Editing Colitis

{{short description|Inflammation of the colon (large intestine)}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox medical condition (new)
| name            = Colitis
| image           = Cryptitis high mag.jpg
| caption         = A [[micrograph]] demonstrating [[cryptitis]], a [[ligh microscope|microscopic]] correlate of colitis. [[H&E stain]].
| field           = [[Gastroenterology]]
| symptoms        =
| complications   =
| onset           =
| duration        =
| types           =
| causes          =
| risks           =
| diagnosis       =
| differential    =
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}
'''Colitis''' is swelling or [[inflammation]] of the large intestine ([[colon (anatomy)|colon]]).<ref>{{Cite web |date=July 1, 2021 |title=Colitis |url=https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/colitis |access-date=2022-11-18 |website=www.pennmedicine.org |archive-date=2022-11-18 |archive-url=https://web.archive.org/web/20221118203814/https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/colitis |url-status=live }}</ref> Colitis may be [[acute (medicine)|acute]] and self-limited or [[chronic condition|long-term]]. It broadly fits into the category of [[digestive diseases]].

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 [[sign (medicine)|signs]] and [[symptom]]s of colitis are quite variable and dependent on the cause of the given colitis and factors that modify its course and severity.<ref>{{Cite web |title=Ulcerative colitis - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326 |access-date=2024-04-11 |website=Mayo Clinic |language=en |archive-date=2024-04-11 |archive-url=https://web.archive.org/web/20240411061541/https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326 |url-status=live }}</ref>

Common symptoms of colitis may include: mild to severe [[abdominal pain]]s and [[Abdominal tenderness|tenderness]] (depending on the stage of the disease), persistent [[Hemorrhage|hemorrhagic]] [[diarrhea]] with pus either present or absent in the [[Human feces|stools]], [[fecal incontinence]], [[flatulence]], [[Fatigue (medical)|fatigue]], [[loss of appetite]] and unexplained [[weight loss]].<ref name=":0">{{Cite web |title = Ulcerative colitis - Symptoms - NHS Choices |url = http://www.nhs.uk/Conditions/Ulcerative-colitis/Pages/Symptoms.aspx |website = www.nhs.uk |access-date = 2015-11-03 |author = NHS Choices |archive-date = 2016-03-21 |archive-url = https://web.archive.org/web/20160321170236/http://www.nhs.uk/Conditions/Ulcerative-colitis/Pages/Symptoms.aspx |url-status = live }}</ref>

More severe symptoms may include: [[Dyspnea|shortness of breath]], a fast or [[irregular heartbeat]] and [[fever]].<ref name=":0" />

Other less common or rare [[non-specific symptoms]] that may accompany colitis include: [[arthritis]], [[mouth ulcer]]s, painful, red and swollen skin and irritated, [[Red eye (medicine)|bloodshot eyes]].<ref name=":0" />

Signs seen on [[colonoscopy]] include: colonic mucosal [[erythema]] (redness of the colon's inner surface), [[ulcer]]ations and [[hemorrhage]].<ref>{{cite web |url=https://www.medicalnewstoday.com/articles/ulcerative-colitis-colonoscopy |title=Colonoscopy for ulcerative colitis: Why to get one, prep, and more |date=30 July 2021 }}</ref>

==Diagnosis==
Symptoms suggestive of colitis are worked-up by obtaining the [[medical history]], a physical examination and laboratory tests ([[complete blood count|CBC]], [[serum electrolytes|electrolytes]], stool culture and sensitivity, stool ova and parasites et cetera).  Additional tests may include medical imaging (e.g. abdominal [[computed tomography]], [[abdominal X-ray]]s) and an examination with a camera inserted into the rectum ([[sigmoidoscopy]], [[colonoscopy]]).<ref>{{Cite web |title=Diagnosis of Ulcerative Colitis {{!}} NIDDK |url=https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis/diagnosis |access-date=2022-11-18 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref>

