{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue"
|-
| colspan="1" style="text-align:center; background:DarkGray" |

'''Colitis Microchapters
'''
|- bgcolor="LightGrey"
!

|- bgcolor="LightCoral"
!
[[Colitis |Home]]
|-
!

|- bgcolor="Pink"
!
[[Colitis (patient information)|Patient Information]]
|-
!

|- bgcolor="Pink"
!
[[Allergic colitis]]
|-
!

|- bgcolor="Pink"
!
[[Infectious colitis]]
|-
!

|- bgcolor="Pink"
!
[[Ischemic colitis (HIV)]]
|-
!

|- bgcolor="Pink"
!
[[Chemical colitis]]
|-
!

|- bgcolor="Pink"
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[[Drug-induced colitis]]
|-
!

|- bgcolor="Pink"
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[[Radiation colitis]]
|-
!
|- bgcolor="PaleGoldenrod "
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{{PAGENAME}} On the Web
|-
!

|- bgcolor="LightYellow"
!
[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&db=pubmed&term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} Most recent articles]
|-
!

|- bgcolor="LightYellow"
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[http://scholar.google.com/scholar?ie=UTF-8&oe=utf-8&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&qt_s=Search&sa=N&tab=ps Most cited articles]
|-
!

|- bgcolor="LightYellow"
!
[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}%20AND%20systematic%5Bsb%5D Review articles]
|-
!

|- bgcolor="LightYellow"
!
[http://www.google.com/search?hl=en&client=firefox-a&rls=org.mozilla:en-US:official&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}+more:health_continuing_education&cx=disease_for_health_professionals&sa=N&oi=coopctx&resnum=0&ct=col3&cd=2 CME Programs]
|-
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|- bgcolor="LightYellow"
!
[http://www.google.com/search?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}+ppt&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a Powerpoint slides]
|-
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|- bgcolor="LightYellow"
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|-
!

|- bgcolor="LightYellow"
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American Roentgen Ray Society Images of {{PAGENAME}}
:[http://goldminer.arrs.org/search.php?query={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} All Images]
:[http://goldminer.arrs.org/search.php?query={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}} X-ray}}}} X-rays]
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|-
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|- bgcolor="LightYellow"
!
[http://clinicaltrials.gov/search/open/condition={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} Ongoing Trials at Clinical Trials.gov]
|-
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|- bgcolor="LightYellow"
!
[http://www.guideline.gov/search/searchresults.aspx?Type=3&txtSearch={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&num=20 US National Guidelines Clearinghouse]
|-
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[http://www.nice.org.uk/search/guidancesearchresults.jsp?keywords={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&searchType=guidance NICE Guidance]
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|-
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[http://news.google.com/news?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&ie=UTF-8&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&sa=N&tab=wn {{PAGENAME}} in the news]
|-
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|- bgcolor="LightYellow"
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[http://blogsearch.google.com/blogsearch?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&ie=UTF-8&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&sa=N&tab=wb Blogs on {{PAGENAME}}]
|-
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|- bgcolor="LightYellow"
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|-
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[http://www.google.com/search?hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&hs=QWo&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}+AND+risk+score+OR+risk+calculator&btnG=Search Risk calculators and risk factors for {{PAGENAME}}]
|-
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|}

Ischemic colitis

2017-01-16T16:52:52Z

Qasim Salau:

Ischemic colitis differential diagnosis

2017-01-16T15:29:15Z

Qasim Salau: /* Overview */

__NOTOC__
{{Ischemic colitis}}
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.

{{CMG}}; {{AOEIC}} {{CZ}}

==Overview==

Ischemic colitis must be differentiated from the many other causes of [[abdominal pain]] and [[lower gastrointestinal bleeding|rectal bleeding]] (for example, [[infection]], [[inflammatory bowel disease]], [[diverticulosis]], or [[colon cancer]]).

It is also important to differentiate ischemic colitis, which often resolves on its own, from the more immediately life-threatening condition of acute mesenteric ischemia of the [[small bowel]].

The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|}

==References==
{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Ischemic colitis differential diagnosis

2017-01-16T15:28:50Z

Qasim Salau:

__NOTOC__
{{Ischemic colitis}}
Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.

{{CMG}}; {{AOEIC}} {{CZ}}

==Overview==

Ischemic colitis must be differentiated from the many other causes of [[abdominal pain]] and [[lower gastrointestinal bleeding|rectal bleeding]] (for example, [[infection]], [[inflammatory bowel disease]], [[diverticulosis]], or [[colon cancer]]).

It is also important to differentiate ischemic colitis, which often resolves on its own, from the more immediately life-threatening condition of acute mesenteric ischemia of the [[small bowel]].

*The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|}

==References==
{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Radiation colitis

2017-01-16T15:27:26Z

Qasim Salau: /* Differentiating radiation colitis from other Diseases */

__NOTOC__
{{SI}}
'''For the main page on colitis, please click [[Colitis|here]]''' 
'''For more information on allergic colitis, please click [[Allergic colitis|here]]''' 
'''For more information on infectious colitis, please click [[Infectious colitis|here]]''' 
'''For more information on ischemic colitis, please click [[Ischemic colitis|here]]''' 
'''For more information on chemical colitis, please click [[Chemical colitis|here]]''' 
'''For more information on drug-induced colitis, please click [[Drug-induced colitis|here]]''' 
'''For patient information on this topic, click [[Radiation colitis (patient information)|here]]'''

{{CMG}}; {{AE}} {{QS}}

{{SK}}

==Overview==
Radiation therapy is a common treatment modality for abdominal and pelvic malignancy. Radiation colitis may complicate this treatment. Radiation colitis tends to develop insidiously and it is often progressive when chronic.

==Historical Perspective==
*Radiation-induced enteritis was first described by Walsh in an individual working with X-rays in 1897.<ref name="pmid20757183">{{cite journal| author=Walsh D| title=Deep Tissue Traumatism from Roentgen Ray Exposure. | journal=Br Med J | year= 1897 | volume= 2 | issue= 1909 | pages= 272-3 | pmid=20757183 | doi= | pmc=2407341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20757183 }} </ref>
*In 1917, radiation-induced enteritis was reported following radiation treatment of malignancy.
*The early and late intestinal effect of radiotherapy was first described by Warren and Friedman in 1942.<ref name="pmid19970638">{{cite journal| author=Warren S, Friedman NB| title=Pathology and Pathologic Diagnosis of Radiation Lesions in the Gastro-Intestinal Tract. | journal=Am J Pathol | year= 1942 | volume= 18 | issue= 3 | pages= 499-513 | pmid=19970638 | doi= | pmc=2032955 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19970638 }} </ref>

==Classification==
Radiation colitis may be classified based on duration of symptoms into acute and chronic radiation colitis.<ref name="pmid12107832">{{cite journal| author=Denton AS, Andreyev HJ, Forbes A, Maher EJ| title=Systematic review for non-surgical interventions for the management of late radiation proctitis. | journal=Br J Cancer | year= 2002 | volume= 87 | issue= 2 | pages= 134-43 | pmid=12107832 | doi=10.1038/sj.bjc.6600360 | pmc=2376119 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12107832 }} </ref><ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid20011363">{{cite journal| author=Kennedy GD, Heise CP| title=Radiation colitis and proctitis. | journal=Clin Colon Rectal Surg | year= 2007 | volume= 20 | issue= 1 | pages= 64-72 | pmid=20011363 | doi=10.1055/s-2007-970202 | pmc=2780150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20011363 }} </ref><ref name="pmid23345941">{{cite journal| author=Shadad AK, Sullivan FJ, Martin JD, Egan LJ| title=Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 2 | pages= 185-98 | pmid=23345941 | doi=10.3748/wjg.v19.i2.185 | pmc=3547560 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345941 }} </ref>
*Acute radiation colitis occurs from after the initiation of therapy to 3 months (90 days) after the onset of therapy.
*Chronic radiation colitis occurs from after 3 months of radiation therapy to years after therapy, with a median duration of 8 to 12 months after completion of radiation therapy.

==Pathophysiology==
===Pathogenesis===
*Occur following radiation therapy for abdominal and pelvic malignancies .<ref name="pmid16693707">{{cite journal| author=Keith NM, Whelan M| title=A STUDY OF THE ACTION OF AMMONIUM CHLORID AND ORGANIC MERCURY COMPOUNDS. | journal=J Clin Invest | year= 1926 | volume= 3 | issue= 1 | pages= 149-202 | pmid=16693707 | doi=10.1172/JCI100072 | pmc=434619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16693707 }} </ref><ref name="pmid27504391">{{cite journal| author=Bansal N, Soni A, Kaur P, Chauhan AK, Kaushal V| title=Exploring the Management of Radiation Proctitis in Current Clinical Practice. | journal=J Clin Diagn Res | year= 2016 | volume= 10 | issue= 6 | pages= XE01-XE06 | pmid=27504391 | doi=10.7860/JCDR/2016/17524.7906 | pmc=4963751 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27504391 }} </ref><ref name="pmid27462390">{{cite journal| author=Nelamangala Ramakrishnaiah VP, Krishnamachari S| title=Chronic haemorrhagic radiation proctitis: A review. | journal=World J Gastrointest Surg | year= 2016 | volume= 8 | issue= 7 | pages= 483-91 | pmid=27462390 | doi=10.4240/wjgs.v8.i7.483 | pmc=4942748 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27462390 }} </ref><ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid20011363">{{cite journal| author=Kennedy GD, Heise CP| title=Radiation colitis and proctitis. | journal=Clin Colon Rectal Surg | year= 2007 | volume= 20 | issue= 1 | pages= 64-72 | pmid=20011363 | doi=10.1055/s-2007-970202 | pmc=2780150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20011363 }} </ref><ref name="pmid11488787">{{cite journal| author=Hayne D, Vaizey CJ, Boulos PB| title=Anorectal injury following pelvic radiotherapy. | journal=Br J Surg | year= 2001 | volume= 88 | issue= 8 | pages= 1037-48 | pmid=11488787 | doi=10.1046/j.0007-1323.2001.01809.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11488787 }} </ref>
*More common with radiation doses higher than 45Gy.<ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref>
*The main site of damage is the DNA. The pathogenesis involves direct ionizing damage to the DNA resulting in inhibition mitosis. Radiation may also affect RNA, proteins and cell membranes. Oxidative injury to the DNA may also be contributory to the development of radiation colitis.
**Injury occur few hours to days, up to three months after irradiation in acute radiation colitis. It affects rapidly dividing cells of the epithelium and mucosa crypts. This leads to cell death, recruitment and activation of polymorphonuclear (PMN) inflammatory cells, mucosal edema and damage to small blood vessels. The effect of this damage to the mucosa is fluid, electrolyte and nutrient loss. Radiation also reduces bowel motility. Acute radiation colitis is usually transient and self limiting, with regeneration of the epithelium.
**In chronic radiation colitis, mesenchymal tissue is involved. The damage is progressive with atrophy of the mucosa, fibrosis of the intestinal wall, obliteration of small arteries, chronic ischemia, ulcers, strictures and fistula formation. This changes usually occur three months to years after radiation. Secondary colonic malignancy may occur.

===Genetics===

There is no specific genetic cause for radiation colitis.

===Gross Pathology===

Endoscopy should be gentle and with care especially in acute radiation colitis.
*The mucosa may appear erythematous or pale, is edematous, friable with or without small erosions in acute radiation colitis.
*In chronic radiation colitis, mucosa atrophy, fibrosis, obliterative arteritis, stenosis, strictures, fistula and ulcers are seen.

===Microscopic Histopathology===

Histopathological findings of radiation colitis may be categorized into the following

*Acute: Reduced mitosis, increased apoptosis bodies, mucin depletion, eosinophilia, presence of crypt abscesses and evidence of regeneration
*Chronic: Dilated capillaries and lymphatics, hyaline fibrosis, atypical fibroblast and endothelial cells and distortion of the crypts.

==Differentiating radiation colitis from other Diseases==
Symptoms of acute radiation proctitis may overlap with other causes of acute colitis, but prior history of radiation will help in distinguishing the cause. Differential diagnosis of acute radiation colitis include:
*Allergic colitis
*Chemical colitis
*NSAID induced colitis
*Ischemic colitis

Differential diagnosis of chronic radiation colitis include:
*Ischemic colitis
*Inflammatory bowel disease

*The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|}

==Epidemiology and Demographics==

The exact prevalence and incidence of radiation colitis is not certain due to different methods of definition. The incidence of acute radiation injury to the bowel is said to be about 75% to 80% of patients receiving pelvic radiotherapy, while 15% to 20% of patients receiving pelvic radiotherapy will develop chronic radiation injury to the bowel. <ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid23208963">{{cite journal| author=Tortora A, Purchiaroni F, Scarpellini E, Ojetti V, Gabrielli M, Vitale G et al.| title=Colitides. | journal=Eur Rev Med Pharmacol Sci | year= 2012 | volume= 16 | issue= 13 | pages= 1795-805 | pmid=23208963 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23208963 }} </ref><ref name="pmid23345941">{{cite journal| author=Shadad AK, Sullivan FJ, Martin JD, Egan LJ| title=Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 2 | pages= 185-98 | pmid=23345941 | doi=10.3748/wjg.v19.i2.185 | pmc=3547560 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345941 }} </ref><ref name="pmid11488787">{{cite journal| author=Hayne D, Vaizey CJ, Boulos PB| title=Anorectal injury following pelvic radiotherapy. | journal=Br J Surg | year= 2001 | volume= 88 | issue= 8 | pages= 1037-48 | pmid=11488787 | doi=10.1046/j.0007-1323.2001.01809.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11488787 }} </ref>

===Age===
The prevalence of radiation colitis is more among older age group (over 60 years) patients. This may be a reflection of the increase frequency of predisposing malignancy requiring radiotherapy in this age group. <ref name="pmid23208963">{{cite journal| author=Tortora A, Purchiaroni F, Scarpellini E, Ojetti V, Gabrielli M, Vitale G et al.| title=Colitides. | journal=Eur Rev Med Pharmacol Sci | year= 2012 | volume= 16 | issue= 13 | pages= 1795-805 | pmid=23208963 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23208963 }} </ref><ref name="pmid23345941">{{cite journal| author=Shadad AK, Sullivan FJ, Martin JD, Egan LJ| title=Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 2 | pages= 185-98 | pmid=23345941 | doi=10.3748/wjg.v19.i2.185 | pmc=3547560 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345941 }} </ref><ref name="pmid7635768">{{cite journal| author=Eifel PJ, Levenback C, Wharton JT, Oswald MJ| title=Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. | journal=Int J Radiat Oncol Biol Phys | year= 1995 | volume= 32 | issue= 5 | pages= 1289-300 | pmid=7635768 | doi=10.1016/0360-3016(95)00118-I | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7635768 }} </ref>

===Gender===

Men and women are affected equally by radiation colitis.

