Colitis

Colitis is swelling (inflammation) of the large intestine (colon) with abdominal discomfort or pain which may be mild and reoccurring over a long period of time or severe and appearing suddenly.

Causes / Types

• Most of the time, the cause is not known
• Causes may include:
  • Infections caused by a virus or a parasite
  • Food poisoning due to bacteria
  • Crohn disease (a type of inflammatory bowel disease)
    • most commonly occurs in the small intestine and the colon, but can affect any part of the gastrointestinal tract from the mouth to the anus
    • severity is from mild to debilitating; severe cases can lead to life threatening flares and complications
    • See this site for more info: Healthline—Understanding Crohn’s Disease
  • Ulcerative colitis (a type of inflammatory bowel disease)
    • is a lifelong disease that causes inflammation and bleeding ulcers within the inner lining of your large intestine. It generally begins in the rectum and spreads to the colon.
    • is the most commonly diagnosed type of colitis.
    • occurs when the immune system overreacts to bacteria and other substances in the digestive tract, but experts don’t know why this happens.
  • Ischemic colitis (lack of blood flow)
    • Blood flow to colon is cut off suddenly or restricted by blood clots or atherosclerosis in the blood vessels that supply the colon
    • Underlying conditions for this this type of colitis include: vasculitis, diabetes, colon cancer, dehydration, blood loss, heart failure, obstruction or blockage, or trauma or injury
    • Rarely it can be a side effect of taking certain medications such as fibrates and non-steroidal anti-inflammatory drugs (NSAIDs), but more research is needed to fully understand all medications that could be a contributing factor
  • Radiation colitis and strictures (Post radiation to the large bowel)
  • Allergic colitis in infants (Necrotizing enterocolitis in newborns)
    • can occur in infants, usually within the first months after birth
    • Symptoms can include: reflux, excessive spitting up, fussiness, possible flecks of blood in a baby’s stool
    • Doctors don’t know exactly what causes it. One of the most popular theories is that infants with allergic colitis have an allergic or hypersensitive reaction to certain components in breast milk.
  • Pseudomembranous colitis
    • occurs from overgrowth of the bacterium Clostridium difficile (C. diff). This kind of bacteria normally lives in the intestine, but it doesn’t cause problems because it’s balanced by the presence of “good” bacteria.
    • Certain medications, especially antibiotics, may destroy healthy bacteria. This allows C. diff to take over, releasing toxins that cause inflammation.
  • Microscopic colitis
    • is a medical condition that a doctor can only identify by looking at a tissue sample of the colon under a microscope
    • sometimes classified into two categories: lymphocytic and collagenous colitis.
      • Lymphocytic colitis is when a significant number of lymphocytes are identified, but the colon tissues and lining are not abnormally thickened
      • Collagenous colitis occurs when the colon’s lining becomes thicker than usual due to a buildup of collagen under the outermost layer of tissue
      • Cause is unknown
    • Risk factors:
      • current smokers
      • those assigned female at birth
      • those with a history of an autoimmune disorder
      • people older than age 50
      • people taking certain medications, such as proton pump inhibitors, selective serotonin reuptake inhibitors, non-steroidal anti-inflammatory drugs
    • Symptoms: chronic watery diarrhea, abdominal bloating, abdominal pain

Symptoms

• Abdominal pain and bloating that may be constant or come and go
• Bloody stools
• Constant urge to have a bowel movement
• Dehydration
• Diarrhea
• Fever

Diagnosis

• Physical exam including questions such as:
  • How long have symptoms been present?
  • How severe is the pain?
  • How often is there pain and how long does it last?
  • Is there diarrhea?
  • Have you been traveling (esp. out of the country)?
  • Recently taking antibiotics?
• Test may include:
  • Flexible sigmoidoscopy or colonoscopy—biopsies may be taken
  • CT scan of the abdomen
  • MRI of the abdomen
  • Barium enema
  • Stool culture
  • Stool examination for ova and parasites

Risks for colitis

Different risk factors are associated with each type of colitis

• Are between ages 15 and 30 (most common) or 60 and 80
• Are white or of Ashkenazi Jewish descent
• Have a family member with ulcerative colitis

For Pseudomembranous colitis:

• taking long-term antibiotics
• are hospitalized
• are receiving chemotherapy
• are taking immunosuppressant drugs
• are older
• have had Pseudomembranous colitis before

For Ischemic colitis:

• are over age 50
• have or are at risk of heart disease
• have low blood pressure
• have had an abdominal operation

Treatment

• Treatment depends on the cause of the disease
• Bowel rest
• Medication
• Surgery

Prognosis

Prognosis depends on the cause of the problem

• Crohn disease is a chronic condition which has no cure but can be controlled
• Ulcerative colitis can usually be controlled with medicines. If not controlled, it can be cured by surgically removing the colon.
• Viral, bacterial and parasitic colitis can be cured with appropriate medicines.
• Pseudomembranous colitis can usually be cured with appropriate antibiotics.

Possible Complications

• Bleeding with bowel movements
• Perforation of the colon
• Toxic megacolon
• Sore (ulceration)

Resources & additional reading

• Penn Medicine -- Colitis
• Mayo Clinic -- Ulcerative colitis
• MedlinePlus -- Colitis
• Healthline -- Everything you need to know about colitis
• Dr. Doni, July 30 2019 – What is Colitis and How is it Treated? Image and info