Browsing by Subject "ulcerative colitis"

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    Clinical Outcomes After Ileal Pouch-Anal Anastomosis in Pediatric Patients
    (Elsevier, 2019-02) Huang, Christina C.; Rescorla, Frederick J.; Landman, Matthew P.; Surgery, School of Medicine
    Background Ileal pouch-anal anastomosis (IPAA) is the standard surgical reconstruction for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) who undergo total proctocolectomy (TPC). Although patients receive the same reconstruction, their postoperative complications can differ. We hypothesize that indication for TPC and other preoperative clinical factors are associated with differences in postoperative outcomes following IPAA. Methods A retrospective cohort of pediatric patients who underwent proctocolectomy with IPAA from 1996 to 2016 was identified. Preoperative, operative, and postoperative clinical variables were collected. Univariate analyses were performed to evaluate for relevant postoperative clinical differences. Results Seventy-nine patients, 17 with FAP and 62 with UC, were identified. FAP patients spent a mean of 1125 ± 1011 d between initial diagnosis and first surgery compared to 585 ± 706 d by UC patients (P = 0.038). FAP patients took a mean of 57 ± 38 d to complete TPC with IPAA compared to UC patients at 177 ± 121 d (P < 0.001). FAP and UC patients did not differ in mean number of bowel movements at their 6-mo postoperative visit (4.7 ± 2.1 versus 5.6 ± 1.9, respectively [P = 0.134]). FAP patients were less likely to experience pouchitis (P = 0.009), pouch failure (P < 0.001), and psychiatric symptoms (P = 0.019) but more likely to experience bowel obstruction (P = 0.002). Conclusions IPAA is a safe, restorative treatment for FAP and UC patients after TPC. Based on diagnosis and preoperative course, there are differences in morbidity in IPAA patients. Clinical data such as these will allow surgeons to help families anticipate their child's preoperative and postoperative courses and to maximize successful postoperative outcomes.
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    IgA Nephropathy in the Setting of Anti-TNF-α Therapy for Inflammatory Bowel Disease
    (Wolters Kluwer, 2020-09-01) Strobel, Thomas; Ahmed, Waseem; De la Sancha, Carlo; Bohm, Matthew; Fischer, Monika; Medicine, School of Medicine
    Tumor necrosis factor-α (TNF-α)-inhibiting agents are a standard therapy for moderate-to-severe inflammatory bowel disease (IBD). IgA nephropathy in the setting of prolonged exposure to TNF-α inhibitors is a rare, clinically significant adverse event often overlooked by gastroenterologists but well documented in the rheumatologic literature. We present a case series of 3 patients with IBD on TNF-α inhibitors who developed biopsy-proven IgA nephropathy. Clinicians prescribing TNF-α inhibitors to patients with IBD need to be aware of this potential side effect. Therapies with alternative mechanisms of action should instead be considered.
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    Myocarditis in an 18-Year-Old with Ulcerative Colitis
    (2021-03-27) Asdell, Stephanie M.; Prabhakar, Mira; Jones, Jenna; Frick, William; Tolliver, Kevin
    CASE DESCRIPTION: An 18-year-old woman with recently-diagnosed ulcerative colitis (UC) on mesalamine presented with chest pain worsened by inspiration and exertion, dyspnea, and subjective fever for 6 hours. She had a self-limited dry cough 2 weeks prior. SARS-CoV-2 PCR was negative. At presentation, her hemoglobin was 7.1 g/dL. EKG showed sinus tachycardia. Peak troponin was 0.21 ng/mL. Transthoracic echocardiogram showed a possible mildly hypokinetic apex, and vasodilator stress test was normal. Due to persistent hematochezia and the possibility of mesalamine-induced myocarditis, mesalamine was changed to sulfasalazine for her UC. The patient was otherwise treated supportively and referred for outpatient cardiac MRI, but declined the study. Subsequently, Coxsackie B Virus Antibody Type 3 titer was strongly positive at > 1:640, confirming viral myocarditis. CONCLUSIONS: This case describes the work-up of an 18-year-old female patient with UC presenting with acute onset chest pain and fever. Differential diagnosis included viral myocarditis, mesalamine-induced myocarditis, pericarditis, pulmonary embolism, acute coronary syndrome (ACS), and multisystem inflammatory syndrome in children secondary to SARS-CoV-2. CLINICAL SIGNIFICANCE: Global incidence of viral myocarditis is 22 cases per 100,000 individuals annually; though significantly more common in males, female patients often present with more severe disease. Suspected myocarditis warrants an initial EKG and cardiac biomarkers followed by echocardiography, and when indicated, testing for ACS. While acute myocarditis is most commonly caused by coxsackievirus B3 and adenovirus in the U.S. and is treated supportively, several case reports of mesalamine-induced myocarditis prompted specific management for this patient with newly diagnosed UC. Thus, the acuity and incidence of myocarditis present a learning opportunity for differential diagnosis building and workup for young female patients with acute onset chest pain.