Parnita Kesar
South Carolina, United States

The symptoms of ulcerative colitis have been documented since the eighteenth century. From 1745, there is evidence that Prince Charles, the Young Pretender to the English crown, had symptoms consistent with the condition we now know as ulcerative colitis. He treated these symptoms by adopting a milk-free diet.¹ But the term “ulcerative colitis” was not coined until 1875 by two English physicians, Wilks and Moxon. In 1888, Sir William Hale White of London published case studies of diarrhea that could not be attributed to a causative agent.² From this time onward, ulcerative colitis was commonly used in medical terminology. It is categorized as an inflammatory bowel disease along with Crohn’s disease, which was first described in 1932.

Both ulcerative colitis and Crohn’s disease have in common symptoms such as diarrhea, melena, pain, cramping, weight loss, and fever. Symptoms result from inflammation and ulceration of the digestive system. However, ulcerative colitis begins in the rectum and moves upward, affecting only the large intestine. Crohn’s disease, on the other hand, causes patchy ulcers in any portion of the digestive tract, from the mouth to the anus. Patients with either condition may also experience symptoms that affect the mouth, eyes, joints, blood, and skin.³

Inflammatory bowel disease today is treated in large part with medications that suppress the immune system. But before effective treatments were available, patients like Miss Banks, whose symptoms of ulcerative colitis were described by Samuel Wilks,² frequently died from complications of the disease. Operative procedures to try to control symptoms were recorded as early as 1900. Partial or total colon removals were performed in an effort to heal these patients.⁴ However, surgery came with its own set of physical and emotional complications.

The first drug that effectively managed ulcerative colitis was introduced in the 1940s: sulfasalazine, an anti-inflammatory. A pivotal change occurred with the introduction of corticosteroids to suppress the immune system. The first controlled trial using steroids to treat ulcerative colitis was conducted by Truelove and Witts in 1955.² The mortality rate for the study group treated with corticosteroids was 7% compared to 24% in the placebo group. The use of radiology and endoscopy has greatly improved understanding of the disease as well as diagnosis and treatment.

Research on ulcerative colitis is ongoing and treatments are improving. What was once a deadly, unidentified disease now has multiple treatment options that allow patients to live healthier lives with fewer complications.

References

1. Michael Gibson, “Ulcerative colitis historical perspective,” Wikidoc, last updated July 30, 2020. https://wikidoc.org/index.php/Ulcerative_colitis_historical_perspective #:~:text=In%201745%2C%20Prince%20Charles%20suffered,technical%20achievement%20for%20the%20time.
2. R Caprilli et al., “Historical evolution of the management of severe ulcerative colitis,” Journal of Crohn’s and Colitis, Vol 2, Iss 3, (Sept 2008): 263-268.
3. Marc D Basson, et al., “Ulcerative Colitis,” Medscape (Updated March 8, 2023). https://emedicine.medscape.com/article/183084-overview
4. DJ Mulder, et al., “A tale of two diseases: The history of inflammatory bowel disease,” Journal of Crohn’s and Colitis, Vol 8, Iss 5, (May 2014): 341-348.