Colitis: Difference between revisions

	Colitis Microchapters
Overview
Classification Allergic colitis Infectious colitis Ischemic colitis Drug-induced colitis Chemical colitis Radiation colitis
Differential Diagnosis
Causes

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Latest revision as of 22:21, 14 August 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M.Umer Tariq [2]; Maham Khan [3]; Ogheneochuko Ajari, MB.BS, MS [4]; Rim Halaby, M.D. [5]; Qasim Salau, M.B.B.S., FMCPaed [6]; Mohamed Riad, M.D.[7]

Synonyms and keywords: Colitis, Proctocolitis, Proctitis, Enterocolitis.

Overview

Colitis is the inflammation of the colon, that can be either acute or chronic. Colitis may be caused by microorganisms such as Chlamydia trachomatis, Neisseria gonorrhoeae, Shigella dysenteriae, HSV, allergy (food protein-induced allergic proctocolitis), drugs (NSAIDs) and radiation. Colitis may co-exist with enteritis (inflammation of the small bowel), proctitis (inflammation of the rectum) or both. The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be fulminant with a rapid downhill clinical course. In addition to the diarrhea, fever, and anemia may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of septicemia, where shock is present. Treatment of colitis depends on the etiology. It may include the elimination of cows-milk protein or other food allergens from the diet, administration of antibiotics and general anti-inflammatory medications such as mesalamine or its derivatives, steroids, or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is antimicrobial therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of ceftriaxone and doxycycline. Supportive therapies such as correction of dehydration and anemia, and reducing the intake of carbohydrates, lactose products, soft drinks, and caffeine is often done for most patients with colitis. Irritable bowel syndrome (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. 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.

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

Classes of Colitis	Disorders
Autoimmune	Ulcerative colitis Crohn's colitis
Allergic	Food protein-induced allergic proctocolitis (FPIAP) Food protein-induced enterocolitis syndrome (FPIES)
Infectious colitis	Pseudomembranous colitis (Clostridium difficile) Enterohemorrhagic colitis (Shigella dysenteriae or Shigatoxigenic group of Escherichia coli (STEC)) Protozoan (Entamoeba histolytica) Chlamydia proctocolitis
Idiopathic	Lymphocytic colitis Collagenous colitis
Iatrogenic	Diversion colitis Chemical colitis Radiation colitis NSAID-induced colitis
Vascular	Ischemic colitis
Drug induced	NSAID-induced colitis
Unclassifiable	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)^[1]^[2]
Enterocolitis: When it involves the small intestine in addition to the colon

Schematic of Anatomical Classification of Colitis

**Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843^[3]**
***Regions 4 to 6:** Enterocolitis
***Region 6:** Colitis
***Regions 6 to 8:** Proctocolitis
***Regions 7 to 8:**Proctitis

Classification by Age

Infantile (first six months of life)^[4]^[5]^[6]
Adult

Classification by duration of symptoms

Acute: Less than three months.^[7]
Chronic: Longer than three months. Often months to years.^[7]

Differential Diagnosis

The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:

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)
Intussusception
Upper Gastrointestinal Infections
Enteritis
Meckel diverticulum
Intestinal duplication cysts
Vascular malformations
Inflammatory bowel disease(early onset)
Hirschsprung disease complicated by enterocolitis
Volvulus
Gastro-duodenal ulcers
Gastrointestinal duplication cyst
Liver disease with clotting factor deficiency
Lymphonodular hyperplasia

Differential diagnosis in Adults

Differentiating Between Different Types 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 differentiates among the common causes of colitis:^[8]^[9]

Diseases	History and Symptoms				Physical Examination				Laboratory findings
Diseases	Diarrhea	Rectal bleeding	Abdominal pain	Atopy	Dehydration	Fever	Hypotension	Malnutrition	Blood in stool (frank or occult)	Microorganism in stool	Pseudomembranes on endoscopy
Allergic Colitis	+	++	+	++					++
Chemical colitis	+	++	++		+	+			++		+
Infectious colitis	++	++	++		+++	+++	++	+	++	++	+
Radiation colitis	+	++	+		+			+	++
Ischemic colitis	+	+	++		+	+	+	+	++
Drug-induced colitis	+	+	++			+			++		+

Causes

Common Causes

Common causes of proctocolitis include infectious agents such as Chlamydia trachomatis (which causes lymphogranuloma venereum), Neisseria gonorrhoeae, HSV, Shigella dysenteriae and Campylobacter species. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. microscopic colitis), vascular (e.g. ischemic colitis), or autoimmune (e.g. inflammatory bowel disease).

Causes by Organ System

Cardiovascular	EVAR, vasculitis
Chemical / poisoning	Chemical colitis from Glutaraldehyde, Coffee enema, Hydrogen peroxide, lanthanum
Dental	Dental braces
Dermatologic	Albinism, Behcet disease, scleroderma, vasculitis
Drug Side Effect	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
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Aganglionic megacolon, alpha 1-antitrypsin deficiency, autistic enterocolitis, bacterial gastroenteritis, 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
Genetic	Albinism, alpha 1-antitrypsin deficiency
Hematologic	No underlying causes
Iatrogenic	Diversion colitis, EVAR, radiation colitis, radiation proctitis
Infectious Disease	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
Musculoskeletal / Ortho	Ankylosing Spondylitis
Neurologic	No underlying causes
Nutritional / Metabolic	Gerson diet, lysinuric protein intolerance, milk allergy, pigbel, soy protein
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Autistic enterocolitis
Pulmonary	Multiple organ dysfunction syndrome
Renal / Electrolyte	Multiple organ dysfunction syndrome
Rheum / Immune / Allergy	Ankylosing spondylitis, Behcet disease, common variable immunodeficiency, allergic colitis (Food protein-induced colitis), scleroderma, vasculitis, Ulcerative colitis
Sexual	Typical STI such as Chlamydia trachomatis, Neisseria gonorrheae, Treponema pallidum, HSV, CMV, Unusual STI Shigella dysenteriae. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital HSV and Chlamydia proctitis occur predominantly in individuals with HIV infection. Neisseria meningitidis causes proctitis among men who have sex with men and individuals with HIV infection.^[10]^[10]
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Microscopic colitis

Causes in Alphabetical Order

Life Threatening Causes

Example include toxic megacolon, ischemic colitis, infectious colitis such as escherichia coli O157:H7 and shigella.

Screening

There is insufficient evidence to recommend routine screening of sexual partners of patients with sexually transmitted enteric pathogens.

Diagnosis

History and Symptoms

Symptoms of proctitis include anorectal pain, tenesmus, or rectal discharge.
Symptoms of proctocolitis include fatigue, weight loss, anorectal pain, tenesmus, rectal discharge, diarrhea or abdominal cramps.

Laboratory Findings

Laboratory findings consistent with the diagnosis of proctitis include:

Stool examination: Detection of blood or fecal polymorphonuclear leukocytes using gram-stained smear of any anorectal exudate from anoscopic or anal examination.
Microbiology workup: NAAT of rectal lesions for HSV, NAAT for Neisseria gonorrhea, syphilis serology, NAAT for Chlamydia trachomatis, and NAAT for Mycoplasma genitalium in case of persistence of symptoms after receiving the recommended treatment. CMV and other opportunistic infections may be evaluated in immunosuppressed individuals as HIV/AIDS.
An elevated erythrocyte sedimentation rate (ESR) is one typical finding in the acute exacerbation of proctocolitis.

Other Imaging Findings

Colonoscopy

Anoscopy or sigmoidoscopy may be helpful in the diagnosis of proctocolitis. Findings on an sigmoidoscopy suggestive of proctocolitis include inflammation of the colonic mucosa extending to 12 cm above the anus and rectal ulcers.

