I'm 61, and was diagnosed with ulcerative colitis about 30 years ago. It was pretty much under control until I had a bad reaction to sulfa drugs after an operation six years ago. It took a long time to get this back in control. Recently, our town discovered E. coli bacteria in the water system. Now, I've had a flare-up of my colitis again. Could this be linked to drinking the water?

Nancy

Ulcerative colitis is a chronic inflammatory disease of the colon characterized by diarrhea, bloody stools and abdominal pain. The cause of ulcerative colitis is unknown, but it most likely involves both genetic and environmental components.

Various anti-inflammatory and immunosuppressive medications can bring ulcerative colitis under control. Often, patients will be able to reduce the doses of their medications after remission has been achieved, but some may require long-term therapy to keep the disease in check. Despite close follow-up and careful management, relapses still occur in up to 80 percent of patients.

The reasons for flare-ups are many. Some patients forget to take the medications as prescribed, especially if they have no symptoms during remission. More frequently, another factor, such as infection, triggers a relapse. Some patients also report that their ulcerative colitis flares during times of stress, or when they have contracted another illness, such as a flu. It may be difficult to determine exactly why your ulcerative colitis flared up. I assume that your doctor performed the appropriate studies to exclude infection or other illness.

The issue you raise concerning E. coli in drinking water is intriguing, especially in light of research that has been done regarding the link between this bacterium and ulcerative colitis. A bowel infection, caused by bacteria such as E. coli, can certainly bring on a relapse. Research studies have also shown that the E. coli strains harbored in the colons of patients with ulcerative colitis are more likely to cause symptoms than strains found in healthy people. It remains to be seen whether this accounts for ulcerative colitis relapses, but this theory is certainly plausible.

At this point, you should discuss future management strategies with your doctor to get your ulcerative colitis back in control and to keep it in remission. One treatment option, especially if it becomes increasingly difficult to control the condition with medications, would be surgery to remove the colon. This would also eliminate the cancer risk that exists with long-term ulcerative colitis.