Long-standing Colitis Research Articles

Inflammatory Bowel Disease (Ulcerative Colitis)

There is uncertainty as to the proper management of a patient with chronic ulcerative colitis who has had his disease for over ten years but has not been sufficiently symptomatic to warrant colectomy. Not all patients are at high risk to develop cancer. Wide extent and long duration of disease are correlated with increased risk. The ability to define a patient at risk beyond these single criteria are very limited. The definition and efficacy of the precancerous lesion observed in rectal biopsies is still a matter of dispute, and the routine use of proctocolectomy for patients with long-standing colitis is still not universally accepted. Careful follow-up is obviously indicated, but it is still uncertain whether roentgenography, colonoscopy, colonic biopsy, or a combination of these methods will ultimately prove the procedure of choice.

Carcinoma and Epithelial Dysplasia Complicating Ulcerative Colitis

The pathology of 19 specimens of carcinoma complicating ulcerative colitis, resected in the University Department of Surgery of the General Infirmary at Leeds, was reviewed with particular reference to the incidence of epithelial dysplasia. The carcinomas were found to be more frequently multiple, more evenly distributed in the large bowel, and much more often of atypical macroscopic appearances and of mucoid histological type than ordinary colorectal carcinomas, but the proportion of poorly differentiated tumours complicating ulcerative colitis was not as high as previously reported. Of the patients in our series 26% are alive and well at least 5 years after surgery. Unequivocal epithelial dysplasia was demonstrated in some part of the large intestine in 15 of 19 specimens with colitis carcinoma, but was also found in 4 of 14 specimens from a "control" series of patients with longstanding total colitis but without carcinoma. Clearly, therefore, the finding of dysplasia in a rectal biopsy of a patient with colitis is not a reliable guide to the presence of a frank carcinoma elsewhere in the bowel. Whether it indicates a special predisposition to the development of a growth in the future, as might be postulated from the analogy of similar changes in other organs, cannot be determined on the data of this study. The fact that epithelial dysplasia when present in colitis is often patchy in distribution and frequently spares the rectum even in patients with definite carcinomas makes a negative rectal biopsy particularly unreliable in deciding on the absence of a tumour or the lack of predisposition to it. Multiple biopsies from different parts of the colon as well as the rectum would thus seem to be desirable if mucosal sampling is to be employed as a screening test.

Various Kinds of Eczematoid Eruptions Attributable to Exposure to Foods

In 1935, in a study of a case of severe angina pectoris, it was observed that the eating of certain foods was followed immediately by attacks of angina and also by acceleration of the pulse. When all foods that caused the acceleration were avoided not only did the heart attacks cease, but other symptoms also disappeared. Among these were a long-standing colitis and migraine, both of which conditions had been generally suspected as allergic.