Resolution of multiple severe colonic strictures with prednisone therapy: CASE PRESENTATION (Part 2)
Gastroduodenoscopy and colonoscopy were carried out on April 21, 2002, and April 25, 2002, respectively. Gastroscopy revealed a diffusely erythematous antrum and body, which were biopsied and found to be histologically normal with no evidence of Helicobacter pylori. On duodenoscopy, four ulcers were found, three of which were clean-based and approximately 1 cm in diameter. The fourth was 3×1 cm in size and had a central elevation but no visible vessel. Her colonoscopy revealed small focal haustral ulcerations and a few diverticuli in the sigmoid colon. The transverse colon was affected by severe circumferential ulcerations limited to the haustra with intervening normal mucosa. Five consecutive haustra were notable for circumferential diaphragmatic narrowings of the lumen to approximately 1.5 cm in diameter (Figure 1). The colonoscope could be just passed through the strictures and the ascending colon was endoscopically normal. Biopsies taken from her colonic ulcers showed ulcers lined by acute inflammatory exudates, consistent with ischemic injury and possibly related to NSAID use. No features of malignancy or Crohn’s disease were seen. A small bowel follow-through revealed no other strictures.
Figure 1) Note the linear ulceration on the haustral ridges as a precursor for colonic strictures
During her course in hospital, she was given blood transfusions and oral iron therapy for her anemia, treated with two 40 mg tablets of pantoprazole sodium per day for her duodenal ulcers, and given 4 g/day of 5-aminosalicylic acid in an attempt to accelerate healing of her colonic lesions. ASA and arthrotec were discontinued and her musculoskeletal pain was managed with acetaminophen, glucosamine sulfate and physiotherapy. Her abdominal pain was still present after meals, but its location became more periumbilical. For this reason, repeat gas-troduodenoscopy and colonoscopy were performed on May 2, 2002. Her duodenum at this time had some residual areas of inflammation but there was no ulceration present. Colonoscopy and biopsies of her colonic lesions were essentially unchanged. Best quality drugs are available at the best pharmacy that you can start shopping with right now whenever you need buy cipro just buy here, never having to doubt the choice made or the quality of the drug you get.