Ileostomy and excisional surgery for chronic inflammatory disease of the colon: A survey of one hospital region: Part I Results and complications of surgery

Ritchie, Jean K.

doi:10.1136/gut.12.7.528

Cited by 99 publications

(23 citation statements)

References 16 publications

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“…3) show some variation, the more stable line for all ages combined is suggestive of an increasing risk up to 20 years. The further increase at [30][31][32][33][34][35] years is the result of six cases noted previously ( Table Table 8 8), five of which occurred in patients aged [15][16][17][18][19][20][21][22][23][24] years at onset of disease.…”

mentioning

confidence: 86%

Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres.

Gyde

Prior²,

Allan³

et al. 1988

Gut

460

183

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SUMMARY A retrospective cohort of 823 patients with ulcerative colitis who resided at the time of diagnosis in one of three defined geographical areas (West Midlands region, Oxford region, England and Stockholm County, Sweden) was assembled. The patients were first seen at named hospitals in these areas and the diagnosis of ulcerative colitis established within five years of onset of symptoms between 1945-1965. All patients were 15 years of age or more at onset of disease and were followed for a minimum of 17 years and a maximum of 38 years. Ninety seven per cent completeness of follow up was achieved. Examining the colorectal cancer risk in the series relative to the risk in the general population by standardised morbidity ratios, there was an eight fold increased risk of cancer in the series as a whole. Dividing the series by extent of colitis, extensive colitis patients showed a 19 fold increase in risk. A four fold increased risk was shown in the remainder of the series (left sided colitis, proctitis and extent unknown). Life table analyses in extensive colitis gave cumulative risks of 7*2% (CI 3-6-10-8) at 20 years from onset of disease and 16-5% (CI 9.0-24.0) at 30 years from onset. No significant effect of age at onset, sex or referral centre could be detected. Examination of the data by interval from onset to cancer and by actual age at development of cancer suggests that patients who develop colorectal cancer will do so in a distribution around 50 years of age independent of duration of disease in adult onset ulcerative colitis (>15 years at onset of disease). An inverse relationship was shown between age at onset of disease and interval from onset of disease to cancer. Further age specific rates for cancer increased up to 50 years and decreased thereafter. These results suggest that extensive colitis patients have a genetic predisposition to colorectal cancer and that longstanding inflammation is not of prinwary importance in the initiation/promotion of cancer in this disease.There is convincing evidence from previous studies more likely to be the result of selection biases that patients with ulcerative colitis have a higher inherent in these series rather than any real differincidence of colorectal cancer than the general ences in the underlying cancer incidence of the population.' This increased incidence occurs pre-groups under review. dominantly in patients with longstanding extensive colitis. Many previous estimates of the colorectal Methods cancer incidence have been based on information drawn from hospital series of patients (Table 1) groups of patients are only found in hospitals special-

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mentioning

confidence: 86%

Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres.

Gyde

Prior²,

Allan³

et al. 1988

Gut

460

183

View full text Add to dashboard Cite

show abstract

“…In a study by Ritchie (1971), 3% of 371 ileostomists followed-up over a 12-year period required hospital admission for non-obstructive, non-infective ileostomy diarrhoea. This type of diarrhoea may be attributable to recurrent Crohn's disease, idiopathic ileitis (Thayer and Spiro, 1962), ileal resection (Nuguid et al, 1963;Hill et al, 1974), or lactose intolerance (Gudmand-Hoyer and Jarnum, 1970), but often the cause is obscure and symptomatic treatment is all that can be offered.…”

mentioning

confidence: 99%

Effect of codeine phosphate, Lomotil, and Isogel on ileostomy function

Newton¹

1978

Gut

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SUMMARYThe effect on ileostomy function of codeine phosphate, Lomotil, or Isogel was tested in 20 subjects at home living a normal life, studied over two three-day periods on and off treatment. Codeine phosphate 60 mg three times daily was associated with a reduction in the mean total weight of ileostomy output and the ileostomy outputs of water, sodium, and potassium (p < 0 05). The proportion of faecal solids increased on codeine and the effluent appeared thicker but the output of faecal solids remained unchanged. Mean.faecal fat increased on codeine. The transit rate from mouth to stoma was slower in four of the five subjects on codeine and a further two subjects withdrew from the trial with temporary intestinal obstruction while on the drug. Lomotil two tablets three times daily was associated with a small and statistically not quite significant fall in the mean total weight of ileostomy output and the ileostomy output of water. Sodium and potassium outputs in the effluent fell on Lomotil (p < 0 05) but the other parameters remained unchanged. Isogel 15 ml three times daily was associated with an increase in the mean total weight of ileostomy output and the ileostomy outputs of water, sodium, potassium, and faecal solids (p < 0-01). Although the effluent looked more viscid on Isogel, the proportion of faecal solids was unchanged. These results suggest that codeine phosphate has a beneficial effect on ileostomy function, reducing the loss of water and electrolytes, while Lomotil has a similar but less effective action in the dosage tested. By contrast, Isogel increases the ileostomy loss of water and electrolytes and will aggravate their depletion in patients with excessive fluid effluents. The increase in faecal fat associated with taking codeine phosphate suggests that it should be stopped before collecting specimens for faecal fat estimations.

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“…There is no doubt that the incidence of postoperative adhesive obstruction after this operation is exceptionally high (Ritchie, 1971).…”

Section: Discussionmentioning

confidence: 96%

Operative intubation in the treatment of complicated small bowel obstruction

Munro

Jones

1978

Journal of British Surgery

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Intestinal intubation carried out at laparotomy for complicated small bowel obstruction is not yet a generally accepted technique. Experience in 32 patients has shown that it is safe and effective. The procedure was initially described in North America for use in recurrent adhesive small intestinal obstruction but the indications have been extended and it has proved of value in other difficult situations. A technique for intubation is described and the results obtained in various clinical situations are given.

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Ileostomy and excisional surgery for chronic inflammatory disease of the colon: A survey of one hospital region: Part I Results and complications of surgery

Cited by 99 publications

References 16 publications

Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres.

Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres.

Effect of codeine phosphate, Lomotil, and Isogel on ileostomy function

Operative intubation in the treatment of complicated small bowel obstruction

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