Download PDF
Endoscopy 2002; 34(3): 212-219
DOI: 10.1055/s-2002-20293
Original Article

© Georg Thieme Verlag Stuttgart · New York

Increased Rectal Wall Thickness May Predict Relapse in Ulcerative Colitis: A Pilot Follow-Up Study by Ultrasonographic Colonoscopy

S.  Higaki 1 , H.  Nohara 1 , Y.  Saitoh 1 , A.  Akazawa 1 , H.  Yanai 1 , T.  Yoshida 1 , K.  Okita 1
  • 1First Dept. of Internal Medicine, Yamaguchi University School of Medicine, Yamaguchi, Japan
Further Information

Publication History

16 January 2001

3 September 2001

Publication Date:
22 February 2002 (online)

Also available at
    Permissions and Reprints

Background and Study Aims: Ulcerative colitis is a chronic inflammatory bowel disease with repeated remission and relapse, although the occurrence of relapse is difficult to predict. We performed a prospective study to determine whether there is a relationship in ulcerative colitis between the inflammatory changes identified by endoscopic ultrasonography (EUS) and relapse.
Patients and Methods: Participants were 23 ulcerative colitis patients who had not suffered a relapse for 1 month, with a Seo activity index ≤ 150 and Baron grade 1 at colonoscopy. The thickness of the first to the third layer of the rectal wall in these patients was measured by EUS at the start of the study. They were subsequently followed up for 1 year to record any relapses, defined as having a Seo activity index > 150 and Baron grade ≥ 2 at colonoscopy.
Results: Relapse occurred in eight patients. The mean activity index of the relapsed patients was 187.3 (95 % confidence interval (CI), 166.4 - 208.2) at the end of the study. The thickness of the first to the third layer of the rectal wall, as evaluated by EUS at the beginning of the study, was significantly larger in the relapse group (mean 2.73 mm, 95 % CI 2.13 - 3.33 mm) than in the nonrelapse group (1.79 mm; 1.56 - 1.99 mm; P = 0.0001).
Conclusions: Catheter probe-assisted endoluminal ultrasonography may predict the occurrence of relapse of ulcerative colitis.

