Revista de enfermedades y trastornos inflamatorios del intestino

Sustained Histologic Remission (Complete Mucosal Healing) 12 Years after One-Time Treatment of Refractory Ulcerative Colitis with Novel Combination Therapy: A Case Report

Abstract

Jay Pravda, Richard Gordon and Pamela B. Sylvestre

Ulcerative colitis is a major form of chronic inflammatory bowel disease affecting millions of individuals worldwide. It most often strikes in the prime of life, during late adolescence and early adulthood. Individuals with ulcerative colitis experience life-long reoccurring and unpredictable episodes of abdominal pain and bloody diarrhea lasting from weeks to months. This results in significant emotional and psychological burdens leading to life-long disruption of daily activities and quality of life. Environmental factors acting in concert with genetic, epigenetic, and microbiome influences are thought to trigger an immune abnormality leading to the chronic colonic inflammation observed in this condition. However, despite extensive research, a primary antecedent immune vulnerability has not been demonstrated in patients or healthy family members. Current therapy is primarily focused on suppressing or modulating the immune response, which is not curative. Other therapeutic modalities such as fecal microbiota transplantation and probiotics are not recommended as viable therapy options. Recent experimental data suggest a build-up of hydrogen peroxide in colonic epithelial cells as a causal factor in the development of this disease. Herein we describe a patient with a 39-year history of ulcerative colitis refractory to standard medical therapy including oral and rectal 5-aminosalicylic acid, oral and rectal steroids in addition to immunosuppressive agents such as 6-mercaptopurine. The patient received the recommended doses of these medications for months at a time in varied combinations without significant improvement. He subsequently received a novel combination therapy aimed at reducing colonic hydrogen peroxide. Histologic remission was achieved 6 weeks after this initial therapy. Colonoscopic evaluation 12-years after initial therapy revealed complete and sustained mucosal healing with histologic restitution to normal colonic mucosa. The patient reports having normal bowel movements during this 12-year period.