Case 2: 35-year-old male with ulcerative colitis requiring 5-ASA to maintain remission
VISIT 1 First visit to Gastroenterologist office 2 weeks after colonoscopy
Since the colonoscopy the patient has been taking 4.8 g of 5-ASA daily with a 1g 5-ASA enema. He was told the importance of using both oral and enema therapy to significantly improve the chance of healing.
The patient’s symptoms are improving, he is now only seeing blood with 50% of his bowel movements, and his urgency associated with his bowel routine is beginning to improve. The doctor explains that the inflammation involves the entire bowel (this is called extensive colitis). Having extensive colitis increases the risk of medications not working and eventually requiring surgery (removal of the bowel).
The doctor is encouraged the patient’s symptoms are improving, but to make sure the treatment is effective he suggests another look at the bowel 3 months later with a flexible sigmoidoscopy to ensure the bowel has healed. VISIT #2
VISIT 2 3 months later: flexible sigmoidoscopy
The patient continues his 5-ASA oral medication, and is feeling great. His bowel routine is normal and he is not seeing any blood.
The flexible sigmoidoscopy shows that the bowel looks almost entirely normal (there is a little redness but the doctor suggests the healing is sufficient).
To prevent the chance of the inflammation returning – which will cause further symptoms and pose a risk of surgery, the doctor prescribes continued use of 5-ASA to keep the inflammation controlled.
The patient is thrilled he is feeling better and understands the importance of continuing to take his prescribed 5-ASA.
The patient’s girlfriend asks him, “Since you are feeling so well why do you need to continue taking your medication?”
The patient answers, “The medication is the reason why I am feeling so good. The 5-ASA medication is keeping my bowel healed and preventing my symptoms from returning.”