DOCSLIB.ORG

Liver Disease in Ulcerative Colitis: an Epidemiological and Follow up Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Liver Disease in Ulcerative Colitis: an Epidemiological and Follow up Study 84 Gut 1994; 35:84-89 Liver disease in ulcerative colitis: an epidemiological and follow up study in the county of Stockholm Gut: first published as 10.1136/gut.35.1.84 on 1 January 1994. Downloaded from U Broome, H Glaumann, G Hellers, B Nilsson, J Sorstad, R Hultcrantz Abstract sclerosing cholangitis (PSC) are said to be more In an epidemiological study ofthe incidence of common in patients with UC.47 The incidence of ulcerative colitis (UC) in the county of Stock- these complications varies in different studies holm between 1955 and 1979, 1274 patients depending on selection criteria and on the with UC were discovered. Almost all these definition of hepatobiliary disease.89 The true patients had regularly been investigated with incidence of hepatobiliary dysfunction in UC, liver function tests; 142 (11%) of them showed however, can only be obtained by tests of liver signs of hepatobiliary disease. A follow up function tests such as transaminases, alkaline study on all 142 patients with abnormal liver phosphatases, and bilirubin made routinely in function and UC was made between 1989 and unselected groups of patients with UC. Because 1991 to evaluate the cause of the liver abnor- the cause of hepatic involvement in UC is mality and to find out if the liver disease had enigmatic it is important to find out if the rate affected the survival rates. At follow up, eight of this complication is increasing, because of patients were reclassified as having Crohn's factors unrelated to UC, or if it mirrors the disease, 60 had developed normal liver func- incidence ofUC in itself. tion as judged from test results, while the Although it is well established that PSC is a remaining 74 still had signs of hepatobiliary harmful disease often associated with UC'° " the disease. The most common explanation for a importance of pathological liver function tests transient abnormality in liver function was among patients with UC has yet to be estab- active colitis. The temporary signs of liver lished. To find out if hepatobiliary dysfunction injury were not associated with changes in affects the survival of patients suffering from survival rates for these patients. Infections, UC, it is necessary to study the patients for a long especially those because of hepatitis B and period of time. C virus transmitted by blood transfusions In a previously reported epidemiological accounted for the abnormalities in liver func- study,'2 1274 patients with UC were identified in http://gut.bmj.com/ tion in 21 patients, nine ofwhich had a chronic, the county of Stockholm between 1955 and 1979. but non-fatal course. Twenty nine (2.3%) of These patients were subsequently investigated the patients developed primary sclerosing for morbidity and mortality with regard to liver cholangitis (PSC), and 12 of them died during function. In this group, 142 patients were found the study period four because ofcholangiocar- to have abnormal liver function tests and all of cinoma and eight because of hepatic failure; them were studied for an average of 15 years after one patient had a transplant. The estimated the onset ofabnormal liver function tests. on September 25, 2021 by guest. Protected copyright. median time of survival from the first presen- The aims of this study were to establish the tation of evidence of a liver function, com- cause of the liver function abnormalities in all patible with the diagnosis of PSC, to death or 142 patients and to find out whether or not the liver transplantation was 21 years. A compari- liver disease affected the survival of the patients. son of survival rates in patients with UC and patients with UC and concurrent PSC showed, a significant reduction in survival in the PSC Patients and methods Departments of group (p<O-OOOl). The number of patients The basis for this study is an epidemiological Medicine, with UC who developed PSC remained con- investigation of the incidence of UC in Stock- U Broome J Sorstad stant during the study period. Thus, although holm county over a 25 year period. 12 Only R Hultcrantz evidence of abnormal liver function is a com- patients having a definite diagnosis of UC mon finding in UC, a spontaneous return to between 1955 and 1979 and who were residing in Infectious Diseases and Pathology, normal levels is common. In this study, which Stockholm at the time of the diagnosis were H Glaumann did not have a selection bias, the median time included. A total of 1274 patients, 681 males and of survival among PSC patients was far longer 593 females, with UC were found.'3 Twenty five Surgery, than previously described although develop- per cent of the patients suffered from proctitis, G Hellers ment of PSC among patients with UC does defined as mucosal changes found at proctosig- Oncology, significantly reduce the estimated median time moidoscopy, with a clear definition between the B Nilsson of survival. affected rectal