I recently had the opportunity to review Dr Brandt's commentary relating to a "cecal patch" that was noted co-lonoscopically in a patient with ulcerative colitis (UC). In his commentary, Dr Brandt describes 2 types of segmental inflammatory change that may be seen in patients with UC (cecal patch and backwash ileitis). I would take this opportunity to add a third scenario to this list. Patients with UC who are treated with topical anti-inflammatory therapy (suppository or enema form) can also be noted to have "segmental" inflammation. Prototypically, when 5-aminosalicylate or corticosteroid suppositories are prescribed, the rectum can be "spared'' of proctitic change, whereas the more proximal colon remains inflamed. Recognition of this possibility remains especially important during the initial diagnosis of inflammatory bowel disease, when a primary health care provider may have prescribed such therapy empirically, unbeknownst to the gastroenterologist to whom the patient has been subsequently referred.
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