Colitis: Difference between revisions

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__NOTOC__
__NOTOC__
{{DiseaseDisorder infobox |
{{Colitis}}
  Name          = Colitis |
   
  ICD10          = {{ICD10|K|50| |k|50}} - K52 |
{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}}; {{Mohamed riad}}<br>
  ICD9          = {{ICD9|558}} |
  Image          = |
  Caption        = |
  DiseasesDB    = 31340 |
  ICDO          = |
  OMIM          = 191390 |
  MedlinePlus    = 001125 |
  eMedicineSubj  = ped |
  eMedicineTopic = 435 |
  MeshName      = Colitis |
  MeshNumber    = C06.405.205.265 |
}}
{{SI}}


{{CMG}}; {{AE}} {{MUT}}; {{MK}}; {{Rim}}
{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.


{{SK}} autoimmune colitis, ulcerative colitis, Crohn's colitis, infectious colitis, pseudomembranous colitis, enterohemorrhagic colitis, microscopic colitis, lymphocytic colitis, collagenous colitis, diversion colitis, chemical colitis, ischemic colitis, indeterminate colitis, atypical colitis, fulminant colitis, immune mediated colitis, immune colitis
==Overview==
==Overview==
 
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]].
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either acute or chronic.


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


Notes:
===Classification by Anatomy===
* 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.
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:
* [[Irritable bowel syndrome]], a separate disease, has been called spastic colitis or spastic colonThis 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.
*[[Proctitis]]: When it involves the [[rectum]]
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|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: 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''' (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>
 
==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===
 
*[[Colorectal cancer|Colorectal malignancy]]
*[[Crohn's disease]]
*[[Behçet's disease|Behcet's disease]]
*[[Arteriovenous malformation]]
*[[Diverticulosis]]
*Enteritis
*[[Coagulopathy]]
*[[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:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721  }} </ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Rectal bleeding
!Abdominal pain
!Atopy
!Dehydration
!Fever
!Hypotension
!Malnutrition
!Blood in stool (frank or occult)
!Microorganism in stool
!Pseudomembranes on endoscopy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
|}


==Causes==
==Causes==
===Common Causes===
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===
===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" | No underlying causes
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|- bgcolor="LightSteelBlue"
|'''Chemical / poisoning'''
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|'''Dental'''
|bgcolor="Beige"|  
| bgcolor="Beige" |[[Dental braces]]
[[Chemical colitis]],
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
|'''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|'''Drug Side Effect'''
|bgcolor="Beige"|  
| 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]]
[[Alosetron (patient information)]],
[[ampicillin oral (patient information)]],
[[auranofin]],
[[aztreonam injection (patient information)]],
[[azithromycin]],
[[cefadroxil (patient information)]],
[[cefaclor]],
[[cefamandole nafate injection (patient information)]],
[[cefazolin sodium injection (patient information)]],
[[cefepime injection (patient information)]],
[[cefepime]],
[[cefoperazone sodium injection (patient information)]],
[[cefotaxime sodium]],
[[cefotaxime sodium injection (patient information)]],
[[cefotetan disodium injection (patient information)]],
[[cefoxitin sodium injection (patient information)]],
[[cefpodoxime (patient information)]],
[[ceftazidime injection (patient information)]],
[[ceftizoxime sodium injection (patient information)]],
[[ceftriaxone sodium injection (patient information)]],
[[cefuroxime sodium injection (patient information)]],
[[cephalexin (patient information)]],
[[cephalosporin]],
[[cephradine oral (patient information)]],
[[clindamycin]],
[[co-amoxiclav]],
[[corticosteroid]],
[[darifenacin (patient information)]],
[[dicloxacillin (patient information)]],
[[dirithromycin (patient information)]],
[[enoxacin (patient information)]],
[[ertapenem]],
[[erythromycin and sulfisoxazole (patient information)]],
[[ethynodiol diacetate and ethinyl estradiol]],
[[flucytosine]],
[[glycopyrrolate (patient information)]],
[[hyoscyamine (patient information)]],
[[idelalisib]],
[[imipenem and cilastatin sodium injection (patient information)]],
[[ipilimumab]],
[[lanthanum (patient information)]],
[[leflunomide]],
[[levofloxacin oral (patient information)]],  
[[lincomycin hydrochloride]],
[[linezolid]],
[[lomefloxacin (patient information)]],
[[loracarbef (patient information)]],
[[methotrexate (patient information)]],
[[miconazole injection (patient information)]],
[[moxifloxacin]],
[[nafcillin sodium injection (patient information)]],  
[[nivolumab]],  
[[norfloxacin (patient information)]],
[[ofloxacin injection (patient information)]],
[[oxacillin sodium injection (patient information)]],
[[oxybutynin (patient information)]],
[[peginterferon alfa-2a (patient information)]],
[[peginterferon alfa-2b (patient information)]],
[[pembrolizumab]]
[[penicillin]],
[[piperacillin sodium injection (patient information)]],
[[prednisolone]],
[[procyclidine (patient information)]],
[[propantheline (patient information)]],
[[reserpine (patient information)]],
[[solifenacin (patient information)]],
[[sparfloxacin (patient information)]],
[[tegaserod (patient information)]]
 
