New-onset Ulcerative Colitis Research Articles

Ulcerative Colitis in Pregnancy: A Japanese Multicenter Cohort Study Focusing on Their Mutual Influence.

Objective To investigate the clinical course of ulcerative colitis (UC) during pregnancy, focusing on their mutual influence. Methods We retrospectively reviewed the medical records of 58 patients with UC who had 73 pregnancies and 3 patients with newly developed UC during pregnancy. We recorded the rate of relapse of UC; the relationship between medication use and UC relapse during pregnancy; treatment for relapse; and the incidence of pregnancy, childbirth, and newborn abnormalities. Results UC was in remission at conception in 78% of the patients. The relapse rate during pregnancy was 27.3%, with most relapses occurring during the second and third trimesters. The relapse rate in patients in whom any UC drug had been discontinued was 50%, a rate significantly higher than the 20.5% of patients for whom all medications were continued (p = 0.016). Thiopurine was discontinued in 60% (6/10) of patients at conception, and the disease relapsed in 50% (3/6) of the patients. Most relapses were successfully treated with 5-aminosalicylic acid or corticosteroids. UC relapse occurred in 26.1% (18/70) of the patients after delivery, mostly within 2 months. Pregnancy, delivery, or neonatal abnormalities occurred in 23.3% (17/73) of patients. In two of the three patients with new-onset UC, UC was severe and required intensive care; however, the pregnancies continued uneventfully. Conclusion Although the progress of pregnancies complicated by UC was mostly uneventful, discontinuing medication carries the risk of UC relapse. Thus, appropriate management of medical treatments for UC during pregnancy is important.

Long-term prognosis and clinical practice for new-onset ulcerative colitis in the era of biologics: A Japanese retrospective study.

There is a scarcity of data on long-term outcomes in patients with new-onset ulcerative colitis (UC) in the era of biologics. We aimed to clarify the long-term prognosis of UC and the clinical practice of prescriptions for UC. We collected 6689 new-onset UC cases using a medical claim database provided by DeSC Healthcare, Inc. We investigated the surgery-free, systemic steroid-free, and molecular targeting drug-free rates and compared their differences based on UC-onset age. We used multivariate analysis to identify clinical factors affecting long-term prognosis and investigated the transition of prescriptions for UC. The surgery-free, systemic steroid-free, and molecular targeting drug-free rates at 5 years post-UC diagnosis were 98.5%, 61.0%, and 88.7%, respectively. Pediatric patients had higher surgery-free rates compared with elderly patients and non-pediatric/non-elderly patients (P = 0.022), whereas the systemic steroid-free and molecular targeting drug-free rates were significantly lower (P< 0.0001, P < 0.0001, respectively). The retention rate of the first molecular targeting drug did not differ between drugs. The prescription rates of systemic steroid, immunomodulator, and molecular targeting drug increased from the second quarter in 2014 to the fourth quarter in 2021 (29.8%-39.1%, 6.8%-17.7%, and 7.6%-16.4%, respectively). We clarified the long-term prognosis and clinical practice of new-onset UC cases. The long-term outcome after UC onset might improve because of increasing use of new therapeutic agents. Further investigations are warranted.

Myocardial Infarction With Nonobstructive Coronary Arteries in New-onset Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a systemic pro-inflamma­tory condition with rare cardiovascular extraintestinal manifestations. Increasing evidence links gut inflammation and cardiovascular pathology, with myopericarditis encompassing approximately 70% of cases.1–3 Myocardial infarction with nonobstructive coronary arteries (MINOCA) has not been described in this population.4 A 36-year-old man with a history of gastroesophageal reflux disease and hypertension presented with a 10-day history of fever, hematochezia, and abdominal pain. Negative history included no travel, suspect foods, or drug use. Family history was negative for IBD or cardiac disease. Exam was unremarkable except for mild abdominal tenderness in bilateral lower quadrants. Labs revealed elevated white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Admission troponin and electrocardiogram (ECG) were normal. Computed tomography (CT) abdomen and pelvis revealed diffuse bowel wall thickening and associated mesenteric inflammation of the entire colon. A stool infectious panel was negative. Sigmoidoscopy demonstrated diffuse continuous ulceration, friability, and granularity up to the splenic flexure (Figure 1A). Colon biopsies demonstrated diffuse, markedly active colitis. Although pathology had no evidence of chronicity, given a negative workup for infection or ischemia, no offending medications, no response to antibiotics, a characteristic endoscopic appearance, and a worsening clinical course that ultimately responded only to steroids, it was determined to be a diagnosis of early and new-onset ulcerative colitis.