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).<ref name=Kellermann2021>{{cite journal|author=Kellermann L, Riis LB.|title=A close view on histopathological changes in inflammatory bowel disease, a narrative review.|journal=Dig Med Res|year=2021|volume=4|issue=3|page=3|doi=10.21037/dmr-21-1|doi-access=free|url=https://dmr.amegroups.org/article/view/7171/html|access-date=2023-10-03|archive-date=2024-01-23|archive-url=https://web.archive.org/web/20240123054132/https://dmr.amegroups.org/article/view/7171/html|url-status=live}}</ref>

Histopathology findings generally associated with chronic colitis include:<ref name=Kellermann2021/>
<gallery mode=packed heights=110>
File:Histopathology of a degenerated crypt of chronic inactive colitis.jpg|Crypt degeneration
File:Histopathology of crypt branching of colon.jpg|Crypt branching and other architectural distortions
File:Histopathology Paneth cell metaplasia.jpg|[[Paneth cell]] (pictured) or gastric metaplasia (only applies in the left colon and rectum)
</gallery>
Other findings include basal plasmacytosis and mucin depletion.<ref name=Kellermann2021/>
Histopathology findings generally associated with active colitis include:<ref name=Kellermann2021/>
<gallery mode=packed heights=110>
File:Histopathology of neutrophilic cryptitis in active colitis, annotated.jpg|Neutrophilic cryptitis (neutrophils within crypt epithelium)
File:Histopathology of a crypt abscess.jpg|Crypt abscesses (luminal neutrophilic aggregates)
File:Histopathology of gland destruction in active colitis.jpg|Gland destruction
File:Histopathology of colonic ulceration.jpg|Ulceration (seen here as absence of epithelium, and granulation tissue with many fibroblasts)
</gallery>

==Types==
There are many types of colitis. They are usually classified by the cause.

Types of colitis include:
[[Image:Crypt branching high mag.jpg|thumb|right|150px|[[Micrograph]] showing [[intestinal crypt]] branching, a [[histopathological]] finding of chronic colitis. [[H&E stain]].]]
[[Image:Collagenous colitis - intermed mag.jpg|thumb|right|[[Micrograph]] of [[collagenous colitis]]. [[H&E stain]].]]
[[Image:Colonic pseudomembranes low mag.jpg|thumb|right|[[Micrograph]] of a [[colon (anatomy)|colonic]] pseudomembrane, as may be seen in [[Clostridioides difficile infection|''Clostridioides difficile'' colitis]], a type of infectious colitis.]]

===Autoimmune===
* [[Inflammatory bowel disease]] (IBD) – a group of chronic colitides.
** [[Ulcerative colitis]] (UC) – a chronic colitis that affects the large intestine.<ref>{{Cite journal |last1=Elghobashy |first1=Maiar |last2=Steed |first2=Helen |date=2024 |title=Ulcerative colitis |url=https://doi.org/10.1016/j.mpmed.2024.01.001 |journal=Medicine |volume=52 |issue=4 |pages=232–237 |doi=10.1016/j.mpmed.2024.01.001 |issn=1357-3039|url-access=subscription }}</ref>
** [[Crohn's disease]] (CD) – another type of IBD that often leads to colitis.

===Unknown===
* [[Microscopic colitis]] – a colitis diagnosed by [[Microscopy|microscopic]] examination of colonic tissue; macroscopically ("to the eye") it appears normal.
** [[Lymphocytic colitis]]
** [[Collagenous colitis]]

===Treatment-caused===
* [[Diversion colitis]]
* [[Chemical colitis]]
* Chemotherapy-induced colitis
* [[Radiation colitis]]
* [[Checkpoint inhibitor induced colitis]]

===Vascular disease===
* [[Ischemic colitis]]

