Enteritis

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Enteritis
Crohn's ileitis - biopsy, intermed. mag.1.jpg
Tissue of the ileum with inflammatory changes due to Crohn's disease
Specialty Internal medicine
Symptoms Diarrhoea; fever; abdominal pain, abdominal bloating; nutrient deficiencies
Complications Dehydration, headache, electrolyte imbalance; sepsis (infectious enteritis); tissue dysplasia, cancer; small intestine bacterial overgrowth
CausesInfectious; autoimmune; ischemic; radiation; toxic; idiopathic; other

Enteritis is inflammation of the small intestine. It is most commonly caused by food or drink contaminated with pathogenic microbes, [1] such as Serratia , but may have other causes such as NSAIDs, radiation therapy as well as autoimmune conditions like Crohn's disease and coeliac disease. Symptoms include abdominal pain, cramping, diarrhoea, dehydration, and fever. [1] Related diseases of the gastrointestinal system (including gastritis, gastroenteritis, colitis, and enterocolitis) involve inflammation of the stomach and large intestine.

Contents

Duodenitis, jejunitis, and ileitis are subtypes of enteritis which are localised to a specific part of the small intestine. Inflammation of both the stomach and small intestine is referred to as gastroenteritis. [2]

Signs and symptoms

Signs and symptoms of enteritis are highly variable and vary based on the specific cause and other factors such as individual variance and stage of disease. Symptoms may include abdominal pain, cramping, diarrhea, [3] dehydration, fever, nausea, vomiting, and weight loss. [4]

Causes

Autoimmune

Crohn's disease – also known as regional enteritis, it can occur along any surface of the gastrointestinal tract. The most common location for Crohn's disease to manifest, with or without the involvement of the colon or other parts of the GI tract, is in the terminal ileum (the final segment of the small intestine). [5] In 40% of cases, it is limited to the small intestine. [6]

Coeliac disease – caused by an autoimmune reaction to gluten by genetically predisposed individuals. [6]

Eosinophilic gastroenteritis, also known as eosinophilic enteropathy or eosinophilic enteritis [7] – a rare and heterogeneous condition where eosinophils build up in the gastrointestinal tract and blood vessels, leading to polyp formation, necrosis, inflammation and ulcers. [8] It is most commonly seen in patients with a history of atopy, however is overall relatively uncommon. [9]

Infectious enteritis

In Germany, 90% of cases of infectious enteritis are caused by four pathogens, Norovirus, Rotavirus , Campylobacter and Salmonella . [10] Other common causes of infectious enteritis include bacteria such as Shigella and E. coli, as well as viruses such as adenovirus, astrovirus and calicivirus. Other less common pathogens include Bacillus cereus, Clostridium perfringens, Clostridium difficile and Staphylococcus aureus . [11]

Campylobacter jejuni is one of the most common sources of infectious enteritis, and the most common bacterial pathogen found in two-year-old and smaller children with diarrhoea. [12] It has been linked to consumption of contaminated water and food, most commonly poultry and milk. [13] [14] The disease tends to be less severe in developing countries, due to the constant exposure which people have with the antigen in the environment, leading to early development of antibodies. [12]

Rotavirus is responsible for infecting 140 million people and causing 1 million deaths each year, mostly in children younger than five years. [6] [15] This makes it the most common cause of severe childhood diarrhoea and diarrhea-related deaths in the world. [6] It selectively targets mature enterocytes in the small intestine, causing malabsorption, as well as inducing secretion of water. It has also been observed to cause villus ischemia, and increase intestinal motility. [15] The net result of these changes is induced diarrhoea.[ citation needed ]

Enteritis necroticans is an often fatal illness, caused by β-toxin of Clostridium perfringens. [16] This causes inflammation and segments of necrosis throughout the gastrointestinal tract. It is most common in developing countries; however, it has also been documented in post-World War II Germany. [16] Risk factors for enteritis necroticans include decreased trypsin activity, which prevent intestinal degradation of the toxin, and reduced intestinal motility, which increases likelihood of toxin accumulation.[ citation needed ]

Vascular disease

Ischemic enteritis is uncommon compared to ischemic colitis due to the highly vascularised nature of the small intestine, [17] allowing for sufficient blood flow in most situations. It develops due to circulatory shock of mesenteric vessels in the absence of major vessel occlusion, often associated with an underlying condition such as hypertension, arrhythmia, or diabetes. [17] Thus, it has been considered to be associated with atherosclerosis. [18] Surgical treatment is usually required due to the likelihood of stenosis or complete occlusion of the small intestine. [17] Ischemic damage can range from mucosal infarction, which is limited only to the mucosa; mural infarction of the mucosa and underlying submucosa; to transmural infarction of the full thickness of the gastrointestinal wall. Mucosal and mural infarcts in and of themselves may not be fatal, however may progress further to a transmural infarct. [6] This has the potential for perforation of the wall, leading to peritonitis.[ citation needed ]

