Colonic involvement in patients with amebic liver abscess: endoscopic findings.

BACKGROUND: Amebic liver abscess is the most common form of extraintestinal amebiasis. Although the parasite enters the liver via the portal vein after invading large bowel mucosa, only 15% to 30% of patients have diarrhea. This study was done to evaluate colonic involvement in patients with amebic liver abscesses. METHODS: In a prospective study, colonoscopy was performed in 50 patients with amebic liver abscesses and 15 control patients with acute amebic colitis. The findings were correlated with clinical features and ultrasonographic appearances. RESULTS: Most patients with amebic liver abscesses presented with fever and abdominal pain. Complete examination of the colon was possible in 45 patients. Twenty six (58%) had evidence of lesions in the colon. Twenty-three of 45 (51%) patients had a few discrete, small ulcers restricted to the right side of colon. Three of 45 (7%) patients with liver abscesses, who also had diarrhea at presentation, had larger and more numerous ulcers with inflammation of the surrounding mucosa of the left colon. Control patients with amebic colitis presented with diarrhea. Endoscopically, they all had multiple large ulcers with diffuse inflammation of the intervening mucosa of the left colon, similar to that seen in patients with liver abscess having diarrhea. CONCLUSIONS: Colonic involvement is common in patients with amebic liver abscess but most patients do not suffer from diarrhea, possibly because of very limited extent of the pathology that is confined mainly to the right side of colon.

Ulcerative colitis in Oman. A prospective study of the incidence and disease pattern from 1987 to 1994.

OBJECTIVE: Inflammatory bowel disease has been reported to have varying frequencies in different parts of the world, and there seem to be significant differences in the disease pattern and clinical course in cases of ulcerative colitis (UC). The aim of the present study was to assess the incidence and disease pattern of UC in Oman. METHOD: A prospective study, over a period of 8 years (1987-1994), was performed to study 108 patients found to have UC. RESULTS: The annual incidence of UC was 1.35/100,000. The disease was mainly seen in the middle and upper middle class group, and the majority were nonsmokers or exsmokers. There was no significant difference in the incidence of the disease between nationalities or sexes. Total colitis was seen in 18%, and a significant number had disease extending up to the splenic flexure. Proctitis was seen in 8%. Although, the extent of the disease was similar to reports from the West, these patients had fewer hospital admissions, blood transfusions and none of them suffered local complications such as toxic dilatation, perforation or severe bleeding. Sclerosing cholangitis occurred in 2 patients. Patients were followed up for a maximum period of up to 7 years after diagnosis and none developed dysplasia or cancer. Three patients had surgery mainly for failure of medical treatment. CONCLUSIONS: From this report it seems that UC occurs in Oman at a lower frequency compared to the West. Although, the extent of the disease was similar to Europeans, these patients had less severe disease with fewer complications.

Human colonic intraepithelial lymphocytes from patients with inflammatory bowel disease fail to down-regulate proliferative responses of primed allogeneic peripheral blood mononuclear cells after rechallenge with antigens.

Human colonic intraepithelial lymphocytes from control subjects down-regulate the proliferative responses of primed allogeneic peripheral blood mononuclear cells on rechallenge with antigens or phytohaemagglutinin (PHA). In contrast, human colonic intraepithelial lymphocytes from patients with inflammatory bowel disease fail to down-regulate the proliferative responses of primed allogeneic peripheral blood mononuclear cells on rechallenge with antigens. These findings may be important in the development and maintenance of the mucosal immunological activation of inflammatory bowel disease.

Human colonic intraepithelial lymphocytes suppress in vitro immunoglobulin synthesis by autologous peripheral blood lymphocytes and lamina propria lymphocytes.

Human colonic intraepithelial lymphocytes have been shown to suppress the proliferation of autologous lamina propria lymphocytes and allogeneic peripheral blood mononuclear cells. This study has shown that, in vitro, intraepithelial lymphocytes suppress IgA and total immunoglobulin synthesis (but not IgG or IgM production) by autologous peripheral blood and lamina propria lymphocytes. This down regulation of IgA production is mediated by a soluble factor secreted by the intraepithelial lymphocytes. There is no difference in immunoglobulin down regulation by intraepithelial lymphocytes of control subjects and patients with inflammatory bowel disease.

Long-term treatment of irritable bowel syndrome: results of a randomized controlled trial.

