Maintenance of remission in ulcerative colitis with sulphasalazine or a high-fibre diet: a clinical trial

Twenty patients with ulcerative colitis in remission were asked to eat a high-fibre diet including 25 g bran daily and, if possible, to discontinue maintenance therapy with sulphasalazine. Only five patients (25 per cent) were able to do this and remained in remission for six months. In contrast,of 15 patients asked to continue susphasalazine and their normal diet 12 (80 per cent) remained in remission. A high-fibre diet is unable to replace sulphasalazine as maintenance treatment of ulcerative colitis in remission.     

Predictive factors of failure of intravenous corticosteroid treatment in acute severe colitis of Crohn's disease and ulcerative colitis

We conducted a retrospective study on 78 cases of acute severe colitis (Crohn's disease in 51 cases, ulcerative colitis in 27 cases). Diagnosis of acute severe colitis was based on presence of Truelove's criteria and/or endoscopical gravity lesions. Failure of corticoid treatment was observed in 35 patients (45%). In overall patients, predictive factors of failure of intravenous corticoid treatment in univariate analysis are diagnosis of ulcerative colitis, number of bloody stool higher than 6/day. level of C-reactive protein lower than 25 mg/l. visibility of muscular mucosa at colonoscopy, absence of decrease in erythrocyte-sedimentation rate for more than 50% of initial value at day 3 of treatment, absence of decrease in C-reactive protein for more than 50% of initial value at day 3 of treatment, and a lower duration of corticoid treatment. In multivariate analysis, independent predictive factors of failure of corticoid treatment are a number of bloody stool higher than 6/day (p=0.01 adjusted OR [CI95%]: 10.2 [1.15 - 72.06]) and a value of initial C-reactive protein lower than 25 mg/l (p < 0.0001 adjusted OR [CI95%] : 3.25 [2.95 - 4.31]). In Crohn's disease, the only independent predictive factor of failure of corticoid treatment is an absence of decrease of C-reactive protein level for more than 50% of initial value at day 3 of treatment (p = 0.001 adjusted OR [CI95%] : 0.79 [0.45-0.95]). Existence of these predictive factors allows the early identification of patients who would be suitable for second-line therapy.     

Mesalazine and sulphasalazine for Crohn's disease: few indications, severe adverse reactions

We report 3 cases of the occurrence of adverse events in patients with Crohn's disease who were given aminosalicylic acids. The first case involved a 43-year-old woman who developed interstitial pneumonitis requiring intubation after switching from mesalazine to sulphasalazine. Thereafter, mesalazine was used without complications. When sulphasalazine was reintroduced, the symptoms recurred. A second patient was a 56-year-old man who experienced worsening of abdominal symptoms after commencing mesalazine for an exacerbation of Crohn's disease; these symptoms improved following discontinuation of mesalazine. A third patient, a 23-year-old woman, had been treated with mesalazine for Crohn's disease for 6 months when budesonide was added because of insufficient response. After 3 weeks she was hospitalized for acute pancreatitis, which resolved after both medications were discontinued. Pancreatitis due to budesonide has not been previously described, but mesalazine is known to cause pancreatitis even after uncomplicated long-term use. Although effective in ulcerative colitis, aminosalicylic acid is not an effective treatment for Crohn's disease in general. Although adverse effects are rare, physicians should be aware of them and avoid unnecessary use.     

Collagenous colitis: macroscopically invisible,but with various treatment options

Two female patients, aged 54 and 67 years, respectively, had suffered from watery diarrhoea for several weeks or months without cramps or blood in the stools. The findings upon physical examination, blood and faecal examination and endoscopy were normal, and subsequent histological examination of intestinal biopsies revealed collagenous colitis. After treatment with a high-fibre diet, sulphasalazine and either prednisone or budesonide, the symptoms subsided. Collagenous colitis is a chronic watery diarrhoea disorder with unknown aetiology and pathogenesis. It is characterised by macroscopically normal mucosa, while histopathologically an abnormal thickening of the subepithelial collagenous layer and an increase in the number of intra-epithelial lymphocytes is found. There are various treatment options such as dietary fibre, mesalazine or bismuthsubsalicylate. Recently budesonide has been found to have a favourable effect both clinically and histologically. Complications of the disease are rare.     

