Page 16 - Boca Club News - February '25

Page 16, Boca Club News
Medical Matters:

Ulcerative Colitis

By Richard Nagler, M.D., a member Complications of the disease are persistent rectal Because of the surgery an ileostomy is required where
of Broken Sound Club and retired bleeding, perforation of the colon with peritonitis, a section of the small intestine is brought outside on the
physician. After graduating from inflammation of the joints and skin, an increased risk left side of the abdomen and a bag attached to collect
the University of Pennsylvania of colon cancer (5%), toxic megacolon where the colon stool. This often creates a significant negative abhorrent
and New York University’s School dilates and loses the ability to contract with a high risk reaction, especially in young women. When possible, an
of Medicine, Dr. Nagler served of perforation with peritonitis, and the development of alternative is to perform a restorative proctocolectomy
his internship and residency at blood clots in both veins and arteries. Liver and biliary where a J pouch (a new rectum) is created from the small
Baltimore City Hospital and Johns tract disease may be a complication of ulcerative colitis intestine and connected directly to the anus so that the
Hopkins. He followed that with a as a result of some forms of drug treatment. patient can defecate normally.
Fellowship in Gastroenterology at Yale University School Diagnostic tests for the disease include blood tests With vastly improved techniques now available this
of Medicine, and was then Chief of Gastroenterology to detect iron deficiency anemia due to persistent works well for many patients and obviates the need for
at Fitzsimons General Army Hospital in Denver. He bleeding from the colon. A high WBC count indicates an ileostomy. I would like to share my experience with
returned to the Yale Medical School for one year as an inflammation. A low serum albumin and a high C reactive a former patient of mine. She was a 20-year-old girl
Assistant Professor of Medicine before opening his own protein in the blood are typical. Finding WBCs in the who suffered beginning at age 14 from ulcerative colitis
successful private practice in Internal Medicine and stool and obtaining a culture to rule out an infection is with chronic bloody diarrhea, iron deficiency anemia,
Gastroenterology. During that time, he also served for important, but the best test is a colonoscopy and biopsy abdominal pain, weight loss, anorexia and social isolation.
ten years as Chief of Medicine at Huntington Hospital which shows the inflammatory process limited to the She failed to have any sustained remissions from these
in Huntington, N.Y. mucosal lining of the colon. A CT scan and an MRI are debilitating symptoms with any of the medications
Ulcerative colitis is an autoimmune inflammatory useful in showing how much of the colon is inflamed. available at that time. She was constantly depressed and
disease of the colon with 200,000 cases appearing each There is no medical cure for ulcerative colitis. felt hopeless with no end in sight to her suffering.
year in the United States. Males and females are equally Limiting dairy products (especially for those with lactose Her parents were long-standing patients of mine and
affected, most under age 30, and Ashkenazi Jews are more intolerance) and fiber from fresh fruits, vegetables, I had established a trusting doctor-patient relationship
likely to get it along with those who have a family history whole grains, spicy foods, alcohol and caffeine—and with them. I arranged a meeting with the girl and her
(20%). eating smaller meals—is of some benefit in ameliorating parents to discuss the situation and offer them my advice
In contrast to Crohn’s disease—the other major symptoms. Alternative therapies such as herbal and as to how to proceed. Because all medical measures had
inflammatory disease which involves the entire wall of all nutritional supplements, probiotics, fish oils, Aloe Vera, failed, another approach had to be considered. I gently
segments of the digestive tract including the esophagus, acupuncture and Turmeric are of little value. Biofeedback, explained that she needed to have a total colectomy which
stomach small intestine and colon—ulcerative colitis Yoga and other relaxation techniques and meditation are would cure her of this awful affliction. I discussed why a
involves only the lining of the colon and rectum. of limited benefit. permanent ileostomy with a bag placed outside the upper
Our immune system, which is normally engaged to However, there are drugs that are effective in inducing left side of her abdomen was needed.
fight invaders to the body such as bacteria, viruses and remissions. Azulfidine given orally or by suppository At that time efforts to hook up a segment of the small
fungi, in this case mistakenly identifies the good bacteria was a mainstay of treatment with some benefit but it is intestine as a pouch in the rectum as an alternative to
that line the wall of the colon as intruders and there is now mostly abandoned in favor of newer drugs. Oral the ileostomy were fraught with frequent undesirable
an overactive response causing inflammation, tiny open prednisone relieves symptoms but is limited to short- complications that made me recommend that it not be
sores, abscesses and ulcerations. This is debilitating and term use because of deleterious side effects. Entocort considered. Years since that time impressive technological
can lead to life-threatening complications. EC capsules taken orally for up to three months is a improvements in surgical technique have now made this
Ulcerative colitis is a chronic disease that can be mild better steroid alternative with fewer side effects. Immune option a very viable alternative.
to moderately severe when various periods of remission modulator drugs used to suppress the immune system, Both she and her parents were visibly upset at my
occur spontaneously or following successful medical such as Imuran, was beneficial but has been replaced recommendation as the thought of an abdominal bag,
treatment. It can be confined to the rectum (proctitis), the by newer biologics that neutralize a damaging protein especially in a young woman, was a terrible thing to live
rectum and sigmoid colon (proctosigmoiditis), the rectum produced by the immune system that blocks inflammatory with. My compassion for her notwithstanding did not
and left side of the colon, or involve the entire colon (pan cells from getting to the site of inflammation. dissuade me from urging them to follow my advice. After
colitis). Remicade was the first and remains effective in many they thought things over the decision to have the surgery
Symptoms and signs of the disease depend on its cases but Humira, Stellara, Entyvio and Xeljanz have was made. She did very well with no complications and
severity and include diarrhea, usually with blood and proven to be better and there are newer immunosuppressive made a full recovery.
pus, abdominal pain and cramping, rectal pain, a strong drugs such as Rinovoq and Styrizi currently available. With the dedicated help of the entire staff she was
urge to defecate, weight loss, anorexia, nausea, fatigue, Nevertheless, 30% of patients with ulcerative colitis taught how to manage the ileostomy, which she mastered
sleep deprivation from frequent nightly trips to the john, are non-responsive or cannot tolerate these medications, remarkably well. All her symptoms disappeared. She
fever, dehydration, sores in the mouth and skin rashes. nor can those who despite these drugs develop toxic was completely cured of the disease. She later went on
Dietary factors and stress do not cause the disease but megacolon, rupture or have severe nonstop bleeding and to college where she met a young man, got married and
can aggravate it. NSAIDs, certain antibiotics and birth will require surgery, which is the only cure for the disease. had two uneventful pregnancies with a healthy son and
control pills can precipitate relapses. It involves total removal of the colon and rectum. daughter.

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