Reevaluation of Clinical Features of Ischemic Colitis Analysis of 68 Consecutive Cases Diagnosed by Early Colonoscopy

Background: Ischemic colitis (IC) is generally considered a disease of elderly patients who have associated diseases. The aim of the present study was to reevaluate the clinical features of IC. Methods: We retrospectively analyzed the clinical characteristics, background, and endoscopic and histologic changes in 68 consecutive patients (16 men and 52 women) with this disease diagnosed by early colonoscopy. Results: The patients' age ranged from 22 to 98 years (mean, 55 years). Twenty-three patients (34%, including 19 women) were less than 50 years of age. The classical predisposing factors were not discernible in patients younger than 50. Chronic constipation and prior history of abdominal surgery were common in both young and old patients. Early colonoscopy (especially by the 3rd day from onset) showed endoscopic and histologic findings consistent with the characteristics of IC. Conclusions: IC is not limited only to the elderly, and it should be considered in the differential diagnosis of colitis with melena in younger patients, especially females, who do not have any predisposing factors. Chronic constipation and prior history of abdominal surgery were commonly associated in both young and old patients. Early colonoscopy, especially by the 3rd day from the clinical onset, is essential for the accurate diagnosis of IC.     

Age-related clinical features in ischemic colitis

Ischemic colitis has been considered to have relatively high prevalence in the elderly population with underlying vascular disorder such as hypertension. However, this disease has been recently reported increased in the young population so that it is not necessarily limited to the aged. The aim of the present study was to elucidate the characteristics of age-related clinical features in ischemic colitis. The subjects consisted of 30 patients with ischemic colitis admitted to our hospital during the last 5 years. They were divided into the aged group more than 65 years old and the young group aged 65 or less. As a result, there were no significant differences in symptoms, resulted serological examination, endoscopic findings, and treatment period. Lesion sites were more extended in the aged group. Concerning underlying disease and etiologic factors, the vascular factor was important in the aged group, while the peristaltic factor, especially constipation was important in the young group. Ten of the 30 patients had habitual constipation, and the aged group had a high percentage of paralytic constipation, while the young group had a high rate of spastic constipation. Many patients with paralytic constipation had a history of underlying diseases and laparotomy, while the patients with spastic constipation did not have such a history. Therefore, it is presumed that the spastic type of constipation is an etiologic factor in ischemic colitis.     

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。     

59例缺血性结肠炎临床研究

目的　了解缺血性肠炎的临床表现、内镜特点及其发病机理。方法　所有病例均于症状出现后１ ～１４ 天内行全结肠内镜检查,并于首次检查后两周至四个月内复查肠镜,部分病例取病变粘膜活检,观察其临床特征及内镜下表现特点。结果　经大肠镜检查确诊的５９ 例缺血性结肠炎、不包括两周内曾服用过抗生素者,男２０ 例,女３９ 例,年龄２５～８１ 岁,平均年龄５３－８６ 岁,其中１１ 例为４０ 岁以下的年青人,高峰年龄为６１ ～７０ 岁组,３６ 例患有动脉硬化相关性疾病,１１ 例无可以证明的基础病变,但其中的８ 例有便秘史,３ 例有下腹部手术史,２ 例发生于乙状结肠癌。大部分为一过性炎症型者。临床表现主要为腹痛、血便及腹泻,少数患者有呕吐或恶心：内镜下表现多样化,病变粘膜与正常粘膜界限清楚,多数病变位于左半结肠,无直肠病变者。病理表现无特异性。结论　缺血性结肠炎可以发生于各个年龄组,但以中年以上发病率为高,发病部位多位于血流相对不足的左半结肠,并易发生纤维狭窄。血管因素与肠管因素为致病的重要原因     

