Non-specific colitis among patients with colitis: frequency and relation to inflammatory bowel disease, a prospective study / Colite inespecífica entre pacientes com colite: estudo prospectivo sobre sua frequência e relação com doença inflamatória intestinal

Abstract Background and study aim: The term non-specific colitis refers to an inflammatory condition of the colon that microscopically lacks the characteristic features of any specific form of colitis and is commonly seen in pathology reports of colonoscopy biopsies. In fact, it has been questioned whether it is a separate pathological entity or it is merely an intermediate stage in the course of inflammatory bowel disease. This study was conducted to estimate the prevalence of non-specific colitis among patients with colitis and characterize its natural history over a 6 months year period. Patients and methods: Eighty adult patients presented for colonoscopy were enrolled. In the final analysis they were divided into Group A; the non-specific colitis Group and Group B; the inflammatory bowel disease Group. All patients were subjected to: full history taking, full clinical examination, laboratory investigations: which included stool analysis, CRP, ESR, complete colonoscopy and entire random colon biopsies for histopathological examination. Results: Group A included 67 patients (83.75%) while Group B included 13 (16.25%) patients. Patients with IBD had clinical and laboratory features of inflammation significantly higher than patients with non-specific colitis. Six patients (8.95%) of non-specific colitis group developed histologic features of florid inflammatory bowel disease after 6 months. There were no independent predictors of this conversion. Conclusion: Among our 80 patients with colonoscopy and biopsy 67 (83.75%) were diagnosed as non-specific colitis and out of them 6 patients (8.95%) were reexamined after 6 months and proved to have inflammtory bowel disese this change was not linked to predictive factors.

Resumo Introdução e objetivos: O termo colite inespecífica (CI) refere-se a uma condição inflamatória do cólon que microscopicamente não apresenta características de qualquer forma específica de colite; é comumente observada em relatórios patológicos de biópsias de colonoscopia. De fato, tem-se questionado se esta seria uma entidade patológica separada ou apenas um estágio intermediário no curso da DII. Este estudo foi realizado para estimar a prevalência de CI entre pacientes com colite e caracterizar seu curso durante um período de seis meses. Pacientes e métodos: O estudo incluiu 80 pacientes adultos que se apresentaram para colonoscopia. Na análise, os pacientes foram divididos em dois grupos: grupo A (CI) e grupo B (DII) Todos os pacientes foram submetidos a anamnese completa, exame clínico completo e investigações laboratoriais que incluíram análise de fezes, PCR, VHS, colonoscopia completa e biópsias aleatórias de cólon para exame histopatológico. Resultados: Do total de pacientes, 67 foram alocados no grupo A (83,75%) e 13 (16,25%) no grupo B. Os pacientes com DII apresentavam sinais clínicos e laboratoriais de inflamação significativamente maiores do que o observado em pacientes com CI. Seis pacientes (8,95%) do grupo CI desenvolveram características histológicas de DII florida após seis meses. Não foram identificados preditores independentes para essa conversão. Conclusão: Entre os 80 pacientes submetidos a colonoscopia e biópsia, o diagnóstico de CI foi feito em 67 (83,75%); destes, seis pacientes (8,95%) foram reexaminados após seis meses e apresentaram DII, sendo que essa conversão não foi associada a fatores preditivos.

The Prevalence of Yersinia Infection in Adult Patients with Acute Right Lower Quadrant Pain / 대한소화기학회지

BACKGROUND/AIMS: Clinical manifestations of intestinal yersiniosis include enterocolitis, mesenteric adenitis, and terminal ileitis presenting with fever, right lower quadrant pain, and leukocytosis. According to a previous Korean study in 1997, Yersinia was revealed in two among 15 adult patients with mesenteric adenitis (13%). However, recent reports on the prevalence of Yersinia infection in adult patients are few. The aim of this study was to investigate the prevalence of Yersinia infection in adult patients with acute right lower quadrant pain. METHODS: Adult patients (>18 years) who visited Eulji medical center, due to acute right lower quadrant pain were enrolled prospectively from December 2007 to July 2009. Abdominal CT, stool culture, serologic test for Yersinia, and Widal test were performed. RESULTS: Among 115 patients, 5 patients were excluded due to positive Widal test or salmonella culture. In 110 patients, abdominal CT showed right colitis in 20 (18.2%), terminal ileitis in 16 (14.5%), mesenteric adenitis in 13 (11.8%), acute appendicitis in 10 (9.1%), acute diverticulitis in 7 (6.4%), non specific mucosal edema in 36 (32.7%) and no specific lesion in 8 (7.3%). Two (1.8%) of the 110 patients had antibodies to Yersinia. One patient showed acute enteritis and the other patient was diagnosed with acute appendicitis and underwent appendectomy. No Yersinia species were grown on stool or tissue culture. CONCLUSIONS: Nowadays, among adult Korean patients presenting with acute right lower quadrant pain, there have been few incidences of Yersinia infection.

