Infliximab is effective in the treatment of ulcerative colitis with dermatomyositis: A case report

BACKGROUNDJoint, skin, oral cavity, and eye lesions are the most common extraintestinal manifestations of ulcerative colitis that can occur before or after its onset. The cases of ulcerative colitis with dermatomyositis (DM) are rare. In this study, we report a rare case of ulcerative colitis with DM that was effectively treated with infliximab.CASE SUMMARYThe patient was a 57-year-old female with a 2-year history of DM. The patient was admitted to hospital with abdominal pain, diarrhea, and blood in stool lasting for more than 2 mo. Colonoscopy revealed multiple erosions and ulcers in the entire colon and rectum. Pathological sections showed chronic inflammatory cell infiltration, especially neutrophil infiltration, in the colonic mucosa; therefore, the patient was diagnosed with ulcerative colitis. Preparations of 5-aminosalicylic acid was added to her treatment based on the original treatment for DM, but its effect was unsatisfactory. The patient’s discomfort was relieved after infliximab treatment.CONCLUSIONInfliximab can improve DM in the treatment of ulcerative colitis. Specialists need to raise awareness about patients with inflammatory bowel disease who have rare extraintestinal manifestations.     

Low incidence of colorectal dysplasia and cancer among patients with ulcerative colitis: A Turkish referral centre study

Abstract

Objectives. To determine the incidences of dysplasia, adenomatous polyp and colon cancer in patients with ulcerative colitis (UC) and to evaluate the risk factors. Material and methods. We retrospectively reviewed the medical records of patients with UC admitted to the Turkiye Yuksek Ihtisas Hospital between 1994 and 2008 and who subsequently developed colorectal cancer (CRC). Results. Between 1994 and 2008, a total of 844 UC patients were followed in our clinic. A total of 275 patients entered our surveillance programme. The duration of UC was as follows: 10–15 years, n = 173 (62.9%); 15–20 years, n = 55 (20.0%); 20–25 years, n = 26 (9.5%), 25–30 years, n = 9 (3.3%); and >?30 years, n = 12 (4.4%). In terms of localization, 80 patients (29.1%) had distal disease, 107 (38.9%) had left-sided disease and 88 (32.0%) had extensive colitis. Adenomatous polyp was found in six patients (2.2%). Five cases (83.3% of the polyps) were in the diseased segment and one case (16.7%) was in the non-diseased segment. Endoscopy revealed dysplasia in 11 cases (4.0%). Of the 275 UC patients, CRC was diagnosed in only three (1.1%) during follow-up. Adenomatous polyp was not found in cases with colon cancer. Conclusions. In our cases with UC, rates of dysplasia and CRC were much lower than in other reports. The difference in rates may be explained by racial factors, specific environmental factors, intensive control of disease activity through medical therapy and effective colonoscopic surveillance programmes.     

Tracheal rupture after vocal cord polyp resection: A case report

Introduction:Transoral laser microsurgery (TLM) is one of the most common operations performed for glottic lesions. Several protection measures are taken to prevent tracheal damage. However, some protection measures and common postoperative complications may still cause delayed tracheal rupture in certain situations. Cases of tracheal rupture after surgery are extremely rare, and there are no previous reports of TLM of the glottis causing tracheal rupture.Patient concerns:A middle-aged woman who underwent TLM for bilateral vocal cord polyps developed sudden neck pain, followed by cough and subcutaneous emphysema.Diagnosis:She underwent head, neck, and chest computed tomography (CT), which revealed a 4-cm membranous tracheal tear located 4.5 cm distal to the glottis, pneumomediastinum, and subcutaneous emphysema extending from the base of skull to the chest.Interventions:The patient underwent an emergency surgical surgical chest exploration and tracheal repair.Outcomes:One month after the surgery, the patient fully recovered with no tracheal stenosis or respiratory dysfunction.Conclusions:Conventional protective measures and common postoperative complications of TLM may also cause tracheal rupture.     

Risk for colorectal cancer in ulcerative colitis： Changes, causes and management strategies

The risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer include extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflammation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epidemiological trends and causes for the observed changes. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this change is unknown; it may partly be explained by the more widespread use of maintenance therapy and surveillance colonoscopy.     

Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses： A case report

Various hepato-biliary complications are an increased incidence in patients with inflammatory bowel disease, and portal bacteremia is well documented in patients with ulcerative colitis (DC). However, few reports mention UC in association with liver abscesses. Recently, there are several reports describing cytomegalovirus (CMV) infection in association with disease exacerbation and steroid refractoriness in patients with UC. Here we present a case of refractory UC accompanied with multiple liver abscesses and CMV colitis. The patient, a 72-year-old male, with a five-year history of repeated admissions to our hospital for UC, presented with an exacerbation of his UC. Sigmoidoscopy performed on admission suggested that his UC was exacerbated, then he was given prednisolone and mesalazine orally, and betamethasone enemas. However, he had exacerbated symptoms. Repeat Sigmoidoscopy revealed multiple longitudinal ulcers and pseudopolyps in the rectosigmoid colon. Although immunohistochemical staining of biopsy specimens and the serum testing for antigenemia were negative on admission and after the repeat Sigmoidoscopy, they became histologically positive for CMV. Nonetheless, the patient developed spiking fevers, soon after ganciclovir was administered. Laboratory studies revealed an increased white cell count with left shift, and Enterococcus fecalis grew in blood cultures. An abdominal computed tomography (CT) scan was obtained and the diagnosis of liver abscesses associated with UC was made, based on CT results. The hepatic abscesses were successfully treated with intravenous meropenem for 6 wk, without further percutaneous drainage. To our knowledge, this is the first reported case of multiple liver abscesses that develop during UC exacerbation complicated by CMV colitis.     

A case report of the therapeutic effect of cryofiltration in a patient with glucocorticoid-resistant ulcerative colitis

Ulcerative colitis (UC) is characterized by chronic inflammation of the colon and its cause and pathogenesis have not been fully clarified. Although UC is treated with various drugs, including 5-amino-salycilate and glucocorticoids, some patients are resistant to them. It was recently reported that apheresis, such as leukocytapheresis and granulocytapheresis, improves intestinal inflammation in refractory cases of UC. On the other hand, cryofiltration, in which plasma apheresis is used to remove immunoglobulin and immune complexes, has been used for the treatment of autoimmune diseases. We herein report a case of glucocorticoid-resistant UC successfully treated with cryofiltration. Interestingly, the level of interleukin-10 (IL-10) in the patient's serum was markedly increased after eight sessions of cryofiltration. This suggests that cryofiltration suppresses intestinal inflammation, in part via up-regulation of IL-10.     

Colorectal cancer and high grade dysplasia complicating ulcerative colitis in Italy: A retrospective co-operative IG-IBD study

BACKGROUND: Ulcerative colitis is a well-known risk factor for colorectal cancer. AIM: To take a census of the cases of colorectal cancer in ulcerative colitis patients observed in Italy and to evaluate the clinical presentation of neoplastic complication. PATIENTS AND METHODS: Experts from 28 Italian centres specialised in the management of inflammatory bowel disease or malignancies participated to the study. They were invited to send clinical data of patients with ulcerative colitis complicated by colorectal cancer or high-grade dysplasia consecutively observed between 1985 and 2000. One hundred and twelve patients (92 with cancer and 20 with high-grade dysplasia) were collected. Fourteen of them had undergone colectomy and ileo-rectal anastomosis for ulcerative colitis. Data of surgical patients were analysed separately. RESULTS: The mean age at diagnosis of ulcerative colitis and colorectal cancer patients was 39.3 and 53.2 years, respectively, and the mean duration between diagnosis of ulcerative colitis and cancer was 13.9 years (range 0-53). Inflammation was proximal to the splenic flexure in 71 cases (76.3%). One hundred and three colorectal cancers were registered (93 patients with single lesion and five patients with two synchronous cancers), with 76.7% of cancers being located in the left colon. As to the surgical patients, the mean age at diagnosis of ulcerative colitis and cancer was 28.9 and 47.0 years, respectively, and the mean diagnostic interval for ulcerative colitis and cancer was 18.1 years. Only 51 out of 112 patients were in follow-up. An early diagnosis of neoplasia (high grade dysplasia, stage A or B sec. Dukes) occurred in 72.5% of patients who were subjected to endoscopic surveillance and in 48.0% of patients who did not undergo endoscopic surveillance (p=0.02). CONCLUSIONS: These data show an earlier diagnosis of cancer in patients who had undergone endoscopic surveillance. The poor compliance to the follow-up program, however, reduces its effectiveness. Moreover, total colectomy allows an easier follow-up, with only the rectum being controlled. Colectomy with ileo-rectal anastomosis or proctocolectomy with ileo-anal anastomosis, could represent a valid alternative in patients at high risk of cancer who refuse endoscopic surveillance.     