Radiation enteritis

Inflammation of the gastrointestinal tract is common after treatment with radiation therapy to the abdomen or pelvis. [19] It is classified as early if it manifests within the first three months, and delayed if it manifests three months after treatment. Early radiation enteritis is caused by cell death of the crypt epithelium and subsequent mucosal inflammation, however usually subsides after the course of radiation therapy is completed. Delayed radiation enteritis is a chronic disease which has a complex pathogenesis involving changes in the majority of the intestinal wall. [19] [20]

Diagnosis

Diagnosis may be simple in cases where the patient's signs and symptoms are idiopathic. However, this is generally not the case, considering that many pathogens which cause enteritis may exhibit similar symptoms, especially early in the disease. In particular, campylobacter, shigella, salmonella and many other bacteria induce acute self-limited colitis, an inflammation of the lining of the colon which appears similar under the microscope. [6]

A medical history, physical examination and tests such as blood counts, stool cultures, CT scans, MRIs, PCRs, colonoscopies and upper endoscopies may be used in order to perform a differential diagnosis. [9] [11] [16] [21] A biopsy may be required to obtain a sample for histopathology.[ citation needed ]

Treatment

Mild cases usually do not require treatment and will go away after a few days in healthy people. [6] [11] In cases where symptoms persist or when it is more severe, specific treatments based on the initial cause may be required.[ citation needed ]

In cases where diarrhea is present, replenishing fluids lost is recommended, and in cases with prolonged or severe diarrhoea which persists, intravenous rehydration therapy or antibiotics may be required. [22] A simple oral rehydration therapy (ORS) can be made by dissolving one teaspoon of salt, eight teaspoons of sugar and the juice of an orange into one litre of clean water. [23] Studies have shown the efficacy of antibiotics in reducing the duration of the symptoms of infectious enteritis of bacterial origin, however antibiotic treatments are usually not required due to the self-limiting duration of infectious enteritis. [11]

Autoimmune

Autoimmune causes of enteritis such as Crohn's disease require significant chronic treatment to avoid nutritional deficiencies, cancer, bacterial overgrowth, and other complications. [5] Some patients with mild forms of the disease may not need treatment, but a majority of people with Crohn's disease require glucocorticoid medications. [24]

For treating eosinophilic gastroenteritis, the main treatment is usually a corticosteroid medication, as these have been shown to have good efficacy in managing eosinophilic gastroenteritis. Other treatments include modifying diets to avoid food allergies, azathioprine and antibodies, including mepolizumab, omalizumab, infliximab, and adalimumab. [7]

Etymology

The word enteritis ( /ˌɛntəˈraɪtɪs/ ) uses combining forms of entero- and -itis , both Neo-Latin from Greek, respectively from ἑντερον (enteron, small intestine) and -ιτις (-itis, inflammation).[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Diarrhea</span> Loose or liquid bowel movements

Diarrhea, also spelled diarrhoea or diarrhœa in British English, is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

<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">Upper gastrointestinal series</span> Radiographs used to examine abnormalities of the digestive system excluding the colon

An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of radiographs used to examine the gastrointestinal tract for abnormalities. A contrast medium, usually a radiocontrast agent such as barium sulfate mixed with water, is ingested or instilled into the gastrointestinal tract, and X-rays are used to create radiographs of the regions of interest. The barium enhances the visibility of the relevant parts of the gastrointestinal tract by coating the inside wall of the tract and appearing white on the film. This in combination with other plain radiographs allows for the imaging of parts of the upper gastrointestinal tract such as the pharynx, larynx, esophagus, stomach, and small intestine such that the inside wall lining, size, shape, contour, and patency are visible to the examiner. With fluoroscopy, it is also possible to visualize the functional movement of examined organs such as swallowing, peristalsis, or sphincter closure. Depending on the organs to be examined, barium radiographs can be classified into "barium swallow", "barium meal", "barium follow-through", and "enteroclysis". To further enhance the quality of images, air or gas is sometimes introduced into the gastrointestinal tract in addition to barium, and this procedure is called double-contrast imaging. In this case the gas is referred to as the negative contrast medium. Traditionally the images produced with barium contrast are made with plain-film radiography, but computed tomography is also used in combination with barium contrast, in which case the procedure is called "CT enterography".

<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">Malabsorption</span> Medical condition

Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal (GI) tract. Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a variety of anaemias.

<span class="mw-page-title-main">Gastroenteritis</span> Inflammation of the stomach and small intestine

Gastroenteritis, also known as infectious diarrhea or simply as gastro, is an inflammation of the gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration may also occur. This typically lasts less than two weeks. Although it is not related to influenza, in the U.S. and U.K., it is sometimes called the "stomach flu".

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

Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.

<span class="mw-page-title-main">Colitis</span> Inflammation of the colon (large intestine)

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

<span class="mw-page-title-main">Small intestinal bacterial overgrowth</span> Medical condition

Small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowth, or small bowel bacterial overgrowth syndrome (SBBOS), is a disorder of excessive bacterial growth in the small intestine. Unlike the colon, which is rich with bacteria, the small bowel usually has fewer than 100,000 organisms per millilitre. Patients with bacterial overgrowth typically develop symptoms which may include nausea, bloating, vomiting, diarrhea, malnutrition, weight loss and malabsorption, which is caused by a number of mechanisms.

