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__NOTOC__
__NOTOC__
{{SI}}
{{Colitis}}
'''For more information on allergic colitis, please click [[Allergic colitis|here]]'''<br>
'''For more information on infectious colitis, please click [[Infectious colitis|here]]'''<br>
'''For more information on ischemic colitis, please click [[Ischemic colitis|here]]'''<br>
'''For more information on chemical colitis, please click [[Chemical colitis|here]]'''<br>
'''For more information on drug-induced colitis, please click [[Drug-induced colitis|here]]'''<br>
'''For more information on radiation colitis, please click [[Radiation colitis|here]]'''<br>
'''For patient information on this topic, click [[Colitis (patient information)|here]]'''
      
      
{{CMG}}; {{AE}} {{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}}
{{CMG}}; {{AE}}{{MUT}}; {{MK}}; {{Ochuko}}; {{Rim}}; {{QS}}; {{Mohamed riad}}<br>


{{SK}} Proctocolitis, Proctitis, Enterocolitis.
{{SK}} Colitis, Proctocolitis, Proctitis, Enterocolitis.


==Overview==
==Overview==
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either acute or chronic. Causes of colitis include infectious causes such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food potein-induced proctocolitis) and radiation. Colitis may co-exist with enteritis (inflammation of the small bowel), proctitis (inflammation of the rectum) or both. The mainstay of therapy for infectious proctocolitis is [[antimicrobial]] therapy. The preferred regimen is a combination of [[Ceftriaxone]] and [[Doxycycline]].
Colitis is the [[inflammation]] of the [[colon (anatomy)|colon]], that can be either [[acute]] or [[Chronic (medical)|chronic]]. Colitis may be caused by microorganisms such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', ''[[Shigella dysenteriae]]'', [[Herpes Simplex Virus|HSV]], allergy (food protein-induced allergic proctocolitis), drugs ([[NSAIDs]]) and [[radiation]]. Colitis may co-exist with enteritis (inflammation of the small bowel), [[proctitis]] (inflammation of the [[rectum]]) or both. The symptoms of colitis such as [[diarrhea]] especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be [[fulminant]] with a rapid downhill clinical course. In addition to the [[diarrhea]], [[fever]], and [[anemia]] may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present. Treatment of colitis depends on the [[etiology]]. It may include the elimination of [[cows-milk protein]] or other food allergens from the diet, administration of [[antibiotic]]s and general anti-inflammatory medications such as [[mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is [[antimicrobial]] therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of [[ceftriaxone]] and [[doxycycline]]. Supportive therapies such as correction of dehydration and [[anemia]], and reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]] is often done for most patients with colitis. [[Irritable bowel syndrome]] (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of [[ulcerative colitis]].  It is a synonym of [[ulcerative colitis]], but it should not be used as a synonym when referring to [[ulcerative colitis]].


==Classification==
==Classification==
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{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align=center |'''Classes of Colitis''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Disorders'''
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 40%" align="center" |'''Classes of Colitis'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align="center" |'''Disorders'''
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Autoimmune''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Autoimmune'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Ulcerative colitis]]
*[[Ulcerative colitis]]
*[[Crohn's disease|Crohn's colitis]]
*[[Crohn's disease|Crohn's colitis]]
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Allergic''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Allergic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced allergic proctocolitis (FPIAP)]]
*[[Food protein-induced enterocolitis syndrome (FPIES)]]
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''[[Infectious colitis]]''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Infectious colitis]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
*[[Pseudomembranous colitis]] (''[[Clostridium difficile]]'')
* Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
*Enterohemorrhagic colitis (''[[Shigella dysenteriae]]'' or [[Shigatoxigenic group of Escherichia coli]] (STEC))
* Protozoan (''[[Entamoeba histolytica]]'')
*Protozoan (''[[Entamoeba histolytica]]'')
* [[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
*[[Lymphogranuloma venereum|''Chlamydia'' proctocolitis]]
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''[[Idiopathic]]'''||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''[[Idiopathic]]'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Lymphocytic colitis]]
*[[Lymphocytic colitis]]
* [[Collagenous colitis]]
*[[Collagenous colitis]]
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Iatrogenic''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Iatrogenic'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Diversion colitis]]
*[[Diversion colitis]]
* [[Chemical colitis]]
*[[Chemical colitis]]
* [[Radiation colitis]]
*[[Radiation colitis]]
*[[NSAID-induced colitis]]
*[[NSAID-induced colitis]]
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Vascular''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Vascular'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* [[Ischemic colitis]]
*[[Ischemic colitis]]
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left|'''Drug induced''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Drug induced'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
*[[NSAID-induced colitis]]
*[[NSAID-induced colitis]]
|-
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left| '''Unclassifiable''' ||style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align=left |
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unclassifiable'''|| style="padding: 0 5px; font-size: 100%; background: #DCDCDC;" align="left" |
* Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
*Indeterminate colitis (features of both [[Crohn's disease]] and [[ulcerative colitis]])
* Atypical colitis
*Atypical colitis
|}
|}


===Classification by Anatomy===
===Classification by Anatomy===
Colitis may co-exist with inflammation involving other parts of the gastrointestinal tract. It can be classified based on anatomy into;
Colitis may co-exist with [[inflammation]] involving other parts of the [[gastrointestinal tract]]. It can be classified based on anatomy into:
*Proctitis: When it involves the rectum
 
*Colitis: When it involves the inflammation is limited to the colon
*[[Proctitis]]: When it involves the [[rectum]]
*Proctocolitis: When it involves the rectum and colon (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref> 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092  }} </ref>
*Colitis: When it involves the inflammation is limited to the [[Colon (anatomy)|colon]]
*Enterocolitis: When it involves the small intestine in addition to the colon
*[[Proctocolitis]]: When it involves the [[rectum]] and [[Colon (anatomy)|colon]] (usually the distal part of the colon 12cm to 15cm above the anus ([[sigmoid colon]])<ref>2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016</ref><ref name="pmid17099092">{{cite journal| author=Hamlyn E, Taylor C| title=Sexually transmitted proctitis. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 973 | pages= 733-6 | pmid=17099092 | doi=10.1136/pmj.2006.048488 | pmc=2660501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099092  }} </ref>
*[[Enterocolitis]]: When it involves the [[small intestine]] in addition to the [[Colon (anatomy)|colon]]


