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Ulcerative colitis is the most prevalent forms of inflammatory bowel diseases and a refractory autoimmune disease and affects millions of people worldwide. Herein, we develop an oral-administration nanosystem (QM@EP) for colitis detection, targeted drug delivery/release to colon and therapy. QM@EP consists of a molecular probe QY-SN-H 2 O 2 , a NLRP3 inhibitor MCC950 and enteric polymers. QY-SN-H 2 O 2 is based on the AIE-active chromophore QY-SN-OH with pentafluorobenzenesulfonate moieties as the recognition moiety for the biomarker H 2 O 2 and the fluorescence quencher. H 2 O 2 can cleave the pentafluorobenzenesulfonate moieties in QY-SN-H 2 O 2 and thus generating the AIE-active chromophore Q-SN-OH. Two biocompatible polymers were employed in the nanosystem, in which poly(lactic-co-glycolic acid) (PLGA) serves as the sustained release excipient and the Eudragit® S100 acts as the excipient for controlled release of drug formulations in colonic pH to prevent premature drug release in stomach. Our experiments demonstrate that, upon oral administration the nanosystem effectively delivers the probe and drug into colon and release them therein upon being triggered by colonic pH. Then the released probe is activated and turned into the AIE-active chromophore upon being triggered by the pathological level of colonic ROS, thereby bringing about strong fluorescence and optoacoustic signals for NIR-II fluorescence and 3D multispectral optoacoustic tomography (MSOT) imaging for diagnosis and therapeutic outcome monitoring; and the released drug exerts high therapeutic efficacy against ulcerative colitis through inhibiting NLRP3 inflammasome formation., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and Objective: Acute severe colitis (ASC) is a potentially life-threatening event. Optimal timing for second-line treatment in children is mainly based on the clinical score Pediatric Ulcerative Colitis Activity Index. The aim of our study was to evaluate the potential role of bowel ultrasound scan (BUS) in predicting the need of second-line therapy in ASC., Methods: Patients younger than 18 years admitted to a single tertiary referral center with ASC were included. We retrospectively reviewed medical records collecting clinical and BUS data. Colonic wall thickness (CWT), loss of colonic wall stratification (CWS), presence of hyperechoic lymph nodes, and colonic wall flow evaluated at power Doppler were assessed at BUS performed within the third day of hospitalization., Results: Sixty-nine ASC episodes from 52 different patients were identified. CWT showed significantly higher values in patients who required second-line therapy (5.14 vs 3.69 mm; P < 0.001). Loss of CWS was present in 17 of 36 (47.2%) of steroid-resistant ASC versus only 1 of 33 of those responding to intravenous corticosteroids (P < 0.001, sensitivity = 47%, specificity = 97%). Using a receiver operating characteristic curve, a cut-off of 3.4 mm was individuated for CWT to predict steroid treatment failure, showing a sensitivity of 92% and a specificity of 52%. The multivariable binary logistic regression analysis identified thickened colonic wall (CWT >3.4 mm) and loss of CWS as independent predictors of steroid resistance., Conclusions: BUS is a noninvasive, easily accessible, and cost-effective resource that may identify at an early stage first-line therapy failure in pediatric ASC.

Computed tomography (CT) is valuable for detection and characterization of many inflammatory conditions of the colon. At CT, a dilated, thickened appendix is suggestive of appendicitis. A 1-4-cm, oval, fatty pericolic lesion with surrounding mesenteric inflammation is diagnostic of epiploic appendagitis. The key to distinguishing diverticulitis from other inflammatory conditions of the colon is the presence of diverticula in the involved segment. In typhlitis, CT demonstrates cecal distention and circumferential thickening of the cecal wall, which may have low attenuation secondary to edema. In radiation colitis, the clinical history is the key to suggesting the diagnosis because the CT findings can be nonspecific. The location of the involved segment and the extent and appearance of wall thickening may help distinguish Crohn disease and ulcerative colitis. In ischemic colitis, CT typically demonstrates circumferential, symmetric wall thickening with fold enlargement. CT findings of graft-versus-host disease include small bowel and colonic wall thickening, which may result in luminal narrowing and separation of bowel loops. In infectious colitis, the site and thickness of colon affected may suggest a specific organism. The amount of wall thickening in pseudomembranous colitis is typically greater than in any other inflammatory disease of the colon except Crohn disease.

