Seasonal variation in exacerbations of ulcerative colitis.

BACKGROUND/AIMS: The aim of this study was to determine whether there is seasonal variability in exacerbations of ulcerative colitis. METHODOLOGY: The timing of ulcerative colitis relapses was retrospectively studied in a group of consecutive patients with quiescent ulcerative colitis. Ninety-four patients were followed-up at least every three months for a mean of 29.3 (range: 12-67) months. RESULTS: In total, 248 relapses of ulcerative colitis were observed with a mean number of 2.6 (range: 0-9) per patient. The timing of the relapses was characterized by a clear monthly and seasonal pattern (p < 0.001). In particular, the occurrence of relapses peaked during October and November (observed/expected (O/E): 30/20 in both months) and showed three troughs: during July and August, during December, and during February (O/E: 13/21, 7/21, 8/20, and 15/21, respectively). Moreover, the relapse rate was high during autumn and spring (O/E: 84/62 and 72/61, respectively) and low during summer and winter (O/E: 45/61 and 47/64, respectively). CONCLUSIONS: These data support the premise that there is seasonal variability in terms of relapses in ulcerative colitis patients and suggest that the role of seasonal triggering factors must be further investigated.

Systemic absorption of 5-aminosalicylic acid in patients with inactive ulcerative colitis treated with olsalazine and mesalazine.

OBJECTIVE: To compare the systemic load of 5-aminosalicylic acid (5-ASA) as a basis for potential long-term toxicity during treatment in usual dosage with olsalazine (Dipentum) and one controlled-release mesalazine preparation (Salofalk) in patients with inactive ulcerative colitis. DESIGN: Open, randomized, crossover study. TREATMENT SCHEDULE: Olsalazine 500 mg twice daily for 7 days and mesalazine 500 mg thrice daily for 7 days consecutively. PATIENTS: Fifteen patients (12 males/3 females) aged between 18-70 years with ulcerative colitis in endoscopically confirmed remission for at least one month. METHODS: A morning predose plasma sample and a 24-h urine collection on days 6 and 7 of each course were obtained from all patients for quantitative determination of 5-ASA and acetyl-5-ASA (Ac-5-ASA) concentrations. High performance liquid chromatography was used and all analyses were performed blindly on coded samples. RESULTS: Treatment with mesalazine compared with olsalazine gave significantly higher levels of 5-ASA and Ac-5-ASA in plasma and urine. Maximum values and ranges of all variables were higher in the mesalazine group than in the olsalazine group. It is noteworthy that there was clear discriminance in the range of urine 5-ASA and Ac-5-ASA concentrations after mesalazine and olsalazine treatment. CONCLUSION: 1. The mesalazine preparation used, in comparison with olsalazine given in usual dosages, causes significantly higher levels of 5-ASA and Ac-5-ASA in plasma and urine in patients with inactive ulcerative colitis. 2. The lower systemic load of 5-ASA may reduce the potential risk of adverse events and in particular of nephrotoxicity.

Characteristics of rectosigmoid adenomas as predictors of synchronous advanced proximal colon neoplasms.

BACKGROUND/AIM: Colonoscopy is recommended to every patient with adenoma in rectosigmoid to disclose synchronous proximal neoplasms. The aim of this study was to determine whether characteristics of rectosigmoid adenomas are associated with proximal advanced neoplasms. PATIENTS/METHODS: One hundred consecutive symptomatic patients who underwent total colonoscopy and had rectosigmoid adenomas were included in the study. Patients with iron-deficiency anemia were excluded. All polyps were removed endoscopically. An adenoma was considered advanced if it had a diameter > 1 cm and/or villous and/or severe dysplasia histology were present. RESULTS: Advanced rectosigmoid adenomas were found in 55 of the 100 patients. Proximal neoplasms were found in 26 (26%) patients. In particular, nonadvanced adenomas were found in 15 (15%), advanced adenomas in eight (8%), and cancer in three (3%) patients. The presence of proximal neoplasms was related to neither sex, age, or presenting symptoms nor to any of the characteristics of rectosigmoid adenomas. On the contrary, the presence of advanced proximal neoplasms (advanced adenoma or cancer) was significantly correlated with the presence of advanced rectosigmoid adenomas, which were detected in 11 (20%) of the 55 patients with advanced and in none of the 45 patients with nonadvanced, rectosigmoid adenomas (odds ratio: 23.5, p = 0.001). Logistic regression analysis revealed that the presence of advanced rectosigmoid adenoma was the main predictor of advanced proximal neoplasms (beta: 1.34, p < 10(-6)). CONCLUSIONS: Among patients with rectosigmoid adenomas, 1) proximal advanced neoplasms appear to exist only in those with advanced adenomas and 2) baseline colonoscopy does not seem necessary in those without advanced adenomas.

Proliferative activity in colonic adenomas as a predictor of metachronous adenomas as assessed by proliferating cell nuclear antigen immunohistochemistry.

OBJECTIVES: The aim of this study was to determine whether cell proliferation in colonic adenomas, as estimated by proliferating cell nuclear antigen (PCNA), predicts the development of metachronous colonic adenomas. METHODS: Forty patients who underwent prior endoscopic polypectomy for colonic adenomas were reevaluated by colonoscopy 2 yr later. The expression of PCNA was studied in all adenomas that were removed. A five-point semiquantitative scale of 1-5 was used to estimate the PCNA score by the percentage of positively stained cells. RESULTS: Among the 40 patients studied, 16 developed recurrent adenomas (group A) and 24 were free of adenomas (group B). At initial colonoscopy, a total number of 51 adenomas (25 in group A and 26 in group B), were found. The median PCNA score in group A and group B index adenomas was 4 (interquartile range, 3-5) and 2 (interquartile range, 1-3), respectively (p < 0.01, Mann-Whitney U-test). A stepwise logistic regression analysis showed that PCNA score is a significant risk factor (p = 0.007, odds ratio 15.8, 95% confidence interval 2.2-112.4) in predicting adenoma recurrence. The median PCNA score in metachronous adenomas was 2 (interquartile range, 1-3). The difference in the PCNA score between group A index and metachronous adenomas was again statistically significant (p < 0.01, Mann-Whitney U-test). CONCLUSIONS: We conclude that the increased expression of PCNA in colonic adenomas may be a predictor for metachronous adenomas.

Folate status and adenomatous colonic polyps. A colonoscopically controlled study.

PURPOSE: The aim of our study was to assess any association of folate with development of colonic adenomas. METHODS: Serum and red blood cell folate levels were measured in 62 colonoscopically and histologically evaluated patients with colon adenomas (Group A) and in 50 selected colonoscopically negative controls (Group B). Patients with colon polyps underwent colonoscopy for alterations of bowel habits or abdominal pain, and detected polyps were found coincidentally. Controls underwent colonoscopy for alterations of bowel habits or abdominal pain. There was no difference in hematocrit between the two groups. RESULTS: The mean serum folate level in patients with colonic adenomas was 4.57 ng/ml +/- 2.8 standard deviations (SD), and the mean red blood cells folate levels were 536 ng/ml +/- 273.3 (SD). In controls the mean folate levels in serum and red blood cells were 5.09 ng/ml +/- 2.7 (SD) and 743.8 ng/ml +/- 297.1 (SD), respectively. The red blood cell folate level of colon adenoma patients was statistically lower than the respective level of controls at a highly significant level (P < 0.01). CONCLUSIONS: We suggest that depressed red blood cell folate levels are associated with development of colonic adenomas.