Document Detail


Long-term treatment of patients with a history of ulcerative colitis who develop gastritis and pan-enteritis after colectomy.
MedLine Citation:
PMID:  22858512     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ulcerative colitis (UC) is generally described as a superficial diffuse inflammation restricted to the colon and rectum. However, several case reports have described a distinct and rare type of UC-related pan-enteritis, typically occurring after colectomy. Corticosteroids are effective for induction of remission of this condition, but it is not clear how these patients should be managed long term.
GOALS: To further describe and define the entity of UC-related pan-enteritis and to investigate the efficacy of azathioprine for maintenance of remission.
RESULTS: We describe 5 patients with superficial diffuse ulcerative inflammation of the stomach, small bowel, and pouch if present. Four of the 5 patients developed enteritis after colectomy for ulcerative pancolitis. Pathology showed severe mucosal inflammation with infiltration of neutrophils and plasma cells from the stomach to the ileum. Video capsule endoscopy in 1 patient confirmed the presence of mucosal inflammation throughout the small bowel. All patients were started on a standardized treatment with intravenous corticosteroids for induction of remission and azathioprine for maintenance therapy. The conditions of all the patients rapidly improved, and subsequently, 4 patients were in full remission on azathioprine monotherapy, despite failure of this UC therapy before surgery, whereas 1 patient continues to have a steroid-dependent disease.
CONCLUSIONS: The outcomes of 5 cases of UC-related pan-enteritis as described in this report support a role for azathioprine in remission maintenance. Future research is needed to improve our understanding of this rare but distinct intestinal inflammatory disorder.
Authors:
Frank Hoentjen; Stephen B Hanauer; John Hart; David T Rubin
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical gastroenterology     Volume:  47     ISSN:  1539-2031     ISO Abbreviation:  J. Clin. Gastroenterol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-11     Completed Date:  2013-06-19     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  7910017     Medline TA:  J Clin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Azathioprine / therapeutic use*
Colectomy / adverse effects*
Colitis, Ulcerative / surgery*
Drug Therapy, Combination
Enteritis / diagnosis,  drug therapy*,  etiology
Female
Gastritis / diagnosis,  drug therapy*,  etiology
Glucocorticoids / therapeutic use*
Humans
Immunosuppressive Agents / therapeutic use*
Male
Middle Aged
Remission Induction
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
P30 DK042086/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Glucocorticoids; 0/Immunosuppressive Agents; MRK240IY2L/Azathioprine
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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