Background and Study Aims: In a previous study, we have shown that rectal endoscopic ultrasound (EUS) could be used to differentiate ulcerative colitis from Crohn's disease by demonstrating the presence of pathological lymph nodes around the rectum and sigmoid colon which were characteristic of ulcerative colitis. The aim of the present study was to evaluate the endosonographic features of infectious colitis and their potential clinical relevance., Patients and Methods: We carried out rectal endosonography in 17 patients with infectious colitis of various etiologies. Wall features and perirectal lymph nodes were documented systematically., Results: In 15 patients no pathological lymph nodes were seen and the EUS wall features were also normal. In two patients where EUS showed pathological lymph nodes, follow-up confirmed ulcerative colitis several weeks later., Conclusions: This preliminary study suggests that, in patients with infectious colitis, EUS may be able to suggest the diagnosis of associated ulcerative colitis; further studies with larger patient numbers are necessary.

Background: To assess the value of high resolution sonography (HRS) in identifying normal and inflammatory bowel wall in nondiverticular ileitis and colitis by using a segment-by-segment analysis., Methods: Thirty-five HRS were performed in patients with nondiverticular inflammatory bowel disease, without knowledge of clinical, endoscopic, and radiologic data. HRS evaluated separately five intestinal segments (terminal ileum, cecum/ascending colon, transverse, descending colon, and sigmoid colon) and was considered positive for inflammation when wall thickness during compression exceeded 3 mm. We compared HRS findings with results of endoscopy or enteroclysis performed within 8 days of HRS; endoscopic and radiologic results were classified into two subgroups: mild inflammatory lesions and frank inflammatory lesions., Results: Segment-by-segment analysis resulted in an accuracy of 81%, a sensitivity of 70%, and a specificity of 93%. Sensitivity was significantly lower for mild lesions (52%) than for frank lesions (87%, p < .001). Of the 32 patients having an inflammatory bowel condition, 29 (91%) had at least one segment correctly identified as inflammatory by HRS., Conclusion: Even if relatively insensitive for minor lesions, HRS is a promising, minimally invasive method for assessing normal and inflammatory bowel wall in nondiverticular ileitis and colitis.

CT plays an important role in the evaluation of patients with suspected colonic inflammation. High-resolution, thin-section imaging of the gastrointestinal tract allows assessment of both the intraluminal and extraluminal components of colonic disease, thereby enabling radiologists to detect and stage colonic pathology accurately. In addition, CT can be used to guide percutaneous drainage of abscess collections, often obviating the need for surgical intervention. This article describes CT techniques for diagnosing inflammatory diseases of the colon as well as the typical CT appearances.

Ultrasonic signs of colitis were studied in 24 adults aged 20 to 53 yr and 38 children aged 3-16 yr in whom chronic colitis was diagnosed. 2 adults and three children had ulcerative colitis. The results obtained showed that with the aid of echography it is possible to detect inflammatory lesions in the large intestine as well as to observe the time course of changes in its wall during the course of treatment. Ultrasonic investigation can be of screening type in detecting an inflammatory process in the large intestine, on the one hand, and a method of profound study of changes in its wall, on the other.

The diagnosis of "indeterminate colitis" was found in 6 patients of 147 operated patients (4%) as compared to the indeterminate diagnosis in 59 of 465 non-operated colitis patients (13%) at the register of inflammatory bowel diseases of Tampere University Hospital. The long-term natural course of the six surgically treated "indeterminate colitis" patients was analysed. The term "indeterminate colitis" included macroscopically either Crohn's colitis or ulcerative colitis which histologically remained indeterminate both pre and peroperatively. Clinicopathological follow-up after the median 5 1/2 years indicated typical Crohn's disease in one case and probable in two cases. However, the final diagnosis remained indeterminate in three cases. The results of the present study showed that patients with indeterminate colitis may have a tendency for Crohn's colitis in the long-term follow-up and thus should be considered when planning an ileal pouch-anal anastomosis.

Purpose: To determine whether colitides can be differentiated based on computed tomographic (CT) features., Materials and Methods: The CT scans of 117 patients with documented colitis and colon wall thickening were reviewed. Features evaluated included mural thickness and homogeneity, distribution of bowel involvement, and associated mesenteric and small bowel disease., Results: The mean colon wall thickness in Crohn colitis (11.0 mm +/- 5.1) was significantly greater than in ulcerative colitis (7.8 mm +/- 1.9) (P < .002). Submucosal fat deposition, not observed in the acute colitides, was present significantly more often in ulcerative (61%) than in Crohn colitis (8%) (P = .0001). Exclusive involvement of the right colon and small bowel was most frequent with Crohn and infectious colitis. Abscess was associated almost exclusively with Crohn colitis (35%) but was seen in one patient with radiation colitis., Conclusion: Although many CT findings in patients with colitis are nonspecific, some features are helpful in suggesting a specific diagnosis.