Frequency of proximal colonic extension of distal ulcerative colitis

AIMS: To evaluate the frequency of colonic extension in patients with rectal or rectosigmoidal forms of ulcerative colitis and to look for factors associated with a higher risk of proximal colonic extension. METHODS: We conduct a retrospective study on cases of ulcerative colitis limited to the rectum and the rectosigmoid followed up at least for 6 months. Colonic extension was defined by apparition of endoscopic features of ulcerative colitis in initially normal segments of the colon. RESULTS: From 1984 to 2004, 70 patients with distal ulcerative colitis were studied. Initial location was the rectum in 25 cases and the rectosigmoid in 45 cases. After a mean follow-up of 49.4 months, proximal colonic extension was observed in 7 cases (10%), with an actuarial frequency of 12% at 5 years, 20% at 10 years and 20% at 20 years. Patients with colonic extension had a higher number of relapses compared to patients without extension (4.28 +/- 1.36 vs. 1,41 +/- 1.22, p = 0.001). Age, sex-ratio, initial location, maintenance therapy and diagnosis of refractory distal colitis were not associated with a higher risk of colonic extension. CONCLUSION: Colonic extension in our population occurs during the first years after the diagnosis of distal ulcerative colitis. Patients with more relapses are at increased risk of proximal colonic extension.     

52例溃疡性结肠炎患者的临床分析

目的探讨溃疡性结肠炎（UC）的临床特点,从而进一步提高其治疗水平。方法回顾我院收治的52例溃疡性结肠炎患者的临床资料进行分析和总结。结果在52例患者当中,痊愈52例,占61．5％,有效20例,占58．5％,总有效率为100％。结论根据溃疡性结肠炎患者的实际情况,对其采取相对应的药物治疗,对于提高患者的治疗疗效,以及降低患者复发率的发生,都具有重要作用。     

Sulfasalazine therapy in spondylarthritis ankylopoietica

In the past few years several reports have been published on the favourable effect of sulphasalazine in ankylosing spondylitis. This induced us to compare sulphasalazine with placebo in a prospective, randomized single-blind trial in 63 patients with active ankylosing spondylitis. After termination of the 24 week course of treatment significant improvement was registered in several clinical parameters both in the group taking the active drug (31 patients) and in that on placebo (32 patients). The advantage of sulphasalazine over placebo only proved to be significant in the duration of articular morning stiffness and in reducing disturbances of sleep. Observations claiming sulphasalazine to act as a remission inducing drug for ankylosing spondylitis have neither been confirmed nor ruled out by our experiences. Accurate appraisal of the effectiveness of sulphasalazine still calls for further extensive placebo-controlled double-blind studies.     

Diet and inflammatory bowel disease: a case-control study.

We conducted a population-based case-control study of inflammatory bowel disease and dietary habits in Stockholm during 1984-1987. We obtained retrospective information about food intake 5 years previously by a postal questionnaire for 152 cases with Crohn's disease, 145 cases with ulcerative colitis, and 305 controls. The relative risk of Crohn's disease was increased for subjects who had a high (55 gm or more per day) intake of sucrose (relative risk = 2.6, 95% confidence interval = 1.4-5.0) and was decreased for subjects who had a high (15 gm or more per day) intake of fiber (relative risk = 0.5, 95% confidence interval = 0.3-0.9). The most striking finding was an increased relative risk of both Crohn's disease and ulcerative colitis associated with consumption of fast foods: the relative risk associated with consumption of fast foods at least two times a week was estimated at 3.4 (95% confidence interval = 1.3-9.3) for Crohn's disease and 3.9 (95% confidence interval = 1.4-10.6) for ulcerative colitis. Although coffee seemed to provide a protective effect for both diseases, there are reasons to consider this finding an artifact.     

