An Observational Chart Review on the Efficacy of Subcutaneous Methotrexate in Mild to Moderate Ulcerative Colitis and the Description of Occurrence of Adenomatous Polyps in Afflicted Patients

Abstract

Ulcerative Colitis (UC) is a type of Inflammatory Bowel Disease (IBD) that affects
the large intestine and produces mainly symptoms of abdominal pain and bloody stools. Chart
reviews of patients from July 2011 to July 2012 with mild to moderate UC enrolled in a community-
based NIH trial on the efficacy of 8 weeks of 12.5 mg once daily subcutaneous methotrexate
demonstrated no significant improvement of abdominal pain and bloody stools. In their
patient diaries and IBD Questionnaire, all 9 patients reported a sense of heaviness or abdominal
fullness, bloating or cramps. The patients experienced decreased energy levels and depressed
feelings with anxiety and decreased sleep at night. Overall, the majority of them reported a
decreased quality of life despite the 8 week trial of MTX. We also noted in the chart review the
incidental finding of histopathologically-confirmed distal adenomatous polyps in all 9 patients
for which we postulate the following: 1) that distal adenomatous polyps may be a risk factor in
UC, 2) that surgical removal or polypectomy for these polyps, if diagnosed earlier especially in
those younger than 40 years of age, may delay progression or prevent development of UC, 3)
the presence of polyps in all 9 patients could have prevented the desired therapeutic response
from methotrexate, and 4) that the presence of the polyps may indicate that low dose methotrexate
is not an effective treatment for UC. The presence of intestinal polyps realigns the structural
integrity and dynamics of the movement of the intestinal walls and valves, causing affected
patients to frequently report feelings of discomfort and lethargy. It is important to understand
that further diagnosis and therapies for UC and IBD are accompanied with ethical questions,
such as treating affected patients with cytotoxic medications and performing colonoscopies under
the standard age care of 50 years. Further research needs to address combination therapies
and other risk factors such diets and preservatives to determine the full extent of this potential
ground-breaking science.