Fifty pediatric patients suspected of having colonic disease were evaluated by antegrade barium study ("antegrade colonogram") and by colonoscopy with multiple biopsy specimens. Radiographic patterns of mucosal irregularity, nodularity, or ulceration, haustral asymmetry or edema, and narrowing of the colonic lumen were easily recognized. Correlation between colonographic patterns, biopsy findings, and gross appearance at colonoscopy showed the colonogram to have an overall accuracy of 77-88%. The antegrade colonogram is easily performed and often provides information regarding areas of the colon not seen by the endoscopist. In some cases it may also be useful in the evaluation of response to therapy for inflammatory bowel disease.

Research into the morphofunctional status of the kidneys was conducted in patients with nonspecific colitis-NC (nonspecific ulcerative colitis-NUC and Crohn's disease). Urodynamics and partial function of the kidneys were assessed in 74 NC patients (51 NUC patients and 23 patients with Crohn's disease) on the basis of the findings of two-nuclide dynamic renal scintigraphy with 131I-hippuran and 99mTc-pentatech. Despite the absence of clinical symptomatology of urinary tract lesions, marked dysfunction of the kidneys of various degree (depending on severity of disease, tactics of its treatment and a type of surgical intervention) was noted in NC patients. In most cases changes of renal function were without visible clinical manifestations and were frequently undetectable by routine laboratory tests. Therefore dynamic renal scintigraphy was found necessary for investigation on NC patients.

Indium 111-leukocyte scanning has recently been introduced as a new method for imaging inflammatory bowel disease. The technique has recently been made more specific for acute inflammation by labeling a pure granulocyte fraction rather than the conventional mixed leukocyte preparation. We now report a prospective study comparing 111In-granulocyte scanning with endoscopy, histology, and fecal 111In-granulocyte excretion for the assessment of disease extent and severity in colonic inflammatory bowel disease. In 52 patients with Crohn's disease or ulcerative colitis, disease extent and severity were assessed macroscopically, histologically, or by scanning using a numerical grading system. Excellent correlations were found between both endoscopy and histology and 111In scans [r = 0.90 (endoscopy) and r = 0.90 (histology) for extent; r = 0.86 and r = 0.91 for disease activity]. Severity graded by scanning also showed a close correlation with fecal 111In-granulocyte excretion (r = 0.90). Indium 111-granulocyte scans are a rapid, accurate, noninvasive means of assessing both disease extent and severity of colonic involvement in inflammatory bowel disease.

The depth of colonic ulceration has been graded histologically in 40 patients treated by urgent colectomy for acute colitis. Dilatation of the colon occurred in only 2 of 16 patients with ulceration limited to the submucosa, but in 18 of 24 patients with ulceration which extended into the muscle layer. Perforation occurred in 4 of the 6 patients in whom ulceration was seen to penetrate the muscle completely; the only two deaths occurred among these 4 patients. Complications of colitis thus correlated with the depth of ulceration. The clinical, laboratory, and radiologic features just before operation have been correlated with the depth of ulceration. While there was tendency for anorexia, abdominal tenderness on palpation, fever, tachycardia, leucocytosis, and hypoproteinemia to occur more commonly as the depth of ulceration increased, no single feature or combination of these features correlated well with ulcer depth. A colonic segment exceeding 5 cm in diameter with an irregular mucosal edge, outlined by gas on a plain abdominal radiograph, correlated strongly with ulceration involving the colonic muscle.

Eight-five patients with inflammatory large bowel disease were reviewed. The reliability of several diagnostic criteria was assessed. Using a single contrast barium technique, with strict attention to these criteria, 90% diagnostic accuracy in ulcerative colitis and Crohn's diseease of the colon was possible.

Description of radiographic lesions in the various stages of ulcerative colitis as well as the deviating alterations of granulomatous colitis are represented. Radiographic signs are discussed with regard to their diagnostical importance. The value of angiography for the differential diagnosis of colitis is pointed out.

It is important clinically to be able to differentiate ulcerative colitis from Crohn's colitis because they differ considerably in the nature of complications and prognoses. Radiographically, it is possible to render a specific diagnosis in the vast majority of cases using criteria described in this article. The problem of the underlying process in inflammatory bowel disease in elderly patients and indeterminate colitis is also discussed.

