Is It Really Ulcerative Colitis?

Life changed quite suddenly for Judith at the age of 52, when she developed a serious episode of abdominal pain and diarrhea. Her doctor diagnosed food poisoning, and her pain resolved within three weeks, but the diarrhea continued. She soon found that most of the foods she loved, such as bread and fresh fruit, increased her bouts of diarrhea and caused uncomfortable swelling of her abdomen.

Her first gastroenterologist performed a colonoscopy (a test that uses a lighted tube to examine the lining of the colon). Finding extensive inflammation in her large intestine, he told her that she had ulcerative colitis (chronic inflammation and ulceration of the lining of the rectum and colon that leads to diarrhea, abdominal cramps and fever). Her doctor prescribed the anti-inflammatory drugs sulfasalazine and prednisone (a steroid), but Judith felt no better-perhaps somewhat worse. Her second gastroenterologist wanted to perform another colonoscopy and suggested treatment with a powerful drug used to treat autoimmune diseases, including ulcerative colitis. Concerned about possible side effects, she refused.

Frustrated by her doctors' inability to treat her condition, Judith started reviewing her own history to look for patterns. A decade earlier, she had found that eliminating sweets and dairy products from her diet had cured her lifelong eczema (inflammation of the skin that causes itching, blisters and redness), so she decided that this new disease might really be caused by eating the wrong food. Judith began to restrict her diet again. For the next year and a half, she lived on buckwheat, millet, sweet potatoes, lettuce, peas, carrots, chicken and lamb—foods she found that she could eat. She had no bloating, but she continued to experience diarrhea three to four times a day, was becoming seriously underweight and the quality of her life was severely impaired.

When Judith consulted me for a fresh opinion, my first impression was that the diagnosis of ulcerative colitis had been made perhaps too quickly, without taking into account all the features of her case that are not typical of this condition…

• Sudden onset at the age of 52. Ulcerative colitis usually begins at a younger age, although it may be triggered by an acute gastrointestinal infection, which is what happened in Judith's case.
  
• Lack of response to anti-inflammatory drugs. Most patients with ulcerative colitis will show at least partial improvement with medication, but Judith did not
  
• Intolerance to multiple foods. Although many patients with ulcerative colitis experience intolerance to some foods, Judith was far more sensitive to a wide variety of common foods than most people.
  

Based on these inconsistencies, my first decision was to test Judith for a chronic intestinal infection using stool testing. During the past two decades, I have evaluated scores of patients with "ulcerative colitis." In all of these cases, I have found that thorough testing for an intestinal infection was crucial to identifying the root cause of the problem. About one-quarter of these patients tested positive for intestinal infection. In almost half of these cases, the intestinal infection was the real cause of their symptoms. In the other half, the diagnosis of chronic ulcerative colitis was correct, but the infection had produced an acute flare-up of symptoms. In either case, curing the infection relieved the symptoms.

Judith's lab results showed that she was infected with two intestinal parasites—Entamoeba bistolytica, which causes a form of colitis that is very hard to distinguish from ulcerative colitis.. and Giardia lamblia, which may cause severe food intolerance. Parasites are organisms that survive by living on or inside another organism. They generally enter the body via the mouth or skin—for example, through exposure to contaminated food or water.

After treatment with the appropriate antibiotics, Judith's diarrhea cleared up and her sensitivity to foods began to decrease. Six months later, she was able to eat a varied diet (she still avoids sweets and dairy products). A follow-up colonoscopy showed no evidence of inflammation in her large intestine.

Correct diagnosis: Intestinal parasites.

Lesson for all: Just because your illness has been given a name, it does not mean that its cause has been found. If you suffer from sudden gastrointestinal symptoms, such as diarrhea, pain, bloating and/or constipation, do not accept a diagnosis until you have been tested for parasitic infection.