Guinea Pig 에서 가수분해된 Carrageenan 으로 유발된 궤양성 대장염의 병태생리에 관한 연구

송인성(In Sung Song),김나영(Na Young Kim),정현채(Hyun Chae Jung),이효석(Hyo Suk Lee),윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),김우호(Woo Ho Kim) 대한내과학회 1992 대한내과학회지 Vol.43 No.3

N/A Background: Ulcerative colitis is a inflammatory bowel disease, of which characteristics are diarrhea, hematochezia, weight low, and the incidence of this disease is rising tendency in Korea, But the causes or pathophysiology of this disease have not been yet clear and the animal model has not been yet established. This paper is concerned with an experimentalnimal odel of ulcerative colitis wherein the ultimate goal is to study the causes and pathopohysiology of ulcerative colitis. Method: For the animal model, we use guinea pigs to observe whether the carrageenan extracted from the seaweed, causes the lesion to large and small intestine, and whether this lesionis similar to human ulcerative colitis clinically and anatomically. We classified the 82guinea pigs into three groups, the first group (the control group) which consisted of 11guinea pigs were given the tap water as drinking water, the 2nd group of 11 guinea pigs were given the 1.5% native carrageenan (1.5% NCG group) and the 3rd group of 60guinea pigs (1.5% HCG group) were given the 1.5% hydrolyzed carrageenan for 40days. In order to identify the pathophysiology of this lesion, we measured the PG4 and LTB4 at the cecal mucosa where the lesion existed. Xanthine oxidase, superoxide dismutase and catalase activity, all of which are closely related to superoxide radical system, were also measured, Results: 1) During experimental period of 40 days, the weight of 11 guinea pigs of the control group increased by 110g to 180g and the weight of 8guinea pig of the 1,5% native carrageenan group increased by 40g to 100g. However, the twenty eight guinea pigs of the 1.5% hydrolyzed carrageenan group lost 10g to 130g during experimental period. All of the 28guinea pigs of the 1.5% HCG group showed diarrhea and loose stools till the end of experiment, the fifty percent of 8 guinea pigs of the l. 5% NCG group showed loose stool, but none of the control group showed loose stool. All of the control group and the 1.5% NCG group showed negative occult blood when the hematest was taken at the end of experiment, but twenty seven guinea pigs (93.3%) of the 1.5% HCG group were positive and 12guinea pigs (43%) showed grossly hematochezia. By the way, the time of onset of clinical symptom in the 1.5% HCG group was very variable among the guinea pigs from 3weeks to 40days after the beginning of HCG intake. Moreover the guinea pig tended to die within 10days once the symptom developed. 2) There was no abnormal finding from the treiz ligament to the rectum in the control group but half of the 1.5% NCG group showed hemorrhagie erosions at the cecum and the twenty seven of 28 guinea pigs of l. 5% HCG group showed hemorrhagic erosions at the cecum. The two guinea pigs of the 1.5% HCG group showed 0.2×0.8cm and 0.3×1.0cm sized ulcerations grossly. 3) When the cecal mucosa was observed with light microscope, the six of the 8guinea pigs of the 1.5% NCG group showed mucosal atrophy and the four of these 6guinea pigs showed mild degree erosions and infiltration of inflammatory cells, but none of 1.5% NCG group showed metachromasia in the toludine blue stain. In the cecal mucosa of the twenty seven of the 28 guinea pigs of the 1.5% HCG group, multiple mucosal confined ulcerations from the shallow and small ulcerations to deep and broad ulcerations were found, and in the 2 of theae 27guinea pigs, the ulcerations were extended to submucosa though the muscularis mucosae. Inflammatory cells such as polymorphonuclear cells, machrophages, lymphocytes and plasma cells were found on the base and margin of the ulcers. Among these inflammatory cells, the infiltration of mechrophages was prominent and definite metachromasia in the toluidine blue stain was found in the machrophages. 4) The mean PGE2 level of the control group was 292.08pg/mg mucosa, and those of the 1.5% NCG group and the 1.5% HCG 281.25pg/mg mucosa, and 429.87pg/mg mucosa, respectively. The mean PGE2 value of 1.5% HCG group was highest among three

궤양대장염(ulcerative colitis)이 동반된 전신홍반루푸스 환자 1예

이경아,배상철,방소영,김원준,김혜영,손창남,이오영,백승삼 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.4

Systemic lupus erythematosus (SLE) and ulcerative colitis (UC) are both considered as systemic diseases with an abnormal immune response that depends on interactions between susceptibility genes and environmental factors. Patients with UC may share common manifestations with SLE, for example peripheral arthritis, oral ulcer. Although many autoimmune disorders tend to coexist in one patient, these two diseases are rarely associated with each other. We reported a case of a 36-year-old female where rectal bleeding was identified as ulcerative colitis. She was diagnosed as SLE prior to ulcerative colitis. There are no documented reports on SLE with ulcerative colitis in Korea.

