Clinical and Prognostic Features of Rectal Sparing in Ulcerative Colitis

Oshitani, Nobuhide; Kitano, Atsuo; Nakamura, Shirô; Obata, Akishige; Hashimura, Hidechika; Hiki, Masato; Matsumoto, Takayuki; Okawa, Kenji; Kobayashi, Kenzo

doi:10.1159/000199823

Cited by 24 publications

(17 citation statements)

References 6 publications

(12 reference statements)

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“…We have previously reported factors in volving the intractability of UC that are of use in the establishment of long-term prog nosis [12]. In addition, the assessment of severity during the acute phase is also of importance in the treatment of patients with UC.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for the Response of Ulcerative Colitis Patients during the Acute-Phase Treatment

et al. 1990

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Twenty-six consecutive admissions of 24 patients with severe ulcerative colitis (UC) hospitalized in our Department at some time between January 1983 and December 1988 were studied to identify factors useful in the prediction of response to medical treatment in the acute inflammatory phase of this disease. Results of laboratory tests (white blood cells, red blood cells, platelet count, hemoglobin, erythrocyte sedimentation rate, total protein, albumin, α₂-microglobulin, cholinesterase, total cholesterol, and triglycerides) and of endoscopic findings (extent of disease, progress of the lesions, sparing of the rectum, and presence of geographic ulcers, longitudinal ulcers, and polypoid mucosal tags) were analyzed for any relationship with the effect of medical treatment during the acute phase. The effect of treatment was evaluated in terms of days it took for a severe condition to improve to an intermediate one defined by Truelove and Witts’ categories for UC severity. C-Reactive protein, nutritive condition (total protein, albumin, and cholinesterase), extent of the lesions, and existence of polypoid mucosal tags provide predictive factors useful in the management of UC during the acute phase.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors for the Response of Ulcerative Colitis Patients during the Acute-Phase Treatment

et al. 1990

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“…In recent years, however, it has become increasingly evident that patchy colonic involvement, proximal greater than distal disease activity, and frank rectal sparing can occur in treated UC or in UC of many years duration, even in the absence of medical therapy. [2][3][4][5][6][7][8][9] Because initial medical management often is similar for either disease, many clinicians begin therapy for inflammatory bowel disease on the basis of the pathology evident in limited biopsy specimens obtained during flexible sigmoidoscopy. Some time later, when issues of colonoscopic surveillance or possible colectomy are raised or when newer therapies specific to one disease (such as methotrexate, cyclosporine, or infliximab 10 ) are being considered, pathologists are asked to distinguish unequivocally between UC and Crohn colitis, usually on biopsy specimens obtained while the patient is being treated.…”

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confidence: 99%

Patterns of Colonic Involvement at Initial Presentation in Ulcerative Colitis

et al. 2004

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Studies have shown that rectal sparing and patchiness develop in treated and longstanding ulcerative colitis (UC), making the distinction from Crohn colitis increasingly difficult after treatment is initiated. However, no histologic studies of the incidence of rectal sparing in adults at UC onset have been performed. Colectomy specimens from 46 patients with classic UC histologic features and no Crohn disease features were identified. Biopsy specimens obtained before medical therapy were retrieved and examined blindly by 2 pathologists, along with appropriate control samples. Slides were scored for chronicity (crypt branching, subcryptal plasma cells, lamina propria plasma cells) and activity (cryptitis, crypt abscesses, epithelial injury). In 28 cases, only rectal biopsy specimens were taken; for 16, rectal and at least 1 proximal biopsy specimen were taken. All cases showed rectal involvement; none had rectal sparing at initial biopsy. Of 16 cases with rectal and more proximal biopsy specimens, 5 (31%) showed relative rectal sparing (lower scores in rectum than in more proximal sites). In 16 cases with rectal and more proximal biopsy specimens, chronicity and activity scores were higher in the rectum than in more proximal sites (P = .01; chronicity and activity). The mean overall chronicity score decreased in a linear manner from rectum to cecum. The rectum is involved and shows evidence of chronicity and activity at disease onset in UC, using colectomy as the gold standard for diagnosis. Because rectal sparing at UC onset has been reported, a prospective study using uniform biopsy protocols is needed to establish the true incidence of rectal sparing at presentation.

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“…In these patients, however, rectal biopsies showed changes compatible with ulcerative colitis (three with only mild changes). Oshitani et al reported nine of 30 patients (30%) with ulcerative colitis who had absolute or relative endoscopic rectal sparing; however, no biopsies were taken in this study (11). In 14 patients enrolled in a topical 5-aminosalicylic acid treatment trial, nine patients (64%) were later found to have normal rectal biopsies, although, interestingly, two had been treated with placebo (12).…”

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confidence: 57%