Clinical outcome of patients with initial diagnosis of acute self‐limiting colitis of unknown aetiology

Abstract

Objective: To investigate the clinical course and outcome of patients whose initial histological features were compatible with acute self‐limiting colitis (ASLC) of unknown aetiology. Materials and Methods: We performed a computer search of our pathology registry for non‐specific inflammation of the colon and rectum for the years 1997–98. The histology reports and clinical notes were reviewed in detail. Results: Thirty‐three suitable patients were identified (17 males) with a median age of 48 years (22–87 years). The commonest presenting symptoms were rectal bleeding and diarrhoea. The passage of mucus and abdominal pain were also commonly found symptoms. Physical examination was usually normal, although abdominal tenderness was occasionally elicited. Systemic upset was unusual. Three patients had complications at presentation: severe bleeding (n = 1), intestinal obstruction (probably unrelated, n = 1), sigmoid colon cancer (probably unrelated, n = 1). Of 30 patients who were observed only, 10 patients’ symptoms resolved and 8 patients improved symptomatically, one worsened and one had not returned for reassessment. Ten subsequently needed medical treatment. Together with the other 3, a total of 13 patients received medication at some stage in their disease and 3 patients eventually required long‐term therapy. Two patients developed ulcerative colitis after 7.5 and 12 years, respectively. Conclusion: Patients with initial histological features of ASLC usually follow a self‐limiting clinical course and an initial period of observation is justified. Progression to a more protracted disease course occurs in one‐third and the diagnosis of ASLC should be revised. Salicylates and steroids are useful in refractory cases. Less than 6% progressed to chronic inflammatory bowel disease.