620例结肠黑变病临床资料分析

目的探讨分析结肠黑变病(MC)的临床特征、内镜表现及与结直肠癌、结直肠息肉等相关肠道疾病的关系。 方法收集2012年10月至2018年12月经宁夏回族自治区人民医院内镜中心行结肠镜检查后诊断的620例MC患者的临床资料、内镜表现及病理诊断结果进行回顾性分析。 结果共纳入620例MC患者,其检出人数呈逐年升高趋势,主要以便秘、腹痛为临床表现,主要好发于女性,以>60岁的患者多见,镜下分度以轻度为主,好发于升结肠-直肠,主要合并结直肠息肉、结直肠癌、炎症性肠病、痔疮等,其中合并的结直肠息肉患者中病理结果以腺瘤性息肉多见。 结论MC的检出人数呈逐年增长趋势,女性、>60岁的患者多见,主要临床表现为便秘、腹痛,好发升结肠-直肠,以轻度为主,可合并结直肠息肉、结直肠癌、炎症性肠病、痔疮等,可为临床医师提供临床诊断思路。     

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.     

缺血性结肠炎的内镜及临床特点

目的 总结缺血性结肠炎的内镜及临床特点。探讨其早期诊断方法。方法 收集分析1975年6月至2000年12月经结肠镜发现，病理确诊的36例缺血性结肠炎的相关资料。所有病例均在腹痛等症状出现后5d内行全结肠内镜及病理检查，并于首次检测后2周至2个月内复查大肠镜，部分病例取病变黏膜活检，观察其内镜下表现及临床病理特点。结果 经结肠镜检查确诊的36例缺血性结肠炎患者，男12例，女24例，年龄为35-84岁，平均年龄为60.5岁，其中50岁以上31例，临床主要表现为腹痛，血便及腹泻等，病变多数位于左半结肠。一过性炎症型者30例，狭窄型5例，仅有1例坏疽型，病理学表现无特异性，结论 早期行结肠镜检查是诊断缺血性结肠炎的主要方法。     

Endoscopic Findings and Clinicopathologic Characteristics of Ischemic Colitis: A Report of 85 Cases

Ischemic colitis is the most common type of intestinal ischemia and has a clinical spectrum of injury that ranges from mild and transient ischemia to acute fulminant colitis. The aim of this study was to explore endoscopic findings and clinicopathologic characteristics of ischemic colitis and be accurate enough to avoid missed diagnosis or misdiagnosis. A retrospective analysis was undertaken of endoscopy findings and clinicopathologic characteristics of 85 cases of ischemic colitis from March 2005 to April 2008 in the endoscopy center of our hospital. All cases underwent colonoscopy with biopsy within 2 weeks of the onset of symptoms, and all specimens with forceps were stained with hematoxylin–eosin and observed under light microscopy. Of the 85 cases of ischemic colitis (24 men and 61 women, average age 61.36 ± 14.49 years old, range 29–84), 71 were over 50 years of age. These cases were associated with the basal diseases such as hypertension, cardiovascular disorders, diabetes, and hematological diseases as well as a history of abdominal operation. The clinical features usually presented with sudden onset of abdominal pain, diarrhea, and hematochezia. Ischemic lesions were located mainly in the left colon with segmental form (only descending colon affected 16%, only splenic flexure 14%, and only sigmoid colon 23%). The 85 patients consisted of the non-gangrenous type (82), which were composed of reversible IC (76) and chronic IC (6), and the gangrenous type (3). Endoscopic appearance of the transient ischemic colitis consisted of petechial hemorrhages, edematous and fragile mucosa, segmental erythema, scattered erosion, longitudinal ulcerations, and sharply defined segment of involvement. Ischemic colitis of stricture was characterized by full-thickness mucosa, lumens stricture, and diseased haustrations. The mucosa of gangrenous colitis with cyanotic and pseudopolyps was endoscopically observed as well. Clinicopathologic characteristics showed mucosal inflammation accompanied by erosion, granulation tissue hyperplasia and gland atrophy, lamina propria hemorrhage, and macrophages with hemosiderin pigmentation in submucosa in particular. Although endoscopy findings and clinicopathologic characteristics of ischemic colitis are nonspecific, colonoscopy with biopsy plays a vital role in the early diagnosis of ischemic colitis.     

溃疡性结肠炎住院患者525例临床特征分析

目的 探讨近16年解放军总医院溃疡性结肠炎(UC)的临床特征的变化特点.方法 总结分析解放军总医院1994至2009年期间确诊并住院治疗的UC患者的临床资料.结果 自1994-2009年共有525例患者诊断为UC,中位发病年龄42岁.在发病部位中,12.4%(65/525)为直肠,25.7%(135/525)为直乙状结...     