====Schematic of Anatomical Classification of Colitis====
====Schematic of Anatomical Classification of Colitis====
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas:<ref name="gitractcolitis"> WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>'''<br>*'''Regions 4 to 6:''' Enterocolitis<br>*'''Region 6: '''Colitis<br>*'''Regions 6 to 8:''' Proctocolitis<br>*'''Regions 7 to 8:'''Proctitis]]</div><p style="clear:left"></p>
<div style="float: left">[[Image:Gastro-intestinal tract.png|thumb|200px|'''Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843<ref name="gitractcolitis">WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016</ref>'''<br>*'''Regions 4 to 6:''' Enterocolitis<br>*'''Region 6: '''Colitis<br>*'''Regions 6 to 8:''' Proctocolitis<br>*'''Regions 7 to 8:'''Proctitis]]</div><p style="clear:left"></p>


===Classification by Age===
===Classification by Age===
*Infantile: More common in early infancy (first six months).<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434  }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489  }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029  }} </ref>
 
*Adults
*'''Infantile''' (first six months of life)<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434  }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489  }} </ref><ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029  }} </ref>
*'''Adult'''


===Classification by duration of symptoms===
===Classification by duration of symptoms===
*Acute: Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268  }} </ref>
*Chronic: Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268  }} </ref>


Notes:
*'''Acute:''' Less than three months.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268  }} </ref>
* Fulminant colitis is any colitis with a rapid downhill clinical course; in addition to the [[diarrhea]], [[fever]], and [[anemia]] seen in colitis, the patient has severe abdominal pain and presents a clinical picture similar to that of [[septicemia]], where [[Shock (medical)|shock]] is present.
*'''Chronic:''' Longer than three months. Often months to years.<ref name="pmid24686268">{{cite journal| author=Hauer-Jensen M, Denham JW, Andreyev HJ| title=Radiation enteropathy--pathogenesis, treatment and prevention. | journal=Nat Rev Gastroenterol Hepatol | year= 2014 | volume= 11 | issue= 8 | pages= 470-9 | pmid=24686268 | doi=10.1038/nrgastro.2014.46 | pmc=4346191 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686268 }} </ref>
* [[Irritable bowel syndrome]], a separate disease, has been called spastic colitis or spastic colon. This name causes confusion, since colitis is not a feature of irritable bowel syndrome.
* Immune mediated colitis is the experimental name in animal studies of ulcerative colitisIt is a synonym of ulcerative colitis, but it should not be used as a synonym when referring to ulcerative colitis.


==Pathophysiology==
==Differential Diagnosis==
The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:
===Differential diagnosis in Infants===


The pathophysiology of colitis depends on the cause. Some pathogenetic mechanisms are not clearly understood.
===Genetics===
There is no specific genetic cause for proctocolitis. However, genetic predisposition may play a role in some causes.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue=  | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355  }} </ref><ref name="pmid26579126">{{cite journal| author=Loddo I, Romano C| title=Inflammatory Bowel Disease: Genetics, Epigenetics, and Pathogenesis. | journal=Front Immunol | year= 2015 | volume= 6 | issue=  | pages= 551 | pmid=26579126 | doi=10.3389/fimmu.2015.00551 | pmc=4629465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26579126  }} </ref>
===Gross pathology===
<gallery>
Image:Allergic proctocolitis.jpg| Allergic proctocolitis<ref name=AP> The Korean Academy of Medical Sciences. Allergic proctocolitis. http://dx.doi.org/10.3346/jkms.2007.22.2.213 Accessed on 31 August, 2016</ref>
Image:Radiation proctitis3.jpg|Radiation Proctitis<ref name=Proctocolitis> Wikipedia. Proctitis. https://en.wikipedia.org/wiki/Proctitis#/media/File:Radiation_proctitis3.jpg Accessed on August 31, 2016 </ref>
Image:Pseudomembranous_colitis.JPG | Pseudomembranous colitis. (WC) <ref name=Pseudomembranous-Proctocolitis> Libre Pathology. Pseudomembranous colitis. https://librepathology.org/wiki/Pseudomembranous_colitis Accessed on August 31, 2016 </ref>
Image:800px-Pseudomembranous Colitis, Colectomy (Gross) (7410584264).jpg| Pseudomembranous colitis. <ref name=pseudomembranous-colitis> Libre Pathology. Pseudomembranous colitis. https://librepathology.org Accessed on September 1, 2016 </ref>
Image:UC granularity.png| Ulcerative colitis.<ref name=ulcerative_colitis> Ulcerative colitis. Wikidoc. http://www.wikidoc.org/index.php/File:UC_granularity.png#filehistory Accessed on August 31, 2016 </ref>
</gallery>
===Microscopic pathology===
<gallery>
Image: Ulcerative colitis (2) active.jpg | Ulcerative colitis. H&E staining showing crypt abscess, a characteristic finding in ulcerative colitis <ref name=ulcerativecolitis1> Libre Pathology. https://librepathology.org/wiki/File:Ulcerative_colitis_(2)_active.jpg Accessed on September 1, 2016 </ref>
Image: Ulcerative colitis (2) endoscopic biopsy.jpg| Ulcerative colitis. H&E stain showing marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and distortion of the architecture of the crypts. <ref name=ulcerativecolitis2> Libre Pathology. https://librepathology.org/wiki/File:Ulcerative_colitis_(2)_endoscopic_biopsy.jpg Accessed on September 1, 2016 </ref>
</gallery>
<gallery>
Image:Ischemic colitis.JPG| Ischemic colitis. H&E staining showing changes seen in ischemic colitis  <ref name=Ischemic-Proctocolitis> Wikipedia. Ischemic colitis. https://en.wikipedia.org/wiki/Ischemic_colitis#/media/File:Ischemic_colitis_-_high_mag.jpg Accessed on August 31, 2016 </ref>
Image:1440px-Colonic pseudomembranes low mag.jpg| Pseudomembranous colitis. H& E staining showing pseudomembranes in Clostridium colitis <ref name=pc> Libre Pathology. Pseudomembranous colitis. https://librepathology.org/wiki/File:Colonic_pseudomembranes_low_mag.jpg Accessed on September 1, 2016 </ref>
</gallery>
==Differentiating Colitis from Other Diseases==
Causes of colitis are diverse and may overlap with other disease. The differential diagnosis of colitis can be classified into two according to age group.
===Differential diagnosis in Infants===
*[[Swallowed maternal blood syndrome]]
*[[Swallowed maternal blood syndrome]]
*[[Anorectal fissure]]
*[[Anorectal fissure]]
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Necrotizing enterocolitis]] especially in preterm babies
*[[Vitamin K dependent hemorrhage]]
*[[Vitamin K dependent hemorrhage]]
*Other Coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as disseminated intravascular coagulopathy)  
*Other coagulopathies: (hereditary such as coagulation factor deficiency or acquired such as [[disseminated intravascular coagulopathy]])
*Food protein-induced enterocolitis
*[[Intussusception]]
*[[Intussusception]]
*Gastrointestinal Infections
*Upper Gastrointestinal Infections
*[[Enteritis]]
*[[Meckel diverticulum]]
*[[Meckel diverticulum]]
*[[Intestinal duplication cysts]]  
*[[Intestinal duplication cysts]]
*Vascular malformations
*Vascular malformations
*Inflammatory bowel disease(early onset)
*Inflammatory bowel disease(early onset)
*[[Hirschsprung disease]] complicated by enterocolitis
*[[Hirschsprung disease]] complicated by [[enterocolitis]]
*[[Volvolus]]
*[[Volvulus]]
*Gastro-duodenal ulcers
*Gastro-duodenal ulcers
*Gastrointestinal duplication cyst
*Gastrointestinal duplication cyst
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*Lymphonodular hyperplasia
*Lymphonodular hyperplasia


