Ulcerative or Amoebic Colitis?

Abstract

The diagnosis of idiopathic ulcerative colitis is based on indirect clinical, radiological and proctoscopic findings. There is not one single symptom or test which could be considered as being specific. For this reason the question arises: are all patients who are diagnosed as cases of ulcerative colitis really suffering from this disease, or is another entity responsible for their illness in some of them? To answer this question we believe that the amoebic origin of such a colitis is generally ignored. If by chance the doctors do think of amoebic colitis they believe that the detection of E. histolytica in the stools is imperative for this diagnosis. Physicians forget that the negative result of the stool examination no more excludes amoebic colitis than the absence of Koch bacilli in the sputum of a patient excludes tuberculosis of the lung. This cannot be stressed strongly enough. The absence of parasites in the faeces appears to support the erroneous belief that the proctoscopic and roentgenological findings are specific for ulcerative colitis. One wonders if they are indeed specific and if their appearance is so different from ulcerations of amoebic origin. It is rarely realized that ulcerative colitis may produce sigmoidoscopic and roentgenological changes identical to those of amoebic colitis.

“If hardly anyone seeks a disease, then few indeed will find it — especially if the disease in question is such as amoebic colitis.”

— Editor, Lancet (8th Dec. 1962)