Colitis Explained

Colitis
Field: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.

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.

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.

Signs seen on colonoscopy include: colonic mucosal erythema (redness of the colon's inner surface), ulcerations and hemorrhage.[4]

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).[5]

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).[6]

Histopathology findings generally associated with chronic colitis include:[6] Other findings include basal plasmacytosis and mucin depletion.[6] Histopathology findings generally associated with active colitis include:[6]

Types

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

Types of colitis include:

Autoimmune

Unknown

Treatment-caused

Vascular disease

Infectious

A subtype of infectious colitis is Clostridioides difficile colitis,[8] 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.[9]

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.[10] Indeterminate colitis' behaviour is usually closer to ulcerative colitis than Crohn's disease.[11]

Treatment

Treatment for this condition can include medications such as steroids and dietary changes.  In some instances, hospitalization and surgery may be required.[12]

Moreover, several studies recently have found significant relationship between colitis and dairy allergy (including: cow milk, cow milk UHT and casein),[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. 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. 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

One study reported successfully treating experimental colitis in mice with mesenchymal stem cells.[19]

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.[20]

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[21] [22] [23] [24] but later trials failed at Phase 2, and most were eventually discontinued.[25] 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.[26]

Notes and References

  1. Web site: July 1, 2021 . Colitis . 2022-11-18 . www.pennmedicine.org.
  2. Web site: Ulcerative colitis - Symptoms and causes . 2024-04-11 . Mayo Clinic . en.
  3. Web site: Ulcerative colitis - Symptoms - NHS Choices. www.nhs.uk . 2015-11-03 . NHS Choices.
  4. Web site: Colonoscopy for ulcerative colitis: Why to get one, prep, and more . 30 July 2021 .
  5. Web site: Diagnosis of Ulcerative Colitis NIDDK . 2022-11-18 . National Institute of Diabetes and Digestive and Kidney Diseases . en-US.
  6. Kellermann L, Riis LB.. A close view on histopathological changes in inflammatory bowel disease, a narrative review.. Dig Med Res. 2021. 4. 3. 3 . 10.21037/dmr-21-1 . free .
  7. Elghobashy . Maiar . Steed . Helen . 2024 . Ulcerative colitis . Medicine . 52 . 4 . 232–237 . 10.1016/j.mpmed.2024.01.001 . 1357-3039.
  8. Web site: Clostridium Difficile Colitis – Overview . WebMD, LLC . 2006-09-15.
  9. Beutin L . 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 . September 2006 . 16930272 . 10.1111/j.1439-0450.2006.00968.x .
  10. Romano C, Famiani A, Gallizzi R, Comito D, Ferrau' V, Rossi P . Indeterminate colitis: a distinctive clinical pattern of inflammatory bowel disease in children . Pediatrics . 122 . 6 . e1278–e1281 . December 2008 . 19047226 . 10.1542/peds.2008-2306 . 1409823 .
  11. Melton GB, Kiran RP, Fazio VW, He J, Shen B, Goldblum JR, Achkar JP, Lavery IC, Remzi FH . 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 . October 2010 . 19624520 . 10.1111/j.1463-1318.2009.02014.x . 44406331 .
  12. Web site: Treatment for Ulcerative Colitis - NIDDK . 2024-04-20 . National Institute of Diabetes and Digestive and Kidney Diseases . en-US.
  13. Yang M, Geng L, Chen P, Wang F, Xu Z, Liang C, Li H, Fang T, Friesen CA, Gong S, Li D . Effectiveness of dietary allergen exclusion therapy on eosinophilic colitis in Chinese infants and young children ≤ 3 years of age . Nutrients . 7 . 3 . 1817–1827 . March 2015 . 25768952 . 4377883 . 10.3390/nu7031817 . free .