===Race===

There is no racial predilection to radiation colitis.

==Risk Factors==
Common risk factors for developing radiation colitis include:<ref name="pmid23345941">{{cite journal| author=Shadad AK, Sullivan FJ, Martin JD, Egan LJ| title=Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 2 | pages= 185-98 | pmid=23345941 | doi=10.3748/wjg.v19.i2.185 | pmc=3547560 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345941 }} </ref><ref name="pmid20011363">{{cite journal| author=Kennedy GD, Heise CP| title=Radiation colitis and proctitis. | journal=Clin Colon Rectal Surg | year= 2007 | volume= 20 | issue= 1 | pages= 64-72 | pmid=20011363 | doi=10.1055/s-2007-970202 | pmc=2780150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20011363 }} </ref><ref name="pmid19109862">{{cite journal| author=Kountouras J, Zavos C| title=Recent advances in the management of radiation colitis. | journal=World J Gastroenterol | year= 2008 | volume= 14 | issue= 48 | pages= 7289-301 | pmid=19109862 | doi= | pmc=2778112 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19109862 }} </ref>

*Radiation dose greater than 54 Gy
*Elderly (above 60 years)
*Past radical abdominal or pelvic surgery such as radical hysterectomy and radical colectomy
*Asthenic individuals
*Smoking
*Chronic co-morbid medical diseases such as diabetes mellitus, hypertension and atherosclerosis
*Past pelvic inflammatory disease
*Collagen vascular disease
*HIV infection- Hypothesized to increase risk for radiation toxicity in the colon

==Screening==
There are no established screening guidelines for radiation colitis<ref name=Screening-radiationcolitis>US preventive service task force.radiation colitis. http://www.uspreventiveservicestaskforce.org/accessed on November 13, 2016</ref>

== Natural History, Complications and Prognosis==
===Natural History===

The symptoms and extent of radiation colitis are variable and usually develop insidiously. The symptoms depend on the dose and duration of the radiation and the how sensitive the bowel is to radiation. In acute radiation colitis, symptoms usually starts shortly after commencement of radiation therapy and progress reaching a peak 1 to 2 weeks later. The symptoms of acute radiation colitis may not start for up to 3 months after commencement of radiation. In most cases, the symptoms of acute radiation colitis are self-limiting and resolve following termination of radiation therapy. The symptoms of chronic radiation colitis often become noticeable months to years after the completion of radiotherapy. The symptoms may occasionally follow acute radiation colitis. However, previous acute radiation colitis does not increase the risk of a patient developing chronic radiation colitis. Also, absence of acute radiation colitis, does not prevent chronic radiation colitis from occurring. Treatment is required for chronic radiation colitis because resolution of the symptoms is uncommon without intervention. <ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid6603628">{{cite journal| author=Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN| title=The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. | journal=Q J Med | year= 1983 | volume= 52 | issue= 205 | pages= 40-53 | pmid=6603628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6603628 }} </ref>

===Complications===
Possible complications of radiation colitis include:<ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid6603628">{{cite journal| author=Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN| title=The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. | journal=Q J Med | year= 1983 | volume= 52 | issue= 205 | pages= 40-53 | pmid=6603628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6603628 }} </ref>
*Anemia
*Intestinal obstruction
*Intestinal perforation
*Fistula
*Fecal incontinence
*Strictures
*Malabsorption
*Failure to thrive
*Sepsis due to loss of the mucosal protective barrier
*Secondary malignancy (uncommon).<ref name="pmid21712948">{{cite journal| author=Asano N, Iijima K, Terai S, Uno K, Endo H, Koike T et al.| title=Signet Ring Cell Gastric Cancer Occurring after Radiation Therapy for Helicobacter pylori-Uninfected Mucosa-Associated Lymphoid Tissue Lymphoma. | journal=Case Rep Gastroenterol | year= 2011 | volume= 5 | issue= 2 | pages= 325-9 | pmid=21712948 | doi=10.1159/000329559 | pmc=3124325 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21712948 }} </ref><ref name="pmid16734262">{{cite journal| author=Narui K, Ike H, Fujii S, Nojiri K, Tatsumi K, Yamagishi S et al.| title=[A case of radiation-induced rectal cancer]. | journal=Nihon Shokakibyo Gakkai Zasshi | year= 2006 | volume= 103 | issue= 5 | pages= 551-7 | pmid=16734262 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16734262 }} </ref>

===Prognosis===
The prognosis of radiation colitis varies with the subtype, severity, duration and responsiveness to treatment.<ref name="pmid6603628">{{cite journal| author=Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN| title=The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. | journal=Q J Med | year= 1983 | volume= 52 | issue= 205 | pages= 40-53 | pmid=6603628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6603628 }} </ref>
<ref name="pmid19109862">{{cite journal| author=Kountouras J, Zavos C| title=Recent advances in the management of radiation colitis. | journal=World J Gastroenterol | year= 2008 | volume= 14 | issue= 48 | pages= 7289-301 | pmid=19109862 | doi= | pmc=2778112 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19109862 }} </ref><ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref>
*Acute radiation colitis is usually self-limiting, with resolution of symptoms few weeks after stopping radiotherapy.
*Chronic radiation colitis is progressive and difficult to manage. The patients may develop secondary radiation-associated malignancy which has a poor prognosis due to late diagnosis.

== Diagnosis ==
===Diagnostic Criteria===
There is no definitive diagnostic criteria for radiation colitis. Diagnosis of radiation colitis is primarily clinical; it is based on history, physical examination and endoscopic findings.<ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid6603628">{{cite journal| author=Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN| title=The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. | journal=Q J Med | year= 1983 | volume= 52 | issue= 205 | pages= 40-53 | pmid=6603628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6603628 }} </ref>

=== History and Symptoms ===
Obtaining a complete history including dietary history is an important aspect in making a diagnosis of radiation colitis. It provides insight into the cause, and any associated underlying conditions. Radiation colitis should be suspected in any individual who presents with intestinal symptoms and has a previous history of abdominal and/ or pelvic radiotherapy. Symptoms of radiation colitis may be categorized according to duration as follows:
====Acute radiation colitis====
*[[Diarrhea]]
*[[Abdominal pain]] which is colicky (cramping and intermittent)
*[[Nausea]]
*Urgency
*Fecal frequency
*[[Tenesmus]]
*Mucus discharge
*Rectal bleeding
====Chronic radiation colitis====
*Symptoms of acute radiation colitis
*Rectal bleeding, which may be severe
*Symptoms of sepsis
*[[Constipation]]
*[[Abdominal pain]]
*[[Abdominal distension]]
*[[Vomiting]]
*[[Fecal vomiting]] especially when stricture develops

=== Physical Examination ===
Physical examination findings may reveal:
*Signs of [[dehydration]] such as lethargy, [[Tachycardia]] and [[Hypotension]]
*[[Abdominal tenderness]] which may be more prominent in lower abdominal quadrants due to involvement of the distal sigmoid colon and/ or rectum
*[[Fever]] due to dehydration or in individuals who have developed sepsis
*[[Pallor]]
*Toxic appearance in those with bowel perforation and sepsis

=== Laboratory Findings ===
Initial investigations should include hematological, biochemistry profiles and stool examination.
====Hematology====
*[[Anemia]]
*[[Leukocytosis]] with [[left shift]] may be seen with sepsis common, but [[leukopenia]] can be seen.

====Electolytes====
*[[Hyponatremia]]

====Stool Examination====
Stool analysis may show
*[[Fecal blood]]
*[[Fecal leukocytes]]
*Stool culture is negative

===Endoscopy===
Endoscopy is important to confirm the diagnosis of radiation colitis. However, endoscopy should be done with care due to the fragile nature of the bowel following radiation therapy. Biopsy is generally not recommended during endoscopy especially in acute radiation colitis.<ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid6603628">{{cite journal| author=Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN| title=The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. | journal=Q J Med | year= 1983 | volume= 52 | issue= 205 | pages= 40-53 | pmid=6603628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6603628 }} </ref>
*Features seen in acute radiation colitis on endoscopy include friable, hyperemic, edematous mucosa with/ or without ulcers that are often shallow. The features seen in acute radiation colitis are limited to the superficial parts of the colonic mucosa.
*Chronic radiation colitis involves the whole of the colonic mucosa. Features include mucosal pallor, fibrosis, strictures, ulcers and telangiectasias which bleeds easily. The colonic wall is often rigid.

=== Other Diagnostic Studies ===
Other diagnostic studies in radiation colitis include:<ref name="pmid11488787">{{cite journal| author=Hayne D, Vaizey CJ, Boulos PB| title=Anorectal injury following pelvic radiotherapy. | journal=Br J Surg | year= 2001 | volume= 88 | issue= 8 | pages= 1037-48 | pmid=11488787 | doi=10.1046/j.0007-1323.2001.01809.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11488787 }} </ref>
====Barium enema====
May show decreased peristalsis and distention of the colon, stenosis, presence of ulcers and fistulas. It is less sensitive to endoscopy
====CT====
CT findings include increased density and fibrosis of the pericolonic fat, fascia and colonic wall. It also helps to rule out perforation. Difficult to distinguish between radiation colitis and cancer.

====Xray====
No specific Xray feature of radiation colitis. However, it helps to rule out perforation.

== Treatment ==
=== Medical Therapy ===
The mainstay of treatment for radiation colitis is conservative medical therapy. Medical therapy depends on whether radiation colitis is acute or chronic.<ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid19109862">{{cite journal| author=Kountouras J, Zavos C| title=Recent advances in the management of radiation colitis. | journal=World J Gastroenterol | year= 2008 | volume= 14 | issue= 48 | pages= 7289-301 | pmid=19109862 | doi= | pmc=2778112 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19109862 }} </ref><ref name="pmid20011363">{{cite journal| author=Kennedy GD, Heise CP| title=Radiation colitis and proctitis. | journal=Clin Colon Rectal Surg | year= 2007 | volume= 20 | issue= 1 | pages= 64-72 | pmid=20011363 | doi=10.1055/s-2007-970202 | pmc=2780150 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20011363 }} </ref><ref name="pmid22057051">{{cite journal| author=Andreyev HJ, Davidson SE, Gillespie C, Allum WH, Swarbrick E, British Society of Gastroenterology et al.| title=Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. | journal=Gut | year= 2012 | volume= 61 | issue= 2 | pages= 179-92 | pmid=22057051 | doi=10.1136/gutjnl-2011-300563 | pmc=3245898 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22057051 }} </ref><ref name="pmid27462390">{{cite journal| author=Nelamangala Ramakrishnaiah VP, Krishnamachari S| title=Chronic haemorrhagic radiation proctitis: A review. | journal=World J Gastrointest Surg | year= 2016 | volume= 8 | issue= 7 | pages= 483-91 | pmid=27462390 | doi=10.4240/wjgs.v8.i7.483 | pmc=4942748 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27462390 }} </ref><ref name="pmid11488787">{{cite journal| author=Hayne D, Vaizey CJ, Boulos PB| title=Anorectal injury following pelvic radiotherapy. | journal=Br J Surg | year= 2001 | volume= 88 | issue= 8 | pages= 1037-48 | pmid=11488787 | doi=10.1046/j.0007-1323.2001.01809.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11488787 }} </ref>
====Acute radiation colitis====
Acute radiation colitis is a self-limiting illness which usually resolves on stopping radiotherapy. Supportive therapy is the only treatment required in the majority of cases. These include:
*Correction of dehydration and electrolyte derangements by giving intravenous fluids or oral rehydration therapy whenever it is feasible
*Use of anti-diarrhea medications like loperamide
*Dietary modification by decreasing fat and lactose intake
*Use of synthetic somatostatin analog octreotide in patients with refractory diarrhea
*Steroid and 5-aminosalicylic acid suppositories have also been used to treat bowel inflammation associated with radiation therapy.
*Definitive treatment is by stopping radiation therapy

====Chronic radiation colitis====
Chronic radiation colitis is a progressive disease that is often difficult to treat. The colon is fragile with fibrosis and neovascularization, making it prone to bleeding with minimal trauma. The most frequent symptom of chronic radiation colitis is diarrhea. The treatment of chronic radiation colitis include:
*Supportive fluid and electrolyte replacement due to chronic diarrhea and use of anti-diarrhea medications
*Giving high fibre (low residue) diet, with low lactose and fats
*Anti-inflammatory therapy using non-steroidal anti-inflammatory drugs (NSAIDS) such as 5-aminosalicylic acid or sulfasalazine with/ without the addition of steroids is often the first-line treatment used in most cases of chronic radiation colitis
*Sucralfate (a sulphated polyanionic disaccharide) is used when anti-inflammatory therapy fails to improve symptoms. It is thought work through promotion of healing of the intestinal epithelium and formation of a protective barrier in the bowel.
*Hyperbaric oxygen (HBO) therapy is also used in the treatment of chronic radiation colitis. It is thought to work through its angiogenic and antibacterial effects, reducing tissue hypoxia and therefore promoting colonic mucosa healing and regeneration.
*Short chain fatty acids (SCFA) enemas have also been used in the treatment of radiation colitis. They stimulate colonic mucosa proliferation and have vasodilatory effect on the arteriole walls.
*Anti-oxidants such as vitamins A, C and E have been used as adjuncts in the treatment of chronic radiation colitis, with favorable response.
*Transfusion may be required to treat anemia from hemorrhagic telengiectasia.

