Biliary Tract Carcinoma Associated with Ulcerative Colitis

This paper reports 15 well-documented cases in which a biliarytract tumour has developed in a patient with ulcerative colitis.Most patients had both a long history of colitis and total involvementof the colon. Seven of the patients were managed medically for the colitisand in eight total proctocolectomy was carried out. In the lattergroup, the tumour was diagnosed at intervals varying from threeto 13 years after surgery. The primary tumour was in the gall bladder in one patient, intrahepaticin site in one case and arose from the extrahepatic bile ductsin 13 patients. It is suggested that these tumours are approximately 10 timesmore frequent in patients with ulcerative colitis than in thegeneral population.     

晚发溃疡性结肠炎的临床特征分析

[目的]探讨发病晚于50岁的溃疡性结肠炎患者的临床特征.[方法]回顾性分析160例溃疡性结肠炎患者的临床资料.[结果]晚发溃疡性结肠炎组患者出现粘液血便、弥漫分布病变表现明显少于早发组,且差异有显著性（P〈0.05）,晚发组肠外症状表现明显轻于早发组,且无并发症发生.[结论]晚发溃疡性结肠炎与早发溃疡性结肠炎二者疾病行为相近,但晚发组患者疾病活动程度相对较轻.     

Inflammatory bowel disease

This review summarizes important publications that have appeared during the last year dealing with imaging techniques and endoscopy, as well as the management of low-grade dysplasia and stenosis in inflammatory bowel disease. Magnetic resonance enteroclysis and capsule endoscopy are currently emerging as new imaging techniques for the small bowel in Crohn's disease. While magnetic resonance enteroclysis is, at least in Europe, increasingly being used as a reference method, the value of capsule endoscopy for the management of inflammatory bowel disease is still being evaluated. Chromoendoscopy is being studied in patients with long-lasting ulcerative colitis and may be a promising and sensitive technique for the diagnosis of dysplasia. However, there are conflicting data regarding the appropriate management when low-grade dysplasia is diagnosed in patients with ulcerative colitis. Endoscopic dilation can often be successfully carried out in cases of intestinal stenosis. The results of long-term follow-up studies indicate that several dilation procedures are often necessary and that a relatively high percentage of patients still have to undergo surgery.     

Transrectal ultrasound in the diagnosis and management of inflammatory bowel disease

BACKGROUND AND STUDY AIMS: To aim of the present study was to determine the value of transrectal ultrasonography (TRUS) in the assessment of disease activity in ulcerative colitis patients, and in differentiating between mucosal inflammation and transmural inflammation. PATIENTS AND METHODS: TRUS examinations were used to study 30 control individuals and 76 patients with inflammatory bowel disease, including 50 cases of ulcerative colitis and 26 of Crohn's disease. A rigid linear endorectal probe was used to examine the rectal wall. RESULTS: In the 30 control individuals, the rectal wall showed five layers, with a mean total diameter of 2.6 mm. There were significant differences between patients with quiescent ulcerative colitis, active ulcerative colitis, and control individuals with regard to the total rectal wall thickness (P<0.001), submucosal thickness (P<0.001) and mucosal thickness (P<0.001). Using cut-off values, differentiation between active ulcerative colitis and remission ulcerative colitis was found to be 100% specific and 73 % sensitive for submucosal thicknesses. TRUS revealed a 100% specificity in differentiating between remission ulcerative colitis and control cases based on the total rectal wall thickness, submucosal, and mucosal thicknesses. In the differential diagnosis of active and remission ulcerative colitis, an increase in submucosal wall thickness and the existence of arterial and venous capillary flow in the submucosa were found to be specific and more sensitive than the other parameters. TRUS examination revealed transmural inflammation in 21 of the 26 Crohn's disease patients, and mucosal inflammation in all 50 of the ulcerative colitis patients. CONCLUSION: TRUS is a reliable and easy method of assessing ulcerative colitis activity and differentiating between rectal diseases.     