===Differential diagnosis in Infants===
===Differential diagnosis in Adults===
*Colorectal malignancy
 
*Crohn's disease
*[[Colorectal cancer|Colorectal malignancy]]
*Behcet's disease
*[[Crohn's disease]]
*Arteriovenous malformation
*[[Behçet's disease|Behcet's disease]]
*Diverticuclosis
*[[Arteriovenous malformation]]
*Infection
*[[Diverticulosis]]
*Coagulopathy
*Enteritis
*Systemic lupus erythematosus(SLE)
*[[Coagulopathy]]
*[[Systemic lupus erythematosus]](SLE)
*Cytomegalovirus colitis


==Differentiating between different forms of colitis==
===Differentiating Between Different Types of Colitis===
*The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below lists the differential diagnosis of common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721  }} </ref>
The symptoms of colitis such as [[diarrhea]] especially [[bloody diarrhea]] and [[abdominal pain]] are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721  }} </ref>
{|
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Physical Examination
! colspan="4" |Laboratory findings
! colspan="4" |Laboratory findings
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diarrhea
!Diarrhea
!Rectal bleeding
!Rectal bleeding
Line 160: Line 127:
!Microorganism in stool
!Microorganism in stool
!Pseudomembranes on endoscopy
!Pseudomembranes on endoscopy
!Lab Test 4
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic Colitis
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chemical colitis
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+++
| style="background: #F5F5F5; padding: 5px;" | +++
|style="background: #F5F5F5; padding: 5px;" |+++
| style="background: #F5F5F5; padding: 5px;" | +++
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Radiation colitis
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Ischemic colitis
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug-induced colitis
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | ++
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
|style="background: #F5F5F5; padding: 5px;" |
|}
|}


==Causes==
==Causes==
===Common Causes===
===Common Causes===
Common causes of Proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes [[Lymphogranuloma Venereum|LGV (Lymphogranuloma Venereum)]], ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (for example food protein-induced proctocolitis), idiopathic (for example [[microscopic colitis]]), vascular (for example [[ischemic colitis]]), or autoimmune (for example [[inflammatory bowel disease]]).
Common causes of proctocolitis include infectious agents such as ''[[Chlamydia trachomatis]]'' (which causes lymphogranuloma venereum), ''[[Neisseria gonorrhoeae]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Shigella dysenteriae]]'' and ''[[Campylobacter|Campylobacter species]]''. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. [[microscopic colitis]]), vascular (e.g. [[ischemic colitis]]), or autoimmune (e.g. [[inflammatory bowel disease]]).


