Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis
Classic teaching emphasizes that chronic ulcerative colitis is characterized morphologically by the presence of fixed architectural and cellular mucosal changes that categorize the process as chronic. To examine the effect of topical 5-aminosalicylic acid (5-ASA) enemas on the presence of six histol...
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Veröffentlicht in: | The American journal of surgical pathology 1993-09, Vol.17 (9), p.869-875 |
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description | Classic teaching emphasizes that chronic ulcerative colitis is characterized morphologically by the presence of fixed architectural and cellular mucosal changes that categorize the process as chronic. To examine the effect of topical 5-aminosalicylic acid (5-ASA) enemas on the presence of six histological features of chronicity in established chronic ulcerative colitis, 123 mucosal biopsies were taken prospectively at 1-month intervals, all from the same anatomic location (10 cm), from 14 patients treated with either 5-ASA or placebo enemas. The biopsies were evaluated for the presence of mixed inflammation in the lamina propria, crypt architectural abnormalities, basally located lymphoid aggregates, basal plasmacytosis, villiform surface epithelial configuration, and Paneth cell metaplasia. Overall, 29% of biopsies from 64% of patients were histologically normal (no chronic features, no active disease). Compared with patients treated with placebo enemas, patients treated with 5-ASA enemas showed a significantly higher percentage of normal biopsies (36% ASA group vs. 12% placebo group; p = 0.005) and a lower percentage occurrence of each individual histological feature of chronicity. In addition, patients treated with 5-ASA had a higher average number of normal biopsies per patient (3.0) than those treated with placebo enemas (1.3). Therefore, histologically normal-appearing mucosal biopsies do occur in established cases of chronic ulcerative colitis, and this finding is enhanced by treatment with 5-ASA enemas. Awareness of these results should prevent the presence of normal rectal mucosal biopsy findings in chronic ulcerative colitis patients from being misinterpreted as either evidence against this diagnosis or as representing focal skip areas characteristic of Crohn's disease. |
doi_str_mv | 10.1097/00000478-199309000-00002 |
format | Article |
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To examine the effect of topical 5-aminosalicylic acid (5-ASA) enemas on the presence of six histological features of chronicity in established chronic ulcerative colitis, 123 mucosal biopsies were taken prospectively at 1-month intervals, all from the same anatomic location (10 cm), from 14 patients treated with either 5-ASA or placebo enemas. The biopsies were evaluated for the presence of mixed inflammation in the lamina propria, crypt architectural abnormalities, basally located lymphoid aggregates, basal plasmacytosis, villiform surface epithelial configuration, and Paneth cell metaplasia. Overall, 29% of biopsies from 64% of patients were histologically normal (no chronic features, no active disease). Compared with patients treated with placebo enemas, patients treated with 5-ASA enemas showed a significantly higher percentage of normal biopsies (36% ASA group vs. 12% placebo group; p = 0.005) and a lower percentage occurrence of each individual histological feature of chronicity. In addition, patients treated with 5-ASA had a higher average number of normal biopsies per patient (3.0) than those treated with placebo enemas (1.3). Therefore, histologically normal-appearing mucosal biopsies do occur in established cases of chronic ulcerative colitis, and this finding is enhanced by treatment with 5-ASA enemas. Awareness of these results should prevent the presence of normal rectal mucosal biopsy findings in chronic ulcerative colitis patients from being misinterpreted as either evidence against this diagnosis or as representing focal skip areas characteristic of Crohn's disease.