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* = Presenting author

P203 Duodenal lesions in postoperative ulcerative colitis

M. Sako*, N. Yoshimura, M. Takazoe

Tokyo Yamate Medical Centre, Centre for Inflammatory Bowel Disease, Tokyo, Japan

Background

The gastroduodenal inflammation is sometimes seen in cases of severe or postoperative ulcerative colitis (UC), and it has been reported since the 1960s. The ulcerative colitis associated duodenal lesion (UCD) shows granular mucosa like UC and frequently needs anti-inflammatory agents. In this study, we aimed to elucidate the characteristics of postoperative UCD.

Methods

We performed a retrospective survey of 117 patients who underwent surgery because of severe or intractable UC from January 2011 to October 2015 at the Centre for Coloproctology in Tokyo Yamate Medical Centre. We analysed the prevalence of UCD and their type of duodenal disease, treatment, and outcomes.

Results

The UCD was seen in 6 (male 2 and female 4) patients (5.1%). Their mean duration of UC before surgery was 36 (1–192) months and all of the patients had severe lesion in colon refractory to intensive treatment with cyclosporine. Four patients (66.7%) had their onset of duodenal disease within 1 month after colectomy. One patient had UC-associated bronchopulmonary lesions at postoperative period and received steroid. Her symptoms from duodenal lesion appeared 1 year after surgery, 20 days after withdrawal of steroid. The appearance of duodenal lesions was diffuse, granular mucosa in 5 patients; 4 of them were followed by ulceration with diffuse mucosal defect. Massive bleeding from geographic ulcer was seen in 1 patient. For duodenal lesion, all patients were initially treated with steroid; 2 patients (33.3%) needed cyclosporine to archive remission, and 1 (16.7%) with massive bleeding had angiographic haemostasis. The recurrence of UCD was detected in 2 cases.

Conclusion

UCD is diagnosed in 5.1% of patients with postoperative UC. They all had severe colitis and treatment with cyclosporine before surgery. Their duodenal mucosa is like active lesion in colon and steroid was effective for half of the patients, whereas others needed further treatments such as cyclosporine and angiographic haemostasis.