Colitis

Dear Dr. B: My doctor thinks I have “colitis”. What is colitis and how is it diagnosed and treated? Yours Miss C.

Dear Miss C: “Colitis” is a very loose term used by many people to indicate some sort of irregularity of bowel movements – especially diarrhoea. If you have diarrhoea or irregular bowel movements then you don’t have “colitis” until proven by biopsy of the lining of the colon or by some other investigation. Literally, colitis means inflammation of the colon.

There are many causes for the inflammation of the colon. One may get colitis from viral infection, bacterial infection, parasitic infection, or fungal infection. Radiation colitis occurs when the colon is “burnt” during radiation therapy to the prostate, cervix or other abdominal organs.

Certain medications can cause colitis. Use of antibiotics can kill good bugs in the colon and allow the bad bugs to thrive causing bloody diarrhoea. This is known as antibiotic associated colitis or pseudomembranous colitis.

Then there is microscopic colitis. Here there is no change in the bowel wall as seen through the naked eye but the changes are visible only microscopically. These patients have chronic diarrhoea without any blood in the stool.

Irritable bowel syndrome (IBS) is quite often called mucous colitis or spastic colitis. But there is no true inflammation of the bowel. It is basically a motility problem.

The term “colitis” is most frequently used for inflammatory bowel disease (IBD). IBD comprises of two conditions: ulcerative colitis and Crohn’s disease. Crohn’s disease can affect any part of the gastro-intestinal tract – from mouth to anus. But most common site is the small intestine where it joins the colon. Colon is the second most common site and it is called Crohn’s colitis. Crohn’s can be at more than one site.

Ulcerative colitis is disease of the colon only and does not affect the rest of the gastro-intestinal tract. It is associated with bloody diarrhoea. Crohn’s and ulcerative colitis can have systemic effects and can affect the joints (arthritis), eyes, skin, bile ducts etc. Ulcerative colitis is a pre-malignant condition. That means that it may turn into cancer. If ulcerative colitis is present for eight years then the risk of cancer increases and the colon needs to be checked on regular basis. If there is evidence to suggest that colitis is turning into cancer then the colon needs to be removed.

On the other hand, Crohn’s does not require same sort of surveillance but the incidence of cancer of the gastro-intestinal tract is increased in patients with Crohn’s. IBD can run in the families. In Crohn’s, there is diarrhoea, which may or may not be bloody. There may be lump in the abdomen. Abdominal pain is more severe than in ulcerative colitis. Sometimes it is difficult to differentiate from irritable bowel syndrome.

Diagnosis of “colitis” is based on history and physical findings. Stools are cultured for growth of bacteria or parasites. Colon is checked by way of barium enema and flexible sigmoidoscopy (a 60 cm. flexible instrument to check the distal colon and rectum), an office procedure or colonoscopy (a longer flexible instrument) under sedation in the hospital.

Treatment depends on the type of “colitis”. As far as IBD is concerned, the medical treatment for ulcerative colitis and Crohn’s disease is the same. But the surgical management varies. And there are many variables when it comes to surgical management of Crohn’s disease.

So we have to be careful before we use the term “colitis”. It is better to give it a proper name. Miss C, you should talk to your doctor and he will give you more details. I hope the information provided here will be of some help.

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