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* 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.
* 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==
== Images ==
 
The pathophysiology of colitis depends on the cause. Some pathogenetic mechanisms are not clearly understood.
 
===Genetics===
There is no specific genetic cause for proctocolitis. However, genetic predisposition may play a role in some causes.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue=  | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355  }} </ref><ref name="pmid26579126">{{cite journal| author=Loddo I, Romano C| title=Inflammatory Bowel Disease: Genetics, Epigenetics, and Pathogenesis. | journal=Front Immunol | year= 2015 | volume= 6 | issue=  | pages= 551 | pmid=26579126 | doi=10.3389/fimmu.2015.00551 | pmc=4629465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26579126  }} </ref>


===Gross pathology===
===Gross pathology===
Line 522: Line 517:
* [[Colonoscopy]]
* [[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.
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 exacerbation of colitis.
 
==Treatment==
===Medical Therapy===
Treatment of colitis depends on the cause of colitis. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[Mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation.
 
Changes in diet can be effective at treating the symptoms of colitis and easing the side effects. These can include reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]]. This approach has been championed by [[Elaine Gottschall]].
 
Hygienic and naturopathic doctors have taken the diet approach further,  attributing bowel inflammation to toxemia stemming from high-protein, fatty diets and other dietary irritants. Changing to a low-fat, minimally-processed, whole-foods diet per the Natural Hygiene self-healing system has been effective in eliminating symptoms and rebuilding health. Dr. Zarin Azar, MD,, is one advocate of this healing system.
 
Supportive treatment include correction of dehydration and anemia.
 
Example of empirical antibiotic regimen in colitis is [[Ceftriaxone]] 250 mg IM {{and}} [[Doxycycline]] 100 mg PO bid for 7 days
 
[[Infliximab]] (or REMICADE) - a drug originally produced to treat Rheumatoid Arthritis - has recently been approved for the treatment of Colitis where traditional treatments have failed.  REMICADE is a biologic therapy that recognizes, attaches to, and blocks the action of a protein in your body called tumor necrosis factor alpha (TNF-alpha). TNF-alpha is made by certain blood cells in your body.  It is administered through a series of infusions.
 
===Surgery===
Surgery in colitis is often done for complications. It may entail dilatation of strictures, removal of the affected part of the colon and creating a "pouch" with portions of the small intestine.
 
To view additional treatment and special considerations for the management of proctitis/proctocolitis, click [[proctitis medical therapy|'''here''']].
 
==See also==
* [[Colitis]]
* [[Proctitis]]


==References==   
==References==   

Revision as of 17:16, 17 January 2017

Colitis Microchapters

Overview

Classification

Allergic colitis
Infectious colitis
Ischemic colitis
Drug-induced colitis
Chemical colitis
Radiation colitis

Differential Diagnosis

Causes

For patient information on this topic, click here

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]

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

Overview

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

Classification

There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.

Classification by etiology

Classes of Colitis Disorders
Autoimmune
Allergic
Infectious colitis
Idiopathic
Iatrogenic
Vascular
Drug induced
Unclassifiable

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:[3]
*Regions 4 to 6: Enterocolitis
*Region 6: Colitis
*Regions 6 to 8: Proctocolitis
*Regions 7 to 8:Proctitis

Classification by Age

  • Infantile: More common in early infancy (first six months).[4][5][6]
  • Adults

Classification by duration of symptoms

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

Notes:

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

Images

Gross pathology

  • Allergic proctocolitis[8]

    Allergic proctocolitis[8]

  • Radiation Proctitis[9]

    Radiation Proctitis[9]

  • Pseudomembranous colitis. (WC) [10]

    Pseudomembranous colitis. (WC) [10]

  • Pseudomembranous colitis. [11]

    Pseudomembranous colitis. [11]

  • Ulcerative colitis.[12]

    Ulcerative colitis.[12]

Microscopic pathology

  • Ulcerative colitis. H&E staining showing crypt abscess, a characteristic finding in ulcerative colitis [13]

    Ulcerative colitis. H&E staining showing crypt abscess, a characteristic finding in ulcerative colitis [13]

  • Ulcerative colitis. H&E stain showing marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and distortion of the architecture of the crypts. [14]

    Ulcerative colitis. H&E stain showing marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and distortion of the architecture of the crypts. [14]

  • Ischemic colitis. H&E staining showing changes seen in ischemic colitis [15]

    Ischemic colitis. H&E staining showing changes seen in ischemic colitis [15]

  • Pseudomembranous colitis. H& E staining showing pseudomembranes in Clostridium colitis [16]

    Pseudomembranous colitis. H& E staining showing pseudomembranes in Clostridium colitis [16]


Differentiating Colitis from Other Diseases

Causes of colitis are diverse and may overlap with other disease. The differential diagnosis of colitis can be classified into two according to age group.

Differential diagnosis in Infants

Differential diagnosis in Infants

  • Colorectal malignancy
  • Crohn's disease
  • Behcet's disease
  • Arteriovenous malformation
  • Diverticuclosis
  • Infection
  • Coagulopathy
  • Systemic lupus erythematosus(SLE)

Differentiating between different forms of colitis

  • The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:[17][18]
Diseases History and Symptoms Physical Examination Laboratory findings
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 LGV (Lymphogranuloma Venereum), Neisseria gonorrhoeae, HSV, Shigella dysenteriae and Campylobacter species. It can also be allergic (for example food protein-induced proctocolitis), idiopathic (for example microscopic colitis), vascular (for example ischemic colitis), or autoimmune (for example inflammatory bowel disease).

Causes by Organ System

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
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Microscopic colitis

Causes in Alphabetical Order

The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}.
3

Life Threatening Causes

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

Diagnosis

Symptoms

Physical Examination

Diagnostic Tests

Colitis is associated with the following findings:

Common tests which reveal these signs include:

Additional tests include stool cultures and blood tests, including blood chemistry tests. A high erythrocyte sedimentation rate (ESR) is one typical finding in acute exacerbation of colitis.

References

  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
  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.
  3. ↑ WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016
  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.
  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.
  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.
  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.
  8. ↑ The Korean Academy of Medical Sciences. Allergic proctocolitis. http://dx.doi.org/10.3346/jkms.2007.22.2.213 Accessed on 31 August, 2016
  9. ↑ Wikipedia. Proctitis. https://en.wikipedia.org/wiki/Proctitis#/media/File:Radiation_proctitis3.jpg Accessed on August 31, 2016
  10. ↑ Libre Pathology. Pseudomembranous colitis. https://librepathology.org/wiki/Pseudomembranous_colitis Accessed on August 31, 2016
  11. ↑ Libre Pathology. Pseudomembranous colitis. https://librepathology.org Accessed on September 1, 2016
  12. ↑ Ulcerative colitis. Wikidoc. http://www.wikidoc.org/index.php/File:UC_granularity.png#filehistory Accessed on August 31, 2016
  13. ↑ Libre Pathology. https://librepathology.org/wiki/File:Ulcerative_colitis_(2)_active.jpg Accessed on September 1, 2016
  14. ↑ Libre Pathology. https://librepathology.org/wiki/File:Ulcerative_colitis_(2)_endoscopic_biopsy.jpg Accessed on September 1, 2016
  15. ↑ Wikipedia. Ischemic colitis. https://en.wikipedia.org/wiki/Ischemic_colitis#/media/File:Ischemic_colitis_-_high_mag.jpg Accessed on August 31, 2016
  16. ↑ Libre Pathology. Pseudomembranous colitis. https://librepathology.org/wiki/File:Colonic_pseudomembranes_low_mag.jpg Accessed on September 1, 2016
  17. ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.

References


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