궤양성 대장염 진단 가이드라인

최창환 ( Chang Hwan Choi ),정성애 ( Sung Ae Jung ),이보인 ( Bo In Lee ),이강문 ( Kang Moon Lee ),김주성 ( Joo Sung Kim ),한동수 ( Dong Soo Han ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.3

Ulcerative colitis is a chronic inflammatory disorder causing mucosal inflammation of the colorectum with crypt abnormality on biopsy. It affects the rectum and a variable extent of the colon in continuity. Ulcerative colitis is characterized by a relapsing and remitting course. It arises from an interaction between genetic and environmental factors, but the precise etiology is unknown. The incidence and prevalence in Korea are still low compared with those of Western countries, but have increased in recent years. There are many challenging issues on the diagnosis of ulcerative colitis, and sometimes these lead to differences in practice between clinicians. Therefore, IBD Study Group of KASID set out the Korean diagnostic guideline of ulcerative colitis. The diagnosis is based on clinical, endoscopic, radiologic, and histologic criteria. The symptoms are dependent upon the extent and severity of disease and most commonly include bloody diarrhea, rectal bleeding, and/or urgency. The systemic symptoms of malaise, tachycardia, fever, or weight loss are features of a severe attack. The laboratory findings may reveal leucocytosis, thrombocytosis, iron deficiency anemia, hypoalbuminemia, and elevated erythrocyte sedimentation rate and C-reactive protein indicating severe disease activity or chronicity. For the elimination of infectious causes, microbial investigation with stool specimens should be performed for common enteric pathogens including assays for Clostridium difficile toxin, and sometimes for amoeba or other parasites. The most typical endoscopic features are continuous, confluent, and concentric colonic involvement proximal to the anal verge. Endoscopic severity may be best well reflected by the presence of mucosal friability, spontaneous bleeding, and deep ulcerations. Typical pathologic findings are composed of widespread crypt architectural distortion (cryptitis, crypt abscess, and crypt atrophy), heavy, diffuse lamina propria cell infiltration, and basal plasmacytosis. (Korean J Gastroenterol 2009;53:145-160)

Protective and Therapeutic Effects of Aloe Vera Gel on Ulcerative Colitis Induced by Acetic Acid in Rats

( Gholamreza Bahrami ),( Hossein Malekshahi ),( Shahram Miraghaee ),( Hamid Madani ),( Atefeh Babaei ),( Bahareh Mohammadi ),( Razieh Hatami ) 한국임상영양학회 2020 Clinical Nutrition Research Vol.9 No.3

Ulcerative colitis (UC) is a chronic intestinal inflammation. Common clinical symptoms are weight loss, diarrhea, ulcers, and inflammation. Aloe vera (AV) has several medicinal properties including antioxidant, anti-inflammatory analgesic, and improvement of gastric and skin ulcers. This study aimed to investigate the protective and therapeutic effects of AV gel on acetic acid-induced UC in rats. UC was induced in 48 rats by injection of 4% acetic acid into the rectum. Protective and treatment groups received treatments 7 days before and after the induction of colitis, respectively. The negative control group, the positive control group, and AV groups received distilled water, sulfasalazine, and 50 and 300 mg/kg of gel extract, respectively. Water and food intake and body weight changes were recorded. The extent of the mucosal ulcers, colon tissue thickening, and mucosal bleeding were scored by the Gerald classification system score (microscopy observations). Slides of tissues were prepared for pathologic assay using the modified Wallace method (macroscopic observations). The results of the macroscopic and microscopic examination showed protective and therapeutic effects of 50 mg/kg dose of AV on acetic acid-induced colitis in rats which reduces the inflammation, ulcers and tissue damage compared with negative control (p < 0.05). There were no significant changes in the amount of water and food intake, body weight changes, and colon weight in protective and treatment groups. Based on the results, AV gel could be used to improve the symptoms of UC, as well as prevent people who are susceptible to the UC.

