궤양성 대장염의 임상적 관찰 = A Clinical Study on 54 Cases of Ulcerative Colitis

다국어 초록 (Multilingual Abstract)

Background : Ulcerative colitis is a chronic inflammatory disease of colon, which is common in western countries but relatively rare in Korea. As the colonoscopic examination becomes popular, early detection rate is increasing in oriental countries, but its precise clinical aspects are still obscure in Korea due to its rarity. The purpose of this study is to review the clinical features and trends of newly diagnosed cases in Korea.
Methods : We studied 54 patients of ulcerative colitis, who were diagnosed by clinical findings, laboratory examinations, barium enema, sigmoidoscopic and colonoscopic examinations at Kosin Medical Center from January 1987 to December 1997.
Results : The most prevalent age was 4th decade, male to female ratio was 1:1.57 and the duration of symptoms was less than 1 year in 63% of the cases, and the recent increase in the incidence of total cases and cases of proctitis was evident. The most common clinical manifestation was bloody diarrhea, while anemia (37.3%) was the most common laboratory abnormality, and the most common complication was abnormal liver function (11.1%). Among the diseases misdiagnosed as ulcerative colitis, irritable bowel syndrome and internal hemorrhoid were common. The most common sigmoidoscopic finding was mucosal friability and the most common histopathologic change was non-specific inflammation (92.3%), while crypt abscess was present in 27.8% of cases. In 29 cases (53.7%), disease severity was of mild degree, while severe course was observed in 2 cases. We found positive correlation between the severity of disease and the extent of colitis (p<0.05), and marginal relationship between the severity of disease and endoscopic grading (p=0.062), but there was no correlation between the severity of disease and the duration of disease (p=0.146). Of all cases, 35 cases (70%) showed longterm improvement to medical therapy, but 11 (22%) had recurrence. Operations were performed in 9 cases and its indications were confirming diagnosis in 3 cases, intractibility in 4 cases, severe dysplasia by histology in 1 case and accompanying adenomatous polyposis in 1 case.
Conclusions : For the accurate and early diagnosis of ulcerative colitis, routine use of sigmoidoscopy in suspected cases is mandatory, especially to exclude hemorrhoid, cancer or irritable bowel syndrome. As the incidence of ulcerative colitis is apparently increasing in this study, more expensive, systematic, nationwide study for ulcerative colitis may be needed for the better description and management of this disease in Korea.