Analgesic ingestion and other factors preceding relapse in ulcerative colitis.

Abstract

SUMMARY To investigate factors which predispose to relapse in patients with ulcerative colitis, we conducted a survey to compare the events occurring in the four weeks preceding the clinic attendance of 62 outpatients in remission with those taking place in the same period before the onset of relapse in 21 patients attending with active disease. The only event which occurred significantly more often in patients who subsequently relapsed was ingestion of paracetamol and other inhibitors of prostaglandin synthesis (76% (16/21) relapse vs 39% (24/62) remission, p<O0O1). Recent upper respiratory tract infection (38% vs 26%) was not significantly more common in patients in relapse than in remission, and emotional stress, atopic events, antibiotic treatment, dietary indiscretions, foreign travel, and gastroenteritis were relatively rare in both groups. The surprisingly high prevalence of analgesic ingestion before relapse itself requires confirmation but does lend indirect support to the theory that colonic mucosal prostaglandin deficiency induces relapse in some patients with ulcerative colitis.

A guideline for the treatment and prevention of nsaid-induced ulcers

“…The incidence of these lesions has not been determined, especially in the United States where the use of NSAID suppositories is rare. NSAID-related complications have been reported in patients with pre-existing diverticulosis (116,117) and inflammatory bowel disease (119,120). In a controlled prospective study evaluating both complications of diverticulosis and perforation, it was found that 31 of 92 patients with complicated diverticular disease were taking NSAIDs, and this was significantly greater than the age-matched control group.…”

“…There are some data to indicate that NSAIDs may have a detrimental effect on patients with inflammatory bowel disease and in patients previously in remission, inducing a relapse only a few days after starting NSAIDs (119,120). A recent case-control study of 200 hospital admissions for acute inflammatory bowel disease showed that the overall odds ratios for current and recent exposure to NSAIDs were 1.77 and 1.93, respectively, when compared with 1198 community controls (121).…”

Search for Enteric Microbial Pathogens in Patients with Ulcerative Colitis

“…Concurrent infection in colitic patients can complicate differential diagnosis, and pa tient management can be problematic [8], Many factors have been implicated in pre cipitating relapse of chronic ulcerative colitis although conclusions from different studies are often conflicting. Of particular interest in a microbiological context is the not infre quent observation that a relatively trivial in fection immediately preceeds relapse, most commonly an upper respiratory tract infec tion [9][10][11][12][13] or gastroenteritis [II]. These cor relations are supported by other, associated, risk factors such as recent foreign travel [11].…”

“…These cor relations are supported by other, associated, risk factors such as recent foreign travel [11]. treatment with antibiotics [11] and use of analgesics [13]. This paper describes a study designed to re-examine the role of enteric infection in ulcerative colitis by retrospective study of an unselected patient group present ing at primary referral clinics with active dis ease.…”

Magnifying chromoscopy, a novel and useful technique for colonoscopy in ulcerative colitis

“…An important factor in choosing treatment methods is the evaluation of disease activity; this is commonly done using clinical criteria based on symptoms [9] owing to its convenience and noninvasiveness. When clinical criteria are used alone, however, 40% of patients in whom remission is achieved relapse within 1 year [10,11] . This finding indicates the need for colonoscopic and histopathologic assessment also, notwithstanding their disadvantages, including inconvenience, invasiveness and prolongation of the colonoscopic examination.…”