mucosa and the normal mucosa in Karolinska Institute at (Gut 1994; 35: 84-89) more proximal parts of the colon and a barium Huddinge, St Goran and enema without further pathology. Thirty eight Karolinska Hospitals, per cent presented with mucosal changes in the Stockholm, Sweden The association of ulcerative colitis (UC) and rectum and radiological changes in the distal Correspondence to: Dr U Broome, Huddinge liver disease was first described in 1873 and was colon (reaching in proximal direction no further Hospital, Department of followed by numerous surveys of liver dysfunc- than to the hepatic flexure) and were defined as Medicine K63, 141 86 Huddinge, Sweden. tion in UC. 1-3 A number of liver disorders, such having left sided colitis. Thirty seven per cent of Accepted for publication as fatty change, chronic autoimmune hepatitis, the patients had total colitis, defined as mucosal 26 May 1993 liver cirrhosis, cholangiocarcinoma, and primary changes in the rectum and radiological evidence Liverdisease in ulcerative colitis: an epidemiological andfollow up study in the county ofStockholm 85 of disease in the colon beyond the hepatic smooth muscle, raised IgG, and negative tests for flexure. All but 55 patients were regularly hepatitis B was required.'5 investigated with liver function tests. Patients Positive markers for hepatitis B (presence of with evidence ofabnormal liver function tests (at surface antigen and antibodies to core antigen) or Gut: first published as 10.1136/gut.35.1.84 on 1 January 1994. Downloaded from least twice the upper normal values of serum antibodies to hepatitis C, proved with the recom- bilirubin, serum activities of alkaline phos- binant immunoblot analysis (RIBA C100-3, phates, or liver transaminases, or all three at two Chiron) and a liver biopsy compatible with occasions with a minimal interval oftwo months) chronic viral hepatitis were interpreted as indica- were defined as having hepatobiliary disease. tive of chronic hepatitis B or C infection. Onset of liver disease was defined as the time of The patients were diagnosed as having a liver the first abnormal liver function tests. One abnormality as a result ofactive colitis ifevidence hundred and forty two patients, 92 males and 50 of abnormal liver function tests was found only females, with UC and abnormal liver function during periods of inflammatory activity in the tests were identified. bowel, as defined by diarrhoea and sigmoido- scopic findings of excess mucus, signs of bleed- ing, or ulcerations, or all three and if the liver METHODS function tests returned to normal after colectomy The files from all 142 patients, both living and or when the patients were in remission and no deceased (n=35), with UC and signs of hepato- other explanation for the abnormality in liver biliary disease were re-evaluated during the years function tests was found. Fatty change was 1989 and 1991. Ifno current data were available, believed to be the cause of increased activities of patients were asked to have liver function tests. transaminases if the patients showed an isolated If no clinical signs of liver disease were present increase in these enzymes unrelated to inflamma- and aspartate aminotransferase and alanine tory activity in the bowel, were overweight aminotransferase were <1-0 iikat/l and alkaline (calculated from as weight (kg)/length (cm)- phosphatase <5 0 pkat/l no further investiga- 100>1), and with no other explanation for tion was carried out. Attempts were made to abnormal liver function tests, such as alcohol retrospectively clarify the cause of the previous abuse. 6 abnormalities in liver function tests. All slides from biopsy specimens and liver All patients with a persistent rise in alkaline tissue obtained at necropsy were re-evaluated by phosphatase >5 [ikat/l (normal upper range one liver pathologist (HG) and one hepatologist <4-2 ,ukat/l) had an ultrasound investigation (UB) according to the international classification and subsequently also an endoscopic retrograde of liver diseases and without knowledge of the cholangiography or percutaneous transhepatic clinical data concerning the patients.'7 cholangiography. http://gut.bmj.com/ All patients with a persistent rise in trans- aminase activities and without a previously STATISTICAL ANALYSES established hepatobiliary diagnosis were Student's t test was used to compare mean examined with conventional laboratory tests and values, and X2 analysis to compare proportions. were questioned concerning intake of alcohol or Survival curves were estimated by the method of drugs, and exposure to other hepatotoxic sub- Kaplan and Meyer and differences between stances. Laboratory tests included assessment of groups were compared using the log rank test. As on September 25, 2021 by guest. Protected copyright. serum y-glutamyltransferase, bilirubin, creati- the development of PSC can be considered to be nine and ferritin, and serum protein electro- time dependent after the development of UC, an phoresis regarding values of ceruloplasmin and analysis of survival curves for patients with both al anti-trypsin.
