BACKGROUND/AIMS: Although erythrocyte sedimentation rate (ESR) is included as a laboratory parameter in Truelove and Witts' classification, C-reactive protein (CRP) is also used for severity assessment in ulcerative colitis (UC). Frequently, the discordance between ESR and CRP is observed in clinical practice. The aim of this study was to determine which parameter is more related with clinical activity in UC patients. METHODS: A total of 155 patients with UC were identified from January 2004 to March 2005. Their medical records were reviewed within these patients, a total of 541 assessments of disease activity were made. Correlation of clinical activity and laboratory tests were evaluated by Pearson's correlation coefficient. RESULTS: Pearson's correlation coefficients of ESR and CRP with clinical symptoms were 0.376 and 0.258, respectively. The correlation coefficient between ESR and CRP was 0.403 (p=0.000). A total of 131 (24.2%) assessments revealed discordance between ESR and CRP. When discordance occurred, the correlation coefficients with clinical symptoms were 0.338 for ESR (p=0.000) and 0.034 for CRP (p>0.01). Dividing discordant patients into high ESR/low CRP group and low ESR/high CRP group, the coefficients were 0.420 for ESR and 0.226 for CRP in high ESR/low CRP group, and 0.333 for ESR and 0.068 for CRP in low ESR/high CRP group. CONCLUSIONS: The correlation analysis indicates that ESR appears to be a more reliable laboratory parameter of disease activity than CRP in assessing the severity of UC. In particular, when the level of ESR and CRP is discordant, ESR is more useful in assessing the disease activity in UC patients.
*Blood Sedimentation ; C-Reactive Protein/*analysis ; Colitis, Ulcerative/blood/*diagnosis ; Humans ; Severity of Illness Index

Ulcerative colitis is a chronic inflammatory disorder causing mucosal inflammation of the colorectum with crypt abnormality on biopsy. It affects the rectum and a variable extent of the colon in continuity. Ulcerative colitis is characterized by a relapsing and remitting course. It arises from an interaction between genetic and environmental factors, but the precise etiology is unknown. The incidence and prevalence in Korea are still low compared with those of Western countries, but have increased in recent years. There are many challenging issues on the diagnosis of ulcerative colitis, and sometimes these lead to differences in practice between clinicians. Therefore, IBD Study Group of KASID set out the Korean diagnostic guideline of ulcerative colitis. The diagnosis is based on clinical, endoscopic, radiologic, and histologic criteria. The symptoms are dependent upon the extent and severity of disease and most commonly include bloody diarrhea, rectal bleeding, and/or urgency. The systemic symptoms of malaise, tachycardia, fever, or weight loss are features of a severe attack. The laboratory findings may reveal leucocytosis, thrombocytosis, iron deficiency anemia, hypoalbuminemia, and elevated erythrocyte sedimentation rate and C-reactive protein indicating severe disease activity or chronicity. For the elimination of infectious causes, microbial investigation with stool specimens should be performed for common enteric pathogens including assays for Clostridium difficile toxin, and sometimes for amoeba or other parasites. The most typical endoscopic features are continuous, confluent, and concentric colonic involvement proximal to the anal verge. Endoscopic severity may be best well reflected by the presence of mucosal friability, spontaneous bleeding, and deep ulcerations. Typical pathologic findings are composed of widespread crypt architectural distortion (cryptitis, crypt abscess, and crypt atrophy), heavy, diffuse lamina propria cell infiltration, and basal plasmacytosis.
Blood Chemical Analysis ; Colitis, Ulcerative/*diagnosis/epidemiology/pathology ; Colonoscopy ; Diagnostic Imaging ; Hematologic Tests ; Humans ; Severity of Illness Index

