In a medical context, the label colitis (without qualification) is used if:
The cause of the inflammation in the colon is undetermined; for example, colitis may be applied to Crohn's disease at a time when the
diagnosis is unknown, or
The context is clear; for example, an individual with
ulcerative colitis is talking about their disease with a physician who knows the
diagnosis.
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]
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]
Crypt degeneration
Crypt branching and other architectural distortions
Paneth cell (pictured) or gastric metaplasia (only applies in the left colon and rectum)
Other findings include basal plasmacytosis and mucin depletion.[5]
Histopathology findings generally associated with active colitis include:[5]
Neutrophilic cryptitis (neutrophils within crypt epithelium)
Crypt abscesses (luminal neutrophilic aggregates)
Gland destruction
Ulceration (seen here as absence of epithelium, and granulation tissue with many fibroblasts)
Types
There are many types of colitis. They are usually classified by the cause.
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.
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]
References
^"Colitis". www.pennmedicine.org. July 1, 2021. Retrieved 2022-11-18.
^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.
PMID16930272.
^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.
PMID19047226.
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^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.
PMID19624520.
S2CID44406331.
^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.
PMID25523228.
^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.
PMID28720335.