Routine Histology-Based Diagnosis of CMV Colitis Was Rare in Pediatric Patients.

Cytomegalovirus (CMV) induced or complicated colitis is important to identify, yet its incidence is unknown among pediatric patients. We aimed to establish the incidence of routine histology-confirmed CMV colitis among pediatric patients with colitis. Pathology reports at Texas Children's Hospital (TCH) between January 1, 2011 and November 6, 2019 were reviewed. Of 1801 cases of histologic colitis, 11 patients had CMV found by histology (mean age 15.4, 72.7% female), with an incidence of 0.6%. Nine out of these 11 (81.8%) patients were immunocompromised and 4 (36.4%) had inflammatory bowel disease (IBD) as an underlying diagnosis of whom 2 had new-onset ulcerative colitis. At an average follow-up of 3.7 years, none of the CMV colitis cases experienced recurrence or severe complications (such as colectomy). An independent analysis of 54 consecutive IBD-associated colectomy cases at TCH showed no histologic evidence of CMV. We conclude that routine histology proven CMV-associated colitis in pediatric patients and IBD-colon explants was rare.Key Words: cytomegalovirus; colitis; children; histopathology; ulcerative colitis.

Evaluation of Difference in Diagnosis Time for Patients with New-onset Ulcerative Colitis by Ultrasound Findings

Evaluation of Difference in Diagnosis Time for Patients with New-onset Ulcerative Colitis by Ultrasound Findings

Role of Serum Proteinase 3 Antineutrophil Cytoplasmic Antibodies in the Diagnosis, Evaluation of Disease Severity, and Clinical Course of Ulcerative Colitis

Background/AimsProteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) is a serologic marker for granulomatosis with polyangiitis. However, recent studies have also shown their role as diagnostic markers for ulcerative colitis (UC). This study was performed to investigate the clinical roles of PR3-ANCAs in the disease severity, disease extension, and clinical course of UC.MethodsSerum PR3-ANCAs were measured in 173 UC patients including 77 patients with new-onset patients UC diagnosed within 1 month, 110 patients with Crohn’s disease, 48 patients with other intestinal diseases, and 71 healthy controls. Associations between the PR3-ANCA titer and clinical data, such as disease severity, disease extension, and clinical course, were assessed. The clinical utility of PR3-ANCA measurement was evaluated by receiver operating characteristic (ROC) analysis.ResultsPR3-ANCA ≥3.5 U/mL demonstrated 44.5% sensitivity and 95.6% specificity for the diagnosis of UC in all patients. PR3-ANCA positivity was more prevalent in the 77 new-onset UC patients (58.4%). In this group, the disease severity and extension were more severe in PR3-ANCA positive patients than in PR3-ANCA negative group (p<0.001). After treatment, the partial Mayo scores were significantly decreased with the PR3-ANCA titers. The proportion of patients who required steroids for induction therapy was significantly higher among PR3-ANCA positive than negative group. ROC analysis revealed that PR3-ANCA ≥3.5 U/mL had 75% sensitivity and 69.0% specificity for steroid requirement in new-onset UC patients.ConclusionsOur results indicate that PR3-ANCA measurement is useful not only for diagnosing UC but also for evaluating disease severity and extension and predicting the clinical course.

