[Ulcero-hemorrhagic rectocolitis].
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The short and long-term efficacy of the combined administration of azathioprine and sulphasalazine in the treatment of ulcerative colitis was evaluated. A complete and durable remission of the clinical, the endoscopic and the histological signs of the disease was achieved in all the patients but one, who did not follow the domiciliary therapeutic regimen. No adverse effects referable to the long-term assumption of the azathioprine have been noted.
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Ulcerative colitis is exceptional in Africa South of the Sahara. The first case was described in 1964: up to 1982, 46 cases were reported. We report on 14 cases (6 females and 8 males) observed in black Senegalese for three years and a half. The medium age of patients was 30 years. All of them had a high social standard of living. Four patients showed intestinal amebiasis in their previous medical history. Clinical and evolutive patterns of ulcerative colitis in Africa present few differences in comparison with the classical ones. The diagnosis is established by endoscopy (rectosigmoidoscopy and/or colonoscopy) and histopathology. Cryptic abscesses were found in only 2 out of 14 cases. Rectal dysplasia was noted in 2 cases. The course of the disease developed on a fulminating acute mode in one case, on a continuous chronic mode in another case and on a chronic mode with relapses in 11 cases. Irrespective to the clinical form observed, intestinal amebiasis represents the most pressing differential diagnosis. Treatment appears to be difficult in severe acute forms out of an intensive care department, as well as in advanced extensive chronic forms. For the later in black Africa endoscopic and histopathological surveillance appears to be preferable to a total colectomy, made necessary by the important rectal lesions, because the functional sequelae of an ileostomy.
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Because colorectal carcinoma is both very frequent and extremely serious, diagnosis and treatment of this cancer are a major Public Health issue in France. The recognition of the filiation between polyps and cancer has led to considering prevention of colorectal cancer through the detection of polyps. The usefulness of the hemoccult test is discussed. Reported results warrant the rejection of this method for the individual detection of colorectal tumors because of poor sensitivity. Conversely, there are grounds for advocating the use of the hemoccult test for mass screening on certain conditions; the most important of these is that a negative test must not be considered as sufficient to eliminate the diagnosis. If screening plans with the hemoccult test are implemented, they will have to be coordinated with an important health education program to promote individual prevention using endoscopy, particularly in high risk and symptomatic subjects.
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