The Conservative Treatment of Ulcerative Colitis

My material covers 40 ambulatory patients treated by me for ulcerative colitis for periods ranging from 1 to 10 years. Ten of these were moderately severe and four were admitted to hospital because of toxic states and severe anaemia. Aetiology. A definite aetiology could not be found. In a few cases the beginning of the illness coincided with emotional stresses. None had definite allergic manifestations. We have not succeeded in isolating either diplostreptococci or shigella. Of course the difficulty in isolating the causative organism in cases of chronic bacillary dysentery is well known. Occasionally E. histolytica was found. Amoebiasis is very common in our country and it is difficult to estimate the role played by the amoebae, whether as a primary aètiologic factor or as a secondary or a coincidental infection. In any case they certainly influence the acuteness and course of the disease. Diagnosis was established by the clinical picture of bloody diarrhoea, fever bouts, weight loss and anaemia, and by typical rectoscopic findings of inflammation and bleeding ulcers. I would like to point out that I have seen cases of neglected amoebiasis, especially among new immigrants, in whom the rectoscopic picture was indistinguishable from that of idiopathic ulcerative colitis. Only the prompt response to specific antiamoebic treatment established the diagnosis. Treatment. The patients received a high protein high vitamin diet with abundant fresh fruit and vegetables including citrus fruit, pomegranates etc., supplemented by vitamin preparations both per os and parenterally. This is in accordance with the hypothesis of many that ulcerative colitis is a haemorrhagic diathesis due to vitamin defficiency. My patients received large doses of dermatol per os and as little opium as possible. A few patients received antibiotics, sulpha drugs and cortisone, but I have not been impressed by the results. Treatment with these drugs in my cases has not resulted in a considerable and sustained improvement. Lately I have tried enemata with Nisulfazole in a few cases. My experience with it is as yet very limited but my first impression was favourable. Local treatment. Often the ulcerative process starts in the rectum and distal colon. This area, 2530 cm, can be reached and treated by means of a rectoscope· Even when the ulcerative process extends further, I find that treating the distal sigmoid and rectum gives subjective relief and objective improvement. 714 Bychovsky Congress 582 The local treatment by means of enemata with various drugs is an old and well known method. I have found that dry local treatment is more effective. By means of a pulverisator I introduce through the rectoscope powders such as dermatol, xeroform and sometimes aureomycin. The