Load more

Recommended publications
  • Inflammatory Bowel Disease Irritable Bowel Syndrome
    Inflammatory Bowel Disease and Irritable Bowel Syndrome Similarities and Differences 2 www.ccfa.org IBD Help Center: 888.MY.GUT.PAIN 888.694.8872 Important Differences Between IBD and IBS Many diseases and conditions can affect the gastrointestinal (GI) tract, which is part of the digestive system and includes the esophagus, stomach, small intestine and large intestine. These diseases and conditions include inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). IBD Help Center: 888.MY.GUT.PAIN 888.694.8872 www.ccfa.org 3 Inflammatory bowel diseases are a group of inflammatory conditions in which the body’s own immune system attacks parts of the digestive system. Inflammatory Bowel Disease Inflammatory bowel diseases are a group of inflamma- Causes tory conditions in which the body’s own immune system attacks parts of the digestive system. The two most com- The exact cause of IBD remains unknown. Researchers mon inflammatory bowel diseases are Crohn’s disease believe that a combination of four factors lead to IBD: a (CD) and ulcerative colitis (UC). IBD affects as many as 1.4 genetic component, an environmental trigger, an imbal- million Americans, most of whom are diagnosed before ance of intestinal bacteria and an inappropriate reaction age 35. There is no cure for IBD but there are treatments to from the immune system. Immune cells normally protect reduce and control the symptoms of the disease. the body from infection, but in people with IBD, the immune system mistakes harmless substances in the CD and UC cause chronic inflammation of the GI tract. CD intestine for foreign substances and launches an attack, can affect any part of the GI tract, but frequently affects the resulting in inflammation.
    [Show full text]
  • Nutritional Considerations in Inflammatory Bowel Disease
    NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #5 Series Editor: Carol Rees Parrish, M.S., R.D., CNSD Nutritional Considerations in Inflammatory Bowel Disease by Kelly Anne Eiden, M.S., R.D., CNSD Nutrient alterations are commonplace in patients with inflammatory bowel disease. The etiology for these alterations is multifactorial. Nutrition assessment is the first step in successful nutrition management of any patient with gastrointestinal disease. Nutritional goals include assisting with nutrition risk, identifying macronutrient and micronutrient needs and implementing a nutrition plan to meet those needs. This article addresses many of the nutrition issues currently facing clinicians including: oral, enteral and parenteral nutrition, common vitamin/mineral deficiencies, medium chain triglycerides and nutrition as primary and supportive therapy. INTRODUCTION and supportive treatment in both Crohn’s and UC. The nflammatory bowel disease (IBD), encompassing following article will provide guidelines to help the both Crohn’s disease and ulcerative colitis (UC), is clinician determine nutritional risk, review specialized Ia chronic inflammatory intestinal disorder of nutrient needs and discuss nutrition as a treatment unknown etiology. A multitude of factors, including modality in the patient with IBD. drug-nutrient interactions, disease location, symp- toms, and dietary restrictions can lead to protein NUTRITION ASSESSMENT IN INFLAMMATORY energy malnutrition and specific nutritional deficien- BOWEL DISEASE cies. It is estimated that up to 85% of hospitalized IBD patients have protein energy malnutrition, based on Factors Affecting Nutritional Status abnormal anthropometric and biochemical parameters in the Patient with IBD (1,2). As Crohn’s disease can occur anywhere from There are many factors that alter nutrient intake in the mouth to anus (80% of cases in the terminal ileum), it patient with IBD.
