Colitis

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Colitis
Cryptitis high mag.jpg
A micrograph demonstrating cryptitis, a microscopic correlate of colitis. H&E stain.
Specialty Gastroenterology

Colitis is swelling or inflammation of the large intestine (colon). [1] Colitis may be acute and self-limited or long-term. It broadly fits into the category of digestive diseases.

Contents

In a medical context, the label colitis (without qualification) is used if:

Signs and symptoms

The signs and symptoms of colitis are quite variable and dependent on the cause of the given colitis and factors that modify its course and severity. [2]

Common symptoms of colitis may include: mild to severe abdominal pains and tenderness (depending on the stage of the disease), persistent hemorrhagic diarrhea with pus either present or absent in the stools, fecal incontinence, flatulence, fatigue, loss of appetite and unexplained weight loss. [3]

More severe symptoms may include: shortness of breath, a fast or irregular heartbeat and fever. [3]

Other less common or rare non-specific symptoms that may accompany colitis include: arthritis, mouth ulcers, painful, red and swollen skin and irritated, bloodshot eyes. [3]

Signs seen on colonoscopy include: colonic mucosal erythema (redness of the colon's inner surface), ulcerations and hemorrhage.[ medical citation needed ]

Diagnosis

Symptoms suggestive of colitis are worked-up by obtaining the medical history, a physical examination and laboratory tests (CBC, electrolytes, stool culture and sensitivity, stool ova and parasites et cetera). Additional tests may include medical imaging (e.g. abdominal computed tomography, abdominal X-rays) and an examination with a camera inserted into the rectum (sigmoidoscopy, colonoscopy). [4]

An important investigation in the assessment of colitis is biopsy for histopathology. A very small piece of tissue (usually about 2mm) is removed from the bowel mucosa during endoscopy and examined under the microscope by a histopathologist. A biopsy report generally does not state the diagnosis, but should state any presence of chronic colitis, give an indication of disease activity, as well as state the presence of any epithelial damage (erosions and ulcerations). [5]

Histopathology findings generally associated with chronic colitis include: [5]

Other findings include basal plasmacytosis and mucin depletion. [5] Histopathology findings generally associated with active colitis include: [5]

Types

There are many types of colitis. They are usually classified by the cause.

Types of colitis include:

Micrograph showing intestinal crypt branching, a histopathological finding of chronic colitis. H&E stain. Crypt branching high mag.jpg
Micrograph showing intestinal crypt branching, a histopathological finding of chronic colitis. H&E stain.
Micrograph of collagenous colitis. H&E stain. Collagenous colitis - intermed mag.jpg
Micrograph of collagenous colitis. H&E stain.
Micrograph of a colonic pseudomembrane, as may be seen in Clostridioides difficile colitis, a type of infectious colitis. Colonic pseudomembranes low mag.jpg
Micrograph of a colonic pseudomembrane, as may be seen in Clostridioides difficile colitis, a type of infectious colitis.

Autoimmune

Unknown

Treatment-caused

Vascular disease

Infectious

A subtype of infectious colitis is Clostridioides difficile colitis, [7] which is informally abbreviated as "C-diff colitis". It classically forms pseudomembranes and is often referred to as pseudomembranous colitis, which is its (nonspecific) histomorphologic description.

Enterohemorrhagic colitis may be caused by Shiga toxin in Shigella dysenteriae or Shigatoxigenic group of Escherichia coli (STEC), which includes serotype O157:H7 and other enterohemorrhagic E. coli. [8]

Parasitic infections, like those caused by Entamoeba histolytica , can also cause colitis.

Unclassifiable colitides

Indeterminate colitis is the classification for colitis that has features of both Crohn's disease and ulcerative colitis. [9] Indeterminate colitis' behaviour is usually closer to ulcerative colitis than Crohn's disease. [10]

Atypical colitis is a phrase that is occasionally used by physicians for a colitis that does not conform to criteria for accepted types of colitis. It is not an accepted diagnosis per se and, as such, a colitis that cannot be definitively classified.[ citation needed ]

Treatment

Treatment for this condition can include medications such as steroids and dietary changes.  In some instances, hospitalization and surgery may be required. [11]

Moreover, several studies recently have found significant relationship between colitis and dairy allergy (including: cow milk, cow milk UHT and casein), [12] [13] [14] [15] suggesting some patients may benefit from an elimination diet.

