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Query: UMLS:C0009319 (colitis)
 19,384 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Evanescent colitis was first reported in 1971. This clinical entity is manifested by abrupt onset of colicky abdominal pain usually out of proportion to the physical findings, loose stools progressing to hematochezia, and segmental colonic involvement with spontaneous resolution in a matter of days. The diagnosis can be suggested by abdominal flat plate; confirmation depends upon barium-enema examination early in the course of the illness. The clinical presentation is identical to that of colonic ischemia with one remarkable exception: while colonic ischemia has come to be regarded as a disease of the elderly, usually with underlying vascular disease, evanescent colitis occurs in young people who are otherwise free of disease. In this report the authors present nine cases whose course is classic for colonic ischemia except that they are all less than 50 years of age and free of underlying vascular disease. Two of the patients were on oral contraceptive medication. A review of the literature revealed 15 additional cases. Five of these cases were associated with oral contraceptives. Conditions to be excluded in the differential diagnosis of this disease are the specific infectious colitides, idiopathic ulcerative colitis, granulomatous colitis and antibiotic-related pseudomembranous colitis.
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PMID:Evanescent colitis. 729 67

The records of 81 patients with colitis whose symptoms began after the age of 50 years were analyzed to determine the importance of ischemia as a cause of colitis in this age group and to evaluate the accuracy of previous diagnoses. Patients were classified by clinical, roentgenological and pathologic criteria. A retrospective diagnosis of ischemic colitis was made in three-fourths of the patients, one-half of whom had original discharge diagnoses of ulcerative, Crohn's or nonspecific colitis. This study supports our belief that ischemia is the most common cause of colitis beginning in patients older than 50 years of age. Moreover, the incorrect diagnosis of idiopathic inflammatory bowel disease in a large proportion of these patients may explain why colitis has been reported to behave differently in the elderly than in the young.
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PMID:Colitis in the elderly. A reappraisal. 731 20

Symptoms and physical findings may indicate the severity of inflammatory disease of the colon, but detailed history taking is needed to limit the wide spectrum of possible causes. Infectious causes should be ruled out before other disease is assumed to be present. No single test is sufficient to diagnose ulcerative colitis or Crohn's disease. Laboratory testing, histologic assessment, endoscopy, radiology, and bowel studies are often necessary in differential diagnosis. Because of the systemic nature of colitis, manifestations in the musculoskeletal, ocular, dermatologic, hepatobiliary, and other systems may occur and provide clues. Treatment depends on the type and severity of disease. Sulfasalazine (Azulfidine), sulfa-free 5-aminosalicylic acid compounds, and corticosteroids are mainstays of treatment of ulcerative colitis and Crohn's disease. Supportive care and judicious use of antimicrobial therapy are usually effective in colitis due to bacterial, parasitic, and sexually transmitted infections and are useful for symptoms caused by colonic ischemia and vasculitis. Colitis resulting from radiation therapy may present several years after the procedure and can be difficult to diagnose and treat. In many cases of inflammatory colon disease, especially chronic conditions, consultation with a gastroenterologist is highly recommended.
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PMID:Inflammatory diseases of the colon. Narrowing a wide field of symptoms and possible causes. 747 59

We report a rare case of rectosigmoid stricture associated with colitis cystica profunda that occurred 21 years after local therapeutic irradiation given for carcinoma of the bladder. We reviewed the literature and compared the clinical features, etiology, and macroscopic findings. The pathogenesis of the lesion may be related to repeated ulceration and regeneration, while chronic colonic ischemia may also play a role. The recognition of this rare entity is important because of its low-power "penetrating" architecture, which may be mistaken histologically as well-differentiated adenocarcinoma.
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PMID:Postirradiation colitis cystica profunda. Case report and literature review. 750 69

Ischemic colitis, a condition of middle-aged to elderly patients, occurs uncommonly in younger persons. In this study, we describe the clinical and pathological features of 18 young adults (mean age, 29 years; age range, 17-39 years) with spontaneous ischemic colitis, 17 of whom were women. All presented with abrupt onset of severe, cramping abdominal pain followed by hematochezia. Colonoscopic visualization of the mucosa showed segmental hyperemia, friability, and erosion affecting the distal transverse colon (three cases), splenic flexure (three cases), descending colon (five cases), and sigmoid (seven cases). Mucosal biopsy documented superficial ischemic necrosis in seven patients; 11 patients had full-thickness mucosal necrosis with regeneration. Colonic mucosa proximal and distal to the ischemic segment was endoscopically normal in all patients and histologically normal in the eight patients in whom biopsies were obtained. All patients recovered with supportive care. Median duration of illness was 2.1 days (range, 1-4 days). Ten women (59%) were using low-dose estrogenic oral contraceptive agents, compared with the 1988 national average of 18.5% oral contraceptive users among females aged 15 to 44 years. The calculated odds ratio yielded a greater than sixfold relative risk for the occurrence of ischemic colitis among oral contraceptive users. In addition, four women not currently on hormonal contraceptive therapy had a past history of oral contraceptive use; the three remaining women were taking estrogen as replacement therapy after oophorectomy. In one patient, documented reversible ischemic colitis recurred on resumption of oral contraceptive use; four women reported symptoms and signs of recurrent ischemia but did not seek further medical evaluation. Our data indicate that transient colonic ischemia represents a form of acute segmental colitis in young adults; before the 5th decade of life, spontaneous ischemic colitis is a disorder found almost exclusively in women and is associated with the clinical use of exogenous estrogenic agents.
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PMID:Reversible ischemic colitis in young women. Association with oral contraceptive use. 769 47

