What is colitis?
Colitis means inflammation of the colon. The colon, also known as the large intestine or large bowel, constitutes the last part of the digestive tract. The colon is a long, muscular tube that receives digested food from the small intestine. It removes water from the undigested food, stores the undigested food, and then eliminates it from the body through bowel movements. The rectum is the last part of the colon adjacent to the anus.
There are many different types of colitis with different causes. Some examples of colitis include:
- infectious colitis caused by bacteria (such as shigella, Campylobacter, E. coli, and C. difficile)
- infectious colitis caused by a virus (such as cytomegalovirus [CMV])
- radiation colitis (such as following treatment with radiation for prostate cancer)
- ischemic colitis (such as blockage of an artery in the colon by a blood clot. If the blood clot interrupts the flow of blood to a segment of the colon, the result is inflammation of that segment and, sometimes, even death [gangrene] of the segment)
- Crohn's disease and ulcerative colitis (two related conditions that are caused by abnormalities of the body's immune system in which the body inappropriately makes antibodies and chemicals that attack the colon). Crohn's disease and ulcerative colitis are also referred to as inflammatory bowel disease (IBD).
Infectious, radiation, ischemic, ulcerative, and Crohn's colitis all have visible abnormalities of the inner lining of the colon. These abnormalities include edema (swelling of the lining), redness, bleeding from the lining with gentle rubbing (friability), and ulcers. These abnormalities can be seen during colonoscopy (examination of the entire colon using a long flexible viewing tube) or flexible sigmoidoscopy (examination of the rectum and the sigmoid colon - the segment of the colon closest to the rectum).
Edema and inflammation of the colon's lining interferes with the absorption of water from the undigested food, and the unabsorbed water exits the rectum as diarrhea. Pus and fluid also are secreted into the colon and add to the diarrhea. The redness, bleeding from the lining with gentle rubbing (friability), and ulcerations in the lining of the colon contribute to the rectal bleeding.
What diseases are not colitis?
Individuals with irritable bowel syndrome (IBS) do not have colitis, even though this condition is sometimes referred to as having "spastic colitis." These individuals may have symptoms that mimic colitis such as diarrhea, abdominal pain, and mucus in stool. Nevertheless, there is no inflammation of the colon in patients with IBS. The cause of symptoms in IBS is not clearly known; it may be caused by either abnormal motility (abnormal contractions) of the intestinal muscles or abnormally sensitive nerves in the intestines (visceral hypersensitivity).
What is microscopic colitis?
Microscopic colitis refers to inflammation of the colon that is only visible when the colon's lining is examined under a microscope. The appearance of the inner colon lining in microscopic colitis is normal by visual inspection during colonoscopy or flexible sigmoidoscopy. The diagnosis of microscopic colitis is made when a doctor, while performing colonoscopy or flexible sigmoidoscopy, takes biopsies (small samples of tissue) of the normal-appearing lining, and then examines the biopsies under a microscope.
There are two types of microscopic colitis: 1) lymphocytic colitis and 2) collagenous colitis.
- In lymphocytic colitis, there is an accumulation of lymphocytes (a type of white blood cell) within the lining of the colon.
- In collagenous colitis, there is an additional layer of collagen (scar tissue) just below the lining.
Some experts believe that lymphocytic colitis and collagenous colitis represent different stages of the same disease.
The inflammation and the collagen probably interfere with absorption of water from the colon, resulting in the diarrhea.
What are the symptoms for colitis?
Signs and symptoms of pseudomembranous colitis may include:
- Diarrhea that can be watery or even bloody
- Abdominal cramps, pain or tenderness
- Pus or mucus in your stool
Symptoms of pseudomembranous colitis can begin as soon as one to two days after you start taking an antibiotic, or as long as several weeks after you finish taking the antibiotic.
When to see a doctor
If you are currently taking or have recently taken antibiotics and you develop Diarrhea, contact your doctor, even if the Diarrhea is relatively mild. Also, see your doctor any time you have severe Diarrhea, with Fever, painful Abdominal cramps, or blood or pus in your stool.
What are the causes for colitis?
Usually, your body keeps the many bacteria in your colon in a naturally healthy balance. However, antibiotics and other medications can upset this balance. Pseudomembranous colitis occurs when certain bacteria — usually C. difficile — rapidly outgrow other bacteria that normally keep them in check. Certain toxins produced by C. difficile, which are usually present in only tiny amounts, rise to levels high enough to damage the colon.