===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[EVAR]], [[vasculitis]]
| style="width:75%" bgcolor="Beige" ; border="1" |[[EVAR]], [[vasculitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|'''Chemical / poisoning'''
|bgcolor="Beige"| [[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]  
| bgcolor="Beige" |[[Chemical colitis]] from Glutaraldehyde, Coffee enema, Hydrogen peroxide, [[lanthanum]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
|'''Dental'''
|bgcolor="Beige"|[[Dental braces]]
| bgcolor="Beige" |[[Dental braces]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
|'''Dermatologic'''
|bgcolor="Beige"|[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
| bgcolor="Beige" |[[Albinism]], [[Behcet disease]], [[scleroderma]], [[vasculitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|'''Drug Side Effect'''
|bgcolor="Beige"| [[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
| bgcolor="Beige" |[[Alosetron]], [[ampicillin Oral]], [[auranofin]], [[azithromycin]], [[aztreonam Injection]], [[cefaclor]], [[cefadroxil]], [[cefamandole Nafate Injection]], [[cefazolin Sodium Injection]], [[cefepime Injection]], [[cefepime]], [[cefoperazone Sodium Injection]], [[cefotaxime Sodium Injection]], [[cefotetan Disodium Injection]], [[cefoxitin Sodium Injection]], [[cefpodoxime]], [[ceftazidime Injection]], [[ceftazidime]], [[ceftizoxime Sodium Injection]], [[ceftriaxone Sodium Injection]], [[cefuroxime Sodium Injection]], [[cephalexin]], [[cephalosporin]], [[cephradine Oral]], [[cidofovir]], [[cilansetron]], [[clindamycin]], [[co-amoxiclav]], [[corticosteroid]], [[darifenacin]], [[desogestrel and ethinyl estradiol]], [[dicloxacillin]], [[dirithromycin]], [[enoxacin]], [[ertapenem]], [[erythromycin and Sulfisoxazole]], [[flucytosine]], [[glycopyrrolate]], [[hyoscyamine]], [[idelalisib]], [[imipenem and Cilastatin Sodium Injection]], [[ipilimumab]], [[ixabepilone]], [[levofloxacin Oral]], [[lincomycin hydrochloride]], [[linezolid]], [[lomefloxacin]], [[loracarbef]], [[methotrexate]], [[miconazole Injection]], [[moxifloxacin]], [[nafcillin Sodium Injection]], [[nivolumab]], [[norfloxacin]], [[ofloxacin injection]], [[oxacillin Sodium Injection]], [[oxcarbazepine]], [[oxybutynin]], [[peginterferon alfa-2a]], [[penicillin]], [[pergolide]], [[piperacillin sodium injection]], [[pramipexole]], [[prednisolone]], [[procyclidine]], [[propantheline]], [[pseudoephedrine]], [[quinolone]], [[ramosetron]], [[reserpine]], [[solifenacin]], [[sparfloxacin]], [[tegaserod]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|'''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
|'''Endocrine'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
|'''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|'''Gastroenterologic'''
|bgcolor="Beige"| [[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
| bgcolor="Beige" |[[Aganglionic megacolon]], [[alpha 1-antitrypsin deficiency]], [[autistic enterocolitis]], [[bacterial gastroenteritis]], [[polyp|cap polyposis]], [[chemical colitis]], [[colitis ulcerosa]], [[collagenous colitis]], [[colonic ischemia]], [[Crohn's disease]], [[diversion colitis]], [[diverticulosis]], [[Gerson diet]], [[infectious colitis]], [[inflammatory bowel disease]], [[intestinal ischemia]], [[irritable bowel syndrome]], [[ischemic colitis]], [[lymphocytic colitis]], [[microscopic colitis]], [[multiple organ dysfunction syndrome]], [[primary sclerosing cholangitis]], [[protein losing enteropathy]], [[pseudomembranous colitis]], [[radiation colitis]], [[radiation proctitis]], [[solitary rectal ulcer syndrome]], [[toxic megacolon]], [[typhlitis]], [[ulcerative colitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
|'''Genetic'''
|bgcolor="Beige"| [[Albinism]], [[alpha 1-antitrypsin deficiency]]
| bgcolor="Beige" |[[Albinism]], [[alpha 1-antitrypsin deficiency]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
|'''Hematologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|'''Iatrogenic'''
|bgcolor="Beige"| [[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
| bgcolor="Beige" |[[Diversion colitis]], [[EVAR]], [[radiation colitis]], [[radiation proctitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|'''Infectious Disease'''
|bgcolor="Beige"| [[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
| bgcolor="Beige" |[[Bacillary dysentery]], [[bacterial gastroenteritis]], [[balantidium coli]], [[campylobacter jejuni]], [[chlamydia trachomatis]], [[clostridium difficile]], [[cryptosporidiosis]], [[cytomegalovirus]], [[entamoeba histolytica]], [[escherichia coli O157:H7]], [[giardiasis]], [[infectious colitis]], [[isosporiasis]], [[neisseria gonorrhoeae]], [[neonatal necrotizing enterocolitis]], [[pigbel]], [[salmonella]], [[schistosoma]], [[sepsis]], [[shigella]], [[strongyloides stercoralis]], [[syphilis]], [[treponema pallidum]], [[yersinia enterocolitica]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|'''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Ankylosing Spondylitis]]
| bgcolor="Beige" |[[Ankylosing Spondylitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
|'''Neurologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|'''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
| bgcolor="Beige" |[[Gerson diet]], [[lysinuric protein intolerance]], [[milk allergy]], [[pigbel]], [[soy protein]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|'''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
|'''Oncologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|'''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|'''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
|'''Psychiatric'''
|bgcolor="Beige"| [[Autistic enterocolitis]]
| bgcolor="Beige" |[[Autistic enterocolitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
|'''Pulmonary'''
|bgcolor="Beige"|[[Multiple organ dysfunction syndrome]]
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|'''Renal / Electrolyte'''
|bgcolor="Beige"|[[Multiple organ dysfunction syndrome]]
| bgcolor="Beige" |[[Multiple organ dysfunction syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|'''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
| bgcolor="Beige" |[[Ankylosing spondylitis]], [[Behcet disease]], [[common variable immunodeficiency]], [[allergic colitis]] (Food protein-induced colitis), [[scleroderma]], [[vasculitis]], [[Ulcerative colitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
|'''Sexual'''
|bgcolor="Beige"| Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''
| bgcolor="Beige" |Typical [[STI]] such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrheae]]'', ''[[Treponema pallidum]]'', ''[[Herpes Simplex Virus|HSV]]'', ''[[Cytomegalovirus|CMV]]'', Unusual [[STI]] ''[[Shigella dysenteriae]]''. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital [[HSV]] and [[Chlamydia]] [[proctitis]] occur predominantly in individuals with HIV infection. [[Neisseria meningitidis]] causes [[proctitis]] among men who have sex with men and individuals with [[HIV infection]].<ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men.<nowiki><ref name="pmid24687130"></nowiki>{{cite journal| author=Pallawela SN, Sullivan AK, Macdonald N, French P, White J, Dean G | display-authors=etal| title=Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K. | journal=Sex Transm Infect | year= 2014 | volume= 90 | issue= 4 | pages= 269-74 | pmid=24687130 | doi=10.1136/sextrans-2013-051401 | pmc=4033117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24687130  }} </ref><ref name="pmid28221124">{{cite journal| author=Gutierrez-Fernandez J, Medina V, Hidalgo-Tenorio C, Abad R| title=Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men Who Have Sex with Men. | journal=Emerg Infect Dis | year= 2017 | volume= 23 | issue= 3 | pages= 542-543 | pmid=28221124 | doi=10.3201/eid2303.161039 | pmc=5382739 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28221124  }} </ref>
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
|'''Trauma'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
|'''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|'''Miscellaneous'''
|bgcolor="Beige"| Microscopic colitis
| bgcolor="Beige" |Microscopic colitis
|-
|-
|}
|}


