Colitis is a particularly common reason for consultation, whether with the attending physician or the gastroenterologist. It is not a disease strictly speaking but a “syndrome” ie a set of manifestations related to inflammation of the colon. This inflammation can have many and very different causes, whether in the mode of occurrence, colonic lesions responsible for inflammation, treatments, evolution and fate of colitis.
Definition of colitis
Colitis is an inflammation of the lining of the colon that can manifest itself acutely or chronically.
Acute colitis can be linked to:
- infection with a virus, a bacterium, a fungus or a parasite, for example with bacteria such as salmonella, shigella, cholera, staphylococci, escherichia coli, or with parasitic diseases such as amoebiasis or bilharziasis intestinal. In these cases, they can be transmitted by direct human-to-food contamination. Infectious colitis can also be linked to a colon disease (cancer, recto-colitis hemorrhagic (RCH), Crohn’s disease, diverticulosis colic, etc.) which they are then a complication.
- medicated colitis after taking antibiotics for example, or an excess of laxatives.
- Ischemic colitis is related to a poor blood supply, more or less brutal, of the colon, because of arterial plaque-like lesions or thrombosis that decrease the diameter of the arteries irrigating and oxygenating the colon.
- Some treatments to fight cancer can cause colitis. Thus colitis occurring after radiotherapy of the abdomen (it is then called “colic radiation”) or some drug treatment of cancer (chemotherapy).
- spasmodic colitis, better known as “irritable bowel syndrome” or functional colopathy.
- two major “Intestinal Chronic Inflammatory Diseases” (or IBD) such as RCH (RectoColitis Hemorrhagic or Ulcerative Colitis) or Crohn’s Disease have a poorer known origin. They can manifest as acute colitis during an outbreak of the disease.
Symptoms of colitis
All colitis is manifested by transit disorders (diarrhea or constipation), abdominal pain, more or less important, permanent or not, often bloating (abdominal meteorism). Depending on the cause, they may be accompanied by an impairment of the general condition, fever, weight loss, fatigue or extra-digestive manifestations.
The digestive or extra-digestive manifestations vary according to the cause of the disease:
- infectious colitis is accompanied by fever and rapid dehydration.
- colitis after antibiotics (lincomycin, clindamycin, ampicillin, cephalosporins, tetracyclines … etc.), result in diarrhea often ocher or green-orange. There are severe forms, such as pseudo-membranous colitis, related to superinfection by a germ, the “Clostridium difficile”. The diarrhea is severe, sometimes bloody with significant abdominal pain and high fever.
- Ischemic colitis is manifested by pain often brutal and intense in the abdomen with occasional bloody diarrhea.
- Post-radiotherapy colitis: they occur several months or even years after radiotherapy of the abdomen. Pain and transit disorders are often accompanied by bleeding or mucus in the stool and sometimes urinary abnormalities.
- Intestinal Chronic Inflammatory Diseases (IBD) result in diarrhea, abdominal pain, often permanent or intermittent bloody stools. Other organs may be affected. IBD can occur at any age but usually affects young people and often appears before the age of 30. The family often has a history of IBD or other conditions such as rheumatoid arthritis or ankylosing spondylitis. These pathologies are still imperfectly known but they are linked to abnormal immune reactions, the body developing defenses against its own tissues.
- Irritable bowel syndrome (IBS) associates abdominal pain, bloating (meteorism), diarrhea or constipation or alternation of the two and often other gastrointestinal manifestations in the stomach or esophagus with sensations of difficult digestion. There is no intestinal lesion (colonoscopy is normal) but an abnormal functioning of the intestine, with no immediate or long-term gravity. Very frequent, it affects women twice as much as men.
The evolution of colitis obviously depends on its cause and the quality of its management. Severe diarrhea poses a risk of dehydration, especially in younger children and the elderly; when it persists, it can lead to vitamin deficiency and weight loss due to poor absorption of nutrients in the colon.
When to consult
- When transit problems or pain persist
- in case of bloody stool
- in case of fever or weight loss
The diagnosis is oriented by the digestive and nondigestive symptoms, the antecedents of the person.
In the case of acute diarrhea, especially when returning from a trip, we first think of a bacterial, viral or parasitic infection that can be identified by a stool examination. Similarly after antibiotic treatment, it is necessary to evoke superinfection of the colon by a bacterium, Clostridium difficile.
In chronic colitis, an endoscopy of the colon and rectum is usually performed, which makes it possible to detect a possible non-digestive cause of pain, and who finds or does not find lesions of the mucous membrane of the colon. This examination also makes it possible to make biopsies to determine if it is or not a MICI for example.
People at risk and risk factors
The risk factors are very different according to the causes:
- food poisoning
- stay in a country with poor hygiene
- treatment with antibiotics, anticancer, radiotherapy
- personal or family history of autoimmune disease
Similarly, the prevention of colitis differs greatly according to their cause.
In general, good hygiene must be respected (washing your hands before meals and after having your bowel movements, eating food before their expiry date and never when you have doubts about the respect of the cold chain , avoid tap water, ice cream, dairy products or raw vegetables in some countries.
To limit pain and transit problems, it is best to limit very fatty or very spicy foods, coffee, tea, soft drinks and alcohol. The role of fibers is discussed. They are recommended in constipation but could also promote bloating and intestinal discomfort.
It is desirable to take Ultra-yeast, which contains a microscopic fungus yeast), Saccharomyces boulardii, when treated with antibiotics. The interest of robotics in the other indications is discussed, but it seems preferable in the case of transit disorders to consume fermented dairy rather than raw milk.
To avoid laxative colitis, it is recommended to limit stimulant laxatives to prefer ballast laxatives or osmotic laxatives (see constipation sheet).
Treatments of colitis
The specific treatment of acute colitis depends on their cause. It should always be combined with rehydration in case of severe diarrhea and compensation for vitamins and other nutrients in case of prolonged diarrhea.
They benefit from a specific anti-infective treatment once the germ has been identified by stool culture (stool culture).
They disappear in principle spontaneously after stopping the antibiotic. Healing can be accelerated by clearing robotics like Ultra-yeast.
Severe forms of superinfection with “clostridium difficile” can now be treated with “fecal transplantation” or “fecal bacteriotherapy”. It involves transplanting the patient’s intestinal flora from a healthy person.
These are emergencies. They must lead to a rapid hospitalization in a unit specialized in the management of intestinal pathologies by vascular occlusion in order to restore the circulation as quickly as possible and / or to remove the necrotic colic or intestinal area (zone damaged by lack of oxygen).
Intestinal Chronic Inflammatory Diseases (IBD)
Although there is not really any treatment that can definitively cure these IBDs, the possibilities of treatment to reduce intestinal inflammation, reduce symptoms and obtain remission are more numerous. The management of these diseases has progressed significantly with the availability of biotherapies.
- the RCH (see sheet).
- Crohn’s disease (see file)
These approaches do not replace the specific treatments for colitis but may be appropriate when used in addition to medical treatments. Do not hesitate to talk to your doctor, some may have side effects or interact with the therapies prescribed for cancer treatment.
They can be useful in chronic colitis. These are usually beverage cures from the hot spring.
Honey may have some effectiveness on the symptomatology of spastic colitis or even the RCH
Some plants could calm the intestinal symptoms, such as black radish, sage, lemon balm, and passionflower.
Stress management is always helpful in dealing with intestinal discomfort.