Although a large number of studies have reported the causes of the exacerbation of ulcerative colitis (UC), the effect of influenza vaccination on the relapse of UC has not been reported. We experienced a case of prompt exacerbation of quiescent UC due to influenza vaccination. A 39-year-old woman was diagnosed as UC 4-years ago and was well controlled with oral mesalazine. She experienced abdominal pain and frequent bowel movements with hematochezia 3 days after the vaccination. On admission, laboratory findings showed elevated erythrocyte sedimentation rate and C-reactive protein. Sigmoidoscopy showed marked edematous mucosa on rectum and sigmoid colon with fine ulceration and spontaneous bleeding. She recovered from the exacerbation of UC after steroid treatment. Vaccination should be administered to the patients with inflammatory bowel disease with the caution of its possible side effects.
Adult ; Blood Sedimentation ; C-Reactive Protein/analysis ; Colitis, Ulcerative/*diagnosis/*etiology/radiography ; Female ; Humans ; Influenza Vaccines/administration & dosage/*adverse effects ; Recurrence ; Sigmoidoscopy ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Several clinical risk factors for low bone mineral density (BMD) in the patients with inflammatory bowel disease (IBD) have been suggested. However, its prevalence and pathophysiology in Korean population have not been fully studied. The aim of this study was to investigate the prevalence and risk factors for low BMD in Korean IBD patient. METHODS: BMD of the lumbar spine and femur was evaluated using dual-energy X-ray absorptiometry in 30 patients with IBD. Biochemical parameters of bone metabolism, such as serum calcium, phosphorus, osteocalcin, and deoxypyridinoline were measured. The associations between low BMD and clinical parameters such as disease duration, disease activity, drug history, body mass index (BMI), and others were evaluated retrospectively using medical records. RESULTS: Low BMD at the lumbar spine or femur was observed in 63.3% of the patients, and there was no significant difference between the patients with Crohn's disease and ulcerative colitis. Clinical and biochemical parameters were irrelevant to BMD. In the patients without glucocorticoid treatment prior to BMD measurement, already 50.0% of patients had low BMD. CONCLUSIONS: Low BMD is a common feature in Korean IBD patients, even those who do not use glucocorticoid. The multiple factors may be involved in the pathogenesis of low BMD. Therefore, BMD should be examined in all IBD patients, irrespective of glucocorticoid treatment.
Absorptiometry, Photon ; Adolescent ; Adult ; Amino Acids/blood ; Body Mass Index ; *Bone Density ; Calcium/blood ; Colitis, Ulcerative/diagnosis/radiography ; Crohn Disease/diagnosis/radiography ; Female ; Glucocorticoids/therapeutic use ; Humans ; Inflammatory Bowel Diseases/diagnosis/drug therapy/*radiography ; Male ; Middle Aged ; Osteocalcin/blood ; Phosphorus/blood ; Prevalence ; Retrospective Studies ; Risk Factors

A 21-year-old man admitted complaining of sudden severe epigastric pain for 1 day. He had been diagnosed as ulcerative colitis (UC) and taking mesalazine for two months. UC was in nearly complete remission at admission. He never drank an alcohol, and serum amylase was 377 IU/L. CT scan showed inferior vena cava (IVC) thrombosis in addition to mild acute pancreatitis. To evaluate the cause of acute pancreatitis and IVC thrombosis, magnetic resonance cholangiopancreatogram (MRCP), endoscopic ultrasonogram (EUS), lower extremity Doppler ultrasonogram (US) and blood test of hypercoagulability including factor V, cardiolipin Ab, protein C, protein S1, antithrombin III, and anti phospholipids antibody were performed. There was no abnormality except mild acute pancreatitis and IVC thrombosis in all the tests. He was recommended to stop taking mesalazine and start having anticoagulation therapy. After all symptoms disappeared and amylase returned normal, rechallenge test with mesalazine was done. Flare-up of abdominal pain occurred and the elevation of serum amylase was observed. Ulcerative colitis came to complete remission with short-term steroid monotherapy. Acute pancreatitis and IVC thrombosis were completely resolved after 3-month anticoagulation therapy with no more mesalazine. We postulated that IVC thrombosis occurred due to hypercoagulable status of UC and intra-abdominal inflammation caused by mesalazine-induced pancreatitis.
Acute Disease ; Amylases/blood ; Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/therapeutic use ; Anticoagulants/therapeutic use ; Cholangiopancreatography, Magnetic Resonance ; Colitis, Ulcerative/complications/*diagnosis/drug therapy ; Endosonography ; Humans ; Male ; Mesalamine/*adverse effects/therapeutic use ; Pancreatitis/chemically induced/*diagnosis/ultrasonography ; Tomography, X-Ray Computed ; Ultrasonography, Doppler ; *Vena Cava, Inferior/ultrasonography ; Venous Thrombosis/complications/*diagnosis/drug therapy ; Young Adult