Treatment

Medical Therapy

Acute proctocolitis among individuals with receptive anal exposure is often sexually-transmitted. Empiric antibiotic treatment should be started while awaiting for the results of laboratory tests for

patients presenting with anorectal exudate on anoscopy or positive Gram-stained smear of anorectal exudate or secretions polymorphonuclear leukocytes or if anoscopy or Gram stain is not available.^[13]

Recommended Regimen for Acute Proctitis

Ceftriaxone 500 mg IM in a single dose

plus

Doxycycline 100 mg orally 2 times/day for 7 days

Doxycycline course is continued to 100 mg orally 2 times/day for 21 days in case of perianal or mucosal ulcers, bloody discharge, or tenesmus and a positive rectal chlamydia test.
For individuals weighing ≥150 kg, 1 g of ceftriaxone is given.
Patients presenting with mucosal or perianal ulcers or bloody diarrhea with positive NAAT for chlamydia should receive empiric therapy for Lymphogranuloma Venereum (LGV) with a prolonged course of doxycycline 100 mg orally 2 times/day for 3 weeks.^[14]
Patients presenting with painful perianal ulcers or mucosal ulcers on anoscopy should also receive empiric treatment for genital herpes.
Herpes proctocolitis and LGV occur predominantly among HIV/AIDS patients; hence empiric treatment in those patients should cover genital herpes and LGV.

Surgery

Surgical intervention is not recommended for the management of proctocolitis.

Primary Prevention

As proctocolitis can be a sexually transmitted disease, effective measures for the primary prevention of proctocolitis include:

Counseling on safe sex practices
Avoiding contact with feces during sexual intercourse
Hand washing after handing objects or materials that have been in contact with the anal area (i.e., sex toys or barriers) and after touching the anal area.

Secondary Prevention

Effective measures for the secondary prevention of proctocolitis include:

Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
Sexual partners with individuals treated for chlamydia or gonorrhea <60 days before the onset of symptoms should receive evaluation and empiric treatment of the causative infection
Testing for other sexually-transmitted diseases
In case of proctocolitis caused by chlamydia or Neisseria gonorrhea, retesting for the causative organism is recommended 3 months after completion of treatment.

References

↑ 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
↑ Hamlyn E, Taylor C (2006). "Sexually transmitted proctitis". Postgrad Med J. 82 (973): 733–6. doi:10.1136/pmj.2006.048488. PMC 2660501. PMID 17099092.
↑ WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016
↑ Nowak-Węgrzyn A (2015). "Food protein-induced enterocolitis syndrome and allergic proctocolitis". Allergy Asthma Proc. 36 (3): 172–84. doi:10.2500/aap.2015.36.3811. PMC 4405595. PMID 25976434.
↑ Pumberger W, Pomberger G, Geissler W (2001). "Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood". Postgrad Med J. 77 (906): 252–4. PMC 1741985. PMID 11264489.
↑ Alfadda AA, Storr MA, Shaffer EA (2011). "Eosinophilic colitis: epidemiology, clinical features, and current management". Therap Adv Gastroenterol. 4 (5): 301–9. doi:10.1177/1756283X10392443. PMC 3165205. PMID 21922029.
↑ ^7.0 ^7.1 Hauer-Jensen M, Denham JW, Andreyev HJ (2014). "Radiation enteropathy--pathogenesis, treatment and prevention". Nat Rev Gastroenterol Hepatol. 11 (8): 470–9. doi:10.1038/nrgastro.2014.46. PMC 4346191. PMID 24686268.
↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
↑ Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.
↑ ^10.0 ^10.1 {{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<ref name="pmid24687130">Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G; et al. (2014). "Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K." Sex Transm Infect. 90 (4): 269–74. doi:10.1136/sextrans-2013-051401. PMC 4033117. PMID 24687130.
↑ Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V (2011). "Granulomatous colitis in oculocutaneous albinism". Dig Liver Dis. 43 (1): e1. doi:10.1016/j.dld.2009.09.006. PMID 19833565.
↑ Gié O, Clerc D, Giulieri S, Demartines N (2014). "[Clostridial colitis: diagnosis and strategies for management]". Rev Med Suisse. 10 (434): 1309–13. PMID 25073304.
↑ Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M (2013). "The etiology of infectious proctitis in men who have sex with men differs according to HIV status". Sex Transm Dis. 40 (10): 768–70. doi:10.1097/OLQ.0000000000000022. PMID 24275725.
↑ Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ (2014). "Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment". J Int AIDS Soc. 17 (4 Suppl 3): 19657. doi:10.7448/IAS.17.4.19657. PMC 4225278. PMID 25394161.

Template:WH Template:WS

[1] 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

[pmid17099092-2] Hamlyn E, Taylor C (2006). "Sexually transmitted proctitis". Postgrad Med J. 82 (973): 733–6. doi:10.1136/pmj.2006.048488. PMC 2660501. PMID 17099092.

[gitractcolitis-3] WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016

[pmid25976434-4] Nowak-Węgrzyn A (2015). "Food protein-induced enterocolitis syndrome and allergic proctocolitis". Allergy Asthma Proc. 36 (3): 172–84. doi:10.2500/aap.2015.36.3811. PMC 4405595. PMID 25976434.

[pmid11264489-5] Pumberger W, Pomberger G, Geissler W (2001). "Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood". Postgrad Med J. 77 (906): 252–4. PMC 1741985. PMID 11264489.

[pmid21922029-6] Alfadda AA, Storr MA, Shaffer EA (2011). "Eosinophilic colitis: epidemiology, clinical features, and current management". Therap Adv Gastroenterol. 4 (5): 301–9. doi:10.1177/1756283X10392443. PMC 3165205. PMID 21922029.

[pmid24686268-7] 7.0 ^7.1 Hauer-Jensen M, Denham JW, Andreyev HJ (2014). "Radiation enteropathy--pathogenesis, treatment and prevention". Nat Rev Gastroenterol Hepatol. 11 (8): 470–9. doi:10.1038/nrgastro.2014.46. PMC 4346191. PMID 24686268.

[pmid14702426-8] Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.

[pmid15537721-9] Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.

[pmid28221124-10] 10.0 ^10.1 {{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<ref name="pmid24687130">Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G; et al. (2014). "Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K." Sex Transm Infect. 90 (4): 269–74. doi:10.1136/sextrans-2013-051401. PMC 4033117. PMID 24687130.

[pmid19833565-11] Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V (2011). "Granulomatous colitis in oculocutaneous albinism". Dig Liver Dis. 43 (1): e1. doi:10.1016/j.dld.2009.09.006. PMID 19833565.

[pmid25073304-12] Gié O, Clerc D, Giulieri S, Demartines N (2014). "[Clostridial colitis: diagnosis and strategies for management]". Rev Med Suisse. 10 (434): 1309–13. PMID 25073304.

[pmid24275725-13] Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M (2013). "The etiology of infectious proctitis in men who have sex with men differs according to HIV status". Sex Transm Dis. 40 (10): 768–70. doi:10.1097/OLQ.0000000000000022. PMID 24275725.