    [Show full text]
  • Chronic Viral Hepatitis in a Cohort of Inflammatory Bowel Disease
    pathogens Article Chronic Viral Hepatitis in a Cohort of Inflammatory Bowel Disease Patients from Southern Italy: A Case-Control Study Giuseppe Losurdo 1,2 , Andrea Iannone 1, Antonella Contaldo 1, Michele Barone 1 , Enzo Ierardi 1 , Alfredo Di Leo 1,* and Mariabeatrice Principi 1 1 Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy; [email protected] (G.L.); [email protected] (A.I.); [email protected] (A.C.); [email protected] (M.B.); [email protected] (E.I.); [email protected] (M.P.) 2 Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, 70124 Bari, Italy * Correspondence: [email protected]; Tel.: +39-080-559-2925 Received: 14 September 2020; Accepted: 21 October 2020; Published: 23 October 2020 Abstract: We performed an epidemiologic study to assess the prevalence of chronic viral hepatitis in inflammatory bowel disease (IBD) and to detect their possible relationships. Methods: It was a single centre cohort cross-sectional study, during October 2016 and October 2017. Consecutive IBD adult patients and a control group of non-IBD subjects were recruited. All patients underwent laboratory investigations to detect chronic hepatitis B (HBV) and C (HCV) infection. Parameters of liver function, elastography and IBD features were collected. Univariate analysis was performed by Student’s t or chi-square test. Multivariate analysis was performed by binomial logistic regression and odds ratios (ORs) were calculated. We enrolled 807 IBD patients and 189 controls. Thirty-five (4.3%) had chronic viral hepatitis: 28 HCV (3.4%, versus 5.3% in controls, p = 0.24) and 7 HBV (0.9% versus 0.5% in controls, p = 0.64).
    [Show full text]
  • Ulcerative Colitis: Diagnosis and Treatment ROBERT C
    Ulcerative Colitis: Diagnosis and Treatment ROBERT C. LANGAN, MD; PATRICIA B. GOTSCH, MD; MICHAEL A. KRAFCZYK, MD; and DAVID D. SKILLINGE, DO, St. Luke’s Family Medicine Residency, Bethlehem, Pennsylvania Ulcerative colitis is a chronic disease with recurrent symptoms and significant morbidity. The precise etiology is still unknown. As many as 25 percent of patients with ulcerative colitis have extraintestinal manifestations. The diagnosis is made endoscopically. Tests such as perinuclear antineutrophilic cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies are promising, but not yet recommended for routine use. Treatment is based on the extent and severity of the disease. Rectal therapy with 5-aminosalicylic acid compounds is used for proc- titis. More extensive disease requires treatment with oral 5-aminosalicylic acid compounds and oral corticosteroids. The side effects of steroids limit their usefulness for chronic therapy. Patients who do not respond to treatment with oral corticosteroids require hospitalization and intravenous steroids. Refractory symptoms may be treated with azathioprine or infliximab. Surgical treatment of ulcerative colitis is reserved for patients who fail medical therapy or who develop severe hemorrhage, perforation, or cancer. Longstanding ulcerative colitis is associated with an increased risk of colon cancer. Patients should receive an initial screening colonos- copy eight years after the onset of pancolitis and 12 to 15 years after the onset of left-sided dis- ease; follow-up colonoscopy should be repeated every two to three years. (Am Fam Physician 2007;76:1323-30, 1331. Copyright © 2007 American Academy of Family Physicians.) This article exempli- lcerative colitis is a chronic dis- of ulcerative colitis is not well understood.
    [Show full text]
  • Peptic Ulceration in Crohn's Disease (Regional Gut: First Published As 10.1136/Gut.11.12.998 on 1 December 1970
    Gut, 1970, 11, 998-1000 Peptic ulceration in Crohn's disease (regional Gut: first published as 10.1136/gut.11.12.998 on 1 December 1970. Downloaded from enteritis) J. F. FIELDING AND W. T. COOKE From the Nutritional and Intestinal Unit, The General Hospital, Birmingham 4 SUMMARY The incidence of peptic ulceration in a personal series of 300 patients with Crohn's disease was 8%. Resection of 60 or more centimetres of the small intestine was associated with significantly increased acid output, both basally and following pentagastrin stimulation. Only five (4 %) of the 124 patients who received steroid therapy developed peptic ulceration. It is suggested that resection of the distal small bowel may be a factor in the probable increase of peptic ulceration in Crohn's disease. Peptic ulceration was observed in 4% of 600 1944 and 1969 for a mean period of 11-7 years patients with Crohn's disease by van Patter, with a mean duration of the disorder of 13.7 Bargen, Dockerty, Feldman, Mayo, and Waugh years. Fifty-one of these patients had Crohn's http://gut.bmj.com/ in 1954. Cooke (1955) stated that 11 of 90 patients colitis. Diagnosis in this series was based on with Crohn's disease had radiological evidence of macroscopic or histological criteria in 273 peptic ulceration whilst Chapin, Scudamore, patients, on clinical and radiological data in 25 Bagenstoss, and Bargen (1956) noted duodenal patients, and on clinical data together with minor ulceration in five of 39 (12.8%) successive radiological features in two patients with colonic patients with the disease who came to necropsy.
