Megacolon en la enfermedad inflamatoria intestinal: respuesta a infliximab / No disponible

El megacolon es una complicación grave de la enfermedad inflamatoria intestinal que con frecuencia requiere colectomía. Infliximab sería una alternativa terapéutica cuando fracasa el tratamiento convencional, antes de la cirugía. En la actualidad, su uso se basa en la publicación de casos aislados. Presentamos nuestra serie de 12 pacientes con megacolon (cinco con signos de toxicidad sistémica) tratados con infliximab. El 75% de los pacientes evitaron la colectomía durante el episodio agudo tras la instauración precoz del tratamiento con infliximab (2,45 días desde el diagnóstico del megacolon), apreciando un mayor riesgo de cirugía entre los pacientes con colitis ulcerosa y criterios de toxicidad. Pese a mantener infliximab a largo plazo, dos pacientes más requirieron cirugía en el seguimiento. Ningún paciente sufrió efectos adversos relevantes en relación con el tratamiento ni complicaciones posquirúrgicas significativas

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Effects of a probiotic (SLAB51™) on clinical and histologic variables and microbiota of cats with chronic constipation/megacolon: a pilot study.

Chronic constipation (CC) and idiopathic megacolon (IMC) occur frequently in cats. The aim of the study was to investigate the effects of a multi-strain probiotic (SLAB51™) in constipated cats (n=7) and in patients with megacolon and constipation (n=3). Ten pet cats with a diagnosis of chronic constipation, non-responsive to medical management received orally 2×1011 bacteria daily for 90 days. For microbiota analysis, selected bacterial groups were analysed by qPCR. Histological samples in megacolons were evaluated for interstitial cells of Cajal (ICC), enteric neurons, and neuronal apoptosis. Biopsies were compared at baseline (T0) and after the end of treatment (T1), and with those obtained from healthy control tissues (archived material from five healthy cats). Constipated cats displayed significantly lower ICC, and cats with idiopathic megacolon had significantly more apoptotic enteric neurons than controls. After treatment with SLAB51™, significant decreases were observed for feline chronic enteropathy activity index (FCEAI) (P=0.006), faecal consistency score, and mucosal histology scores (P<0.001). In contrast, a significant increase of ICC was observed after probiotic therapy. Lactobacillus spp. and Bacteroidetes were increased significantly after treatment (comparing constipated cats before and after treatment, and control healthy cats to constipated cats after treatment), but no other differences in microbiota were found between healthy controls and constipated cats. Treatment with SLAB51™ in cats with chronic constipation and idiopathic megacolon showed significant clinical improvement after treatment, and histological parameters suggest a potential anti-inflammatory effect of SLAB51™, associated with a reduction of mucosal infiltration, and restoration of the number of interstitial cells of Cajal.

Clinical Features and Colonic Motor Disturbances in Chronic Megacolon in Adults.

BACKGROUND: Chronic megacolon is a rare disease of the colonic motor function characterized by a permanent increase in colonic diameter. METHODS: We reviewed electronic medical records of all patients diagnosed with chronic megacolon from 1999 to 2014 at Mayo Clinic. Our aim was to summarize clinical and motility features, including colonic compliance and tone measured by colonic barostat-controlled 10-cm-long infinitely compliant balloon. Colonic compliance curves were compared to healthy control (40) and disease (47) control groups. RESULTS: Among 24 identified patients, the mean maximal colonic diameter on abdominal radiograph was 12.7 ± 0.8 cm. The cause of megacolon was idiopathic in 16 of 24 and secondary in 8 of 24. A relatively high prevalence (10/24) of comorbid pelvic floor dyssynergia was identified. At the time of this report, 16 patients had undergone colectomy. In general, megacolon presented high fasting colonic volume at relatively low pressures (16-20 mmHg), suggesting high colonic compliance; similarly, volumes at operating pressures that ensured apposition of the balloon to the colonic wall suggested low colonic tone. Median balloon volume at 44 mmHg distension was 584 mL (IQR 556.5-600) in patients with megacolon compared to 251 mL (212-281) in healthy, 240 mL (207-286) in functional constipation, and 241 mL (210.8-277.5) in diarrhea-predominant irritable bowel syndrome controls. Colon's tonic response to feeding was generally intact, and there was frequently maintained phasic contractile response to feeding. CONCLUSIONS: Chronic megacolon is a severe colonic dysmotility, manifesting radiologically with increased colonic diameter; it can be proven by measuring colonic compliance and typically requires colectomy because of failed medical therapy.

[Effect of combined drug treatment on megacolon with severe constipation].

