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Mark A. Peppercorn, MD, Discussant

JAMA. 1998;279:949-953.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR PARKER: Mrs F is a 66-year-old woman troubled by loose, bloody bowel movements. A retired professor of psychology, widowed and with 1 son, she remains active professionally and socially. She has both Medicare and commercial indemnity insurance coverage.

She first noticed blood on the toilet tissue in 1993. In 1994, a flexible sigmoidoscopy for hematochezia revealed a "friable appearance, edema, and a granular appearance in the rectum." Biopsy results showed "chronic active colitis, severe without granulomas or dysplasia." She was diagnosed with ulcerative proctitis. Subsequently, a flexible sigmoidoscopy showed extension of disease above the rectum.

Initially, Cortenemas were helpful, but lost their efficacy over time. She finds the unpredictable urgency to defecate increasingly bothersome, and fears traveling to places without easily accessible bathrooms. She has not experienced fever, weight loss, or significant abdominal pain. She is not certain if prednisone taken for her severe . . . [Full Text of this Article]

MRS F: HER UNDERSTANDING AND PERCEPTIONS

AT THE CROSSROADS: QUESTIONS TO DR PEPPERCORN

Epidemiologic Considerations

Clinical Manifestations, Diagnostic Evaluation, and Differential Diagnosis

Natural History

Medical Management

Surgical Options

Psychosocial Support

Summary

QUESTIONS AND DISCUSSION

Dr Peppercorn is Professor of Medicine, Harvard Medical School, and in the Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Mass.

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