ABSTRACT
Nonsteroidal anti-inflammatory drug-induced colonic strictures are uncommon and usually occur in the proximal ascending colon. We describe the progressive findings of nonsteroidal anti-inflammatory drug-induced strictures in the ascending colon and at the ileocecal valve with subsequent bowel obstruction secondary to intussusception.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Colonic Diseases/chemically induced , Indomethacin/adverse effects , Aged , Colonic Diseases/diagnostic imaging , Humans , Ileocecal Valve , Intussusception/chemically induced , Intussusception/diagnostic imaging , Male , RadiographyABSTRACT
The objective of this study was to determine the effect of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) on inflammatory bowel disease (IBD). A retrospective survey of the medical records of St. Paul's Hospital and its AIDS-care physicians/gastroenterologists searching for patients with both HIV/AIDS and IBD was conducted. Of 1,839 hospitalized patients (4,459 hospital admissions) from 1989 to 1993, two patients with AIDS/HIV and IBD were found. The physician survey revealed four patients for a total of six patients. Four patients developed de novo IBD--two ulcerative colitis (UC), one Crohn's disease (CrD), and one indeterminate colitis (IC)--after HIV infection. Two patients had UC predating HIV seroconversion. The absolute CD4 count of patients with de novo IBD was 210-700 cells/ml at the time of IBD. The patient with IC maintained quiescent IBD from a CD4 count of 190-30 cells/ml. The other had many relapses before HIV seropositivity. With CD4 count depletion, disease activity improved. IBD medications were discontinued at a CD4 count of 130 cells/ml. Diarrhea returned at a CD4 count of 20 cells/ml; however, sigmoidoscopy was unremarkable, and mucosal biopsy revealed cryptosporidiosis without active UC. No patient had an AIDS-related illness during active IBD. Two patients followed to CD4 counts of < 30 cells/ml suffered AIDS-related infections with quiescent IBD. With a progressive decline in CD4 count, IBD disease activity may improve and remit. The CD4 count at which remission occurs may reflect severe immunodeficiency such that risk for AIDS-related infection is high. Active IBD may occur with lesser degrees of immunodeficiency.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Colitis, Ulcerative/complications , Crohn Disease/complications , HIV Infections/complications , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/immunology , Adult , CD4 Lymphocyte Count , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/epidemiology , Colon/pathology , Crohn Disease/diagnosis , Crohn Disease/epidemiology , HIV Infections/epidemiology , HIV Infections/immunology , Humans , Intestinal Mucosa/pathology , Male , Middle Aged , Retrospective StudiesABSTRACT
Two patients who developed painless jaundice while taking sulindac are described. Rechallenge in one case confirmed the association of hepatic damage with sulindac administration. Laboratory data and liver biopsy findings suggested a hepatitis with cholestatic features.
