Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-in-Chief: M.Umer Tariq ; Maham Khan ; Ogheneochuko Ajari, MB.BS, MS ; Rim Halaby, M.D. ; Qasim Salau, M.B.B.S., FMCPaed 
Synonyms and Keywords: Colitis, Proctocolitis, Proctitis, Enterocolitis.
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.
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|
Classification by Anatomy
- 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)
- Enterocolitis: When it involves the small intestine in addition to the colon
Schematic of Anatomical Classification of Colitis
Classification by Age
Classification by duration of symptoms
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)
- Upper Gastrointestinal Infections
- Meckel diverticulum
- Intestinal duplication cysts
- Vascular malformations
- Inflammatory bowel disease(early onset)
- Hirschsprung disease complicated by enterocolitis
- Gastro-duodenal ulcers
- Gastrointestinal duplication cyst
- Liver disease with clotting factor deficiency
- Lymphonodular hyperplasia
Differential diagnosis in Adults
- Colorectal malignancy
- Crohn's disease
- Behcet's disease
- Arteriovenous malformation
- Systemic lupus erythematosus(SLE)
- Cytomegalovirus colitis
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:
|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|
Common tests which may reveal diagnosis of colitis include:
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
Causes in Alphabetical Order
Life Threatening Causes
- 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
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- 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.