===Infectious===
{{anchor|Bacterial colitis|Bacterial}}
* Infectious colitis

A subtype of infectious colitis is [[Clostridioides difficile infection|''Clostridioides difficile'' colitis]],<ref>{{cite web  | title = Clostridium Difficile Colitis – Overview  | publisher = WebMD, LLC  | url = http://www.webmd.com/digestive-disorders/tc/clostridium-difficile-colitis-overview  | access-date = 2006-09-15  | archive-date = 2007-10-16  | archive-url = https://web.archive.org/web/20071016061526/http://www.webmd.com/digestive-disorders/tc/clostridium-difficile-colitis-overview  | url-status = live  }}</ref> which is informally abbreviated as "C-diff colitis". It classically forms [[wikt:pseudomembrane#Noun|pseudomembranes]] and is often referred to as pseudomembranous colitis, which is its (nonspecific) [[histomorphologic]] description.

[[Enterohemorrhagic]] colitis may be caused by [[Shiga toxin]] in ''[[Shigella dysenteriae]]'' or ''Shigatoxigenic group'' of ''[[Escherichia coli]]'' (STEC), which includes [[serotype]] [[Escherichia coli O157:H7|O157:H7]] and other enterohemorrhagic ''E. coli''.<ref name=Beutin_2006>{{cite journal | vauthors = Beutin L | title = Emerging enterohaemorrhagic Escherichia coli, causes and effects of the rise of a human pathogen | journal = Journal of Veterinary Medicine. B, Infectious Diseases and Veterinary Public Health | volume = 53 | issue = 7 | pages = 299–305 | date = September 2006 | pmid = 16930272 | doi = 10.1111/j.1439-0450.2006.00968.x }}</ref>

[[Parasitic]] infections, like those caused by ''[[Entamoeba histolytica]]'', can also cause colitis.

===Unclassifiable colitides===
''Indeterminate colitis'' is the classification for colitis that has features of both ''Crohn's disease'' and ''ulcerative colitis''.<ref>{{cite journal | vauthors = Romano C, Famiani A, Gallizzi R, Comito D, Ferrau' V, Rossi P | title = Indeterminate colitis: a distinctive clinical pattern of inflammatory bowel disease in children | journal = Pediatrics | volume = 122 | issue = 6 | pages = e1278–e1281 | date = December 2008 | pmid = 19047226 | doi = 10.1542/peds.2008-2306 | s2cid = 1409823 }}</ref>  Indeterminate colitis' behaviour is usually closer to ulcerative colitis than Crohn's disease.<ref name=pmid19624520>{{cite journal | vauthors = Melton GB, Kiran RP, Fazio VW, He J, Shen B, Goldblum JR, Achkar JP, Lavery IC, Remzi FH | title = Do preoperative factors predict subsequent diagnosis of Crohn's disease after ileal pouch-anal anastomosis for ulcerative or indeterminate colitis? | journal = Colorectal Disease | volume = 12 | issue = 10 | pages = 1026–1032 | date = October 2010 | pmid = 19624520 | doi = 10.1111/j.1463-1318.2009.02014.x | s2cid = 44406331 }}
</ref>

==Treatment==
Treatment for this condition can include medications such as steroids and dietary changes.  In some instances, hospitalization and surgery may be required.<ref>{{Cite web |title=Treatment for Ulcerative Colitis - NIDDK |url=https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis/treatment |access-date=2024-04-20 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref>

