Ulcerative colitis in Thailand: a clinical study and long term follow-up.

Ulcerative colitis (UC) is uncommon in Thailand. Few reports have been published and confirmation of the diagnosis was difficult. To make a firm diagnosis of UC in Thailand, long-term follow-up and demonstration of chronic and relapsing clinical courses should help to confirm the existence of UC in Thailand. OBJECTIVE: To review the demographic data, clinical presentation and clinical courses of the diagnosed UC cases in Thailand. MATERIAL AND METHOD: Diagnosed UC patients who were followed-up for longer than 3 months at the Diarrhea Clinic, Siriraj Hospital between 1988-2000 were included. RESULTS: Forty cases of UC were followed-up. The duration of follow-up ranged from 3-75 months (mean 27 months). Male to female ratio was 19:21 and age of onset varied from 13-77 years (mean 37.7 years). Extents of the disease was left-sided colitis in 58 per cent, left and right-sided colitis in 8 per cent, pancolitis in 21 per cent, proctosigmoiditis in 13 per cent and ileal involvement in 8 per cent. At presentation, the disease was mild in 28 per cent, moderate in 60 per cent, severe in 13 per cent and fulminant in 2. Clinical presentations were diarrhea in 97.5 per cent, lower GI bleeding in 17.5 per cent, abdominal pain in 50 per cent, fever in 27.5 per cent, weight loss in 62.5 per cent and extraintestinal manifestations in 20 per cent. Diagnoses were made in all cases by sigmoidoscopy plus barium enema or colonoscopy and biopsies were taken in all cases. Histologic findings supported the diagnoses in 69 per cent of cases. Seventy per cent responded to sulfasalazine or 5-ASA with or without corticosteroid, but in 30 per cent, azathioprine was added for a period during the treatment. Clinical courses of the diseases were chronic intermittent with remission and relapse in 44 per cent, chronic continuous activity without remission in 27 per cent, single episode without relapse in 27 per cent and acute fulminating course in 6 per cent. One patient died from fulminant pancolitis with colonic perforation. There was no colonic cancer in our cases throughout the follow-up period. CONCLUSIONS: UC is very uncommon in Thailand. Firm diagnosis of UC can be made through long-term follow-up and demonstration of chronic and relapsing clinical courses. The disease severity and extent of disease involvement was slightly different from that in Western countries. Incidence of extraintestinal manifestation was 20 per cent. Most cases responded to sulfasalazine, 5-ASA or corticosteroids.

Intestinal microsporidiosis in HIV infected patients with chronic diarrhea in Thailand.

Microsporidia have been recognized as emerging opportunistic agents affecting multiple organs. Intestinal microsporidiosis caused by Enterocytozoon bieneusi and Encephalitozoon intestinalis is a common disease which is associated with gastrointestinal symptoms, particularly in AIDS patients. So far, information on the frequency of this enteric disease in Thailand is not available. Therefore, the present study was undertaken to investigate the prevalence of intestinal microsporidiosis in HIV infected persons with chronic diarrhea. From 1995 to 1996, multiple diarrheal stool specimens were received and examined for the presence of the organism using Weber's modified trichrome staining method and transmission electron microscopy for confirmation. Twenty-two of 66 patients (33.3%) were positive for microsporidia which appeared as pink-red spores of 0.8-1.2 x 0.7-0.9 microm with the characteristic transverse or oblique band representing the coiled polar filament. Clinical features of these patients included chronic diarrhea (100%), weight loss (100%), abdominal pain (77%), fever (36%), vomiting (36%) and anorexia (18%). Transmission electron microscopic examination of fecal specimens from the 22 patients with positive staining results revealed E. bieneusi in 18 cases.

Effects of cigarette smoking on duodenal ulcer healing and relapse rate.

