Two Cases of Ulcerative Colitis-like Gastroduodenitis after Total Proctocolectomy for Intractable Ulcerative Colitis

Abstract

Two rare cases of ulcerative colitis (UC)-like gastroduodenitis that developed after total proctocolectomy are reported. Two women (Case 1 : 22-year-old and Case 2 : 29-year-old) had a 5-year and a 7-year history of left-sided UC, respectively. Both patients underwent total proctocolectomy with stapled ileal pouch anal anastomosis and covering ileostomy for intractable UC. Two months later, Case 1 had epigastralgia and nausea, and Case 2 had nausea and malaise. Upper gastrointestinal endoscopy showed UC-like gastroduodenitis in both cases. Although their symptoms initially improved with prednisolone treatment, they relapsed when the dose of prednisolone was tapered. Case 1 was successfully managed with repeat courses of prednisolone treatment. Nevertheless, Case 2 required therapy with mesalazine powder and granulocyte and monocyte adsorptive apheresis. Following these therapies, they finally achieved steroid-free remission of gastroduodenitis. UC-like gastroduodenitis is a rare clinical entity that is often persistent and intractable. Early diagnosis and treatment are essential to improve treatment outcomes.