Predictors of Clinical Relapse in Patients with New-Onset Inflammatory Bowel Disease

Background and Aims: Inflammatory bowel disease (IBD) usually follows a pattern of more or less frequent relapses of alterable duration, interspersed with periods of remission. Various clinical predictors have been broadly studied, but the research study populations reported are mostly from Western countries. Methods: From January 2013 to December 2018, 106 new-onset Crohn's disease (CD) patients and 76 new-onset ulcerative colitis (UC) patients were followed up for a median of 12 months or until relapse. The predictors of clinical relapse were analyzed according to demographic, clinical, histological, endoscopic, and imaging variables. Results: In multivariate analysis, predictors of relapse were age of onset &lt;35 years (hazard ratio [HR] = 5.236; 95% confidence interval [CI] 1.252–22.222; P = 0.023) in CD patients and poor medication adherence (HR = 2.070; 95% CI 1.018–4.202; P = 0.044) in UC patients. Conclusion: Younger age of onset and poor medication adherence increases the risk of clinical relapse in CD and UC, respectively.

Analysis of Using the Total White Blood Cell Count to Define Severe New-onset Ulcerative Colitis in Children.

The aim of this study was to assess common laboratory tests in identifying severe ulcerative colitis in children at diagnosis. A cohort of 427 children 4 to 17 years of age newly diagnosed with ulcerative colitis (UC) was prospectively enrolled. Boosted classification trees were used to characterize predictive ability of disease attributes based on clinical disease severity using Pediatric Ulcerative Colitis Activity Index (PUCAI), severe (65+) versus not severe (<65) and total Mayo score, severe (10-12) versus not severe (<10); mucosal disease by Mayo endoscopic subscore, severe (3) versus not severe (<3); and extensive disease versus not extensive (left-sided and proctosigmoiditis). Mean age was 12.7 years; 49.6% (n = 212) were girls, and 83% (n = 351) were Caucasian. Severe total Mayo score was present in 28% (n = 120), mean PUCAI score was 49.8 ± 20.1, and 33% (n = 142) had severe mucosal disease with extensive involvement in 82% (n = 353). Classification and regression trees identified white blood cell count, erythrocyte sedimentation rate, and platelet count (PLT) as the set of 3 best blood laboratory tests to predict disease extent and severity. For mucosal severity, albumin (Alb) replaced PLT. Classification models for PUCAI and total Mayo provided sensitivity of at least 0.65 using standard clinical cut-points with misclassification rates of approximately 30%. A combination of the white blood cell count, erythrocyte sedimentation rate, and either PLT or albumin is the best predictive subset of standard laboratory tests to identify severe from nonsevere clinical or mucosal disease at diagnosis in relation to objective clinical scores.

New-Onset Ulcerative Colitis After Kidney Transplant Immunosuppression

New-Onset Ulcerative Colitis After Kidney Transplant Immunosuppression

Use of corticosteroids for remission induction therapy in patients with new-onset ulcerative colitis in real-world settings

ABSTRACTBackground: Corticosteroids may be temporarily effective for ulcerative colitis (UC), but long-term use increases the risk of adverse drug reactions.Objective: The goal of the study was to examine steroid use in remission induction therapy after diagnosis of UC.Study Design: A retrospective observational study using the Japan Medical Data Center (JMDC) Claims Database from January 2008 to December 2014.Setting: Clinics, university hospitals, and national/public hospitals.Intervention: Initiation of steroids after diagnosis of UC.Main outcome measures: Start time and annual rate of steroid use, and use during the first 6 months of remission induction therapy.Results: The subjects were 399 patients were newly diagnosed with UC in the study period. The rate of steroid use after diagnosis was 58.4% in 2009, and showed a significant decreasing trend yearly after 2010 (p ≤ 0.0001). Regarding the start time, 52.2% of patients began steroids within 60 days after diagnosis of UC. At 6 months after initiation, 23.7% continued to use steroids and 73.9% of these patients used high-dose steroids.Conclusion: In treatment of UC after diagnosis, many patients continue to use steroids for >6 months after initiation. Reduced use of steroids based on clinical practice guidelines for UC should be promoted.