Moreover, several studies recently have found significant relationship between colitis and [[dairy allergy]] (including: [[cow milk]], [[UHT]] cow milk and [[casein]]),<ref name="Yang_2015">{{cite journal | vauthors = Yang M, Geng L, Chen P, Wang F, Xu Z, Liang C, Li H, Fang T, Friesen CA, Gong S, Li D | title = Effectiveness of dietary allergen exclusion therapy on eosinophilic colitis in Chinese infants and young children ≤ 3 years of age | journal = Nutrients | volume = 7 | issue = 3 | pages = 1817–1827 | date = March 2015 | pmid = 25768952 | pmc = 4377883 | doi = 10.3390/nu7031817 | doi-access = free }}</ref><ref name="Lucendo_2015">{{cite journal | vauthors = Lucendo AJ, Serrano-Montalbán B, Arias Á, Redondo O, Tenias JM | title = Efficacy of Dietary Treatment for Inducing Disease Remission in Eosinophilic Gastroenteritis | journal = Journal of Pediatric Gastroenterology and Nutrition | volume = 61 | issue = 1 | pages = 56–64 | date = July 2015 | pmid = 25699593 | doi = 10.1097/MPG.0000000000000766 | s2cid = 26195645 | doi-access = free }}</ref><ref name="Sun_2015">{{cite journal | vauthors = Sun J, Lin J, Parashette K, Zhang J, Fan R | title = Association of lymphocytic colitis and lactase deficiency in pediatric population | journal = Pathology, Research and Practice | volume = 211 | issue = 2 | pages = 138–144 | date = February 2015 | pmid = 25523228 | doi = 10.1016/j.prp.2014.11.009 }}</ref> 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.<ref>{{Cite journal |last1=Limketkai |first1=Berkeley N |last2=Akobeng |first2=Anthony K |last3=Gordon |first3=Morris |last4=Adepoju |first4=Akinlolu Adedayo |date=2020-07-17 |editor-last=Cochrane Gut Group |title=Probiotics for induction of remission in Crohn's disease |journal=Cochrane Database of Systematic Reviews |language=en |volume=2020 |issue=7 |pages=CD006634 |doi=10.1002/14651858.CD006634.pub3 |pmc=7389339 |pmid=32678465}}</ref>

For ulcerative colitis, there is low-certainty evidence that probiotic supplements may increase the probability of clinical remission.<ref name=":5">{{Cite journal |last1=Kaur |first1=Lakhbir |last2=Gordon |first2=Morris |last3=Baines |first3=Patricia Anne |last4=Iheozor-Ejiofor |first4=Zipporah |last5=Sinopoulou |first5=Vasiliki |last6=Akobeng |first6=Anthony K |date=2020-03-04 |editor-last=Cochrane IBD Group |title=Probiotics for induction of remission in ulcerative colitis |journal=Cochrane Database of Systematic Reviews |language=en |volume=3 |issue=3 |pages=CD005573 |doi=10.1002/14651858.CD005573.pub3 |pmc=7059959 |pmid=32128795}}</ref> 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.<ref name=":5" /> Although there was no clear evidence of greater remission when probiotic supplements were compared with [[Mesalazine|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.<ref name=":5" /> 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]].<ref>{{Cite journal |last1=Iheozor-Ejiofor |first1=Zipporah |last2=Kaur |first2=Lakhbir |last3=Gordon |first3=Morris |last4=Baines |first4=Patricia Anne |last5=Sinopoulou |first5=Vasiliki |last6=Akobeng |first6=Anthony K |date=2020-03-04 |editor-last=Cochrane IBD Group |title=Probiotics for maintenance of remission in ulcerative colitis |journal=Cochrane Database of Systematic Reviews |language=en |volume=3 |issue=3 |pages=CD007443 |doi=10.1002/14651858.CD007443.pub3 |pmc=7059960 |pmid=32128794}}</ref>

== Research ==
One study reported successfully treating experimental colitis in mice with [[mesenchymal stem cell]]s.<ref>{{cite journal | vauthors = Yang F, Ni B, Liu Q, He F, Li L, Zhong X, Zheng X, Lu J, Chen X, Lin H, Xu R, He Y, Zhang Q, Zou X, Chen W | title = Human umbilical cord-derived mesenchymal stem cells ameliorate experimental colitis by normalizing the gut microbiota | journal = Stem Cell Research & Therapy | volume = 13 | issue = 1 | pages = 475 | date = September 2022 | pmid = 36104756 | pmc = 9476645 | doi = 10.1186/s13287-022-03118-1 | doi-access = free }}</ref>