    [Show full text]
  • Crohn's Disease and Ulcerative Colitis in the Same Patient
    Gut: first published as 10.1136/gut.24.9.857 on 1 September 1983. Downloaded from Gut, 1983, 24, 857-862 Case report Crohn's disease and ulcerative colitis in the same patient C L WHITE III, S R HAMILTON, M P DIAMOND, AND J L CAMERON From the Departments ofPathology, Medicine, and Surgery, The Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland, USA SUMMARY A well documented case of a patient with both Crohn's disease and ulcerative colitis is presented. A 29 year old woman underwent resection of her terminal ileum and ascending colon for typical Crohn's disease with ileocolitis. Eleven years later, an ileoproctocolectomy was performed for typical ulcerative colitis involving the left colon. The resection specimen also showed evidence of colonic Crohn's disease near the anastomotic site. This unusual case shows that Crohn's disease and ulcerative colitis can occur in the same patient. The rarity of such cases supports the concept that Crohn's disease and ulcerative colitis are separate entities, rather than different manifestations of the same disease process. Crohn's disease and ulcerative colitis are the two healed with conservative measures. Four months well recognised forms of idiopathic inflammatory later she developed rectal bleeding. Proctoscopy bowel disease. As the aetiologies (or aetiology) of showed slightly inflamed rectal mucosa, but no idiopathic inflammatory bowel disease are biopsy was performed. Barium enema showed a unknown, these entities are distinguished on the stricture in the ascending colon; the caecum and basis of their pathologic and resulting clinical, and colon distal to the hepatic flexure were normal.
    [Show full text]
  • Ulcerative Colitis Your Guide
    CROHN’S & COLITIS UK SUPPORTING YOU TO MANAGE YOUR CONDITION ULCERATIVE COLITIS YOUR GUIDE 3 INTRODUCTION ABOUT THIS BOOKLET Being diagnosed with Ulcerative Colitis can be a shock, and you probably have many questions. Now that you’ve put a name to your symptoms, you can start to manage them. The more you know about your Colitis, the more you’ll be able to take an active part in decisions about your care. This booklet will give you and your family and friends a better understanding of Colitis, how it is treated, and how it will affect your life. All our publications are research-based and produced in consultation with patients, medical advisers and other health or associated professionals. They are prepared as general information and are not intended to replace specific advice from your own doctor or any other professional. Crohn’s & Colitis UK does not endorse or recommend any products mentioned. If you would like more information about the sources of evidence on which this booklet is based, or details of any conflicts of interest, or if you have any feedback on our publications, please email publications@ crohnsandcolitis.org.uk. About Crohn’s & Colitis UK We are a national charity established in 1979. Our aim is to improve life for anyone affected by Crohn’s and Colitis. We have 40,000 members and 50 Local Networks throughout the UK. Membership costs start from £15 per year with concessionary rates for anyone experiencing financial hardship or on a low income. © Crohn’s & Colitis UK 2017 & 2019 This publication is available free of charge, but we Ulcerative Colitis Edition 9d would not be able to do this without our supporters and Last review - June 2017 members.