Characterization of Shigella spp. by antimicrobial resistance and PCR detection of ipa genes in an infantile population from Porto Velho (Western Amazon region), Brazil

The incidence of Shigella spp. was assessed in 877 infants from the public hospital in Rondônia (Western Amazon region, Brazil) where Shigella represents the fourth cause of diarrhea. Twenty-five isolates were identified: 18 were Shigella flexneri, three Shigella sonnei, three Shigella boydii and one Shigella dysenteriae. With the exception of S. dysenteriae, all Shigella spp. isolated from children with diarrhea acquired multiple antibiotic resistances. PCR detection of ipa virulence genes and invasion assays of bloody diarrhea and fever (colitis) were compared among 25 patients testing positive for Shigella. The ipaH and ipaBCD genes were detected in almost all isolates and, unsurprisingly, all Shigella isolates associated with colitis were able to invade HeLa cells. This work alerts for multiple antibiotic resistant Shigella in the region and characterizes presence of ipa virulence genes and invasion phenotypesin dysenteric shigellosis.

Colitis microscópica: valor predictivo de la sospecha clínico-endoscópica en nuestro medio / Microscopic colitis: predictive value of clinical/endoscopical approach

Introducción. El estudio y tratamiento de la diarrea crónica es complejo y de múltiples etapas. En pacientes portadores de diarrea crónica acuosa no sanguinolenta, con estudio normal, se debe considerar la posibilidad de una lesión histológica, aún con aspecto macroscópico normal a la colonoscopía: la Colitis Microscópica (CM). Esta entidad clínico-patológica involucra dos conceptos, la colitis linfocítica (CL), que compromete a la mucosa/submucosa de revestimiento del colon con infiltrado de linfocitos CD8 citotóxicos, o bien la colitis colágena (CC) ,que compromete la membrana basal. Ante la sospecha de CM, obtener biopsias secuenciales en colon derecho e izquierdo para su correcto diagnóstico de acuerdo a patrones histológicos. Objetivos. Conocer la frecuencia de esta entidad clínica en pacientes con diarrea crónica acuosa no sanguinolenta, con colonoscopía y biopsias, y evaluar la relación entre la sospecha clínica y la confirmación histológica. Pacientes y métodos. Se incluyen pacientes estudiados por diarrea crónica acuosa no sanguinolenta en el período enero 2003-febrero 2005, que fueron referidos a colonoscopía. Requisito era estudio completo normal de acuerdo a protocolo de diarrea crónica (leucocitos fecales, estudio malabsorción, intolerancia al glúten, función tiroidea, tolerancia a la lactosa, serología VIH, parasitosis, coprocultivo y cultivos especiales, Toxina A de C. difficile, evaluación psiquiátrica, uso de fármacos, etc). En las íleocolonoscopias se efectuaron biopsias secuenciales colon derecho, izquierdo y recto. El estudio histológico se realizó con Hematoxilina y Eosina, rojo congo, Masón y tricrómico para colágeno. Se excluyeron los pacientes con causa conocida de diarrea crónica o hallazgos de lesión a la colonoscopía. Resultados: De 1.145 colonoscopías, cumplen con los criterios de inclusión 16 pacientes, los que son el objetivo del estudio (1,3 por ciento). Corresponden a 8 varones y 8 mujeres, edad promedio de 60,7 años (47-87). En 10 casos las muestras fueron informadas como Colitis leve (62,5 por ciento); un paciente como colitis moderada (6,25 por ciento) y 4 con alteraciones leves e inespecíficas. Sólo 1 paciente (6,25 por ciento) cumplía con los criterios histológicos exigidos para colitis linfocítica. Conclusiones. La frecuencia en esta serie es inferior a lo referido en la literatura, con un solo caso que cumple con los criterios histológicos de 16 pacientes sospechados.

