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On Abe Shinzo’s retirement: ulcerative colitis

Anya Ungson
Sep 12, 2020
3 min read

Updated: Jan 15, 2021

STEPPING DOWN. Shinzo Abe announces his resignation from his position as prime minister to the people of Japan due to chronic illness. ©Wall Street Journal & Arias

Last August 24, Japan’s prime minister Shinzo Abe decided to step down from his position due to worsening health. He suffers from a long-term condition that he has carried for most of his life, ulcerative colitis, which causes the lining of the colon and rectum to become inflamed and develop ulcers. The cause for this is still unknown, but there are several risk factors to be wary of—recent gut infections, a family history of the disease, and taking anti-inflammatory painkillers such as ibuprofen. This disease is unpredictable, appearing at different stages of life and having symptoms that come and go.

Most new cases are reported in early adulthood, but some people develop the disease in childhood or in later life as well. Abe has been monitoring his disease since junior high school, experiencing flare-ups of symptoms in between periods of remission. Symptoms tend to come and go, and the periods between remission can last as long as months or years but symptoms will still return. A flare-up in 2007 had caused Abe to resign as premier after having been in office for only one year. In 2012, he made a return to power, becoming the first Japanese former premier to return to office since 1948. In that time, he had promised to pull Japan out of long-term deflation.

There remains to be no cure for the disease and only a set of drugs to help reduce symptoms or lengthen periods of remission. They aim to completely heal the inflamed gut to reduce the chance of disease flare-ups and complications.

Usually, when dealing with mild or moderate ulcerative colitis, the first treatment option would be to turn to aminosalicylates or 5-ASAs; they are delivered orally or as an enema and work locally in the gut to reduce infection. Abe started taking these in 2009. Corticosteroids are also prescribed to patients as initial treatment to reduce inflammation and treat symptoms. However, they are not recommendable to use in the long run—when these drugs are absorbed in the blood, they are associated with side-effects like causing osteoporosis and cataracts. In most cases, they are used alongside or instead of 5-ASAs, if 5-ASAs alone are not effective.

Apart from this, immunosuppressants like tacrolimus and tofacitinib are used to induce and maintain disease remission. Azathioprine is the long-term treatment to do this. Biologic drugs, including infliximab, adalimumab, and vedolizumab, target specific inflammatory pathways and are given as injections or infusions.

However, these drugs do not ensure recovery, and it is also likely that the treatment is not enough to combat the disease. It is important to monitor the disease to know when to require a switch strategy. About one in four people with ulcerative colitis require switch strategies, the drugs unsuccessfully treating the disease or causing complications. For these people, undergoing surgery may become the next course of action. The operation involves removing the colon, leaving a stoma. Many people then have their gut joined back to the bottom muscles with the formation of a pouch. People with ulcerative colitis hold an increased risk of colon cancer and require extra caution, advised to have a regular colonoscopy, starting 8 to 10 years after receiving a diagnosis.