比较美沙拉嗪与柳氮磺吡啶治疗溃疡性结肠炎的疗效与安全性的meta分析

目的比较美沙拉嗪与柳氮磺吡啶2种药物治疗溃疡性结肠炎（UC）的疗效与安全性。方法计算机检索PubMed、Cochrane Library、EMbase、CNKI、CBM和万方数据库,查找所有比较2种药物治疗UC的随机对照试验（RCT）,检索时限均为建库至2014年2月12日。按照纳入与排除标准选择文献、评价质量并提取资料后,采用RevMan 5.2软件进行meta分析,并采用Jadad评价量表进行质量评价。结果共纳入13个RCT,其研究质量均为中等。合计1 104例UC患者。Meta分析结果显示,美沙拉嗪对比柳氮磺吡啶治疗UC总有效率差异有统计学意义[RR=1.21,95%CI（1.12,1.32）,P〈0.01],美沙拉嗪组总有效率高于柳氮磺吡啶组;共有3个RCT报道了复发率,结果显示,美沙拉嗪对比柳氮磺吡啶治疗UC,在复发率方面,差异有统计学意义[RR=0.60,95%CI（0.37,0.96）,P=0.03],美沙拉嗪组复发率低于柳氮磺吡啶组。共有9个RCT报道了不良反应,采用随机效应模型,meta分析结果显示：两组差异有统计学意义[RR=0.45,95%CI（0.33,0.59）,P〈0.01],美沙拉嗪组不良反应发生率低于柳氮磺吡啶组。结论现有证据显示,美沙拉嗪治疗UC的疗效和安全性均优于柳氮磺吡啶。     

Medical therapy of inflammatory bowel diseases: ulcerative colitis

There are fewer significant changes in the medical therapy of ulcerative colitis (UC) compared to Crohn's disease. The most important factors that determine therapy are disease extent and severity. 5-aminosalicylates (5-ASA) constitute the treatment of choice in mild-to-moderate UC. The efficacy of new compounds (e.g. mesalazine) is only mildly improved compared to sulphasalazine; however, their use has become more frequent due to a more favorable side effects profile. Topical medication is more effective in proctitis and distal colitis, and the combination of topical and orally-administered drugs is superior to oral therapy alone also in extensive disease. Thus, this latter regimen should be considered for cases where the escalation of treatment is required. Systemic steroids still represent the first line therapy in acute, severe UC, while in patients who do not respond to steroids, cyclosporine and infliximab should be considered as a second line therapy and as alternatives for colectomy. Maintenance treatment is indicated in all UC cases. 5-ASA compounds are suggested as first line maintenance therapy with the optimal dose still being under investigation. Topical compounds are effective also for maintenance in distal colitis or proctitis, if accepted by the patients. Immunosuppressives, especially azathioprine, should be considered in chronically active, steroid dependent or resistant patients. According to recent publications, azathioprine is almost equally effective in UC and CD. The question of chemoprevention is important during maintenance. There are increasing data supporting the notion that aminosalicylates may lower the risk for UC-associated colorectal cancer. The most important changes in the management of UC are the more frequent use of topical aminosalicylates and azathioprine, the availability of infliximab in severe UC, and increasing use of aminosalicylates for chemoprevention of colorectal carcinoma. Furthermore, adequate attention is needed to better organize the patient-doctor relationship and for greater adherence to medical therapy.     

Prevalence of the microscopic colitis to the course of the chronic diarrhea: about 150 cases

The goal of our survey is to value the microscopic colitis frequency at 150 patients, colliged on a period of 6 years (1997-2003), that have a chronic diarrhea with a normal total coloscopy and that benefitted of systematic biopsies. The microscopic colitis has been recovered at 44 patients on 150 either 29.3%. 16 of our patients (37%) are put on Salazopyrine, they answered well to the treatment with a receding of 3 years. The microscopic colitis is a pathology whose frequency seems under valued, it is certainly benign but can give a frequent diarrhea requiring a curative treatment.     