检测核周型抗中性粒细胞胞浆抗体在溃疡性结肠炎中的意义

【摘要】目的探讨核周型抗中性粒细胞胞浆抗体（peri—nuclearanti—neutrophilcytoplasmicantibodies，pANCA）在溃疡性结肠炎中的临床意义。方法选择溃疡性结肠炎患者60例为研究对象，以正常健康人60例为对照，采用间接免疫荧光法检测pANCA，比较二者差异，并分析与临床病理因素的关系。结果溃疡性结肠炎患者pANCA阳性率68．3％，正常健康人1．7％，差异有统计学意义（P〈0．01）。pANCA对溃疡性结肠炎的诊断特异性92．7％，灵敏度65．9％。溃疡性结肠炎患者pANCA阳性率与性别、年龄和病变部位差异无统计学意义，与病程、病情严重程度差异有统计学意义（P〈0．05），病程越短、病情越严重，pANCA阳性率越高。结论pANCA诊断溃疡性结肠炎具有特异性强、灵敏度高优点，病程越短、病情越严重，pANCA阳性率越高。     

Inflammatory bowel disease. Part II: Clinical and therapeutic aspects

Once regarded as medical curiosities, ulcerative colitis and Crohn's disease have achieved a remarkable change in status recently and today are among the more compelling of all human illnesses. The cause(s) of inflammatory bowel disease (IBD) are not known. Genetic, environmental, microbial, and immunologic factors are involved, but the precise mechanisms are obscure. The incidence of ulcerative colitis is relatively stable, while Crohn's disease continues to increase in frequency. In 10% to 15% of patients, it is hard to differentiate between ulcerative colitis and Crohn's colitis, however, problems with diagnosis usually resolve with time and repeated examinations. In part I of his two-part monograph on IBD, Dr. Kirsner addressed the nature and pathogenesis of the disease. Increased study of ulcerative colitis and Crohn's disease in recent years has generated new knowledge regarding their etiology. Part I focused on microbial, immunologic, and genetic mechanisms of, and the inflammatory process involved in the disease. In this part, Dr. Kirsner deals with the clinical features, course, and management of IBD, based on the author's 55 years of experience with these problems and supplemented by critical examination of the recent (1988-1990) literature. Particular attention is directed to the symptoms and physical findings of ulcerative colitis and Crohn's disease. The laboratory, radiologic, endoscopic, and pathologic features, and the many systemic complications. IBDs are mimicked by several enterocolonic infections and other conditions making differential diagnosis necessary. Inflammatory bowel disease in children and the elderly conforms to conventional clinical patterns modified by the health circumstances of the respective age groups. Because the cause of IBD has not been established, current medical therapy is facilitative and supportive rather than curative. The principles of medical treatment are approximately the same for ulcerative colitis and Crohn's disease. Treatment emphasizes a program rather than a drug and also considers the individuality of the therapeutic response. A clearer understanding of dietary and nutritional needs, including hyperalimentation and electrolyte and fluid balance, aids treatment. Antidiarrheal and antispasmodal preparation and sedatives are prescribed for symptom relief. The bowel inflammation is controlled with sulfasalazine or the newer 5-amino-salicylic acid (5-ASA) compounds, antibacterial drugs for complications of Crohn's disease and IBD, adrenocortical steroids, and the immunosuppressive compounds 6-mercaptopurine (6MP), azathioprine, and cyclosporine, as determined in each patient. The surgical procedures available for treatment of ulcerative colitis include total proctocolectomy and ileostomy or ileoanal anastomosis.(ABSTRACT TRUNCATED AT 400 WORDS)     

Evolution of the concept of proctosigmoiditis: clinical observation

Proctosigmoiditis, or distal colon ulcerative colitis, has been recognized as a clinical entity for over 50 years and considerable information has emerged from the study of the clinical course of patients with distal colon ulcerative colitis who are followed for a period of years. For most patients the condition is benign, although periods of exacerbation can occur between remissions, characterized by rectal bleeding. However, extension of the disease, development of cancer, and the requirement of surgery are all relatively unusual. It has recently been recognized that there are many other causes of proctitis than the idiopathic form, and this has raised important questions in differential diagnosis, particularly in the proctitis occurring in homosexual males. Proctitis, proctosigmoiditis, and distal colon ulceratice colitis and not Crohn's disease; conversely perianal fistulae and abscesses are rare in distal colon ulcerative colitis. Treatment with various forms of topical agents has often been satisfactory.     

