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Colon Ecology

óColitis By Any Name

Majid Ali, M.D.

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 knew I had a story to tell. Sometime after that Choua said, "Can you make more slides from that colon and see if you can get another professor to diagnose yet another type of colitis from the same colon?" he challenged. I smiled. Worth a try, I murmured to myself.

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.

 

List of Tutorials

* Evolutionís Intelligent Design for the Alimentary Tract

Gut Immunity

* Colon Ecology - Colitis by Any Name

* Colon Polyps

* The Seed-Feed-and-Occasionally-Weed-Way

* The Butyrate Blessing

* Recipes for Healthful Aging

* Healthy Mouth, Unhealthy Mouths

* Oral Thrush

* Canker Sores

 

 

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