Use of cyclosporin retention enemas in a patient with intractable pouchitis after proctocolectomy for ulcerative colitis: a case report

We report the case of a 46-year-old male with a 24-year history of ulcerative colitis who underwent proctocolectomy and ileal S-pouch-anal anastomosis. Six months after surgery the patient complained of increased daytime bowel frequency; pouchoscopy revealed severe pouchitis. Because of the failure of conventional treatments, the patient underwent a cycle of cyclosporin A (CsA) enemas. The therapy consisted of one enema each day for 5 weeks (35 administrations). The patient was submitted to a total of five pouchoscopies, the first before the beginning of the enemas cycle and the last one 2 months after the end of the treatment, Endoscopy showed a remarkable improvement at day 10, but these findings were not confirmed later. Biopsies showed a marked improvement at 10 days, but at later stages a reappearance of crypt abscesses with an increasing number of inflammatory infiltrates. In spite of the grim picture at endoscopy and histology, the patient felt better and noted a progressive reduction of the bowel movements and cessation of mucous and bloody discharge. At present, he reports six bowel movements per day and no bleeding. Received: 2 October 1996 / Accepted in revised form: 6 January 1999     

Appendix adenocarcinoma associated with ulcerative colitis: a case report and literature review

Ulcerative colitis (UC) represents a risk factor for colorectal cancer, but the association between UC and appendix cancer is uncommon. A 60–year–old woman with a 5–year history of UC initially received medical treatment with mesalazine and prednisone with no satisfactory response; therefore surgery was indicated. The procedure was a total intersphincteric proctocolectomy with ileostomy. Histopathological analysis indicated adenocarcinoma from the cecal appendix, and chronic–active ulcerative colitis of the colon. In conclusion, surgeons and pathologists should examine every surgical specimen from patients with UC because of the possibility, although remote, of a neoplasic pathology. The appendix adenocarcinoma and ulcerative colitis may or may not be associated, same as colon cancer in patients with UC.     

Pouchitis and pre-pouch ileitis developed after restorative proctocolectomy for ulcerative colitis： A case report

We report a case of pouchitis and pre-pouch ileitis, and inflammation in the neo-terminal ileum proximal to the pouch, developed after restorative proctocolectomy for ulcerative colitis. A 35-year old female presented with fever and abdominal pain five weeks after ileostomy closure following proctocolectomy. ComputEd tomography showed collection of feces in the pouch and proximal ileum. A drainage tube was placed in the pouch perianally, and purulent feces were discharged. With antibiotic treatment, her symptoms disappeared, but two weeks later, she repeatedly developed fever and abdominal pain along with anal bleeding. Pouchscopy showed mucosal inflammation in both the pouch and the pre-pouch ileum. The mucosal cytokine production was elevated in the pouch and pre-pouch ileum. With antibiotic and corticosteroid therapy, her symptoms were improved along with improvement of endoscopic inflammation and decrease of mucosal cytokine production. The fecal stasis with bacterial overgrowth is the major pathogenesis of pouchitis and pre-pouch ileitis in our case.     

Fulminant ulcerative colitis associated with steroid-resistant minimal change disease and psoriasis： A case report

A 43-year-old Chinese patient with a history of psoriasis developed fulminant ulcerative colitis after immunosuppressive therapy for steroid-resistant minimal change disease was stopped. Minimal change disease in association with inflammatory bowel disease is a rare condition. We here report a case showing an association between ulcerative colitis, minimal change disease, and psoriasis. The possible pathological link between 3 diseases is discussed.     

Skip lesion of the cecum associated with proctitis: an atypical case of ulcerative colitis

The authors report the clinical case of a patient who underwent total colectomy for acute ulcerative colitis. The unusual element in this case was the presence of a lesion (‘skip lesion’), typical of ulcerative colitis, in the periappendiceal area of the cecum, which was discontinuous to the main site of disease located in the rectum and left colon. The presence of skip lesions, whose clinicopathological relevance is still unknown, would seem to disprove the widely held view that ulcerative colitis involves only the mucous membrane of the large intestine, with inflammatory processes of varying intensity, but without intervening normal areas. The alteration in mucosal immune response by sharing of some factors as bacterial flora, stasis and secretory products is a suggestive pathogenetic supposition.     

