Colitis

Colitis
A micrograph demonstrating cryptitis, a microscopic correlate of colitis. H&E stain.
Specialty	Gastroenterology

Colitis is an inflammation of the colon. Colitis may be acute and self-limited or long-term. It broadly fits into the category of digestive diseases.

In a medical context, the label colitis (without qualification) is used if:

• The cause of the inflammation in the colon is undetermined; for example, colitis may be applied to Crohn's disease at a time when the diagnosis is unknown, or
• The context is clear; for example, an individual with ulcerative colitis is talking about their disease with a physician who knows the diagnosis.

Signs and symptoms

The signs and symptoms of colitis are quite variable and dependent on the cause of the given colitis and factors that modify its course and severity.

Symptoms of colitis may include: mild to severe abdominal pain and tenderness (depending on the stage of the disease), recurring bloody diarrhea with/without pus in the stools, fecal incontinence, flatulence, fatigue, loss of appetite and unexplained weight loss.^[1]

More severe symptoms may include: shortness of breath, a fast or irregular heartbeat and fever.^[1]

Other less or rare non-specific symptoms that may accompany colitis include: arthritis, mouth ulcers, painful, red and swollen skin and irritated, red eyes.^[1]

Signs seen on colonoscopy include: colonic mucosal erythema (redness of the inner surface of the colon), ulcers, and bleeding.

Diagnosis

Symptoms suggestive of colitis are worked-up by obtaining the medical history, a physical examination and laboratory tests (CBC, electrolytes, stool culture and sensitivity, stool ova and parasites et cetera). Additional tests may include medical imaging (e.g. abdominal computed tomography, abdominal X-rays) and an examination with a camera inserted into the rectum (sigmoidoscopy, colonoscopy).

An important investigation in the assessment of colitis is biopsy. A very small piece of tissue (usually about 2mm) is removed from the bowel mucosa during endoscopy and examined under the microscope by a histopathologist. It can provide important information regarding the cause of the disease and the extent of bowel damage.

Types

There are many types of colitis. They are usually classified by the cause.

Types of colitis include:

Micrograph showing intestinal crypt branching, a histopathological finding of chronic colitis. H&E stain.

Micrograph of collagenous colitis. H&E stain.

Micrograph of a colonic pseudomembrane, as may be seen in Clostridium difficile colitis, a type of infectious colitis.

Autoimmune

• Inflammatory bowel disease (IBD) – a group of chronic colitides.
  Main article: Inflammatory bowel disease
  • Ulcerative colitis – a chronic colitis that affects the large intestine.
    Main article: Ulcerative colitis
  • Crohn's disease – a type of IBD that often leads to colitis.
    Main article: Crohn's disease

Unknown

• Microscopic colitis – a colitis is diagnosed by microscopic examination of colonic tissue; macroscopically it is normal appearing.
  Main article: Microscopic colitis
  • Lymphocytic colitis
    Main article: Lymphocytic colitis
  • Collagenous colitis
    Main article: Collagenous colitis

Treatment caused

• Diversion colitis
  Main article: Diversion colitis
• Chemical colitis
  Main article: Chemical colitis

Vascular disease

• Ischemic colitis
  Main article: Ischemic colitis

Infectious

• Infectious colitis

A subtype of infectious colitis is Clostridium difficile colitis,^[2] which is informally abbreviated as "c diff colitis". It classically forms pseudomembranes and is often referred to as pseudomembranous colitis, which is its (nonspecific) histomorphologic description.

Enterohemorrhagic colitis may be caused by Shiga toxin in Shigella dysenteriae or Shigatoxigenic group of Escherichia coli (STEC), which includes serotype O157:H7 and other enterohemorrhagic E. coli.^[3]

Parasitic infections, like those caused by Entamoeba histolytica, can also cause colitis.

Unclassifiable colitides

Indeterminate colitis is the classification for colitis that has features of both Crohn's disease and ulcerative colitis.^[4] Indeterminate colitis' behaviour is usually closer to ulcerative colitis than Crohn's disease.^[5]

Atypical colitis is a phrase that is occasionally used by physicians for a colitis that does not conform to criteria for accepted types of colitis. It is not an accepted diagnosis per se and, as such, a colitis that cannot be definitively classified.

Treatment

Some people may be admitted into the hospital following the colonoscopy depending on results. It is sometimes necessary to get the patient started on a steroid to speed up the healing of the colon. It may also be necessary to get the patient hydrated from the fluid loss and iron replaced from the loss of blood. After a hospital stay, the patient may be put on a daily medication to manage their chronic colitis. The medication can be an anti-inflammatory or an immunosuppressant. There are many different types of medication used and the doctor will prescribe the one they see fit. If the patient doesn't respond, new medications will be tried until there is a good fit.

Moreover, several studies recently have found significant relationship between colitis and dairy allergy (including: cow milk, cow milk UHT and casein),^[6][7][8][9] suggesting some patients may benefit from an elimination diet.

See also

Wikimedia Commons has media related to Colitis.

• Gastroenterology

Notes

External links