Unspecific Colitis Research Articles

A Rare Case Report of Primary Eosinophilic Colitis

Eosinophilic enterocolitis is the rarest form in primary eosinophilic gastrointestinal disease (EGID) without other causes of eosinophilia. There are few described cases in the literature. We reported a rare case of eosinophilic colitis, where a 35-year-old woman presented to us with chronic diarrhoea associated with abdominal pain and rectal bleeding for 6 months. She had features of unspecific colitis and significant eosinophilia with the colonic biopsy reported. Diarrhoea was resolved with a course of corticosteroid. No complications or recurrences were reported. In conclusion, Eosinophilic colitis is rarely reported. Eosinophilic colitis ethology and pathogenesis is unknown. Its clinical, endoscopic and imaging features are not specific. However, this could be underdiagnosed. All chronic diarrhoea cases should be offered colonoscopy with biopsy to rule out Eosinophilic Colitis.

A High Prevalence of Gastrointestinal Manifestations in Common Variable Immunodeficiency.

OBJECTIVES:Common variable immunodeficiency (CVID) is associated with a spectrum of autoimmune complications. We studied the prevalence of gastrointestinal (GI) manifestations and infections in patients with CVID.METHODS:Complete clinical data of 132 Finnish patients with CVID (106 probable and 26 possible CVID) followed up between 2007 and 2016 were collected to a structured database. Data on endoscopies, histology, and laboratory studies were retrieved from patient files.RESULTS:Most common referral indications were diarrhea and/or weight loss (47%–67%). Patients with probable CVID had higher fecal calprotectin and α1-antitrypsin and lower blood vitamin B12 than patients with possible CVID. Gastroscopy and colonoscopy were done to 71 (67%) and 63 (59%) patients with probable CVID, respectively. Endoscopies showed that 15% of them had chronic active gastritis and 17% atrophic gastritis and 3% had gastric adenocarcinoma. A celiac sprue-like condition was found in 7 patients (10%), of whom 3 responded to a gluten-free diet. Colonoscopies demonstrated unspecific colitis (14%), ulcerative colitis (8%), microscopic colitis (10%), and Crohn's disease (2%). Colonic polyps were noted in 30% of patients, and 3% had lower GI malignancies. Thirty-five patients with CVID had bacterial or parasitic gastroenteritis; chronic norovirus was detected in 4 patients with probable CVID. Patients with GI inflammation had higher levels of fecal calprotectin and blood CD8+ T lymphocytes but lower counts of CD19+CD27+ memory B cells and/or CD19+ B cells. Immunophenotype with low B-cell counts was associated with higher fecal calprotectin levels.DISCUSSION:Patients with CVID had a high prevalence of GI manifestations and infections of the GI tract. GI inflammation was associated with a distinct immunophenotype and elevated fecal calprotectin.

Eosinophilic colitis: Case series and literature review

IntroductionPrimary eosinophilic colitis (EC) in adults is a rare and poorly studied disease, with 3 case series, 2 database-based studies and 52 case reports published to date. MethodsRetrospective study of all adult EC cases diagnosed in a large tertiary hospital (Hospital Clínico San Carlos, Madrid) between 2006 and 2016. We included all cases with a histopathological diagnosis of EC and we selected only those cases that were clinically recognized primary EC. We report their clinical, endoscopic and histopathological features and review the literature on this topic. ResultsWe identified 22 primary EC cases. Patients were mostly women (77%) with a mean age of 41 years. 4 patients (18%) had coexistent allergic diseases. Most patients consulted with diarrhea (86%) and 3 patients also suffered from rectal bleeding. Blood tests showed peripheral eosinophilia in 4 cases (18%). 19 patients had no endoscopic lesions, 2 had features of unspecific colitis and one showed features suggestive of IBD. Mean and maximum number of eosinophils per high power field ranged from 16 to 199 and 20 to 253 (mean: 48 and 70). They were mainly located in the lamina propria and most cases were associated with signs of eosinophil activation. Most patients were treated by corticosteroids, diet or budesonide and the result of treatment was generally good. No complications or recurrences were reported. ConclusionsEC etiology and pathogenesis is unknown. Its clinical, endoscopical and imaging features are not specific, and clear histopathological criteria are lacking. Identification of signs of eosinophilic activation could be helpful.