    [Show full text]
  • Fact Sheet: News from the IBD Help Center: Intestinal Complications
    Fact Sheet News from the IBD Help Center INTESTINAL COMPLICATIONS The complications of Crohn’s disease and ulcerative colitis are generally classified as either local or systemic. The term “local” refers to complications involving the intestinal tract itself, while the term “systemic” (or extraintestinal) refers to complications that involve other organs or that affect the patient as a whole. Intestinal complications tend to occur when the intestinal inflammation: • is severe • extends beyond the inner lining (mucosa) of the intestines • is widespread • is chronic (of long duration) Some intestinal complications occur in both ulcerative colitis and Crohn’s disease, although they may occur more commonly in one than in the other. Not everyone will experience these complications. However, early recognition and prompt treatment are key. If you notice a change in your symptoms, be sure to contact your doctor immediately. Ulcerative Colitis-Local Complications Perforation (rupture) of the bowel. Intestinal perforation occurs when chronic inflammation and ulceration of the intestine weakens the wall to such an extent that a hole develops in the intestinal wall. This perforation is potentially life- threatening because the contents of the intestine, which contain a large number of bacteria, can spill into the abdomen and cause a serious infection called peritonitis. In colitis, this complication is generally linked with toxic megacolon (see below). In Crohn’s disease, it may occur as a result of an abscess or fistula. Fulminant colitis. This complication, which affects less than 10% of people with colitis, involves damage to the entire thickness of the intestinal wall. When severe inflammation causes the colon to become extremely dilated and swollen, a condition called ileus may develop.
    [Show full text]
  • Enteric Viruses and Inflammatory Bowel Disease
    viruses Review Enteric Viruses and Inflammatory Bowel Disease Georges Tarris 1,2, Alexis de Rougemont 2 , Maëva Charkaoui 3, Christophe Michiels 3, Laurent Martin 1 and Gaël Belliot 2,* 1 Department of Pathology, University Hospital of Dijon, F 21000 Dijon, France; [email protected] (G.T.); [email protected] (L.M.) 2 National Reference Centre for Gastroenteritis Viruses, Laboratory of Virology, University Hospital of Dijon, F 21000 Dijon, France; [email protected] 3 Department of Hepatogastroenterology, University Hospital of Dijon, F 21000 Dijon, France; [email protected] (M.C.); [email protected] (C.M.) * Correspondence: [email protected]; Tel.: +33-380-293-171; Fax: +33-380-293-280 Abstract: Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a multifactorial disease in which dietary, genetic, immunological, and microbial factors are at play. The role of enteric viruses in IBD remains only partially explored. To date, epidemiological studies have not fully described the role of enteric viruses in inflammatory flare-ups, especially that of human noroviruses and rotaviruses, which are the main causative agents of viral gastroenteritis. Genome-wide association studies have demonstrated the association between IBD, polymorphisms of the FUT2 and FUT3 genes (which drive the synthesis of histo-blood group antigens), and ligands for norovirus and rotavirus in the intestine. The role of autophagy in defensin-deficient Paneth cells and the perturbations of cytokine secretion in T-helper 1 and T-helper 17 inflammatory pathways following enteric virus infections have been demonstrated as well.
    [Show full text]
  • Primary Sclerosing Cholangitis: Introduction
    Primary Sclerosing Cholangitis: Introduction Primary sclerosing cholangitis (PSC) is a chronic , usually progressive, stricturing disease of the biliary tree. Remissions and relapses characterize the disease course. Primary sclerosing cholangitis may remain quiescent for long periods of time in some patients; in most cases, however, it is progressive. The prevalence of primary sclerosing cholangitis in the United States is approximately 1–6 cases per 100,000 population. Most patients with primary sclerosing cholangitis are men (75%) with an average age of approximately 40 years at diagnosis. The overwhelming majority of patients affected with primary sclerosing cholangitis are Caucasian. The etiology is unknown but current opinion favors an immune cause. Management of this disease in the early stages involves the use of drugs to prevent disease progression. Endoscopic and surgical approaches are reserved for the time when symptoms develop. Liver transplantation may ultimately be required and offers the only chance for a complete cure. Patients with primary sclerosing cholangitis are at an increased risk for cholangiocarcinoma (10–15%). Figure 1. Location of the biliary tree in the body. What is PSC? Primary sclerosing cholangitis is a chronic fibrosing inflammatory process that results in the obliteration of the biliary tree and biliary cirrhosis. There is variability in the extent of involvement of the biliary system. The majority of patients with primary sclerosing cholangitis have underlying inflammatory bowel disease, namely ulcerative colitis or Crohn’s disease. Patients with primary sclerosing cholangitis are more likely to have ulcerative colitis than Crohn’s disease (85% versus 15%), with approximately 2.5–7.5% of all ulcerative colitis patients having primary sclerosing cholangitis.
