ULCERATIVE COLITIS – TREATMENTS, SPECIAL POPULATIONS AND THE FUTURE Edited by Mortimer O'Connor Ulcerative Colitis – Treatments, Special Populations and the Future Edited by Mortimer O'Connor Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Danijela Duric Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Dim Dimich, 2011. Used under license from Shutterstock.com First published October, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Ulcerative Colitis – Treatments, Special Populations and the Future, Edited by Mortimer O'Connor p. cm. ISBN 978-953-307-739-0 Contents Preface IX Part 1 Treatments 1 Chapter 1 Surgical Treatment of Ulcerative Colitis 3 Gianluca Pellino, Guido Sciaudone, Gabriele Riegler, Silvestro Canonico and Francesco Selvaggi Chapter 2 Laparoscopic Surgery for Severe Ulcerative Colitis 15 Kazuhiro Watanabe, Hitoshi Ogawa, Chikashi Shibata, Koh Miura, Takeshi Naitoh, Masayuki Kakyou, Takanori Morikawa, Sho Haneda, Naoki Tanaka, Katsuyoshi Kudo, Shinobu Ohnuma, Hiyroyuki Sasaki and Iwao Sasaki Chapter 3 Drug Therapy in Ulcerative Colitis 31 Xue-Gang Guo, Xiang-Ping Wang and Chang-Tai Xu Chapter 4 New Biologic Drugs for Ulcerative Colitis 49 Francesca Zorzi, Emma Calabrese and Francesco Pallone Chapter 5 Clinical, Biological, and Laboratory Parameters as Predictors of Severity of Clinical Outcome and Response to Anti–TNF–Alpha Treatment in Ulcerative Colitis 61 Trine Olsen and Jon Florholmen Chapter 6 Polysaccharides for Colon–Targeted Drug Delivery: Improved Drug–Release Specificity and Therapeutic Benefits 83 Annette Hartzell and Devin J. Rose Chapter 7 Food and Intestinal Microorganisms: Factors in Pathogenesis, Prevention and Therapy of Ulcerative Colitis 99 Rok Orel and Darja Urlep VI Contents Part 2 Special Population Groups 115 Chapter 8 Ulcerative Colitis and Pregnancy 117 A. Alakkari and C. O’Morain Chapter 9 Ulcerative Colitis in Children and Adolescents 133 Andrew S. Day and Daniel A. Lemberg Part 3 From Bench to Bedside 159 Chapter 10 Animal Models of Colitis: Lessons Learned, and Their Relevance to the Clinic 161 Matthew Barnett and Alan Fraser Preface Gastroenterology is the branch of medicine whereby the digestive system and its disorders are studied. The name is a combination of three Ancient Greek words gaster (gastros or stomach), enteron (intestine), and logos (reason). Its documented history dates back to Egyptian times where, citing from Egyptian papyri, Nunn identified significant knowledge of gastrointestinal diseases among practicing physicians during the periods of the pharaohs, while Irynakhty, of the tenth dynasty, c. 2125 B.C., was a court physician specializing in gastroenterology and proctology. Among ancient Greeks, Hippocrates attributed digestion to concoction, while Galen’s concept of the stomach having four faculties was widely accepted up to modernity in the seventeenth century. Since then the works of Maximilian Stroll in 1777 (described cancer of the gallbladder), Karl Wilhelm von Kupffer in 1876 (described the properties of liver Kupffer cells), Burrill Bernard Crohn in 1932 (described Crohn’s disease), and Barry Marshall, Robin Warren and James Leavitt in 1982/1983 (discovery of Helicobacter pylori and its role in peptic ulcer disease), to mention just a few, has evolved the thinking of gastroenterology. It is clearly seen by the history of Gastroenterology the speciality continues to develop at a rapid pace due to growth in the understanding of disease processes and the discovery of new diagnostic and treatment strategies. Ulcerative Colitis is no exception to this trend. This book is just another step in marking the current developing knowledge and thinking around the area of Ulcerative colitis. This book, which comes in two volumes, is intended to act as an up to date reference point and knowledge developer for all readers interested in the area of gastroenterology and in particular Ulcerative Colitis. All of the chapter authors are experts in their fields of publication and deserve individual credit and praise for their contributions to this book. We hope that you will find this publication informative, stimulating and a reference point for the area of Ulcerative colitis as we move forward in our understanding of the field of medicine. With that hope, I remind you of the though provoking quote by the French Philosopher and writer, Voltaire (1694 – 1778), “Doctors are men who prescribe medicines of which they know little, to cure disease of which they know less, in human beings of whom they know nothing”. X Preface Acknowledgements Many thanks to the authors of each Chapter of this book. The outstanding contributions they have made resulted in a very easy book to edit. It was very enjoyable and a privilege reading each contribution. Your work is now a mark for the future. To the publisher, InTech, thank you for being ever present and encouraging me in my endeavors to stay up to date with the review and editing process. I would never have been so organized without the assistance of Ms. Danijela Duric, Publishing Process Manager. It was a pleasure to edit my first book with such a wonderful group. To my father (Tim) and late mother (Eileen), thank you for all the encouragement over the years to achieve my goals and become the ever developing doctor that I am today. I could not have achieved a fraction of my success without the support and love. Mam, I know you are always watching over and guiding me from a place nearby. Dr Catherine O’Connor, my late aunt, who was always an inspiration. The ever present support and guidance in my early years of life and career where far beyond the role of an aunt or godmother. You will always be an example of professionalism I will strive to achieve. Finally, to my other half, Bernie. All those long evenings spent without me while I was reading chapters and doing background knowledge discovery for this book are finally over. Your support is always beyond the call of duty and appreciated. Thank you. Mortimer B. O’Connor Department of Medicine, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork Ireland . ULCERATIVE COLITIS – TREATMENTS, SPECIAL POPULATIONS AND THE FUTURE Edited by Mortimer O'Connor Ulcerative Colitis – Treatments, Special Populations and the. Extension of ulcerative colitis at presentation Ulcerative Colitis – Treatments, Special Populations and the Future 4 In case of pancolitis, in about 10-20% of patients also the last 5-15. Ulcerative Colitis – Treatments, Special Populations and the Future 8 anastomosis at that level. This was regarded as a fundamental time of the procedure, allowing complete removal of the