Autoimmunity is thought to play a central role in the pathogenesis of inflammatory bowel disease and associated extraintestinal manifestations. Autoimmune hemolytic anemia associated with ulcerative colitis is a rare occurrence. No more than 50 cases have been described in the international literatures, and only 2 cases reported in Korea. A 29-year-old woman who was diagnosed as ulcerative colitis two years ago was complicated with autoimmune hemolytic anemia, and did not respond to steroid therapy. Ultimately, total colectomy and splenectomy were carried out for the treatment of ulcerative colitis and hemolytic anemia. After the operation, anemia was resolved. We present the case with a review of literature.
Adult ; Anemia, Hemolytic, Autoimmune/*diagnosis/drug therapy/etiology ; Colectomy ; Colitis, Ulcerative/complications/*diagnosis/pathology ; Drug Resistance ; Female ; Humans ; Splenectomy ; Steroids/therapeutic use

Anti-Inflammatory Agents ; therapeutic use ; Colitis, Ulcerative ; diagnosis ; drug therapy ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Integrative Medicine

Amebic colitis is a disease revealing diverse clinical manifestations and endoscopic gross features and often confused with other types of colitis. In case of misdiagnosis as an idiopathic inflammatory bowel disease or delayed recognition of intestinal amebiasis, an undesirable outcome may occur resulting from erroneous administration of steroids or delayed antiamebic treatment. To demonstrate the pitfalls in the diagnosis and treatment of intestinal amebiasis, 3 cases of amebic colitis with atypical clinical manifestations are presented in this paper. In conclusion, despite the low sensitivities of routine stool examination for parasite and histopathologic confirmation in biopsy specimen, every effort must be made to find amebic trophozoites either in fresh stool or biopsy specimens for prompt and correct diagnosis of amebic colitis when we manage patients with chronic intestinal ulcerations, even though their clinical course and endoscopic findings are not typical of amebiasis. Moreover, following initial successful anti-amebic therapy, more careful clinical, endoscopical, and parasitological follow-up should be done for the early detection of recurrence.
Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/diagnosis ; Diagnosis, Differential ; Diarrhea/etiology ; Dysentery, Amebic/complications/drug therapy/*pathology ; Female ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Male ; Middle Aged

Kaposi's sarcoma is a rare and slowly progressive disease that primarily affects the skin but has an associated visceral involvement. It can occur in the HIV-positive patients or patients treated with immunosuppressants. However, it is extremely rare in the patients receiving the treatment for inflammatory bowel disease. We used corticosteroid for the treatment of ulcerative colitis in 60-year-old woman. Then, Kaposis's sarcoma occured in the skin and colon of the patient. Since she was HIV-negative, we believed that it was developed from the condition of corticosteroid-induced immunosuppression. We present a case of skin and colonic Kaposi's sarcoma in a HIV-negative woman following treatment with corticosteroid for ulcerative colitis.
Aged ; Colitis, Ulcerative/*complications/drug therapy ; Colonic Neoplasms/*complications/diagnosis ; English Abstract ; Female ; Humans ; Sarcoma, Kaposi/*complications/diagnosis ; Skin Neoplasms/*complications/diagnosis

BACKGROUND/AIMS: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to be lower in individuals with inflammatory bowel disease (IBD) in some Western countries. We investigated H. pylori infection in Korean patients with IBD and any possible associations of H. pylori infection with drug therapy for IBD and the phenotype of Crohn's disease (CD). METHODS: We studied 316 unselected patients with IBD, including 169 ulcerative colitis (UC) patients and 147 with CD, and the control group consisted of 316 age- and gender-matched healthy people who received a comprehensive medical examination for a regular checkup purpose. Infection rates of H. pylori as detected by the urea breath test were compared between the IBD patients and the controls. RESULTS: A statistically significant difference in H. pylori infection rate was noticed between the IBD patients (25.3%) and the controls (52.5%; p<0.001), and between UC (32.0%) and CD patients (17.7%; p=0.04). Among the IBD patients, the age group of <60 and individuals with a history of taking metronidazole (13.0%; p=0.038) or ciprofloxacin (6.7%; p=0.001) were found to have a meaningfully lower infection rate, but those who did not take antibiotics still showed H. pylori infection rate significantly lower than the controls (CD 22.0% vs. UC 33.8% vs. Control 52.5%, p<0.001). With an exception of age, phenotypic characteristics showed no significant relations with H. pylori infection rate in CD patients. CONCLUSIONS: Korean patients with IBD, particularly CD, were found to have a significantly lower H. pylori infection rate than the controls. This association was more evident in those <60 years old, which suggested that H. pylori infection might be deemed to lower possible risks of IBD in younger adults.
Adolescent ; Adult ; Age Factors ; Aged ; Colitis, Ulcerative/complications/diagnosis/drug therapy ; Crohn Disease/complications/diagnosis/drug therapy ; Female ; Helicobacter Infections/complications/diagnosis/*epidemiology ; *Helicobacter pylori ; Humans ; Inflammatory Bowel Diseases/*complications/diagnosis/drug therapy ; Korea ; Male ; Middle Aged ; Phenotype ; Prevalence