[pmid25394161-14] Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ (2014). "Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment". J Int AIDS Soc. 17 (4 Suppl 3): 19657. doi:10.7448/IAS.17.4.19657. PMC 4225278. PMID 25394161.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{SI}}
+{{Colitis}}
-{{CMG}}; {{AE}} {{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}}
+{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}}; {{Mohamed riad}}<br>
-{{SK}} Proctocolitis, Proctitis, Enterocolitis.
+{{SK}} Colitis, 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]], allergic cause( 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]].
+Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. 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. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. 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]].
 ==Classification==
@@ Line 13: / Line 14: @@
 {| 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="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 |
+| 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 |
+| 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 proctocolitis (FPIP)]]
+*[[Food protein-induced allergic proctocolitis (FPIAP)]]
+*[[Food protein-induced enterocolitis syndrome (FPIES)]]
 |-
-|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''[[Infectious colitis]]''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
+| 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]]'')
+*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
-* Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
+*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
-* Protozoan (''[[Entamoeba histolytica]]'')
+*Protozoan (''[[Entamoeba histolytica]]'')
-* [[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
+*[[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 |
+| 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]]
+*[[Lymphocytic colitis]]
-* [[Collagenous 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 |
+| 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]]
+*[[Diversion colitis]]
-* [[Chemical colitis]]
+*[[Chemical colitis]]
-* [[Radiation 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 |
+| 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]]
+*[[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 |
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
-*[[NSAIDs proctocolitis]]
+*[[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 |
+| 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]])
+*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
-* Atypical 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;
+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
+*[[Proctitis]]: When it involves the [[rectum]]
-*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>
+*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
-*Enterocolitis: When it involves the small intestine in addition to the colon
+*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|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 (anatomy)|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>'''<br>*'''Regions 4 to 6:''' Enterocolitis<br>*'''Region 6: '''Colitis<br>*'''Regions 6 to 8:''' Proctocolitis<br>*'''Regions 7 to 8:'''Proctitis]]</div><p style="clear:left"></p>
+<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>'''<br>*'''Regions 4 to 6:''' Enterocolitis<br>*'''Region 6: '''Colitis<br>*'''Regions 6 to 8:''' Proctocolitis<br>*'''Regions 7 to 8:'''Proctitis]]</div><p style="clear:left"></p>
 ===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
+*'''Infantile''' (first six months of life)<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>
+*'''Adult'''
 ===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:
+*'''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>
-* 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.
+*'''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>
-* [[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==
+==Differential Diagnosis==
+The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
+===Differential diagnosis in Infants===
-The pathophysiology of colitis depends on the cause. Some pathogenetic mechanisms are not clearly understood.
+*[[Swallowed maternal blood syndrome]]
-===Pathogenesis===
+*[[Anorectal fissure]]
-====Hypothesis regarding pathogenesis of Allergic colitis====
+*[[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]])
+*[[Intussusception]]
+*Upper Gastrointestinal Infections
+*[[Enteritis]]
+*[[Meckel diverticulum]]
+*[[Intestinal duplication cysts]]
+*Vascular malformations
+*Inflammatory bowel disease(early onset)
+*[[Hirschsprung disease]] complicated by [[enterocolitis]]
+*[[Volvulus]]
+*Gastro-duodenal ulcers
+*Gastrointestinal duplication cyst
+*[[Liver disease]] with clotting factor deficiency
+*Lymphonodular hyperplasia
-*It is a non IgE immunological reaction against food protein antigens which is thought to be T cell mediated.<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="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue=  | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530  }} </ref><ref name="pmid25125777">{{cite journal| author=Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H et al.| title=Reliability and validity of two versions of the upper extremity functional index. | journal=Physiother Can | year= 2014 | volume= 66 | issue= 3 | pages= 243-53 | pmid=25125777 | doi=10.3138/ptc.2013-45 | pmc=4130402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25125777  }} </ref><ref name="pmid22050274">{{cite journal| author=Academy of Breastfeeding Medicine| title=ABM Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant. | journal=Breastfeed Med | year= 2011 | volume= 6 | issue= 6 | pages= 435-40 | pmid=22050274 | doi=10.1089/bfm.2011.9977 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22050274  }} </ref><ref name="pmid23843067">{{cite journal| author=Fagundes-Neto U, Ganc AJ| title=Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports. | journal=Einstein (Sao Paulo) | year= 2013 | volume= 11 | issue= 2 | pages= 229-33 | pmid=23843067 | doi= | pmc=4872900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23843067  }} </ref>
+===Differential diagnosis in Adults===
-**T cell (CD8 and TH-2) results in release of proinflammatory cytokines, such as TNF, attracting Eosinophils mainly and other polymorphonuclear cells (PMN) to the intestinal tract and subsequent inflammation.
-**Genetic influence may have a role to play, may be seen in families.
-*Could also be an autoimmune disease. Atypical p antineutrophil cytoplasmic antibodies (a-pANCA) have been seen in some infants with intestinal infiltration by Neutrophils.<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>
+*[[Colorectal cancer|Colorectal malignancy]]
+*[[Crohn's disease]]
+*[[Behçet's disease|Behcet's disease]]
+*[[Arteriovenous malformation]]
+*[[Diverticulosis]]
+*Enteritis
+*[[Coagulopathy]]
+*[[Systemic lupus erythematosus]](SLE)
+*Cytomegalovirus colitis
-====Pathogenesis of Infectious colitis====
+===Differentiating Between Different Types of Colitis===
-*Enteric organisms that cause colitis are usually acquired through feco-oral contamination especially in children. As few as 100 bacterial cells can be enough to cause an infection.<ref>{{cite book|last=Levinson|first=Warren E|title=Review of Medical Microbiology and Immunology|year=2006|publisher=McGraw-Hill Medical Publishing Division|isbn=978-0-07-146031-6|edition=9|url=http://books.google.ca/books?id=Q_80CUAd_ikC&printsec=frontcover#v=onepage&q&f=false|accessdate=February 27, 2012|page=30}}</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 differentiates among the 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>
-*Can also be acquired as a sexually transmitted infection (STI) among individuals who practice unsafe anal sex.
+{|
-**The pathogens are transmitted directly through overt abrasions or microabrasions in the rectal mucosa or indirectly during oral-anal contact.<ref name="Rompalo">{{Rompalo AM. Chapter 9: Proctitis and Proctocolitis. In Klausner JD, Hook III EW. CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases. McGraw Hill Professional; 2007 }} </ref>
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-*May also occur following antibiotic use, especially broad spectrum antibiotics.
+! rowspan="2" |Diseases
-:'''Chlamydia trachomatis'''
+! colspan="4" |History and Symptoms
