Ulcerative Colitis in the Philippines: A Rising Concern and Diagnostic Challenges

By: Norberto I. Estanislao IV, MD

As a physician practicing in the Philippines, I've observed a concerning trend in recent years: a notable increase in the prevalence of Ulcerative Colitis (UC). This chronic inflammatory bowel disease (IBD) primarily affects the large intestine, causing inflammation and ulcers in the lining. While the exact cause of UC remains unknown, it's believed to involve a complex interplay of genetic, environmental, and immunological factors.

Diagnosing UC in the Philippines presents unique challenges due to the high prevalence of infectious colitis. Often, the determining factor between the two is the duration of symptoms. If symptoms like diarrhea, abdominal pain, and bloody stools persist for more than two weeks to a month, UC becomes a stronger consideration.

Another diagnostic hurdle is the presence of tuberculosis (TB), particularly gastrointestinal TB. While it often mimics Crohn's disease (another type of IBD), it can also present with symptoms similar to UC, further complicating the diagnostic process. As part of our protocol, we routinely test for TB in patients suspected of having UC.

A Rare Case of UC with Pyoderma Gangrenosum

Recently, I encountered a patient with a particularly rare and severe manifestation of UC. Diagnosed with UC last year after presenting with chronic diarrhea and bloody stools, she had no other apparent symptoms at the time. However, this year, after discontinuing her medications, she was admitted with Pyoderma Gangrenosum (PG), a painful skin condition characterized by deep ulcers.

PG is a rare extra-intestinal manifestation of IBD, occurring in less than 1% of patients with UC. The exact link between the two remains unclear, but it's believed to involve an abnormal immune response.

Upon her admission, I immediately resumed her UC medications and added a steroid to manage the PG. The patient is currently under close observation, and I am cautiously optimistic about her recovery.

The Importance of Early Diagnosis and Treatment

The case of my patient underscores the importance of early diagnosis and continuous treatment for UC. Uncontrolled inflammation can lead to severe complications, including bowel obstruction, malnutrition, and even an increased risk of colorectal cancer.

Furthermore, extra-intestinal manifestations like PG can significantly impact a patient's quality of life. Prompt treatment with appropriate medications, including immunomodulators and biologics, can help control inflammation and prevent complications.

Looking Ahead

I plan to continue monitoring my patient's progress closely and will provide updates on her condition in future blog posts. I hope that by sharing my experiences and insights, I can raise awareness about UC in the Philippines and encourage healthcare professionals to remain vigilant in diagnosing and managing this challenging condition.

Disclaimer: This blog post is intended for informational purposes only and should not be considered medical advice. Please consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.