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Clinical Crossroads |

A 66-Year-Old Woman With Ulcerative Colitis

Mark A. Peppercorn, MD, Discussant
JAMA. 1998;279(12):949-953. doi:10.1001/jama.279.12.949.
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DR PARKER: Mrs F is a 66-year-old woman troubled by loose, bloody bowel movements. A retired professor of psychology, widowed and with 1 son, she remains active professionally and socially. She has both Medicare and commercial indemnity insurance coverage.

She first noticed blood on the toilet tissue in 1993. In 1994, a flexible sigmoidoscopy for hematochezia revealed a "friable appearance, edema, and a granular appearance in the rectum." Biopsy results showed "chronic active colitis, severe without granulomas or dysplasia." She was diagnosed with ulcerative proctitis. Subsequently, a flexible sigmoidoscopy showed extension of disease above the rectum.

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