Idiopathic inflammatory bowel disease in childhood was once considered rare but is now being increasingly recognized. Although ulcerative colitis and Crohn's disease, the two most common types, have some features in common with the adult form, in all of these diseases the differential diagnoses, presentation, and therapy differ in many important ways from those in adults. Infants are also susceptible to diseases not seen in older children. These differences and the often extremely young age of the patient markedly affect the choice and performance of diagnostic imaging techniques. These techniques have to be modeled more to the individual's requirements than in adults, and infants need a different approach even from older children.

The clinical behavior and course of ischemic, ulcerative, and Crohn's colitis in the elderly are analyzed. Fifty-two patients with ischemic colitis, 11 with ulcerative colitis, and four with Crohn's colitis composed the study group. Patients with ischemic colitis were older and had a higher incidence of arteriosclerotic cardiovascular disease than those with inflammatory bowel disease. A potentially obstructing colonic lesion was present in 12% of those with ischemic colitis. Spontaneous rapid resolution occurred in 42% of those with ischemic colitis, but in no patient with ulcerative or Crohn's colitis. Of the 31 remaining patients with ischemic colitis, 20% had recurrent disease and 80% required operation. Almost 10% of patients with ischemic colitis died postoperatively. Of those patients with ulcerative colitis, two developed toxic dilitation, three required operation, and three died on the first admission. All patients with Crohn's colitis required operation. The prognosis for colitis in elderly patients, regardless of type, is worse than in young patients.

By paying attention to the detailed relief pattern of the colonic mucosa on double contrast films, it is possible to recognise the early changes due to inflammatory colonic disease. The presence of a granular appearance suggests an early stage of ulcerative colitis; multiple small flecks of contrast, sometimes surrounded by a clear area, indicate aphthous ulcers in an early stage of Crohn's disease.

The value of computed tomography (CT) in the differentiation of an enlarged retrorectal space was analyzed in 132 cases. Classification of barium enema findings into those with simultaneous mucosal alterations and those without any visible lesions of the rectal mucosa seems to be useful. Computed tomography helps in those cases without mucosal changes to differentiate between retrorectal fibrosis, tumorous masses, and inflammatory diseases of the colon. It also demonstrates the lack of pathologic lesions in equivocal cases of pelvic lipomatosis and so-called "normal variants." If simultaneous mucosal involvement on barium enema--especially in rectal carcinoma or recurrent carcinoma of the rectum--is found, CT may show the perirectal extension of tumorous masses and thus help to clarify local operability.

Salmonella species have recently been shown to involve the colon in a diffuse fashion resembling ulcerative colitis by radiographic and endoscopic appearance. We describe a case of Salmonella colitis in which the radiographic and colonoscopic features were focal ulcerations, mucosal edema, friability, and a loss of normal vascularity, an appearance resembling Crohn's disease. This is the first well-documented example of this clinical presentation.

The collar button-shaped ulcer is a distinctive radiographic manifestation of inflammatory disease of the GI tract. Its hallmark is mucosal ulceration with undermining submucosal extension limited by the relatively resistant underlying muscle wall. Such a process is commonly associated with ulcerative colitis where it may be seen diffusely in advanced stages of the acute disease. Occasionally, however, it may be seen in any ulcerating inflammatory disease. In the more aggressive transmural diseases, it is likely to be a localized and transient phenomenon. The same pathophysiological mechanism gives rise to the common appearance of benign ulceration anywhere in the GI tract and, particularly, in the undermined gastric ulcer.

The plain abdominal radiograph is an important investigation in acute colitis, but may fail to demonstrate the state of the colon owing to a lack of intracolonic gas. The extent of the colitis can be demonstrated by introducing air directly into the large bowel; the air also provides sufficient contrast to distinguish a granular from an ulcerated mucosa. The "air enema" may be used as an alternative to an unprepared barium enema. Its accuracy has been established by comparison with an unprepared barium enema in 10 patients with acute colitis.

Eight patients with ulcerative colitis, three with colitis indeterminate, and 15 patients with Crohn disease were studied by computed tomography (CT) to establish CT criteria for each disorder in hopes of providing a new diagnostic perspective useful in the radiographic evaluation of inflammatory colitis. The CT findings in ulcerative colitis included thickening of the colon wall (mean, 7.8 mm), which was characterized by inhomogeneous attenuation and a "target" appearance of the rectum, and proliferation of perirectal fat. Bowel wall thickening (mean, 13 mm) with homogeneous attenuation, fistula and abscess formation, and mesenteric abnormalities were observed in patients with Crohn colitis. Patients with colitis indeterminate showed colonic changes on CT observed in both disorders. Initial experience suggests that CT can differentiate patients with well established ulcerative and Crohn colitis.