Microbiome modification

The use of oral probiotic supplements to modify the composition and behavior of the microbiome has been considered as a possible therapy for both induction and maintenance of remission in people with Crohn's disease and ulcerative colitis. A Cochrane review in 2020 did not find clear evidence of improved remission likelihood, nor lower adverse events, in people with Crohn's disease, following probiotic treatment. [16]

For ulcerative colitis, there is low-certainty evidence that probiotic supplements may increase the probability of clinical remission. [17] People receiving probiotics were 73% more likely to experience disease remission and over 2x as likely to report improvement in symptoms compared to those receiving a placebo, with no clear difference in minor or serious adverse effects. [17] Although there was no clear evidence of greater remission when probiotic supplements were compared with 5‐aminosalicylic acid treatment as a monotherapy, the likelihood of remission was 22% higher if probiotics were used in combination with 5-aminosalicylic acid therapy. [17] Whereas in people who are already in remission, it is unclear whether probiotics help to prevent future relapse, either as a monotherapy or combination therapy. [18]

Research

In the lab, the CRISPR-Cas systems effectively killed C. difficile bacteria. Researchers tested this approach in mice infected with C. difficile. Two days after the CRISPR treatment, the mice showed reduced C. difficile levels. Next steps include retooling the phage to prevent C. difficile from returning after the initial effective killing. [19]

In 2022, Yang et al. published a report on a successful treatment, using mesenchymal stem cells, of experimental colitis in mice. [20]

Additional research was conducted by Huang et al. that analyzed specific genes and biological markers that are associated with the risk of colon cancer development in patients with colitis. The results showed a correlation between certain biomarkers and the development of disease. [21]

Colitis is common in parts of the world where helminthic colonisation is rare, and uncommon in those areas where most people carry worms. Infections with helminths may alter the autoimmune response that causes the disease. Early trials of Trichuris suis ova (TSO) showed promising results when used in people with IBD [22] [23] [24] [25] but later trials failed at Phase 2, and most were eventually discontinued. [26] However, the phase 2 trials had used a different formulation of TSO from the one that had been used in the earlier studies that had shown positive outcomes. [27]

Related Research Articles

<i>Trichuris trichiura</i> Parasitic roundworm that causes intestinal infection

Trichuris trichiura, Trichocephalus trichiuris or whipworm, is a parasitic roundworm that causes trichuriasis when it infects a human large intestine. It is commonly known as the whipworm which refers to the shape of the worm; it looks like a whip with wider "handles" at the posterior end.

<span class="mw-page-title-main">Crohn's disease</span> Type of inflammatory bowel disease

Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the gastrointestinal tract may include anemia, skin rashes, arthritis, inflammation of the eye, and fatigue. The skin rashes may be due to infections as well as pyoderma gangrenosum or erythema nodosum. Bowel obstruction may occur as a complication of chronic inflammation, and those with the disease are at greater risk of colon cancer and small bowel cancer.

<span class="mw-page-title-main">Ulcerative colitis</span> Inflammatory bowel disease that causes ulcers in the colon

Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease. It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.

<span class="mw-page-title-main">Inflammatory bowel disease</span> Medical condition

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, with Crohn's disease and ulcerative colitis (UC) being the principal types. Crohn's disease affects the small intestine and large intestine, as well as the mouth, esophagus, stomach and the anus, whereas UC primarily affects the colon and the rectum.

<span class="mw-page-title-main">Toxic megacolon</span> Potentially lethal large intestine emergency

Toxic megacolon is an acute form of colonic distension. It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.

In medicine, the ileal pouch–anal anastomosis (IPAA), also known as restorative proctocolectomy (RPC), ileal-anal reservoir (IAR), an ileo-anal pouch, ileal-anal pullthrough, or sometimes referred to as a J-pouch, S-pouch, W-pouch, or a pelvic pouch, is an anastomosis of a reservoir pouch made from ileum to the anus, bypassing the former site of the colon in cases where the colon and rectum have been removed. The pouch retains and restores functionality of the anus, with stools passed under voluntary control of the person, preventing fecal incontinence and serving as an alternative to a total proctocolectomy with ileostomy.

<span class="mw-page-title-main">Megacolon</span> Medical condition

Megacolon is an abnormal dilation of the colon. This leads to hypertrophy of the colon. The dilation is often accompanied by a paralysis of the peristaltic movements of the bowel. In more extreme cases, the feces consolidate into hard masses inside the colon, called fecalomas, which can require surgery to be removed.

<span class="mw-page-title-main">Helminthic therapy</span> Deliberate infestation with parasitic worms

Helminthic therapy, an experimental type of immunotherapy, is the treatment of autoimmune diseases and immune disorders by means of deliberate infestation with a helminth or with the eggs of a helminth. Helminths are parasitic worms such as hookworms, whipworms, and threadworms that have evolved to live within a host organism on which they rely for nutrients. These worms are members of two phyla: nematodes, which are primarily used in human helminthic therapy, and flat worms (trematodes).