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.<ref name=":02">{{cite journal | vauthors = Huang Y, Zhang X, Li Y, Yao J | title = Identification of hub genes and pathways in colitis-associated colon cancer by integrated bioinformatic analysis | journal = BMC Genomic Data | volume = 23 | issue = 1 | pages = 48 | date = June 2022 | pmid = 35733095 | pmc = 9219145 | doi = 10.1186/s12863-022-01065-7 | doi-access = free }}</ref>

Colitis is common in parts of the world where [[helminthic]] colonisation is rare, and uncommon in those areas where most people carry worms. [[Helminthiasis|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<ref>{{cite journal |vauthors=Summers RW, Elliott DE, Urban JF, Thompson RA, Weinstock JV |title=Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial |journal=Gastroenterology |volume=128 |issue=4 |pages=825–32 |year=2005 |pmid=15825065 |doi=10.1053/j.gastro.2005.01.005|doi-access=free }}</ref><ref>{{cite book |vauthors=Pommerville J |title=Fundamentals of microbiology |publisher=Jones & Bartlett Learning |location=Burlington, MA |year=2014 |isbn=978-1-4496-8861-5}}</ref><ref name="ElliottWeinstock2012">{{cite journal |vauthors=Elliott DE, Weinstock JV |title=Where are we on worms? |journal=Current Opinion in Gastroenterology |volume=28 |issue=6 |pages=551–6 |date=November 2012 |pmid=23079675 |pmc=3744105 |doi=10.1097/MOG.0b013e3283572f73}}</ref><ref name="WeinstockElliott2013">{{cite journal |vauthors=Weinstock JV, Elliott DE |title=Translatability of helminth therapy in inflammatory bowel diseases |journal=International Journal for Parasitology |volume=43 |issue=3–4 |pages=245–51 |date=March 2013 |pmid=23178819 |pmc=3683647 |doi=10.1016/j.ijpara.2012.10.016 |quote=Early clinical trials suggested that exposure to helminths such as Trichuris suis or Necator americanus can improve IBD.}}</ref> but later trials failed at Phase 2, and most were eventually discontinued.<ref>{{cite web |url=https://globenewswire.com/news-release/2013/11/07/587752/10056769/en/Coronado-Biosciences-Announces-Independent-Data-Monitoring-Committee-Recommendation-to-Discontinue-Falk-Phase-2-Trial-of-TSO-in-Crohn-s-Disease.html |title=Coronado Biosciences Announces Independent Data Monitoring Committee Recommendation to Discontinue Falk Phase 2 Trial of TSO in Crohn's Disease |author=Coronado Biosciences |access-date=August 16, 2016|url-status=dead|archive-url=https://web.archive.org/web/20160816142726/https://globenewswire.com/news-release/2013/11/07/587752/10056769/en/Coronado-Biosciences-Announces-Independent-Data-Monitoring-Committee-Recommendation-to-Discontinue-Falk-Phase-2-Trial-of-TSO-in-Crohn-s-Disease.html|archive-date=August 16, 2016 |date=November 7, 2013}}</ref> 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.<ref>{{cite journal |author=Parker W |title=Not infection with parasitic worms, but rather colonization with therapeutic helminths |journal=Immunology Letters |volume=196 |pages=104–105 |date=December 2017 |doi=10.1016/j.imlet.2017.07.008 |pmid=28720335}}</ref>

== References ==
{{reflist}}

== External links ==
{{Medical resources
| meshName        = Colitis
| meshNumber      = C06.405.205.265
| ICD10          = {{ICD10|K|50| |k|50}} - K52
| ICD9           = {{ICD9|556.9}}
| DiseasesDB     = 31340
| ICDO           =
| OMIM           = 191390
| MedlinePlus    = 001125
| eMedicineSubj  = ped
| eMedicineTopic = 435
}}
{{Commons category}}
{{Gastroenterology}}
{{Portal bar|Biology|Medicine}}

{{Authority control}}

[[Category:Colitis| ]]
[[Category:Conditions diagnosed by stool test]]
[[Category:Inflammations]]
[[Category:Noninfective enteritis and colitis]]
[[Category:Diarrhea]]