-**Inoculation and replication of ''[[Chlamydia trachomatis]]'' [[Serovar|serovars]] L1, L2, or L3 depends on alternation between two forms of the bacterium: the infectious elementary body (EB) and noninfectious, replicating reticulate body (RB).<ref name="pmid11159992">{{cite journal| author=Taraktchoglou M, Pacey AA, Turnbull JE, Eley A| title=Infectivity of Chlamydia trachomatis serovar LGV but not E is dependent on host cell heparan sulfate. | journal=Infect Immun | year= 2001 | volume= 69 | issue= 2 | pages= 968-76 | pmid=11159992 | doi=10.1128/IAI.69.2.968-976.2001 | pmc=PMC97976 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11159992  }} </ref>
+! colspan="4" |Physical Examination
-**The EB form is responsible for inoculation with ''C. trachomatis''.
+! colspan="4" |Laboratory findings
-**The ''C. trachomatis'' EB enters the body during sexual intercourse or by crossing [[epithelial cells]] of [[mucous membranes]].<ref name="pmid12081191">{{cite journal| author=Mabey D, Peeling RW| title=Lymphogranuloma venereum. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 2 | pages= 90-2 | pmid=12081191 | doi= | pmc=PMC1744436 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12081191  }} </ref>
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-**Once inside the host cell, EBs immediately start differentiating into reticulate bodies (RBs) that undergo replication.
+!Diarrhea
-**The process of endocytosis and accumulation of RBs within host epithelial cells causes host cell destruction ([[necrosis]]) which leads to the formation of a [[papule]] at the site of inoculation   which may ulcerate, depending on the extent of infection and number or EBs transmitted.<ref name="pmidPMID 2030670">{{cite journal| author=Moulder JW| title=Interaction of chlamydiae and host cells in vitro. | journal=Microbiol Rev | year= 1991 | volume= 55 | issue= 1 | pages= 143-90 | pmid=PMID 2030670 | doi= | pmc=372804 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2030670  }} </ref>
+!Rectal bleeding
-:'''Shigella specie'''
+!Abdominal pain
-**''[[Shigella]]'' first invades the epithelial cells of the large intestine (the rectosigmoid mucosa) by using M cells as entry ports for transcytosis. Shigella then invades macrophages and induces cellular apoptosis, which results in inflammation, generation of proinflammatory cytokines, and recruitment of polymorphonuclear neutrophils (PMNs).<ref name="Mounier">{{cite journal | title=Shigella flexneri Enters Human Colonic Caco-2 Epithelial Cells through the Basolateral Pole | author=Mounier, Joëlle | journal=Infection and Immunity |date=January 1992 | volume=60 | issue=1 | pages=237–248 | pmc=257528 | first2=T | last3=Hellio | first3=R | last4=Lesourd | first4=M | last5=Sansonetti | first5=PJ | pmid=1729185| last2=Vasselon }} </ref>
+!Atopy
-:'''Campylobacter'''
+!Dehydration
-**Regarding ''[[Campylobacter jejuni]]'' colitis the exact pathogenesis by which it causes colitis after transmission is not fully understood.
+!Fever
-**However, it is hypothesized that requirement for C. jejuni virulence include (1) motility, (2) drug resistance, (3) host cell adherence, (4) host cell invasion, (5) alteration of the host cell signaling pathways, (6) induction of host cell death, (7) evasion of the host immune system defenses, and (9) acquisition of iron which serves as a micronutrient for growth and works as a catalyst for hydroxyl radical formation.<ref name="pmid4522793">{{cite journal| author=Capra JD, Kehoe JM| title=Variable region sequences of five human immunoglobulin heavy chains of the VH3 subgroup: definitive identification of four heavy chain hypervariable regions. | journal=Proc Natl Acad Sci U S A | year= 1974 | volume= 71 | issue= 3 | pages= 845-8 | pmid=4522793 | doi= | pmc=388111 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4522793  }} </ref>
+!Hypotension
-**''C. jejuni'' is known to also secrete proteins that may contribute to the ability of the bacterium to invade the host epithelial cells.<ref name="pmid4522793">{{cite journal| author=Capra JD, Kehoe JM| title=Variable region sequences of five human immunoglobulin heavy chains of the VH3 subgroup: definitive identification of four heavy chain hypervariable regions. | journal=Proc Natl Acad Sci U S A | year= 1974 | volume= 71 | issue= 3 | pages= 845-8 | pmid=4522793 | doi= | pmc=388111 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4522793  }} </ref>
+!Malnutrition
-'''Entameoba histolytica'''
+!Blood in stool (frank or occult)
-**Following transmission of ''[[Entameoba histolytica]]'', the trophozoites undergo excystation in the small intestine, after which it migrates to the large intestine using pseudopods.
+!Microorganism in stool
-**In the large intestine, the trophozoites invades the intestinal mucosa into the bloodstream. Simultaneously, they form resistant cysts in the large intestines that are then excreted in human stools.<ref name="pmid10756002">{{cite journal| author=Espinosa-Cantellano M, Martínez-Palomo A| title=Pathogenesis of intestinal amebiasis: from molecules to disease. | journal=Clin Microbiol Rev | year= 2000 | volume= 13 | issue= 2 | pages= 318-31 | pmid=10756002 | doi= | pmc=PMC100155 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10756002  }} </ref>
+!Pseudomembranes on endoscopy
-**''E. histolytica'' trophozoites secrete proteases, which induce the release of mucin from goblet cells, resulting in glandular hyperplasia.<ref name="pmid10756002">{{cite journal| author=c M, Martínez-Palomo A| title=Pathogenesis of intestinal amebiasis: from molecules to disease. | journal=Clin Microbiol Rev | year= 2000 | volume= 13 | issue= 2 | pages= 318-31 | pmid=10756002 | doi= | pmc=PMC100155 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10756002  }} </ref>
+|-
-**''E. histolytica'' is also said to contain glycosidases that cleave glycsolyated mucin molecules, resulting in mucin degradation.<ref name="pmid2456386">{{cite journal| author=Müller FW, Franz A, Werries E| title=Secretory hydrolases of Entamoeba histolytica. | journal=J Protozool | year= 1988 | volume= 35 | issue= 2 | pages= 291-5 | pmid=2456386 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2456386  }} </ref><ref name="pmid9561780">{{cite journal| author=Spice WM, Ackers JP| title=The effects of Entamoeba histolytica lysates on human colonic mucins. | journal=J Eukaryot Microbiol | year= 1998 | volume= 45 | issue= 2 | pages= 24S-27S | pmid=9561780 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9561780  }} </ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
-:'''Pseudomembranous colitis'''
+| style="background: #F5F5F5; padding: 5px;" | +
-**Under normal condition, there is usually a balance in the normal intestinal commensals.
+| style="background: #F5F5F5; padding: 5px;" | ++
-**Following broad spectrum systemic antibiotics use, especially penicillin-based antibiotic such as [[amoxicillin]], [[cephalosporin]]s, [[fluoroquinolones]] and macrolides this balance is affected with killing susceptible bacteria and allowing for proliferation of the remaining non-susceptible bacteria.
+| style="background: #F5F5F5; padding: 5px;" | +
-**''Clostridium difficile'', an obligate [[anaerobic]] gram positive spore forming bacillus tends to proliferate under such conditions and is the usual cause (almost 99 percent of cases) pseudomembranous colitis.<ref name="pmid10095149">{{cite journal| author=Surawicz CM, McFarland LV| title=Pseudomembranous colitis: causes and cures. | journal=Digestion | year= 1999 | volume= 60 | issue= 2 | pages= 91-100 | pmid=10095149 | doi=7633 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10095149  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" | ++
-**''Clostridium difficile'', produces toxin A (enterotoxin), toxin B (cytotoxin), and binary toxin. These toxins are required for it to colonize the gut, intestinal cell disruption, attract inflammatory cells and cause disease.<ref>{{cite journal | title=The role of toxin A and toxin B in''Clostridium difficile'' infection | author= Sarah A. Kuehne, Stephen T. Cartman, John T. Heap, Michelle L. Kelly, Alan Cockayne & Nigel P. Minton | journal=[[Nature (journal)|Nature]] | year=2010 |doi=10.1038/nature09397 | pmid=20844489 | volume=467 | issue=7316 | pages=711–3}}</ref><ref name="pmid10095149">{{cite journal| author=Surawicz CM, McFarland LV| title=Pseudomembranous colitis: causes and cures. | journal=Digestion | year= 1999 | volume= 60 | issue= 2 | pages= 91-100 | pmid=10095149 | doi=7633 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10095149  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" |
-**Other reported causes of pseudomembranous colitis include infections such as ''[[Staphylococcus aureus]]'', ''[[Yersinia specie]]'', ''[[Salmonella specie]]'', ''[[Shigella specie]]'', NSAIDs such as indomethacin, chemotherapeutic drugs like - cisplatin and inflammatory bowel disease.
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
