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Case Reports
. 2013 Jan;47(1):52-7.
doi: 10.1097/MCG.0b013e3182582c1d.

Long-term treatment of patients with a history of ulcerative colitis who develop gastritis and pan-enteritis after colectomy

Frank Hoentjen  1 , Stephen B Hanauer, John Hart, David T Rubin
Affiliations
Case Reports

Long-term treatment of patients with a history of ulcerative colitis who develop gastritis and pan-enteritis after colectomy

Frank Hoentjen et al. J Clin Gastroenterol. 2013 Jan.

Abstract

Background: Ulcerative colitis (UC) is generally described as a superficial diffuse inflammation restricted to the colon and rectum. However, several case reports have described a distinct and rare type of UC-related pan-enteritis, typically occurring after colectomy. Corticosteroids are effective for induction of remission of this condition, but it is not clear how these patients should be managed long term.

Goals: To further describe and define the entity of UC-related pan-enteritis and to investigate the efficacy of azathioprine for maintenance of remission.

Results: We describe 5 patients with superficial diffuse ulcerative inflammation of the stomach, small bowel, and pouch if present. Four of the 5 patients developed enteritis after colectomy for ulcerative pancolitis. Pathology showed severe mucosal inflammation with infiltration of neutrophils and plasma cells from the stomach to the ileum. Video capsule endoscopy in 1 patient confirmed the presence of mucosal inflammation throughout the small bowel. All patients were started on a standardized treatment with intravenous corticosteroids for induction of remission and azathioprine for maintenance therapy. The conditions of all the patients rapidly improved, and subsequently, 4 patients were in full remission on azathioprine monotherapy, despite failure of this UC therapy before surgery, whereas 1 patient continues to have a steroid-dependent disease.

Conclusions: The outcomes of 5 cases of UC-related pan-enteritis as described in this report support a role for azathioprine in remission maintenance. Future research is needed to improve our understanding of this rare but distinct intestinal inflammatory disorder.

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Conflict of interest statement

Disclosures: No conflicts of interest exist.

Figures

Figure 1
Figure 1
Representative endoscopy images. 1A: stomach in retroflexion, showing granular, erythematous and friable mucosa (case 4). 1B: 2nd portion duodenum, showing erythematous, edematous mucosa with superficial ulceration (case 1). 1C: distal ileum, demonstrating continuous extensive superficial ulcers and spontaneous bleeding (case 4). 1D: pouch with erythematous mucosa and decreased vascular pattern (case 1).
Figure 1
Figure 1
Representative endoscopy images. 1A: stomach in retroflexion, showing granular, erythematous and friable mucosa (case 4). 1B: 2nd portion duodenum, showing erythematous, edematous mucosa with superficial ulceration (case 1). 1C: distal ileum, demonstrating continuous extensive superficial ulcers and spontaneous bleeding (case 4). 1D: pouch with erythematous mucosa and decreased vascular pattern (case 1).
Figure 1
Figure 1
Representative endoscopy images. 1A: stomach in retroflexion, showing granular, erythematous and friable mucosa (case 4). 1B: 2nd portion duodenum, showing erythematous, edematous mucosa with superficial ulceration (case 1). 1C: distal ileum, demonstrating continuous extensive superficial ulcers and spontaneous bleeding (case 4). 1D: pouch with erythematous mucosa and decreased vascular pattern (case 1).
Figure 1
Figure 1
Representative endoscopy images. 1A: stomach in retroflexion, showing granular, erythematous and friable mucosa (case 4). 1B: 2nd portion duodenum, showing erythematous, edematous mucosa with superficial ulceration (case 1). 1C: distal ileum, demonstrating continuous extensive superficial ulcers and spontaneous bleeding (case 4). 1D: pouch with erythematous mucosa and decreased vascular pattern (case 1).
Figure 2
Figure 2
Representative images of the jejunum (A) and ileum (B) during videocapsule endoscopy in case 4. The images show erythematous and edematous mucosa with superficial ulceration.
Figure 2
Figure 2
Representative images of the jejunum (A) and ileum (B) during videocapsule endoscopy in case 4. The images show erythematous and edematous mucosa with superficial ulceration.
Figure 3
Figure 3
Representative histology sections of the duodenum (A) and pouch (B) from case 2. The findings in both the duodenal and pouch biopsies are nearly identical and show very dense lamina propria inflammatory cell infiltrates, including a very prominent component of plasma cells as well as large clusters of neutrophils. The duodenal biopsies exhibit moderate villous blunting as well.
Figure 3
Figure 3
Representative histology sections of the duodenum (A) and pouch (B) from case 2. The findings in both the duodenal and pouch biopsies are nearly identical and show very dense lamina propria inflammatory cell infiltrates, including a very prominent component of plasma cells as well as large clusters of neutrophils. The duodenal biopsies exhibit moderate villous blunting as well.
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