Colitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M.Umer Tariq [2]; Maham Khan [3]; Rim Halaby, M.D. [4]

Synonyms and keywords: 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

Colitis is the inflammation of the colon, that can be either acute or chronic.

Classification

Classes of Colitis	Disorders
Autoimmune colitis	Ulcerative colitis Crohn's colitis
Infectious colitis	Pseudomembranous colitis (Clostridium difficile) Enterohemorrhagic colitis (Shigella dysenteriae or Shigatoxigenic group of Escherichia coli (STEC)) Parasite infection (Entamoeba histolytica)
Microscopic colitis	Lymphocytic colitis Collagenous colitis
Iatrogenic	Diversion colitis Chemical colitis
Vacular disease	Ischemic colitis
Unclassifiable	Indeterminate colitis (features of both Crohn's disease and ulcerative colitis) Atypical colitis

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.

Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	Chemical colitis,
Dermatologic	No underlying causes
Drug Side Effect	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)
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Aganglionic Megacolon, Irritable bowel syndrome, Ischemic colitis, Inflammatory bowel disease, Lymphocytic colitis, Microscopic colitis, Crohn disease,
Genetic	Albinism,
Hematologic	No underlying causes
Iatrogenic	Diversion colitis, EVAR,
Infectious Disease	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,
Musculoskeletal / Ortho	Ankylosing Spondylitis,
Neurologic	No underlying causes
Nutritional / Metabolic	Gerson diet, Milk allergy,
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Autistic enterocolitis,
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Behcet disease, Collagenous colitis, Dental braces, Inflammatory bowel disease,
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Multiple organ dysfunction syndrome,

Causes by Alphabetical Order

• Aganglionic megacolon
• Albinism
• Alosetron (patient information)
• Ampicillin Oral (patient information)
• Ankylosing Spondylitis
• Auranofin
• Autistic enterocolitis
• Azithromycin
• Aztreonam Injection (patient information)
• Bacillary dysentery
• Bacterial gastroenteritis
• Behcet disease
• Campylobacter jejuni
• Cefaclor
• Cefadroxil (patient information)
• Cefamandole Nafate Injection (patient information)
• Cefazolin Sodium Injection (patient information)
• Cefepime
• Cefepime Injection (patient information)
• Cefoperazone Sodium Injection (patient information)
• Cefotaxime Sodium Injection (patient information)
• Cefotetan Disodium Injection (patient information)
• Cefoxitin Sodium Injection (patient information)
• Cefpodoxime (patient information)
• Ceftazidime Injection (patient information)
• Ceftazidime
• Ceftizoxime Sodium Injection (patient information)
• Ceftriaxone Sodium Injection (patient information)
• Cefuroxime Sodium Injection (patient information)
• Cephalexin (patient information)
• Cephalosporin
• Cephradine Oral (patient information)
• Chemical colitis
• Chlamydia trachomatis
• Cidofovir
• Clindamycin
• Clostridium difficile
• Co-amoxiclav
• Colitis ulcerosa
• Collagenous colitis
• Corticosteroid
• Crohn disease
• Cryptosporidiosis
• Cytomegalovirus
• Cytomegalovirus
• Darifenacin (patient information)
• Dental braces
• Desogestrel and Ethinyl Estradiol
• Dicloxacillin (patient information)
• Dirithromycin (patient information)
• Diversion colitis
• Enoxacin (patient information)
• Entamoeba histolytica
• Ertapenem
• Erythromycin and Sulfisoxazole (patient information)
• Escherichia coli O157:H7
• EVAR
• Flucytosine
• Gerson diet
• Glycopyrrolate (patient information)
• Hyoscyamine (patient information)
• Imipenem and Cilastatin Sodium Injection (patient information)
• Infectious colitis
• Inflammatory bowel disease
• Irritable bowel syndrome
• Ischemic colitis
• Isosporiasis
• Ixabepilone
• Lanthanum (patient information)
• Levofloxacin Oral (patient information)
• Lincomycin Hydrochloride
• Linezolid
• Lomefloxacin (patient information)
• Loracarbef (patient information)
• Lymphocytic colitis
• Methotrexate (patient information)
• Miconazole Injection (patient information)
• Microscopic colitis
• Milk allergy
• Moxifloxacin
• Multiple organ dysfunction syndrome
• Nafcillin Sodium Injection (patient information)
• Neisseria gonorrhoeae
• Neonatal necrotizing enterocolitis
• Norfloxacin (patient information)
• Ofloxacin injection (patient information)
• Oxacillin Sodium Injection (patient information)
• Oxcarbazepine
• Oxybutynin (patient information)
• Peginterferon alfa-2a (patient information)
• Peginterferon alfa-2b (patient information)
• Penicillin
• Pergolide
• Piperacillin sodium injection (patient information)
• Pramipexole
• Prednisolone
• Procyclidine (patient information)
• Propantheline
• Pseudoephedrine
• Pseudomembranous colitis
• Quinolone
• Radiation colitis
• Reserpine
• Scleroderma
• Sepsis
• Solifenacin
• Sparfloxacin
• Syphilis
• [[Tegaserod]
• Treponema pallidum
• Typhilitis
• Ulcerative colitis
• Yersinia enterocolitica

Diagnosis

Symptoms

• Diarrhea
• Abdominal pain
• Rectal bleeding

Physical Examination

• Abdominal tenderness
• Fever
• Hypotension and tachycardia

Diagnostic Tests

Colitis is associated with the following findings:

• Swelling of the colon tissue
• Bleeding
• Erythema (redness) of the surface of the colon
• Ulcerations of the colon

Common tests which reveal these signs include:

• X-rays of the colon
• Testing the stool for blood and pus
• Sigmoidoscopy
• Colonoscopy

Additional tests include stool cultures and blood tests, 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 antibiotics and general anti-inflammatory medications such as Mesalamine or its derivatives, 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.

References

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