Diffuse gastroduodenitis and pouchitis associated with ulcerative colitis

Abstract

We experienced a very rare case of ulcerative colitis (UC) accompanied with analogous lesions in the stomach, duodenum, and ileal J-pouch. Ileal J-pouch anal anastomosis was performed on a 29-year old woman in 1996. Six years later, she was admitted again to our hospital because of epigastralgia, nausea, watery diarrhea and low fever. Based on the results of endoscopic examination, we diagnosed it as pouchitis. Moreover, on hypotonic duodenography, expansion of the duodenal bulb and the descending portion were poor. Kerckring folds disappeared with typical lead-pipe appearance. The pathogenesis of the gastric and duodenal lesion in this patient was similar to that of the colonic lesions of UC. For the gastroduodenal lesions in this patient, symptomatic remission was obtained following administration of crushed mesalazine tablets (1500 mg/d) for 14 d with continuous administration of omeprazole. Firstly we used ciprofloxacin to treat pouchitis. On the fifth day, she got a fever because of catheter infection. In the catheter culture, methicillin-resistant Staphylococcus aureus (MRSA) was detected. Therefore we changed ciprofloxacin to vancomycin hydrochloride (Vancomycin). Vancomycin was very effective, and the stool frequency dramatically improved in three days. Now she continues to take mesalazine, but her condition is stable and there has been no recurrence of pouchitis.

Capsule-Endoscopic Findings of Ulcerative Colitis Patients

“…UC is considered to be a multifactorial polygenic chronic inflammatory disease that predominantly affects the gastrointestinal system, with the potential also for systemic involvement, such as of the biliary tract, joints, skin and eyes [7,8,9]. Moreover, gastroduodenal lesions of UC have recently been reported, in addition to backwash ileitis and postcolectomy pouchitis [1,2,3,4,5,6]. It is thus not surprising that UC patients were also found to have small-bowel lesions, including reddened lesions and erosions, in this study.…”

“…UC is traditionally regarded as predominantly involving the rectum and spreading proximally, generally sparing the alimentary canal proximal to the ileocecal valve. However, gastroduodenal lesions have also been reported recently in cases of UC, such as backwash ileitis and postcolectomy pouchitis [1,2,3,4,5,6]. Furthermore, some investigators have proposed that since UC is also commonly associated with extraintestinal involvement, such as of the biliary tract, anterior chamber of the eye and synovium, it should be considered as a systemic disease and not as a localized colonic disease [7,8,9].…”

“…Data on the small-bowel abnormalities in UC are limited, owing to the lack of availability of an optimum tool for exploring the entire length of the small-bowel. While some reports of postcolectomy pouchitis have been published [3,4,5,10], there are no reports, until date, of frequency and nature of small-bowel involvement in unoperated UC patients. Capsule endoscopy is a newly developed tool with a high diagnostic yield for small-bowel pathologies [11,12].…”

Severe Diffuse Duodenitis Successfully Treated with Intravenous Tacrolimus after Colectomy for Ulcerative Colitis

“…Previous case reports of gastroduodenitis have shown no response to proton pump inhibitors, although several reports indicated the oral intake of crushed mesalazine tablets to be effective (6,8). In the present case, the patient was initially unable to take crushed mesalazine tablets orally due to SMA syndrome.…”

A contemporary and critical appraisal of ‘indeterminate colitis‘

“…Gastric and/or duodenal involvement has, rarely, been reported in association with UC. 29,30,[62][63][64][65][66] For instance, in a recent study by Lin et al, 65 esophageal, gastric and duodenal biopsies in 69 UC patients were compared with 97 non-UC controls. In that study, UC patients showed a higher prevalence rate of focal gastritis, basal mucosal mixed inflammation, superficial plasmacytosis and diffuse chronic, or chronic active, duodenitis (Figure 4).…”