  14. Lucendo AJ, Serrano-Montalbán B, Arias Á, Redondo O, Tenias JM . Efficacy of Dietary Treatment for Inducing Disease Remission in Eosinophilic Gastroenteritis . Journal of Pediatric Gastroenterology and Nutrition . 61 . 1 . 56–64 . July 2015 . 25699593 . 10.1097/MPG.0000000000000766 . 26195645 . free .
  15. Sun J, Lin J, Parashette K, Zhang J, Fan R . Association of lymphocytic colitis and lactase deficiency in pediatric population . Pathology, Research and Practice . 211 . 2 . 138–144 . February 2015 . 25523228 . 10.1016/j.prp.2014.11.009 .
  16. Limketkai . Berkeley N . Akobeng . Anthony K . Gordon . Morris . Adepoju . Akinlolu Adedayo . 2020-07-17 . Cochrane Gut Group . Probiotics for induction of remission in Crohn's disease . Cochrane Database of Systematic Reviews . en . 2020 . 7 . CD006634 . 10.1002/14651858.CD006634.pub3 . 7389339 . 32678465.
  17. Kaur . Lakhbir . Gordon . Morris . Baines . Patricia Anne . Iheozor-Ejiofor . Zipporah . Sinopoulou . Vasiliki . Akobeng . Anthony K . 2020-03-04 . Cochrane IBD Group . Probiotics for induction of remission in ulcerative colitis . Cochrane Database of Systematic Reviews . en . 3 . 3 . CD005573 . 10.1002/14651858.CD005573.pub3 . 7059959 . 32128795.
  18. Iheozor-Ejiofor . Zipporah . Kaur . Lakhbir . Gordon . Morris . Baines . Patricia Anne . Sinopoulou . Vasiliki . Akobeng . Anthony K . 2020-03-04 . Cochrane IBD Group . Probiotics for maintenance of remission in ulcerative colitis . Cochrane Database of Systematic Reviews . en . 3 . 3 . CD007443 . 10.1002/14651858.CD007443.pub3 . 7059960 . 32128794.
  19. Yang F, Ni B, Liu Q, He F, Li L, Zhong X, Zheng X, Lu J, Chen X, Lin H, Xu R, He Y, Zhang Q, Zou X, Chen W . Human umbilical cord-derived mesenchymal stem cells ameliorate experimental colitis by normalizing the gut microbiota . Stem Cell Research & Therapy . 13 . 1 . 475 . September 2022 . 36104756 . 9476645 . 10.1186/s13287-022-03118-1 . free .
  20. Huang Y, Zhang X, Li Y, Yao J . Identification of hub genes and pathways in colitis-associated colon cancer by integrated bioinformatic analysis . BMC Genomic Data . 23 . 1 . 48 . June 2022 . 35733095 . 9219145 . 10.1186/s12863-022-01065-7 . free .
  21. Summers RW, Elliott DE, Urban JF, Thompson RA, Weinstock JV . Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial . Gastroenterology . 128 . 4 . 825–32 . 2005 . 15825065 . 10.1053/j.gastro.2005.01.005. free .
  22. Book: Pommerville J . Fundamentals of microbiology . Jones & Bartlett Learning . Burlington, MA . 2014 . 978-1-4496-8861-5.
  23. Elliott DE, Weinstock JV . Where are we on worms? . Current Opinion in Gastroenterology . 28 . 6 . 551–6 . November 2012 . 23079675 . 3744105 . 10.1097/MOG.0b013e3283572f73.
  24. Weinstock JV, Elliott DE . Translatability of helminth therapy in inflammatory bowel diseases . International Journal for Parasitology . 43 . 3–4 . 245–51 . March 2013 . 23178819 . 3683647 . 10.1016/j.ijpara.2012.10.016 . Early clinical trials suggested that exposure to helminths such as Trichuris suis or Necator americanus can improve IBD..
  25. Web site: Coronado Biosciences Announces Independent Data Monitoring Committee Recommendation to Discontinue Falk Phase 2 Trial of TSO in Crohn's Disease . Coronado Biosciences . August 16, 2016. dead. https://web.archive.org/web/20160816142726/https://globenewswire.com/news-release/2013/11/07/587752/10056769/en/Coronado-Biosciences-Announces-Independent-Data-Monitoring-Committee-Recommendation-to-Discontinue-Falk-Phase-2-Trial-of-TSO-in-Crohn-s-Disease.html. August 16, 2016 . November 7, 2013.
  26. Parker W . Not infection with parasitic worms, but rather colonization with therapeutic helminths . Immunology Letters . 196 . 104–105 . December 2017 . 10.1016/j.imlet.2017.07.008 . 28720335.

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