Impact of esophagogastroduodenoscopy and ileocolonoscopy on diagnosis and therapy in patients with rheumatic diseases—a retrospective cohort study

Objectives: Many rheumatic diseases as well as their medications may cause gastrointestinal (GI) pathologies; in addition, some primary GI diseases may contribute or lead to rheumatic disease manifestations. The aim of this study is to analyze the clinical relevance of esophagogastroduodenoscopy (EGD) and ileocolonoscopy (IC) in patients suffering from inflammatory rheumatic diseases.Methods: A retrospective chart review was performed for all rheumatological inpatients who underwent EGD and/or IC within 2 years.Results: Within 2 years, 456 patients (261 female, 195 male) underwent 752 endoscopic investigations of the GI tract (419 EGDs and 333 ICs). Of all patients, 152 (33.3%) did not report any GI complaints. However, 28 of these asymptomatic patients (18.4%) suffered from esophagitis, a gastric ulcer could be identified in 20 patients (13%), whereas unspecific colitis was diagnosed in 19 patients (12.5%). In addition, 14 patients (9.2%) suffered from clinically unapparent Crohn's disease and two patients from Whipple's disease. In one patient with polymyalgia rheumatica, colon cancer was diagnosed. Altogether 304 patients reported GI complaints. Of these, 292 (39%) endoscopic investigations had impact on the final diagnosis or therapeutic strategy. The antirheumatic medication or the concomitant medication was changed in 18% of the patients due to the endoscopic findings; in 29 patients (6.5%) the initially clinically presumed diagnosis had to be corrected. In 70 patients (15%) with an undefined rheumatic diagnosis prior to endoscopy, endoscopic findings were decisive to establish the final diagnosis.Conclusion: EGD and IC have a high diagnostic impact on patients with rheumatic diseases presenting with or without concomitant GI symptoms.

Colonoscopia em pacientes não pediátricos abaixo de 20 anos de idade traz pouca contribuição nos resultados

INTRODUÇÃO: A utilização da colonoscopia como método de diagnóstico e prevenção das doenças do cólon e reto é cada ano mais freqüente. Esse aumento na indicação também é observado nos extremos de idade, como pacientes não pediátricos abaixo dos 20 anos. MÉTODO: Entre outubro de 1998 a julho de 2006, 4354 pacientes foram submetidos à colonoscopia na clínica privada de um dos autores. Foram analisados retrospectivamente, os prontuários de 66 pacientes com vinte anos ou menos de idade. O estudo histológico foi obtido nos pacientes com exames alterados. RESULTADOS: A idade variou de 11 a 20 anos (média de 17,96 anos). Trinta e nove pacientes pertenciam ao sexo feminino e 27 ao masculino. O exame foi normal em 40, observou-se apenas hiperplasia de tecido linfóide em 10, divertículos em 2, colite inespecífica em 1 e pólipo hiperplásico em 1 paciente, totalizando 54 (81,81%) exames sem alteração específica. Colites foram observadas em 10 e pólipos em 5. Em dois pacientes havia história familiar de doença inflamatória intestinal e em um de câncer de cólon. CONCLUSÃO: A seleção dos pacientes é fundamental para evitar exames colonoscópicos desnecessários em pacientes abaixo de 20 anos de idade.

Inducible and constitutive beta-defensins are differentially expressed in Crohn's disease and ulcerative colitis.

Antimicrobial peptides such as defensins provide nonspecific mucosal defense against a multitude of microorganisms. Recently, it has been shown that luminal bacteria may invade the mucosa in inflammatory bowel diseases, suggesting a defect in innate mucosal immunity. The aim of this study was to investigate the expression of human beta-defensins (HBD) in controls, Crohn's disease (CD), ulcerative colitis (UC), and unspecific inflammation. Up to 4 biopsies were taken from 103 patients (33 controls, 24 with Crohn's disease, 36 with ulcerative colitis, 10 with unspecific colitis). Mucosal mRNA was measured using real-time fluorescence temperature cycler reverse-transcription polymerase chain reaction with primers for HBD-1, HBD-2, HBD-3, tumor necrosis factor alpha, and interleukin 8. Mucosal HBD-1 expression was marginally decreased in both CD and UC. HBD-2 was increased exclusively in UC but not in CD. The expression of the novel defensin HBD-3 was strongly correlated with HBD-2 and also raised predominantly in UC. The expression of both inducible beta-defensins was enhanced in the state of inflammation. Expression of HBD-2 showed a weak correlation with interleukin 8 only in inflamed CD biopsies but not with tumor necrosis factor alpha. The missing induction of both inducible beta-defensins in CD as compared with UC may cause a defect in barrier function that predisposes to bacterial invasion.