<span class="mw-page-title-main">Blood in stool</span> Medical condition

Blood in stool or rectal bleeding looks different depending on how early it enters the digestive tract—and thus how much digestive action it has been exposed to—and how much there is. The term can refer either to melena, with a black appearance, typically originating from upper gastrointestinal bleeding; or to hematochezia, with a red color, typically originating from lower gastrointestinal bleeding. Evaluation of the blood found in stool depends on its characteristics, in terms of color, quantity and other features, which can point to its source, however, more serious conditions can present with a mixed picture, or with the form of bleeding that is found in another section of the tract. The term "blood in stool" is usually only used to describe visible blood, and not fecal occult blood, which is found only after physical examination and chemical laboratory testing.

Pouchitis is an umbrella term for inflammation of the ileal pouch, an artificial rectum surgically created out of ileum in patients who have undergone a proctocolectomy or total colectomy. The ileal pouch-anal anastomosis is created in the management of patients with ulcerative colitis, indeterminate colitis, familial adenomatous polyposis, cancer, or rarely, other colitides.

<span class="mw-page-title-main">Microscopic colitis</span> Medical condition

Microscopic colitis refers to two related medical conditions which cause diarrhea: collagenous colitis and lymphocytic colitis. Both conditions are characterized by the presence of chronic non-bloody watery diarrhea, normal appearances on colonoscopy and characteristic histopathology findings of inflammatory cells.

<span class="mw-page-title-main">Collagenous colitis</span> Medical condition

Collagenous colitis is an inflammatory condition of the colon. Together with the related condition lymphocytic colitis, it is a subtype of microscopic colitis, which is characterized by inflammation that specifically affects the colon, and a clinical presentation that involves watery diarrhea but a lack of rectal bleeding. Microscopic colitis does not usually cause macroscopic changes to the colon that allow a visual diagnosis during colonoscopy, instead causing microscopic changes that can be detected through histopathological examination of colonic biopsies. The nature of these microscopic changes is what differentiates collagenous from lymphocytic colitis, with the characteristic finding in collagenous colitis being depositions of collagen in the connective tissue between the colonic glands. Collagenous colitis, and microscopic colitis as a whole, is sometimes considered to be an inflammatory bowel disease (IBD) along with Crohn's disease and ulcerative colitis. However, little is known about the etiology of microscopic colitis, and so the degree of similarity to the inflammatory bowel diseases is uncertain.

Management of Crohn's disease involves first treating the acute symptoms of the disease, then maintaining remission. Since Crohn's disease is an immune system condition, it cannot be cured by medication or surgery. Treatment initially involves the use of medications to eliminate infections and reduce inflammation. Surgery may be required for complications such as obstructions, fistulae, abscesses, or if the disease does not respond to drugs within a reasonable time. However, surgery cannot cure Crohn's disease. It involves removing the diseased part of the intestine and rejoining the healthy ends, but the disease tends to recur after surgery.

Management of ulcerative colitis involves first treating the acute symptoms of the disease, then maintaining remission. Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon. The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset which often leads to anaemia. Ulcerative colitis is, however, a systemic disease that affects many parts of the body outside the intestine.

Dysbiosis is characterized by a disruption to the microbiome resulting in an imbalance in the microbiota, changes in their functional composition and metabolic activities, or a shift in their local distribution. For example, a part of the human microbiota such as the skin flora, gut flora, or vaginal flora, can become deranged, with normally dominating species underrepresented and normally outcompeted or contained species increasing to fill the void. Similar to the human gut microbiome, diverse microbes colonize the plant rhizosphere, and dysbiosis in the rhizosphere, can negatively impact plant health. Dysbiosis is most commonly reported as a condition in the gastrointestinal tract or plant rhizosphere.

<span class="mw-page-title-main">Biological therapy for inflammatory bowel disease</span>

Biological therapy, the use of medications called biopharmaceuticals or biologics that are tailored to specifically target an immune or genetic mediator of disease, plays a major role in the treatment of inflammatory bowel disease. Even for diseases of unknown cause, molecules that are involved in the disease process have been identified, and can be targeted for biological therapy. Many of these molecules, which are mainly cytokines, are directly involved in the immune system. Biological therapy has found a niche in the management of cancer, autoimmune diseases, and diseases of unknown cause that result in symptoms due to immune related mechanisms.