===Ablative therapy===
Ablative treatment using formalin, endoscopic coagulation, or argon plasma coagulation is done when symptom fail to improve with medical therapy. Ablative treatment should be done with care in patients with chronic radiation colitis because of the fragile bowel which increases the risk of complications such as bleeding, stenosis, perforation and fistula formation.

=== Surgical Therapy ===
Surgical intervention in chronic radiation colitis is commonly reserved for management of complications or rarely for diagnosis. About 10 to 30 percent of individuals with radiation colitis will require surgery. <ref name="pmid22144997">{{cite journal| author=Do NL, Nagle D, Poylin VY| title=Radiation proctitis: current strategies in management. | journal=Gastroenterol Res Pract | year= 2011 | volume= 2011 | issue= | pages= 917941 | pmid=22144997 | doi=10.1155/2011/917941 | pmc=3226317 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22144997 }} </ref><ref name="pmid19109862">{{cite journal| author=Kountouras J, Zavos C| title=Recent advances in the management of radiation colitis. | journal=World J Gastroenterol | year= 2008 | volume= 14 | issue= 48 | pages= 7289-301 | pmid=19109862 | doi= | pmc=2778112 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19109862 }} </ref>
Indications for surgery in radiation colitis include:
*Intestinal obstruction
*Intestinal perforation
*Fistulae formation
*Severe bleeding
*Rarely, for treatment of uncontrollable pain

Surgical interventions for chronic radiation colitis include intestinal bypass procedures, colonic resection and bowel reconstruction.

==Prevention==

===Primary prevention===
There is presently no established method of prevention for radiation colitis. However, individuals with chronic radiation colitis should be followed up closely because of the risk of development of secondary radiation-induced malignancy in them.

===Secondary prevention===
There are no secondary prevention methods for radiation colitis.

==References==
{{Reflist|2}}

[[Category:Primary care]]
[[Category:Gastroenterology]]
[[Category:Radiology]]

{{WS}}
{{WH}}

Drug-induced colitis

2017-01-16T15:26:54Z

Qasim Salau: /* Differentiating drug-induced colitis from other Diseases */

__NOTOC__
{{SI}}
'''For the main page on colitis, please click [[Colitis|here]]''' 
'''For more information on allergic colitis, please click [[Allergic colitis|here]]''' 
'''For more information on infectious colitis, please click [[Infectious colitis|here]]''' 
'''For more information on ischemic colitis, please click [[Ischemic colitis|here]]''' 
'''For more information on chemical colitis, please click [[Chemical colitis|here]]''' 
'''For more information on radiation colitis, please click [[Radiation colitis|here]]''' 
'''For patient information on this topic, click [[Drug-induced colitis (patient information)|here]]'''

{{CMG}}; {{AE}} {{QS}}

{{SK}} Drug-related colitis, Drug-induced enterocolitis, Non-steroidal anti-inflammatory drug (NSAID) induced colitis; Chemotherapeutic drug-induced colitis

==Overview==
Drug-induced colitis is inflammation of the large intestine or colon, caused by the introduction of drugs or chemicals to the colon usually by the oral route but occasionally through the rectum. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common drugs implicated in drug-induced colitis and also the most commonly used drugs worldwide. Drug-induced colitis can resemble ulcerative colitis, infectious colitis and ischemic colitis endoscopically. Most cases of drug-induced colitis resolve after stopping the offending medication.<ref name="pmid8500743">{{cite journal| author=Bjarnason I, Hayllar J, MacPherson AJ, Russell AS| title=Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. | journal=Gastroenterology | year= 1993 | volume= 104 | issue= 6 | pages= 1832-47 | pmid=8500743 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8500743 }} </ref><ref name="pmid123">{{cite book | last = Odze | first = Robert | title = Odze and Goldblum surgical pathology of the GI tract, liver, biliary tract, and pancreas | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2015 | isbn = 978-1455707478 }} </ref>

==Historical Perspective==
*NSAID-induced colitis was first described by Debenham, a Canadian doctor, in 1966 following a patient who developed ulcer in the caecum during oxyphenbutazone therapy.<ref name="pmid5934387">{{cite journal| author=Debenham GP| title=Ulcer of the cecum during oxyphenbutazone (tandearil) therapy. | journal=Can Med Assoc J | year= 1966 | volume= 94 | issue= 22 | pages= 1182-4 | pmid=5934387 | doi= | pmc=1935486 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5934387 }} </ref>
*Diaphragm disease was first mentioned in 1987, by Lang et al to describe small bowel strictures from NSAIDs use.<ref name="pmid3384981">{{cite journal| author=Lang J, Price AB, Levi AJ, Burke M, Gumpel JM, Bjarnason I| title=Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs. | journal=J Clin Pathol | year= 1988 | volume= 41 | issue= 5 | pages= 516-26 | pmid=3384981 | doi= | pmc=1141503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3384981 }} </ref>
*Sheers and Williams in 1989, subsequently described similar diaphragm disease in the colon of patients on NSAIDs.<ref name="pmid2572870">{{cite journal| author=Sheers R, Williams WR| title=NSAIDs and gut damage. | journal=Lancet | year= 1989 | volume= 2 | issue= 8672 | pages= 1154 | pmid=2572870 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2572870 }} </ref>

==Classification==
*There is no established classification method for drug-induced colitis. However, it may be classified based on the pathophysiology pattern, type of drug and duration of symptoms.<ref name="pmid27472233">{{cite journal| author=Marginean EC| title=The Ever-Changing Landscape of Drug-Induced Injury of the Lower Gastrointestinal Tract. | journal=Arch Pathol Lab Med | year= 2016 | volume= 140 | issue= 8 | pages= 748-58 | pmid=27472233 | doi=10.5858/arpa.2015-0451-RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27472233 }} </ref><ref name="pmid123">{{cite book | last = Odze | first = Robert | title = Odze and Goldblum surgical pathology of the GI tract, liver, biliary tract, and pancreas | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2015 | isbn = 978-1455707478 }} </ref>

===Classification based on histologic pattern===
Based on the pathophysiology, drug-induced colitis may be classified into:

{| class="wikitable"
!Pathophysiologic pattern of colitis
!Drugs
|-
|Focal active colitis
|NSAIDs, sodium phosphate (oral)
|-
|Eosinophilic colitis
|NSAIDs, carbamazepine, antiplatelet drugs, estrogen, progesteron, gold
|-
|Ischemic colitis
|NSAIDs, digoxin, diuretics, cocaine, ergotamine, serotonin agonists/antagonists, amphetamines, glutaraldehyde, antibiotics, chemotherapy drugs, drugs that cause constipation, laxatives, vasopressor agents, estrogen, progesteron, mycophenolic acid
|-
|Microscopic colitis
|NSAIDs, Protein pump inhibitors (lansoprazole), H2 receptor blockers (e.g. ranitidine), ticlopidine, simvastatin, carbamazepine, sertraline, oral penicillin
|-
|Pseudomembranous colitis
|Antibiotic-associated ''[[Clostridium difficile]]'' colitis (e.g. penicillins, clindamycin, cephalosporins, fluoroquinolones)
|-
|Apoptotic colitis
|NSAIDs, oral sodium phosphate, laxatives, chemotherapy drugs (especially anti-metabolites), and cyclosporine A
|-
|Neutropenic necrotizing enterocolitis
|Chemotherapy drugs
|-
|Immune-mediated colitis
|Antibody to cytotoxic T-lymphocyte–associated antigen (CTLA4)
|}

===Classification based on type of drugs===
Drug-induced colitis can be classified based on the type of drugs into:
*Non-steroidal anti-inflammatory drugs (NSAID)-induced colitis
*Chemotherapy drug-induced colitis
*Antibiotic-associated ''[[Clostridium difficile]]'' colitis
*H2 receptor blockers induced colitis

===Classification based on duration of symptoms===
Based on the duration of symptoms, drug-induced colitis can be classified into:
*Acute
*Chronic e.g. diaphragm disease (results from long-term use of NSAIDs)

==Pathophysiology==
===Pathogenesis===
*The pathogenesis of drug-induced colitis depends on the causative drug. The most common drugs implicated in drug-induced colitis are NSAIDs.
**The exact mechanism by which NSAID cause colitis is not completely understood. NSAIDs can either induce new-onset colitis or exacerbate a pre-existing colitis.<ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref><ref name="pmid3774712">{{cite journal| author=Ravi S, Keat AC, Keat EC| title=Colitis caused by non-steroidal anti-inflammatory drugs. | journal=Postgrad Med J | year= 1986 | volume= 62 | issue= 730 | pages= 773-6 | pmid=3774712 | doi= | pmc=2418853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3774712 }} </ref><ref name="pmid24942356">{{cite journal| author=Philpott HL, Nandurkar S, Lubel J, Gibson PR| title=Drug-induced gastrointestinal disorders. | journal=Postgrad Med J | year= 2014 | volume= 90 | issue= 1065 | pages= 411-9 | pmid=24942356 | doi=10.1136/postgradmedj-2013-100316rep | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24942356 }} </ref><ref name="pmid14651719">{{cite journal| author=Price AB| title=Pathology of drug-associated gastrointestinal disease. | journal=Br J Clin Pharmacol | year= 2003 | volume= 56 | issue= 5 | pages= 477-82 | pmid=14651719 | doi= | pmc=1884388 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14651719 }} </ref>
***NSAIDs inhibit cyclooxygenase and thus prostaglandin production. Prostaglandin helps to maintain mucosal integrity. NSAIDs also impair oxidative phosphorylation, increasing risk of oxidative injury to the gut.
***Direct damage to the intestinal mucosa is another proposed mechanism in NSAID related injury, since the rectum is often spared with colitis mainly limited to the right side of the colon.
***Increased intestinal permeability to antigens following the use of NSAIDs is another hypothesized mechanism. This is said to cause the activation of the immune system and subsequent inflammation.

===Genetics===
*There is no specific genetic cause for drug-induced colitis

===Gross Pathology===
Gross pathology findings in drug-induced colitis depends on the causative drug.
*NSAID-induced colitis is characterized by nonspecific mucosal erosions and ulcers of varying degree, with intervening areas of normal mucosa. Perforations and fibrosis may also be seen. The lesions are predominantly on the right and may be single or multiple, sparing the rectum.<ref name="pmid27472233">{{cite journal| author=Marginean EC| title=The Ever-Changing Landscape of Drug-Induced Injury of the Lower Gastrointestinal Tract. | journal=Arch Pathol Lab Med | year= 2016 | volume= 140 | issue= 8 | pages= 748-58 | pmid=27472233 | doi=10.5858/arpa.2015-0451-RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27472233 }} </ref><ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref><ref name="pmid3774712">{{cite journal| author=Ravi S, Keat AC, Keat EC| title=Colitis caused by non-steroidal anti-inflammatory drugs. | journal=Postgrad Med J | year= 1986 | volume= 62 | issue= 730 | pages= 773-6 | pmid=3774712 | doi= | pmc=2418853 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3774712 }} </ref><ref name="pmid24942356">{{cite journal| author=Philpott HL, Nandurkar S, Lubel J, Gibson PR| title=Drug-induced gastrointestinal disorders. | journal=Postgrad Med J | year= 2014 | volume= 90 | issue= 1065 | pages= 411-9 | pmid=24942356 | doi=10.1136/postgradmedj-2013-100316rep | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24942356 }} </ref><ref name="pmid14651719">{{cite journal| author=Price AB| title=Pathology of drug-associated gastrointestinal disease. | journal=Br J Clin Pharmacol | year= 2003 | volume= 56 | issue= 5 | pages= 477-82 | pmid=14651719 | doi= | pmc=1884388 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14651719 }} </ref><ref name="pmid10826432">{{cite journal| author=Püspök A, Kiener HP, Oberhuber G| title=Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. | journal=Dis Colon Rectum | year= 2000 | volume= 43 | issue= 5 | pages= 685-91 | pmid=10826432 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10826432 }} </ref>

*Pseudomembranes may be seen in NSAID-induced colitis and antibiotic induced ''[[Clostridium difficile]]'' colitis.

