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J Clin Gastroenterol. 2013 Jan;47(1):52-7. doi: 10.1097/MCG.0b013e3182582c1d.

Long-term treatment of patients with a history of ulcerative colitis who develop gastritis and pan-enteritis after colectomy.

Author information

  • 1Inflammatory Bowel Disease Center, University of Chicago Medical Center, Chicago, IL, USA. frankhoentjen@gmail.com

Abstract

BACKGROUND:

Ulcerative colitis (UC) is generally described as a superficial diffuse inflammation restricted to the colon and rectum. However, several case reports have described a distinct and rare type of UC-related pan-enteritis, typically occurring after colectomy. Corticosteroids are effective for induction of remission of this condition, but it is not clear how these patients should be managed long term.

GOALS:

To further describe and define the entity of UC-related pan-enteritis and to investigate the efficacy of azathioprine for maintenance of remission.

RESULTS:

We describe 5 patients with superficial diffuse ulcerative inflammation of the stomach, small bowel, and pouch if present. Four of the 5 patients developed enteritis after colectomy for ulcerative pancolitis. Pathology showed severe mucosal inflammation with infiltration of neutrophils and plasma cells from the stomach to the ileum. Video capsule endoscopy in 1 patient confirmed the presence of mucosal inflammation throughout the small bowel. All patients were started on a standardized treatment with intravenous corticosteroids for induction of remission and azathioprine for maintenance therapy. The conditions of all the patients rapidly improved, and subsequently, 4 patients were in full remission on azathioprine monotherapy, despite failure of this UC therapy before surgery, whereas 1 patient continues to have a steroid-dependent disease.

CONCLUSIONS:

The outcomes of 5 cases of UC-related pan-enteritis as described in this report support a role for azathioprine in remission maintenance. Future research is needed to improve our understanding of this rare but distinct intestinal inflammatory disorder.

PMID:
22858512
[PubMed - indexed for MEDLINE]
PMCID:
PMC3874322
Free PMC Article

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