerative colitis were found to have lactose intolerance by a lactose-tolerance test. It appears likely that the inflamed, irritated bowel of patients with ulcerative colitis cannot handle the osmotic-acid load and that lactose intolerance imposes an extra burden upon the inflamed bowel. Therefore, a lactose-free diet is advisable in patients with ulcerative colitis who also have lactose intolerance.Supported in part by Grants AM-04759 and AM-08870 from the U. S. Public Health Service.The lactose-free diet used for the patients reported was prepared by Doris Johnson, Ph.D., Director of Dietetics, Yale-New Haven Hospital.     

High prevalence of celiac disease in patients with lactose intolerance

BACKGROUND/AIMS: Acquired lactase deficiency is a common cause of gastrointestinal symptoms but its etiology remains unclear. Celiac disease could lead to lactase deficiency and is much more common than previously suspected. Several studies have highlighted the prevalence of lactose intolerance in celiac disease, but studies assessing the prevalence of celiac disease in lactose intolerance are lacking. We evaluated the prevalence of celiac disease in patients with a positive H2-lactose breath test compared to a control group. METHODS: This retrospective study included 54 patients (15 males/39 females; mean age 37.8 +/- 7 years) from southern Italy, referred to the Gastroenterology Unit for bloating and diarrhea after the introduction of milk or dietary lactose. They had a positive H2-lactose breath test and a negative H2-glucose breath test. 50 blood donors were drawn from a similar population, matched for sex and age, and enrolled as a control group. All patients were screened for possible celiac disease by measuring the serum level of IgA antibodies to endomysium, anti-transglutaminase and total IgA. Patients positive for at least one of these markers were submitted to upper gastrointestinal endoscopy. RESULTS: None of the patients had a IgA deficiency. 24% of the patients showed positivity of celiac disease antibodies compared to 2% in the control group (p < 0.001). Histologic samples of these patients showed villous atrophy (53.8% Marsh type IIIa, 38.4% Marsh IIIb, and 7.6% with Marsh type IIIc) confirming the celiac disease, while in the control subjects duodenal biopsies were normal. CONCLUSIONS: A high prevalence of celiac disease was observed in patients with a positive H2-lactose breath test compared to healthy controls. In these subjects lactase deficiency seems to be the only manifestation of celiac disease. We suggest serologic screening for celiac disease in all patients with a positive H2-lactose breath test before beginning a milk-exclusion diet.     

Lower Prevalence of Diverticulosis in Patients with Ulcerative Colitis

Purpose Colonic diverticulosis is characterized by abnormal thickening of the bowel wall, associated with luminal overpressure and increase of sigmoid contractility. However, patients with ulcerative colitis show chronic inflammatory alterations determining a reduction of both bowel wall muscle tone and contractility. Thus, we could presume ulcerative colitis and colonic diverticulosis as two pathophysiologically and mutually excluding diseases. This study was designed to evaluate the prevalence of colonic diverticulosis in patients with ulcerative colitis compared with a control endoscopic population. Methods We prospectively analyzed the prevalence of colonic diverticulosis in 85 patients, older than aged 45 years, with known ulcerative colitis compared with that in 85 age/gender-matched patients without colitis. All patients underwent pancolonoscopy with ulcerative colitis and colonic diverticulosis diagnosis made by endoscopy and histopathology. The patients with ulcerative colitis also were divided in three subgroups according to the age at diagnosis (<30 years, 30–45 years, >45 years) and extension of disease (sigmoiditis, left colitis, extensive colitis). Results Colonic diverticulosis was present in 7 of 85 patients with and in 24 patients without ulcerative colitis (8.2 vs. 28.2 percent; P < 0.001; relative risk, 3.4; 95 percent confidence interval, 1.56–7.52). All seven patients with both diseases were diagnosed with ulcerative colitis when older than age 45 years. No differences were found between the two groups in terms of extension of diverticula. Conclusions Patients with ulcerative colitis show a significantly lower prevalence of colonic diverticulosis, with this finding probably reflecting the motor alterations caused by chronic bowel wall inflammation. In the patients affected by ulcerative colitis with late onset of the disease, the reduced prevalence of colonic diverticulosis is not evident.     