===Microscopic Histopathology===
*On histology, NSAID-induced colitis findings include ulcers that are often discrete and superficial with minimal inflammatory cells which are mainly eosinophils and lymphocytes. The area of pathology is surrounded by normal colonic mucosa. In diaphragm disease, characteristic submucosal fibrosis (the fibers pointing in the direction of peristalsis) with submucosal architectural destruction and normal or minimal inflammation of the overlying epithelium is seen. <ref name="pmid27472233">{{cite journal| author=Marginean EC| title=The Ever-Changing Landscape of Drug-Induced Injury of the Lower Gastrointestinal Tract. | journal=Arch Pathol Lab Med | year= 2016 | volume= 140 | issue= 8 | pages= 748-58 | pmid=27472233 | doi=10.5858/arpa.2015-0451-RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27472233 }} </ref><ref name="pmid14651719">{{cite journal| author=Price AB| title=Pathology of drug-associated gastrointestinal disease. | journal=Br J Clin Pharmacol | year= 2003 | volume= 56 | issue= 5 | pages= 477-82 | pmid=14651719 | doi= | pmc=1884388 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14651719 }} </ref><ref name="pmid10826432">{{cite journal| author=Püspök A, Kiener HP, Oberhuber G| title=Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. | journal=Dis Colon Rectum | year= 2000 | volume= 43 | issue= 5 | pages= 685-91 | pmid=10826432 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10826432 }} </ref><ref name="pmid19937416">{{cite journal| author=Geramizadeh B, Taghavi A, Banan B| title=Clinical, endoscopic and pathologic spectrum of non-steroidal anti-inflammatory drug-induced colitis. | journal=Indian J Gastroenterol | year= 2009 | volume= 28 | issue= 4 | pages= 150-3 | pmid=19937416 | doi=10.1007/s12664-009-0053-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19937416 }} </ref>

*Other histologic findings associated with drug-induced colitis include increased epithelial apoptosis especially involvement of the crypts, presence of pseudomembranes, cytoplasmic vacuoles, and features of microscopic colitis (presence of subepithelial thickening and/ or increased lymphocytes within the crypts in an otherwise normal looking mucosa).<ref name="pmid27472233">{{cite journal| author=Marginean EC| title=The Ever-Changing Landscape of Drug-Induced Injury of the Lower Gastrointestinal Tract. | journal=Arch Pathol Lab Med | year= 2016 | volume= 140 | issue= 8 | pages= 748-58 | pmid=27472233 | doi=10.5858/arpa.2015-0451-RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27472233 }} </ref><ref name="pmid14651719">{{cite journal| author=Price AB| title=Pathology of drug-associated gastrointestinal disease. | journal=Br J Clin Pharmacol | year= 2003 | volume= 56 | issue= 5 | pages= 477-82 | pmid=14651719 | doi= | pmc=1884388 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14651719 }} </ref>

==Causes==
* The most common causes of drug-induced colitis are NSAIDs.
Causes of drug-induced colitis include:

{| class="wikitable"
!Pathophysiologic pattern of colitis
!Drugs
|-
|Focal active colitis
|NSAIDs, sodium phosphate (oral)
|-
|Eosinophilic colitis
|NSAIDs, carbamazepine, antiplatelet drugs, estrogen, progesteron, gold
|-
|Ischemic colitis
|NSAIDs, digoxin, diuretics, cocaine, ergotamine, serotonin agonists/antagonists, amphetamines, glutaraldehyde, antibiotics, chemotherapeutic drugs, drugs that cause constipation, laxatives, vasopressor agents, estrogen, progesteron, mycophenolic acid
|-
|Microscopic colitis
|NSAIDs, Protein pump inhibitors (lansoprazole), H2 receptor blockers (e.g. ranitidine), ticlopidine, simvastatin, carbamazepine, sertraline, oral penicillin
|-
|Pseudomembranous colitis
|Antibiotic-associated ''[[Clostridium difficile]]'' colitis (e.g. penicillins, clindamycin, cephalosporins, fluoroquinolones)
|-
|Apoptotic colitis
|NSAIDs, oral sodium phosphate, laxatives, chemotherapeutic drugs (especially anti-metabolites), and cyclosporine A
|-
|Neutropenic necrotizing enterocolitis
|Chemotherapy drugs
|-
|Immune-mediated colitis
|Antibody to cytotoxic T-lymphocyte–associated antigen (CTLA4)
|}

==Differentiating drug-induced colitis from other Diseases==
*Drug-induced colitis must be differentiated from other diseases that cause diarrhea especially bloody diarrhea and abdominal pain. The symptoms of drug-induced colitis may overlap with other forms of colitis such as inflammatory bowel disease and ischemic colitis.<ref name="pmid10826432">{{cite journal| author=Püspök A, Kiener HP, Oberhuber G| title=Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. | journal=Dis Colon Rectum | year= 2000 | volume= 43 | issue= 5 | pages= 685-91 | pmid=10826432 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10826432 }} </ref>

*The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|}

==Epidemiology and Demographics==
The overall prevalence and incidence of drug-induced colitis is not known.<ref name="pmid3265394">{{cite journal| author=Tanner AR, Raghunath AS| title=Colonic inflammation and nonsteroidal anti-inflammatory drug administration. An assessment of the frequency of the problem. | journal=Digestion | year= 1988 | volume= 41 | issue= 2 | pages= 116-20 | pmid=3265394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3265394 }} </ref>

===Epidemiology===
*The overall prevalence and incidence of drug-induced colitis is not known. NSAIDs are the most common prescribed drugs worldwide and most reports of drug-induced colitis have been related to their use.
*The incidence of NSAID-induced colitis is reported as 10 percent of all cases of colitis.<ref name="pmid3265394">{{cite journal| author=Tanner AR, Raghunath AS| title=Colonic inflammation and nonsteroidal anti-inflammatory drug administration. An assessment of the frequency of the problem. | journal=Digestion | year= 1988 | volume= 41 | issue= 2 | pages= 116-20 | pmid=3265394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3265394 }} </ref><ref name="pmid7682167">{{cite journal| author=Bakshi R, Ezzet N, Frey L, Lasry D, Salliere D| title=Efficacy and tolerability of diclofenac dispersible in painful osteoarthrosis. | journal=Clin Rheumatol | year= 1993 | volume= 12 | issue= 1 | pages= 57-61 | pmid=7682167 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7682167 }} </ref>

===Demography===
====Age====
NSAID-induced colitis is more common among the elderly. This may be related to the increased use of NSAIDs in this age group.<ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref>

====Gender====
The prevalence and incidence of NSAID-induced colitis is more in women than men. <ref name="pmid123">{{cite book | last = Odze | first = Robert | title = Odze and Goldblum surgical pathology of the GI tract, liver, biliary tract, and pancreas | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2015 | isbn = 978-1455707478 }} </ref>

====Race====
There is no racial predilection to drug-induced colitis

==Risk Factors==
*Common risk factors in the development of NSAID-induced colitis include: <ref name="pmid123">{{cite book | last = Odze | first = Robert | title = Odze and Goldblum surgical pathology of the GI tract, liver, biliary tract, and pancreas | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2015 | isbn = 978-1455707478 }} </ref><ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref>
:*Elderly age group
:*Long-term NSAID use
:*Alcohol use
:*Smoking

== Natural History, Complications and Prognosis==
===Natural History===
*The severity and extent of drug-induced colitis depend on the offending drug and duration of use the drug.
*The natural history of NSAID-induced colitis is poorly defined. In the majority of patients the symptoms often develop insidiously following months of use of NSAIDs and may require hospitalization in about 20% of them. Early symptoms include abdominal pain, diarrhea and intestinal bleeding. There symptoms usually resolve following stoppage of the offending NSAID and symptomatic treatment. Long-term NSAID use may result in development of intestinal diaphragm strictures which persist.<ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref><ref name="pmid19937416">{{cite journal| author=Geramizadeh B, Taghavi A, Banan B| title=Clinical, endoscopic and pathologic spectrum of non-steroidal anti-inflammatory drug-induced colitis. | journal=Indian J Gastroenterol | year= 2009 | volume= 28 | issue= 4 | pages= 150-3 | pmid=19937416 | doi=10.1007/s12664-009-0053-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19937416 }} </ref><ref name="pmid20361083">{{cite journal| author=Aftab AR, Donnellan F, Zeb F, Kevans D, Cullen G, Courtney G| title=NSAID-induced colopathy. A case series. | journal=J Gastrointestin Liver Dis | year= 2010 | volume= 19 | issue= 1 | pages= 89-91 | pmid=20361083 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20361083 }} </ref><ref name="pmid9203940">{{cite journal| author=Evans JM, McMahon AD, Murray FE, McDevitt DG, MacDonald TM| title=Non-steroidal anti-inflammatory drugs are associated with emergency admission to hospital for colitis due to inflammatory bowel disease. | journal=Gut | year= 1997 | volume= 40 | issue= 5 | pages= 619-22 | pmid=9203940 | doi= | pmc=1027164 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9203940 }} </ref>

===Complications===
Complications of NSAID-induced colitis include:<ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref>
*Perforation
*Peritonitis
*Diaphragm-like strictures
*Iron deficiency anemia

===Prognosis===
The prognosis of drug-induced colitis varies with the offending drug. It is generally good with resolution of symptoms following treatment.<ref name="pmid27472233">{{cite journal| author=Marginean EC| title=The Ever-Changing Landscape of Drug-Induced Injury of the Lower Gastrointestinal Tract. | journal=Arch Pathol Lab Med | year= 2016 | volume= 140 | issue= 8 | pages= 748-58 | pmid=27472233 | doi=10.5858/arpa.2015-0451-RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27472233 }} </ref><ref name="pmid123">{{cite book | last = Odze | first = Robert | title = Odze and Goldblum surgical pathology of the GI tract, liver, biliary tract, and pancreas | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2015 | isbn = 978-1455707478 }} </ref>

== Diagnosis ==
===Diagnostic Criteria===
*There is no definitive diagnostic criteria for drug-induced colitis. Diagnosis of drug-induced colitis is primarily clinical, based on detailed history, physical examination and endoscopic findings.

=== Symptoms ===
*Obtaining a complete history including drug history is important in making a diagnosis of drug-induced colitis. Symptoms of drug-induced colitis are not specific,
*Symptoms of NSAID-induced may include the following:
:*Diffuse abdominal pain which is colicky
:*Diarrhea
:*Rectal bleeding
:*Vomiting

*Chronic symptoms include:
:*Symptoms of iron-deficiency anemia
:*Recurring episodes of constipation due to partial intestinal obstruction in patients with diaphragm disease
:*Failure to thrive

===Physical Examination===

*Physical examination findings in patients with NSAID-induced colitis may be remarkable for:
:*[[Abdominal tenderness]] which is often diffuse
:*[[Pallor]] due to anemia
:*Signs of [[dehydration]] such as lethargy, [[Tachycardia]] and [[Hypotension]]
:*[[Fever]] due to dehydration or in individuals who have developed sepsis
:*Toxic appearance in those with bowel perforation and sepsis
:*Weight loss in patients with diaphragm disease

=== Laboratory Findings ===
There are no specific laboratory findings associated with chemical colitis. Initial investigations should include hematological, biochemistry profiles and stool examination.
====Hematology====
*[[Anemia]]

====Electolytes====
*[[Hyponatremia]]

====Stool Examination====
Stool analysis may show
*[[Fecal occult blood]]
*Stool culture is negative.

===Endoscopy===
*Endoscopy is required for diagnosis of drug-induced colitis.
*Endoscopic features in NSAID-induced colitis include:<ref name="pmid19937416">{{cite journal| author=Geramizadeh B, Taghavi A, Banan B| title=Clinical, endoscopic and pathologic spectrum of non-steroidal anti-inflammatory drug-induced colitis. | journal=Indian J Gastroenterol | year= 2009 | volume= 28 | issue= 4 | pages= 150-3 | pmid=19937416 | doi=10.1007/s12664-009-0053-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19937416 }} </ref><ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref><ref name="pmid10826432">{{cite journal| author=Püspök A, Kiener HP, Oberhuber G| title=Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. | journal=Dis Colon Rectum | year= 2000 | volume= 43 | issue= 5 | pages= 685-91 | pmid=10826432 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10826432 }} </ref><ref name="pmid20361083">{{cite journal| author=Aftab AR, Donnellan F, Zeb F, Kevans D, Cullen G, Courtney G| title=NSAID-induced colopathy. A case series. | journal=J Gastrointestin Liver Dis | year= 2010 | volume= 19 | issue= 1 | pages= 89-91 | pmid=20361083 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20361083 }} </ref>
:*Normal mucosal which may be seen in as much as 45% of the patients.
:* Nonspecific mucosa changes such as friable, hyperemic, edematous mucosa with/ or without erosions and ulcers. This findings may be seen in any part of the colon, but more commonly on the right side.
:*In diaphragm disease, multiple diaphragm-like membrane strictures are seen with normal or minimally inflamed surrounding mucosa.