Colonoscopy in children

Pediatric colonoscopy is routinely performed in most hospitals in Saudi Arabia and yet published data are scarce. The objective of this report is to describe our experience in the practice of pediatric colonoscopy in Saudi Arabia. Retrospective analysis of data of all patients below 18 years of age who underwent colonoscopy over a 10-year period. From 1414 H [1993 G] to 1423 H [2002 G], two hundred and seventeen colonoscopies, of which 183 diagnostic procedures, were performed on 183 children. The majority [94%] were Saudi nationals, the age range was between 5 months and 18 years, and the female to male ratio was 1: 0.8. Colonoscopy was total in 58 [32%] and limited in 125 patients [68%]. The commonest reason for not completing the procedure was securing the diagnosis in 45/125 patients [36%]. The commonest indication was rectal bleeding [35%]. The highest yield was in children with bloody diarrhea [91%] and the lowest in those with abdominal pain [27%] with an overall yield of 44%. Colitis was the most common diagnosis occurring in 66% of the children this report highlights the role of colonoscopy in the recognition of diseases of the colon in our community and identifies some of the problems areas associated with the performance of this procedure in our institution

Retrospective study of pathologically proven colitis in King Chulalongkorn Memorial Hospital.

To assess the basic clinicopathological information of colonic inflammation in Thai patients, the authors retrospectively analyzed the 249 biopsied cases with pathological diagnosis as colitis in King Chulalongkorn Memorial Hospital during the five-year period from 1998 to 2002. All subjects were included in this study, whether newly diagnosed or follow-up cases. There were 122 (49%) males and 127 (51%) females with the mean age of 51 years. Non-specific colitis was the most frequent histological diagnosis (72%), followed by infectious colitis (12%), in particular mycobacterial infection. The biopsy specimens were commonly obtained from the rectosigmoid colon (38%). Mucous bloody diarrhea (28%), watery diarrhea (26%), and lower gastrointestinal bleeding (19%) were the three most common symptoms at presentation in order of frequency.

Frequency and spectrum of microorganisms isolated from cases of chronic colitis

Forty patients, 24 males and 16 females aged 17-65 years, diagnosed clinically, sigmoidoscopically and histopathologically as chronic colitis cases [14 [35%] ulcerative colitis, 4 [10%] Crohn's disease and 22[55%] non specific colitis] were investigated by stool analysis, stool culture and biopsy culture. Chlamydia antigen was detected in biopsy specimens by direct immunofluorescence technique. Ten healthy subjects we included as controls. Hundred percent of cases of inflammatory bowel disease [IBD] were positive for bacterial infections compared to 73% in cases of nonspecific colitis [P<0.05] and infection rate was prominant in bilharzial cases 85%. Salmonella paratyphi [A] and Shigella dysentriae were isolated from both rectal biopsy and stool culture each in 2 cases only. The potentially pathogenic bacteria isolated from biopsy culture only were chlamydia trachomatis, Aeromonas hydrophlla, Pseudomonas aeruginosa, Staph. aureus and Diphtheroid. E. coli were isolated from 40 cases by stool culture and from 14 cases by biopsy culture compared to 4 and 20 cases for Klebsiella sp. In cases that were positive by both biopsy and stool cultures the organisms isolated were identical. There were 4 cases that were diagnosed macroscopically as suspecious ulcerative colitis and microscopically as non specific colitis, while by bacterial cultures each of the following organisms were isolated from one case; Klebsiella sp., E. coli, Chlamydia trachomatis and Pseudomonas aeruginosa. The results of the present work revealed that an appropriate diagnostic program of chronic colitis must include endoscopic, histopathologic and bioptic microbiological examinations in addition to stool culture and analysis to avoid inevitable misdiagnosis of IBD and there is a necessity for the cooperation between the endoscopists, histopathologists and microbiologists to reach a proper diagnosis and proper management

Colite relacionada à derivação fecal

Uma forma de colite, denominada colite relacionada à derivação fecal, foi observada em segmentos colônicos excluídos do trânsito fecal. O presente estudo prospectivo objetivou identificar e caracterizar esta nova afecção, estabelecer critérios epidemiológicos, endoscópicos e histopatológicos para seu diagnóstico, bem como observar sua evolução após reanastomose colônica. Em 13 pacientes avaliados sem prévia história de doença inflamatória intestinal inespecífica, os aspectos endoscópicos e histológicos desta afecção foram o de um processo inflamatório inespecífico, indistinguível daquele apresentado por colite ulcerativa. Os portadores de colite de derivação eram usualmente oligossintomáticos. Após cirurgia de reconstrução do trânsito intestinal houve regressão das alterações inflamatórias no colo-reto refuncionalizado, o que torna a cirurgia de reanastomose colônica sua forma de tratamento definitivo

A form of colitis named divertion related colitis was observed in segments of excluded colon from the fecal stream by a diverting colostomy. This prospective study aimed to recognize this new pathology and to know its evaluation after the reestablishment of continuity of bowel. We studied 13 patients with no previous history of inflammatory bowel disease. Patients were usually oligossymptomatic. Their endoscopic and histologic features resembled those of active ulcerative colitis. There was resolution once continuity of the colon was reestablished in alI patients