===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{columns-list|3|
{{columns-list|
*[[Aganglionic megacolon]]
*[[Aganglionic megacolon]]
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565  }} </ref>
*[[Albinism]] <ref name="pmid19833565">{{cite journal| author=Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V| title=Granulomatous colitis in oculocutaneous albinism. | journal=Dig Liver Dis | year= 2011 | volume= 43 | issue= 1 | pages= e1 | pmid=19833565 | doi=10.1016/j.dld.2009.09.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19833565  }} </ref>
Line 508: Line 468:


===Life Threatening Causes===
===Life Threatening Causes===
Example include toxic megacolon, ischemic colitis, infectious colitis such as  [[escherichia coli O157:H7]] and [[shigella]].
Example include [[toxic megacolon]], [[ischemic colitis]], [[infectious colitis]] such as  [[escherichia coli O157:H7]] and [[shigella]].
 
==Screening==
There is insufficient evidence to recommend routine screening of sexual partners of patients with sexually transmitted enteric pathogens.


==Diagnosis==
==Diagnosis==
===Symptoms===
* [[Diarrhea]]
* [[Abdominal pain]]
* [[Rectal bleeding]]


===Physical Examination===
===History and Symptoms===
* [[Abdominal tenderness]]
* [[Fever]]
* [[Hypotension]]
* [[Tachycardia]]


===Diagnostic Tests===
*Symptoms of [[proctitis]] include [[anorectal pain]], [[tenesmus]], or [[rectal]] [[discharge]].
Colitis is associated with the following findings:
*Symptoms of [[proctocolitis]] include fatigue, weight loss, [[anorectal pain]], [[tenesmus]], [[rectal]] [[discharge]], [[diarrhea]] or [[abdominal cramps]].
* Swelling of the colon tissue
* [[Bleeding]]
* [[Erythema]] (redness) of the surface of the colon
* [[Ulcer]]ations of the colon


Common tests  which reveal these signs include:
===Laboratory Findings===
* [[X-ray]]s of the colon
Laboratory findings consistent with the diagnosis of proctitis include:
* Testing the stool for blood and pus
* [[Sigmoidoscopy]]
* [[Colonoscopy]]


Additional tests include [[stool culture]]s and [[blood test]]s, including blood chemistry tests. A high [[erythrocyte sedimentation rate]] (ESR) is one typical finding in acute exacerbations of colitis.
*[[Stool examination]]: Detection of  [[blood]] or fecal [[polymorphonuclear leukocytes]] using gram-stained smear of any [[anorectal]] [[exudate]] from anoscopic or anal examination.
*[[Microbiology]] [[workup]]: [[Nucleic acid test|NAAT]] of [[rectal]] lesions for HSV, [[Nucleic acid test|NAAT]] for [[Neisseria gonorrhoeae|Neisseria gonorrhea]], [[syphilis serology]], [[Nucleic acid test|NAAT]] for [[Chlamydia trachomatis]], and [[Nucleic acid test|NAAT]] for [[Mycoplasma genitalium infection|Mycoplasma genitalium]] in case of persistence of symptoms after receiving the recommended treatment. [[CMV]] and other [[Opportunistic infection|opportunistic infections]] may be evaluated in [[Immunosuppression|immunosuppressed]] individuals as [[HIV AIDS|HIV/AIDS]].
*An elevated [[erythrocyte sedimentation rate]] ([[Erythrocyte sedimentation rate|ESR]]) is one typical finding in the acute exacerbation of [[proctocolitis]].
 
===Other Imaging Findings===
 
====Colonoscopy====
[[Anoscopy]] or [[sigmoidoscopy]] may be helpful in the diagnosis of [[proctocolitis]]. Findings on an sigmoidoscopy suggestive of proctocolitis include [[inflammation]] of the colonic mucosa extending to 12 cm above the [[anus]] and [[rectal]] [[Ulcer|ulcers]].<br />


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
Treatment of colitis may include the administration of [[antibiotic]]s and general anti-inflammatory medications such as [[Mesalamine]] or its derivatives, [[glucocorticoids|steroids]], or one of a number of other drugs that ameliorate inflammation.
Acute [[proctocolitis]] among individuals with receptive anal exposure is often [[sexually-transmitted]]. [[Empiric therapy|Empiric]] [[antibiotic]] treatment should be started while awaiting for the results of laboratory tests for


Changes in diet can be effective at treating the symptoms of colitis and easing the side effects. These can include reducing the intake of [[carbohydrates]], [[lactose]] products, soft drinks, and [[caffeine]]. This approach has been championed by [[Elaine Gottschall]].
patients presenting with anorectal [[exudate]] on anoscopy or positive [[Gram staining|Gram]]-stained [[Smear test|smear]] of [[anorectal]] exudate or secretions [[polymorphonuclear leukocytes]] or if anoscopy or Gram stain is not available.<ref name="pmid24275725">{{cite journal| author=Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C, Chen M| title=The etiology of infectious proctitis in men who have sex with men differs according to HIV status. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 10 | pages= 768-70 | pmid=24275725 | doi=10.1097/OLQ.0000000000000022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275725  }}</ref>