=== Other Diagnostic Studies ===
*Other diagnostic test include

====CT scan====
There is no specific CT scan feature for NSAID-induced colitis.
====Xray====
There is no specific Xray feature of NSAID-induced colitis. However, it may help to rule out complications such as intestinal obstruction and perforation.<ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref>

== Treatment ==
=== Medical Therapy ===
*There is no specific treatment for NSAID-induced colitis; the mainstay of therapy is medical supportive care.<ref name="pmid24339669">{{cite journal| author=Tonolini M| title=Acute nonsteroidal anti-inflammatory drug-induced colitis. | journal=J Emerg Trauma Shock | year= 2013 | volume= 6 | issue= 4 | pages= 301-3 | pmid=24339669 | doi=10.4103/0974-2700.120389 | pmc=3841543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24339669 }} </ref>
*Medical treatment include:
:*Stoppage of use the offending NSAID
:*Correction of anemia
:*Correction of dehydration and electrolyte derangements by giving intravenous fluids or oral rehydration therapy whenever it is feasible
:*Broad-spectrum antibiotic given as an adjunct therapy

=== Surgical Therapy ===
Surgical intervention may occasionally be required in NSAID-induced colitis. It is usually reserved for management of complications such as bowel perforation and stenosis. Surgical treatment include endoscopic dilatation, open dilatation or bowel resection. <ref name="pmid10882981">{{cite journal| author=Smith JA, Pineau BC| title=Endoscopic therapy of NSAID-induced colonic diaphragm disease: two cases and a review of published reports. | journal=Gastrointest Endosc | year= 2000 | volume= 52 | issue= 1 | pages= 120-5 | pmid=10882981 | doi=10.1067/mge.2000.105979 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10882981 }} </ref><ref name="pmid10385740">{{cite journal| author=Gopal DV, Katon RM| title=Endoscopic balloon dilation of multiple NSAID-induced colonic strictures: case report and review of literature on NSAID-related colopathy. | journal=Gastrointest Endosc | year= 1999 | volume= 50 | issue= 1 | pages= 120-3 | pmid=10385740 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10385740 }} </ref><ref name="pmid1234">{{cite journal| author=Lazaraki G, Chatzimavroudis G, Pilpilidis I, Paikos D, Soufleris K, Triantafillidis I, Gatopoulou A, Katsinelos P| title=Endoscopic Balloon Dilatation of NSAID-Induced Sigmoid Diaphragm-Stricture. | journal=Annals of Gastroenterology | year= 2007 | volume= 20 | issue= 2 | pages= 142-5 | pmid=1234 | doi= | pmc= | url=http://www.annalsgastro.gr/index.php/annalsgastro/article/view/574 }} </ref>

=== Prevention ===
*There are no established preventive measures available for NSAID-induced colitis.

==References==
{{Reflist|2}}

[[Category:Pick One of 28 Approved]]

{{WS}}
{{WH}}

Chemical colitis

2017-01-16T15:26:19Z

Qasim Salau: /* Differentiating chemical colitis from other Diseases */

__NOTOC__
{{SI}}
'''For the main page on colitis, please click [[Colitis|here]]''' 
'''For more information on allergic colitis, please click [[Allergic colitis|here]]''' 
'''For more information on infectious colitis, please click [[Infectious colitis|here]]''' 
'''For more information on ischemic colitis, please click [[Ischemic colitis|here]]''' 
'''For more information on drug-induced colitis, please click [[Drug-induced colitis|here]]''' 
'''For more information on radiation colitis, please click [[Radiation colitis|here]]''' 
'''For patient information on this topic, click [[Chemical colitis (patient information)|here]]'''

{{CMG}}; {{AE}} {{QS}}

{{SK}} Disinfectant colitis, Corrosive colitis, Iatrogenic colitis.

==Overview==
'''Chemical colitis''' is [[inflammation]] of the large intestine or [[colon (anatomy)|colon]], caused by the introduction of harsh chemicals to the colon by an [[enema]] or other anorectal procedures. Chemical colitis can resemble [[ulcerative colitis]], [[infectious colitis]] and [[pseudomembranous colitis]] endoscopically.

Prior to 1950, [[hydrogen peroxide]] enemas were commonly used for certain conditions. This practice will often result in chemical colitis.

Soap enemas may also cause chemical colitis. <ref>K. Harish, Severe colitis induced by soap enemas, Indian J. Gastroent., 2006 [http://www.indianjgastro.com/article.asp?issn=0254-8860;year=2006;volume=25;issue=2;spage=99;epage=100;aulast=K]</ref>
Harsh chemicals, such as compounds used to clean [[colonoscopy|colonoscopes]], are sometimes accidentally introduced into the colon during [[colonoscopy]] or other procedures. This can also lead to chemical colitis.

Chemical colitis may trigger a flare of [[ulcerative colitis]] or [[Crohn's disease]].

==Historical Perspective==
*The first description of chemical colitis was by Pinnock (1937), Murray (1937), and Gabriel (1937) when they reported deaths following use of soapsuds enemas.<ref name="pmid6053991">{{cite journal| author=Smith D| title=Severe anaphylactic reaction after a soap enema. | journal=Br Med J | year= 1967 | volume= 4 | issue= 5573 | pages= 215 | pmid=6053991 | doi= | pmc=1748582 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6053991 }} </ref>
*In 1945, Barker described acute colitis from soapsuds enema.<ref name="pmid20323382">{{cite journal| author=Barker CS| title=Acute Colitis Resulting from Soapsuds Enema. | journal=Can Med Assoc J | year= 1945 | volume= 52 | issue= 3 | pages= 285 | pmid=20323382 | doi= | pmc=1582117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20323382 }} </ref>
*In 1945, Bendit reported rectal gangrene following soap enema. Turrell further described that xray findings may be confusing following chemical colitis.<ref name="pmid6053991">{{cite journal| author=Smith D| title=Severe anaphylactic reaction after a soap enema. | journal=Br Med J | year= 1967 | volume= 4 | issue= 5573 | pages= 215 | pmid=6053991 | doi= | pmc=1748582 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6053991 }} </ref>
*Sheehan and Bryjolfsson in 1960, reported ulcerative colitis following self-administration of hydrogen peroxide enema.<ref name="pmid14445720">{{cite journal| author=SHEEHAN JF, BRYNJOLFSSON G| title=Ulcerative colitis following hydrogen peroxide enema: case report and experimental production with transient emphysema of colonic wall and gas embolism. | journal=Lab Invest | year= 1960 | volume= 9 | issue= | pages= 150-68 | pmid=14445720 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14445720 }} </ref>
*Since the earlier description, several cases of chemical colitis have been reported from glutaraldehyde or hydrogen peroxide used for cleansing endoscopes.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid27696496">{{cite journal| author=Zanelli M, Ragazzi M, De Marco L| title=Chemical gastritis and colitis related to hydrogen peroxide mouthwash. | journal=Br J Clin Pharmacol | year= 2016 | volume= | issue= | pages= | pmid=27696496 | doi=10.1111/bcp.13100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27696496 }} </ref><ref name="pmid21857533">{{cite journal| author=Love BL, Siddiqui S, McCallum BJ, Helman RM| title=Severe chemical colitis due to hydrogen peroxide enema. | journal=J Clin Gastroenterol | year= 2012 | volume= 46 | issue= 1 | pages= 87 | pmid=21857533 | doi=10.1097/MCG.0b013e31822a288d | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21857533 }} </ref>

==Classification==
There is no established classification system for chemical colitis. However, chemical colitis may be classified based on the mechanism or the causative chemical.

===Classification based on the mechanism===
Based on the mechanism, chemical colitis can be classified into:
*Accidental (most common) or non-accidental

===Classification based on the causative chemical===
Chemical colitis can be classified based on the causative chemical such as:<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref>
*Glutaraldehyde-induced chemical colitis
*Hydrogen peroxide-induced chemical colitis
*Soap-induced chemical colitis
*Radio-contrast (e.g Renografin-76) induced chemical colitis
*Alcohol-induced chemical colitis

==Pathophysiology==
===Pathogenesis===
Chemical colitis usually results from accidental or intentional rectal introduction of chemicals such as endoscopy cleaning solutions (glutaraldehyde and hydrogen peroxide), radiologic contrast material, hydrogen peroxide, soaps, formalin, hydrofluoric acid, alcohol, ammonia, lye, hot water, and herbal substances. Rarely it could occur following accidental ingestion of chemicals, such as accidental swallowing of hydrogen peroxide mouthwash during oral procedures.<ref name="pmid23208963">{{cite journal| author=Tortora A, Purchiaroni F, Scarpellini E, Ojetti V, Gabrielli M, Vitale G et al.| title=Colitides. | journal=Eur Rev Med Pharmacol Sci | year= 2012 | volume= 16 | issue= 13 | pages= 1795-805 | pmid=23208963 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23208963 }} </ref><ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid21873825">{{cite journal| author=Lim CH, Lee HY, Kim WC, Cho SH, Jeong HS, Jeon YJ et al.| title=[A case of chemical colitis caused by hydrogen peroxide enema]. | journal=Korean J Gastroenterol | year= 2011 | volume= 58 | issue= 2 | pages= 100-2 | pmid=21873825 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21873825 }} </ref><ref name="pmid7698592">{{cite journal| author=West AB, Kuan SF, Bennick M, Lagarde S| title=Glutaraldehyde colitis following endoscopy: clinical and pathological features and investigation of an outbreak. | journal=Gastroenterology | year= 1995 | volume= 108 | issue= 4 | pages= 1250-5 | pmid=7698592 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7698592 }} </ref><ref name="pmid22208542">{{cite journal| author=Shih HY, Wu DC, Huang WT, Chang YY, Yu FJ| title=Glutaraldehyde-induced colitis: case reports and literature review. | journal=Kaohsiung J Med Sci | year= 2011 | volume= 27 | issue= 12 | pages= 577-80 | pmid=22208542 | doi=10.1016/j.kjms.2011.06.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22208542 }} </ref><ref name="pmid27696496">{{cite journal| author=Zanelli M, Ragazzi M, De Marco L| title=Chemical gastritis and colitis related to hydrogen peroxide mouthwash. | journal=Br J Clin Pharmacol | year= 2016 | volume= | issue= | pages= | pmid=27696496 | doi=10.1111/bcp.13100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27696496 }} </ref>
*The most common implicated chemical agents in the pathogenesis of chemical colitis are glutaraldehyde and/or hydrogen peroxide disinfectants. The improper cleaning of the endoscopes allows the disinfectants to remain on the endoscopes, subsequently causing a chemical proctocolitis when the endoscopes are used.
*The main mechanism for developing chemical colitis is the direct contact of the chemical agent with the mucosa, subsequently causing corrosive injury to the mucosa and activation of the inflammatory pathway. Reactive oxygen formation, lipid peroxidation and vascular smooth muscle contraction also occur in hydrogen peroxide-induced chemical colitis.
*The primary mucosa toxin in glutaraldehyde is not fully known. However, it may be related to aldehyde. In addition to direct damage, glutaraldehyde is thought to activate arachidonic acid pathway and recruitment of inflammatory cells and substances. <ref name="pmid7698592">{{cite journal| author=West AB, Kuan SF, Bennick M, Lagarde S| title=Glutaraldehyde colitis following endoscopy: clinical and pathological features and investigation of an outbreak. | journal=Gastroenterology | year= 1995 | volume= 108 | issue= 4 | pages= 1250-5 | pmid=7698592 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7698592 }} </ref>
*The symptoms of chemical colitis typically develop within 48 hours, often less than 12 hours after introduction of the chemical, but may sometimes take days to weeks when frequent small dilute amount is ingested.<ref name="pmid27696496">{{cite journal| author=Zanelli M, Ragazzi M, De Marco L| title=Chemical gastritis and colitis related to hydrogen peroxide mouthwash. | journal=Br J Clin Pharmacol | year= 2016 | volume= | issue= | pages= | pmid=27696496 | doi=10.1111/bcp.13100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27696496 }} </ref>

===Genetics===
There are no identified genetic factors associated with chemical colitis.

===Gross Pathology===
Gross pathology findings in most cases shows predominant superficial mucosa involvement. The mucosa is erythematous, friable, edematous with areas of necrosis. Also, multiple shallow mucosal ulcers with fibrinous and/ or purulent exudate and hemorrhage are present. In addition, in hydrogen peroxide-induced colitis, gas may be seen in the colonic wall.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid20066605">{{cite journal| author=Kara M, Turan I, Polat Z, Dogru T, Bagci S| title=Chemical colitis caused by peracetic acid or hydrogen peroxide: a challenging dilemma. | journal=Endoscopy | year= 2010 | volume= 42 Suppl 2 | issue= | pages= E3-4 | pmid=20066605 | doi=10.1055/s-0029-1215260 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20066605 }} </ref><ref name="pmid19340747">{{cite journal| author=Morini S, Campo SM, Zullo A, Guarini A, Ridola L, Hassan C| title=Chemical colitis induced by peracetic acid: further evidence. | journal=Endoscopy | year= 2009 | volume= 41 | issue= 4 | pages= 383 | pmid=19340747 | doi=10.1055/s-0029-1214493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19340747 }} </ref>

===Microscopic Histopathology===
*Microscopy shows loss of superficial glands and epithelium, mucosa congestion, capillary hemorrhage and erosions and presence of polymorphonuclear inflammatory infiltrates in the crypts. Chronic inflammatory infiltrates (lymphoplasma cells) may also be seen in formalin-induced colitis. In hydrogen peroxide-induced colitis, the goblet cells in the mucosa appear as empty vacuoles, so-called “pseudolipomatosis". <ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid20066605">{{cite journal| author=Kara M, Turan I, Polat Z, Dogru T, Bagci S| title=Chemical colitis caused by peracetic acid or hydrogen peroxide: a challenging dilemma. | journal=Endoscopy | year= 2010 | volume= 42 Suppl 2 | issue= | pages= E3-4 | pmid=20066605 | doi=10.1055/s-0029-1215260 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20066605 }} </ref><ref name="pmid19340747">{{cite journal| author=Morini S, Campo SM, Zullo A, Guarini A, Ridola L, Hassan C| title=Chemical colitis induced by peracetic acid: further evidence. | journal=Endoscopy | year= 2009 | volume= 41 | issue= 4 | pages= 383 | pmid=19340747 | doi=10.1055/s-0029-1214493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19340747 }} </ref>
*Pseudomembranes composed of necrotic tissue and exudates may occasionally be seen lining the crypt.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref>

==Differentiating chemical colitis from other Diseases==
Chemical colitis must be differentiated from other causes of bloody diarrhea, especially acute causes and abdominal pain. Although the symptoms of chemical colitis may overlap with other causes of colitis, history of prior use of enema containing a known chemical agent shortly before onset of symptom will help in distinguishing the cause.

