Effect of an H2-receptor blocking agent on diarrhoeas after extensive small bowel resection in Crohn's disease

The effect of an H2-receptor blocking agent, cimetidine, on faecal losses of fluid, electrolytes and fat was examined in 10 patients with Crohn's disease, who had diarrhoeas after extensive small bowel resection. A randomized, double-blind and cross-over design was applied, and patients were hospitalized and on a defined diet during the study. Cimetidine, 4 x 400 mg, significantly reduced diarrhoeal volumes by an average of 22% (p less than 0.05) and faecal sodium by 27% (p less than 0.05). Patients with severe diarrhoeas responded better to treatment. No side-effects were recorded. The reported data suggest that cimetidine may be useful in symptomatic treatment of patients with severe diarrhoeas after extensive ileal resection. Due to deficient drug absorption, higher doses may be needed for optimal effect.

Pelvic reservoir with S-pouch: can surgeons evaluate the results of their own operations?

PURPOSE

This study was designed to evaluate whether operating surgeons could follow up the functional outcome of their own operations, without bias, by using standardized methods at follow-up.

METHODS

Fifty-five patients who received a pelvic reservoir with an S-pouch were evaluated regarding functional outcome after at least one year postoperative follow-up. The functional surgical outcome was evaluated by an internist especially trained in gastroenterology and the operating surgeon by using a standardized scale comprising eight functional variables.

RESULTS

None of the variables analyzed reached statistically significant difference between the two observers, and a high degree of agreement could be shown by using kappa and weighted kappa analysis.

CONCLUSIONS

Our results indicate that it is possible for an operating surgeon to assess the postoperative surgical outcome using standardized methods at follow-up.

Functional alterations of the microflora in patients with ulcerative colitis

The aim of the study was to examine microflora-associated characteristics in patients with inactive ulcerative colitis, receiving sulphasalazine, in relation to the spread of the disease. The conversion of cholesterol to coprostanol, the production of urobilinogen, and the degradation of tryptic activity (FTA) and beta-aspartylglycine were measured in faecal samples from patients with proctitis or left-sided or total ulcerative colitis and in age- and sex-matched controls. No significant differences in the results were observed in patients with various degrees of extension of inflammatory bowel disease. However, the coprostanol ratio and the urobilinogen level were lower and the FTA was higher in patients with colitis than in the controls (p < 0.05). Beta-aspartylglycine was not found in any faecal sample. The results indicate that patients with ulcerative colitis taking sulphasalazine have a microflora with abnormal metabolic characteristics.

Prevalence of inflammatory bowel disease among relatives of patients with Crohn's disease

The prevalence of familial inflammatory bowel disease was 13.4% in a population-based study of 1048 patients with Crohn's disease (CD). Seventy-two of the index cases had 82 first-degree relatives. Forty-nine were more distantly related (19 first cousins from the same generation as the index patient). The prevalence of CD among first-degree relatives was 21 times higher than among non-relatives. Four of six monozygotic twins were concordant. The age at onset was 25 years in the patients with familial CD, compared with 33 years in the entire group. An additional 53 relatives were found to have ulcerative colitis (UC). The prevalence of UC among first-degree relatives of patients with CD was six times higher than among non-relatives.

Extracolonic diagnoses in ulcerative colitis: an epidemiological study

In a population-based study of 1274 patients with ulcerative colitis (UC), the overall prevalence of extracolonic diagnoses was 21%. Seventy percent of patients with extracolonic diagnoses had extensive colitis. Patients without extracolonic diagnoses had only 28% extensive colitis (p less than 0.001), compared with 37% in the entire test population. The prevalence was higher in familial UC (p less than 0.05). The extracolonic diagnoses could be classified into two major groups, activity related and autoimmune, with regard to the extent and activity of UC and to the effects of medical and surgical treatment. Three hundred sixty-four diagnoses were distributed in 271 UC patients. It is concluded that extracolonic diagnoses are less frequent in an unselected patient group. However, extracolonic diagnoses are associated with the extent of UC at the time of diagnosis and with familial UC, and they can be classified as either activity related or autoimmune, with characteristic combinations of several extracolonic diagnoses occurring in 25% of the 271 patients.

Evidence for a major additive gene in ulcerative colitis

Complex segregation analysis of 124 families with ulcerative colitis with two or more affected individuals suggests a rare additive major gene causing the disease with about 20% affected among the heterozygotes for the gene. There was no evidence for multifactorial inheritance.

Prognosis and mortality of ulcerative colitis in Stockholm County, 1955-1979

All 1274 patients in Stockholm County who were diagnosed as having ulcerative colitis during the 25-year period 1955-79 were followed up and studied with regard to prognosis and mortality. There were 109 deaths recorded--41 caused by ulcerative colitis and 68 from other causes. The cumulative survival probability (computed by life-table methods) was worse than expected. For males it was approximately 80% at 20 years, to be compared with the approximately 97% expected in the background population. For females the corresponding figures were approximately 85% and 98%, respectively. The excess death risk increased with increasing age and was more commonly due to unrelated causes than to ulcerative colitis as such. In patients with total colitis at onset the death risk was greater than for other patients during the first years of disease. Thereafter the prognosis was, if anything, better than in other cases. There was no major change in postoperative mortality or general mortality pattern during the 25 years of observation.

Prevalence of inflammatory bowel disease among relatives of patients with ulcerative colitis

The familial occurrence of inflammatory bowel disease (IBD) was investigated among 963 patients with ulcerative colitis (UC) diagnosed in 1955-1979 in Stockholm County. For 76 patients who had a relative with IBD a pedigree was drawn. The diagnoses of the diseased relatives were verified. There was a general prevalence of 7.9% for IBD among relatives. In 80% one relative was affected, in most cases a first-degree relative with UC. Sibship was the commonest relationship. No concordance for UC was found among three pairs of monozygotic twins. The prevalence of UC in first-degree relatives was 15 times higher than in non-relatives. The age of onset was significantly lower among patients with a family history for UC; they also had a higher incidence of total colitis. The prevalence of Crohn's disease in first-degree relatives of patients with UC was almost 3.5 times higher than in non-relatives.