mercaptopurine and Proctitis

Perianal complications of Crohn's disease are fairly common in the adult and pediatric populations. Transrectal ultrasonography is effective for the diagnosis and follow-up of patients with anorectal abscesses and fistulas in Crohn's disease. Metronidazole and 6-mercaptopurine therapy have been used effectively to treat perianal complications of Crohn's disease in the pediatric population. Asymptomatic perianal fistulas in a patient with Crohn's disease do not require treatment. If a fistula is symptomatic and involves only a small portion of the sphincter mechanism, conventional fistulotomy may be performed with good results. Complex fistulas that involve larger areas of the sphincter are best treated by optimizing medical management and seton placement. The management of rectovaginal fistulas in the presence of Crohn's disease is controversial. Conventional fistulotomy and transvaginal mucosal advancement flap with diverting ileostomy have been advocated as primary treatment modalities. Rectovaginal fistulas secondary to ulcerative colitis may be treated by ileoanal pouch anastomosis and primary repair.

Topics: Abscess; Adult; Colitis, Ulcerative; Combined Modality Therapy; Crohn Disease; Female; Humans; Male; Mercaptopurine; Metronidazole; Proctitis; Rectal Fistula; Rectovaginal Fistula

A disturbed epithelial barrier could play a pivotal role in ulcerative colitis (UC). We performed a family-based study analyzing in vivo gastrointestinal permeability in patients with UC, their healthy relatives, spouses, and controls.. In total, 89 patients with UC in remission, 35 first-degree relatives (UC-R), 24 nonrelated spouses (UC-NR), and 99 healthy controls (HC) were studied. Permeability was assessed by a sugar-drink test using sucrose (gastroduodenal permeability), lactulose/mannitol (intestinal permeability), and sucralose (colonic permeability). Data were correlated with clinical characteristics including medical treatment.. Increased intestinal permeability was detected significantly more often in UC patients in remission (25/89, 28.1%) compared with HC (6/99, 6.1%; P < 0.001). Similar results were obtained in UC-R (7/35, 20.0%; P = 0.01 compared with HC) regardless of sharing the same household with the patients or not. No difference was found between UC-NR (3/24, 12.5%) and HC. Notably, in UC patients increased intestinal permeability was found in 12/28 patients (42.9%) with pancolitis, 7/30 (23.3%) patients with left-sided colitis, and in 2/19 (10.5%) patients with proctitis (P = 0.04). Gastroduodenal and colonic permeability were similar in all groups. Among patients on azathioprine, increased intestinal permeability was only seen in 1/18 (5.6%) patients. In contrast, in 24/70 (34.3%) patients without azathioprine, an increased intestinal permeability was found (P = 0.005).. An increased intestinal but not colonic permeability was found in UC patients in clinical remission that could mark a new risk factor for extensive disease location. Similar findings in healthy relatives but not spouses suggest that this barrier defect is genetically determined.

Topics: Adult; Azathioprine; Case-Control Studies; Colitis, Ulcerative; Colon; Female; Genetic Predisposition to Disease; Humans; Immunosuppressive Agents; Intestinal Absorption; Intestine, Small; Male; Mercaptopurine; Permeability; Proctitis; Remission Induction; Risk Factors; Spouses; Sucrose; Tissue Distribution

Topics: Administration, Oral; Administration, Rectal; Aminosalicylic Acids; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Azathioprine; Colitis, Ulcerative; Colorectal Neoplasms; Controlled Clinical Trials as Topic; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Mercaptopurine; Meta-Analysis as Topic; Patient Selection; Placebos; Proctitis; Remission Induction; Suppositories; Time Factors

Topics: Agranulocytosis; Female; Humans; Leukemia, Myeloid, Acute; Mercaptopurine; Middle Aged; Proctitis