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Clinical Crossroads
March 25, 1998

A 66-Year-Old Woman With Ulcerative Colitis

Author Affiliations

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 .

JAMA. 1998;279(12):949-953. doi:10.1001/jama.279.12.949

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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