Protective effect of appendectomy on the development of ulcerative colitis

PURPOSE: Appendectomy and cigarette smoking have been suggested to reduce the chance of developing ulcerative colitis. A case-control study was undertaken to determine the relative incidence of appendectomy in patients with ulcerative colitis. METHODS: This case-control study examined the incidence of appendectomy in patients with ulcerative colitis and patients attending an orthopedic outpatient clinic. RESULTS: Of 100 patients with ulcerative colitis, 75 pairs were matched for age, gender, and cigarette smoking. The ulcerative colitis group had an appendectomy rate of 8 percent (6/75), compared with 21 percent in the control group (P=0.018). The odds ratio was 3.5 (95 percent confidence interval, 1.15–10.6). CONCLUSIONS: No previous study has examined the effect of appendectomy, controlling for cigarette smoking. This study confirms that appendectomy protects against or reduces the chance of development of ulcerative colitis. A possible immunological explanation for this effect is advanced.     

Clinical characteristics and long‐term prognosis of elderly onset ulcerative colitis

Background and Aim

The aim of this study was to investigate the clinical characteristics and prognosis of patients with elderly onset ulcerative colitis (EOUC), a new growing subgroup of UC.

Methods

This study retrospectively analyzed 3060 South Korean UC patients diagnosed between 1977 and 2014. The clinical characteristics and prognosis of EOUC, defined as UC in those aged ≥ 60 years at diagnosis, were compared with those of non‐EOUC (NEOUC).

Results

Among the 3060 patients, 226 were diagnosed with EOUC (7.4%, median age at diagnosis 65.9 years [interquartile range, 62.9–68.7 years], 58.4% male). The frequency of EOUC increased from 3.9% in the interval 1977–1999 to 9.7% in the interval 2008–2014 (P < 0.001). There were more ex‐smokers in the EOUC than in the NEOUC group (44.2% vs 19.9%, P < 0.001). In the EOUC group, extensive colitis at diagnosis, and the maximum extent thereof, was less than in the NEOUC group (13.7% vs 22.6%, P = 0.002, and 34.5% vs 42.5%, P = 0.011, respectively). The 10‐year cumulative colectomy rate was significantly higher in the EOUC than in the NEOUC group (12.6% vs 7.7%, P = 0.015). UC‐related and all‐cause mortality were higher in the EOUC than in the NEOUC group (3.5% vs 0.6%, P < 0.001, and 12.4% vs 1.8%, P < 0.001, respectively).

Conclusion

Elderly onset ulcerative colitis patients are likely to exhibit distinct features both at diagnosis and during follow‐up. It is necessary to pay more attention to, and to conduct further studies on, this particular group of patients.     

Expression of p53, VEGF, Microvessel Density, and Cyclin-D1 in Noncancerous Tissue of Inflammatory Bowel Disease

We aimed to evaluate the carcinogenesis risk in inflammatory bowel disease via p53 mutation and its relation with hyperproliferation (cyclin-D1) and angiogenesis (with vascular endothelial growth factor [VEGF] and microvessel density) and whether these events play important roles in pathogenesis of inflammatory bowel disease. Colonic tissue samples of 26 ulcerative colitis, 6 Crohn’s disease, and 8 amoebic colitis patients as well as samples of 10 healthy controls were stained with p53, cyclin-D1, CD34, and VEGF monoclonal antibodies by immunohistochemistry and evaluated semiquantitatively. Expression of p53 was higher in ulcerative colitis than in the healthy control and amoebic colitis groups (4.15 ± 2.07, 1.4 ± 1.5, 1.3 ± 1.5; P < 0.001). The Crohn’s disease group had the highest p53 expression (4.6 ± 1.6). The Crohn’s disease, ulcerative colitis, and amoebic colitis groups all had higher VEGF expression than did the healthy controls (respectively, 4.3 ± 1.2, 2.92 ± 2.0, 2.3 ± 1.5, 0.6 ± 0.97; P < 0.001). Also, microvessel density was statistically higher in all three colitis groups than in healthy controls. Cyclin-D1 expression in all four groups was similar. The study showed that p53 mutation was present in nonneoplastic mucosa of inflammatory bowel disease patients. Detecting strong p53 overexpression with VEGF overexpression may help in differentiating inflammatory bowel disease from other colitis.