The instant, or unprepared, double contrast barium enema has been used routinely at St Mark's Hospital in the investigation of active inflammatory disease of the colon since 1963. The use of air contrast is preferred to show the fine detail of the mucosal changes and to detect early involvement. With the instant enema technique the diagnostic results are satisfactory and patients are minimally disturbed by the procedure. The majority of examinations consist of a total of four films, which includes a plain film of the abdomen prior to the administration of contrast. For short-term follow-up a repeat enema with a single film is usually adequate.

99mTc-DTPA was found to localize in segments of bowel with inflammation due to ulcerative colitis, regional enteritis, and other forms of enterocolitis. The concentration of tracer was apparently related to the clinical activity of the disease process. Imaging with 99mTc-DTPA may offer an appealing, noninvasive alternative for identifying and following up patients with inflammatory bowel disease.

Diverse signs may be seen on barium enema in the various forms of colitis. Barium enema is only reasonably specific in the diagnosis of Crohn's disease and ulcerative colitis once the other possible diseases have been excluded from consideration by biopsy, microscopy, culture, or therapeutic trial. In particular, campylobacter colitis has proved to be such a common entity that many patients originally thought to have had one attack of ulcerative colitis, ischemic colitis, or Crohn's colitis may never have had these diseases. Many of the relatively specific signs can be seen in a variety of conditions. For example, aphthae in the colon may be seen in Crohn's disease, yersinia enterocolitis, Behçet's syndrome, amebiasis, ischemia, tuberculosis, and campylobacter colitis. Continuity of disease is characteristic in ulcerative colitis. Nevertheless, patches of healing may occur, so that a rare patient may be seen during a resolving attack of ulcerative colitis in whom only scattered patches of active disease can be seen on barium enema. In general, few radiologic signs on barium enema are truly specific for one disease, with penumatosis cystoides coli being an exception to this rule. However, the sensitivity of barium enema with currently available materials for double-contrast techniques is such that radiology continues to be useful at present in diagnosing the colitides and in managing patients.

Rotavirus infections are a common cause of childhood gastroenteritis but are rarely severe enough to justify radiographs. However, there appears to be a small subset of children in whom a rotavirus-induced diarrheal illness accompanied by bloody stools is sufficiently severe and protracted to warrant barium studies. We have observed spasm and minute mucosal ulcerations of the colon in three of these children. These findings, under other circumstances, would have prompted the diagnosis of ulcerative colitis. These children also had a variety of other findings, such as osteomyelitis, intraocular mycetoma, and positive blood cultures. We suggest that when bloody diarrhea follows or accompanies a typical viral illness, rotavirus particles or antibodies be sought. This may prevent misdiagnosis of ulcerative colitis and unnecessary treatment with steroids.

The examinations were performed in 40 outpatients, of whom 21 were women. From the rectal and colonic mucosa 185 biopsies were obtained. The X-ray examination was performed within one week from the colonoscopy, using a conventional barium enema. A complete agreement between the colonoscopic diagnosis and that of the directed biopsy was found in 33 cases (80 per cent), and minor disagreements in 3 cases. A complete agreement between the colonoscopic and X-ray diagnoses was obtained in 22 patients (55 per cent), and minor disagreements in 16 cases, most of whom showed "unspecific" non-ulcerative colitis. In 3 cases with ulcerative colitis a normal colon was found by X-ray. A higher percentage of cases showed decreased haustration by X-ray examination than by colonoscopy, whereas a fairly equal percentage of ulceration was detected by the two methods. Erosions, mucus covering, oedema, vascular injection, and bleedings were not detected by X-ray examination.

The hemolytic-uremic syndrome consists of hemolytic anemia, renal failure, and thrombocytopenia. Submucosal hemorrhage with "thumbprinting" on roentgenographic examination of the colon with barium was demonstrated in four patients, prolapse of the rectum in two patients, and pseudomembranous enterocolitis and toxic megacolon in one. These lesions are not generally associated with hemolytic-uremic syndrome. The presence of these lesions in a child with bloody diarrhea should suggest hemolytic-uremic syndrome as a possible diagnosis. Sigmoidoscopy and roentgenographic examination of the colon with barium should be done in selected patients with hemolytic-uremic syndrome to evaluate the degree of colonic involvement and the need for surgery.