Hygienic and naturopathic doctors have taken the diet approach further,  attributing bowel inflammation to toxemia stemming from high-protein, fatty diets and other dietary irritants. Changing to a low-fat, minimally-processed, whole-foods diet per the Natural Hygiene self-healing system has been effective in eliminating symptoms and rebuilding health. Dr. Zarin Azar, MD,, is one advocate of this healing system.
====Recommended Regimen for Acute Proctitis====
'''[[Ceftriaxone]]''' 500 mg IM in a single dose


[[Infliximab]] (or REMICADE) - a drug originally produced to treat Rheumatoid Arthritis - has recently been approved for the treatment of Colitis where traditional treatments have failed.  REMICADE is a biologic therapy that recognizes, attaches to, and blocks the action of a protein in your body called tumor necrosis factor alpha (TNF-alpha). TNF-alpha is made by certain blood cells in your body.  It is administered through a series of infusions.
plus


===Surgery===
'''[[Doxycycline]]''' 100 mg orally 2 times/day for 7 days
Approximately half of patients with fulminant colitis require surgery.  Surgery usually entails removing the colon and bowel and creating a "pouch" with portions of the small intestine.


==Treatment==
*[[Doxycycline]] course is continued to 100 mg orally 2 times/day for 21 days in case of [[Perianal abscess|perianal]] or [[mucosal]] [[Ulcer|ulcers]], [[Dysentery|bloody]] [[discharge]], or [[tenesmus]] and a positive [[rectal]] [[chlamydia]] test.
===Medical Therapy===
*For individuals weighing ≥150 kg, 1 g of [[ceftriaxone]] is given.
*Patients presenting with [[mucosal]] or [[Perianal abscess|perianal]] ulcers or [[bloody diarrhea]] with positive [[Nucleic acid test|NAAT]] for [[chlamydia]] should receive [[Empiric therapy|empiric]] therapy for [[Lymphogranuloma venereum|Lymphogranuloma Venereum]] (LGV)  with a prolonged course of [[doxycycline]] 100 mg orally 2 times/day for 3 weeks.<ref name="pmid25394161">{{cite journal| author=Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ| title=Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. | journal=J Int AIDS Soc | year= 2014 | volume= 17 | issue= 4 Suppl 3 | pages= 19657 | pmid=25394161 | doi=10.7448/IAS.17.4.19657 | pmc=4225278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25394161  }}</ref>
*Patients presenting with [[painful]] [[Perianal abscess|perianal]] [[Ulcer|ulcers]] or [[mucosal]] [[Ulcer|ulcers]] on anoscopy should also receive [[Empiric therapy|empiric]] treatment for [[genital herpes]].
*[[Herpes Genitalis|Herpes]] [[proctocolitis]] and [[Lymphogranuloma venereum|LGV]] occur predominantly among [[HIV AIDS|HIV/AIDS]] patients; hence [[Empiric therapy|empiric]] treatment in those patients should cover [[Herpes simplex|genital herpes]] and [[Lymphogranuloma venereum|LGV]].


*All patients with proctocolitis should be treated.
===Surgery===
*Treatment of proctocolitis is similar to that of proctitis.
Surgical intervention is not recommended for the management of [[proctocolitis]].
*Generally, the following regimen is recommended:
:: Preferred regimen: [[Ceftriaxone]] 250 mg IM {{and}} [[Doxycycline]] 100 mg PO bid for 7 days
To view additional treatment and special considerations for the management of proctitis/proctocolitis, click [[proctitis medical therapy|'''here''']].


===Surgery===
==Primary Prevention==
As [[proctocolitis]] can be a sexually transmitted disease, effective measures for the primary prevention of [[proctocolitis]] include:


===Prevention===
*[[Counseling]] on safe sex practices
*Avoiding contact with feces during [[sexual intercourse]]
*Hand washing after handing objects or materials that have been in contact with the [[Anal-oral contact|anal]] area (i.e., sex toys or barriers) and after touching the anal area.


==See also==
==Secondary Prevention==
* [[Colitis]]
Effective measures for the secondary prevention of [[proctocolitis]] include:
* [[Proctitis]]


==References==  
*Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
{{reflist|2}}
*Sexual partners with individuals treated for [[Chlamydia infection|chlamydia]] or [[gonorrhea]] <60 days before the onset of symptoms should receive evaluation and empiric treatment of the causative infection
*Testing for other sexually-transmitted diseases
*In case of [[proctocolitis]] caused by [[Chlamydia infection|chlamydia]] or [[Neisseria gonorrhoeae|Neisseria gonorrhea]], retesting for the causative organism is recommended 3 months after completion of treatment.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
{{WS}}


[[Category:Inflammations]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Crowdiagnosis]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Crowdiagnosis]]
[[Category:Up-To-Date]]
 
 
{{WH}}
{{WS}}
{{jb1}}

Latest revision as of 22:21, 14 August 2021

Colitis Microchapters

Overview

Classification

Allergic colitis
Infectious colitis
Ischemic colitis
Drug-induced colitis
Chemical colitis
Radiation colitis

Differential Diagnosis

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M.Umer Tariq [2]; Maham Khan [3]; Ogheneochuko Ajari, MB.BS, MS [4]; Rim Halaby, M.D. [5]; Qasim Salau, M.B.B.S., FMCPaed [6]; Mohamed Riad, M.D.[7]

Synonyms and keywords: Colitis, Proctocolitis, Proctitis, Enterocolitis.

