title: Diagnosis and clinical course of ulcerative gastroduodenal lesion associated with ulcerative colitis: possible relationship with pouchitis.
abstract: OBJECTIVE
  Ulcerative colitis (UC) is not only characterized by pathological lesions localized to colonic mucosa, but also to various complications involving other organs, including postoperative pouchitis. Among these complications, diffuse gastroduodenitis with lesions resembling colonic lesions has been reported, albeit rarely.The aim of the present study was to attempt to characterize the lesions of the upper gastrointestinal tract occurring as a complication of UC, and to assess the frequency and clinical course of these lesions.
  
  
  METHODS
  A total of 322 UC patients who had undergone upper gastrointestinal endoscopy were retrospectively analyzed. We assessed the frequency of endoscopic findings, including diffuse gastroduodenal lesions resembling colonic lesions. Ulcerative gastroduodenal lesion (UGDL) associated with UC was diagnosed if lesions satisfied the following criteria: (i) improvement of the lesions with treatment of UC; and/or (ii) resemblance to UC in pathological findings.
  
  
  RESULTS
  UGDL satisfying the aforementioned criteria was found in 15 (4.7%) of 322 patients. All the 15 patients had UGDL accompanied by pancolitis or after proctocolectomy. Frequency in 146 patients with pancolitis was 6.2% (nine patients) and that in 81 patients who had undergone proctocolectomy was 7.4% (six patients). Four patients with diffuse ulcerative upper-gastrointestinal mucosal inflammation (DUMI) had pouchitis. In all patients except one, the lesions resolved easily with medical treatment.
  
  
  CONCLUSIONS
  In more than half of the post-proctocolectomy patients, UGDL was related to the occurrence of pouchitis. The existence of characteristic UGDL must be taken into account in the diagnosis and treatment of UC, and UGDL is possibly related to the occurrence of pouchitis.
authors.affiliation: Department of Gastroenterology Pathology Surgery, Fukuoka University, Fukuoka, Japan. hisabe@cis.fukuoka-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Hisabe
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsui
authors.forename: Masaki
authors.initials: M
authors.lastname: Miyaoka
authors.forename: Kazeo
authors.initials: K
authors.lastname: Ninomiya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishihara
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagahama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takaki
authors.forename: Fumihito
authors.initials: F
authors.lastname: Hirai
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ikeda
authors.forename: Akinori
authors.initials: A
authors.lastname: Iwashita
authors.forename: Daijiro
authors.initials: D
authors.lastname: Higashi
authors.forename: Kitaro
authors.initials: K
authors.lastname: Futami
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D004382:Duodenitis / Q000175:diagnosis / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005756:Gastritis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D019449:Pouchitis / Q000175:diagnosis / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D012720:Severity of Illness Index