Gastroduodenitis associated with ulcerative colitis.
BACKGROUND
Ulcerative colitis (UC) is regarded as confined to the colorectum; however, there are several case reports showing upper gastrointestinal involvement. The aim of this study was to examine the prevalence and characteristics of gastroduodenitis associated with UC (GDUC).


METHODS
Esophagogastroduodenoscopy with biopsies was prospectively performed on 250 UC patients (134 men, 116 women; mean age, 42 years; 162 with colectomy, 163 with pancolitis). Criteria for GDUC were created on the basis of endoscopic and histological comparisons with non-UC controls, and the prevalence and characteristics were statistically analyzed.


RESULTS
GDUC was defined endoscopically as friable mucosa (erosive or ulcerative mucosa with contact or spontaneous bleeding), granular mucosa (multiple white spots almost without a red halo), or, conditionally, multiple aphthae (multiple white spots surrounded by a red halo, clinically excluding other disorders such as Crohn's disease). The prevalence of GDUC was 19/250 (7.6%). The clinical characteristics included more extensive colitis, lower dose of prednisolone, higher prevalence of pouchitis, and longer postoperative period. In our population, the presence of pancolitis and a lower dose of prednisolone were significant risk factors for developing GDUC in multivariate analysis.


CONCLUSIONS
The high prevalence of GDUC suggests that the gut inflammatory reaction in UC may not be restricted to the large intestine. Administered steroids might conceal GDUC, and more aggressive UC such as active pancolitis may be related to the development of GDUC.
Hori
Kazutoshi
K
Department of Endoscopy Center, Hyogo College of Medicine, Nishinomiya, 663-8501, Japan.
Ikeuchi
Hiroki
H
Nakano
Hiroki
H
Uchino
Motoi
M
Tomita
Toshihiko
T
Ohda
Yoshio
Y
Hida
Nobuyuki
N
Matsumoto
Takayuki
T
Fukuda
Yoshihiro
Y
Miwa
Hiroto
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D004382:Duodenitis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005756:Gastritis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000008:administration & dosage; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D005938:Glucocorticoids; D011239:Prednisolone