Comparative Histologic Assessment of Proctocolectomy Specimens from Japanese and American Patients with Ulcerative Colitis with or Without Dysplasia

Abstract

There have been no reports of histologic differences in ulcerative colitis (UC) between Japanese and American patients. We therefore compared histology in proctocolectomy resection specimens between Japanese patients with UC (19 cases with and 21 without dysplasia) at the Kitasato University East Hospital and American patients with UC (21 cases with and 24 without dysplasia) at the University of Washington Medical Center. In cases of UC with, but not without dysplasia, cryptitis (p = 0.010) and epithelial apoptosis (p < 0.001) in the nondysplastic mucosa were more frequently observed in Japanese than in American cases, whereas lamina propria fibrosis was more prominent in American counterparts (p = 0.008). In patients with UC with dysplasia, the duration of disease was significantly longer in American than in Japanese patients (median, 17 vs 14 years, respectively; p = 0.038). This might, in part, explain the histologic variation. Another possibility for the differences is that the preoperative medications may have differed in the populations.

Fibrosis in ulcerative colitis is directly linked to severity and chronicity of mucosal inflammation

“…It should be mentioned that our results showing no link between the amount of fibrosis and disease duration stand in contrast to several series of Ulcerative colitis patients with colonic fibrosis with and without strictures, in which fibrosis severity was linked to longer disease duration 8, 18, 19, 34 , although as described above, there was no comprehensive evaluation of samples longitudinally along the colon in these studies, but rather single slides per patient. The use of biologics and immunomodulators was not linked to less fibrosis, but prolonged anti-tumor necrosis factor use was associated with a thinner muscularis mucosae.…”

“…Some studies have described excessive ECM deposition, mainly in the submucosa, as a significant component of stricturing Ulcerative colitis 17 . Surprisingly, few reports of Ulcerative colitis-associated fibrosis outside of the area of strictures are available 18–21 . These reports, however, are based on the evaluation of single tissue sections per patient, often comparing distinct colonic locations in different patients, which limit their value in regard to learning about the real frequency and degree of severity of localized fibrosis.…”

Inflammatory bowel disease–associated intestinal fibrosis

“…In UC, on the other hand, the progression of intestinal fibrosis does not correlate with disease duration or location; however, inflammatory activity does correlate with medical treatment. In contrast, in CD, the duration and location of the disease and type of treatment are related to the risk of intestinal fibrosis [ 55 , 69 , 70 ].…”

Intestinal Dynamic Color Doppler Sonographic Tissue Perfusion Measurement

“…It is helpful to describe the degree of inflammation numerically in order to substantiate the visual impression of imaging and the verbal description of findings. The columns demonstrate clearly how DTPM can tell severe from medium and low grade inflammation whereas the images themselves are important and impressive but cannot convey such precise information that would make them numerically Erosions or ulcerations (Bentley et al, 2002;Hendrickson et al, 2002) none erosion large erosions ulcera regenerative epithelium (Lee, 1987;Morson, 1971) none scarce relevant Fibrosis (Mitomi et al, 2005;SchmitzMoormann & Himmelmann, 1988) none minor moderate severe…”