While almost any antibiotic can cause pseudomembranous colitis, some antibiotics are more likely to cause pseudomembranous colitis than others:
- Fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin)
- Penicillins, such as amoxicillin and ampicillin
- Clindamycin (Cleocin)
- Cephalosporins, such as cefixime (Suprax)
Other medications besides antibiotics can sometimes cause pseudomembranous colitis. Chemotherapy drugs that are used to treat cancer may disrupt the normal balance of bacteria in the colon.
Certain diseases that affect the colon, such as ulcerative colitis or Crohn's disease, may also predispose people to pseudomembranous colitis.
C. difficile spores are resistant to many common disinfectants and can be transmitted from the hands of health care professionals to patients. Increasingly, C. difficile has been reported in people with no known risk factors, including people with no recent health care contact or use of antibiotics. This is called community-acquired C. difficile.
What are the treatments for colitis?
The treatment of microscopic colitis has not been standardized because there have not been adequate large scale, prospective, placebo controlled treatment trials. The following strategies are safe and may relieve diarrhea in some patients:
- Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) and the other drugs mentioned under causes of microscopic colitis.
- Trial of lactose elimination (just to eliminate the possibility that intolerance to lactose in milk is aggravating the diarrhea)
- Antidiarrhea agents such as loperamide (Imodium) or diphenoxylate and atropine (Lomotil)
- Bismuth subsalicylate (Pepto-Bismol)
- budesonide (Entocort EC)
- 5-ASA (mesalamine) compounds such as Asacol, Pentasa, or Colazal
Controlled trials showed that budesonide (Entocort, a poorly absorbed steroid) is effective in controlling diarrhea in more than 75% of the patients with collagenous colitis, but the diarrhea tends to recur soon after stopping Entocort.
Though data supporting their use is lacking, some doctors may use medications that potently suppress the immune system such as azathioprine (Imuran, Azasan) and 6-mercaptopurine in patients with severe microscopic colitis that is unresponsive to other treatments.
What are the risk factors for colitis?
Factors that may increase your risk of pseudomembranous colitis include:
- Taking antibiotics
- Staying in the hospital or a nursing home
- Increasing age, especially over 65 years
- Having a weakened immune system
- Having a colon disease, such as inflammatory bowel disease or colorectal cancer
- Undergoing intestinal surgery
- Receiving chemotherapy treatment for cancer
Is there a cure/medications for colitis?
Ulcerative colitis is often treated with either medication therapy or surgery. Certain medication classifications may be effective in curing ulcerative colitis. The type you choose will be determined by the severity of your disease.
Drugs that work well for one person may not work well for another, so it may take some time to discover a medication that works for you. Furthermore, because some medications have major side effects, you must consider the benefits and dangers of any treatment.
Anti-inflammatory medicines are frequently used as the first step in the therapy of ulcerative colitis and are suitable for the vast majority of patients. These medications include:
Suppressors of the immune system
These medications also lower inflammation, but they do so by blocking the immune system response that initiates the inflammatory process. For some persons, a combo of these medicines is more effective than either drug alone.
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan)
- Cyclosporine (Gengraf, Neoral, Sandimmune)
- Cyclosporine (Gengraf, Neoral, Sandimmune)
This type of therapy targets proteins produced by the immune system. The following biologics are used to cure ulcerative colitis:
- Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi)
- Vedolizumab (Entyvio)
- Ustekinumab (Stelara)
Additional medications may be required to treat specific ulcerative colitis symptoms. Before using over-the-counter drugs, always consult your doctor.
- Anti-diarrheal medications
- Pain relievers
- Iron supplements
Severe bleeding,A hole in the colon (perforated colon),Severe dehydration,Bone loss (osteoporosis),Inflammation of your skin, joints and eyes,An increased risk of colon cancer,A rapidly swelling colon
5-aminosalicylates,Corticosteroids,Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan),Cyclosporine (Gengraf, Neoral, Sandimmune),Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi),Vedolizumab (Entyvio),Ustekinumab (Stelara),Pain relievers,Antispasmodics,Iron supplements
Diarrhea, frequently with blood or pus,Cramping and pain in the abdomen,Rectal discomfort,Rectal bleeding is the passing of a tiny amount of blood with the stool,Urgency to urinate,Loss of the ability to urinate despite a strong need,Loss of weight,Fatigue,Fever,Failure to grow in children