The cyclooxygenase (COX) is a key enzyme in the coversion of arachidonic acid to prostaglandins. COX-1 is constitutively expressed and is a critical housekeeping gene, whereas COX-2 is rapidly upregulated by growth factors and cytokines and thus responsible for inflammation. COX-2 is frequently overexpressed in colonic adenoma and carcinoma. Specific inhibitors of COX-2 have been shown to induce apoptosis in tumor cells and to inhibit tumor growth in animal models and in humans. Long-standing IBD patients have increased risk of developing colorectal cancer compared to general population. IBD-associated colorectal carcinogenesis is probably promoted by chronic inflammation and closely related to COX-2. In a recent study, powerful chemopreventive ability of selective COX-2 inhibitor was observed in colitis-related colon carcinogenesis in mouse model. But it was reported that even selective COX inhibitors aggravated the DSS-induced colonic inflammation. It is assumed that endogenous PGs are involved in the mucosal defense against DSS-induced colonic ulcerations which are produced by COX-1 at early phase and by COX-2 at late phase. Long-term use of COX-2 inhibitors for the chemoprevention of colitic cancer is needed to define their mechanism of action, that reduce side effects and have specific tumor target.
Animals ; Colitis, Ulcerative/*drug therapy ; Colonic Neoplasms/diagnosis ; Cyclooxygenase 1/metabolism ; Cyclooxygenase 2/metabolism ; Cyclooxygenase 2 Inhibitors/pharmacology/*therapeutic use ; Humans ; Mice ; Models, Animal

OBJECTIVETo observe the clinical effects of Qingchang Huashi Recipe (QHR) for treating active ulcerative colitis (UC) patients of inner-accumulation of damp-heat syndrome (IADHS), and to evaluate its safety.

METHODSUsing a central random system, 60 patients with mild-to-moderately initial onset or relapsed active UC of IADHS were assigned to the test group (30 cases) and the control group (30 cases). Patients in the test group took QHR (Rhizoma Coptidis 6 g, Radix Scutellariae 10 g, Radix Pulsatillae 10 g, Radix Aucklandiae 10 g, parched Radix Angelicae sinensis 10 g, Radix Paeoniae alba 20 g, Cortex Cinnamomi 3 g, Radix Glycyrrhizae 6 g, and so on), 1 dose each time, decocted twice, mixed to 300 mL, taken in two portions. The components were modified according to the condition of illness. Enema of Guanchang Recipe (GCR) was combined (Cortex Phellodendri 30 g, Radix Sophorae flavescentis 10 g, Radix Sanguisorbae 30 g, Rhizoma bletillae 9 g, Radix notoginseng 3 g, Xilei powder 1.5 g), decocted twice, mixed and concentrated to 120 mL, applied before sleep every evening, with an interval of 12 days after 12 successive days). Those in the control group took Mesalazine Enteric-coated Tablet (MECT, 0.25 g/tablet), 1 g each time, 4 times daily. The therapeutic course for all was 8 weeks. The symptom integral, the colonoscopic results, the pathological efficacy, and the remission rate were compared between the two groups. The medication safety was monitored.

RESULTSBy the end of the treatment the improvement of symptoms was superior in the test group to that of the control group (P<0.05). The colonoscopic and pathological results were improved in the two groups, but with no statistical difference (P>0.05). There was no statistical difference in the mucosal healing rate (50.0% vs 43.3%) and the remission rate (36.7% vs 30.0%) between the two groups. Only 1 patient of the control group had moderate increase of ALT during the whole test.

CONCLUSIONSQHR was effective and safe in treating active UC patients of IADHS. Besides, its effect on improving the symptoms was better than that of MECT.

Adult ; Colitis, Ulcerative ; diagnosis ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Mesalamine ; therapeutic use ; Middle Aged ; Phytotherapy ; methods ; Treatment Outcome

OBJECTIVETo explore the role of mast cells in the pathogenesis of ulcerative colitis in rats with dampness and heat syndrome, and observe the regulatory effect of Huangqin decoction on the mast cells.