*The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|}

==Epidemiology and Demographics==
The overall prevalence and incidence of chemical colitis is not known.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref>

===Epidemiology===
The overall prevalence and incidence of chemical colitis are not known. Although, most reports of chemical colitis have been related to inadvertent residual contamination of endoscopes with the disinfectants glutaraldehyde and/ or hydrogen peroxide or following radio-contrast studies.

*The incidence of glutaraldehyde-induced colitis ranges from 0.1% to 4.7%.

===Demography===
====Age====
Patient of all age group can develop chemical colitis. However, the incidence of may be higher in elderly due to increased frequency of diagnostic and/ or therapeutic endoscopy in this age group.
====Gender====
The prevalence and incidence of chemical colitis does not vary by gender.

====Race====
There is no racial predilection to chemical colitis.

==Risk Factors==
The common risk factors for developing chemical colitis include:<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref>

*Bowel obstruction
*Population with high prevalence of use of enemas for treatment of constipation.
*Persons with mental health problems especially suicidal persons, munchausen disease setting and those with schizophrenia.

==Screening==
There are no established screening guidelines for chemical colitis<ref name=Screening-chemicalcolitis>US preventive service task force.chemical colitis. http://www.uspreventiveservicestaskforce.org/accessed on December 5, 2016</ref>

== Natural History, Complications and Prognosis==

===Natural History===
The symptoms and course of chemical colitis is highly variable. The severity and extent chemical colitis depend on the type of chemical agent, the concentration of the chemical agent, the quantity and duration of use the chemical agent. The symptoms often develop insidiously within 48 hours of the procedure and resolve following a period of bowel rest and symptomatic treatment.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid27696496">{{cite journal| author=Zanelli M, Ragazzi M, De Marco L| title=Chemical gastritis and colitis related to hydrogen peroxide mouthwash. | journal=Br J Clin Pharmacol | year= 2016 | volume= | issue= | pages= | pmid=27696496 | doi=10.1111/bcp.13100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27696496 }} </ref><ref name="pmid21857533">{{cite journal| author=Love BL, Siddiqui S, McCallum BJ, Helman RM| title=Severe chemical colitis due to hydrogen peroxide enema. | journal=J Clin Gastroenterol | year= 2012 | volume= 46 | issue= 1 | pages= 87 | pmid=21857533 | doi=10.1097/MCG.0b013e31822a288d | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21857533 }} </ref>
===Complications===
Complications of chemical colitis include<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid27696496">{{cite journal| author=Zanelli M, Ragazzi M, De Marco L| title=Chemical gastritis and colitis related to hydrogen peroxide mouthwash. | journal=Br J Clin Pharmacol | year= 2016 | volume= | issue= | pages= | pmid=27696496 | doi=10.1111/bcp.13100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27696496 }} </ref><ref name="pmid21857533">{{cite journal| author=Love BL, Siddiqui S, McCallum BJ, Helman RM| title=Severe chemical colitis due to hydrogen peroxide enema. | journal=J Clin Gastroenterol | year= 2012 | volume= 46 | issue= 1 | pages= 87 | pmid=21857533 | doi=10.1097/MCG.0b013e31822a288d | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21857533 }} </ref><ref name="pmid861870">{{cite journal| author=Pietsch JB, Shizgal HM, Meakins JL| title=Injury by hypertonic phosphate enema. | journal=Can Med Assoc J | year= 1977 | volume= 116 | issue= 10 | pages= 1169-70 | pmid=861870 | doi= | pmc=1879475 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=861870 }} </ref>
*Perforation
*Peritonitis
*Fecal incontinence following loss of rectal function
*Stricture
*Gangrene of the colon
*Fistula
*Anemia

===Prognosis===
The prognosis of chemical colitis varies with the type of chemical. However, prognosis is generally good with resolution of symptoms following treatment. <ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref>

== Diagnosis ==
===Diagnostic Criteria===
There is no definitive diagnostic criteria for chemical colitis. Diagnosis of chemical colitis is primarily clinical, based on detailed history, physical examination and endoscopic findings.

=== History and Symptoms ===
Obtaining a complete history including any anorectal procedure done and recent use of enemas is important in making a diagnosis of chemical colitis. Symptoms of chemical colitis are not specific, and the severity depends on the type of chemical. Therefore, diagnosis of chemical colitis should be suspected in any individual who presents acutely (typically within 12 hours) with intestinal symptoms and has a prior history of endoscopy and/ or administration of enema. Common symptoms of chemical colitis include.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid27696496">{{cite journal| author=Zanelli M, Ragazzi M, De Marco L| title=Chemical gastritis and colitis related to hydrogen peroxide mouthwash. | journal=Br J Clin Pharmacol | year= 2016 | volume= | issue= | pages= | pmid=27696496 | doi=10.1111/bcp.13100 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27696496 }} </ref><ref name="pmid21857533">{{cite journal| author=Love BL, Siddiqui S, McCallum BJ, Helman RM| title=Severe chemical colitis due to hydrogen peroxide enema. | journal=J Clin Gastroenterol | year= 2012 | volume= 46 | issue= 1 | pages= 87 | pmid=21857533 | doi=10.1097/MCG.0b013e31822a288d | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21857533 }} </ref><ref name="pmid21873825">{{cite journal| author=Lim CH, Lee HY, Kim WC, Cho SH, Jeong HS, Jeon YJ et al.| title=[A case of chemical colitis caused by hydrogen peroxide enema]. | journal=Korean J Gastroenterol | year= 2011 | volume= 58 | issue= 2 | pages= 100-2 | pmid=21873825 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21873825 }} </ref><ref name="pmid21365964">{{cite journal| author=Desai Y, Orledge J| title=Chemical colitis from a hydrogen peroxide enema. | journal=J Miss State Med Assoc | year= 2010 | volume= 51 | issue= 11 | pages= 314-6 | pmid=21365964 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21365964 }} </ref>
*Sudden onset of [[Abdominal pain]] which is colicky
*Anorectal pain
*[[Diarrhea]]
*Rectal bleeding
*Fecal incontinence
*[[Tenesmus]]
*Mucus discharge
*[[Vomiting]]

=== Physical Examination ===
Physical examination findings in patients with chemical colitis may reveal:<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref>
*[[Abdominal tenderness]] which may be more prominent in lower abdominal quadrants due to involvement of the distal sigmoid colon and/ or rectum
*Signs of [[dehydration]] such as lethargy, [[Tachycardia]] and [[Hypotension]]
*[[Fever]] due to dehydration or in individuals who have developed sepsis
*[[Pallor]]
*Toxic appearance in those with bowel perforation and sepsis

=== Laboratory Findings ===
There are no specific laboratory findings associated with chemical colitis. Initial investigations should include hematological, biochemistry profiles and stool examination.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref>
====Hematology====
*[[Anemia]]
*[[Leukocytosis]] with [[left shift]] may be seen with sepsis (most common), but [[leukopenia]] can be seen.

====Electolytes====
*[[Hyponatremia]]

====Stool Examination====
Stool analysis may show
*[[Fecal blood]]
*[[Fecal leukocytes]]
*Stool culture is negative.

===Endoscopy===
Endoscopy is required for confirmation of chemical colitis. Endoscopic features of chemical colitis include.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid11308232">{{cite journal| author=Stein BL, Lamoureux E, Miller M, Vasilevsky CA, Julien L, Gordon PH| title=Glutaraldehyde-induced colitis. | journal=Can J Surg | year= 2001 | volume= 44 | issue= 2 | pages= 113-6 | pmid=11308232 | doi= | pmc=3695104 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11308232 }} </ref><ref name="pmid2792676">{{cite journal| author=Bilotta JJ, Waye JD| title=Hydrogen peroxide enteritis: the "snow white" sign. | journal=Gastrointest Endosc | year= 1989 | volume= 35 | issue= 5 | pages= 428-30 | pmid=2792676 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2792676 }} </ref>
*Friable, hyperemic, edematous mucosa with/ or without ulcers of varying degree and patchy necrotic areas.
*White plaques may be seen in glutaraldehyde and hydrogen peroxide chemical colitis.
*Pseudomembranes may also be seen.
*Blanching of the mucosa can also be seen on flushing the with hydrogen peroxide (snow white sign).

=== Other Diagnostic Studies ===
Other diagnostic test include

====CT scan====
Abdominal CT scan may show characteristic homogenous thickened colonic wall (target sign) in glutaraldehyde-induced chemical colitis<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref>

====Xray====
There is no specific Xray feature of chemical colitis. However, it may help to rule out complications such as intestinal obstruction and perforation.

== Treatment ==
Majority of patients with chemical colitis can be managed medically.<ref name="pmid18209577">{{cite journal| author=Sheibani S, Gerson LB| title=Chemical colitis. | journal=J Clin Gastroenterol | year= 2008 | volume= 42 | issue= 2 | pages= 115-21 | pmid=18209577 | doi=10.1097/MCG.0b013e318151470e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18209577 }} </ref><ref name="pmid11308232">{{cite journal| author=Stein BL, Lamoureux E, Miller M, Vasilevsky CA, Julien L, Gordon PH| title=Glutaraldehyde-induced colitis. | journal=Can J Surg | year= 2001 | volume= 44 | issue= 2 | pages= 113-6 | pmid=11308232 | doi= | pmc=3695104 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11308232 }} </ref>
=== Medical Therapy ===
Medical treatment involves
*Stopping further exposure to the offending chemical
*Resting the bowel
*Correction of dehydration and electrolyte derangements by giving intravenous fluids or oral rehydration therapy whenever it is feasible
*Broad-spectrum antibiotic is given as an adjunct therapy
*Steroid therapy may be be needed, especially when severe

=== Surgical Therapy ===
Surgical intervention may occasionally be required in chemical colitis. It is usually reserved for management of complications such as bowel perforation and stenosis.

==Prevention==

===Primary prevention===
There is presently no established method of prevention for chemical colitis. However, endoscopy probes should be properly rinsed after cleansing with disinfectant to avoid inadvertent exposure that may cause chemical colitis.

===Secondary prevention===
There are no secondary prevention methods for chemical colitis.

==References==
{{Reflist|2}}

[[Category:Primary care]]
[[Category:Gastroenterology]]
[[Category:Inflammations]]

{{WS}}
{{WH}}

Infectious colitis differential diagnosis

2017-01-16T15:25:42Z

Qasim Salau: /* Differentiating Infectious colitis from other Diseases */

__NOTOC__
{{Infectious colitis}}
{{CMG}}; {{AE}}{{QS}}
==Overview==
Symptoms and signs of infectious colitis are seen in other causes of colitis and some systemic diseases. Infectious colitis must be differentiated from other diseases that cause [[fever]], [[bloody diarrhea]], [[dehydration]], [[tachycardia]] and [[low blood pressure]]. Therefore, detailed history, physical examination and laboratory tests are needed to make the diagnosis. In addition, endoscopy with biopsy may be required to confirm the diagnosis. In infants and young children, infectious colitis must be differentiated from allergic colitis, necrotizing enterocolitis, intussusception, volvolus and early onset inflammatory bowel disease. In adolescents and adults, infectious colitis must be differentiated from inflammatory bowel disease and colorectal malignancy.<ref name="pmid27080713">{{cite journal| author=Palle SK, Prasad M, Kugathasan S| title=Approach to a Child with Colitis. | journal=Indian J Pediatr | year= 2016 | volume= | issue= | pages= | pmid=27080713 | doi=10.1007/s12098-016-2091-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27080713 }} </ref><ref name="pmid22080825">{{cite journal| author=DuPont HL| title=Approach to the patient with infectious colitis. | journal=Curr Opin Gastroenterol | year= 2012 | volume= 28 | issue= 1 | pages= 39-46 | pmid=22080825 | doi=10.1097/MOG.0b013e32834d3208 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22080825 }} </ref>

==Differentiating Infectious colitis from other Diseases==
The differential diagnosis of Infectious colitis can be classified into two according to age group.
===Differential diagnosis in Infants/ young children===
*Allergic colitis
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Intussusception]]
*[[Hirschsprung disease]] complicated by enterocolitis
*[[Volvolus]]
*Inflammatory bowel disease early onset)

===Differential diagnosis in adolescent/ adult===
*Inflammatory bowel disease
*Diverticulosis
*Allergic colitis
*[[Henoch-Schonlein purpura]]
*Systemic lupus erythematosus(SLE)
*Colorectal malignancy
*Behcet's disease

*The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|}

==References==
{{Reflist|2}}
{{WS}}{{WH}}

Allergic colitis differential diagnosis

2017-01-16T15:24:43Z

Qasim Salau: /* Differentiating Allergic colitis from other Diseases */

__NOTOC__
{{Allergic colitis}}
{{CMG}}; {{AE}}{{QS}}
==Overview==
Symptoms and signs of allergic colitis are non-specific and seen in other causes of colitis and some systemic diseases. Detailed history and physical examination is needed to make the diagnosis. In addition, endoscopy with biopsy may be required to confirm the diagnosis. In infancy, allergic colitis must particularly be differentiated from necrotizing enterocolitis, infectious colitis, anal fissure, intussusception and volvolus. In adolescent and adults, allergic colitis must be differentiated from inflammatory bowel disease, infectious colitis, and colorectal malignancy.<ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref><ref name="pmid10634300">{{cite journal| author=Lake AM| title=Food-induced eosinophilic proctocolitis. | journal=J Pediatr Gastroenterol Nutr | year= 2000 | volume= 30 Suppl | issue= | pages= S58-60 | pmid=10634300 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10634300 }} </ref>

