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Editor,
The Journal of Integrative Medicine
Formerly, Associate Professor of Pathology (adj.), College
of Physicians
and Surgeons of Columbia University, NY
Formerly, President of Staff and Chief Pathologist,
Holy Name Hospital, Teaneck, NJ
Fellow, Royal
College of Surgeons of England -
Diplomate,
American Board of Anatomic and Clinical Pathology
Diplomate, American Boards of Environmental Medicine
Past President Capital University of Integrative
Medicine |
Colitis: What's In A Name?
My own
ecologic thinking, as I recall it, began one day in 1969. As a pathology resident, I
received a large basin brimming with a messy inflamed and distended colon with copious
bloody fecal matter spilling out of some tears in its wall. It was not much fun to clean
that bowel and take tissue samples for preparing microscopic slides. The next day I
examined the slides and observed the expected microscopic features of ulcerative colitis:
acute and chronic inflammation, dead and dying immune and other types of cells, ulceration
of the lining mucosa, disruption of the general architecture of the colon wall, and
pockets of pus. After finishing my study, I took the case to one of my professors. He
examined the slides and agreed that it was a case of ulcerative colitis.
The next day,
something unexpected happened. Without purpose, I picked another slide of that colon,
looked at it, and chanced upon a cluster of large, pale cells forming a discrete round
structure. Such a formation is called a granuloma and is considered diagnostic of
Crohn's colitis. "Look at that!" I said to myself in surprise. "Now, that
granuloma makes it Crohn's colitis, doesn't it? Yesterday it was ulcerative colitis. Today
it seems to be Crohn's colitis. Interesting!" I marked the microscopic field with ink
and took the slides to a second professor, since the first one was out of the department.
He looked at the case and readily diagnosed Crohn's colitis.
The next day
as I prepared to carry the slides to one of the secretaries for filing, I picked another
slide from the same case and started gazing at an area that showed discrete layers of
tissue debris covering small patches of the inner surface of the bowel wall. Those are the
features of another common type of colitis called pseudomembranous colitis. "Aha!
Another diagnosis!" I exclaimed. "Let's see if I can get someone also to agree
with me." That time I purposefully looked for a third professor and decided not to
tell him about the diagnoses made by the other two. I pointed out to him the membrane-like
structures and he agreed that we had a case of pseudomembranous colitis. I returned to my
desk triumphantly.
I went back to
that colon and took many more sections of tissues. A technician looked at me, a little
annoyed because she had to prepare the slides from all those sections. The next day she
brought me several trays of slides and I went to work. In one of the slides, I found areas
that showed well-preserved bowel architecture, congested blood vessels, pooled and
disintegrating red blood cells in the tissue, and small surface erosions. Bingo! I knew
those were the features of another type of colitis called ischemic colitis. I continued my
search. I was not disappointed. I found some microscopic fields that showed diagnostic
features of a type of colitis called collagenous colitis. "Ah! Another
diagnosis!" I congratulated myself and continued study of the case with yet other
slides. There were many fields which could only be diagnosed as nonspecific colitis. With
some more persistence I found other areas qualifying for other forms of colitis. Getting
my teachers to agree to those various diagnoses with different slides of the
same
colon did not prove to be difficult either. I spoke to Talat, my wife, about my
accomplishment, but decided not to tell my professors about it. I did not know how some of
them might take it.
Next I turned
my attention to my pathology textbooks for a critical study of the causes of those
various types of colitis. That turned out to be a yet more fruitful search. I made the
second and equally important discovery: The cause of none of those types of colitis was
known. It was not that dozens of pages of those texts were not filled with discussion
of the etiology (cause) of all those types of colitis. For every type of colitis, some
immune disorder, infectious agent, or vascular event was suspected or proposed, but in
every case the final conclusion was always the same: The cause is not fully understood.
That search
led me to a third important discovery: There is such a large overlap in the clinical symptomatology, microscopic appearances, and suspected causes that there was hardly any
point in slavishly adhering to the system of classification of colitis which I was being
taught as "science."
The young
pathologist in me was jolted by his three discoveries. An image of several blind men
surrounding an elephant arose in my mind's eye. During the weeks and months that followed,
some vague, ill-defined notion of altered states of bowel ecology began to evolve. It took
me several years before I could muster courage to begin writing about what I thought were
my awkward notions of bowel pathology, which I thought would be heartily laughed at.
The Bowel
Ecosystem
In my view, the most remarkable phenomenon in the entire field of human
biology is this: A vast number of clinical problems that are seemingly unrelated to the
bowel spontaneously resolve when the focus of clinical management turns to all the issues
in bowel ecology. How often do symptoms of persistent debilitating fatigue in young men
and women clear up when an altered state of bowel ecology is restored to normal? How often
do troublesome mood swings subside when therapies focus on the bowel? How often does arthralgia (pain and stiffness in joints with or without joint swelling) resolve when all
the bowel issues are addressed? How often do we successfully prevent chronic headache and
anxiety; lightheadedness and palpitations; menstrual irregularities and incapacitating
PMS; recurrent attacks of vaginitis and cystitis; recurrent sore throats and asthma; and
eczema and related skin lesions by correcting the abnormalities in the internal
environment of the bowel? The answers to these questions will vary widely among
physicians.
THE GUT IS A
MISUNDERSTOOD ORGAN
Physicians who regularly neglect the bowel (and those who never
understood the issues of bowel ecology in the first place) will dismiss these questions
with scorn. None of this has been proven with double-blind cross-over studies, they will
strenuously protest. Other physicians who have learned to respect the bowel—as the
ancients did—and care for their patients with a sharp focus on bowel issues will
readily and unequivocally validate my personal (and fairly extensive) clinical experience.
LIFE IN THE
BOWEL ECOSYSTEM
The bowel
ecosystem teems with life. Shrouded in metabolic mists, it is as rich in biologic
diversity and as broad in biochemical interrelationships as any other ecosystem on this
planet Earth. The ancients seemed to have an intuitive sense about it. Death begins in the
bowel, they pronounced in more than one way. Anton van Leeuwenhoek (1632-1723) studied
fecal bacteria during his work with the microscope and thus was the first man to study
life in the bowel ecosystem with modern scientific methods. Metchnikoff, the Russian
biologist, who single-handedly developed the concept of the cellular arm of the immune
system, became intensely interested in the aging process in his later years when he moved
to Paris, where he served as the head of the Pasteur Institute. He studied the longevity
of Bulgarians and provided strong evidence that certain bowel microbes played important
roles in preserving health and promoting longevity among them. He named the microbe he
thought was most prominent in this field as Lactobacillus bulgaricus. Metchnikoff's
work opened the floodgates of basic research on the bowel flora.
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