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Colitis is an inflammation of the lining of the colon. Some of the common symptoms of this condition include abdominal cramping, frequent loose stools or persistent diarrhea, loss of control of bowel function, fever, and weight loss. There are many potential causes of colon inflammation, and its treatment typically depends on the cause.
Some forms of colitis might be caused by infection through bacteria, certain viruses and some parasites. For example, it might be caused by exposure to salmonella bacteria or an amoebic infection. Antibiotics or anti-parasitic medication typically are required to treat colon inflammation that has any of these causes.
Viruses such as rotavirus and norovirus also can cause colon inflammation and can result in dehydration, particularly in people who are very young or very old. Rest and increased fluid intake are often prescribed in these cases. If a person becomes severely dehydrated, however, he or she might need care in a hospital to receive intravenous fluids.
Certain diseases can predispose patients to attacks of colitis. The most frequent cause of colon inflammation in people who have intestinal diseases is Crohn’s disease, which is a degenerative intestinal disorder. A person who has Crohn’s disease is more prone to colon inflammation and to other serious conditions such as perforated bowel. He or she should see a healthcare professional immediately whenever any symptoms of colon inflammation are present, because any of these symptoms can necessitate medical treatment.
Many different diseases, disorders and conditions can cause colitis. Colitis can be a sign of inflammatory disorders, intestinal infections, lack of blood flow to the colon, and side effects of radiation or medication treatment. Because of the range of possible causes of colitis, a correct diagnosis of the underlying disease, disorder or condition is very important. Contact your healthcare provider for a physical exam.
Colitis is categorized based on the underlying disease, disorder or condition.
Colitis may arise from acute (sudden) or chronic (long-lasting) intestinal infections by viruses, bacteria and parasites including:
CMV colitis (infection caused by cytomegalovirus)
Cryptosporidium enterocolitis (parasitic infection)
Food poisoning from a wide variety of pathogens, such as botulism, cholera, E. coli, Listeria, Salmonella, Shigella and viruses
Pseudomembranous colitis (overgrowth of Clostridium difficile caused by antibiotic therapy)
Inflammatory causes of colitis include:
Crohn’s disease (inflammatory bowel disease that can affect any part of the digestive tract)
Microscopic colitis (inflammatory condition that must be diagnosed by looking at cells with a microscope; sometimes called collagenous colitis and lymphocytic colitis)
Ulcerative colitis (inflammatory bowel disease that only affects the colon)
Other causes of colitis can include:
Irritable bowel syndrome (IBS; digestive discomfort that does not cause intestinal damage or serious disease)
Ischemic colitis (insufficient flow of blood to the colon)
Necrotizing enterocolitis (disorder that primarily affects premature or sick infants and results in death of large intestine tissue)
Radiation of the colon
Symptoms of colitis will depend upon the type of colitis that is present, but in general, colitis most often is associated with abdominal pain and diarrhea.
Other symptoms of colitis that may or may not be present include:
Blood in the bowel movement may or may not be present. Diarrhea can sometimes cause hemorrhoids, which can bleed. However, blood with a bowel movement is not normal and the affected person should contact their health care practitioner or seek other medical care.
Tenesmus may exist; this is the constant urge to have a bowel movement.
The abdominal pain may come in waves, building to diarrhea, and then waning.
There may be constant pain.
Fever, chills, and other signs of infection and inflammation may be present depending upon the cause of colitis.
The treatment of one cause of colitis, necrotizing enterocolitis (NEC), includes cessation of feedings, nasogastric decompression, and intravenous fluid resuscitation with attention to electrolytes and acid-base balance. Antibiotics should be started as soon as cultures are obtained. Close monitoring with cardiorespiratory support is provided as required. Exploratory laparotomy with resection of bowel and external ostomy diversion is indicated if there is failure of medical management, erythema of abdominal wall, a single fixed loop, a palpable mass, and/or evidence of perforation (eg, pneumoperitoneum, brown paracentesis). Central venous access is needed after bowel resection for total parenteral nutrition. Closely monitor the child for complications of short bowel syndrome and central catheters.
Treatment of allergic colitis consists of elimination of the offending protein from the infant's diet. Infants should receive a formula containing casein-hydrolysate as the protein source (eg, Nutramigen, Pregestimil, Alimentum). Mothers of exclusively breastfed infants with allergic colitis should eliminate the offending proteins (typically milk) from their diets. Persistence of gross bleeding after 14 days following a formula change is an indication for proctosigmoidoscopy. Infants with response to diet change should be challenged around their first birthday. A study by Baldassarre et al found the addition of Lactobacillus rhamnosus GG (LGG) to extensively hydrolyzed casein formula (EHCF) (eg, Nutramigen) significantly improved hematochezia and fecal calprotectin compared with EHCF alone.
Treatment of a child with pseudomembranous colitis depends on the severity of disease. Mild cases require cessation of antibiotics and supportive therapy with fluids and electrolytes. Evaluate patients with severe or persistent antibiotic-associated colitis for C difficile toxin in the stool. The patient should be treated with oral metronidazole (30 mg/kg/d in 4 divided doses) or oral vancomycin (40 mg/kg/d in 4 divided doses).
Management of bacterial colitis is somewhat controversial. Shigellosis stands alone as the only form of bacterial colitis for which antibiotics have proved efficacious.
Antimicrobial therapy shortens the course of the illness and the duration of excretion of the organisms in the stool by alleviating the signs and symptoms and limiting the transmission of the disease. Trimethoprim-sulfamethoxazole (TMP-SMZ) is the initial drug of choice; fluoroquinolones and ceftriaxone are the alternatives.
If Salmonella bacteremia is suspected, intravenous cefotaxime (200 mg/kg/d in 4 divided doses) or ceftriaxone (100 mg/kg/d in 2 divided doses) should be initiated. Alternative treatments include chloramphenicol (100 mg/kg/d in 4 divided doses) or, in adolescents, fluoroquinolones. TMP-SMZ is the drug of choice when oral treatment is indicated.
In Yersinia enterocolitica, antibiotic therapy of intravenous gentamicin (5-7.5 mg/kg/d in 3 divided doses) is indicated in patients with persistent diarrhea or suspected sepsis. Alternative antibiotics may include chloramphenicol, colistin, and kanamycin.
Campylobacter enteritis is usually self-limited. The organism is sensitive to erythromycin and ciprofloxacin, but antibiotic treatment has not been proved to decrease the duration of diarrhea.
Treatment of amebic colitis includes metronidazole and iodoquinol or paromomycin.