==Differentiating Allergic colitis from other Diseases==
The differential diagnosis of allergic colitis can be classified into two according to age group.
===Differential diagnosis in Infants===
*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K deficiency hemorrhage]]
*Other Coagulopathies (hereditary such as coagulation factor deficiency or acquired such as [[Liver disease]] with clotting factor deficiency)
*[[Intussusception]]
*Infectious colitis
*[[Hirschsprung disease]] complicated by enterocolitis
*[[Volvolus]]
*Inflammatory bowel disease(early onset)
*[[Meckel diverticulum]]
*Dermatitis
*Gastrointestinal duplication cyst
*Vascular malformations
*Gastro-duodenal ulcers
*Lymphonodular hyperplasia

===Differential diagnosis in adolescent/ adult===
*Inflammatory bowel disease
*Behcet's disease
*Arteriovenous malformation
*Diverticulosis
*Infectious colitis
*Coagulopathy
*[[Henoch-Schonlein purpura]]
*Systemic lupus erythematosus(SLE)
*Colorectal malignancy

*The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|}

==References==
{{Reflist|2}}

[[Category:Gastroenterology]]
[[Category:InfectiousDisease]]
[[Category:PrimaryCare]]

{{WS}}{{WH}}

Colitis

2017-01-16T15:22:39Z

Qasim Salau: /* Differentiating between different forms of colitis */

__NOTOC__
{{SI}}
'''For more information on allergic colitis, please click [[Allergic colitis|here]]''' 
'''For more information on infectious colitis, please click [[Infectious colitis|here]]''' 
'''For more information on ischemic colitis, please click [[Ischemic colitis|here]]''' 
'''For more information on chemical colitis, please click [[Chemical colitis|here]]''' 
'''For more information on drug-induced colitis, please click [[Drug-induced colitis|here]]''' 
'''For more information on radiation colitis, please click [[Radiation colitis|here]]''' 
'''For patient information on this topic, click [[Colitis (patient information)|here]]'''

{{CMG}}; {{AE}} {{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}}

{{SK}} Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either acute or chronic. Causes of colitis include infectious causes such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food potein-induced proctocolitis) and radiation. Colitis may co-exist with enteritis (inflammation of the small bowel), proctitis (inflammation of the rectum) or both. The mainstay of therapy for infectious proctocolitis is [[antimicrobial]] therapy. The preferred regimen is a combination of [[Ceftriaxone]] and [[Doxycycline]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align=center |'''Classes of Colitis''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Disorders'''
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Autoimmune''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Allergic''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''[[Infectious colitis]]''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* [[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
* Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
* Protozoan (''[[Entamoeba histolytica]]'')
* [[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''[[Idiopathic]]'''||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* [[Lymphocytic colitis]]
* [[Collagenous colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Iatrogenic''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* [[Diversion colitis]]
* [[Chemical colitis]]
* [[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Vascular''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* [[Ischemic colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Drug induced''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
*[[NSAID-induced colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Unclassifiable''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
* Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with inflammation involving other parts of the gastrointestinal tract. It can be classified based on anatomy into;
*Proctitis: When it involves the rectum
*Colitis: When it involves the inflammation is limited to the colon
*Proctocolitis: When it involves the rectum and colon (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref> 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*Enterocolitis: When it involves the small intestine in addition to the colon

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas:<ref name="gitractcolitis"> WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===
*Infantile: More common in early infancy (first six months).<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*Adults

===Classification by duration of symptoms===
*Acute: Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*Chronic: Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

Notes:
* Fulminant colitis is any colitis with a rapid downhill clinical course; in addition to the [[diarrhea]], [[fever]], and [[anemia]] seen in colitis, the patient has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present.
* [[Irritable bowel syndrome]], a separate disease, has been called spastic colitis or spastic colon. This name causes confusion, since colitis is not a feature of irritable bowel syndrome.
* Immune mediated colitis is the experimental name in animal studies of ulcerative colitis. It is a synonym of ulcerative colitis, but it should not be used as a synonym when referring to ulcerative colitis.

==Pathophysiology==

The pathophysiology of colitis depends on the cause. Some pathogenetic mechanisms are not clearly understood.

===Genetics===
There is no specific genetic cause for proctocolitis. However, genetic predisposition may play a role in some causes.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue= | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355 }} </ref><ref name="pmid26579126">{{cite journal| author=Loddo I, Romano C| title=Inflammatory Bowel Disease: Genetics, Epigenetics, and Pathogenesis. | journal=Front Immunol | year= 2015 | volume= 6 | issue= | pages= 551 | pmid=26579126 | doi=10.3389/fimmu.2015.00551 | pmc=4629465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26579126 }} </ref>

===Gross pathology===
<gallery>
Image:Allergic proctocolitis.jpg| Allergic proctocolitis<ref name=AP> The Korean Academy of Medical Sciences. Allergic proctocolitis. http://dx.doi.org/10.3346/jkms.2007.22.2.213 Accessed on 31 August, 2016</ref>
Image:Radiation proctitis3.jpg|Radiation Proctitis<ref name=Proctocolitis> Wikipedia. Proctitis. https://en.wikipedia.org/wiki/Proctitis#/media/File:Radiation_proctitis3.jpg Accessed on August 31, 2016 </ref>
Image:Pseudomembranous_colitis.JPG | Pseudomembranous colitis. (WC) <ref name=Pseudomembranous-Proctocolitis> Libre Pathology. Pseudomembranous colitis. https://librepathology.org/wiki/Pseudomembranous_colitis Accessed on August 31, 2016 </ref>
Image:800px-Pseudomembranous Colitis, Colectomy (Gross) (7410584264).jpg| Pseudomembranous colitis. <ref name=pseudomembranous-colitis> Libre Pathology. Pseudomembranous colitis. https://librepathology.org Accessed on September 1, 2016 </ref>
Image:UC granularity.png| Ulcerative colitis.<ref name=ulcerative_colitis> Ulcerative colitis. Wikidoc. http://www.wikidoc.org/index.php/File:UC_granularity.png#filehistory Accessed on August 31, 2016 </ref>
</gallery>

===Microscopic pathology===
<gallery>
Image: Ulcerative colitis (2) active.jpg | Ulcerative colitis. H&E staining showing crypt abscess, a characteristic finding in ulcerative colitis <ref name=ulcerativecolitis1> Libre Pathology. https://librepathology.org/wiki/File:Ulcerative_colitis_(2)_active.jpg Accessed on September 1, 2016 </ref>
Image: Ulcerative colitis (2) endoscopic biopsy.jpg| Ulcerative colitis. H&E stain showing marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and distortion of the architecture of the crypts. <ref name=ulcerativecolitis2> Libre Pathology. https://librepathology.org/wiki/File:Ulcerative_colitis_(2)_endoscopic_biopsy.jpg Accessed on September 1, 2016 </ref>
</gallery>

<gallery>
Image:Ischemic colitis.JPG| Ischemic colitis. H&E staining showing changes seen in ischemic colitis <ref name=Ischemic-Proctocolitis> Wikipedia. Ischemic colitis. https://en.wikipedia.org/wiki/Ischemic_colitis#/media/File:Ischemic_colitis_-_high_mag.jpg Accessed on August 31, 2016 </ref>
Image:1440px-Colonic pseudomembranes low mag.jpg| Pseudomembranous colitis. H& E staining showing pseudomembranes in Clostridium colitis <ref name=pc> Libre Pathology. Pseudomembranous colitis. https://librepathology.org/wiki/File:Colonic_pseudomembranes_low_mag.jpg Accessed on September 1, 2016 </ref>
</gallery>

==Differentiating Colitis from Other Diseases==
Causes of colitis are diverse and may overlap with other disease. The differential diagnosis of colitis can be classified into two according to age group.
===Differential diagnosis in Infants===
*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*Other Coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as disseminated intravascular coagulopathy)
*Food protein-induced enterocolitis
*[[Intussusception]]
*Gastrointestinal Infections
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]
*Vascular malformations
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by enterocolitis
*[[Volvolus]]
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*[[Liver disease]] with clotting factor deficiency
*Lymphonodular hyperplasia

===Differential diagnosis in Infants===
*Colorectal malignancy
*Crohn's disease
*Behcet's disease
*Arteriovenous malformation
*Diverticuclosis
*Infection
*Coagulopathy
*Systemic lupus erythematosus(SLE)

==Differentiating between different forms of colitis==
*The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426 }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |+++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
|style="background: #F5F5F5; padding: 5px;" |
|}

==Causes==
===Common Causes===
Common causes of Proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes [[Lymphogranuloma Venereum|LGV (Lymphogranuloma Venereum)]], ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (for example food protein-induced proctocolitis), idiopathic (for example [[microscopic colitis]]), vascular (for example [[ischemic colitis]]), or autoimmune (for example [[inflammatory bowel disease]]).

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[EVAR]], [[vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"|[[Dental braces]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Ankylosing Spondylitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Autistic enterocolitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Multiple organ dysfunction syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|[[Multiple organ dysfunction syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include toxic megacolon, ischemic colitis, infectious colitis such as [[escherichia coli O157:H7]] and [[shigella]].

==Diagnosis==
===Symptoms===
* [[Diarrhea]]
* [[Abdominal pain]]
* [[Rectal bleeding]]

===Physical Examination===
* [[Abdominal tenderness]]
* [[Fever]]
* [[Hypotension]]
* [[Tachycardia]]

===Diagnostic Tests===
Colitis is associated with the following findings:
* Swelling of the colon tissue
* [[Bleeding]]
* [[Erythema]] (redness) of the surface of the colon
* [[Ulcer]]ations of the colon

Common tests which reveal these signs include:
* [[X-ray]]s of the colon
* Testing the stool for blood and pus
* [[Sigmoidoscopy]]
* [[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbations of colitis.

==Treatment==
===Medical Therapy===
Treatment of colitis depends on the cause of colitis. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[Mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation.

Changes in diet can be effective at treating the symptoms of colitis and easing the side effects. These can include reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]]. This approach has been championed by [[Elaine Gottschall]].

Hygienic and naturopathic doctors have taken the diet approach further, attributing bowel inflammation to toxemia stemming from high-protein, fatty diets and other dietary irritants. Changing to a low-fat, minimally-processed, whole-foods diet per the Natural Hygiene self-healing system has been effective in eliminating symptoms and rebuilding health. Dr. Zarin Azar, MD,, is one advocate of this healing system.

Supportive treatment include correction of dehydration and anemia.

::Example of empirical antibiotic regimen in colitis is [[Ceftriaxone]] 250 mg IM {{and}} [[Doxycycline]] 100 mg PO bid for 7 days

[[Infliximab]] (or REMICADE) - a drug originally produced to treat Rheumatoid Arthritis - has recently been approved for the treatment of Colitis where traditional treatments have failed. REMICADE is a biologic therapy that recognizes, attaches to, and blocks the action of a protein in your body called tumor necrosis factor alpha (TNF-alpha). TNF-alpha is made by certain blood cells in your body. It is administered through a series of infusions.

To view additional treatment and special considerations for the management of proctitis/proctocolitis, click [[proctitis medical therapy|'''here''']].

===Surgery===
Surgery in colitis is often done for complications. It may entail dilatation of strictures, removal of the affected part of the colon and creating a "pouch" with portions of the small intestine.

==See also==
* [[Colitis]]
* [[Proctitis]]

==References==
{{reflist|2}}

==References==
{{Reflist|2}}

[[Category:Inflammations]]
[[Category:Gastroenterology]]
[[Category:Disease]]
[[Category:Crowdiagnosis]]

{{WH}}
{{WS}}
{{jb1}}

2017-01-09T20:54:45Z

Qasim Salau: /* Differentiating {{PAGENAME}} from Other Diseases */

__NOTOC__
{{SI}}
'''For more information on allergic colitis, please click [[Allergic colitis|here]]''' 
'''For more information on infectious colitis, please click [[Infectious colitis|here]]''' 
'''For more information on ischemic colitis, please click [[Ischemic colitis|here]]''' 
'''For more information on chemical colitis, please click [[Chemical colitis|here]]''' 
'''For more information on drug-induced colitis, please click [[Drug-induced colitis|here]]''' 
'''For more information on radiation colitis, please click [[Radiation colitis|here]]''' 
'''For patient information on this topic, click [[Colitis (patient information)|here]]'''

{{CMG}}; {{AE}} {{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}}

{{SK}} Proctocolitis, Proctitis, Enterocolitis.

==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either acute or chronic. Causes of colitis include infectious causes such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food potein-induced proctocolitis) and radiation. Colitis may co-exist with enteritis (inflammation of the small bowel), proctitis (inflammation of the rectum) or both. The mainstay of therapy for infectious proctocolitis is [[antimicrobial]] therapy. The preferred regimen is a combination of [[Ceftriaxone]] and [[Doxycycline]].

