TY - JOUR
T1 - Ulcerative colitis-related severe enteritis
T2 - an infrequent but serious complication after colectomy
AU - Kohyama, Atsushi
AU - Watanabe, Kazuhiro
AU - Sugita, Akira
AU - Futami, Kitaro
AU - Ikeuchi, Hiroki
AU - Takahashi, Ken ichi
AU - Suzuki, Yasuo
AU - Fukushima, Kouhei
N1 - Funding Information:
This study was supported by a grant for Intractable Diseases from the Health and Labor Sciences Research Grants from the Ministry of Health, Labor and Welfare of Japan. We would like to acknowledge the help of the Study Group of the Research Committee on Inflammatory Bowel Disease, Ministry of Health, Welfare and Labor of Japan: Toshiaki Watanabe, MD, Motoi Uchino, MD, Munenori Nagao, MD, Hideaki Kimura, MD, Katsuyoshi Matsuoka, MD, Tetsuhiro Yamada, MD, Yo Ishiguro, MD, Sakiko Hiraoka, MD, Hitoshi Kameyama, MD, Noritaka Takatsu, MD, Noriko Okaba, MD, Makoto Sasaki, MD, Shinya Ashizuka, MD, Satoshi Yamada, MD, Yusuke Watadani, MD, Masunao Nasuno, MD, Toshimitsu Araki, MD, Takayuki Yamamoto, MD, Shigeki Baba, MD, Ri-ichiro Nezu, MD, Ryota Hokari, MD, and Tetsu Kinjo, MD.
Funding Information:
The authors have the following financial conflicts of interest regarding this manuscript. YS has received speaker honoraria from Abbvie, Mitsubishi Tanabe Pharma, Zeria, Mochida Pharmaceutical Co. Ltd., Kyorin Pharmaceutical Co. Ltd., Jansen, and EA Pharma Co. Ltd.; and has received research support from Abbvie, Mitsubishi Tanabe Pharma, EA Pharma Co. Ltd., Jimro Co. Ltd., Mochida Pharmaceutical. Co. Ltd., Kissei, and Nippon Kayaku. The other authors have no declared conflicts of interest.
Funding Information:
This study was supported by a grant for Intractable Diseases from the Health and Labor Sciences Research Grants from the Ministry of Health, Labor and Welfare of Japan. We would like to acknowledge the help of the?Study Group of the Research Committee on Inflammatory Bowel Disease, Ministry of Health, Welfare and Labor of Japan: Toshiaki Watanabe, MD, Motoi Uchino, MD, Munenori Nagao, MD, Hideaki Kimura, MD, Katsuyoshi Matsuoka, MD, Tetsuhiro Yamada, MD, Yo Ishiguro, MD, Sakiko Hiraoka, MD, Hitoshi Kameyama, MD, Noritaka Takatsu, MD, Noriko Okaba, MD, Makoto Sasaki, MD, Shinya Ashizuka, MD, Satoshi Yamada, MD, Yusuke Watadani, MD, Masunao Nasuno, MD, Toshimitsu Araki, MD, Takayuki Yamamoto, MD, Shigeki Baba, MD, Ri-ichiro Nezu, MD, Ryota Hokari, MD, and Tetsu Kinjo, MD.
Publisher Copyright:
© 2020, Japanese Society of Gastroenterology.
PY - 2021/3
Y1 - 2021/3
N2 - Background and aim: After colectomy for ulcerative colitis (UC), very severe and sometimes lethal enteritis can develop. However, the clinical features remain uncertain because of the low incidence, diversity of symptoms, and undefined diagnostic criteria. The aim of this study was to define postoperative ulcerative colitis-related severe enteritis (UCRSE) and to investigate its clinical features. Methods: A retrospective multicenter study was performed as a survey of major medical facilities utilizing surgical supplies for inflammatory bowel disease in Japan from 2001 to 2014. UCRSE was defined as a case with massive intestinal bleeding, intestinal perforation, high-output stoma, and/or a requirement for medications, such as steroids and biologics. Patients with gastroduodenal lesions or pouchitis alone were excluded. The incidence, symptoms, involvement of bacteria, cytomegalovirus reactivation, treatment, and prognosis were examined for patients with UCRSE after colectomy. Results: Forty-two (0.8%) out of 5284 cases met the criteria for UCRSE. Major symptoms were massive intestinal bleeding (76.2%), which required a median of 3850 (560–18900) mL blood transfusion; high-output stoma (38.1%) with excretion of fluid of 5000 (2000–7800) mL/day; and intestinal perforation (7.1%). Hypovolemic shock (35.7%) and/or disseminated intravascular coagulation (31.0%) developed as serious complications. Tests for cytomegalovirus reactivation were positive in 26.2% of cases. The presence of pathogenic bacteria was confirmed in only 5 cases. Corticosteroids or infliximabs were effective in half of the patients. Thirteen cases (31.0%) were treated surgically and 22 cases (56.4%) required maintenance therapy. The mortality rate was 11.9%. Conclusion: UCRSE is a rare but serious complication after colectomy and is sometimes life-threatening.
AB - Background and aim: After colectomy for ulcerative colitis (UC), very severe and sometimes lethal enteritis can develop. However, the clinical features remain uncertain because of the low incidence, diversity of symptoms, and undefined diagnostic criteria. The aim of this study was to define postoperative ulcerative colitis-related severe enteritis (UCRSE) and to investigate its clinical features. Methods: A retrospective multicenter study was performed as a survey of major medical facilities utilizing surgical supplies for inflammatory bowel disease in Japan from 2001 to 2014. UCRSE was defined as a case with massive intestinal bleeding, intestinal perforation, high-output stoma, and/or a requirement for medications, such as steroids and biologics. Patients with gastroduodenal lesions or pouchitis alone were excluded. The incidence, symptoms, involvement of bacteria, cytomegalovirus reactivation, treatment, and prognosis were examined for patients with UCRSE after colectomy. Results: Forty-two (0.8%) out of 5284 cases met the criteria for UCRSE. Major symptoms were massive intestinal bleeding (76.2%), which required a median of 3850 (560–18900) mL blood transfusion; high-output stoma (38.1%) with excretion of fluid of 5000 (2000–7800) mL/day; and intestinal perforation (7.1%). Hypovolemic shock (35.7%) and/or disseminated intravascular coagulation (31.0%) developed as serious complications. Tests for cytomegalovirus reactivation were positive in 26.2% of cases. The presence of pathogenic bacteria was confirmed in only 5 cases. Corticosteroids or infliximabs were effective in half of the patients. Thirteen cases (31.0%) were treated surgically and 22 cases (56.4%) required maintenance therapy. The mortality rate was 11.9%. Conclusion: UCRSE is a rare but serious complication after colectomy and is sometimes life-threatening.
KW - Bacteria
KW - Colectomy
KW - Cytomegalovirus
KW - Enteritis
KW - Ulcerative colitis
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UR - http://www.scopus.com/inward/citedby.url?scp=85095110709&partnerID=8YFLogxK
U2 - 10.1007/s00535-020-01742-3
DO - 10.1007/s00535-020-01742-3
M3 - Article
C2 - 33155079
AN - SCOPUS:85095110709
SN - 0944-1174
VL - 56
SP - 240
EP - 249
JO - Journal of Gastroenterology
JF - Journal of Gastroenterology
IS - 3
ER -