James F. Patterson

Studies of Intestinal Microflora: V. Fecal microbial ecology in ulcerative colitis and regional enteritis: relationship to severity of disease and chemotherapy

Summary Quantitative and qualitative microbiological studies of the stools were carried out in 25 patients with untreated ulcerative colitis and regional enteritis. The mild to moderately ill patients with idiopathic ulcerative colitis were noted to harbor a fecal microflora very similar to that of healthy individuals. However, those with regional enteritis and severe ulcerative colitis had increased numbers of colif orms in their stools. Treatment of ulcerative colitis with salicylazosulf apyridine (Azulfidine) tended to increase the numbers of some microbial species, especially Gram-positive forms. These changes did not appear to be related to the severity of disease or the effectiveness of treatment. In a group of normal individuals receiving drug or placebo in a double blind study, salicylazosulf apyridine caused no definite alterations in the fecal microflora. Systemic corticosteroid therapy of ulcerative colitis resulted in little change in the intestinal flora. Modest decreases in the number of fecal colif orms appeared to be associated with clinical improvement.

Liver Disease and Gallstones in Regional Enteritis

A prospective study of liver function was carried out in 50 consecutive patients with regional enteritis. Although 30% of these patients had abnormal liver function tests, primarily an elevation of alkaline phosphatase and bromsulfophthalein, none had clinically significant liver disease. Liver biopsies were done on 19 patients. Chronic pericholangitis was the most common lesion and was present in 15 patients. Fatty infiltration and portal fibrosis were found in 7 and 5 patients respectively and noncaseating granulomata in 2. The most significant finding was a high prevalence of gallstones—34% in 41 patients specifically examined for the presence of gallbladder disease. No cause for this high prevalence was established, although it may be related to bile salt deficiency.

TOXIC MEGACOLON IN ULCERATIVE COLITIS

A consecutive series of 18 patients with toxic megacolon has been managed with a policy of early operative intervention if optimal medical therapy has failed to effect a rapid remission. One patient achieved a sustained remission on medical management alone. Seventeen patients underwent ileostomy and colectomy. There was one death (5.6% mortality rate) in a complication of ulcerative colitis in which the average reported mortality rate has been 23.1%. It is suggested that surgical intervention be used early enough to prevent colonic perforation and the progressive metabolic deterioration that prolonged nonoperative medical management may produce. The ominous prognosis of toxic megacolon and of its surgical management in the past can be overcome by resort to earlier surgical intervention. Colectomy, rather than decompressive enterostomy, is advocated as the operative treatment of choice.

Azathioprine treatment of ulcerative colitis, granulomatous colitis and regional enteritis

Twenty-four patients with ulcerative colitis, granulomatous colitis or regional enteritis were treated with azathioprine, starting with 2.5 mg/kg body weight. Seven received treatment for less than 4 months. Seventeen received treatment for 4 months or longer. Of these, 14 had partial or full benefit; all of those in the latter group who were on steroids were taken off the drugs. One patient died from complications that arose partly from preexisting renal disease. One patient was found to have a small carcinoma at colectomy after 22 months of therapy. Side effects were minor and easily reversible. Azathioprine is reasonably safe and effective for treating inflammatory bowel disease in patients who cannot tolerate or do not respond to the usual therapy with salicylazosulfapyridine, corticosteroids or surgery.

Regional Enteritis and Granulomatous Colitis Associated with Erythrocyte Glucose-6-Phosphate Dehydrogenase Deficiency

THE simultaneous occurrence of two uncommon diseases in several families originating from a relatively circumscribed geographical region suggests a relation. Erythrocyte glucose-6-phosphate dehydro...

Relationship Between Net Water Absorption and Hexanoic Acid Absorption from the Intact Human Jejunum

SummaryThe effect of net water absorption on the rate of disappearance of hexanoic acid from a 30-cm, test segment of jejunum in normal human subjects was studied. The results suggest that the disappearance rate of hexanoic acid is independent of water absorption. There was no change in fatty acid disappearance rate when water absorption was doubled, or when there was a reversal of water flow with secretion of water into the lumen.

Biosynthesis of squalene by rat preputial gland.

Summary Preputial glands from rats, when incubated with C14 acetate show a marked incorporation of C14 into squalene, a sterol precursor, and little into sterols. In this regard, the preputial glands differ from many other mammalian tissues which show incorporation of C14 mainly into sterols and little into squalene. Human dermis, which contains sebaceous glands, is another mammalian tissue which shows preferential accumulation of the C14 into squalene. The mechanism of the difference is unknown, though it seems likely that factors necessary for conversion of squalene to sterols are missing in these tissues, or that an inhibitor of this reaction is present.

Gallstones with Ulcerative Proctitis

Excerpt To the editor: The increased prevalence of gallstones in patients with diseases of the terminal ileum is consistent with the current concept of cholesterol gallstone formation. Since the di...