Tuesday, 3 December 2013

Colitis - Diseases associated with colitis

Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.
Diseases associated with colitis
1. Cholelithiasis (gallstone disease)
Cholelithiasis is considered an extraintestinal manifestation of Crohn's ileitis but has not been associated with ulcerative colitis. In the study to evaluate if an increased risk of cholelithiasis exists in patients with ulcerative colitis, biliary ultrasonography was performed on 159 patients with inflammatory bowel disease, 114 patients with ulcerative colitis, and 45 patients with Crohn's disease, indicated that there is an increased risk of gallstones in both patients with Crohn's disease (odds ratio = 3.6; 95 percent confidence limits = 1.2 - 10.4; P = 0.02) and patients with ulcerative colitis (odds ratio = 2.5; 95 percent confidence limits = 1.2 - 5.2; P = 0.01). The risk was highest in patients with Crohn's disease involving the distal ileum (odds ratio = 4.5; 95 percent confidence limits = 1.5 - 14.1; P = 0.009) and in patients with total ulcerative colitis extending to the cecum (odds ratio = 3.3; 95 percent confidence limits = 1.3 - 8.6; P = 0.01). These results confirm that there is an increased risk of gallstones in Crohn's ileitis but they show that there also exists an increased risk in patients with total ulcerative colitis(31).

2. Liver disorders
Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inflammatory bowel disease (IBD). According to the study by Department of Pediatric Gastroenterology and Hepatology, these disorders are sometimes due to a shared pathogenesis with IBD as seen in primary sclerosing cholangitis (PSC) and small-duct primary sclerosing cholangitis (small-duct PSC). There are also hepatobiliary manifestations such as cholelithiasis and portal vein thrombosis that occur due to the effects of chronic inflammation and the severity of bowel disease. Lastly, medications used in IBD such as sulfasalazine, thiopurines, and methotrexate can adversely affect the liver(32).

3. Primary sclerosing cholangitis
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease that is associated with inflammatory bowel disease (IBD), particularly chronic ulcerative colitis and, to a lesser degree, Crohn's disease. But according to the study by Hacettepe University, in contrast to findings in Western Europe and the USA, in Turkey: 1) PSC is not regularly associated with idiopathic IBD; 2) most patients with PSC are female; 3) PSC accounts for only 18% of patients with a primary disorder of the biliary tree; 4) the incidence of small-duct primary sclerosing cholangitis is greater than that reported in the literature; and, 5) the incidence of IBD and PSC in Turkey is relatively lower than in other countries(33).

4. Eczema
In the study of nineteen mothers and babies took part in a double blind crossover trial of exclusion of egg and cows' milk, and 18 took part in open exclusion of 11 foods followed by double blind challenge to those mothers whose infants seemed to respond, indicated that the eczema improved in six infants when their mothers avoided egg and cows' milk and worsened again when these were reintroduced. Two infants suffered gastrointestinal reactions after maternal ingestion of egg and cows' milk, one developing colitis. Maternal dietary exclusion seems to benefit some breast fed babies with eczema(34).

5. Chronic polyarthritis and collagenous colitis
There is a report of a 26-year-old woman simultaneously developed chronic seronegative non-destructive polyarthritis and chronic watery diarrhoea. Biopsies from the colorectal mucosa showed a thickened subepithelial collagen layer consistent with collagenous colitis(35).

6. Atopic disease 
In the study of three hundred patients with ulcerative colitis, 200 with Crohn's disease and matched control subjects completed questionnaires about atopic disease, indicated that in ulcerative colitis asthma, hay fever, allergic rhinitis or eczema; occurred with twice the frequency, but in Crohn's disease only eczema was more common than in controls(36).

7. Asthma
Recent attention has been devoted to the respiratory manifestations that may be associated with diseases of distant organs. According to the study by Osaka City University, showed that airway microvascular hyper-permeability induced by VEGF may have a profound effect on airway function and can explain the heightened airway hyper-responsiveness characteristic of asthma associated with ulcerative colitis (UC)(37).

8. Thyroid diseases
In the study to assess the prevalence of abnormalities in the structure of the thyroid gland in IBD patients and to compare it to the control group, found that in patients with inflammatory bowel diseases focal lesions relating to tumors of the thyroid gland are more common than in the control group. In patients with ulcerative colitis enlargement of the thyroid gland is more frequent than in the control group. Initial assessments of IBD patients should include ultrasound examinations of the thyroid gland(38).

9. Psoriasis
Numerous reports have demonstrated the epidemiological, pathogenic, and genetic association between psoriasis and Crohn's disease. According to the study by Clalit Health Services, Tel Aviv, Hod Hasharon, indicated that psoriasis is associated both with Crohn's disease and ulcerative colitis. Future studies on comorbidities in patients with psoriasis should focus on ulcerative colitis(39).

10. Etc.
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(31) http://www.ncbi.nlm.nih.gov/pubmed/2202567
(32) http://www.ncbi.nlm.nih.gov/pubmed/22474447
(33) http://www.ncbi.nlm.nih.gov/pubmed/9951867
(34) http://www.ncbi.nlm.nih.gov/pubmed/3089466
(35) http://www.ncbi.nlm.nih.gov/pubmed/6857179
(36) http://www.ncbi.nlm.nih.gov/pubmed/466750
(37) http://www.ncbi.nlm.nih.gov/pubmed/16297138
(38) http://www.ncbi.nlm.nih.gov/pubmed/23214298
(39) http://www.ncbi.nlm.nih.gov/pubmed/19207663

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