==Classification==
There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.
===Classification by etiology===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align=center |'''Classes of Colitis''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Disorders'''
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Autoimmune''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Allergic''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''[[Infectious colitis]]''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* [[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
* Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
* Protozoan (''[[Entamoeba histolytica]]'')
* [[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''[[Idiopathic]]'''||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* [[Lymphocytic colitis]]
* [[Collagenous colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Iatrogenic''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* [[Diversion colitis]]
* [[Chemical colitis]]
* [[Radiation colitis]]
*[[NSAID-induced colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Vascular''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* [[Ischemic colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Drug induced''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
*[[NSAID-induced colitis]]
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Unclassifiable''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
* Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
* Atypical colitis
|}

===Classification by Anatomy===
Colitis may co-exist with inflammation involving other parts of the gastrointestinal tract. It can be classified based on anatomy into;
*Proctitis: When it involves the rectum
*Colitis: When it involves the inflammation is limited to the colon
*Proctocolitis: When it involves the rectum and colon (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref> 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092 }} </ref>
*Enterocolitis: When it involves the small intestine in addition to the colon

====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas:<ref name="gitractcolitis"> WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>''' *'''Regions 4 to 6:''' Enterocolitis *'''Region 6: '''Colitis *'''Regions 6 to 8:''' Proctocolitis *'''Regions 7 to 8:'''Proctitis]]</div>

===Classification by Age===
*Infantile: More common in early infancy (first six months).<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref>
*Adults

===Classification by duration of symptoms===
*Acute: Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
*Chronic: Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>

Notes:
* Fulminant colitis is any colitis with a rapid downhill clinical course; in addition to the [[diarrhea]], [[fever]], and [[anemia]] seen in colitis, the patient has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present.
* [[Irritable bowel syndrome]], a separate disease, has been called spastic colitis or spastic colon. This name causes confusion, since colitis is not a feature of irritable bowel syndrome.
* Immune mediated colitis is the experimental name in animal studies of ulcerative colitis. It is a synonym of ulcerative colitis, but it should not be used as a synonym when referring to ulcerative colitis.

==Pathophysiology==

The pathophysiology of colitis depends on the cause. Some pathogenetic mechanisms are not clearly understood.

===Genetics===
There is no specific genetic cause for proctocolitis. However, genetic predisposition may play a role in some causes.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue= | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355 }} </ref><ref name="pmid26579126">{{cite journal| author=Loddo I, Romano C| title=Inflammatory Bowel Disease: Genetics, Epigenetics, and Pathogenesis. | journal=Front Immunol | year= 2015 | volume= 6 | issue= | pages= 551 | pmid=26579126 | doi=10.3389/fimmu.2015.00551 | pmc=4629465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26579126 }} </ref>

===Gross pathology===
<gallery>
Image:Allergic proctocolitis.jpg| Allergic proctocolitis<ref name=AP> The Korean Academy of Medical Sciences. Allergic proctocolitis. http://dx.doi.org/10.3346/jkms.2007.22.2.213 Accessed on 31 August, 2016</ref>
Image:Radiation proctitis3.jpg|Radiation Proctitis<ref name=Proctocolitis> Wikipedia. Proctitis. https://en.wikipedia.org/wiki/Proctitis#/media/File:Radiation_proctitis3.jpg Accessed on August 31, 2016 </ref>
Image:Pseudomembranous_colitis.JPG | Pseudomembranous colitis. (WC) <ref name=Pseudomembranous-Proctocolitis> Libre Pathology. Pseudomembranous colitis. https://librepathology.org/wiki/Pseudomembranous_colitis Accessed on August 31, 2016 </ref>
Image:800px-Pseudomembranous Colitis, Colectomy (Gross) (7410584264).jpg| Pseudomembranous colitis. <ref name=pseudomembranous-colitis> Libre Pathology. Pseudomembranous colitis. https://librepathology.org Accessed on September 1, 2016 </ref>
Image:UC granularity.png| Ulcerative colitis.<ref name=ulcerative_colitis> Ulcerative colitis. Wikidoc. http://www.wikidoc.org/index.php/File:UC_granularity.png#filehistory Accessed on August 31, 2016 </ref>
</gallery>

===Microscopic pathology===
<gallery>
Image: Ulcerative colitis (2) active.jpg | Ulcerative colitis. H&E staining showing crypt abscess, a characteristic finding in ulcerative colitis <ref name=ulcerativecolitis1> Libre Pathology. https://librepathology.org/wiki/File:Ulcerative_colitis_(2)_active.jpg Accessed on September 1, 2016 </ref>
Image: Ulcerative colitis (2) endoscopic biopsy.jpg| Ulcerative colitis. H&E stain showing marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and distortion of the architecture of the crypts. <ref name=ulcerativecolitis2> Libre Pathology. https://librepathology.org/wiki/File:Ulcerative_colitis_(2)_endoscopic_biopsy.jpg Accessed on September 1, 2016 </ref>
</gallery>

<gallery>
Image:Ischemic colitis.JPG| Ischemic colitis. H&E staining showing changes seen in ischemic colitis <ref name=Ischemic-Proctocolitis> Wikipedia. Ischemic colitis. https://en.wikipedia.org/wiki/Ischemic_colitis#/media/File:Ischemic_colitis_-_high_mag.jpg Accessed on August 31, 2016 </ref>
Image:1440px-Colonic pseudomembranes low mag.jpg| Pseudomembranous colitis. H& E staining showing pseudomembranes in Clostridium colitis <ref name=pc> Libre Pathology. Pseudomembranous colitis. https://librepathology.org/wiki/File:Colonic_pseudomembranes_low_mag.jpg Accessed on September 1, 2016 </ref>
</gallery>

==Causes==
===Common Causes===
Common causes of Proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes [[Lymphogranuloma Venereum|LGV (Lymphogranuloma Venereum)]], ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (for example food protein-induced proctocolitis), idiopathic (for example [[microscopic colitis]]), vascular (for example [[ischemic colitis]]), or autoimmune (for example [[inflammatory bowel disease]]).

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[EVAR]], [[vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"|[[Dental braces]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Ankylosing Spondylitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Autistic enterocolitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Multiple organ dysfunction syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|[[Multiple organ dysfunction syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| Microscopic colitis
|-
|}

===Causes in Alphabetical Order===
{{columns-list|3|
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565 }} </ref>
*[[Alosetron ]]
*[[Alpha 1-antitrypsin deficiency]]
*[[Ampicillin Oral]]
*[[Ankylosing spondylitis]]
*[[Auranofin]]
*[[Autistic enterocolitis]]
*[[Azithromycin]]
*[[Aztreonam Injection]]
*[[Bacillary dysentery]]
*[[Bacterial gastroenteritis]]
*[[Balantidium coli]]
*[[Behcet disease]]
*[[Campylobacter jejuni]]
*[[polyp|Cap polyposis]]
*[[Cefaclor]]
*[[Cefadroxil]]
*[[Cefamandole Nafate Injection]]
*[[Cefazolin Sodium Injection]]
*[[Cefepime]]
*[[Cefepime Injection]]
*[[Cefoperazone Sodium Injection]]
*[[Cefotaxime Sodium Injection ]]
*[[Cefotetan Disodium Injection ]]
*[[Cefoxitin Sodium Injection]]
*[[Cefpodoxime]]
*[[Ceftazidime]]
*[[Ceftazidime Injection]]
*[[Ceftizoxime Sodium Injection]]
*[[Ceftriaxone Sodium Injection]]
*[[Cefuroxime Sodium Injection]]
*[[Cephalexin]]
*[[Cephalosporin]]
*[[Cephradine Oral]]
*[[Chemical colitis]]
*[[Chlamydia trachomatis]]
*[[Cidofovir]]
*[[Cilansetron]]
*[[Clindamycin]]
*[[Clostridium difficile]] <ref name="pmid25073304">{{cite journal| author=Gié O, Clerc D, Giulieri S, Demartines N| title=[Clostridial colitis: diagnosis and strategies for management]. | journal=Rev Med Suisse | year= 2014 | volume= 10 | issue= 434 | pages= 1309-13 | pmid=25073304 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25073304 }} </ref>
*[[Co-amoxiclav]]
*[[Colitis ulcerosa]]
*[[Collagenous colitis]]
*[[Colonic ischemia]]
*[[Common variable immunodeficiency]]
*[[Corticosteroid]]
*[[Crohn's disease]]
*[[Cryptosporidiosis]]
*[[Cytomegalovirus]]
*[[Darifenacin ]]
*[[Dental braces]]
*[[Desogestrel and Ethinyl Estradiol]]
*[[Dicloxacillin ]]
*[[Dirithromycin]]
*[[Diversion colitis]]
*[[Diverticulosis]]
*[[Enoxacin ]]
*[[Entamoeba histolytica]]
*[[Ertapenem]]
*[[Erythromycin and Sulfisoxazole]]
*[[Escherichia coli O157:H7]]
*[[EVAR]]
*[[Flucytosine]]
*[[Gerson diet]]
*[[Giardiasis]]
*[[Glycopyrrolate]]
*[[Hyoscyamine]]
*[[Idelalisib]]
*[[Imipenem and Cilastatin Sodium Injection]]
*[[Infectious colitis]]
*[[Inflammatory bowel disease]]
*[[Intestinal ischemia]]
*[[Ipilimumab]]
*[[Irritable bowel syndrome]]
*[[Ischemic colitis]]
*[[Isosporiasis]]
*[[Ixabepilone]]
*[[Lanthanum ]]
*[[Levofloxacin Oral]]
*[[Lincomycin hydrochloride]]
*[[Linezolid]]
*[[Lomefloxacin]]
*[[Loracarbef]]
*[[Lymphocytic colitis]]
*[[Lysinuric protein intolerance]]
*[[Methotrexate]]
*[[Miconazole Injection]]
*[[Microscopic colitis]]
*[[Milk allergy]]
*[[Moxifloxacin]]
*[[Multiple organ dysfunction syndrome]]
*[[Nafcillin Sodium Injection]]
*[[Neisseria gonorrhoeae]]
*[[Neonatal necrotizing enterocolitis]]
*[[Nivolumab]]
*[[Norfloxacin]]
*[[Ofloxacin injection]]
*[[Oxacillin Sodium Injection]]
*[[Oxcarbazepine]]
*[[Oxybutynin]]
*[[Peginterferon alfa-2a]]
*[[Penicillin]]
*[[Pergolide]]
*[[Pigbel]]
*[[Piperacillin sodium injection]]
*[[Pramipexole]]
*[[Prednisolone]]
*[[Primary sclerosing cholangitis]]
*[[Procyclidine]]
*[[Propantheline]]
*[[Protein losing enteropathy]]
*[[Pseudoephedrine]]
*[[Pseudomembranous colitis]]
*[[Quinolone]]
*[[Radiation colitis]]
*[[Radiation proctitis]]
*[[Ramosetron]]
*[[Reserpine]]
*[[Salmonella]]
*[[Schistosoma]]
*[[Scleroderma]]
*[[Sepsis]]
*[[Shigella]]
*[[Solifenacin]]
*[[Solitary rectal ulcer syndrome]]
*[[Soy protein]]
*[[Sparfloxacin]]
*[[Strongyloides stercoralis]]
*[[Syphilis]]
*[[Tegaserod]]
*[[Toxic megacolon]]
*[[Treponema pallidum]]
*[[Typhlitis]]
*[[Ulcerative colitis]]
*[[Vasculitis]]
*[[Yersinia enterocolitica]]
}}

===Life Threatening Causes===
Example include toxic megacolon, ischemic colitis, infectious colitis such as [[escherichia coli O157:H7]] and [[shigella]].

==Diagnosis==
===Symptoms===
* [[Diarrhea]]
* [[Abdominal pain]]
* [[Rectal bleeding]]

===Physical Examination===
* [[Abdominal tenderness]]
* [[Fever]]
* [[Hypotension]]
* [[Tachycardia]]

===Diagnostic Tests===
Colitis is associated with the following findings:
* Swelling of the colon tissue
* [[Bleeding]]
* [[Erythema]] (redness) of the surface of the colon
* [[Ulcer]]ations of the colon

Common tests which reveal these signs include:
* [[X-ray]]s of the colon
* Testing the stool for blood and pus
* [[Sigmoidoscopy]]
* [[Colonoscopy]]

Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbations of colitis.

==Treatment==
===Medical Therapy===
Treatment of colitis may include the administration of [[antibiotic]]s and general anti-inflammatory medications such as [[Mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation.

Changes in diet can be effective at treating the symptoms of colitis and easing the side effects. These can include reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]]. This approach has been championed by [[Elaine Gottschall]].

Hygienic and naturopathic doctors have taken the diet approach further, attributing bowel inflammation to toxemia stemming from high-protein, fatty diets and other dietary irritants. Changing to a low-fat, minimally-processed, whole-foods diet per the Natural Hygiene self-healing system has been effective in eliminating symptoms and rebuilding health. Dr. Zarin Azar, MD,, is one advocate of this healing system.

[[Infliximab]] (or REMICADE) - a drug originally produced to treat Rheumatoid Arthritis - has recently been approved for the treatment of Colitis where traditional treatments have failed. REMICADE is a biologic therapy that recognizes, attaches to, and blocks the action of a protein in your body called tumor necrosis factor alpha (TNF-alpha). TNF-alpha is made by certain blood cells in your body. It is administered through a series of infusions.

===Surgery===
Approximately half of patients with fulminant colitis require surgery. Surgery usually entails removing the colon and bowel and creating a "pouch" with portions of the small intestine.

==Treatment==
===Medical Therapy===

*All patients with proctocolitis should be treated.
*Treatment of proctocolitis is similar to that of proctitis.
*Generally, the following regimen is recommended:
:: Preferred regimen: [[Ceftriaxone]] 250 mg IM {{and}} [[Doxycycline]] 100 mg PO bid for 7 days
To view additional treatment and special considerations for the management of proctitis/proctocolitis, click [[proctitis medical therapy|'''here''']].

===Surgery===

===Prevention===

==See also==
* [[Colitis]]
* [[Proctitis]]

==References==
{{reflist|2}}

==References==
{{Reflist|2}}

[[Category:Inflammations]]
[[Category:Gastroenterology]]
[[Category:Disease]]
[[Category:Crowdiagnosis]]

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