Change of clinical characteristics of ulcerative colitis in Japan: analysis of 844 hospital-based patients from 1981 to 2000

BACKGROUND: Although the number of ulcerative colitis patients has increased rapidly in Japan, few reports have been published regarding their clinical aspects. We investigated the clinical characteristics and chronological change of ulcerative colitis in Japanese patients. METHODS: Patients diagnosed with ulcerative colitis during the period from 1981 to 2000 were registered and their clinical profiles were analyzed. The chronological changes in clinical aspects, such as onset age, sex distribution, severity, extent of disease, clinical course, and corticosteroid use, were also determined. RESULTS: A total of 844 patients were registered, composed of 431 men and 413 women, with a median onset age of 34 years. The proportion of mild colitis and proctitis was significantly larger in patients with an onset at over 60 years of age, relative to those with an onset at less than 30 years (P<0.016). The proportion of ulcerative colitis patients with old age onset (P=0.09), male sex (P<0.01), mild colitis (P<0.01), proctitis (P<0.01), one-attack-only type (P<0.01), and not-treated-with-corticosteroid (P<0.01) demonstrated a chronological increase from 1981 to 2000. CONCLUSIONS: The distinctive clinical features and chronological change were seen in Japanese ulcerative colitis patients in recent years. Our data can help understand clinical aspects of ulcerative colitis patients in Asia, where the incidence of ulcerative colitis is still increasing.     

Epidemiologic and clinical features of invasive amebiasis in Bangladesh: a case-control comparison with other diarrheal diseases and postmortem findings

To describe the epidemiologic and clinical features associated with invasive amebiasis in Bangladesh, 85 hospitalized diarrheal patients with hematophagous trophozoites of Entamoeba histolytica in their stools were compared to a control group of 84 hospitalized diarrheal patients without amebiasis. Postmortem examinations were carried out in 22 deaths due to amebiasis. For the patients with amebiasis, there was a bimodal age distribution with peaks at 2-3 years and greater than 40 years, whereas the control patients had a unimodal distribution with the peak at 0-1 year. The sex distribution was equal in childhood but young adults were predominantly female and older adults predominantly male. The clinical features significantly associated with amebiasis were prolonged dysentery, prior measles rash, malnutrition, hyponatremia, hypokalemia, and hypoproteinemia (all P less than 0.05). The case fatality rate in amebiasis was 29%, which was significantly higher than 11% for the controls (P less than 0.05). Postmortem findings included extensive colitis with deep ulcers and complications, including colonic perforation in 2 cases, peritonitis in 4 cases, pneumonia in 9 cases, and septicemia in 5 cases. These results indicate that invasive amebiasis in this population differs from other diarrheal diseases, affecting mainly children greater than 2 years and adults and causing severe and fatal illness characterized by extensive colitis with diverse systemic consequences.     

Clinical and radiographic features of spondylitic hip disease.

The clinical and radiographic features of hip disease in 76 patients with definite ankylosing spondylitis have been studied. Symptomatic hip involvement occurred late in the course of the disease, with a mean delay after the onset of 12 years in males and 7 years in females. Patients with disease onset before the age of 20 developed hip symptoms at an earlier stage. Associated diseases included uveitis (13%), colitis (4%). Bilateral concentric loss of hip joint space with a relatively undeformed femoral head was the commonest radiological change (61%). Localised loss of joint space at the upper pole (16%) was associated with femoral head destruction and a greater degree of osteophytosis, suggesting coincidental or secondary osteoarthrosis. Bony ankylosis of the hips (10%) was present only in women, and the absence of osteophytes, cysts, and bone lesions of the iliac crests and ischial rami suggests that it is a distinct radiographic manifestation of female ankylosing spondylitis.     

