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

In the course of their disease about 15% of all ulcerative colitis patients have a severe attack with evidence of systemic toxicity. On the basis of our personal experience of a recent series of 46 patients, and of a review of the literature, several conclusions can be drawn. A number of more severe attacks (28 out of 46 patients in our series), defined as "fulminating" or "toxic" colitis, must be regarded as major determinants of complications and mortality (4.3% in our series). The disease severity and the presence of signs and symptoms of toxicity seem likely to be determined by the amount of colonic tissue involved by inflammation, both in depth and in extent. A number of laboratory abnormalities are frequently found in the acute phase of severe ulcerative colitis, but C-reactive protein appears the most reliable factor reflecting activity and extension of lesion. Patients with increased small intestinal gas and multiple air-fluid levels, seen on the abdominal plain film, even in the absence of megacolon, must be considered to be gravely ill and at high risk of complications and mortality. With regard to timing of surgery, a short period of medical management (72-120 hrs) is justified to exclude an infectious etiology, to prepare the patient for surgery, and to allow for improvement.
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PMID:Severe ulcerative colitis: a personal point of view. 268 Aug 62

We estimated the extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patients with their first attack of ulcerative colitis. Proctitis was found in 12, proctosigmoiditis in 19, left-sided colitis in 10, and extensive colitis in 19. Fourteen clinical variables and laboratory measurements (bowel frequency, stool consistency, rectal bleeding, fecal mucus/pus, temperature, pulse rate, white blood cell count, hematocrit, sedimentation rate, serum iron, serum albumin, serum alpha 2-globulin, serum C-reactive protein, and seromucoids) were determined. All the variables except rectal bleeding and hematocrit were correlated (p less than 0.001) with the extent of colitis. On stepwise discriminant analysis, only C-reactive protein distinguished proctosigmoiditis from more improved the discrimination. Cross-validation by the "jack-knife method" showed that 86.7% of patients were correctly classified, the errors consisting in underestimation of disease in 8/29 patients with extensive colitis.
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PMID:Clinical and laboratory indicators of extent of ulcerative colitis. Serum C-reactive protein helps the most. 335 84

Random fecal alpha 1-antitrypsin levels were determined in 34 patients, 24 with Crohn's disease, and 10 "controls" having diarrheal illnesses not associated with intestinal protein loss, in an effort to evaluate its usefulness as a measure of Crohn's disease intestinal activity. In the control group, all alpha 1-antitrypsin levels were less than 2 mg/g dry wt of stool. The mean fecal level among those with Crohn's disease was 52.9 mg/g (range less than 2 to greater than or equal to 200). There was a strong correlation between disease activity, as measured by a clinical score, and the alpha 1-antitrypsin levels (Spearman r = 0.65, p = 0.001). This correlation was similarly strong among those with colitis or ileitis. A fecal value greater than 20 mg/g may provide a rough guideline to separate patients with clinically active disease from those with inactive Crohn's disease, despite a considerable range of fecal levels among patients with a particular clinical score. Fecal alpha 1-antitrypsin levels correlated with several other laboratory measures that have been proposed as indicators of Crohn's disease activity. The serum orosomucoid, C-reactive protein, and albumin correlated with the clinical activity score among some of our patient groups. Both clinical scores and laboratory parameters, however, may have limited usefulness in a variety of circumstances. Random fecal alpha 1-antitrypsin determinations seem to provide a reliable, although not directly quantitative, measure of the intestinal activity among patients with Crohn's disease, especially when other methods may be inconclusive.
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PMID:Fecal alpha 1-antitrypsin measurement: an indicator of Crohn's disease activity. 387 10

Serum immunoglobulins and C-reactive protein (CRP) levels were examined in 85 ulcerative colitis (UC) patients and were correlated with activity, extension and duration of the disease, as well as with extraintestinal manifestations and therapeutic effects. An increase of IgG, IgA, IgM, IgE, CRP and decrease of IgD levels was found in UC, but the activity of the disease was correlated only with CRP level. Patients with extraintestinal manifestations showed elevation of IgG, IgA and IgM level, however, only in inactive colitis. After 12 months of therapy with sulphasalazine the immunoglobulins and CRP returned to the level found in the inactive colitis. An elevation of IgE level was also observed in patients with accompanying allergic disorders. The examined parameters did not reveal any relationship with the duration or extension of the disease. It seems that abnormality in immunoglobulin and CRP levels is an accompanying phenomenon in UC. Increase of IgE level suggests the share of allergic mechanism in pathogenesis of the disease.
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PMID:Humoral immune system and ulcerative colitis activity. I. Serum immunoglobulins and C-reactive protein levels. 615 29

C4, C3 and C5 levels and the complement hemolytic activity were analysed in 84 ulcerative colitis patients and correlated with activity, extension and duration of the disease, with the presence of extraintestinal manifestation, and with therapeutic effects. The elevation of C3 was observed in both mild active and in severe colitis. Only C3 correlated with disease activity and with C-reactive protein level. On the other hand, C4 and C5 levels were significantly decreased in the active disease extended to the left side or to total great bowel. The importance of these findings is discussed. No significant connection of the examined complement components with duration, therapy and extraintestinal manifestation was observed. A trend to increase the complement hemolytic activity in severe colitis was noted. Our study of complement and its components activity suggests the secondary role of analysed parameters in pathogenesis of UC and clinical usefulness of C3 level as an indicator of the disease activity.
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PMID:Humoral immune system and ulcerative colitis activity. II. Complement level. 615 30

