Early course of ulcerative colitis.

Watts, J. F.; Dombal, F. T. de; Watkinson, G.; Goligher, J. C.

doi:10.1136/gut.7.1.16

Cited by 96 publications

(16 citation statements)

References 14 publications

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“…From these data it is apparent that the natural history of the first referred attack of Crohn's disease is completely different from that of ulcerative colitis as reported from Oxford (Edwards and Truelove, 1963) and from our earlier studies in Leeds (Watts et al, 1966a). Table IX shows that whilst 70% of patients suffering from an initial attack of ulcerative colitis may expect to achieve remission of symptoms on conservative management, the comparable figure for Crohn's disease is only 5*1 %.…”

Section: Comparison With Ulcerative Colitismentioning

confidence: 52%

“…To have adopted a highly selective classification of this variable, as was done in our previous studies of ulcerative colitis (Watts et al, 1966a), would have resulted in many different categories of cases each with few patients so making statistical analysis of the results difficult. We have chosen, therefore, to group our patients merely according to whether the disease was in the large bowel, in the small bowel, or in both sites.…”

Section: Severity Ofdiseasementioning

confidence: 99%

“…and to our ownTable X Outcome offirst referred attack in cases of Crohn's disease of the large bowel related to ulcerative colitis 'FromWatts et al (1966a) …”

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confidence: 99%

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Short-term course and prognosis of Crohn's disease

Dombal¹,

Burton²,

Clamp³

et al. 1974

Gut

142

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SUmMARY An analysis is presented of the course and outcome of the initial referred attack in a group of 332 patients with Crohn's disease treated at the General Infirmary at Leeds from 1939 to 1968 inclusive. A further 50 cases were excluded on the basis of insufficient diagnostic evidence: usually such patients had acute terminal ileitis.Only 5 % of patients achieved full remission on conservative management, and most eventually came to surgery. The overall fatality rate was some 3.3 % and this was affected chiefly by the severity of attack and the age of the patient. The severity of attack was classified as mild, moderate, or severe according to a system which took into account factors such as bowelhabit, rectal bleeding, abdominal pain, pulse rate, temperature, haemoglobin, and weight. In attacks graded as 'mild', no deaths occurred; in those graded 'severe' the fatality rate was 8-8%. Similarly, whilst no patient under 20 years of age died, the fatality rate in the over 60s was some 14.8 %.Further comparison between the present group of 332 patients and an earlier series of 204 patients suffering from ulcerative colitis (Watts, de Dombal, Watkinson, and Goligher, 1966a) shows considerable differences in the course and prognosis of the two diseases. In particular 70% of patients with ulcerative colitis achieved remission on conservative management alone whereas only 5% of Crohn's disease patients did so.These differences, and in particular the poor response to conservative therapy, are discussed, together with their implications for management.

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Section: Comparison With Ulcerative Colitismentioning

confidence: 52%

Section: Severity Ofdiseasementioning

confidence: 99%

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Short-term course and prognosis of Crohn's disease

Dombal¹,

Burton²,

Clamp³

et al. 1974

Gut

142

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“…The other main differences were the number of patients with total colitis, 17 (63%) in the bowel rest group and 8 (40%) in the oral diet group, and the number of patients with a fever, 15 (56%) in the bowel rest and seven (35%) in the oral diet group. Both these factors have been shown to be associated with a greater risk of failure of medical treatment8 9 and may indicate a rather sicker population.…”

Section: Discussionmentioning

confidence: 99%

Controlled trial of bowel rest in the treatment of severe acute colitis.

McIntyre¹,

Powell-Tuck²,

Wood³

et al. 1986

Gut

240

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SUMMARY In a prospective, randomised clinical trial, 47 patients with severe, acute, noninfective colitis treated with 60 mg intravenous prednisolone daily, received either bowel rest with parenteral nutrition or oral diet. Although those who received 'bowel rest' experienced a reduction in daily stool weight, there were no differences in the operation or mortality rates between the groups. Fourteen of the 27 patients with ulcerative colitis, but none of the 16 patients with Crohn's disease required urgent surgery. Bowel rest did not affect the outcome in severe ulcerative colitis treated with intravenous prednisolone. Ulcerative colitis and Crohn's colitis behaved differently in the acute attack.Severe attacks of colitis are uncommon but potentially dangerous, particularly if urgent surgical treatment is needed.' 2 Medical treatment of severe colitis relies upon intravenous corticosteroids and nutritional replacement. There has been considerable interest in the use of parenteral nutrition as a possible treatment to reduce mucosal inflammation. The concept of 'bowel rest' is theoretically attractive and one might expect that inflamed intestine would heal more quickly if relieved of mechanical trauma, intestinal secretions, and the antigenic challenge of food. The only controlled trial so far published was not encouraging3 and the present trial was designed to study further the effect of 'bowel rest' in patients with severe attacks of non-infective colitis. Methods PATIENTSA diagnosis of non-specific colitis was established by endoscopy and/or barium enema, in the absence of specific infection or possibility of antibiotic associated colitis.Patients were admitted to the trial if they presented with an attack of colitis severe enough to necessitate admission to hospital and to require treatment with intravenous prednisolone. They were excluded from entry if, at the time of presentation, they exhibited Addrcss for corrcspondcncc: Professor J E Lennard-Jones. St Mark's Hospital, London ECI V 2PS.

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“…course, morbidity and mortality [16][17][18]. These factors contribute to determining whether patients with UC will In contrast to an increased prevalence of IBD in firstdegree relatives, the prevalence of IBD in spouses is need colectomy early or later on in their clinical course.…”

Section: Clinical Heterogeneitymentioning

confidence: 99%

Genetics of Inflammatory Bowel Disease. The Candidate Gene Approach: Susceptibility versus Disease Heterogeneity

Peña

1998

Dig Dis

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Ulcerative colitis and Crohn’s disease are complex diseases of unknown etiology. Several genes are involved in the susceptibility. These genes are necessary to suffer from these diseases but not sufficient. Environmental factors trigger the inflammatory response. Evidence is accumulating that this response is abnormal in these patients. Therefore, the study of genes that are involved in the regulation of the inflammation may help to clarify the pathogenesis of the disease. The working hypothesis is that HLA and cytokine gene polymorphisms, of extreme importance in the regulation of inflammation, contribute to determining the heterogeneity of the disease and the prognosis. In this case, the candidate genes are those involved in the regulation of the immune response of the host. These studies may be of great importance in the tailoring of an appropriate treatment for particular subgroups of patients. A premise for the success of these studies is to use a solid classification, which should take into account the dynamic process and the natural evolution of the disease; to use a carefully selected and ethnically matched group of healthy controls, and to use the advanced molecular biological typing techniques. In the present article, this concept is explored by taking into account some of the recent findings obtained with the HLA and cytokine gene polymorphisms in inflammatory bowel diseases. The results support the concept that these gene polymorphisms are of greater importance in determining the severity of the disease than in determining the susceptibility to suffer from the disease. From this point of view, these studies are complementary and a necessary addition to studies using the whole genome approach in the effort to understand the genetics of these chronic multifactorial diseases.

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Early course of ulcerative colitis.

Cited by 96 publications

References 14 publications

Short-term course and prognosis of Crohn's disease

Short-term course and prognosis of Crohn's disease

Controlled trial of bowel rest in the treatment of severe acute colitis.

Genetics of Inflammatory Bowel Disease. The Candidate Gene Approach: Susceptibility versus Disease Heterogeneity

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