As at July 15, 2020, my ulcerative colitis was in clinical, endoscopic, and histologic remission.

I was diagnosed with ulcerative colitis in March 2018. Last month (June 2020), I described how I was free of any symptoms or clinical signs of the disease. Periodic blood tests measuring inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) since my diagnosis have been within their normal reference ranges.

On July 15, 2020 (a little over a fortnight ago), I underwent a follow-up colonoscopy. Other than internal haemorrhoids, a problem I’ve known to have for nearly three decades, this colonoscopy was normal, i.e. no specific pathology was seen in my rectum or any other part of my colon.

Colonoscopy on July 15, 2020

Below are some photos taken of my distal rectum.

Photos of distal rectum on colonoscopy on July 15, 2020
:small_red_triangle:Images of my distal rectum taken during colonoscopy on July 15, 2020. The rectal mucosa was normal; there was no evidence of the proctitis seen on colonoscopy on February 20, 2018.

The two photographs below compare the proctitis seen on colonoscopy in February 2018 (left) with the normal mucosa seen on July 15, 2020 (right).

Comparison of distal rectum in February 2018 with that in July 2020
:small_red_triangle:Distal rectum on colonoscopy on February 20, 2018 (left) and July 15, 2020 (right). Inflammation of the rectal mucosa was seen on the February 2018 colonoscopy (left photo). This inflammation was no longer seen on colonoscopy on July 15, 2020; the rectal mucosa appeared normal (right photo).

Histopathology of Biopsies

Mucosal biopsies were taken during colonoscopy from my terminal ileum, caecum, transverse colon and rectum. Histopathological examination of these biopsies, the report of which I received only yesterday (July 29, 2020), showed no significant pathology.

Conclusion and Change of Treatment Plan

The obvious conclusion is that my ulcerative colitis is in clinical, endoscopic, and histologic remission.

My dose of mesalazine (mesalamine, 5-aminosalicylic acid (5-ASA)) was reduced to 1 gram twice a day (therefore 2 grams per day). Provided there is no symptom to suggest a relapse, I’ll continue to take 2 grams of mesalazine daily for the next three months and have some blood tests (complete blood count, C-reactive protein, erythrocyte sedimentation rate) done in mid-October 2020. If my disease remains in clinical remission and the lab results are normal, I expect my dosage of mesalazine to be reduced further to 500 mg twice daily, i.e. 1 gram per day.

Needless to say, I’m overjoyed with the results of the investigations performed this month because they indicate endoscopic and histologic remission of my ulcerative colitis, which accompany my clinical remission. I’m also pleased that my medications now follow a (more convenient) twice daily regimen, instead of the thrice daily regimen I was on until yesterday.

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