Further Experience of Hyposplenism in Inflammatory Bowel Disease

We have reported previously the association between hyposplenismand inflammatory bowel disease. Our study has now been extendedto a total of 65 patients with ulcerative colitis and 42 wIthCrohn's disease so that the incidence of hyposplenism couldbe more accurately determined. Hyposplenism rarely complicateddistal ulcerative colitis, but was found in 15 of 37 patientswith total colonic disease. Hyposplenism occurred in 11 outof 31 patients with Crohn's disease of the colon, but in noneof 11 indIviduals with isolated ileal disease. In order to determinewhether hyposplenism has any prognostic implications, the peri-operativecourse of 12 hyposplenic individuals who underwent colectomywas compared with that of 12 controls who required surgery andwho had normal splenic function. Four of the hyposplenic subjectsbecame severely shocked after operation and developed disseminatedintravascular coagulation. In contrast, the post-operative coursein the control patients was uneventful.     

CT小肠造影影像对结肠型克罗恩病与溃疡性结肠炎的诊断价值

目的  探究CT小肠造影（CTE）对结肠型克罗恩病与溃疡性结肠炎的诊断及鉴别诊断价值。方法  选取蚌埠医学院第一附属医院和南京中医药大学附属江苏省中医院于2019年1月~2022年1月收治的结肠型克罗恩病患者36例和溃疡性结肠炎患者36例行CTE检查,分别观察两组影像特征,结合实验室指标、临床表现对克罗恩病和溃疡性结肠炎患者进行回顾性分析。结果  36例克罗恩病患者中,CTE影像示肠壁不均匀增厚21例、肠道狭窄22例、瘘管形成7例及累及升结肠21例,均高于溃疡性结肠炎患者,差异有统计学意义（P < 0.05）;36例溃疡性结肠炎患者,粘液便18例及血便22例高于克罗恩病患者（P < 0.05）,溃疡性结肠炎患者平均发病年龄较结肠型克罗恩病患者平均发病年龄大（P < 0.05）。克罗恩病患者与溃疡性结肠炎患者的C反应蛋白及红细胞沉降率含量均值分别为28.17 mg/L vs 17.67 mg/L、32.25 mm/h vs 22.95 mm/h;C反应蛋白及红细胞沉降率含量的平均值对克罗恩病与溃疡性结肠炎的鉴别无统计学意义（P > 0.05）。结论  通过CTE影像特征更直观地对结肠型克罗恩病与溃疡性结肠炎进行鉴别,结合临床、内镜表现及病理诊断,为治疗方案设计提供更可靠的依据。     

