Two Cases of Diffuse Duodenitis Associated with Ulcerative Colitis

Endo, Katsuya; Kuroha, Masatake; Shiga, Hisashi; Kakuta, Yoichi; Takahashi, Seiichi; Kinouchi, Yoshitaka; Shimosegawa, Tooru

doi:10.1155/2012/396521

Cited by 7 publications

(12 citation statements)

References 10 publications

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“…Cases of UC complicated by extensive involvement in the stomach, duodenum, and small intestine are rare, and 29 cases were previously reported in the literature ( Table 1 ). 1 2 3 4 5 6 7 8 9 10 11 14 15 16 17 18 Almost all of the cases had duodenitis, which was not seen in our case. A total of 16 cases were confirmed to have jejunitis or ileitis, all were postoperative enteritis or pouchitis, and only 7 cases had no history of colectomy; however, our case did not have these characteristic complications.…”

Section: Discussioncontrasting

confidence: 50%

“…UC predominantly involves the rectum and spreads proximally, generally sparing the other parts of the digestive tract proximal to the ileocecal valve. However, gastroduodenal lesions 1 2 3 4 5 6 7 8 9 10 11 and enteritis were also recently reported in cases of UC, including backwash ileitis, 12 postoperative enteritis, and pouchitis. Moreover, due to technological advances and the development of new devices visualizing the entire small intestine, rare cases of small intestinal lesions complicated by UC have recently been reported.…”

Section: Introductionmentioning

confidence: 98%

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Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab

et al. 2017

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Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that was refractory to steroids. A 20-year-old man was diagnosed with UC of typical pancolitis without ileal involvement and started treatment with pH-dependent mesalazine and oral prednisolone. Although his symptoms transiently resolved, the condition flared when the steroid dose was tapered down. Computed tomography revealed marked thickening of the ileal wall, and capsule endoscopy and balloon-assisted enteroscopy found diffuse mucosal inflammation with ulcers in the ileum. On the contrary, the inflammation in the colon and rectum was improving. Since the response to the second steroid course was inadequate, treatment with adalimumab and 6-mercaptopurine was initiated and finally achieved clinical and endoscopic remission. The investigation of small intestinal lesions is necessary in patients with UC whose clinical deterioration cannot be explained by colonic lesions.

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Section: Discussioncontrasting

confidence: 50%

Section: Introductionmentioning

confidence: 98%

Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab

et al. 2017

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“…A variety conditions are known to cause duodenal mucosal lesions including inflammatory bowel disease (IBD), tuberculosis, immunologic disorders, or other rare infections [ 12 - 17 ], especially, these secondary causes of duodenal lesions might be frequently detected in hospitalized patients. Upper gastrointestinal (GI) endoscopy is a useful and relatively non-invasive technique to diagnose duodenal mucosal lesion by causes other than H. pylori infection.…”

Section: Introductionmentioning

confidence: 99%

Identification of distinctive clinical significance in hospitalized patients with endoscopic duodenal mucosal lesions

Han

Jung

Chang

et al. 2017

Korean J Intern Med

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Background/AimsDuodenitis is not infrequent finding in patient undergoing endoscopy. However, hospitalized patients have a higher incidence of secondary duodenal mucosal lesions that might be related with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infection, tuberculosis, immunologic disorders, or other rare infections. We aimed to identify clinicopathologic features of duodenal mucosal lesions in hospitalized patients.MethodsAll hospitalized patients having duodenal mucosal lesions were identified by endoscopic registration data and pathologic data query from 2011 to 2014. The diagnostic index was designed to be sensitive; however, a detailed review of medical record and endoscopic findings was undertaken to improve specificity. Secondary duodenal lesion was defined as having specific reason to explain the duodenal lesion.ResultsAmong 6,334 hospitalized patients have undergone upper endoscopy, endoscopic duodenal mucosal lesions was detected in 475 patients. Secondary duodenal lesions was 21 patients (4.4%) and the most frequent secondary cause was IBD (n = 7). The mean age of secondary group was significantly lower than that in primary group (42.3 ± 18.9 years vs. 58.5 ± 16.8 years, p = 0.00), and nonsteroidal anti-inflammatory drugs were less frequently used in secondary group, but there was no differences of gender or presence of Helicobacter pylori. The involvement of distal part of duodenum including postbulbitis or panduodenitis was more frequently detected in secondary group than in primary group. By multivariate regression analysis, younger age of 29 years and the disease extent were significant predictors for the secondary mucosal lesions.ConclusionsSecondary duodenal mucosal lesions with different pathophysiology, such as IBD or CMV infection, are rare. Disease extent and age seems the most distinctive feature of secondary duodenal mucosal lesions.

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“…However, he was able to resume the oral intake of crushed tablets (mesalazine: 1,500 mg/d) after the SMA syndrome improved. Corticosteroids have also been reported to be effective in most cases (7,(10)(11)(12), while some cases required a combination of corticosteroids and azathioprine (7,11). On the other hand, some patients require surgery for complications, such as perforation (9).…”

Section: Discussionmentioning

confidence: 99%

Severe Diffuse Duodenitis Successfully Treated with Intravenous Tacrolimus after Colectomy for Ulcerative Colitis

et al. 2014

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We encountered a rare case of severe diffuse duodenitis associated with ulcerative colitis (UC). A 23-yearold man underwent total proctocolectomy with ileal J-pouch anal anastomosis for UC. He suffered from severe abdominal pain, fever and bloody diarrhea for six months after the surgery. Upper double-balloon enteroscopy disclosed severe diffuse duodenitis, of which the findings were endoscopically and histologically similar to those of colonic lesions of UC. Although the administration of prednisolone was ineffective, treatment with intravenous tacrolimus markedly improved the clinical findings. This is the first report of the successful treatment of severe UC-associated diffuse duodenitis with intravenous tacrolimus.

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Two Cases of Diffuse Duodenitis Associated with Ulcerative Colitis

Cited by 7 publications

References 10 publications

Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab

Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab

Identification of distinctive clinical significance in hospitalized patients with endoscopic duodenal mucosal lesions

Severe Diffuse Duodenitis Successfully Treated with Intravenous Tacrolimus after Colectomy for Ulcerative Colitis

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