Mortality in Elderly Onset Ulcerative Colitis: A Population-Based Cohort Study

Introduction: Elderly-onset inflammatory bowel disease (IBD) composes up to 20% of new cases of IBD, and ulcerative colitis (UC) is up to twice as common as Crohn's disease (CD) among the elderly. Some, but not all, studies have shown a modest increase in mortality among all patients with IBD. To our knowledge, no studies have evaluated the long-term mortality among patients with elderly-onset UC in the United States. Methods: We conducted a retrospective cohort study to evaluate the all-cause mortality and survival among patients with elderly-onset UC vs. non-IBD patients in the US National VA health care system from January 1, 2000 to June 30, 2016 using data from the VA Informatics and Computing Infrastructure. We included individuals with new-onset UC in the exposure group (UC group) if they met the following conditions: 1) ≥2 UC diagnoses and no diagnoses of CD or other diseases of the anus/rectum; 2) age>60 at the time of first UC diagnosis; 3) ≥1 year of pre-diagnosis VA care; 4) ≥5 VA visits prior to UC diagnosis 5) ≥ 4 pharmacy claims for aminosalicylates. For each elderly-onset UC patient, up to 4 non-IBD veterans were selected, matching on: 1) date of birth; 2) first VA visit; 3) VA location and 4) gender. Time to death was the outcome of interest. We estimated the incidence rate of death in the exposed and unexposed groups, respectively. Cox regression was used to determine the hazard ratio for time to death associated with elderly-onset UC. Results: The mean age was 70.7 (SD 7.4) years among the UC group and 70.3 (SD 7.4) in the non-IBD group. As expected, there was male predominance in the groups (97.6%). Elderly-onset UC patients had worse survival compared to matched non-IBD patients (Figure, log-rank test p value<0.0001). The incidence rate of death after UC diagnosis among the exposed group (N= 4,327) was 106.8 deaths per 1000 patient-years (95% CI 106.7 - 106.9) compared with 74.5 (95% CI 74.5- 74.6) in the matched non-IBD comparison group (N= 17,164). Compared with the non-IBD group, the hazard ratio for death associated with elderly-onset UC was 1.49 (95% CI: 1.42 - 1.55). Conclusion: We report a novel population-based mortality rate among elderly-onset UC patients. In addition, we observed that elderly-onset UC is associated with significantly increased risk of mortality compared to an age and sex matched non-IBD population. These prognostic data would be of great interest to patients and health policy makers.576 Figure 1. Death after UC Diagnosis vs. Matched Date in UC and non-IBD cohorts.

874g - Microbial Dysbiosis Associated with Disease Severity in Treatment Naive Pediatric Patients with New-Onset Ulcerative Colitis

874g - Microbial Dysbiosis Associated with Disease Severity in Treatment Naive Pediatric Patients with New-Onset Ulcerative Colitis

Current approaches to the management of new-onset ulcerative colitis.

Ulcerative colitis (UC) is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity) but must also take into consideration treatment options for the long-term. The following review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to- moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids) or thiopurines (as bridging therapy). Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon) should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide a comprehensive evidence-based approach to current treatment options for new-onset UC with discussion of long-term therapeutic efficacy and safety, patient-centered perspectives including quality of life and medication compliance, and future directions in related inflammatory bowel disease care.