104 duodenal ulcer patients were classified into non-smokers (76) and smokers (28). Their age range was between 14-72 years. They were randomly treated with cimetidine (28 non-smokers and 8 smokers), colloidal bismuth (27 non-smokers and 10 smokers) and sucralfate (21 non-smokers and 10 smokers). Follow-up endoscopic examination at 4, 6 and 8 weeks showed that overall healing rates were better in the non-smokers than in the smokers (64.5% against 46.4% at 4 weeks and 92.1% against 67.8% at 6 weeks) and almost all ulcers had healed at the end of 8 weeks (100% in non-smokers and 96.4% in smokers). Among non-smokers, there were no statistically significant differences in the healing rates by any medication at any period of time. Among smokers, colloidal bismuth had significant better healing rate at 6 weeks over cimetidine and sucralfate. (p = 0.04 and p = 0.041 respectively). Overall relapse rates were higher among smokers (32.1%) than non-smokers (10.5%). Of the 3 medications, sucralfate had the lowest relapse rate in both smokers (20%) and non-smokers (9.5%), while colloidal bismuth had the highest relapse rates (40% for smokers and 11.1% for non-smokers).

Gastric acid secretion in Thai patients with particular reference to the characteristics differentiating types of gastric and duodenal ulcer.

Acid secretion in both basal and stimulated states (using augmented histalog test) was studied in 31 normal control patients, 64 duodenal ulcer patients and 101 gastric ulcer patients. Having had the result of acid output study, the 64 DU patients could be classified according to their acid secretion results as 35 DU type I or Normosecretor (54.7%) and 29 DU type II or Hypersecretor (45.3%). For the GU patients which were classified according to the sites of lesions as GU type I (GU above angulus), GU type II (GU associated with DU) and GU type III (GU below the angulus). Their acid output study showed that the GU type I had a rather low BAO and a high MAO close to that of the Normosecretor, but the GU type II and III had their BAO and MAO significantly higher than that of the normal control and close to that of the Hypersecretor. Comparison of acid secretion in this study group to other racial groups showed that the Thai population had acid secretion patterns close to other Asian populations, except that the Chinese in Singapore had a higher proportion of Normosecretor (69.0%) than Hypersecretor (31%). The MAO of the Asian population was found to be lower than that of Europeans.

Detection of Salmonella typhi protein antigen in serum and urine: a value for diagnosis of typhoid fever in an endemic area.

Using haemoculture as the gold standard, a double antibody sandwich ELISA for the detection of Salmonella typhi Barber protein antigen (BP) was compared with the Widal test. Specimens used were serum and urine obtained from normal healthy individuals and from patients with typhoid fever, paratyphoid fever, pyrexia caused by other bacteria and pyrexia with negative haemoculture. The ELISA for antigenuria gave a significantly higher sensitivity, specificity, accuracy and positive predictive value than the Widal test (p less than 0.05). The ELISA for antigenaemia gave a significantly higher sensitivity and positive predictive value only. All other values were not significantly different. The timing of specimen collection was critical for sensitivity in the ELISA for antigenaemia and antigenuria, and the best results could be obtained by carrying out both assays simultaneously. The clearance of BP from serum into urine occurred around 16 days after the onset of fever in one patient. In two patients, BP could be detected in sera up to 3 weeks after the onset of fever. In two patients, serum BP could still be detected although haemoculture was negative.

Chronic diarrhoea: a prospective study in Thai patients at Chulalongkorn University Hospital, Bangkok.

Fifty-five Thai patients with chronic diarrhoea were prospectively studied to find out the underlying causes. The aetiology was identified in 38.2%, uncertain in 29.1%, and unknown in 32.7% of the patients. In the group with a definitive aetiologic diagnosis, parasitic and infective causes were commoner than non-infective causes. Amoebiasis and giardiasis were more frequent than expected, such that empirical therapeutic trial with an antiprotozoal may be justified if initial routine investigations fail to uncover the cause of the diarrhoea. No significant clinical features were noted between the infective and the non-infective groups. Overall, repeated stool microscopy using the concentration technique was the most useful single investigation in approaching the chronic diarrhoea problem.