Overview

Colitis is the inflammation of the colon, that can be either acute or chronic. Colitis may be caused by microorganisms such as Chlamydia trachomatis, Neisseria gonorrhoeae, Shigella dysenteriae, HSV, allergy (food protein-induced allergic proctocolitis), drugs (NSAIDs) and radiation. Colitis may co-exist with enteritis (inflammation of the small bowel), proctitis (inflammation of the rectum) or both. The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain (which may be mild) are seen in all forms of colitis. Colitis may be fulminant with a rapid downhill clinical course. In addition to the diarrhea, fever, and anemia may be reported. The patient with fulminant colitis has severe abdominal pain and presents a clinical picture similar to that of septicemia, where shock is present. Treatment of colitis depends on the etiology. It may include the elimination of cows-milk protein or other food allergens from the diet, administration of antibiotics and general anti-inflammatory medications such as mesalamine or its derivatives, steroids, or one of a number of other drugs that ameliorate inflammation. The mainstay of therapy for infectious colitis is antimicrobial therapy. A common antibiotic regimen in treatment of patients with colitis is a combination of ceftriaxone and doxycycline. Supportive therapies such as correction of dehydration and anemia, and reducing the intake of carbohydrates, lactose products, soft drinks, and caffeine is often done for most patients with colitis. Irritable bowel syndrome (spastic colitis or spastic colon) has been called colitis, causing confusion despite colitis not being a feature of the disease. Immune mediated colitis is the experimental name in animal studies of ulcerative colitis. It is a synonym of ulcerative colitis, but it should not be used as a synonym when referring to ulcerative colitis.

Classification

There is no established classification system for colitis. However, it may be classified based on etiology, age and duration of symptom.

Classification by etiology

Classes of Colitis Disorders
Autoimmune
Allergic
Infectious colitis
Idiopathic
Iatrogenic
Vascular
Drug induced
Unclassifiable

Classification by Anatomy

Colitis may co-exist with inflammation involving other parts of the gastrointestinal tract. It can be classified based on anatomy into:

Schematic of Anatomical Classification of Colitis

Affected anatomical areas: By Edelhart Kempeneers - Gray's Anatomy, Public Domain, https://commons.wikimedia.org/w/index.php?curid=534843[3]
*Regions 4 to 6: Enterocolitis
*Region 6: Colitis
*Regions 6 to 8: Proctocolitis
*Regions 7 to 8:Proctitis

Classification by Age

  • Infantile (first six months of life)[4][5][6]
  • Adult

Classification by duration of symptoms

  • Acute: Less than three months.[7]
  • Chronic: Longer than three months. Often months to years.[7]

Differential Diagnosis

The differential diagnosis of colitis can be classified into two categories according to age group. A work up for colitis must include the following differentials:

Differential diagnosis in Infants

Differential diagnosis in Adults

Differentiating Between Different Types of Colitis

The symptoms of colitis such as diarrhea especially bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:[8][9]

Diseases History and Symptoms Physical Examination Laboratory findings
Diarrhea Rectal bleeding Abdominal pain Atopy Dehydration Fever Hypotension Malnutrition Blood in stool (frank or occult) Microorganism in stool Pseudomembranes on endoscopy
Allergic Colitis + ++ + ++ ++
Chemical colitis + ++ ++ + + ++ +
Infectious colitis ++ ++ ++ +++ +++ ++ + ++ ++ +
Radiation colitis + ++ + + + ++
Ischemic colitis + + ++ + + + + ++
Drug-induced colitis + + ++ + ++ +

Causes

Common Causes

Common causes of proctocolitis include infectious agents such as Chlamydia trachomatis (which causes lymphogranuloma venereum), Neisseria gonorrhoeae, HSV, Shigella dysenteriae and Campylobacter species. It can also be allergic (e.g. food protein-induced proctocolitis), idiopathic (e.g. microscopic colitis), vascular (e.g. ischemic colitis), or autoimmune (e.g. inflammatory bowel disease).

Causes by Organ System

Cardiovascular EVAR, vasculitis
Chemical / poisoning Chemical colitis from Glutaraldehyde, Coffee enema, Hydrogen peroxide, lanthanum
Dental Dental braces
Dermatologic Albinism, Behcet disease, scleroderma, vasculitis
Drug Side Effect Alosetron, ampicillin Oral, auranofin, azithromycin, aztreonam Injection, cefaclor, cefadroxil, cefamandole Nafate Injection, cefazolin Sodium Injection, cefepime Injection, cefepime, cefoperazone Sodium Injection, cefotaxime Sodium Injection, cefotetan Disodium Injection, cefoxitin Sodium Injection, cefpodoxime, ceftazidime Injection, ceftazidime, ceftizoxime Sodium Injection, ceftriaxone Sodium Injection, cefuroxime Sodium Injection, cephalexin, cephalosporin, cephradine Oral, cidofovir, cilansetron, clindamycin, co-amoxiclav, corticosteroid, darifenacin, desogestrel and ethinyl estradiol, dicloxacillin, dirithromycin, enoxacin, ertapenem, erythromycin and Sulfisoxazole, flucytosine, glycopyrrolate, hyoscyamine, idelalisib, imipenem and Cilastatin Sodium Injection, ipilimumab, ixabepilone, levofloxacin Oral, lincomycin hydrochloride, linezolid, lomefloxacin, loracarbef, methotrexate, miconazole Injection, moxifloxacin, nafcillin Sodium Injection, nivolumab, norfloxacin, ofloxacin injection, oxacillin Sodium Injection, oxcarbazepine, oxybutynin, peginterferon alfa-2a, penicillin, pergolide, piperacillin sodium injection, pramipexole, prednisolone, procyclidine, propantheline, pseudoephedrine, quinolone, ramosetron, reserpine, solifenacin, sparfloxacin, tegaserod
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Aganglionic megacolon, alpha 1-antitrypsin deficiency, autistic enterocolitis, bacterial gastroenteritis, cap polyposis, chemical colitis, colitis ulcerosa, collagenous colitis, colonic ischemia, Crohn's disease, diversion colitis, diverticulosis, Gerson diet, infectious colitis, inflammatory bowel disease, intestinal ischemia, irritable bowel syndrome, ischemic colitis, lymphocytic colitis, microscopic colitis, multiple organ dysfunction syndrome, primary sclerosing cholangitis, protein losing enteropathy, pseudomembranous colitis, radiation colitis, radiation proctitis, solitary rectal ulcer syndrome, toxic megacolon, typhlitis, ulcerative colitis
Genetic Albinism, alpha 1-antitrypsin deficiency
Hematologic No underlying causes
Iatrogenic Diversion colitis, EVAR, radiation colitis, radiation proctitis
Infectious Disease Bacillary dysentery, bacterial gastroenteritis, balantidium coli, campylobacter jejuni, chlamydia trachomatis, clostridium difficile, cryptosporidiosis, cytomegalovirus, entamoeba histolytica, escherichia coli O157:H7, giardiasis, infectious colitis, isosporiasis, neisseria gonorrhoeae, neonatal necrotizing enterocolitis, pigbel, salmonella, schistosoma, sepsis, shigella, strongyloides stercoralis, syphilis, treponema pallidum, yersinia enterocolitica
Musculoskeletal / Ortho Ankylosing Spondylitis
Neurologic No underlying causes
Nutritional / Metabolic Gerson diet, lysinuric protein intolerance, milk allergy, pigbel, soy protein
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric Autistic enterocolitis
Pulmonary Multiple organ dysfunction syndrome
Renal / Electrolyte Multiple organ dysfunction syndrome
Rheum / Immune / Allergy Ankylosing spondylitis, Behcet disease, common variable immunodeficiency, allergic colitis (Food protein-induced colitis), scleroderma, vasculitis, Ulcerative colitis
Sexual Typical STI such as Chlamydia trachomatis, Neisseria gonorrheae, Treponema pallidum, HSV, CMV, Unusual STI Shigella dysenteriae. Proctitis is more common among individuals who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). Genital HSV and Chlamydia proctitis occur predominantly in individuals with HIV infection. Neisseria meningitidis causes proctitis among men who have sex with men and individuals with HIV infection.[10][10]
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Microscopic colitis