References

  • 1 Edwards F C, Truelove S C. The course and prognosis of ulcerative colitis. Part I. Short-term prognosis. Part II. Long-term prognosis.  Gut. 1963;  4 299-315
    CrossrefPubMedGoogle Scholar
  • 2 Truelove S C, Witts L J. Cortisone in ulcerative colitis. Final report on a therapeutic trial.  Br Med J. 1955;  2 1041-1048
    CrossrefPubMedGoogle Scholar
  • 3 Powell-Tuck J, Bown R L, Lennard-Jones J E. A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis.  Scand J Gastroenterol. 1978;  13 833-837
    PubMedGoogle Scholar
  • 4 Seo M, Okada M, Yao T. et al . An index of disease activity in patients with ulcerative colitis.  Am J Gastroenterol. 1992;  87 971-976
    PubMedGoogle Scholar
  • 5 Matts S GF. The value of rectal biopsy in the diagnosis of ulcerative colitis.  Q J Med. 1961;  30 393-407
    PubMedGoogle Scholar
  • 6 Baron J H, Connell A M, Lennard-Jones J E. Variation between observers in describing mucosal appearances in proctocolitis.  Br Med J. 1964;  i 89-92
    PubMedGoogle Scholar
  • 7 Riley S A, Mani V, Goodman M J. et al . Microscopic activity in ulcerative colitis: what does it mean?.  Gut. 1991;  32 174-178
    CrossrefPubMedGoogle Scholar
  • 8 Ludwig D, Wiener S, Bruning A. et al . Mesenteric blood flow is related to disease activity and risk of relapse in ulcerative colitis: a prospective follow up study.  Gut. 1999;  45 546-552
    CrossrefPubMedGoogle Scholar
  • 9 Rasmussen S N, Riis P. Rectal wall thickness measured by ultrasound in chronic inflammatory diseases of the colon.  Scand J Gastroenterol. 1985;  20 109-114
    PubMedGoogle Scholar
  • 10 Cho E, Yasuda K, Nakajima M. Endoscopic ultrasonography (EUS) in the diagnosis of ulcerative colitis.  Gastroenterology. 1990;  98 (part 2) A164
    PubMedGoogle Scholar
  • 11 Shimizu S, Tada M, Kawai K. Value of endoscopic ultrasonography in the assessment of inflammatory bowel diseases.  Endoscopy. 1992;  24 (Suppl 1) 354-358
    PubMedGoogle Scholar
  • 12 Arienti V, Campieri M, Boriani L. et al . Management of severe ulcerative colitis with the help of high resolution ultrasonography.  Am J Gastroenterol. 1996;  91 2163-2169
    PubMedGoogle Scholar
  • 13 Dubbins P A. Ultrasound demonstration of bowel wall thickness in inflammatory bowel disease.  Clin Radiol. 1984;  35 227-231
    CrossrefPubMedGoogle Scholar
  • 14 Aibe T, Fuji T, Okita K. et al . A fundamental study of normal layer structure of the gastrointestinal wall visualized by endoscopic ultrasonography.  Scand J Gastroenterol. 1986;  21 (Suppl 123) 6-15
    PubMedGoogle Scholar
  • 15 Silverstein F E, Martin R W, Kimmey M B. et al . Experimental evaluation of an endoscopic ultrasound probe: in vitro and in vivo canine studies.  Gastroenterology. 1989;  96 1058-1062
    PubMedGoogle Scholar
  • 16 Kimmey M B, Martin R W, Haggitt R C. et al . Histologic correlates of gastrointestinal ultrasound images.  Gastroenterology. 1989;  96 433-441
    CrossrefPubMedGoogle Scholar
  • 17 Soweid A M, Chak A, Katz J A. et al . Catheter probe-assisted endoluminal US in inflammatory bowel disease.  Gastrointest Endosc. 1999;  50 41-46
    PubMedGoogle Scholar
  • 18 Tsuga K, Haruma K, Fujimura J. et al . Evaluation of the colorectal wall in normal subjects and patients with ulcerative colitis using an ultrasonic catheter probe.  Gastrointest Endosc. 1998;  48 477-484
    PubMedGoogle Scholar
  • 19 Matsuura S, Awaya S, Higaki S. et al . Endosonographic diagnosis of early colon cancer and ulcerative colitis [In Japanese with English abstract].  Endoscopia Digestiva. 1993;  5 177-182
    PubMedGoogle Scholar
  • 20 Dagli U, Over H, Tezel A. et al . Transrectal ultrasound in the diagnosis and management of inflammatory bowel disease.  Endoscopy. 1999;  31 152-157
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Truelove S C, Richards W CD. Biopsy studies in ulcerative colitis.  Br Med J. 1956;  i 1315-1318
    PubMedGoogle Scholar
  • 22 Dick A P, Holt L P, Dalton E R. Persistence of mucosal abnormality in ulcerative colitis.  Gut. 1966;  7 355-360
    PubMedGoogle Scholar
  • 23 Powell-Truck J, Day D W, Buckell N A. et al . Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis.  Dig Dis Sci. 1982;  27 533-537
    CrossrefPubMedGoogle Scholar
  • 24 Langholz E, Munkholm P IA, Davidsen M. et al . Course of ulcerative colitis: analysis of changes in disease activity over years.  Gastroenterology. 1994;  107 3-11
    PubMedGoogle Scholar
  • 25 Jarnerot G, Rolny P, Sandberg-Gertzen H. Intensive intravenous treatment of ulcerative colitis.  Gastroenterology. 1985;  89 1005-1013
    PubMedGoogle Scholar
  • 26 Moum B, Ekbom A, Vatn M H. et al . Clinical course during the 1st year after diagnosis in ulcerative colitis and Crohn's disease.  Scand J Gastroenterol. 1997;  32 1005-1012
    CrossrefPubMedGoogle Scholar
  • 27 Riley S A, Mani V, Goodman M J. et al . Why do patients with ulcerative colitis relapse?.  Gut. 1990;  31 179-183
    PubMedGoogle Scholar
  • 28 Rijk M CM, van Lier H JJ, van Tongeren J HM. Relapse-preventing effect and safety of sulfasalazine and olsalazine in patients with ulcerative colitis in remission: a prospective, double-blind, randomized multicenter study.  Am J Gastroenterol. 1992;  87 438-442
    PubMedGoogle Scholar
  • 29 Nilsson A, Danielsson A, Lofberg R. et al . Olsalazine versus sulphasalazine for relapse prevention in ulcerative colitis: a multicenter study.  Am J Gastroenterol. 1995;  90 381-387
    PubMedGoogle Scholar
  • 30 Kiilerich S, Ladefoged K, Rannem T. et al . Prophylactic effects of olsalazine vs. sulphasalazine during 12 months maintenance treatment of ulcerative colitis.  Gut. 1992;  33 252-255
    CrossrefPubMedGoogle Scholar

S. Higaki, M.D.

First Department of Internal Medicine · Yamaguchi University School of Medicine

1-1-1 Minami Kogushi · Ube · Yamaguchi 755-8505 · Japan ·

Fax: +81-836-222240

Email: higaki@mx51.tiki.ne.jp