METHODSRat models of dampness and heat syndrome were established by feeding with high-fat and-sugar chow, maintenance of a hot and humid environment, and intrarectal administration of 2,4,6-trinitro-benzene-sulfonic acid. The model rats were then randomized into the model group (n=12), Huangqin decoction group (n=13) and mesalazine group (n=12). After a one-week treatment, the inflammatory cell infiltration was observed using HE staining, and the number of mast cells was determined using toluidine blue staining. Immunohistochemistry was used to detect the expression of tryptase, and serum IL-4 and IL-6 levels were measured using ELISA.

RESULTSCompared with the normal control rats (n=15), the rats in the model group showed obvious inflammatory cell infiltration at the lesion site with significantly increased mast cells and serum IL-6 level (P<0.05). Huangqin and mesalazine significantly lessened inflammatory cell infiltration and decreased the mast cell number and serum IL-6 level after a one-week treatment.

CONCLUSIONThe intestinal mucosal immune cells such as the mast cells play an important role in the pathogenesis of ulcerative colitis associated with dampness and heat syndrome. Huangqin decoction can ameliorate the inflammation, decrease mast cell number and tryptase release, and inhibit IL-6 secretion for treatment of ulcerative colitis in rats with dampness and heat syndrome.

Animals ; Colitis, Ulcerative ; drug therapy ; pathology ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Male ; Mast Cells ; pathology ; Medicine, Chinese Traditional ; Phytotherapy ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVEComplementary and alternative medicine, particularly herbal therapy, is widely used by patients with ulcerative colitis (UC), but controlled data are limited. To describe the clinical presentation and treatment strategies for UC in inpatients from Shanghai, China and to improve the therapeutic outcomes for patients with UC.

METHODSMedical records from 247 patients with UC who were admitted to Longhua Hospital Affifiliated to Shanghai University of Traditional Chinese Medicine between January 2008 and June 2013 were analyzed for gender, age, course of the disease, clinical type, extent and severity of the disease, treatment strategies, and therapeutic outcomes.

RESULTSGender ratios and disease onset of inpatients with UC in the Shanghai area were consistent with other reports in the literature. In contrast to previous studies, most patients exhibited disease of the left colon, over half of the patients had problems of the rectum or sigmoid colon, and most patients had either mild or moderate UC. Comparison of Sutherland Disease Actirity Index scores for patients treated with Chinese medicine (CM) and those treated with integrated CM and Western medicine revealed signifificant reductions in scores for both groups after treatment (P<0.01), with no signifificant difference in therapeutic effects between groups (P=0.938).

CONCLUSIONSHerbal medicine has been widely used in patients with mild to moderate disease and as adjunct therapy in patients with moderate to severe disease. Therefore, the strategy was proposed for the treatment of UC with CM therapy based on 2 steps according to the stage of the disease, even in the clinical setting.

Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Child ; Colitis, Ulcerative ; diagnosis ; drug therapy ; Female ; Humans ; Inpatients ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

A 2-year-old girl presented with a one-day history of acute-onset bilateral painful, swollen eyes and a two‑month history of loose stools. Physical examination revealed a right eyelid swelling with proptosis. Magnetic resonance imaging revealed a right orbital pseudotumour. The patient responded well to treatment with intravenous antibiotics and nonsteroidal anti-inflammatory drugs. However, three weeks later, she was readmitted with a vasculitic lesion over her left upper chest, with mucous-bloody diarrhoea. Histopathology confirmed the diagnosis of ulcerative colitis. The patient was treated with intravenous pulse methylprednisolone and sulphasalazine. Two weeks after discharge, she was readmitted for cutaneous vasculitis and worsening diarrhoea. The patient's bowel and extraintestinal diseases resolved upon addition of infliximab to her treatment regimen. Her inflammatory markers also normalised. Azathioprine was subsequently added. Infliximab was discontinued after four doses and prednisolone was tapered off. The patient remained well without any flare-up after 24 months of follow-up.
Azathioprine ; therapeutic use ; Child, Preschool ; Colitis, Ulcerative ; diagnosis ; drug therapy ; Drug Therapy, Combination ; Female ; Gastrointestinal Agents ; therapeutic use ; Humans ; Immunosuppressive Agents ; therapeutic use ; Infliximab ; therapeutic use ; Magnetic Resonance Imaging ; Orbital Pseudotumor ; diagnosis ; drug therapy