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INTRODUCTION: Ulcerative colitis is a chronic inflammatory disease affecting areas of the colon or the full length. From the endoscopic point of view, ulcerative colitis presents lesions that stretch continuously from the rectum to variable colon segments, a characteristic that is of great value when distinguishing it from Crohn's disease. Continuous involvement, without healthy patches, justifies ending endoscopic exploration once the distal end of the lesion has been reached. OBJECTIVE: To retrospectively study the frequency of segmental lesions in the colonoscopies performed in patients with ulcerative colitis. METHODS: Diagnosis of ulcerative colitis and proctitis was established by clinical, endoscopic, histologic, analytical, and radiological criteria. The indication and number of endoscopies was made on the basis of the clinical criteria of diagnosis, acute episodes, refractoriness or dysplasia screening. The extent of the examination also depended on clinical criteria: the severity of the episode, tolerance to colonoscopy or the degree of cleansing. RESULTS: A total of 155 coloscopies were performed. In 113 colonoscopies (73%) the distal end of the lesion was reached and in 70 (45%) the cecum was reached. Of the 80 patients, 27 (33%) presented ulcerative proctitis at diagnosis. Nine of the 80 patients (11.3%) biopsies were performed in healthy colonic patches, which confirmed histological normality. Six of the 9 patients were receiving no treatment. In all patients except two, the cecum was reached in one or more of the colonoscopies. The distribution of the segmental lesions varied but these were mainly found in the periappendicular region and in the cecum in 6 of the 7 patients in whom the cecum was reached. Of the 80 patients, endo

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Colorectal cancer is an important public health problem that is amenable to prevention and early treatment. Traditional screening techniques - fecal occult blood testing, flexible sigmoidoscopy, barium enema and colonoscopy - each have limitations in terms of diagnostic accuracy, cost and/or patient acceptability. Compliance with recommendations for screening has been poor, in part, because of negative perceptions about the available modalities. Virtual colonoscopy, or computerized tomographic colography, is a minimally invasive technique that safely evaluates the entire colon and does not require sedation. Thorough cleansing as well as immobilization and air insufflation of the colon is crucial to a successful examination. Sensitivity and specificity rates are reasonable, compared with conventional colonoscopy, and it has been shown that the latter technique can be averted in over two-thirds of cases, with few false-negative examinations. Most patients find virtual colonoscopy more acceptable than the conventional technique, and would prefer it if a repeat procedure were warranted. An economic analysis that found that computerized tomographic colography was less cost effective than conventional colonoscopy did not consider the indirect costs of the latter, which is an important limitation. Virtual colonoscopy is a novel radiological technique that may revolutionize screening for colorectal cancer.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12605252&dopt=Abstract constipation laxative colon cleansing




Clin Radiol. 1976 Jan;27(1):103-12.
The double contrast enema in ulcerative and Crohn's colitis.

Fraser GM, Findlay JM.

One hundred double contrast enema examinations using a colonic activator (veripaque in the preliminary cleansing enema and 51 conventional barium enema examinations without a preliminary veripaque enema have been performed on 94 patients with either ulcerative colitis or Crohn's disease of the colon. The severity of the disease at barium enema examinations has been graded and compared with the severity of the disease found at sigmoidoscopy. In the double contrast examination, there was agreement between the radiological and sigmoidoscopic findings in 77% of cases and a disagreement of one grade in the remaining 23% of cases. The double contrast enema demonstrated lesions in the colon proximal to the range of the sigmoidoscope of a greater severity than that seen at sigmoidoscopy in 30% of cases. It was not found possible to use the same grading method with the conventional enema, and unless frank ulceration is present, it is considered that the conventional enema is unreliable in assessing the state of the colonic mucosa. It is concluded that the double contrast enema, using a colonic activator in the preliminary cleansing enema, causes no greater risk of complications than either the conventional enema or sigmoidoscopy.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1261191&dopt=Abstract constipation laxative colon cleansing



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