|-
|-
|-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"|  
| 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]]
Aganglionic [[Megacolon]],
[[Irritable bowel syndrome]],
[[Ischemic colitis]],
[[Inflammatory bowel disease]],
[[Lymphocytic colitis]],
[[Microscopic colitis]],
[[Crohn disease]],
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
|'''Genetic'''
|bgcolor="Beige"|  
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
[[Albinism]],
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
|'''Hematologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|'''Iatrogenic'''
|bgcolor="Beige"|  
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
[[Diversion colitis]],
[[EVAR]],
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|'''Infectious Disease'''
|bgcolor="Beige"|  
| 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]]
[[Bacterial gastroenteritis]],
[[Bacillary dysentery]],
[[Campylobacter jejuni]],
[[Chlamydia trachomatis]],
[[Clostridium difficile]],
[[Cryptosporidiosis]],
[[Cytomegalovirus]],
[[Escherichia coli O157:H7]],
[[Entamoeba histolytica]],
[[Isosporiasis]],
[[Neisseria gonorrhoeae]],
[[Treponema pallidum]],
Typhlitis,
[[Yersinia enterocolitica]],
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|'''Musculoskeletal / Ortho'''
|bgcolor="Beige"|  
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
[[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"|  
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
[[Gerson diet]],
[[Milk allergy]],
 
|-
|-
|-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"|  
| bgcolor="Beige" |[[Autistic enterocolitis]]
[[Autistic enterocolitis]],
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
|'''Pulmonary'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|'''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|'''Rheum / Immune / Allergy'''
|bgcolor="Beige"|  
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
[[Behcet disease]],
[[Collagenous colitis]],
[[Dental braces]],
[[Inflammatory bowel disease]],
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
|'''Sexual'''
|bgcolor="Beige"| No underlying causes
| 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"|  
| bgcolor="Beige" |Microscopic colitis
[[Multiple organ dysfunction syndrome]],
 
|-
|-
|}
|}


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


===Physical Examination===
===History and Symptoms===
* [[Abdominal tenderness]]
 
* [[Fever]]
*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
* [[Hypotension]] and [[tachycardia]]
*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:


===Diagnostic Tests===
*[[Stool examination]]: Detection of  [[blood]] or fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
Colitis is associated with the following findings:
*[[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]].
* Swelling of the colon tissue
*An elevated [[erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]]) is one typical finding in the acute exacerbation of [[proctocolitis]].
* [[Bleeding]]
* [[Erythema]] (redness) of the surface of the colon
* [[Ulcer]]ations of the colon


Common tests  which reveal these signs include:
===Other Imaging Findings===
* [[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.
====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]] [[Ulcer|ulcers]].<br />


==Treatment==
==Treatment==
===Medical Therapy===
===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.
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
 
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>
 
====Recommended Regimen for Acute Proctitis====
'''[[Ceftriaxone]]''' 500 mg IM in a single dose


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]].
plus


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.
'''[[Doxycycline]]''' 100 mg orally 2 times/day 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 failedREMICADE 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 bodyIt is administered through a series of infusions.
*[[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.
*For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
*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>
*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]].
*[[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===
===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.
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-oral contact|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 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==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Inflammations]]
[[Category:Digestive diseases]]
[[Category:Conditions diagnosed by stool test]]
[[Category:Disease]]


{{WH}}
{{WH}}
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[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Latest revision as of 22:21, 14 August 2021

Colitis Microchapters

Overview

Classification

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

Differential Diagnosis

Causes

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
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:

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

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
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

Laboratory Findings

Laboratory findings consistent with the diagnosis of proctitis include:

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

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

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