-====Pathogenesis of radiation colitis====
+| style="background: #F5F5F5; padding: 5px;" |
-*Occur following radiation treatment for pelvic tumors.<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>
+| style="background: #F5F5F5; padding: 5px;" | ++
-*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>
+| style="background: #F5F5F5; padding: 5px;" |
-*The DNA is the main site of damage. May also affect RNA, proteins  and cell membranes.
+| style="background: #F5F5F5; padding: 5px;" |
-**Injury occurs few hours to days, up to three months  after irradiation in acute radiation proctocolitis. It affects rapidly dividing cells of the epithelium and mucosa.
+|-
-**This leads to cell death, recruitment and activation of polymorphonuclear (PMN) inflammatory cells, mucosal edema and damage to small blood vessels.
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
-**Usually self limiting.
+| style="background: #F5F5F5; padding: 5px;" | +
-**In chronic radiation colitis, mesenchymal tissue is involved.
+| style="background: #F5F5F5; padding: 5px;" | ++
-**The damage is progressive with atrophy of the mucosa, fibrosis of the intestinal wall, obliteration of small arteries, chronic ischemia, ulcers, and fistula formation.
+| style="background: #F5F5F5; padding: 5px;" | ++
-**This occurs usually after three months to years.
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | +
-====Pathogenesis of ischemic colitis====
+| style="background: #F5F5F5; padding: 5px;" | +
-*Rare cause of colitis
+| style="background: #F5F5F5; padding: 5px;" |
-*Seen in the elderly with low cardiovascular status
+| style="background: #F5F5F5; padding: 5px;" |
-*The exact pathogenesis remains unclear. It is characterized by polymorphonuclear (PMN) cells infiltration, extensive mucosal necrosis and bleeding, submucosa edema and absence of lymphocytes and plasma cells in the deeper aspect of the lamina propria.<ref name="pmid18521689">{{cite journal| author=Abhishek K, Kaushik S, Kazemi MM, El-Dika S| title=An unusual case of hematochezia: acute ischemic proctosigmoiditis. | journal=J Gen Intern Med | year= 2008 | volume= 23 | issue= 9 | pages= 1525-7 | pmid=18521689 | doi=10.1007/s11606-008-0673-2 | pmc=2518031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18521689  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" | ++
+| style="background: #F5F5F5; padding: 5px;" |
-====Hypotheses related to the pathogenesis of ulcerative proctocolitis====
+| style="background: #F5F5F5; padding: 5px;" | +
-* Exact pathogenesis not fully clear.
+|-
-*It is a chronic inflammatory disease affecting the innermost part of the lamina propria.
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
-*An interplay between hyper-reactive immune system, gut microbiota, Impaired gut mucosa barrier, genetic factors, and environmental factors.<ref name="pmid27499766">{{cite journal| author=Cai M, Zeng L, Li LJ, Mo LH, Xie RD, Feng BS et al.| title=Specific immunotherapy ameliorates ulcerative colitis. | journal=Allergy Asthma Clin Immunol | year= 2016 | volume= 12 | issue=  | pages= 37 | pmid=27499766 | doi=10.1186/s13223-016-0142-0 | pmc=4975874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27499766  }} </ref><ref name="pmid27493597">{{cite journal| author=Lopez J, Grinspan A| title=Fecal Microbiota Transplantation for Inflammatory Bowel Disease. | journal=Gastroenterol Hepatol (N Y) | year= 2016 | volume= 12 | issue= 6 | pages= 374-9 | pmid=27493597 | doi= | pmc=4971820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27493597  }} </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>
+| style="background: #F5F5F5; padding: 5px;" | ++
-*Cytotoxic T cells and autoantibodies (IgG and IgE) against the colon, cytoskeleton and bowel smooth muscles are seen.<ref name="pmid27499766">{{cite journal| author=Cai M, Zeng L, Li LJ, Mo LH, Xie RD, Feng BS et al.| title=Specific immunotherapy ameliorates ulcerative colitis. | journal=Allergy Asthma Clin Immunol | year= 2016 | volume= 12 | issue=  | pages= 37 | pmid=27499766 | doi=10.1186/s13223-016-0142-0 | pmc=4975874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27499766  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" | ++
-*The balance in gut microbes is shifted toward pathogenic microorganism, including colonic sulphate reducing bacteria.<ref name="pmid27493597">{{cite journal| author=Lopez J, Grinspan A| title=Fecal Microbiota Transplantation for Inflammatory Bowel Disease. | journal=Gastroenterol Hepatol (N Y) | year= 2016 | volume= 12 | issue= 6 | pages= 374-9 | pmid=27493597 | doi= | pmc=4971820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27493597  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" | ++
-*About 160 genetic loci have been identified for inflammatory bowel disease (IBD) with newer potential loci being identified. Some of these loci are associated with impaired mucosal barrier function.<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>
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | +++
-====Other pathogenetic mechanisms of proctocolitis=====
+| style="background: #F5F5F5; padding: 5px;" | +++
+| style="background: #F5F5F5; padding: 5px;" | ++
-*NSAIDS can also cause proctocolitis. The mechanism is not completely understood.<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>
+| style="background: #F5F5F5; padding: 5px;" | +
-**Inhibits cyclooxygenase and thus prostaglandin production. Prostaglandin helps maintain mucosal integrity.
+| style="background: #F5F5F5; padding: 5px;" | ++
-**NSAIDS also impair oxidative phosphorylation, increasing risk of oxidative injury to the gut.
+| style="background: #F5F5F5; padding: 5px;" | ++
-**Direct damage to the intestinal mucosa has been suggested in NSAID related injury since the rectum is often spared.
+| style="background: #F5F5F5; padding: 5px;" | +
-**It is also hypothesized that there is increased intestinal permeability with to antigenic materials following NSAID use, causing activation of the immune system and subsequent inflammation.
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
-*Glutaraldehyde, a disinfectant used in cleaning endoscopes is an uncommon cause of proctocolitis.<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>
+| style="background: #F5F5F5; padding: 5px;" | +
-**Proctocolitis results from direct mucosa contact with the chemical.
+| style="background: #F5F5F5; padding: 5px;" | ++
-**Improper cleaning of the endoscopes allows the glutaraldehyde disinfectant to remain, subsequently causing a chemical proctocolitis.
+| style="background: #F5F5F5; padding: 5px;" | +
-**The primary mucosa toxin in glutaraldehyde is not fully known. However, it may be related to the aldehyde.<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>
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | +
-===Genetics===
+| style="background: #F5F5F5; padding: 5px;" |
-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>
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | +
-===Associated conditions===
+| style="background: #F5F5F5; padding: 5px;" | ++
+| style="background: #F5F5F5; padding: 5px;" |
-*[[Human Immunodeficiency Virus (HIV)]]/ [[AIDS]]
+| style="background: #F5F5F5; padding: 5px;" |
-*Arterosclerosis
+|-
-*Artificial infant feeding
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
+| style="background: #F5F5F5; padding: 5px;" | +
-===Gross pathology===
+| style="background: #F5F5F5; padding: 5px;" | +
-*Gross pathological findings are often limited to the rectosigmoid region and show evidence of acute or chronic inflammation with or without necrosis, ulcers and hemorrhage. In addition, specific changes based on the cause may be seen.
+| style="background: #F5F5F5; padding: 5px;" | ++
-**Food protein-induced proctocolitis (FPIP) shows patchy or diffuse erythematous and friable mucosa. Characteristic circumscribed nodular hyperplasia with central pit-like erosions and ulcers may also be seen.<ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref><ref name="pmid17449926">{{cite journal| author=Hwang JB, Park MH, Kang YN, Kim SP, Suh SI, Kam S| title=Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis. | journal=J Korean Med Sci | year= 2007 | volume= 22 | issue= 2 | pages= 213-7 | pmid=17449926 | doi=10.3346/jkms.2007.22.2.213 | pmc=2693584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17449926  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" |
-**Pseudomembranous colitis. The gross pathologic finding is presence of diffuse, small, 2 to 10mm, raised yellowish (or whitish) lesions. Mucosa in between lesions may appear normal. Lesions may merge giving rise to a characteristic "pseudomembrane" layer over the mucosa.
