Inflammatory bowel diseases: fertility, pregnancy, labor

Inflammatory bowel diseases (IBD) including ulcerous colitis (UC) and Crohn’s disease (CD) are widely spread among young persons and therefore there are many questions from both patients and specialists regarding management tactics for this category of patients. The paper presents the main items of The Second European Consensus on Reproduction and Pregnancy in Patients with IBD including the questions of fertility, optimization of pregnancy planning, characteristic features of its course, labor and postpartum period.

Peculiar features of immunoinflammatory syndrome in patients with ulcerous colitis, depending on severity of disease attack

Aim. To study the blood serum interleukin-6 (IL) and circulating immune complexes (CIC) levels in patients with ulcerous colitis (UC), depending on the severity of disease attack, colonic inflammation dissemination, and presence of abenteric manifestations. Materials and methods. One hundred patients with UC in the phase of active inflammation were examined. Blood serum IL-6 and CIC concentrations were studied with IFA method. Results. 88,5 % of UC patients in the phase of active inflammation showed an elevated mean IL-6 index, 80 % had increased CIC concentration as compared with normal values. The highest IL-6 and CIC levels were obtained in case of severe forms of disease (11,50 (7,30–23,65) pg/ml and 115,50 (105,00–118,00), respectively); CIC and IL-6 levels were significantly higher in patients with abenteric manifestations and frequently relapsing course in comparison with patients, having rare UC relapses (p < 0,005). Strong direct correlations of IL-6 and CIC with each other (r = 0,65; p = 0,001) as well as with the severity of pathological changes in the colon were established. Conclusions. Among patients with UC, significantly elevated blood serum IL-6 and CIC concentrations were determined. Patients with severe attack of disease as well as those with abenteric manifestations and frequent relapses demonstrated reliably higher levels of these indices. It is recommended to use determination of blood serum IL-6 and CIC levels as an available and informative method, permitting to estimate the degree of severity of inflammatory process in the colonic wall among patients with ulcerous colitis.

Differential diagnosis problem of pulmonary changes in ulcerative colitis

Introduction. Inflammatory intestinal diseases are often accompanied with extraintestinal and even pulmonary manifestations. The treatment of these intestinal diseases includes sulphasalazine and mesalazine, which may have undesirable allergic and other side effects, including hypersensitive pneumonitis. Case report. Having performed colonoscopy due to abdominal pains and mushy stools, the diagnosis of ulcerous colitis was established in a 20-year old female patient and the treatment with mesalazine initiated. However, the patient developed slimy and bloody stools, slightly increased body temperature, dry cough and bilateral lung lesions. The bronchological exploration established interstitial and organizing pneumonia. Despite the treatment with antibiotics, corticosteroids and mesalazine, dry cough, fever and bloody stools persisted, accompanied with bilateral inhomogeneous lesions of the pulmonary parenchyma. Upon discontinuation of the treatment with mesalazine, clinical symptoms and pulmonary lesions disappeared. Conclusion. The differential diagnosis of pulmonary lesions in patients with ulcerous colitis may be a problem. In the reported case, pulmonary lesions were interpreted as interstitial pneumonitis accompanying ulcerous colitis. However, they are most probably a consequence of allergic response to mesalazine.