A young patient with ulcerative colitis (UC) of the rectosigmoid area: a typical case

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

A 30-year-old African American female (AAF) with a past medical history (PMH) of ulcertive colitis (UC) is at the GI clinic for a follow-up (F/U) of a colonoscopy she had 2 months ago.

Before the procedure, she was c/o diarrhea with bloody stools. She was satrted on Rowasa enema QHS and reports a great relief in her symptoms with regular BM 2 times per day and only spots of blood on the toilet paper. She gained some weight, has good appetite and generally feels happy taking care of her 3 children, the youngest one is 6 months old. She started using Rowasa every 1-2 days instead of daily.

Past medical history (PMH)

UC since she was 18 yo, yearly colonoscopies. Colonoscopy (2 months ago) showed active UC in the rectosimoid area, ending at 25 cm from rectum. Stool C.diff, O/P, C/S were all negative.
Biopsy was done of the proximal, left and rectosigmoid colon. There were changes of UC in the rectosigmoid onle, the rest of the colon was normal (which is good because the prognosis is different). No dysplasia.


Colonoscopy report, biopsy results and labs (click to enlarge the images). CBC shows microcytic anemia.

Medications

Rowasa enema PR QHS, FeSO4.

Family medical history (FMH)

No UC or colon CA.

Physical examination

Obese lady, 236 lbs, otherwise WNL.

What to do?

Rowasa should be continued 3 times per week.
We can consider Canasa supp. which have better compliance.

How often does she need colonoscopies? Yearly?

The good news for this patient is that her UC is located in the rectosigmoid only and this is the area with the lowes risk for CA. The further right you go in the colon, the higher the CA risk is, and subsequently patients need colonoscopies more often.

This patien needs a repeat colonoscopy in one year and it is OK, pobably every 2-3 years.

Final diagnosis

UC with good response to local 5-ASA therapy.

What did we learn from this case?

UC, when managed properly, can be failrly well controlled. All patients need CA screening, the frequency of the colonoscopy depends on the particular form of UC they are having.
Management algorithms are useful. For this patient, the therapy was literally copied from the first arm of the AFP UC algorithm.

References

Ulcerative Colitis - NEJM update, 2011.

Published: 01/12/2004
Updated: 04/12/2008

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