Causes in Alphabetical Order

Life Threatening Causes

Example include toxic megacolon, ischemic colitis, infectious colitis such as escherichia coli O157:H7 and shigella.

Screening

There is insufficient evidence to recommend routine screening of sexual partners of patients with sexually transmitted enteric pathogens.

Diagnosis

History and Symptoms

Laboratory Findings

Laboratory findings consistent with the diagnosis of proctitis include:

Other Imaging Findings

Colonoscopy

Anoscopy or sigmoidoscopy may be helpful in the diagnosis of proctocolitis. Findings on an sigmoidoscopy suggestive of proctocolitis include inflammation of the colonic mucosa extending to 12 cm above the anus and rectal ulcers.

Treatment

Medical Therapy

Acute proctocolitis among individuals with receptive anal exposure is often sexually-transmitted. Empiric antibiotic treatment should be started while awaiting for the results of laboratory tests for

patients presenting with anorectal exudate on anoscopy or positive Gram-stained smear of anorectal exudate or secretions polymorphonuclear leukocytes or if anoscopy or Gram stain is not available.[13]

Recommended Regimen for Acute Proctitis

Ceftriaxone 500 mg IM in a single dose

plus

Doxycycline 100 mg orally 2 times/day for 7 days

Surgery

Surgical intervention is not recommended for the management of proctocolitis.

Primary Prevention

As proctocolitis can be a sexually transmitted disease, effective measures for the primary prevention of proctocolitis include:

  • Counseling on safe sex practices
  • Avoiding contact with feces during sexual intercourse
  • Hand washing after handing objects or materials that have been in contact with the anal area (i.e., sex toys or barriers) and after touching the anal area.

Secondary Prevention

Effective measures for the secondary prevention of proctocolitis include:

  • Abstinence from sexual activity until the patient and their partners are successfully treated (i.e., completion of a 7-day regimen and resolution of symptoms)
  • Sexual partners with individuals treated for chlamydia or gonorrhea <60 days before the onset of symptoms should receive evaluation and empiric treatment of the causative infection
  • Testing for other sexually-transmitted diseases
  • In case of proctocolitis caused by chlamydia or Neisseria gonorrhea, retesting for the causative organism is recommended 3 months after completion of treatment.

References

  1. 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (2015).http://www.cdc.gov/std/tg2015/proctitis.htm Accessed on August 29, 2016
  2. Hamlyn E, Taylor C (2006). "Sexually transmitted proctitis". Postgrad Med J. 82 (973): 733–6. doi:10.1136/pmj.2006.048488. PMC 2660501. PMID 17099092.
  3. WikiMedia Commons https://commons.wikimedia.org/wiki/File:Gastro-intestinal_tract.png. Accessed on September 09, 2016
  4. Nowak-Węgrzyn A (2015). "Food protein-induced enterocolitis syndrome and allergic proctocolitis". Allergy Asthma Proc. 36 (3): 172–84. doi:10.2500/aap.2015.36.3811. PMC 4405595. PMID 25976434.
  5. Pumberger W, Pomberger G, Geissler W (2001). "Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood". Postgrad Med J. 77 (906): 252–4. PMC 1741985. PMID 11264489.
  6. Alfadda AA, Storr MA, Shaffer EA (2011). "Eosinophilic colitis: epidemiology, clinical features, and current management". Therap Adv Gastroenterol. 4 (5): 301–9. doi:10.1177/1756283X10392443. PMC 3165205. PMID 21922029.
  7. 7.0 7.1 Hauer-Jensen M, Denham JW, Andreyev HJ (2014). "Radiation enteropathy--pathogenesis, treatment and prevention". Nat Rev Gastroenterol Hepatol. 11 (8): 470–9. doi:10.1038/nrgastro.2014.46. PMC 4346191. PMID 24686268.
  8. Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
  9. Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.
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