Treatment of recalcitrant pyoderma gangrenosum with ulcerative colitis by adalimumab (Humira®) injection

( In Kyu Chang ),( Hae Eul Lee ),( Myung Im ),( Young Joon Seo ),( Jeung Hoon Lee ),( Young Lee ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Pyoderma gangrenosum (PG) is a rare ulcerative cutaneous condition that is associated with systemic disease. We report a case of a 20-year-old woman with severe recalcitrant PG and ulcerative colitis who was successfully treated by adalimumab injection. After she was diagnosed with PG, her skin lesions persisted despite treatment with oral prednisolone and cyclosporine. Therefore, we started treatment with etanercept (50 mg twice weekly), and observed dramatic improvement of the ulcer. Unfortunately, after one year, the skin lesions worsened even with etanercept treatment. Adalimumab was then administered at a dose of 80 mg in week 0 and 40 mg in week 1, followed by 40 mg every second week. After the second dose of adalimumab, rapid clinical improvement was observed, with complete PG healing after 8 weeks of treatment. Since the last (ninth) treatment, the therapeutic effect has been maintained for about 6 months. The successful treatment of PG in our patient suggests that adalimumab may be a valuable therapeutic option for PG among ulcerative colitis patients who fail to respond to etanercept and other conventional immunosuppressive regimens.

궤양성 대장염에서 다발성으로 발생된 괴저농피증 1예

강경인,유선영,오상하,김재영,Kang, Kyoung-In,You, Sun-Young,Oh, Sang-Ha,Kim, Jae-Young 대한소아소화기영양학회 2009 Pediatric gastroenterology, hepatology & nutrition Vol.12 No.2

만성 염증성 장 질환에서 유발되는 드문 피부 병변인 괴저 농피증은 초기에는 홍반으로 둘러싸인 농포로 시작하지만 빠르게 주변부로 확장되고 염증이 진피 내로 파급 되면서 깊은 궤양이 생겨 피부 함몰을 일으킨다. 초기에 감염성 연부조직염 등으로 오인하여 절개 배농이나 강한 압박 배농을 하게 되면 이 질환의 이상초과민현상 때문에 병변이 악화되는 경향이 있다. 따라서 조기 진단과 습윤-비밀폐 드레싱으로 상처에 가하는 충격을 최소화하면서 상처 부위를 보존하고 2차 세균 감염을 예방하는 것이 초기 치료에 매우 중요하다. 저자들은 궤양성 대장염을 가진 15세 여자에서 발생한 괴저 농피증을 초기 에 압박 배농하여 병변이 빠르게 악화된 증례의 치료 경험을 보고하면서 조기 진단과 초기 치료 대응의 중요성을 강조하고자 한다. Pyoderma gangrenosum associated with ulcerative colitis is an unknown etiology of destructive skin disorder, characterized by progressive painful ulceration. It begins as a erythematous areola or pustule and rapidly progress into a deep ulceration with a discrete and violaceous edge. Early diagnosis followed with non-compressive moist dressing, topical application and systemic immunosuppressants are cornerstone in treating this disease. We report a case of pyoderma gangrenosum exacerbated with incision and drainage in a 15 year old girl with ulcerative colitis. This case emphasizes the importance of early consideration of pyoderma gangrenosum in patient with a background of related systemic disease and minimal traumatized wound care.

Approach to cytomegalovirus infections in patients with ulcerative colitis

( Sung Chul Park ),( Yoon Mi Jeen ),( Yoon Tae Jeen ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.3

Cytomegalovirus (CMV) reactivation is common in patients with severe ulcerative colitis (UC), and may ref lect exacerbation of mucosal inf lammation and/or administration of immunosuppressants. The question of whether CMV is an active pathogen or `an innocent bystander` in the exacerbation of UC remains controversial. Patients with UC exacerbated by reactivated CMV experience worse prognoses than those without CMV reactivation and antiviral therapy significantly reduces the need for colectomy in patients with severe UC and high-grade CMV infection, indicating that CMV plays a role in UC prognosis. Therefore, the CMV status of patients on immunosuppressants, particularly those with steroid-refractory or -dependent UC, should be tested. When CMV is detected, be performed based on should adequate treatment the extent of the viral load and the presence of certain clinical features including a large ulcer. Anti-tumor necrosis factor agents may be useful for treating CMV colitis complicating UC.