<span class="mw-page-title-main">Pancolitis</span> Medical condition

Pancolitis, in its most general sense, refers to inflammation of the entire colon. This can be caused by a variety of things. Pancolitis or universal colitis is frequently used in a more specific fashion to denote a very severe form of ulcerative colitis. This form of ulcerative colitis is spread throughout the entire large intestine including the right colon, the left colon, the transverse colon, descending colon, and the rectum. A diagnosis can be made using a number of techniques but the most accurate method is direct visualization via a colonoscopy. Symptoms are similar to those of ulcerative colitis but more severe and affect the entire large intestine. Patients with ulcerative colitis generally exhibit symptoms including rectal bleeding as a result of ulcers, pain in the abdominal region, inflammation in varying degrees, and diarrhea. Pancolitis patients exhibit these symptoms and may also experience fatigue, fever, and night sweats. Due to the loss of function in the large intestine patients may lose large amounts of weight from being unable to procure nutrients from food. In other cases the blood loss from ulcers can result in anemia which can be treated with iron supplements. Additionally, due to the chronic nature of most cases of pancolitis, patients have a higher chance of developing colon cancer.

<span class="mw-page-title-main">Enteropathic arthropathy</span> Medical condition

Enteropathic arthropathy commonly referred to as enteropathic arthritis, is a type of arthritis linked to Crohn's disease, ulcerative colitis, and chronic inflammatory bowel diseases.

<span class="mw-page-title-main">Segmental colitis associated with diverticulosis</span> Medical condition

Segmental colitis associated with diverticulosis (SCAD) is a condition characterized by localized inflammation in the colon, which spares the rectum and is associated with multiple sac-like protrusions or pouches in the wall of the colon (diverticulosis). Unlike diverticulitis, SCAD involves inflammation of the colon between diverticula, while sparing the diverticular orifices. SCAD may lead to abdominal pain, especially in the left lower quadrant, intermittent rectal bleeding and chronic diarrhea.

Shomron Ben-Horin is an Israeli physician, a co-founder & Chief Medical Officer of Evinature, and professor of medicine at the Tel-Aviv University.