OBJECTIVE: To assess the effectiveness of combined drug treatment on megacolon complicated by severe constipation. METHODS: Ten patients with megacolon confirmed by barium enema examination, 4 males and 6 females, aged 38 (15 - 66), with a mean course of 10 years (2 weeks - 23 years), all complicated by severe constipation and 5 cases with colonic obstruction confirmed by X-ray examination, 1 being diagnosed as with Hirschsprung' disease, 3 secondary to chronic constipation, 1 with diabetes mellitus, 1 with a history of anorectal malformation, 4 with colonic pseudo-obstruction, and 4 with colonic pseudo-obstruction, were treated with combined conservative therapy including tegaserod (6 mg 2/d), polyethylene glycol (PEG) 4000 (20 - 40 g/d), and liuweianxiao (traditional Chinese medicine, 5 # 3/d). Colon enema was used in the first week if necessary. Follow-up was conducted for 1 - 7 months. The major clinical data included bowel symptoms, complications and adverse effects. RESULTS: After 1 - 2 weeks of treatment, properties of feces, defecation times, defecation difficulty, and abdominal symptoms, and X-ray findings were all notably improved. No relapse of colonic obstruction was found. The 5 patients with colonic obstruction all showed release. Regarding adverse effect, mild diarrhea was found in 2 cases and was relieved when the dosage was decreased. CONCLUSION: Combined drug treatment including tegaserod, PEG 4000 and traditional Chinese medicine is effective in treating megacolon with severe constipation and may help avoid surgical treatment.

Does aggressive medical therapy for acute ulcerative colitis result in a higher incidence of staged colectomy?

BACKGROUND: Colectomy with ileal pouch-anal anastomosis is the operation of choice in patients with medically refractory ulcerative colitis. However, aggressive or prolonged medical treatment may result in the patient's needing an urgent operation in which a staged subtotal colectomy is necessary. OBJECTIVE: Our hypothesis is that the incidence of patients requiring a staged approach has increased, along with an increase in hospital stay and total hospital costs. DESIGN: We examined the medical records of 250 consecutive patients with ulcerative colitis who underwent ileal pouch-anal anastomosis between 1984 and 1993. RESULTS: Simultaneous colectomy and ileal pouch-anal anastomosis were performed in 196 patients (78%), while 54 patients (21.6%) required staged subtotal (78%) or partial colectomy (22%). Indications for initial colectomy included failure of medical therapy (42 patients [77.8%]), undifferentiated colitis (five patients [9.3%]), and perforation (six patients [11.1%]). An increase in the incidence of patients requiring staged colectomy during this period was observed (P < .05). Staged procedures led to a prolonged hospital course at a significantly greater total cost. CONCLUSION: We conclude that aggressive medical therapy of acute ulcerative colitis has increased the incidence of urgent staged colectomy with a resulting increase in morbidity, hospital stay, and cost and a less-optimal functional result.

Campylobacter-induced toxic megacolon.

A case of a compromised host with myeloproliferative syndrome who presented with severe, relentless but nonbloody diarrhea, fever, severe colitis, and toxic megacolon is presented. Blood cultures grew out Campylobacter fetus ssp. fetus. Specific treatment with erythromycin reversed the grave clinical picture to normal in a 5-day period.

Hirschsprung's enterocolitis, prostaglandins, and response to cholestyramine.

An infant with Hirschsprung's enterocolitis developed a fulminant secretory diarrhea unresponsive to all conventional therapy until cholestyramine was administered. A 12-fold decrease in prostaglandin E (PGE) levels in the colostomy fluid was documented in response to cholestyramine therapy. It is postulated that increased PGE activity, enterotoxin, and bile acid malabsorption may be involved in the enterocolitis of Hirschsprung's disease.

[Arthropathies due to bismuth poisoning]. / Les arthropathies de l'intoxication par le bismuth

Encephalopathies caused by intoxication with bismuth are liable to be complicated by arthropathies of the shoulder, on one or both sides, of an osteolytic, and probably osteonecrotic, type involving to a greater or lesser extent the humeral head and/or by destruction of articular cartilage with ateration and flattening of the heumeral head. The relation between these arthropathies and bismuth intoxication appears certain but is not yet understood. The strict electivity of the condition for the shoulder is not understood either. Certain analogies indicate similarity with metabolic arthropathies.

[D(--)alpha-aminobenzylpenicilline and amino acid pattern in urine (author's transl)]. / D(--)alpha-Aminobenzylpenicillin und Aminosäurenspektrum im Harn

Three cases of patients with D(--)alpha-aminobenzylpenicillinuria are reported. On the quantitative, urinary amino acid chromatogram we found a high ninhydrinpostitive peak between the xi-aminocaproic acid and the arginine peak. Column chromatographic and thin-layer chromatographic studies with test substances permitted to identify the unknown peak as D(--)alpha-aminobenzylpenicillin.