Cytomegalovirus (CMV) infection is a substantial cause of morbidity and mortality among immunocompromised patients. It may present with a mild, self-limited syndrome, retinitis, colitis, or invasive disease with pneumonitis, hepatitis, and bone marrow suppression. We review another, less common manifestation of CMV disease: CMV-associated vasculitis. CMV may productively infect vascular endothelial cells (25), causing a local vasculitis (3, 14, 19) and ischemia. Alternatively, the host immune response to cells expressing viral antigen may be the stimulus for vasculitis (12, 53). Since there are no pathognomonic appearances to mucosal or cutaneous lesions, biopsy of accessible sites is critical for diagnosis and expeditious initiation of appropriate antiviral therapy. The CMV-associated vasculitides represent a broad spectrum of diseases, with GI vasculitis in nontransplant recipients having the best prognosis. Cutaneous vasculitis associated with CMV seems to be a more fulminant disease, with the majority of cases having a fatal outcome. These differences likely reflect the degree of viral burden and the state of immune competence. Additionally, since the virus itself is immunosuppressive, host defenses may be further compromised by the infection. Although a large collective experience assessing the impact of ganciclovir and foscarnet is not currently available, both the prompt initiation of antiviral treatment and a concurrent reduction in any immunosuppressive regimen, including steroids, should be undertaken since these therapeutic strategies have clearly improved outcome for other CMV syndromes (22, 34, 55). As the number of recipients rises and the HIV pandemic spreads we are likely to see an increase in the number of cases of vasculitis associated with CMV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cytomegalovirus vasculitis. Case reports and review of the literature. 793 9

Cytomegalovirus disease is an opportunistic infection that is seen in patients with inmunodeficiencies. The group most commonly affected are AIDS and transplanted patients. Only a few cases of cytomegalovirus disease in non-immunocompromised patients have been reported. In localized disease, the gastrointestinal tract is the most frequently affected. We report two cases of acute abdomen caused by cytomegalovirus enteritis and colitis (histopathological diagnosis) without any underlying immune disorder. The role that the cytomegalovirus infection might play in the development of the clinical manifestations in these two cases is discussed. Without an established immunodeficiency we must be careful to attribute to cytomegalovirus infection the direct responsibility of the lesions. In the reported cases, the existence of intestinal ischemia is more than just a clinical hypothesis and pathological examination is inconclusive. The absence of an immunocompromised state, the presentation as an acute abdomen and the clinical course forwards intestinal occlusion in the first case are not characteristic of cytomegalovirus enteritis and colitis. We conclude that the two reported cases are in fact an ischemic enteritis upon which cytomegalovirus enteritis and colitis was superimposed, an association that has not been reported before.
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PMID:[Cytomegalovirus enteritis and colitis in nonimmunodepressed patients, a primary disease or superinfection?]. 798 12

Graded compression color Doppler sonography was used to evaluate gastrointestinal blood flow in 20 normal fasting subjects and 32 patients with focal gastrointestinal lesions. Imaging was optimized for color sensitivity using a 5 MHz linear array transducer. Criteria were established for normal mural blood flow based on findings in normal controls. Two reviewers blinded to the final diagnosis compared patterns of mural vascularity in normal and abnormal patients. Increased mural blood flow was demonstrated in all 32 patients with gastrointestinal inflammatory disorders and in seven of nine patients with neoplasms. No mural flow was demonstrated in four patients with small bowel infarction. The greatest overall degree of flow was noted in patients with Crohn's disease and cytomegalovirus colitis. Flow in tumors was variable, ranging from strikingly increased flow in a giant villoglandular polyp to absent flow in a metastasis from lung carcinoma. Our preliminary experience suggests that the presence of considerable overlap in the color Doppler patterns of mural blood flow in inflammatory and neoplastic lesions. Color Doppler sonography alone without spectral waveform analysis may not distinguish focal inflammatory from neoplastic disorders of the gastrointestinal tract reliably. However, this technique potentially may be useful in diagnosing small bowel ischemia when thickened segments of small bowel are identified with absent flow.
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PMID:Color Doppler sonography of focal gastrointestinal lesions: initial clinical experience. 808 48

Besides classical necrotizing enterocolitis (in neonates), which is seen in India as elsewhere in the world, we observe sporadic cases of tropical enterocolitis, i.e. segmental jejunitis, ileitis or colitis and rarely duodenitis. This is a distinct clinico-pathological entity presenting as "acute abdomen", with pain, bilious vomiting, constipation or bloody diarrhoea. The clinical course is not as fulminating as neonatal necrotizing enterocolitis. Most cases are salvaged by conservative treatment especially after the confidence brought by laparoscopic vision of the abdomen, thus excluding perforation or gangrene of the bowel involved. Without laparoscopy, most of the cases end up in laparotomy. The pathology appears to be a kind of local hyperimmune reaction in the segment of bowel involved, ranging from punctate haemorrhages in the seromuscular layer of the bowel to a generalized red fiery look or perforation due to mucosal ulceration. Whatever the causative agent, the pathogenesis is of local vasculitis leading to ischemia and various patterns of disease.
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PMID:Tropical enterocolitis in children. 808 96

The radiographic appearance of intestinal edema, including colonic edema, has been well described in the literature. Severe wall circumferential thickening can occur within the colon in a number of conditions. This includes edema secondary to colitis, allergy, ischemia, and infiltrative neoplastic processes. Edema may be secondary to low protein levels, as from protein losing enteropathy, nephrotic syndrome, and hepatic cirrhosis. The following case, in which there was severe ascending colonic wall thickening due to edema, is unusual in two respects: it had well-developed demonstrated "protective" right colonic varices and a normal protein level.
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PMID:CT demonstration of ascending colon varices. 818 Aug 60


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