References

  1. ↑ "Colitis". www.pennmedicine.org. July 1, 2021. Retrieved 2022-11-18.
  2. ↑ "Ulcerative colitis - Symptoms and causes". Mayo Clinic. Retrieved 2024-04-11.
  3. 1 2 3 NHS Choices. "Ulcerative colitis - Symptoms - NHS Choices". www.nhs.uk. Retrieved 2015-11-03.
  4. ↑ "Diagnosis of Ulcerative Colitis | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2022-11-18.
  5. 1 2 3 4 Kellermann L, Riis LB. (2021). "A close view on histopathological changes in inflammatory bowel disease, a narrative review". Dig Med Res. 4 (3): 3. doi: 10.21037/dmr-21-1 .
  6. ↑ Elghobashy M, Steed H (2024). "Ulcerative colitis". Medicine. 52 (4): 232–237. doi:10.1016/j.mpmed.2024.01.001. ISSN   1357-3039.
  7. ↑ "Clostridium Difficile Colitis – Overview". WebMD, LLC. Retrieved 2006-09-15.
  8. ↑ Beutin L (September 2006). "Emerging enterohaemorrhagic Escherichia coli, causes and effects of the rise of a human pathogen". Journal of Veterinary Medicine. B, Infectious Diseases and Veterinary Public Health. 53 (7): 299–305. doi:10.1111/j.1439-0450.2006.00968.x. PMID   16930272.
  9. ↑ Romano C, Famiani A, Gallizzi R, Comito D, Ferrau' V, Rossi P (December 2008). "Indeterminate colitis: a distinctive clinical pattern of inflammatory bowel disease in children". Pediatrics. 122 (6): e1278–e1281. doi:10.1542/peds.2008-2306. PMID   19047226. S2CID   1409823.
  10. ↑ Melton GB, Kiran RP, Fazio VW, He J, Shen B, Goldblum JR, et al. (October 2010). "Do preoperative factors predict subsequent diagnosis of Crohn's disease after ileal pouch-anal anastomosis for ulcerative or indeterminate colitis?". Colorectal Disease. 12 (10): 1026–1032. doi:10.1111/j.1463-1318.2009.02014.x. PMID   19624520. S2CID   44406331.
  11. ↑ "Treatment for Ulcerative Colitis - NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2024-04-20.
  12. ↑ Yang M, Geng L, Chen P, Wang F, Xu Z, Liang C, et al. (March 2015). "Effectiveness of dietary allergen exclusion therapy on eosinophilic colitis in Chinese infants and young children ≤ 3 years of age". Nutrients. 7 (3): 1817–1827. doi: 10.3390/nu7031817 . PMC   4377883 . PMID   25768952.
  13. ↑ Lucendo AJ, Serrano-Montalbán B, Arias Á, Redondo O, Tenias JM (July 2015). "Efficacy of Dietary Treatment for Inducing Disease Remission in Eosinophilic Gastroenteritis". Journal of Pediatric Gastroenterology and Nutrition. 61 (1): 56–64. doi: 10.1097/MPG.0000000000000766 . PMID   25699593. S2CID   26195645.
  14. ↑ Judaki A, Hafeziahmadi M, Yousefi A, Havasian MR, Panahi J, Sayehmiri K, et al. (2014). "Evaluation of dairy allergy among ulcerative colitis patients". Bioinformation. 10 (11): 693–696. doi:10.6026/97320630010693. PMC   4261114 . PMID   25512686.
  15. ↑ Sun J, Lin J, Parashette K, Zhang J, Fan R (February 2015). "Association of lymphocytic colitis and lactase deficiency in pediatric population". Pathology, Research and Practice. 211 (2): 138–144. doi:10.1016/j.prp.2014.11.009. PMID   25523228.
  16. ↑ Limketkai BN, Akobeng AK, Gordon M, Adepoju AA (2020-07-17). Cochrane Gut Group (ed.). "Probiotics for induction of remission in Crohn's disease". Cochrane Database of Systematic Reviews. 2020 (7): CD006634. doi:10.1002/14651858.CD006634.pub3. PMC   7389339 . PMID   32678465.
  17. 1 2 3 Kaur L, Gordon M, Baines PA, Iheozor-Ejiofor Z, Sinopoulou V, Akobeng AK (2020-03-04). Cochrane IBD Group (ed.). "Probiotics for induction of remission in ulcerative colitis". Cochrane Database of Systematic Reviews. 3 (3): CD005573. doi:10.1002/14651858.CD005573.pub3. PMC   7059959 . PMID   32128795.
  18. ↑ Iheozor-Ejiofor Z, Kaur L, Gordon M, Baines PA, Sinopoulou V, Akobeng AK (2020-03-04). Cochrane IBD Group (ed.). "Probiotics for maintenance of remission in ulcerative colitis". Cochrane Database of Systematic Reviews. 3 (3): CD007443. doi:10.1002/14651858.CD007443.pub3. PMC   7059960 . PMID   32128794.
  19. ↑ "Study shows CRISPR effectiveness against colitis pathogen". medicalxpress.com. Retrieved 2020-03-13.
  20. ↑ Yang F, Ni B, Liu Q, He F, Li L, Zhong X, et al. (September 2022). "Human umbilical cord-derived mesenchymal stem cells ameliorate experimental colitis by normalizing the gut microbiota". Stem Cell Research & Therapy. 13 (1): 475. doi: 10.1186/s13287-022-03118-1 . PMC   9476645 . PMID   36104756.
  21. ↑ Huang Y, Zhang X, Li Y, Yao J (June 2022). "Identification of hub genes and pathways in colitis-associated colon cancer by integrated bioinformatic analysis". BMC Genomic Data. 23 (1): 48. doi: 10.1186/s12863-022-01065-7 . PMC   9219145 . PMID   35733095.
  22. ↑ Summers RW, Elliott DE, Urban JF, Thompson RA, Weinstock JV (2005). "Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial". Gastroenterology. 128 (4): 825–32. doi: 10.1053/j.gastro.2005.01.005 . PMID   15825065.
  23. ↑ Pommerville J (2014). Fundamentals of microbiology. Burlington, MA: Jones & Bartlett Learning. ISBN   978-1-4496-8861-5.
  24. ↑ Elliott DE, Weinstock JV (November 2012). "Where are we on worms?". Current Opinion in Gastroenterology. 28 (6): 551–6. doi:10.1097/MOG.0b013e3283572f73. PMC   3744105 . PMID   23079675.
  25. ↑ Weinstock JV, Elliott DE (March 2013). "Translatability of helminth therapy in inflammatory bowel diseases". International Journal for Parasitology. 43 (3–4): 245–51. doi:10.1016/j.ijpara.2012.10.016. PMC   3683647 . PMID   23178819. Early clinical trials suggested that exposure to helminths such as Trichuris suis or Necator americanus can improve IBD.
  26. ↑ Coronado Biosciences (November 7, 2013). "Coronado Biosciences Announces Independent Data Monitoring Committee Recommendation to Discontinue Falk Phase 2 Trial of TSO in Crohn's Disease". Archived from the original on August 16, 2016. Retrieved August 16, 2016.
  27. ↑ Parker W (December 2017). "Not infection with parasitic worms, but rather colonization with therapeutic helminths". Immunology Letters. 196: 104–105. doi:10.1016/j.imlet.2017.07.008. PMID   28720335.
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