Gastric adenocarcinoma in young adults: A comparative study with elderly patients

"Background: Gastric adenocarcinoma (GA) has been considered a disease of elderly age and has been rarely reported in patients younger than 35 years of age. The aim of this demographic, clinicopathological and prognosis of gastric cancer in young patients and to compare their features with the behavior in elder adults. Methods: Between 1993 and 2008, 1536 patients with GA were enrolled in a retrospective database. Clinical and pathologic features of thirty patients aged 35 years or less (young group) were compared with those of 458 aged 75 years or more (elder group). Results: Mean patient age was 31 and 80-years old in the young and elder groups, respectively, with a predominance of females in the last group (61%). Lauren diffuse type carcinoma was more frequent in people younger than 35 years (70%) than in older patients (17.4%). Main symptoms were dyspepsia (40%) and hemorrhage (20%). The most common T stage in young and elder patients was T3 (52.9% and 56.7% respectively). Surgical resection was performed in 68% of cases and the rest received only systemic chemotherapy. Conclusion: Gastric adenocarcinoma is rare in young patients and most cases presented at advanced clinical stage similar to elderly patients, so the prognosis in both age groups is poor. For this reason is important to be aware of alarm symptoms and risk factors in order to perform an early endoscopic diagnosis and a treatment with curative intent."     

Drug-Responsive Chronic Segmental Colitis Associated with Diverticula: A Clinical Syndrome in the Elderly

This report reviews the clinical presentation, endoscopic, radiologic, and pathologic features, and response to therapy in eight patients more than 60 yr old who presented with segmental chronic active colitis associated with sigmoid diverticula. The finding of colitis limited to the sigmoid colon in an area of multiple diverticula with no associated features of Crohn's disease, the age at onset, the response to therapy, and the benign course all suggest a distinctive form of inflammatory bowel disease in these patients.     

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.     

The spectrum of ischaemic colitis.

OBJECTIVE: Ischaemic colitis is generally considered a disease of the elderly with considerable cardiovascular morbidity. We aimed to determine the effect of age, co-morbidity and clinical presentation on type, severity and anatomy of involvement of ischaemic colitis. Thrombophilic tendencies have been poorly studied and coagulation status was performed in available patients. DESIGN: Retrospective case identification with prospective follow-up. SETTING: University teaching hospital. PARTICIPANTS: Twenty-four patients (16 female, mean age 64 years) with ischaemic colitis. INTERVENTIONS: Blood analysis for clotting tendencies. MAIN OUTCOME MEASURES: Operation rates, death rates and frequency of clotting abnormalities. RESULTS: Five patients (21%) were below the age of 45, and seven of the 24 had died by the time of follow-up. Four had died of ischaemic colitis during the acute episode. The four patients that died of ischaemic colitis had a more extensive and more severe type of disease and presented with worse clinical features. The main predisposing factors were ischaemic heart disease in 12 (50%) and malignancy in five (21%). Six of the 24 cases (25%) had right-sided lesions and this conferred a good prognosis. Shock, peritonism, extensive disease and uncontrolled atrial fibrillation were all poor prognostic factors. Clotting factor abnormalities could be detected in three of nine patients despite a time lapse between assay and episode of ischaemic colitis. CONCLUSIONS: Ischaemic colitis appears to have two patterns of severity. Anatomical distribution is more variable than a developmental explanation of the vascular supply. Clotting abnormalities may be detected in a minority even on retrospective testing.     

Epidemiology of inflammatory bowel diseases in the elderly in the province of Liège

OBJECTIVE: Inflammatory bowel diseases (IBD) are heterogeneous diseases which affect preferentially young adults. The late onset could represent a particular form of expression of these diseases. The aim of our prospective study was to describe the incidence of IBD in patients older than 60 years as well as their clinical pattern in comparison with a population younger than 60.METHODS: A standardized questionnaire for each new case diagnosed in the province of Liège between 01/06/1993 and 31/05/1996 was completed.RESULTS: During the three years, 270 patients were enrolled. In group IBD > 60 years old, there were 60 new cases, including 23 cases with Crohn's disease (CD) (38%), 30 with ulcerative colitis (UC) (50%), and 7 with undetermined colitis (IC) (12%). The proportion of CD was significantly lower in the group IBD > 60 years old than in the group<60 (114 CD (54%), 81 UC (39%) and 15 IC (7%); P=0.04).The annual incidence tended to be higher for UC than for CD in group IBD > 60 (4.5 and 3.5 per 100,000, respectively) while it was the contrary in younger patients (3.4 and 4.8 per 100,000, respectively). There was no striking difference in the clinical features for both diseases in the two groups, except more frequent diarrhea, weight loss and extraintestinal symptoms in CD patients<60 years old.CONCLUSIONS: In the province of Liège, the incidence of IBD in people older than 60 years is high. IBD in the elderly is characterized by a lower proportion of CD than in the younger population. Clinical features tend to be the same whatever the age at diagnosis for each disease.     