</description><identifier>ISSN: 0147-5185</identifier><identifier>DOI: 10.1097/00000478-199309000-00002</identifier><identifier>PMID: 8352372</identifier><language>eng</language><publisher>United States</publisher><subject>Administration, Topical ; Adult ; Aged ; Aminosalicylic Acids - administration & dosage ; Aminosalicylic Acids - therapeutic use ; Biopsy ; Colitis, Ulcerative - drug therapy ; Colitis, Ulcerative - pathology ; Female ; Humans ; Intestinal Mucosa - drug effects ; Intestinal Mucosa - pathology ; Male ; Mesalamine ; Middle Aged ; Prospective Studies ; Rectum - drug effects ; Rectum - pathology</subject><ispartof>The American journal of surgical pathology, 1993-09, Vol.17 (9), p.869-875</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8352372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Odze, R</creatorcontrib><creatorcontrib>Antonioli, D</creatorcontrib><creatorcontrib>Peppercorn, M</creatorcontrib><creatorcontrib>Goldman, H</creatorcontrib><title>Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis</title><title>The American journal of surgical pathology</title><addtitle>Am J Surg Pathol</addtitle><description>Classic teaching emphasizes that chronic ulcerative colitis is characterized morphologically by the presence of fixed architectural and cellular mucosal changes that categorize the process as chronic. To examine the effect of topical 5-aminosalicylic acid (5-ASA) enemas on the presence of six histological features of chronicity in established chronic ulcerative colitis, 123 mucosal biopsies were taken prospectively at 1-month intervals, all from the same anatomic location (10 cm), from 14 patients treated with either 5-ASA or placebo enemas. The biopsies were evaluated for the presence of mixed inflammation in the lamina propria, crypt architectural abnormalities, basally located lymphoid aggregates, basal plasmacytosis, villiform surface epithelial configuration, and Paneth cell metaplasia. Overall, 29% of biopsies from 64% of patients were histologically normal (no chronic features, no active disease). Compared with patients treated with placebo enemas, patients treated with 5-ASA enemas showed a significantly higher percentage of normal biopsies (36% ASA group vs. 12% placebo group; p = 0.005) and a lower percentage occurrence of each individual histological feature of chronicity. In addition, patients treated with 5-ASA had a higher average number of normal biopsies per patient (3.0) than those treated with placebo enemas (1.3). Therefore, histologically normal-appearing mucosal biopsies do occur in established cases of chronic ulcerative colitis, and this finding is enhanced by treatment with 5-ASA enemas. Awareness of these results should prevent the presence of normal rectal mucosal biopsy findings in chronic ulcerative colitis patients from being misinterpreted as either evidence against this diagnosis or as representing focal skip areas characteristic of Crohn's disease.</description><subject>Administration, Topical</subject><subject>Adult</subject><subject>Aged</subject><subject>Aminosalicylic Acids - administration & dosage</subject><subject>Aminosalicylic Acids - therapeutic use</subject><subject>Biopsy</subject><subject>Colitis, Ulcerative - drug therapy</subject><subject>Colitis, Ulcerative - pathology</subject><subject>Female</subject><subject>Humans</subject><subject>Intestinal Mucosa - drug effects</subject><subject>Intestinal Mucosa - pathology</subject><subject>Male</subject><subject>Mesalamine</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Rectum - drug effects</subject><subject>Rectum - pathology</subject><issn>0147-5185</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNotkM1OxCAUhVloxnH0EUxYGV2gQEspy8lk_EkmcaGuG0rBwdBSgZr07aVxTnJzc26-cxYXAEjwA8GCP-JFJa8REaLAIhu0XOgZWGNScsRIzS7AZYzfGBNaE7oCq7pgtOB0Dea9MVol6A1MfrRKOsiQ7O3go3RWzXmgVLaDdwxt37f3MB11kOMM_QBDDma-n9QCw9b6Mc6w92E8eue_ZmgHqI7BD7ljcirnkv3VUHlnk41X4NxIF_X1aW_A59P-Y_eCDm_Pr7vtAY0UVwkpxqVU1JCy1NqUBOuWsbZoKyEZoVQLbLipWGkExUaYrsKMdTUtOyV5x6goNuD2v3cM_mfSMTW9jUo7Jwftp9hwVi_iGbw5gVPb664Zg-1lmJvTr4o_2v9sPw</recordid><startdate>19930901</startdate><enddate>19930901</enddate><creator>Odze, R</creator><creator>Antonioli, D</creator><creator>Peppercorn, M</creator><creator>Goldman, H</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19930901</creationdate><title>Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis</title><author>Odze, R ; Antonioli, D ; Peppercorn, M ; Goldman, H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p206t-c57aac2f144eef410eb55b3b69a5122e90f7f654f920f9fd6055d824dca7d5293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Administration, Topical</topic><topic>Adult</topic><topic>Aged</topic><topic>Aminosalicylic Acids - administration & dosage</topic><topic>Aminosalicylic Acids - therapeutic use</topic><topic>Biopsy</topic><topic>Colitis, Ulcerative - drug therapy</topic><topic>Colitis, Ulcerative - pathology</topic><topic>Female</topic><topic>Humans</topic><topic>Intestinal Mucosa - drug effects</topic><topic>Intestinal Mucosa - pathology</topic><topic>Male</topic><topic>Mesalamine</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Rectum - drug effects</topic><topic>Rectum - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Odze, R</creatorcontrib><creatorcontrib>Antonioli, D</creatorcontrib><creatorcontrib>Peppercorn, M</creatorcontrib><creatorcontrib>Goldman, H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgical pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Odze, R</au><au>Antonioli, D</au><au>Peppercorn, M</au><au>Goldman, H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis</atitle><jtitle>The American journal of surgical pathology</jtitle><addtitle>Am J Surg Pathol</addtitle><date>1993-09-01</date><risdate>1993</risdate><volume>17</volume><issue>9</issue><spage>869</spage><epage>875</epage><pages>869-875</pages><issn>0147-5185</issn><abstract>Classic teaching emphasizes that chronic ulcerative colitis is characterized morphologically by the presence of fixed architectural and cellular mucosal changes that categorize the process as chronic. To examine the effect of topical 5-aminosalicylic acid (5-ASA) enemas on the presence of six histological features of chronicity in established chronic ulcerative colitis, 123 mucosal biopsies were taken prospectively at 1-month intervals, all from the same anatomic location (10 cm), from 14 patients treated with either 5-ASA or placebo enemas. The biopsies were evaluated for the presence of mixed inflammation in the lamina propria, crypt architectural abnormalities, basally located lymphoid aggregates, basal plasmacytosis, villiform surface epithelial configuration, and Paneth cell metaplasia. Overall, 29% of biopsies from 64% of patients were histologically normal (no chronic features, no active disease). Compared with patients treated with placebo enemas, patients treated with 5-ASA enemas showed a significantly higher percentage of normal biopsies (36% ASA group vs. 12% placebo group; p = 0.005) and a lower percentage occurrence of each individual histological feature of chronicity. In addition, patients treated with 5-ASA had a higher average number of normal biopsies per patient (3.0) than those treated with placebo enemas (1.3). Therefore, histologically normal-appearing mucosal biopsies do occur in established cases of chronic ulcerative colitis, and this finding is enhanced by treatment with 5-ASA enemas. Awareness of these results should prevent the presence of normal rectal mucosal biopsy findings in chronic ulcerative colitis patients from being misinterpreted as either evidence against this diagnosis or as representing focal skip areas characteristic of Crohn's disease.</abstract><cop>United States</cop><pmid>8352372</pmid><doi>10.1097/00000478-199309000-00002</doi><tpages>7</tpages></addata></record> |
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subjects | Administration, Topical Adult Aged Aminosalicylic Acids - administration & dosage Aminosalicylic Acids - therapeutic use Biopsy Colitis, Ulcerative - drug therapy Colitis, Ulcerative - pathology Female Humans Intestinal Mucosa - drug effects Intestinal Mucosa - pathology Male Mesalamine Middle Aged Prospective Studies Rectum - drug effects Rectum - pathology |
title | Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis |
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