+| style="background: #F5F5F5; padding: 5px;" | +
-**Ulcerative colitis. On gross pathology, the inflammation is seen in the innermost part of the lamina propria.
+| style="background: #F5F5F5; padding: 5px;" | +
-**Ischemic proctocolitis shows marked mucosal congestion with areas of necrosis and ulceration on gross patholgy.<ref name="pmid18521689">{{cite journal| author=Abhishek K, Kaushik S, Kazemi MM, El-Dika S| title=An unusual case of hematochezia: acute ischemic proctosigmoiditis. | journal=J Gen Intern Med | year= 2008 | volume= 23 | issue= 9 | pages= 1525-7 | pmid=18521689 | doi=10.1007/s11606-008-0673-2 | pmc=2518031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18521689  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" | +
+| style="background: #F5F5F5; padding: 5px;" | +
-<gallery>
+| style="background: #F5F5F5; padding: 5px;" | ++
-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>
+| style="background: #F5F5F5; padding: 5px;" |
-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>
+| style="background: #F5F5F5; padding: 5px;" |
-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>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
-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>
+| style="background: #F5F5F5; padding: 5px;" | +
-</gallery>
+| style="background: #F5F5F5; padding: 5px;" | +
+| style="background: #F5F5F5; padding: 5px;" | ++
-===Microscopic pathology===
+| style="background: #F5F5F5; padding: 5px;" |
-*Food protein-induced proctocolitis is characterized by marked eosinophil infiltrates in the mucosa of the rectosigmoid area.<ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref><ref name="pmidhttp://dx.doi.org/10.1016/S0022-3476(95)70540-6">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1016/S0022-3476(95)70540-6 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" |
-**The mucosa architecture is usually preserved on microscopy.<ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref>
+| style="background: #F5F5F5; padding: 5px;" | +
-*In pseudomembranous colitis microscopy shows<ref name =HistologyPC>Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 837-8. ISBN 0-7216-0187-1}} </ref>
+| style="background: #F5F5F5; padding: 5px;" |
-**Heaped necrotic tissue
+| style="background: #F5F5F5; padding: 5px;" |
-**Polymorphonuclear neutrophils in the lamina propria, breeching the epithelium like a "volcanic eruption".
+| style="background: #F5F5F5; padding: 5px;" | ++
-**With or without capillary thrombi
+| style="background: #F5F5F5; padding: 5px;" |
-*On microscopy, the characteristic finding in ulcerative colitis is presence of lymphocytes and plasma cells in the deeper aspect of the lamina propria (basal lymphoplasmacytosis).
+| style="background: #F5F5F5; padding: 5px;" | +
-**Crypt architecture is destroyed.
+|}
-**Abscesses may also be seen in the crypts.
-<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]]).
+Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).
 ===Causes by Organ System===
-{|style="width:80%; height:100px" border="1"
+{| style="width:80%; height:100px" border="1"
-|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
+| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
-|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[EVAR]], [[vasculitis]]
+| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Chemical / poisoning'''
+|'''Chemical / poisoning'''
-|bgcolor="Beige"| [[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
+| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Dental'''
+|'''Dental'''
-|bgcolor="Beige"|[[Dental braces]]
+| bgcolor="Beige" |[[Dental braces]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Dermatologic'''
+|'''Dermatologic'''
-|bgcolor="Beige"|[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
+| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Drug Side Effect'''
+|'''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="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"
+|- bgcolor="LightSteelBlue"
-| '''Ear Nose Throat'''
+|'''Ear Nose Throat'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Endocrine'''
+|'''Endocrine'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Environmental'''
+|'''Environmental'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Gastroenterologic'''
+|'''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="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"
+|- bgcolor="LightSteelBlue"
-| '''Genetic'''
+|'''Genetic'''
-|bgcolor="Beige"| [[Albinism]], [[alpha 1-antitrypsin deficiency]]
+| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Hematologic'''
+|'''Hematologic'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Iatrogenic'''
+|'''Iatrogenic'''
-|bgcolor="Beige"| [[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
+| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Infectious Disease'''
+|'''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="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"
+|- bgcolor="LightSteelBlue"
-| '''Musculoskeletal / Ortho'''
+|'''Musculoskeletal / Ortho'''
-|bgcolor="Beige"| [[Ankylosing Spondylitis]]
+| bgcolor="Beige" |[[Ankylosing Spondylitis]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Neurologic'''
+|'''Neurologic'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Nutritional / Metabolic'''
+|'''Nutritional / Metabolic'''
-|bgcolor="Beige"| [[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
+| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Obstetric/Gynecologic'''
+|'''Obstetric/Gynecologic'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Oncologic'''
+|'''Oncologic'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Opthalmologic'''
+|'''Opthalmologic'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Overdose / Toxicity'''
+|'''Overdose / Toxicity'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Psychiatric'''
+|'''Psychiatric'''
-|bgcolor="Beige"| [[Autistic enterocolitis]]
+| bgcolor="Beige" |[[Autistic enterocolitis]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Pulmonary'''
+|'''Pulmonary'''
-|bgcolor="Beige"|[[Multiple organ dysfunction syndrome]]
+| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Renal / Electrolyte'''
+|'''Renal / Electrolyte'''
-|bgcolor="Beige"|[[Multiple organ dysfunction syndrome]]
+| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Rheum / Immune / Allergy'''
+|'''Rheum / Immune / Allergy'''
-|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
+| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Sexual'''
+|'''Sexual'''
-|bgcolor="Beige"| Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''
+| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130  }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124  }} </ref>
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Trauma'''
+|'''Trauma'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Urologic'''
+|'''Urologic'''
-|bgcolor="Beige"| No underlying causes
+| bgcolor="Beige" |No underlying causes
 |-
-|-bgcolor="LightSteelBlue"
+|- bgcolor="LightSteelBlue"
-| '''Miscellaneous'''
+|'''Miscellaneous'''
-|bgcolor="Beige"| Microscopic colitis
+| bgcolor="Beige" |Microscopic colitis
 |-
 |}
 ===Causes in Alphabetical Order===
-{{columns-list|3|
+{{columns-list|
 *[[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>
@@ Line 453: / Line 468: @@
 ===Life Threatening Causes===
-Example include toxic megacolon, ischemic colitis, infectious colitis such as  [[escherichia coli O157:H7]] and [[shigella]].
+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.
-==Differentiating {{PAGENAME}} from Other Diseases==
-Causes of proctocolitis are diverse and may overlap with other disease. The differential diagnosis of proctocolitis 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)
-==Epidemiology and Demographics==
-The causes of proctocolitis are diverse and overlap with other diseases.
-===Prevalence and Incidence===
-*The exact prevalence and incidence of proctocolitis is difficult to establish due to diverse causes and appropriate diagnostic criteria
-*The prevalence and incidence of proctocolitis may be influenced by the patient’s age, genetic factors and race
-:*[[Food protein-induced proctocolitis]] (FPIP): Exact prevalence unknown
-:**Reported to be 1.6 in 1000 children under 1 year for cow-milk protein allergy in a population based study<ref name="pmid23050491">{{cite journal| author=Elizur A, Cohen M, Goldberg MR, Rajuan N, Cohen A, Leshno M et al.| title=Cow's milk associated rectal bleeding: a population based prospective study. | journal=Pediatr Allergy Immunol | year= 2012 | volume= 23 | issue= 8 | pages= 766-70 | pmid=23050491 | doi=10.1111/pai.12009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23050491  }} </ref>
