One of the most rapidly developing challenges we have in this world is to deal with Colitis, I came to discover its existence the moment my friend was admitted in hospital due to severe abdominal pain that is literally unbearable. He was in so much pain that I had to make a point of researching about this “new” illness. Here is a little from my research that I could share with you.
Definition of Colitis
The term colitis is generally used to refer to the inflammation of the large intestines (the colon, rectum and the caecum) in plural it is called collitides. The inflammation is majorly brought about by infections, poor blood supply or by autoimmune diseases (body’s immune system fighting its own cells). The condition may be acute and heals spontaneously without treatment (self-limiting) or it may be chronic with associated morbidity and mortality in severe cases.
Anatomy of the colon
The large intestines are divided into majorly three parts: the ascending colon, the transverse and descending colon. On the right side is the ascending colon, appendix and caecum, the mid portion is the transverse and on the left side is the descending colon that joins up with the sigmoid portion which then connects to the rectum and opens out through the anus.
The major role of the colon is to absorb water and ‘push’ nitrogenous waste through the anus by elimination. It has numerous layers of which the outer smooth muscles aid in the process of pushing the nitrogenous products (poop) out of the body and the inner mucus layer is responsible for water and electrolytes (sodium, potassium, chlorides e.t.c) absorption .This mucosal layer is the target site for inflammation.
Signs and symptoms of Colitis
As there are many conditions that present with colitis, the presentation depends on the etiology (cause) of the inflammation and factors that aggravate (make worse) the underlying condition. Common signs include: abdominal tenderness, observable weight loss, fever, diarhoea, blood in stool that may be seen (overt) or occult blood (cannot be seen by the naked eye but has to be determined microscopically). Symptoms include: Abdominal Pain, Lethargy, Loss of Appetite, Cramping and Bloated-ness.
Types of Colitis
This is cause by bacteria, viruses or parasites. Some of the conditions are food borne illnesses also known as food poisoning that are caused by bacteria such as Shigella,Escherichia coli(E-coli),Salmonella and Camphylobacter. These organisms either produce toxins(poisons) that destroy the mucosal layer of the colonic wall or directly attack the wall. The infection produces bloody diarrhea and may lead to dehydration due poor absorption of water and electrolytes.
Parasites such as Gardia lamblia and Entamoeba histolytica can also destroy the integrity of the mucosal layer leading to inflammation. Such infections can be traced to drinking of un-boiled or un-treated water and eating contaminated foods
Pseudomembranous colitis is a unique case caused by a bacterium called Clostridium difficle which causes formation of a pseudomembrane(not a real membrane or layer) on top of the mucosal layer. It occurs in situations where the patient is on long term antibiotic therapy which affects the normal gut bacteria and encourages growth of the Clostridium difficle which releases an enterotoxin ( a poison in the gut) that mediates the inflammation. The infection presents with fever and often with non bloody diarrhea
Ischaemia means lack of blood supply to cells leading to cell death and inflammation of the surrounding areas. Arteries supplying blood to the colon just like in other organs can be narrowed by diseases such as arthrosclerosis (narrowing of blood vessels due to deposition of cholesterol on the inner layer of the vessels).In the heart this narrowing causes heart attack while in the brain it causes stroke. In the colon it causes inflammation of the mucosal layer.
The lack of blood supply can also be mechanical like in the case of a volvulus where the long tube coils on itself and cuts blood supply or in the occurrence of an abdominal hernia (a portion of the intestine gets trapped in an out pouching of the abdomen in the case of a weak area. Such situations cut blood supply and inflammation ensues characterized by sharp abdominal pains, fever and bloody bowel movements accompanied by anemia and dehydration leading to shock
- Ulcerative colitis: this is an auto immune condition where the body produces immune cells that attack the mucosal cells leading to ulceration and open sores lining the colon. It begins down from the colon coming upwards it is associated with pain and bloody bowel movements
- Crohn’s disease: also auto immune in nature but has recently been categorized as an immune deficiency condition as the body tries to produce immune cells against infectious bacteria and destroys normal cells. It may begin from the esophagus down to the colon and usually has alternating healthy and the inflamed mucosa. Presents with pain, diarrhea which is bloody and weight loss
Microscopic colitis: this may be lymphocytic or collagenous in nature in which case when observed microscopically the lining is infiltrated (filled) with either lymphocytes or collagenous cells that induce an inflammatory reaction. Pain and watery diarrhea are the major features
The mucosal layer can become irritated by ingested chemicals or drugs administered anully (through the anus like enemas and suppositories) leading to ulceration of the cells
Diagnosis and Treatment of Colitis
This is arrived through the patient’s history, physical examination and laboratory tests like the complete blood count, stool for ova and cyst, occult blood analysis and other tests like colonoscopy(use of a light guided camera to view the colon),computed tomography(CT) and abdominal x-rays
Fulminant colitis: this is the colitis that worsens rapidly and apart from the obvious symptoms of pain. Diarrhea and fever the patient presents with severe abdominal pains and shock can occur. In such situations the patients requires immediate surgery
Irritable bowel syndrome: this is a symptom based diagnosis that is classified as spastic colitis. It could be wrong to assume that colitis is always a cause of IBS as it is causes are miltifactorial in nature though colitis is one of them
This depends on the etiology of the colitis.
- infectious form can be treated using antimicrobial drugs e.g antibiotics and antifungal (for the parasitic infections)
- Autoimmune type can be managed by use of steroids to reduce the inflammation,cytotoxic drugs to destroy the immune cells and immune modulators
- Ischemic colitis if mechanical is treated through surgery to correct the volvulus or hernia while the atherosclerotic cause can be managed by vasodilators that increase the size of the vessel
- Chemical colitis can be corrected through avoidance of the irritant.
Opiates are the general mainstay therapy as they help to control pain which is the major symptom in all cases morphine, pethidine, fentanyl are the opiates of choice.
Non steroidal anti-inflammatory agents are avoided in this situation due to their side effect of causing ulceration to the GIT which causes further abdominal pain.