Treatment of new‐onset ulcerative colitis and ulcerative proctitis: a retrospective study

Although guidelines recommend use of oral 5-aminosalicylates (5-ASAs) as first-line therapy in patients with mild to moderate ulcerative colitis (UC) and ulcerative proctitis (UP) and steroids with or without 5-ASAs in those more severely ill, little is known about how UC and UP are actually treated. To document treatment of new-onset UC and UP in routine clinical practice. Using a large US health insurance database, we identified all persons with new-onset UC or UP between 1 January 2005 and 31 December 2007, based on: (i) initial receipt of an oral 5-ASA, mesalazine (mesalamine) suppository, 5-ASA enema, steroid, antimetabolite, budesonide or TNF inhibitor; (ii) sigmoidoscopy/colonoscopy in prior 30days resulting in a new diagnosis of UC or UP and (iii) no prior encounters for Crohn's disease. We examined patterns of pharmacotherapy over 1year. We identified 1516 UC patients and 636 UP patients who met study entry criteria. In UC, initial therapies most frequently used were oral 5-ASAs (53% of patients), oral 5-ASAs and systemic steroids (12%), systemic steroids (8%) and mesalazine suppositories (6%); in UP, mesalazine suppositories (42%) and oral 5-ASAs (19%) were most often used, followed by combination therapy (14%), mesalazine enema(11%) and rectal steroids (10%). Few patients received maintenance therapy, and there was limited use of antimetabolites and biological agents. Oral 5-ASAs and systemic steroids are the mainstay of treatment in patients with new-onset ulcerative colitis; in those with new-onset ulcerative proctitis, it is mesalazine suppositories. Care of these patients appears consistent with treatment guidelines.

Future Therapeutic Approaches for Inflammatory Bowel Diseases

In this review, we speculate about future therapeutic approaches for inflammatory bowel diseases (IBDs), focusing on the need for better preclinical and clinical models and approaches beyond small molecules and systemically administered biologics. We offer ideas to change clinical trial programs and to use immunologic and genetic biomarkers to personalize medicine. We attempt to reconcile past therapeutic successes and failures to improve future approaches. Some of our ideas might be provocative, but we hope that the examples we provide will stimulate discussion about what will advance the field of IBD therapy.

New-Onset Ulcerative Colitis in a Patient Treated With the Anti-CD11a Monoclonal Antibody Efalizumab

1Department of Gastroenterology, Royal College of Surgeons, Beaumont Hospital, Dublin, Ireland. Correspondence: Garret Cullen, MD, Department of Gastroenterology, Royal College of Surgeons, Beaumont Hospital, Dublin 9, Ireland. published online 3 March 2009 E-mail: [email protected]

Short‐ and Long‐term Response to and Weaning from Infliximab Therapy in Pediatric Ulcerative Colitis

We evaluated the response to infliximab in pediatric patients with ulcerative colitis (UC) and their long-term follow-up. We expanded our previous study of 14 patients and furthermore evaluated the success of weaning patients from infliximab. We reviewed the charts of 27 pediatric patients with UC who were treated with infliximab instead of undergoing a colectomy. Patients with new-onset UC refractory to intravenous steroids for 5 to 10 days and patients with non-steroid-dependent UC with an acute exacerbation were classified as acutely ill (n = 16); patients with chronic steroid-dependent UC were classified as chronically ill (n = 11). The Lichtiger Colitis Activity Index (LCAI) was measured for all patients at baseline and at 1 and 2 months after treatment with infliximab was initiated. Patients were regarded as successfully treated if they remained off steroids and avoided colectomy. The acutely ill group had a mean LCAI score of 11.4 at induction and 0.3 after 2 months. The chronically ill group had a mean LCAI score of 11.2 at induction and 5.5 after 2 months. Treatment with infliximab was successful in 75% of acutely ill patients and in 27% of chronically ill patients. Infliximab was discontinued in 80% of successfully treated patients (83% of acutely ill, 67% of chronically ill). These patients had an average of 10 infusions and a mean follow-up time of 10 months from their last infliximab infusion. Our results suggest that infliximab is more effective in acutely ill UC patients than in patients with chronic steroid-dependent UC. In addition, some patients treated with infliximab can be weaned from infliximab and maintain remission.