Human beta-defensin 2 but not beta-defensin 1 is expressed preferentially in colonic mucosa of inflammatory bowel disease.

Various antimicrobial peptides such as defensins are part of innate immunity and contribute to the intestinal barrier that may be defective in inflammatory bowel disease (IBD). This study investigated beta-defensin mRNA and peptide expression in the colon from controls and patients with Crohn's disease, ulcerative colitis or unspecific colitis as inflammatory controls. Mucosal mRNA expression was measured by multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) with primers for human beta-defensin 1 (HBD-1) and human beta-defensin 2 (HBD-2) in CaCo-2 cells and in biopsies from 103 patients (33 controls, 24 Crohn's disease patients, 36 ulcerative colitis patients, 10 unspecific colitis patients). Paraffin-embedded tissue from colonic resections was tested for HBD-1 and HBD-2 peptides by immunohistochemistry. HBD-1 mRNA was expressed constitutively whereas HBD-2 was induced by pro-inflammatory cytokines in CaCo-2 cells. HBD-1 mRNA was detectable in 61% of control and Crohn's disease biopsies and 53% of ulcerative colitis biopsies. HBD-2 transcript was expressed differentially, with 18% of control biopsies positive as opposed to 34% in Crohn's disease and 53% in ulcerative colitis. HBD-2 mRNA but not HBD-1 mRNA was expressed preferentially in inflamed areas. Immunohistochemical investigation demonstrated the presence of defensin peptides in colonic epithelium as well as the differential induction in IBD. HBD-1 is expressed constitutively in colonic tissue irrespective of inflammation. HBD-2 is barely present in uninflamed colon but it is induced in inflammation. The lower expression of HBD-2 in Crohn's disease compared with ulcerative colitis indicates different responses of the mucosal innate defence. Defensins may play a crucial role in controlling pathogen invasion in IBD, although the functional significance remains to be established.

Innate immunity and colonic inflammation: enhanced expression of epithelial alpha-defensins.

Human alpha-defensins contribute to local intestinal host defense as part of innate immunity and may be of major relevance in microbial infection and chronic inflammatory bowel disease. The objective was to investigate human defensin 5 and 6 (HD-5, HD-6) mRNA expression by RT-PCR from colonic biopsies and peptide expression by immunohistochemistry from colonic resections under basal and inflammatory conditions. Both alpha-defensins were induced by proinflammatory cytokines in cell culture. HD-5 mRNA expression was enhanced in both idiopathic and nonidiopathic inflammatory states of the large bowel [32% of control vs 73% of unspecific colitis, 69% of Crohn's disease (CD) and 73% of ulcerative colitis (UC)], whereas HD-6 was specifically related to CD and UC (14% in controls vs 20% in unspecific coltis, 49% in CD and 42% in UC). Immunohistochemistry confirmed the presence of HD-5 in colonic epithelium. Antimicrobial peptides in the colon may be of importance in maintaining the mucosal barrier and controlling microbial invasion in inflammatory bowel diseases.

Intestinal disease in acquired immunodeficiency: evaluation by CT.

Intestinal symptoms affect most AIDS patients at some point in their disease. The purpose of this study was to evaluate the use of CT in this setting. A total of 339 abdominal CT exams were reviewed for signs of intestinal disease. Abdominal CT scans of 45 patients with intestinal symptoms were compared with colonoscopy and histologic data. The CT results were correlated with CD4( +) T-lymphocyte counts and patient survival. More than 14 % of all abdominal CT exams displayed signs of enteric disease. Of the 45 patients studied with both CT and colonoscopy, 35 (78 %) had signs of intestinal disease by CT. Of these 35 patients, colonoscopic signs of an intestinal lesion were found in 29 and histologic proof of disease was established in 30 cases. Colonoscopy and histology detected 8 lesions missed by CT. There were 14 cases of unspecific colitis, 15 cases of cytomegalovirus (CMV) colitis, and 4 cases of enteric tuberculosis as per biopsy. Five patients presented with Kaposi's sarcoma and 1 with a non-Hodgkin's lymphoma. Neither colonoscopic nor CT signs of intestinal disease did reliably distinguish between histologic subgroups. Specifically, CMV colitis could not be distinguished from unspecific colitis. CD4( +) T-lymphocyte counts for histologic subgroups were not significantly different, either. No colonoscopic or histologic feature predicted survival, whereas low CD4 counts and ascites on CT indicated a poor prognosis. Whereas CT detects signs of intestinal disease in most AIDS patients, these signs remain largely unspecific. Colonoscopy and biopsies provide no consistently valid standard with which to compare CT because of controversial sensitivity and specificity of these methods. The CT technique detects small bowel as well as extraintestinal disease. Therefore, CT is an important diagnostic modality in abdominal disease of immunocompromised patients.