慢性假性肠梗阻的临床特征和诊断

目的 分析慢性假性肠梗阻（CIP）的临床特征和诊断方法。方法 对北京协和医院1978年11月至2000年12月诊断的23例CIP的临床资料进行了分析,并结合文献,总结CIP的临床特征和诊断方法。结果 23例CIP患者中男性9例,女性14例,年龄4-75岁（中位数50岁）。主要症状有腹胀（87%）、腹痛（57%）、腹泻（65%）、便秘（48%）、呕吐（39%）和体重下降（83%）。CIP患者腹胀突出而腹痛相对较轻,伴有腹泻、体重明显下降和消化道其他部位动力的异常;很少出现机械性肠梗阻的体征;腹部平片除存在液气平面（17/20,85%）外,可见肠管普遍扩张的结肠积气（13/20,65%）;消化道钡造影显示肠管明显扩张（19/23,83%）,肠蠕动减慢和消失（17/23,74%）;有关检查或（和）手术探查均未发现机械性肠梗阻的证据。病变主要累及小肠（83%）和结肠（39%）。18例为慢性特发性假性肠梗阻,其中1例为家庭性内脏肌病,5例继发于结缔组织病。结论 CIP的临床表现具有一定的特征性,凭借腹部平片的特点,有针对性地选择消化道钡剂造影,结合胃肠道动力检查的异常发现可对CIP做出正确诊断。     

Segmental colitis associated with diverticula: a prospective study. Gruppo di Studio per le Malattie Infiammatorie Intestinali (GSMII)

OBJECTIVE: Little is known about the clinical features and natural history of segmental colitis associated with diverticula. Our aim was to evaluate the incidence of segmental colitis associated with diverticula in patients undergoing colonoscopy, its clinical picture, and its outcome. METHODS: This was a multicenter, prospective study. Patients with inflammatory bowel disease (IBD)-like lesions limited to colonic segments with diverticula were enrolled. Patients were treated with oral and topical 5-aminosalicylic (5-ASA) until remission was achieved; clinical and endoscopic follow-up was planned at 6 wk and 12 months. RESULTS: A total of 5457 consecutive colonoscopies were recorded at five participating institutions; 20 patients (0.36%) met the endoscopic criteria for segmental colitis associated with diverticula. All had lesions in the left colon, and one also had lesions in the right colon. In six cases, a specific diagnosis was made thereafter. The remaining 14 patients (0.25% of colonoscopies; eight men; age range, 49-80 yr) were in clinical and endoscopic remission at the first follow-up visit. At onset, 13/14 had hematochezia, seven had diarrhea, and five had abdominal pain; only one had weight loss. No subject had fever. In all but one case, blood chemistries were normal. Five patients had had similar symptoms previously. Thirteen of 14 patients were in clinical and endoscopic remission at 12 months. CONCLUSIONS: This endoscopic picture is not an exceptional finding. Hematochezia was the main clinical feature, and no relation with gender, age, or smoking habit was found. Blood chemistries were generally normal and the rectum was spared. The histological features were not diagnostic and most patients did not complain of any abdominal symptoms 12 months after enrollment.     

缺血性结肠炎与溃疡性结肠炎临床表现及内镜特点的对比分析

目的 比较缺血性结肠炎(IC)与溃疡性结肠炎(UC)临床及内镜表现的差异,研究对两者的鉴别以利对其的诊断和治疗.方法 回顾分析2007年1月～2010年8月诊断为IC 30例和UC 40例患者的资料,重点分析两者在年龄分布、性别构成、病程、基础疾患、临床和内镜表现及病理诊断的异同点.结果 IC组和UC组在年龄分布、病...