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Tuesday, 3 December 2013

Colitis - The Complications

Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.
Complications
1. Congenital abnormalities
Women who are pregnant with Ulcerative colitis are associated with significantly increased risk of some selected congenital abnormalities (limb deficiencies, obstructive urinary and multiple congenital abnormalities) according to the birth outcomes in women with ulcerative colitis  examined in a nationwide, Danish, cohort of women based on data from the Danish National Hospital Discharge Registry and the Danish Medical Birth Registry, and within a Hungarian case-control data set(22).

2. Nutritional deficiency
It is reported that malnutrition is not a feature of Ulcerative Colitis (UC), but according to the study by the Institute of Drug Research, Faculty of Medicine, University of Toronto, ulcerative colitis and Crohn's disease are the two main entities of inflammatory bowel disease (IBD). There is an intricate relationship between IBD features in human patients, in vitro and animal colitis models, mechanisms and possible therapeutic approaches in these models, and strategies that can be extrapolated and applied in humans. Malnutrition, particularly protein-energy malnutrition and vitamin and micronutrient deficiencies, as well as dysregulation of the intestinal microbiota, are common features of IBD(23).

3. Rectovaginal fistulas
Patients with Crohn's disease are at increased risk to develop fistulas
According to the study by Kaiser Permanente Medical Center, during a 9-year period, six women with ulcerative colitis (UC) and rectovaginal fistulas were surgically treated. Three underwent ileoanal pull-through procedures with simultaneous repair of the rectovaginal fistulas. Two patients had Kock pouches, and one had a Brooke ileostomy because extensive destruction of the rectal sphincter prohibited ileoanal procedures. The three patients who had ileoanal procedures all had excellent functional results. There has been no evidence of Crohn's disease or fistula recurrence(24)

3. Other complications
Microscopic forms of colitis have been described, including collagenous colitis, a possibly heterogeneous disorder. Collagenous colitis most often appears to have an entirely benign clinical course that usually responds to limited treatment. Acording to the study by University of British Columbia, significant extracolonic disorders, especially arthritis, spondylitis, thyroiditis and skin disorders, such as pyoderma gangrenosum, dominate the clinical course and influence the treatment strategy. Colitis and toxic megacolon may develop. Concomitant gastric and small intestinal inflammatory disorders have been described including celiac disease and more extensive collagenous inflammatory disease. Colonic ulceration has been associated with the use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn disease, may evolve directly from collagenous colitis. Submucosal 'dissection', colonic fractures, or mucosal tears and perforation, possibly from air insufflation during colonoscopy, have been reported. Similar changes may result from increased intraluminal pressures that may occur during radiological imaging of the colon. Neoplastic disorders of the colon may also occur during the course of collagenous colitis, including colon carcinoma and neuroendocrine tumours (ie, carcinoids). Finally, lymphoproliferative disease has been reported(25).

4. Etc.
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Sources
(22) http://www.ncbi.nlm.nih.gov/pubmed/22142578
(23) http://www.ncbi.nlm.nih.gov/pubmed/22736018
(24) http://www.ncbi.nlm.nih.gov/pubmed/1914728
(25) http://www.ncbi.nlm.nih.gov/pubmed/22993735