Pediatric Patients With Untreated Ulcerative Colitis May Present Initially With Unusual Morphologic Findings

Anecdotal observations by the authors of this study, together with the results of a few previous smaller studies, suggest that children with new-onset (previously untreated) ulcerative colitis (UC) may occasionally present with discontinuous disease, relative or absolute rectal sparing, and may lack histologic features ofchronicity. Therefore, the objectives of this study were to determine the clinical and pathologic features of new-onset UC in children and to compare the initial presentation of UC in this group with a control group of adults. Routinely processed rectal and colonic mucosal biopsies from 73 pediatric (male/female ratio 33/40, mean age 11.5 years, range 2.5-18 years) and 38 adult patients (male/female ratio 15/23, mean age 41.5 years, range 27-64 years) who presented with new-onset UC were evaluated for a variety of clinical and pathologic features, including duration of symptoms prior to presentation, crypt architectural (e.g., atrophy, branching) and nonarchitectural (e.g., basal plasmacytosis, Paneth cell metaplasia) features of chronicity, degree of active inflammation, and distribution and extent of disease. A significant proportion of children with new-onset UC had patchiness of microscopic features of chronicity (21% of patients), relative (23%), or absolute (3%), rectal sparing, and had little or no crypt architectural distortion in their rectal biopsies (8%). These features were not observed in adult patients with UC. In addition, a higher proportion of children with UC initially presented with subtotal or with pancolitis compared with the adults (42% vs. 11%; P < 0.002). A significant proportion of children with new-onset UC may show unusual patterns of disease. Pathologists should be aware of these findings since they have significant implications for the differential diagnosis of pediatric inflammatory bowel disease.

Colorectal disease in liver allograft recipients -- a clinicopathological study with follow-up.

To determine the spectrum and outcome of colorectal diseases occurring in adult liver allograft recipients. A retrospective cohort analysis of clinical, microbiological and histopathological data regarding colorectal disease. Forty three out of 302 adult primary liver allograft recipients were transplanted and followed up (at median 42 months) at a tertiary referral centre/teaching hospital. Out of 302 patients, 43 (14%) were investigated (by endoscopy and/or laparotomy) for symptoms of colorectal disease after orthotopic liver transplantation. The symptoms were: diarrhoea (n = 31); per-rectal bleeding (n = 5); and symptoms relating to pre-transplant ulcerative colitis (n = 7). Among the patients without known ulcerative colitis, per-rectal bleeding occurring early after orthotopic liver transplantation was most commonly caused by cytomegalovirus colitis and carried a poor prognosis. Excluding ulcerative colitis, the commonest causes of diarrhoea were Clostridium difficile, cytomegalovirus infection and medications, particularly during the first 2 months after orthotopic liver transplantation. No cases of colorectal graft-versus-host disease, cryptosporidiosis, amoebiasis, atypical mycobacterial infection or post-transplant lymphoproliferative disease were demonstrated. The activity of pre-transplant ulcerative colitis was unchanged or increased after orthotopic liver transplantation. Two further patients developed new-onset ulcerative colitis after orthotopic liver transplantation. Ulcerative colitis, C. difficile, cytomegalovirus infection and medications are the commonest colorectal causes of morbidity after orthotopic liver transplantation. Adult liver allograft recipients are, however, unlikely to show certain large bowel diseases encountered in other immunosuppressed groups. Amongst non-ulcerative colitis patients, those presenting with diarrhoea show a good outcome with appropriate management, whereas those with per-rectal bleeding have a more guarded prognosis.

Pancreatitis After Rectal Administration of 5-Aminosalicylic Acid

A patient treated with sulfasalazine for new-onset ulcerative colitis developed self-limited pancreatitis. Rechallenge with 5-aminosalicylic acid (5-ASA) in enema form (Rowasa) again induced pancreatitis. Recent case reports suggest that the salicylate component of sulfasalazine can lead to the development of pancreatitis with oral 5-ASA administration. This patient's course demonstrates further that rechallenge with 5-ASA in a rectal form may also lead to pancreatitis.