An Observational Chart Review on the Efficacy of Subcutaneous Methotrexate in Mild to Moderate Ulcerative Colitis and the Description of Occurrence of Adenomatous Polyps in Afflicted Patients

Abstract

ResearchPage 23 ABSTRACTUlcerative Colitis (UC) is a type of Inflammatory Bowel Disease (IBD) that affects the large intestine and produces mainly symptoms of abdominal pain and bloody stools. Chart reviews of patients from July 2011 to July 2012 with mild to moderate UC enrolled in a community-based NIH trial on the efficacy of 8 weeks of 12.5 mg once daily subcutaneous methotrexate demonstrated no significant improvement of abdominal pain and bloody stools. In their patient diaries and IBD Questionnaire, all 9 patients reported a sense of heaviness or abdominal fullness, bloating or cramps. The patients experienced decreased energy levels and depressed feelings with anxiety and decreased sleep at night. Overall, the majority of them reported a decreased quality of life despite the 8 week trial of MTX. We also noted in the chart review the incidental finding of histopathologically-confirmed distal adenomatous polyps in all 9 patients for which we postulate the following: 1) that distal adenomatous polyps may be a risk factor in UC, 2) that surgical removal or polypectomy for these polyps, if diagnosed earlier especially in those younger than 40 years of age, may delay progression or prevent development of UC, 3) the presence of polyps in all 9 patients could have prevented the desired therapeutic response from methotrexate, and 4) that the presence of the polyps may indicate that low dose methotrexate is not an effective treatment for UC. The presence of intestinal polyps realigns the structural integrity and dynamics of the movement of the intestinal walls and valves, causing affected patients to frequently report feelings of discomfort and lethargy. It is important to understand that further diagnosis and therapies for UC and IBD are accompanied with ethical questions, such as treating affected patients with cytotoxic medications and performing colonoscopies under the standard age care of 50 years. Further research needs to address combination therapies and other risk factors such diets and preservatives to determine the full extent of this potential ground-breaking science.