Chronic Nonspecific Colitis Research Articles

Inflammatory Bowel Disease in Infancy: An Increasing Problem?

SummarySeven children with intractable diarrhoea of infancty seen between 1990 and 1993 developed endoscopically established inflammatory bowel disease unrelated to bacterial infection and not responsive to whole protein exclusion. Mouth ulcers were present in two patients, endoscopic upper‐gastrointestinal‐tract inflammation in two, villous atrophy in six, and chronic nonspecific colitis in all seven. There was considerable clinical and histological heterogeneity. All patients required parenteral nutrition. Steroid therapy was completely successful in only one child, while two underwent colectomy, and two died. Previously described cases other than those due to infection or milk intolerance have been rare and sporadic. The prevalence of inflammatory bowel disease in infancy is unknown but appears to be increasing.

Chronic Inflammatory Bowel Disease in Childhood

Definition Chronic inflammatory bowel disease (IBD) of childhood is generally defined as either ulcerative colitis (UC) or Crohn disease (CD). The inflammation of UC is restricted to the mucosal lining of the colon, with the colonic involvement beginning universally in the rectum and extending proximally continuously. Although proctitis, persistent isolated involvement of the rectum, is common in adults (40%), it is rare in children (<10%). In contrast, the enteric inflammation of CD is transmural and involves any level of the intestinal tract discontinuously. The intervals of relatively normal bowel are termed "skip areas." In CD, characteristic lesions range from oral ulcerations to perianal lesions, although the most frequently involved area is the terminal ileum of the small bowel, a process termed ileitis. Recognition of these conditions by pediatricians is important because the peak incidence of IBD is in the second decade. Fewer than 5% of patients are diagnosed prior to age 5 years. In many children presenting with isolated colitis, the diagnosis of the chronic inflammation of IBD is established by biopsy before a clinical distinction between UC and CD can be established. These children carry the diagnosis of chronic nonspecific colitis or colitis type indeterminant. In our experience, the disease in approximately 50% of these children evolves within 5 years into more classic cases of UC or CD.

Chronic Inflammatory Bowel Disease in Childhood

Definition Chronic inflammatory bowel disease (IBD) of childhood is generally defined as either ulcerative colitis (UC) or Crohn disease (CD). The inflammation of UC is restricted to the mucosal lining of the colon, with the colonic involvement beginning universally in the rectum and extending proximally continuously. Although proctitis, persistent isolated involvement of the rectum, is common in adults (40%), it is rare in children ( Recognition of these conditions by pediatricians is important because the peak incidence of IBD is in the second decade. Fewer than 5% of patients are diagnosed prior to age 5 years. In many children presenting with isolated colitis, the diagnosis of the chronic inflammation of IBD is established by biopsy before a clinical distinction between UC and CD can be established. These children carry the diagnosis of chronic nonspecific colitis or colitis type indeterminant. In our experience, the disease in approximately 50% of these children evolves within 5 years into more classic cases of UC or CD.

Frequency and Spectrum of Microorganisms Isolated from Biopsy Specimens in Chronic Colitis

In 109 patients with chronic diarrhea colonic biopsies were examined for the presence of specific microorganisms. A positive result was obtained in 48% of patients with ulcerative colitis, 50% with Crohn's disease, 21% with non-specific colitis and 36% with non-specific proctitis. Chlamydiae were found most frequently in all groups. Obligate enteropathogenic bacteria were isolated in only three cases of nonspecific colitis. Of the facultatively enteropathogenic organisms Klebsiella and Pseudomonas aeruginosa were isolated in 31% and 24%, respectively, of patients with ulcerative colitis, in 21% and 7% of patients with Crohn's disease, and in 10% and 6% of patients with non-specific colitis. Whereas chlamydial proctitis is a well-known disease, the results of this study point also to a possible pathogenic role of chlamydiae in the proximal colon. Facultatively enteropathogenic organisms causing acute diarrhea might have aetiologic relevance in some cases of chronic non-specific colitis.

The place and recognition of emotional factors in the etiology and treatment of chronic non-specific colitis.

The place and recognition of emotional factors in the etiology and treatment of chronic non-specific colitis.