Inflammatory bowel disease. Part I: Nature and pathogenesis

Once regarded as medical curiosities, ulcerative colitis and Crohn's disease have achieved a remarkable change in status recently and today are among the more compelling of all human illnesses. The cause(s) of inflammatory bowel disease (IBD) are not known. Genetic, environmental, microbial, and immunologic factors are involved, but the precise mechanisms are obscure. The incidence of ulcerative colitis is relatively stable, while Crohn's disease continues to increase in frequency. In 10% to 15% of patients, it is hard to differentiate between ulcerative colitis and Crohn's colitis; however, problems with diagnosis usually resolve with time and repeated examinations. In part I of his two-part monograph on IBD, Dr. Kirsner addresses the nature and pathogenesis of the disease. Increased study of ulcerative colitis and Crohn's disease in recent years has generated new knowledge regarding their etiology. Part I focuses on microbial, immunologic, and genetic mechanisms and the inflammatory processes involved in the disease. In part II, which will be presented in next month's issue of Disease-a-Month, Dr. Kirsner deals with the clinical features, course, and management of IBD, based on the author's 55 years of experience with these problems and supplemented by critical examination of the recent (1988-1990) literature. Particular attention is directed to the symptoms and physical findings of ulcerative colitis and Crohn's disease, the laboratory, radiologic, endoscopic, and pathologic features, and the many systemic complications. The IBDs are mimicked by several enterocolonic infections and other conditions, making differential diagnosis necessary. Inflammatory bowel disease in children and the elderly conforms to conventional clinical patterns modified by the health circumstances of the respective age groups. Because the cause of IBD has not been established, current medical therapy is facilitative and supportive rather than curative. The principles of medical treatment are approximately the same for ulcerative colitis and Crohn's disease. Treatment emphasizes a program rather than a drug and also considers the individuality of the therapeutic response. A clearer understanding of dietary and nutritional needs, including hyperalimentation and electrolyte and fluid balance, aids treatment. Antidiarrheal and antispasmodic preparations and sedatives are prescribed for symptom relief. The bowel inflammation is controlled with sulfasalazine or the newer 5-amino salicylic acid (5-ASA) compounds, antibacterial drugs for complications of Crohn's disease and IBD, adrenocortical steroids, and the immunosuppressive compounds 6-mercaptopurine (6-MP), azathioprine, and cyclosporine, as determined in each patient. The surgical procedures available for treatment of ulcerative colitis include total proctocolectomy and ileostomy or ileoanal anastomosis.(ABSTRACT TRUNCATED AT 400 WORDS)     

复方黄柏液保留灌肠治疗溃疡性结肠炎的疗效

目的探讨复方黄柏液保留灌肠治疗溃疡性结肠炎的临床疗效。方法将202例溃疡性结肠炎患者按随机数字表法分为2组:治疗组和对照组,每组101例。2组患者均采用柳氮磺吡啶片1.0 g口服,4次.d-1。在此基础上,治疗组加用复方黄柏液100 mL保留灌肠,对照组采用生理盐水100 mL保留灌肠。观察2组患者临床疗效及不良反应的情况。结果治疗组总有效率为83.17%,明显高于对照组的61.39%(P<0.05),治疗组出现恶性呕吐6例,对照组出现恶性呕吐7例,无其他不良反应。随访1年,治疗组、对照组复发率分别为17.65%、22.78%。结论复方黄柏液保留灌肠治疗溃疡性结肠炎有良好的疗效,不良反应少。     

溃疡性结肠炎的中西医结合治疗与护理

目的探讨中西医结合疗法对湿热型溃疡性结肠炎的治疗和护理效果。方法应用中西医结合治疗与护理的方法治疗32例湿热型溃疡性结肠炎,并观察其疗效。结果 31例好转,1例未愈,总有效率为96.9%。结论中西医结合疗法与护理对溃疡性结肠炎的治疗有明显效果,值得推广。     

Chromium 51-ethylenediaminetetraacetate test: a useful test in the assessment of inflammatory bowel disease

