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Long-term Treatment of Patients With a History of Ulcerative Colitis Who Develop Gastritis and Pan-Enteritis After Colectomy

Hoentjen, Frank MD, PhD*,†; Hanauer, Stephen B. MD*; Hart, John MD; Rubin, David T. MD*

Journal of Clinical Gastroenterology: January 2013 - Volume 47 - Issue 1 - p 52–57
doi: 10.1097/MCG.0b013e3182582c1d
ALIMENTARY TRACT: Original Articles

Background: Ulcerative colitis (UC) is generally described as a superficial diffuse inflammation restricted to the colon and rectum. However, several case reports have described a distinct and rare type of UC-related pan-enteritis, typically occurring after colectomy. Corticosteroids are effective for induction of remission of this condition, but it is not clear how these patients should be managed long term.

Goals: To further describe and define the entity of UC-related pan-enteritis and to investigate the efficacy of azathioprine for maintenance of remission.

Results: We describe 5 patients with superficial diffuse ulcerative inflammation of the stomach, small bowel, and pouch if present. Four of the 5 patients developed enteritis after colectomy for ulcerative pancolitis. Pathology showed severe mucosal inflammation with infiltration of neutrophils and plasma cells from the stomach to the ileum. Video capsule endoscopy in 1 patient confirmed the presence of mucosal inflammation throughout the small bowel. All patients were started on a standardized treatment with intravenous corticosteroids for induction of remission and azathioprine for maintenance therapy. The conditions of all the patients rapidly improved, and subsequently, 4 patients were in full remission on azathioprine monotherapy, despite failure of this UC therapy before surgery, whereas 1 patient continues to have a steroid-dependent disease.

Conclusions: The outcomes of 5 cases of UC-related pan-enteritis as described in this report support a role for azathioprine in remission maintenance. Future research is needed to improve our understanding of this rare but distinct intestinal inflammatory disorder.

*Inflammatory Bowel Disease Center

Department of Pathology, University of Chicago Medical Center, Chicago, IL

Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands

This publication was in part funded by the Gastro-intestinal Research Foundation Associates' Board, Chicago, IL.

The authors declare that they have nothing to disclose.

Reprints: Frank Hoentjen, MD, PhD, Department of Gastroenterology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands (e-mail:

Received October 17, 2011

Accepted March 30, 2012

© 2013 Lippincott Williams & Wilkins, Inc.