What does colitis mean?

Colitis is simply an inflammation of the colon (a part of the large intestine). It results in discomfort in the abdomen. Usually, colitis can be acute and chronic (reoccurring) or mild and severe. Colitis is usually characterized by diarrhea, bloating, abdominal pain, and blood in the stool.  

The colon is a part of the large intestine responsible for water absorption. Digestive materials that get into the colon are transferred to the rectum after the bacteria in the colon break them down. The large intestine is also described as the large bowel where food waste is stored as feces which are later passed out through the anus.  

What are the Types of Colitis?

1. Inflammatory bowel disease

a) Ulcerative Colitis 

Ulcerative Colitis and Crohn’s disease are classified as Inflammatory Bowel Syndrome. Many celebrities have Irritable Bowel Syndrome. Notable among them is Mumtaz. Mumtaz is a veteran Bollywood actress who recently disclosed her experience with Irritable Bowel Syndrome and colitis.

Unlike the usual forms of colitis, ulcerative colitis is a chronic disease that can span a person’s lifetime. It results in inflammation and bleeding ulcers in the large intestine. Ulcerative colitis is the most common type of colitis and spreads from the rectum to the colon. It results from the body’s (immune system) overreaction to bacteria and other materials within the digestive tract. Studies have not been able to show why this occurs.

The different types of ulcerative colitis, based on the way the disease affects parts of the colon, include:

• Ulcerative Proctitis: Here, the rectum is first inflamed. Common signs include pain in the rectum, urgent need to use the bathroom, bloody diarrhea or diarrhea without blood, and constipation in a few people.
• Left-sided colitis: This is the most common type of ulcerative colitis. The left side of the colon is inflamed, hence its name. Symptoms include weight loss, lack of appetite, bloody diarrhea, and usually severe pain on the left side.
• Pancolitis: In this case, the inflammation occurs throughout the entire colon. Symptoms include; lack of appetite, bloody diarrhea, abdominal pain, cramping, and weight loss.   

b) Crohn’s disease

Crohn’s disease is a type of inflammatory bowel disease, which causes inflammation of the digestive tract, which can lead to pain in abdomen, diarrhea, fatigue, weight loss and malnutrition. Inflammation often spreads into deeper layers of the bowel and sometimes may lead to life- threatening situation.  

2. Ischemic Colitis 

This type occurs when there is a sudden restriction of blood flow to the colon. Blood clot formation can cause immediate blockage. In cases where ischemic colitis occurs again, it is usually due to fat deposit buildup (atherosclerosis) in the blood vessels supplying the colon.

Ischemic colitis can also occur as a side effect of taking certain medications like NSAIDs (non-steroidal anti-inflammatory drugs) and fibrates. This is rare type and requires more research. Ischemic colitis can be acute but usually occurs over a period of  time. Medications that treat blood clots can aid. In extreme cases, the patient may require surgery to remove any ischemic tissue that has died.

There are underlying conditions (risk factors) that could cause ischemic colitis, and they include:

• Diabetes
• Dehydration
• Blood loss
• Obstruction or blockage
• Colon cancer
• Trauma or injury
• Vasculitis (inflammation of the blood vessels

3. Microscopic Colitis 

It is usually diagnosed under a microscope. A colon tissue sample is examined under the microscope for signs of inflammation and the presence of lymphocytes (white blood cells). Common symptoms of microscopic colitis include:

• Abdominal pain
• Abdominal bloating
• Chronic watery diarrhea
• Weight loss

Microscopic Colitis is classified under lymphocytic and collagenous colitis. Treatment usually depends on the severity of the symptoms.

1. Lymphocytic colitis shows a significant number of lymphocytes present in the colon tissue sample. There is no abnormal thickening of the colon tissues and lining.
2. Collagenous colitis shows an abnormal thickening of the colon’s lining. This is due to collagen buildup in the outermost layer of the tissue.

The exact cause of microscopic colitis is unknown, but risk factors for developing this condition include:

• Smoking 
• History of autoimmune conditions 
• Abnormal bile acid absorption 
• Genetic predispositions 
• Intake of certain medications like NSAIDs (e.g., aspirin ), selective serotonin reuptake inhibitors (SSRIs), proton pump inhibitors (PPIs)

4. Pseudomembranous Colitis 

It is the result of the overgrowth of the bacterium Clostridium difficile (C. difficile). This bacterium is normally present in the intestine but remains harmless due to the balance with “good” bacteria. An imbalance in normal flora that can cause the overgrowth of C. difficile is seen in some infections, other forms of colitis, or taking broad-spectrum antibiotics. C. difficile then produces toxins that lead to inflammation of the colon.  