We evaluated the usefulness of urinary excretion values in assessing mucosal damage in inflammatory bowel disease after administration of chromium 51-labeled EDTA either orally or rectally. In the oral study, 19 controls, 18 patients with Crohn's disease, and 13 patients with ulcerative colitis were given 100 microCi 51Cr-EDTA by mouth. The amount of 51Cr-EDTA in a 24-hour urine collection was expressed as a percentage of the ingested dose. The patients with Crohn's disease of the small bowel excreted 6.3% +/- 4.3%, which was significantly (P less than 0.001) higher than the percentage in patients with ulcerative colitis (1.7% +/- 1.1%) and controls (1.4% +/- 0.6%). In the enema study, 19 patients with ulcerative colitis, two with Crohn's disease, two with radiation colitis, and four controls (spastic colitis, lactose intolerance) were given 100 microCi 51Cr-EDTA by retention enema. The patients with active colonic inflammation excreted 8.4% +/- 3.9% of the dose given by enema, which was significantly (P less than 0.01) higher than in other controls (1.9% +/- 0.91%) or patients with inactive colitis (2.2% +/- 1.9%). The 51Cr-EDTA excretion test is a safe, inexpensive test useful in evaluating patients with inflammatory bowel disease. It can be given orally to screen patients with abdominal complaints who are suspected of having Crohn's disease involving the small intestine, and when given by enema it provides additional objective assessment of idiopathic ulcerative colitis or proctitis.     

Clinical features, morbidity and mortality of Scottish children with inflammatory bowel disease

From the Scottish Hospitals in-patients statistics for the years 1968-1983 all children and teenagers (a total of 1257) admitted to a National Health Service hospital with Crohn's disease or ulcerative colitis were identified. Case records of samples of patients with onset of symptoms at or before age 16 years were examined to establish the features, morbidity and mortality of unselected cohorts of young patients with inflammatory bowel disease. Median delay in diagnosis was less than six months. Anatomical distribution for Crohn's disease was similar to that in adults (small bowel 30 per cent; large bowel 28 per cent; small and large bowel 38 per cent) and almost half the patients with ulcerative colitis had extensive colitis. The morbidity was substantial in both. In-patient days for Crohn's disease ranged from seven to 322, median 64 days and for ulcerative colitis one to 275, median 30 days. At diagnosis, 11 of 40 young children with Crohn's disease but none of 14 with ulcerative colitis, were below the third centile for height. Despite treatment with corticosteroids 72 per cent of patients with Crohn's disease and 30 per cent of patients with ulcerative colitis required surgical treatment. Seventeen per cent have a permanent stoma. There were only six deaths, all before 1978.     

Epidemiological survey of coeliac disease and inflammatory bowel disease in first-degree relatives of coeliac patients

One hundred and sixty-two of 182 patients with coeliac disease provided satisfactory details of family size and the prevalence of coeliac disease and inflammatory bowel disease among their first-degree relatives. Patients ranged in age from 11 months to 79 years with a mean age of 41 (+/- 23) years. Twenty patients had at least one first-degree relative with coeliac disease: a total of 25 of 861 relatives were affected (prevalence = 2904/100,000) compared with an expected 0.9 cases (prevalence = 100/100,000; p less than 0.001). Six relatives had inflammatory bowel disease (prevalence = 697/100,000) compared with an expected 1.3 cases (prevalence = 150/100,000; p less than 0.001). Five of these had ulcerative colitis, and one had Crohn's disease. The relative risk of ulcerative colitis is, therefore, five times greater for first-degree relatives of people with coeliac disease than for the general population (95 per cent confidence interval, 4.7-7.2). There is a clear association between coeliac disease and ulcerative colitis, which may point to factors involved in the aetiology of colitis.     

Manipulation of cytokines in the management of patients with inflammatory bowel disease

In recent years, new concepts have been formulated for the therapeutic management of the intractable forms of Crohn's disease and ulcerative colitis, the two major forms of inflammatory bowel disease. These advances are based largely on new insights into the immune-inflammatory events occurring in the gut of these patients. Analysis of the types of immune response ongoing in the inflamed intestine has revealed that in Crohn's disease there is predominantly a T-helper cell type 1 response, with exaggerated production of interleukin (IL)-12 and interferon (IFN)-gamma, whereas in ulcerative colitis the lesion seems more of an antibody-mediated hypersensitivity reaction. Despite these differences, downstream inflammatory events are the same in both conditions. In both Crohn's disease and ulcerative colitis mucosa, IL-1gamma, IL-6, IL-8 and tumour necrosis factor (TNF)-alpha are produced in excess, and the production of free radicals accompanying the influx of nonspecific inflammatory cells into the mucosa is above the normal range. Strategies aimed at inhibiting T-cell responses are therefore more relevant in Crohn's disease, whereas, in theory at least, inhibition of downstream inflammatory processes should be therapeutic in both Crohn's disease and ulcerative colitis. This review seeks to summarize studies in which anticytokine antibodies, cytokines or cytokine-modifying agents have been used in the treatment of either Crohn's disease or ulcerative colitis.     