-:**Prevalence of FPIP is documented to range from a low of 16 percent to a high of 64 percent among infants with rectal bleeding<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="pmid16585287">{{cite journal| author=Arvola T, Ruuska T, Keränen J, Hyöty H, Salminen S, Isolauri E| title=Rectal bleeding in infancy: clinical, allergological, and microbiological examination. | journal=Pediatrics | year= 2006 | volume= 117 | issue= 4 | pages= e760-8 | pmid=16585287 | doi=10.1542/peds.2005-1069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16585287  }} </ref><ref name="pmid15990624">{{cite journal| author=Xanthakos SA, Schwimmer JB, Melin-Aldana H, Rothenberg ME, Witte DP, Cohen MB| title=Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study. | journal=J Pediatr Gastroenterol Nutr | year= 2005 | volume= 41 | issue= 1 | pages= 16-22 | pmid=15990624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15990624  }} </ref>
-:**Sixty percent of infants with FPIP are babies who are on exclusive breastfeeding<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><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>
-:**FPIP is the most common cause of non-infectious colitis in infancy <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>
-:*The prevalence of proctocolitis from an adults study in a developed country between 1979 and 1983 was 58.4 cases per 100,000<ref name="pmid3685885">{{cite journal| author=Shivananda S, Peña AS, Mayberry JF, Ruitenberg EJ, Hoedemaeker PJ| title=Epidemiology of proctocolitis in the region of Leiden, The Netherlands. A population study from 1979 to 1983. | journal=Scand J Gastroenterol | year= 1987 | volume= 22 | issue= 8 | pages= 993-1002 | pmid=3685885 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3685885  }} </ref>
-:**The incidence of proctocolitis from the same study was 6.8 cases per 100,000 individuals per year<ref name="pmid3685885">{{cite journal| author=Shivananda S, Peña AS, Mayberry JF, Ruitenberg EJ, Hoedemaeker PJ| title=Epidemiology of proctocolitis in the region of Leiden, The Netherlands. A population study from 1979 to 1983. | journal=Scand J Gastroenterol | year= 1987 | volume= 22 | issue= 8 | pages= 993-1002 | pmid=3685885 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3685885  }} </ref>
-:*Regarding [[radiation proctitis]] the incidence is not fully known due in part to no standard definition and method of reporting<ref name="pmid/10.1155/2011/917941">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=/10.1155/2011/917941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
-:**The incidence of radiation proctitis following external beam radiation studies range from 2% to 39%, brachytherapy 8% to 13%, while that of intensity-modulated radiation therapy (IMRT) range from 1% to 9%<ref name="pmid/10.1155/2011/917941">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=/10.1155/2011/917941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
-:**Also, the incidence of acute radiation proctitis occurs in 20% of individuals undergoing radiation therapy, while chronic radiation proctitis occurs in 2% to 20% of individuals having radiation therapy<ref name="pmid/10.1155/2011/917941">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=/10.1155/2011/917941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
-:*Ischemic proctocolitis  makes up 3% to 5% of cases of ischemic injury to the colon<ref name="pmid18521689">{{cite journal| author=Abhishek K, Kaushik S, Kazemi MM, El-Dika S| title=An unusual case of hematochezia: acute ischemic proctosigmoiditis. | journal=J Gen Intern Med | year= 2008 | volume= 23 | issue= 9 | pages= 1525-7 | pmid=18521689 | doi=10.1007/s11606-008-0673-2 | pmc=2518031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18521689  }} </ref>
-===Age===
-*[[Food protein-induced proctocolitis]] is mainly a disease of infants, with onset usually in the first two to three months of life<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="pmid16585287">{{cite journal| author=Arvola T, Ruuska T, Keränen J, Hyöty H, Salminen S, Isolauri E| title=Rectal bleeding in infancy: clinical, allergological, and microbiological examination. | journal=Pediatrics | year= 2006 | volume= 117 | issue= 4 | pages= e760-8 | pmid=16585287 | doi=10.1542/peds.2005-1069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16585287  }} </ref><ref name="pmid15990624">{{cite journal| author=Xanthakos SA, Schwimmer JB, Melin-Aldana H, Rothenberg ME, Witte DP, Cohen MB| title=Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study. | journal=J Pediatr Gastroenterol Nutr | year= 2005 | volume= 41 | issue= 1 | pages= 16-22 | pmid=15990624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15990624  }} </ref>. An adolescent form may develop later.<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>
-*The incidence of infectious proctocolitis that is not acquired as a [[sexually transmitted infection (STI)]] is higher among pediatric age group
-*Ischemic proctocolitis is more common among the elderly with average age range of 65 to 70 years<ref name="pmid18521689">{{cite journal| author=Abhishek K, Kaushik S, Kazemi MM, El-Dika S| title=An unusual case of hematochezia: acute ischemic proctosigmoiditis. | journal=J Gen Intern Med | year= 2008 | volume= 23 | issue= 9 | pages= 1525-7 | pmid=18521689 | doi=10.1007/s11606-008-0673-2 | pmc=2518031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18521689  }} </ref><ref name="pmid8931407">{{cite journal| author=Bharucha AE, Tremaine WJ, Johnson CD, Batts KP| title=Ischemic proctosigmoiditis. | journal=Am J Gastroenterol | year= 1996 | volume= 91 | issue= 11 | pages= 2305-9 | pmid=8931407 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8931407  }} </ref>
-*Other causes of proctocolitis are more common among the adult population than pediatric age group
-===Gender===
-*Infectious proctocolitis from [[sexually transmitted infections|STI]] is more common in men<ref name="pmid22783058">{{cite journal| author=Gallegos M, Bradly D, Jakate S, Keshavarzian A| title=Lymphogranuloma venereum proctosigmoiditis is a mimicker of inflammatory bowel disease. | journal=World J Gastroenterol | year= 2012 | volume= 18 | issue= 25 | pages= 3317-21 | pmid=22783058 | doi=10.3748/wjg.v18.i25.3317 | pmc=3391771 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22783058  }} </ref><ref name="pmid27583686">{{cite journal| author=de Voux A, Kent JB, Macomber K, Krzanowski K, Jackson D, Starr T et al.| title=Notes from the Field: Cluster of Lymphogranuloma Venereum Cases Among Men Who Have Sex with Men - Michigan, August 2015-April 2016. | journal=MMWR Morb Mortal Wkly Rep | year= 2016 | volume= 65 | issue= 34 | pages= 920-1 | pmid=27583686 | doi=10.15585/mmwr.mm6534a6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27583686  }} </ref><ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref><ref name="pmid16410585">{{cite journal| author=Williams D, Churchill D| title=Ulcerative proctitis in men who have sex with men: an emerging outbreak. | journal=BMJ | year= 2006 | volume= 332 | issue= 7533 | pages= 99-100 | pmid=16410585 | doi=10.1136/bmj.332.7533.99 | pmc=1326936 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16410585  }} </ref>
-*The other causes of proctocolitis have no sex predilection
-===Race===
-*There is no racial predilection for proctocolitis
-==Risk Factors==
-Common risk factors for developing proctocolitis include:
-===Risk factors for food protein-induced proctocolitis (FPIP)===
-:*Family history of atopy/ previous sibling with FPIP
-:*Use of formula feeds
-===Risk factors for ischemic proctocolitis===
-:*Elderly or debilitated patients who have multiple comorbidities.
-:*Cardiovascular disease including atherosclerotis and peripheral vascular disease
-:*Diabetes mellitus
-:*Aortoiliac surgery
-:*Hemodialysis
-:*Pulmonary vascular disease
-:*Shock
-:*Sepsis
-===Risk factors for radiation proctocolitis===
-:*Dose of radiation > 70 Gy
-:*Diabetes
-:*Peripheral vascular disease
-:*Co-existing inflammatory bowel disease
-:*HIV/AIDS
-===Risk factors for sexually transmitted infectious proctocolitis===
-:*Men who have sex with men
-:*Unprotected anal sex
-:*HIV/AIDS
-:*Previously diagnosed sexually transmitted infection
-:*Casual sex acquaintance especially meeting on the internet/ multiple
-:*Recent foreign travel
-:*Co-existing ulcerative colitis
-===Risk factors for Clostridium difficile proctocolitis===
-:*Elderly
-:*Use of antimicrobials especially broad spectrum antibiotics such as penicillins, cephalosporins, clindamycin and fluoroquinolones
-:*Chemotherapy
-:*Immune hypo-function