Pseudomembranous colitis gets its name from the inflammation of the colon, which forms a yellow-white pseudo membrane.  

Symptoms include:  

• Fever
• Nausea
• Diarrhea
• Dehydration
• Mucus in the stool
• Abdominal tenderness
• Abdominal cramps or pain

Treatment usually varies due to the primary cause of Pseudomembranous colitis. In severe cases, a fecal microbiota transplant (administration of a solution of fecal matter from a healthy donor to the recipient) may be needed to restore normal flora (bacteria commonly found in the digestive tract). A blood test, endoscopy (colonoscopy), and stool cultures can be used to discover the cause of colitis.

Risk factors affecting the development of Pseudomembranous colitis:

• Antibiotic use
• Intestinal surgery
• History of another gastrointestinal disorder
• People over 65 years
• Weak immune system (probably from chemotherapy)

5. Allergic Colitis in Infants  

This condition can occur in breastfeeding infants. The notable symptom is blood in the feces. Other symptoms include fussiness, reflux, and excessive spitting up.

It is usually due to a food allergy noticed in the infants. They exhibit  hypersensitivity or allergic reaction to some of breast milk components. A certain 2020 review of studies showed that protein allergies could contribute. It could be protein in breast milk, formula milk, or cow milk.

Another type of allergic colitis is Eosinophilic colitis which shows up in the same infants but is also related to a protein allergy.

Usually, the treatment involves eliminating some foods known to contribute to allergic colitis in the patient’s diet. If this elimination results in the cessation of symptoms in the nursing infant, then these foods are marked out as the problem. Otherwise, severe cases require the use of monoclonal antibodies (like those used in treating inflammatory bowel disease) as another treatment option.

How do we diagnose colitis patients?

One would need to speak with a doctor (gastroenterologist) when signs like persistent diarrhea (bloody or not) with abdominal cramps not related to infection, or fever, are experienced. Generally, the doctor will ask about all the symptoms being experienced, diet, family history, and current medications. Some of the tests the doctor will do include:

1. Blood tests are used to determine the presence of infection and the reason for blood loss. It is not directly used to diagnose colitis.
2. Barium enema: Barium is used to highlight areas of the colon under X-ray
3. Abdominal imaging, like CT and MRI scans, provides computerized x-ray images and detailed abdomen images.  
4. Colonoscopy involves viewing the rectum and colon with a camera attached to a flexible tube passed through the anus.
5. Flexible sigmoidoscopy is similar to colonoscopy but only shows the last section of the colon. 
6. Stool tests: Stool samples are collected and tested for the presence of blood, bacterial or parasitic infections.
7. Ultrasound uses sound waves to provide a noninvasive means of viewing intestinal contents.  

How to treat colitis?

Treatment can vary based on the patient’s age, type of colitis, and the patient’s overall physical condition. The primary aim is to reduce the symptoms.

1. Bowel rest: Take fluids and nutrition and limit what is orally consumed, especially when one has Ischemic Colitis. Usually, fluids and nutrition are given intravenously at this time.

2. Medication: The doctor will prescribe some drugs to treat colitis symptoms. They include; 

• Antidiarrheal drugs
• Supplements for nutritional deficiencies  
• Pain medications
• Antibiotics
• Anti-inflammatory drugs for swellings and pain
• Immune system suppressors
• Biologics like adalimumab, infliximab

3. Surgery: If other treatment options do not work, surgery to remove all or part of the colon may be required.

Diet to Avoid if a Person has Colitis  

What foods have to be avoided if a patient is diagnosed with colitis?

People with colitis usually notice that their symptoms worsen with the intake of certain foods. It is important to keep a food diary or journal so one can note these foods and avoid them in their diet.  

Lactose-intolerant people should avoid dieting with milk or any food containing lactose. Most doctors recommend avoiding certain foods like:

• Milk or its byproducts
• Fried foods
• High-fiber foods like corn, nuts, etc.

Symptoms

What are the most common symptoms associated with colitis?

Symptoms of Colitis are:

• Chills or fever
• Diarrhea with or without blood
• Vomiting
• Weight loss
• Skin inflammation
• Joint swelling
• Fatigue
• Dehydration
• Abdominal pain or cramps
• Bloating
• Urgent need to use the toilet

Causes

What are the most common causes of Colitis?

The most common causes of colitis are listed below: 

• Bacteria
• Certain medications such as NSAIDs, chemotherapy drugs, H2 receptor blockers, antibiotics, etc.
• Allergic reactions
• Restriction of blood flow to the colon
• Radiation to the large intestine
• Viral or parasitic infections
• Food poisoning

FAQ