<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.

Enteropathy refers to any pathology of the intestine. Although enteritis specifically refers to an inflammation of the intestine, and is thus a more specific term than "enteropathy", the two phrases are sometimes used interchangeably.

<span class="mw-page-title-main">Abdominal distension</span> Physical symptom

Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion. It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right. People with this condition often describe it as "feeling bloated". Affected people often experience a sensation of fullness, abdominal pressure, and sometimes nausea, pain, or cramping. In the most extreme cases, upward pressure on the diaphragm and lungs can also cause shortness of breath. Through a variety of causes, bloating is most commonly due to buildup of gas in the stomach, small intestine, or colon. The pressure sensation is often relieved, or at least lessened, by belching or flatulence. Medications that settle gas in the stomach and intestines are also commonly used to treat the discomfort and lessen the abdominal distension.

<span class="mw-page-title-main">Protein losing enteropathy</span> Medical condition

Protein losing enteropathy (PLE) is a syndrome in which blood proteins are lost excessively via the gastrointestinal (GI) tract. It may be caused by many different underlying diseases that damage the lining of the GI tract (mucosa) or cause blockage of its lymphatic drainage.

Radiation enteropathy is a syndrome that may develop following abdominal or pelvic radiation therapy for cancer. Many affected people are cancer survivors who had treatment for cervical cancer or prostate cancer; it has also been termed pelvic radiation disease with radiation proctitis being one of the principal features.

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

Eosinophilic gastroenteritis, also known as eosinophilic enteritis, is a rare and heterogeneous condition characterized by patchy or diffuse eosinophilic infiltration of gastrointestinal (GI) tissue, first described by Kaijser in 1937. Presentation may vary depending on location as well as depth and extent of bowel wall involvement and usually runs a chronic relapsing course. It can be classified into mucosal, muscular and serosal types based on the depth of involvement. Any part of the GI tract can be affected, and isolated biliary tract involvement has also been reported. The stomach is the organ most commonly affected, followed by the small intestine and the colon.

Campylobacter upsaliensis is a gram-negative bacteria in the Campylobacter genus. C. upsaliensis is found worldwide, and is a common cause of campylobacteriosis in humans, as well as gastroenteritis in dogs and cats. Human infections are primarily associated with raw or undercooked meat and contaminated water sources, however there is some zoonotic risk associated with the spread from dogs and cats. C. upsaliensis primarily affects the gastrointestinal tract as it damages gastrointestinal epithelial cells. There are many methods for detecting C.upsaliensis including PCR and ELISA, however there is no current gold standard in detection techniques. Infection is typically self limiting, however there is antimicrobial therapy available.

Chronic diarrheaof infancy, also called toddler's diarrhea, is a common condition typically affecting up to 1.7 billion children between ages 6–30 months worldwide every year, usually resolving by age 4. According to the World Health Organization (WHO), diarrheal disease is the second greatest cause of death in children 5 years and younger. Diarrheal disease takes the lives of 525,000 or more children per year. Diarrhea is characterized as the condition of passing of three or more loose or watery bowel movements within a day sometimes with undigested food visible. Diarrhea is separated into three clinical categories; acute diarrhea may last multiple hours or days, acute bloody diarrhea, also known as dysentery, and finally, chronic or persistent diarrhea which lasts 2–4 weeks or more. There is normal growth with no evidence of malnutrition in the child experiencing persistent diarrhea. In chronic diarrhea there is no evidence of blood in the stool and there is no sign of infection. The condition may be related to irritable bowel syndrome. There are various tests that can be performed to rule out other causes of diarrhea that don't fall under the chronic criteria, including blood test, colonoscopy, and even genetic testing. Most acute or severe cases of diarrhea have treatment guidelines revolving around prescription or non prescription medications based on the cause, but the treatment protocols for chronic diarrhea focus on replenishing the body with lost fluids and electrolytes, because there typically isn't a treatable cause.

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

Ileitis is an inflammation of the ileum, a portion of the small intestine. Mycobacterium tuberculosis infection may mimic Crohn’s disease Ileitis. Ileitis may be linked to a broad range of illnesses, such as sarcoidosis, amyloidosis, ischemia, neoplasms, spondyloarthropathies, vasculitides, drug-related conditions, and eosinophilic enteritis.`

Bile acid malabsorption (BAM), known also as bile acid diarrhea, is a cause of several gut-related problems, the main one being chronic diarrhea. It has also been called bile acid-induced diarrhea, cholerheic or choleretic enteropathy, bile salt diarrhea or bile salt malabsorption. It can result from malabsorption secondary to gastrointestinal disease, or be a primary disorder, associated with excessive bile acid production. Treatment with bile acid sequestrants is often effective. It is recognised as a disability in the United Kingdom under the Equality Act 2010

References

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  15. 1 2 Ramig RF (2004-10-01). "Pathogenesis of intestinal and systemic rotavirus infection". Journal of Virology. 78 (19): 10213–10220. doi:10.1128/JVI.78.19.10213-10220.2004. ISSN   0022-538X. PMC   516399 . PMID   15367586.
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