To examine the long-term management of irritable bowel syndrome we conducted a two-part controlled therapeutic trial on 28 patients who had recovered completely after four to six weeks of treatment with ispaghula husk and propantheline. In part I patients were randomly divided into two groups. Group A received a placebo capsule while Group B continued with treatment as before. After six months the response to treatment was assessed according to a scoring system. The overall relapse rate in Group B was 46 per cent compared to 82 per cent in group A. With continued treatment patients in Group B became asymptomatic from the fourth month while patients in Group A continued to deteriorate. In part II, patients who had relapsed whilst on placebo received active treatment. Six of the seven who agreed to continue with the study became asymptomatic within four weeks. However, all the patients who were asymptomatic while on active treatment relapsed on discontinuation and again recovered on reinstitution of active treatment. We conclude that irritable bowel syndrome is a chronic relapsing disorder and that treatment with a combination of ispaghula husk and propantheline is effective, both in relieving symptoms and in the maintenance of remission.

Peripheral blood and portal tract lymphocyte populations in primary sclerosing cholangitis.

The relative distribution of lymphocyte subpopulations in the blood and liver of patients with primary sclerosing cholangitis (PSC) and related diseases has been studied using immunoenzyme techniques. The peripheral blood CD4/CD8 T lymphocyte ratio was significantly higher in active ulcerative colitis (UC) and in PSC with inactive UC than in inactive UC alone. In contrast, no relationship with disease activity was seen in Crohn's disease. The portal tract t lymphocyte count per high power field (mean +/- S.D.) was higher in pre-cirrhotic PSC (173 +/- 105) and primary biliary cirrhosis (PBC: 210 +/- 110) than in histologically normal liver (42 +/- 27). However, the overall portal tract CD4/CD8 ratio was similar in PSC (1.49), PBC (1.89) and normal controls (1.63). The results are consistent with immunological involvement in the pathogenesis of PSC, but argue against the hypothesis that changes in the peripheral blood T cell subsets are due to sequestration at the site of tissue inflammation.

Ethanolamine oleate versus absolute alcohol as a variceal sclerosant: a prospective, randomized, controlled trial.

Forty-seven patients with esophageal variceal bleeding were randomly allocated to undergo sclerotherapy on a 3 weekly schedule with either 5% ethanolamine oleate (23 patients) or absolute alcohol (24 patients), in an attempt to compare the efficacy and safety of the two sclerosants. Sclerotherapy with absolute alcohol eradicated esophageal varices significantly earlier compared with ethanolamine oleate (12.9 +/- 5.2 vs 22.3 +/- 8.2 wk, respectively, p less than 0.001). The mean number of injection courses and the mean amount of sclerosant required for variceal obliteration was also significantly (p less than 0.001) less in the alcohol-injected group. Although the total number of rebleeding episodes were significantly (p less than 0.05) less in the alcohol-injected group, the frequency of rebleeding was not significantly different between the two groups (20.8% vs 30.4%, respectively, p greater than 0.05). Two (8.1%) patients died due to rebleeding in the ethanolamine-injected group, whereas in the alcohol group, none died. There was no significant difference in the frequency of complications with the two sclerosants. Besides the relative ease of rapid injection due to its aqueous nature, alcohol is readily available and relatively economical (total cost of sclerosant per patient; alcohol US $0.50, ethanolamine US $60). In conclusion, absolute alcohol appears to be a useful alternative to 5% ethanolamine oleate as a variceal sclerosant.

Response of tuberculous stricture to antituberculous treatment.

Tuberculous infection of the gastrointestinal tract results in a variety of histopathological lesions. Some patients develop intestinal strictures and present with subacute intestinal obstruction. The treatment is controversial and vary from a trial of antituberculous drugs to early surgery:the response to medical therapy is not clear. To examine this issue the present prospective therapeutic trial was carried out on 39 patients with symptoms of bowel obstruction and radiological evidence of intestinal stricture. All patients were treated with conventional antituberculous drugs (streptomycin, rifampicin, and isoniazid) under close supervision. Thirty four (87%) patients completed the trial, five were lost to follow up. Thirty one (91%) of these showed significant clinical improvement:26 became completely symptom free, while the remaining five complained of only vague abdominal discomfort. Only three (8%) patients failed to respond to treatment and were subjected to surgery. Barium series were repeated in 23 of 31 who completed the treatment; the remaining eight refused further investigations. Complete resolution of the radiological abnormality was seen in 16 (70%) patients. In the remaining seven (30%) the stricture persisted; in two of these the treatment was continued for another year and both showed substantial radiological improvement. It is concluded that most patients with tuberculous strictures respond well to medical treatment and surgery should be resorted to only if drug therapy fails.

Jejunal mucosal morphology in healthy north Indian subjects.

Morphometric measurements have been performed on small intestinal biopsy specimens obtained from 18 healthy adult Indian volunteers. The measurements were made using a computer aided measuring system, and results were similar to those previously reported for an adult Caucasian population.