Dr Peppercorn is Professor of Medicine, Harvard Medical School, and in the Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Mass.
Clinical Crossroads at Beth Israel Deaconess Medical Center is produced
and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD, and Richard A. Parker,
MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor:
Margaret A. Winker, MD, Senior Editor, JAMA .
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.
Peppercorn MA. A 66-Year-Old Woman With Ulcerative Colitis. JAMA. 1998;279(12):949-953. doi:10.1001/jama.279.12.949