궤양성 대장염에 동반된 농포형 괴저고름피부증

김윤환 ( Yoon Hwan Kim ),박지혜 ( Ji Hye Park ),최종원 ( Chong Won Choi ),이가영 ( Ga Young Lee ),김원석 ( Won Serk Kim ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.12

Pyoderma gangrenosum (PG) is a rare and painful skin disease, frequently associated with underlying systemic conditions, such as inflammatory bowel disease or hematological malignancy. PG is generally classified into 4 types: classic (ulcerative), bullous, pustular, and vegetative. Pustular PG is an uncommon variant of PG that the pustules do not progress to form ulcers. We report a case of pustular PG, which was successfully treated with infliximab and topical tacrolimus, in a 28 year-old Korean man with ulcerative colitis. (Korean J Dermatol 2012;50(12):1050∼1053)

Clinical characteristics of inflammatory bowel disease patients with immunoglobulin A nephropathy

( Ryohei Hayashi ),( Yoshitaka Ueno ),( Shinji Tanaka ),( Kana Onishi ),( Takeshi Takasago ),( Masaki Wakai ),( Toshikatsu Naito ),( Kensuke Sasaki ),( Shigehiro Doi ),( Takao Masaki ),( Kazuaki Chaya 대한장연구학회 2021 Intestinal Research Vol.19 No.4

Background/Aims: Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract. Some patients with this condition have been reported to present with immunoglobulin A nephropathy (IgAN), a renal complication that can cause end-stage renal failure, but the frequency of this comorbidity has not been described. Thus, the aim of this study was to investigate the frequency of IgAN in patients with IBD. Methods: This study included 620 patients with IBD (338 with ulcer-ative colitis [UC] and 282 with Crohn’s disease [CD]) from the Hiroshima University Hospital outpatient department. IgAN cases were identified from medical interviews, blood examinations (serum immunoglobulin A), and urinalyses (occult blood, proteinuria). Definitive IgAN cases were diagnosed by renal biopsies, while those detected through the clinical course and test results, but not clinically recommended for renal biopsy, were defined as suspected IgAN. Results: We analyzed 427 cases meeting the inclusion criteria (220 with UC and 207 with CD). The incidence of IgAN across all patients with IBD was 3.0%. The frequency of IgAN was significantly higher in patients with CD (11/207, 5.3%) than in those with UC (2/220, 0.9%) (P< 0.01). Moreover, a significant correlation was found between CD patients with ileostomy or colostomy and a diagnosis of IgAN. Con-clusions: Patients with IBD present a high incidence of IgAN, especially those with CD who have undergone ileostomy or co-lostomy. (Intest Res 2021;19:430-437)

궤양성 대장염에서 대장 점막 Mucin의 조직화학적 특성과 Lectin 반응

송근암(Geun Am Song),김태오(Tae Oh Kim),안진광(Jin Kwang An),이준홍(Jun Hong Lee),강대환(Dae Hwan Kang),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Backgrounds : In the pathogenesis of ulcerative colitis, a defective mucosal barrier to luminal antigens is currently under consideration, and alterations in mucin structure and lectin binding may play an important role in the defect of mucosal barrier. It is also, suggested that the differences in clinical manifestation and complication of ulcerative colitis are associated with the change in glycosylation of colonic mucus glycoconjugates. This study was performed in order to investigate the histochemical properties of the mucin in korean ulcerative colitis. Methods : The histochemical staining (HID-AB, mild PAS, PBT-KOH-PAS) and the binding of lectin (PNA, DBA, UEA-1, RCA-1, WGA, with avidin-biotin peroxidase complex method) to mucin glycoconjugates were analyzed in paraffin-embedded tissue sections obtained from 14 normal colons and 20 ulcerative colitis. Results : In the ulcerative colitis, number of goblet cell and amount of mucin were decreased, but the expression of its sulphomucin was consistently predominant and strong like normal colon. The expression of N-acetylated sialomucin was more common in the ulcerative colitis(80%) than normal colon(50%) and its grading mildly increased in ulcerative colitis. The expression of O-acetylated sialomucin was present in all cases of normal colon and its staining grade decreased in the ulcerative colitis. Compared to normal colonic mucosa, ulcerative colitis showed the increase in PNA and DBA binding in the supranuclear cytoplasm, the decrease in DBA and RCA-1 binding in the goblet cells, and no change in UEA-1 and WGA binding in both. In the ulcerative colitis, the increase in PNA and DBA binding was mild in the supranuclear cytoplasm and the expression of DBA and RCA-1 binding in goblet cells variably decreased. Conclusions : This study demonstrates the changes in the mucosal glycoconjugates between the ulcerative colitis and normal colon. The mucinous glycoconjugate expression of korean ulcerative colitis are different from that of western patients. There may be a genetic, racial variation in the glycoconjugate, which may also play a part in the differences in pathogenesis, clinical manifestation, and complication of ulcerative colitis.(Korean J Med 58:532-541, 2000)