Chemical colitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [3]
Synonyms and keywords: Disinfectant colitis, Corrosive colitis, Iatrogenic colitis.
Overview
Chemical colitis is a type of colitis, an inflammation of the large intestine or colon, caused by the introduction of harsh chemicals to the colon by an enema or other procedure. Chemical colitis can resemble ulcerative colitis, infectious colitis and pseudomembranous colitis endoscopically.
Prior to 1950, hydrogen peroxide enemas were commonly used for certain conditions. This practice will often result in chemical colitis.
Soap enemas may also cause chemical colitis. [1] Harsh chemicals, such as compounds used to clean colonoscopes, are sometimes accidentally introduced into the colon during colonoscopy or other procedures. This can also lead to chemical colitis.
Chemical colitis may trigger a flare of ulcerative colitis or Crohn's disease.
Historical Perspective
Classification
Pathophysiology
Pathogenesis
Chemical colitis usually results from accidental or intentional rectal introduction of chemicals such as endoscopy cleaning solutions (glutaraldehyde and hydrogen peroxide), radiologic contrast material, hydrogen peroxide, soaps, formalin, hydrofluoric acid, alcohol, ammonia, lye, hot water, and herbal substances. Rarely it occurs from accidental ingestion of chemicals, such as accidental swallowing of hydrogen peroxide mouthwash during oral procedures.[2][3][4][5][6][7]
- The most common implicated chemical agents in the pathogenesis of chemical colitis are glutaraldehyde and/or hydrogen peroxide disinfectants. The improper cleaning of the endoscopes allows the disinfectants to remain on the endoscopes, subsequently causing a chemical proctocolitis when the endoscopes are used.
- The main mechanism for developing chemical colitis is the direct contact of the chemical agent with the mucosa, subsequently causing corrosive injury to the mucosa and activation of the inflammatory pathway. Reactive oxygen formation, lipid peroxidation and vascular smooth muscle contraction also occur in hydrogen peroxide-induced chemical colitis.
- The primary mucosa toxin in glutaraldehyde is not fully known. However, it may be related to aldehyde. In addition to direct damage, glutaraldehyde is thought to activate arachidonic acid pathway and recruitment of inflammatory cells and substances. [5]
- The symptoms of chemical colitis usually develop within 12 to 48 hours after introduction of the chemical, but may sometimes take days to weeks when frequent small dilute amount is ingested.[7]
Genetics
There are no identified genetic factors associated with chemical colitis.
Gross Pathology
Microscopic Histopathology
Differentiating chemical colitis from other Diseases
Epidemiology and Demographics
Age
Gender
Race
Risk Factors
Screening
There are no established screening guidelines for chemical colitis[8]
Natural History, Complications and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
Symptoms
Physical Examination
Laboratory Findings
Endoscopy
Other Diagnostic Studies
Barium enema
CT scan
Treatment
Medical Therapy
Surgical Therapy
Prevention
Primary prevention
Secondary prevention
References
- ↑ K. Harish, Severe colitis induced by soap enemas, Indian J. Gastroent., 2006 [1]
- ↑ Tortora A, Purchiaroni F, Scarpellini E, Ojetti V, Gabrielli M, Vitale G; et al. (2012). "Colitides". Eur Rev Med Pharmacol Sci. 16 (13): 1795–805. PMID 23208963.
- ↑ Sheibani S, Gerson LB (2008). "Chemical colitis". J Clin Gastroenterol. 42 (2): 115–21. doi:10.1097/MCG.0b013e318151470e. PMID 18209577.
- ↑ Lim CH, Lee HY, Kim WC, Cho SH, Jeong HS, Jeon YJ; et al. (2011). "[A case of chemical colitis caused by hydrogen peroxide enema]". Korean J Gastroenterol. 58 (2): 100–2. PMID 21873825.
- ↑ 5.0 5.1 West AB, Kuan SF, Bennick M, Lagarde S (1995). "Glutaraldehyde colitis following endoscopy: clinical and pathological features and investigation of an outbreak". Gastroenterology. 108 (4): 1250–5. PMID 7698592.
- ↑ Shih HY, Wu DC, Huang WT, Chang YY, Yu FJ (2011). "Glutaraldehyde-induced colitis: case reports and literature review". Kaohsiung J Med Sci. 27 (12): 577–80. doi:10.1016/j.kjms.2011.06.036. PMID 22208542.
- ↑ 7.0 7.1 Zanelli M, Ragazzi M, De Marco L (2016). "Chemical gastritis and colitis related to hydrogen peroxide mouthwash". Br J Clin Pharmacol. doi:10.1111/bcp.13100. PMID 27696496.
- ↑ US preventive service task force.chemical colitis. http://www.uspreventiveservicestaskforce.org/accessed on December 5, 2016