Reversibility in Ulcerative Colitis

Abstract

Ulcerative colitis is recognized as a chronic disease, varying in clinical severity and characterized by remissions and exacerbations (1). In some patients the illness is relatively mild; the process seems limited to the rectum and rectosigmoid, as judged proctoscopically, and the roentgenologic examination is normal. In others the clinical symptoms are severe; the proctoscopic changes are more pronounced; varying involvement of the colon is demonstrable by x-ray. In still other patients the bowel appears roentgenologically to be extensively and irreversibly diseased; yet clinically the manifestations may be minimal. The clinical features have been thoroughly described by Bargen (2). The tendency of ulcerative colitis to progress and the high incidence of complications have been stressed repeatedly. The potential reversibility of the disease, on the other hand, has received little emphasis. The purpose of this paper is to direct attention to the pronounced improvement and complete healing of ulcerative colitis observed in a representative group of 24 medically treated patients in whom recent follow-up studies were made. The diagnosis in each case was established on the basis of characteristic clinical, proctoscopic, and roentgenologic evidence and the exclusion of all known pathogenic agents. The demonstration of reversibility in ulcerative colitis assumes significance in relation to therapy and in the implication it presents for the ultimate clarification of this poorly understood disease. Ulcerative Colitis: Normal Roentgen Findings; Complete Healing Roentgen examination of the colon is normal in approximately one-third of patients with ulcerative colitis. The clinical course, though it may be severe, usually is comparatively mild. In the following three cases, illustrative of a much larger group, healing was manifested in the subsidence of symptoms and proctoscopic findings. Two patients have remained well for approximately seven years. Ulcerative colitis probably is more common than is generally realized; perhaps many cases follow a benign course as observed in these three examples. In the absence of roentgen changes, the diagnosis depends largely upon the proctoscopic examination. S. K., a 44-year-old salesman, had symptoms of ulcerative colitis in 1929; ten to twelve bloody stools were passed daily. Treatment with acriflavine and stovarsol was ineffective. Prolonged rest resulted in definite improvement, although gross blood persisted in the feces. Proctoscopy demonstrated a finely granular, friable mucosa. The rectal mucosa appeared normal in November 1932. Another recurrence in August subsided with bed rest and the patient remained in good health until April 1936, when the rectal mucosa again was very friable. Symptoms persisted until January 1938 and then subsided after bed rest and the use of a bland diet and antispasmodics. The patient has been in excellent health since 1940.