How to avoid overtreatment of benign colorectal lesions: Rationale for an evidence-based management

Implementing population-based screening programs for colorectal cancer has led to an increase in the detection of large but benign histological lesions. Currently, endoscopic mucosal resection can be considered the standard technique for the removal of benign lesions of the colon due to its excellent safety profile and good clinical results. However, several studies from different geographic areas agree that many benign colon lesions are still referred for surgery. Moreover, the referral rate to surgery is not decreasing over the years, despite the theoretical improvement of endoscopic resection techniques. This article will review the leading causes for benign colorectal lesions to be referred for surgery and the influence of the endoscopist experience on the referral rate. It will also describe how to categorize a polyp as complex for resection and consider an endoscopist as an expert in endoscopic resection. And finally, we will propose a framework for the accurate and evidence-based treatment of complex benign colorectal lesions.     

Repeat full-thickness resection device use for recurrent duodenal adenoma: A case report

BACKGROUND Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique. There have been several recent studies of full-thickness resection device (FTRD) use in the colon, but data regarding its use and efficacy in the duodenum are still limited.CASE SUMMARY A 64-year-old female underwent resection of a recurrent adenoma of 7 mm in size in the duodenum after FTRD use for an adenoma eight months prior. The biopsies revealed a low-grade adenoma. The adenoma was removed using the gastroduodenal FTRD, and the pathology results revealed clear margins. Except for minor bleeding that was treated by argon plasma coagulation, no further complications occurred.CONCLUSION Repeat use of the FTRD appears to be a safe and efficacious approach for the treatment of recurrent duodenal lesions. Further prospective studies are needed to investigate the long-term safety and utility of repeat FTRD use after Endoscopic full-thickness resection.     

Underwater endoscopic mucosal resection of a follicular lymphoma: A case report

Introduction:Endoscopic resection of a follicular lymphoma (FL) presenting as a gastric subepithelial tumor (SET), along with periodic follow up can be a treatment option because gastrointestinal FL cells tend to reside in the primary site, which may explain its indolent nature.Patient concerns:A gastric lesion was found incidentally during a screening endoscopy in 73-year-old woman without any gastrointestinal symptom.Diagnosis:The patient was diagnosed with a grade I FL that was 1.4 cm large, at the greater curvature of lower-body.Intervention:We performed underwater endoscopic mucosal resection (UW-EMR), and there was no serious complication, such as bleeding and perforation.Outcomes:Complete en bloc resection was achieved with UW-EMR. Follow-up endoscopic biopsy after 3 months revealed no residual tumor on the resection site.Conclusion:UW-EMR may be a simple and safe resection method for gastric FL without metastases, that measure >1 cm.     

A case of Evans’ syndrome in a patient with ulcerative colitis

The case of a 37-year-old male diagnosed 16 years previously with ulcerative colitis, admitted on account of hemolytic anaemia and thrombocytopaenia that responded to immunosuppressive therapy, is reported. Despite various peculiarities discussed, this may be the first reported case of Evans' syndrome associated with ulcerative colitis.     

Incidence of ulcerative colitis in Central Greece： A prospective study

AIM: To study the incidence of ulcerative colitis UC in the prefecture of Trikala, Central Greece. METHODS: A prospective and population based epidemiological study of UC from 1990 to the end of 1994 was conducted. Trikala is a semirural prefecture of Central Greece with a population of 138 946 (census 1991). Three gastroenterologists (one hospital based, two private doctors) of the prefecture participated in this study. RESULTS: During the study period, 66 new historically verified cases of UC were recorded. The mean annual incidence of the disease in 1990-1994 was 11.2 per 105 inhabitants (95%CI: 8.7-14.3). There was no difference between men and women (annual incidence: 10.5 and 12.0 per 105 inhabitants respectively), either among urban, semirural or rural populations (annual incidence: 11.7, 17.1 and 9,9 per 105 inhabitants respectively). The majority (56%) of the patients never smoked and a quarter were ex-smokers. About a half of all cases had proctitis. CONCLUSION: UC is common in Central Greece and its incidence is similar to that in North-Western European countries.