    [Show full text]
  • The Risk of Colorectal Cancer in Patients with Ulcerative Colitis
    Dig Dis Sci (2015) 60:492–501 DOI 10.1007/s10620-014-3373-2 ORIGINAL ARTICLE The Risk of Colorectal Cancer in Patients with Ulcerative Colitis Tobias M. Nowacki • Markus Bru¨ckner • Maria Eveslage • Phil Tepasse • Friederike Pott • Nils H. Thoennissen • Karin Hengst • Matthias Ross • Dominik Bettenworth Received: 11 April 2014 / Accepted: 24 September 2014 / Published online: 4 October 2014 Ó Springer Science+Business Media New York 2014 Abstract associated with the risk of CAC (P \ 0.0014); disease Background and Aim Ulcerative colitis increases the risk duration between 9 and 15 years: OR of 2.5 (95 % CI of developing dysplasia and colitis-associated cancer 0.2–41.1), more than 15 years: OR of 21.4 (95 % CI (CAC). The purpose of this study was to determine the risk 2.6–173.6). The risk of developing dysplasia (low-grade factors as well as protective measures for disease burden, intraepithelial neoplasia, LGIEN and high-grade intraepi- need for colectomy and the development of CAC in thelial neoplasia, HGIEN) or the need to undergo colec- ulcerative colitis (UC) patients. tomy was also significantly related to disease duration Methods A cohort of n = 434 UC patients was evaluated. (P = 0.006, P = 0.002, respectively). Established anti- Data analysis was performed by univariate and multivariate inflammatory medication (e.g., 5-ASA, anti-TNF-a) sig- logistic regression. Odds ratios (OR) and 95 % confidence nificantly reduced the risk of both dysplasia and CAC intervals (CI) were calculated, and significance was (P = 0.02). assessed by the likelihood ratio test. Conclusions Despite the use of modern therapies for UC, Results Mean patient age at UC diagnosis was CAC rates remain high.
    [Show full text]
  • Acute Gastroenteritis: Adult ______Gastrointestinal
    Acute Gastroenteritis: Adult _____________________________ Gastrointestinal Clinical Decision Tool for RNs with Effective Date: December 1, 2019 Authorized Practice [RN(AAP)s] Review Date: December 1, 2022 Background Gastroenteritis, also known as enteritis or gastroenterocolitis, is an inflammation of the stomach and intestines that manifests as anorexia, nausea, vomiting, and diarrhea (Thomas, 2019). Gastroenteritis can be acute or chronic and can be caused by bacteria, viruses, parasites, injury to the bowel mucosa, inorganic poisons (sodium nitrate), organic poisons (mushrooms, shellfish), and drugs (Thomas, 2019). Chronic causes include food allergies and intolerances, stress, and lactase deficiency (Thomas, 2019). Gastroenteritis caused by bacterial toxins in food is often known as food poisoning and should be suspected when groups of individuals present with the same symptoms (Thomas, 2019). Immediate Consultation Requirements The RN(AAP) should seek immediate consultation from a physician/NP when any of the following circumstances exist: ● moderate dehydration (six to 10% loss of body weight), and blood pressure and mental status do not stabilize in the normal range within one hour of initiating rehydration therapy; ● severe dehydration (>10% loss of body weight); ● high fever and appears acutely ill; ● tachycardia or palpitations; ● hypotension; ● severe headache; ● blood or pus in stool; ● severe abdominal pain; ● abdominal distention; ● absent bowel sounds; ● altered mental status; ● older and immunocompromised clients; and/or ● severe vomiting (Interprofessional Advisory Group [IPAG], personal communication, October 20, 2019). GI | Acute Gastroenteritis - Adult The RN(AAP) should initiate an intravenous fluid replacement as ordered by the physician/NP or as contained in an applicable RN Clinical Protocol within RN Specialty Practices if any of the ​Immediate Consultation​ circumstances exist.
    [Show full text]