Case 6: 27-year-old female with ulcerative colitis requiring 5-ASA suppositories
VISIT 1 First visit to the gastroenterologist
27-year-old female previously healthy who has noticed significant rectal bleeding over the past 6 months. Initially the bleeding was only occurring every few days however over the past 2 months the bleeding has occurred much more frequently and most bowel movements now only consist of passing blood with mucus (in total she is having 6 URGENT bowel movements every 24 hrs with 1 bowel movement being in the middle of the night).
Occasional right sided abdominal pain, no fevers, no weight loss, no nausea.
Her uncle has ulcerative colitis.
The doctor orders blood and stool tests, and books a flexible sigmoidoscopy
VISIT 2 At the flexible sigmoidoscopy 2 weeks later
The results of the blood and stool tests are normal.
The flexible sigmoidoscopy shows inflammation in the lowest 6cm of the rectum. Above this 6cm the bowel looks healthy.
The diagnosis: ulcerative proctitis
The treatment: 5-ASA 1g suppository for 1 month. The physician explains that although the bleeding and other symptoms may improve quickly it is important to take the suppository for the full course as the desired effect is to heal the bowel (which takes longer then to improve symptoms).
VISIT 3 1 month later: gastroenterologist visit
The patient’s symptoms has completely resolved. Her bowel routine is normal and she is not seeing any blood
No further medications needed, told to call gastroenterologist’s office if symptoms return.
VISIT 4 6 months later
The patient remains well without any concerning symptoms.
No medication is needed. The important feature of this management plan is that the patient understood the importance of using her suppositories beyond the resolution of symptoms to achieve healing of the bowel. If one can achieve healing of the bowel, the chance of a return of symptoms is lower.