Acute and chronic gastrointestinal manifestations associated with Yersinia enterocolitica infection. A Norwegian 10-year follow-up study on 458 hospitalized patients.

The aim of the present study was to elucidate the gastrointestinal manifestations of yersiniosis. During the period 1974 to 1983, Yersinia enterocolitica infection was diagnosed in 458 patients, by isolation from fecal samples or by antibody response. At first admission, 184 patients had abdominal pain; 200, diarrhea; 45, vomiting; and 36, weight loss. Ulcerative colitis was diagnosed in 7 patients, Crohn's disease in 2, and unspecific colitis in 11. Mesenteric lymphadenitis or ileitis were found in 43 of 56 patients at laparotomy. The patients were followed for 4 to 14 years (1987). Thirty-eight patients were readmitted with abdominal pain and 28 with diarrhea; these symptoms were significantly correlated with the corresponding symptoms at first admission. Chronic colitis was diagnosed in 4 patients, chronic weight loss in 12. A follow-up inquiry (380 patients) indicated that patients with right iliac fossa pain during the acute infection less frequently developed chronic abdominal complaints. Gastrointestinal symptoms are common in both the acute and chronic states of yersiniosis. The correlations between acute and chronic symptoms indicate that yersiniosis is a chronic disease. Immunologically competent individuals may profit by fighting the infection in the right iliac fossa. The relationship between yersiniosis and inflammatory bowel diseases may still not be settled.

Sclerosing cholangitis in cystic fibrosis.

Four of 102 patients with cystic fibrosis with symptoms or signs suggesting sclerosing cholangitis had typical findings at endoscopic retrograde cholangiography (ERC), indicating this syndrome. All patients had pulmonary symptoms, pancreatic insufficiency, and pathologic sweat test results. Three females (aged 15-20 years), two of whom had unspecific colitis, presented with abdominal pain, and a 25-year-old male patient was asymptomatic. Two of the patients had persistently and one patient only intermittently pathologic serum concentrations of transaminases and gamma-glutamyltransferase. The fourth patient, who only had a transient increase of standard liver function tests, showed no progress in any variable (including liver biopsy and ERC) for 3 years, indicating a benign course. Disturbances of the liver and biliary system are well-known complications in cystic fibrosis. Our observations indicate that sclerosing cholangitis is another expression of biliary tract involvement in this disease.

2. SCLEROSING CHOLANGITIS IN CYSTIC FIBROSIS

Three (3.0%) of the 102 patients with cystic fibrosis (CF) attending our CF-center were shown to have ERCP-findings indicating sclerosing cholangitis. All had pulmonary symptoms. Two of them, both females (aged 17 and 20 years), presented with abdominal pain while a 26 years old male was asymptomatic. One of the females also had an unspecific colitis. Two of the patients had persistently altered liver function tests with increase of serum concentration of transaminases and glutamyltransferase while one normalized her laboratory findings. This patient, who was the only one with a microgall bladder, showed no progress during a three years follow up. Liverbiopsies revealed portal fibrosis, bile duct proliferation and an inflammatory reaction and in one case heavy steatosis. Congenital anomalies, biliary calculi, previous operative trauma and malignancy was not found.Primary sclerosing cholangitis is usually related to inflammatory bowel diseases which may be associated with a wide variety of extraintestinal lesions including pulmonary disease. Gastrointestinal manifestations such as liver and biliary diseases are well known complications to CF. To the best of our knowledge this is the first report of sclerosing cholangitis in this disease.