- Ulcerative colitis and primary sclerosing cholangitis (PSC) are chronic disorders of unknown cause which are presumed to be chronic immune inflammatory in nature.
- Restorative proctocolectomy with ileal reservoir has become established as an important surgical alternative for patients with severe ulcerative colitis, familial adenomatous polyposis (FAP), and other pancolic conditions such as idiopathic megacolon.
- The indications for reservoir surgery were ulcerative colitis in 20 patients and FAP in three.
- The reported recurrence risk ratios ( R ), which are defined by the risk to a relative of class R (K R ) divided by the population prevalence (K p ), fit a multifactorial model better than a monogenic model for both ulcerative colitis and Crohn's disease (see table; note that recurrence risks corrected for sex and age are not available to permit rigorous analysis of these data).
- It is known that 70% of PSC patients have coexisting ulcerative colitis, and about 5% of ulcerative colitis patients develop PSC.
- It has been further postulated that pouchitis represents a recurrence of ulcerative colitis in reservoirs with colonic metaplasia.
- In a previous paper we estimated that the sex and age standardised population relative risk for ulcerative colitis and Crohn's disease was about 10 among first degree relatives of probands with ulcerative colitis and Crohn's disease.
- To confirm that differences in treatment duration for individual patients did not affect the analysis, we also compared ulcerative colitis disease activity in the placebo and cyclosporin groups at one year when all patients were still in the study.
- Twenty three quadruple loop ileal pouches constructed for ulcerative colitis (20 patients) and familial adenomatous polyposis (FAP) (three patients were studied) No patient fulfilled clinical, endoscopic, or histopathological criteria for pouchitis.
- Fifteen of 45 (33%) ulcerative colitis patients and 1 of 3 chronic active hepatitis patients showed similar staining.
- These findings should be balanced, however, with a report from another group, which showed that DNA from M paratuberculosis is present not only in Crohn's disease but also in ulcerative colitis and other non-inflammatory bowel disorders.
- Specifically, a stricture in ulcerative colitis is more likely to be malignant (1) if it occurs after 20 years of duration of the disease, (2) if it is located proximal to the splenic flexure, and (3) if it presents with obstructive symptoms.
- Thus a considerable number of cases of both ulcerative colitis and Crohn's disease are sporadic or non-genetic.