-:*Gastrointestinal surgery including proctocolectomy
-:*Mechanical bowel preparation
-:*Constipation
-:*Gut ischemia
-:*Hirschsprung disease
-:*Altered gut motility
-:*Malnutrition
-===Risk factors for drug/ chemical related proctocolitis===
-:*Elderly age group
-:*Prolonged medication use e.g NSAIDs
-:*Improper cleaning/ rinsing of glutaraldehyde disinfectant used in endoscopes
 ==Screening==
-'''Proctocolitis in  [[men who have sex with men|MSM]]'''<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>
+There is insufficient evidence to recommend routine screening of sexual partners of patients with sexually transmitted enteric pathogens.
-*According to the CDC routine screening, at least annually for common sexually transmitted diseases should be done in sexually active MSM
-*A test for rectal infection with N. gonorrhoeae and C. trachomatis in men who have had receptive anal intercourse during the preceding year (using nucleic acid amplification testing (NAAT) of a rectal swab is the preferred approach)
-*More frequent STD screening at 3-6 month intervals is indicated for MSM who have multiple or anonymous partners and in those who use illicit drug (particularly methamphetamine use) or whose sex partners participate in these activities
-'''Other causes of proctocolitis'''
+==Diagnosis==
-*Screening is not recommended for the other causes of proctocolitis
-==Natural History, Complications, and Prognosis==
+===History and Symptoms===
-===Natural History===
-The natural history of proctocolitis depends on the cause
-'''Food protein-induced proctocolitis (FPIP)'''
-*The symptoms of FPIP typically develop in the first two or three months of life in an exclusively breastfed infant. Symptoms resolve within 48hrs to 96 hrs following avoidance of trigger protein. Spontaneous resolution of symptoms may occur in 20% of the children without elimination of the offending protein. Most infants will be able to tolerate the offending protein by 1 to 3 years of age.<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="pmid22569527">{{cite journal| author=Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S et al.| title=Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. | journal=J Pediatr Gastroenterol Nutr | year= 2012 | volume= 55 | issue= 2 | pages= 221-9 | pmid=22569527 | doi=10.1097/MPG.0b013e31825c9482 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22569527  }} </ref><ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue=  | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530  }} </ref>
-*The natural history of FPIP that develop in adolescence or early adulthood is not fully characterized<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>
+*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
+*Symptoms of [[proctocolitis]] include fatigue, weight loss, [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].
-===Ischemic colitis===
+===Laboratory Findings===
-The presentation depends on the degree of bowel involvement. Mortality is high among those with full thickness bowel ischemia.<ref name="pmid18521689">{{cite journal| author=Abhishek K, Kaushik S, Kazemi MM, El-Dika S| title=An unusual case of hematochezia: acute ischemic proctosigmoiditis. | journal=J Gen Intern Med | year= 2008 | volume= 23 | issue= 9 | pages= 1525-7 | pmid=18521689 | doi=10.1007/s11606-008-0673-2 | pmc=2518031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18521689  }} </ref>
+Laboratory findings consistent with the diagnosis of proctitis include:
-===Complications===
+*[[Stool examination]]: Detection of  [[blood]] or fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
+*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].
+*An elevated [[erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]]) is one typical finding in the acute exacerbation of [[proctocolitis]].
-===Prognosis===
+===Other Imaging Findings===
-==Diagnosis==
+====Colonoscopy====
-===Diagnostic Criteria===
+[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]].<br />
-===History and Symptoms===
+==Treatment==
-===Physical Examination===
+===Medical Therapy===
+Acute [[proctocolitis]] among individuals with receptive anal exposure is often [[sexually-transmitted]]. [[Empiric therapy|Empiric]] [[antibiotic]] treatment should be started while awaiting for the results of laboratory tests for
-===Laboratory Findings===
+patients presenting with anorectal [[exudate]] on anoscopy or positive [[Gram staining|Gram]]-stained [[Smear test|smear]] of [[anorectal]] exudate or secretions [[polymorphonuclear leukocytes]] or if anoscopy or Gram stain is not available.<ref name="pmid24275725">{{cite journal| author=Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M| title=The etiology of infectious proctitis in men who have sex with men differs according to HIV status. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 10 | pages= 768-70 | pmid=24275725 | doi=10.1097/OLQ.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275725  }}</ref>
-===Imaging Findings===
+====Recommended Regimen for Acute Proctitis====
+'''[[Ceftriaxone]]''' 500 mg IM in a single dose
-===Other Diagnostic Studies===
+plus
-==Treatment==
+'''[[Doxycycline]]''' 100 mg orally 2 times/day for 7 days
-===Medical Therapy===
-*All patients with proctocolitis should be treated.
+*[[Doxycycline]] course is continued to 100 mg orally 2 times/day for 21 days in case of [[Perianal abscess|perianal]] or [[mucosal]] [[Ulcer|ulcers]], [[Dysentery|bloody]] [[discharge]], or [[tenesmus]] and a positive [[rectal]] [[chlamydia]] test.
-*Treatment of proctocolitis is similar to that of proctitis.
+*For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
-*Generally, the following regimen is recommended:
+*Patients presenting with [[mucosal]] or [[Perianal abscess|perianal]] ulcers or [[bloody diarrhea]] with positive [[Nucleic acid test|NAAT]] for [[chlamydia]] should receive [[Empiric therapy|empiric]] therapy for [[Lymphogranuloma venereum|Lymphogranuloma Venereum]] (LGV)  with a prolonged course of [[doxycycline]] 100 mg orally 2 times/day for 3 weeks.<ref name="pmid25394161">{{cite journal| author=Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ| title=Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. | journal=J Int AIDS Soc | year= 2014 | volume= 17 | issue= 4 Suppl 3 | pages= 19657 | pmid=25394161 | doi=10.7448/IAS.17.4.19657 | pmc=4225278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25394161  }}</ref>
-:: Preferred regimen: [[Ceftriaxone]] 250 mg IM {{and}} [[Doxycycline]] 100 mg PO bid for 7 days
+*Patients presenting with [[painful]] [[Perianal abscess|perianal]] [[Ulcer|ulcers]] or [[mucosal]] [[Ulcer|ulcers]] on anoscopy should also receive [[Empiric therapy|empiric]] treatment for [[genital herpes]].
-To view additional treatment and special considerations for the management of proctitis/proctocolitis, click [[proctitis medical therapy|'''here''']].
+*[[Herpes Genitalis|Herpes]] [[proctocolitis]] and [[Lymphogranuloma venereum|LGV]] occur predominantly among [[HIV AIDS|HIV/AIDS]] patients; hence [[Empiric therapy|empiric]] treatment in those patients should cover [[Herpes simplex|genital herpes]] and [[Lymphogranuloma venereum|LGV]].
 ===Surgery===
+Surgical intervention is not recommended for the management of [[proctocolitis]].
-===Prevention===
+==Primary Prevention==
+As [[proctocolitis]] can be a sexually transmitted disease, effective measures for the primary prevention of [[proctocolitis]] include:
-==See also==
+*[[Counseling]] on safe sex practices
-* [[Colitis]]
+*Avoiding contact with feces during [[sexual intercourse]]
-* [[Proctitis]]
+*Hand washing after handing objects or materials that have been in contact with the [[Anal-oral contact|anal]] area (i.e., sex toys or barriers) and after touching the anal area.
-==References==
+==Secondary Prevention==
-{{reflist|2}}
+Effective measures for the secondary prevention of [[proctocolitis]] include:
+*Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
+*Sexual partners with individuals treated for [[Chlamydia infection|chlamydia]] or [[gonorrhea]] <60 days before the onset of  symptoms should receive evaluation and empiric treatment of the causative infection
+*Testing for other sexually-transmitted diseases
+*In case of [[proctocolitis]] caused by [[Chlamydia infection|chlamydia]] or [[Neisseria gonorrhoeae|Neisseria gonorrhea]], retesting for the causative organism is recommended 3 months after completion of treatment.
 ==References==
 {{Reflist|2}}
+{{WH}}
+{{WS}}
-[[Category:Inflammations]]
 [[Category:Gastroenterology]]
+[[Category:Crowdiagnosis]]
+[[Category:Emergency medicine]]
 [[Category:Disease]]
-[[Category:Crowdiagnosis]]
+[[Category:Up-To-Date]]
-{{WH}}
-{{WS}}
-{{jb1}}