溃疡性结肠炎中医护理体会

目的探讨溃疡性结肠炎的中医护理理想方法。方法回顾分析了2012年3月-2013年3月来我院治疗溃疡性结肠炎80例患者资料。结果80例溃疡性结肠炎患者其中45例已经痊愈,33例取得了较好的疗效,继续治疗,2例效果不明显,总有效率高达97．5％。结论对溃疡性结肠炎患者进行心理护理、饮食护理和灌肠护理,有利于患者病情的恢复。     

Risk factors for intestinal invasive amebiasis in Japan, 2003-2009

We determined yearly change in prevalence and risk factors for amebic colitis caused by intestinal invasive amebiasis among persons who underwent endoscopy and assessed differences between HIV-positive and HIV-negative persons in Japan. A total of 10,930 patients were selected for analysis, of whom 54 had amebic colitis. Prevalence was in 2009 (0.88%, 12/1360) compared with 2003 (0.16%, 3/1904). Male sex (odds ratio [OR] 8.39, 95% CI 1.99-35.40), age <50 years (OR 4.73, 95% CI 2.43-9.20), history of syphilis (OR 2.90, 95% CI 1.40-5.99), and HIV infection (OR 15.85, 95% CI 7.93-31.70) were independent risk factors. No differences in risk factors were identified between HIV-positive and HIV-negative patients. Contact with commercial sex workers was a new risk factor among HIV-negative patients. Homosexual intercourse, rather than immunosuppressed status, appears to be a risk factor among HIV-positive patients.     

50例溃疡性结肠炎患者的“三位一体”中医特色辨证施护研究

目的探讨"病、证、体质"三位一体中医特色辨证施护模式对溃疡性结肠炎(UC)的临床疗效。方法将100例UC患者随机分为"三位一体"中医特色组和规范化组各50例。两组患者均建立在西医规范化常规治疗的基础上,中医特色组加以从"病、证、体质"三位一体辨证入手,采用个体化护理原则施护,观察两组护理1个疗程后的疗效。结果中医特色组临床治愈25例,显效16例,有效7例,无效2例,总有效率96.0%,临床疗效明显优于规范化组的70.0%,两组疗效比较差异有统计学意义(P<0.05)。结论 "三位一体"中医特色护理模式可提高溃疡性结肠炎的临床治疗效果,值得临床推广。     

The course of illness in ulcerative colitis

The data of 301 ulcerative proctitis/colitis patients, with a mean follow-up of 10 (1/2-26) years were analysed retrospectively. In 84 patients (28%) the diagnosis was made in this hospital (non-selected group), the other 217 patients were referred from other hospitals with an established diagnosis of ulcerative colitis. At any time after the fifth year of illness approximately 55% of the non-selected patients were free of symptoms, for the referred patients this proportion was 30%. In one half of the cases the inflammation started as a proctitis, almost 60% of these progressed to colitis later. Fourteen patients (5%) had a toxic megacolon, and a colon carcinoma developed in 9 patients (3%) on average 13 years after the first symptoms of colitis. We recorded 9 colitis-related deaths. Fifty patients (17%) underwent a colectomy, mostly because of failure of conservative therapy.     

联用补脾益肠丸和柳氮磺吡啶治疗溃疡性结肠炎的临床观察

目的探讨应用补脾益肠丸和柳氮磺胺吡啶合用治疗溃疡性结肠炎的效果。方法选择2006年1月至2009年11月来我院就诊的溃疡性结肠炎患者218例,随机分为两组,治疗组服用补脾益肠丸和柳氮磺吡啶片治疗;对照组服用柳氮磺胺吡啶片。结果治疗组总有效率96.33%,对照组总有效率87.16%,治疗组明显优于对照组。结论补脾益肠丸联用柳氮磺吡啶片治疗溃疡性结肠炎疗效好,副作用小,值得临床推广。     

联用补脾益肠丸和柳氮磺吡啶治疗溃疡性结肠炎的临床观察

目的探讨应用补脾益肠丸和柳氮磺胺吡啶合用治疗溃疡性结肠炎的效果。方法选择2006年1月至2009年11月来我院就诊的溃疡性结肠炎患者218例,随机分为两组,治疗组服用补脾益肠丸和柳氮磺吡啶片治疗;对照组服用柳氮磺胺吡啶片。结果治疗组总有效率96．33％,对照组总有效率87．16％,治疗组明显优于对照组。结论补脾益肠丸联用柳氮磺吡啶片治疗渍疡性结肠炎疗效好,副作用小,值得临床推广。     