Ultrasound findings in Crohn's disease and ulcerative colitis: a prospective study

In a prospective study, 118 patients with Crohn's disease, 51 patients with ulcerative colitis, and 72 patients with no disease of the intestine proximal to the rectum were evaluated by ultrasound. In Crohn's disease, thickening of the bowel wall and inflammatory masses were detected in 72.0% of the patients. With a transducer having optimal imaging properties in the near range, these findings were detected in 87.2% of a group of 47 patients. In ulcerative colitis, bowel wall thickening was detected in 52.9% of all patients. Thickening of the bowel wall was more marked in Crohn's disease than in ulcerative colitis. Most pathologic findings in Crohn's disease were located in the right lower abdomen, whereas those in ulcerative colitis were in the left abdomen, in particular in the lower quadrant. The frequency of wall thickening was correlated to the activity of the disease in ulcerative colitis but not in Crohn's disease. Considerably increased wall thickness, when localized in the right lower quadrant and found in combination with inflammatory masses or an abscess, suggests Crohn's disease.     

Autoimmunity, inflammatory bowel disease and hyposplenism.

The presence or absence of nine autoantibodies were assessed in 44 patients with ulcerative colitis (17 with hyposplenism) and 22 patients with Crohn's disease (eight with hyposplenism). The purpose of the study was to determine whether hyposplenism in inflammatory bowel disease is associated with an increased tendency to autoimmunity, or whether autoimmunity is linked not to hyposplenism itself but to the underlying bowel disease. The results strongly suggest that the latter hypothesis is correct. There was a much higher frequency of autoantibodies in patients with ulcerative colitis than in those with Crohn's disease (P < or = 0.01), suggesting that autoimmune factors are more important in the pathogenesis of ulcerative colitis than in Crohn's disease.     

Zinc status in inflammatory bowel disease

1. The zinc contents of plasma, erythrocytes, polymorphonuclear leucocytes and mononuclear leucocytes from 18 normal control subjects, 31 patients with Crohn's disease and 15 patients with ulcerative colitis were measured. 2. Plasma zinc levels were low in Crohn's disease, particularly in malnourished patients, and related to plasma albumin concentrations, but were normal in ulcerative colitis. 3. Erythrocyte zinc levels were normal in both Crohn's disease and ulcerative colitis. 4. Mean polymorphonuclear leucocyte zinc levels were normal in Crohn's disease and ulcerative colitis. Ten per cent of Crohn's disease patients had subnormal levels, which were associated with inactive disease, while 10% had elevated levels, which were associated with active disease. Seven per cent of ulcerative colitis patients had subnormal levels. Mononuclear leucocyte zinc levels were normal in Crohn's disease and in ulcerative colitis. 5. Tissue zinc depletion occurs in only a few patients with Crohn's disease and ulcerative colitis.     

Surgical treatment of ulcerative colitis

Known indications in the surgical treatment of ulcerative colitis are acute severe attacks, intractability, and cancer prophylaxis. This study was performed to determine the optimum timing of operation in ulcerative colitis. Of 59 patients with intractability, 9(15%) had severe attacks and 6(10%) developed colorectal cancer. The mean duration of disease was 3.6 yr for 14 with severe attacks alone, 6 yr for 44 with intractability alone, 8.6 yr for 9 with both, and 16.5 yr for 16 with cancer prophylaxis. In this series, the operations for intractable disease were more likely to be delayed, and the longer these were delayed, the higher the rate was of pre- and postoperative complications.