71 patients with nonspecific diseases of the colon were examined before and after hemosorption for concentrations of seromucoid, orosomucoid, immunoglobulins G,M,A, C3 and C4 complement component fractions, haptoglobin, ceruloplasmin, alpha 1-antitrypsin, C-reactive protein, properdin, transferrin. It was found that hemosorption results in lowering of all the above concentrations in nonspecific ulcerative colitis, except seromucoid and orosomucoid in moderate and acute colitis. In response to hemosorption serum glycoproteins levels varied with the disease severity, its duration and metabolic activity of the liver. Concentrations of seromucoids, orosomucoid, alpha 1-antitrypsin changed in correlation with clinical manifestations of colon inflammation and may serve as criteria of hemosorption efficacy.
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PMID:[The effect of hemosorption on the glycoprotein concentration of the blood serum in inflammatory diseases of the large intestine]. 753 60

The in vivo appearance of soluble interleukin (IL)-6 receptor (sIL-6R) in serum from patients with inflammatory bowel disease was examined using an enzyme linked immunosorbent assay (ELISA). The serum sIL-6R concentrations in patients with active disease (ulcerative colitis, 148.4 (5.1); Crohn's disease, 142.3 (9.3) ng/ml; mean (SEM)) were significantly raised compared with those in patients with inactive disease (ulcerative colitis, 116.2 (7.2); Crohn's disease, 114.3 (7.1) ng/ml), some other type of colitis (104.8 (11.6) ng/ml), or in normal subjects (107.3 (2.4) ng/ml). These differences were also seen in paired samples examined during both active and inactive phases. Additionally, serum sIL-6R and IL-6 concentrations correlated significantly with C-reactive protein levels in both ulcerative colitis and Crohn's disease patients (r = 0.23 and 0.56, respectively; p < 0.05 for both). Furthermore, gel filtration analysis of serum from these patients showed two major peaks of immunoreactive IL-6-one peak corresponding to free IL-6 and another peak to sIL-6R-bound IL-6-this was further confirmed by a luminescence sandwich ELISA. These results, together with its in vitro effects, indicate that natural sIL-6R may function as a powerful enhancer of the IL-6-dependent immune processes observed in inflammatory bowel disease.
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PMID:Soluble interleukin-6 receptors in inflammatory bowel disease: relation to circulating interleukin-6. 789 Feb 34

Metronidazole has been used to treat pouchitis, but there are no controlled data that show it is effective. Chronic unremitting pouchitis is a form of the disorder particularly difficult to manage. Diarrhea is the main symptom of pouchitis, which results from acute inflammation of the mucosa of an ileal reservoir. To test the hypothesis that metronidazole (400 mg thrice daily for seven days) is no better than placebo at reducing stool frequency in chronic unremitting pouchitis, a double-blind placebo-controlled crossover study has been performed. Thirteen patients who had undergone restorative proctocolectomy for ulcerative colitis were studied. The diagnosis of pouchitis was based on clinical, endoscopic, and histological criteria. At entry all patients had symptomatic pouchitis and were passing more than six stools/24 hr or had consistently bloody stools with at least four of six endoscopic criteria of mucosal inflammation. The median frequency of defecation decreased by 3 bowel actions/24 hr (conservative 95% confidence intervals 0-4/24 hr) on metronidazole but increased by a median of 1/24 hr on placebo. The difference between the median number of bowel motions, when treatment with metronidazole was compared to placebo, was 4 motions/24 hr (P < 0.05) in favor of metronidazole. There was no significant change in the endoscopic or histological grade of inflammation, in the serum C-reactive protein level, or symptomatic scores. In a parallel study, metronidazole did not alter stool frequency in asymptomatic patients without pouchitis who had endoscopically normal reservoirs (six polyposis, six colitis).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Double-blind crossover trial of metronidazole versus placebo in chronic unremitting pouchitis. 820 Feb 50

In connection with inflammatory diseases of various origins an increasing amount of research has been directed towards trace elements, in particular zinc. However, proving changes in the zinc concentration of organisms or single cells still encounters major methodological difficulties. This is also probably the reason why many of the research findings to be found in current publications still significantly differ from one another. The present study utilizes a novel leucocyte-preparation method, which proved to be very reliable as regards the constancy of measured values. Thus, results obtained in 1989 which show a significant decrease in leucocyte zinc concentrations of patients with Crohn's disease were confirmed (1) as well as extended to the clinical pictures of Colitis ulcerosa and chronic pancreatitis of ethylic origin by studying a group of patients. Significant changes in serum zinc levels could not be proved. There was also no correlation between the leucocyte zinc concentrations and the serum zinc concentrations, on the one hand and the clinical parameters C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), body weight, humeral muscle area as well as activity of the disease, on the other.
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PMID:Zinc concentration in serum and leucocytes in chronic inflammatory diseases. 882 84

Antibiotic-associated colitis was diagnosed in 23 orthopaedic patients: 17 had abdominal symptoms, 3 had a fever and the remaining 3 had no symptoms but increasing C-reactive protein values or white blood count. The antibiotic was clindamycin in 19, cephalosporins in 3 and a combination of vancomycin and fusidic acid intravenously in one. The antibiotics were stopped in 12, changed in 5 and continued in the remaining 5. Oral treatment for colitis was given in 21 patients, and in one patient the only treatment was stopping the antibiotics. One patient died after a myocardial infarct; the remaining 22 were discharged after successful treatment of their primary condition and the colitis.
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PMID:Antibiotic-associated colitis in orthopaedic patients. 887 40


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