56例缺血性结肠炎临床回顾分析

目的 探讨缺血性结肠炎的临床特点、内镜特征及诊断和治疗方法.方法 对56例缺血性结肠炎患者的临床资料进行回顾性分析.结果 缺血性结肠炎多发生于老年患者,男女比例为1∶1.8.多伴有糖尿病（53.6％,30/56）、高血压（39.3％,22/56）、冠心病（32.1％,18/56）等基础疾病.腹痛（100.0％,56/56）及便血（89.3％,50/56）为主要临床表现.结肠镜检查以黏膜充血、水肿、糜烂、溃疡等非特异性表现为主,病变主要见于左半结肠,呈节段性分布.多数患者预后良好.结论 老年患者出现急性腹痛和便血时应警惕缺血性结肠炎可能,早期结肠镜检查可及时明确诊断和指导治疗.     

The uncertain primary diagnosis of inflammatory bowel diseases

BACKGROUND: The purpose of this study is to re-evaluate our series of patients affected by a colonic non-neoplastic disease, in order to measure the percentage in whom we were unable to make a correct diagnosis after the first clinical and histological approach and to single-out the reasons for our inability to reach the correct diagnosis. METHODS: During the period 1985-1999 we observed 1228 patients affected by chronic inflammatory colonic diseases. RESULTS: In 859 patients (69.9%) an ulcerative colitis was diagnosed for the first time, and 248 patients (20.1%) were affected by Crohn's colitis. One hundred and twenty-one patients (9.8%) were defined as being affected by an undetermined colitis. Forty-three patients of these had a definite diagnosis, afterwards: 27 patients were affected by ulcerative colitis and 16 by Crohn's colitis. Differential diagnosis between inflammatory large bowel diseases (ILBD) and other forms of colitis was set out as follows: 62 cases out of 1228 were consequent on a bacterial infection or parasitosis; in 28 patients a colitis pseudomembranosus was diagnosed. Eighteen cases of ischemic colitis are reported and 14 patients were affected by NSAID-related colitis. In another 6 patients we diagnosed a postradiation colitis. In 22 cases mimicking a Crohn's colitis we ascertained 9 patients affected by intestinal lymphoma, 11 mycobacterium tuberculosis related intestinal infections and 2 cytomegalovirus related colitis. CONCLUSIONS: Despite progress in scientific acquisitions and in diagnostic methods, correct initial diagnosis of ILBD is still difficult, even though it will be defined with time.     

Nonspecific inflammatory bowel disease and smoking

The authors assessed the relation between cigarette smoking and nonspecific inflammatory bowel disease in a case-control study of 124 cases of ulcerative colitis, 109 cases of Crohn's disease, and 250 age- and sex-matched control subjects in hospital for acute nongastric or intestinal conditions unrelated to smoking. For ulcerative colitis, the risk for current smoking compared with never smoking was 0.5, with a 95% confidence interval (Cl) of 0.3-1.0. They observed decreasing risk with increasing number of cigarettes smoked. The risk for ex-smokers, however, was greater than that for never smokers (relative risk = 2.7; 95% Cl = 1.5-4.9). The elevated risk of ulcerative colitis in ex-smoking in the presence of an overall lack of association with ever-smoking may plausibly be attributed to either 1) brief induction time of a protective effect of smoking on ulcerative colitis or 2) selective cessation of smoking due perhaps to very early symptoms of the disease. If time at first onset of bowel symptoms, instead of clinical diagnosis, is considered as the index date, the negative association between ulcerative colitis and current smoking would have weakened in men and disappeared in the overall series. There was clear evidence of a positive association between cigarette smoking and Crohn's disease (relative risk for ever smokers vs. never smokers = 4.0; 95% Cl = 2.2-7.3). The risk estimates increased with the number of cigarettes smoked per day and duration of habit. The association between current smoking and Crohn's disease was even stronger when age at first onset of bowel symptoms was considered as the index date, but the risk for ex-smokers fell below unity.