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Summary and overview
Colitis is the inflammation of the colon (large intestine). The generic term to describe diseases of the colon and small intestine are inflammatory bowel diseases (IBDs). The two main types of IBDs are Ulcerative Colitis and Crohn’s disease. The onset of inflammatory bowel disease commonly happens during adolescence or young adulthood. The prevalence of ulcerative colitis in the United States is about 100 to 200 per 100,000 people.

The colon or the large intestine is the organ responsible for the collection and storage of the waste products during digestion. As food is digested, it passes through the small intestine where the body absorbs its nutrients. As this liquid mixture enters the colon, the residing mucus and normal bacteria in the colon mixes with it. The wall of a colon has many layers. One layer is a smooth muscle that aids in squeezing undigested food throughout the whole colon. Inside is a mucosal layer which absorbs water and electrolytes, and helps solidify feces. It is the mucosal layer where inflammation usually takes place.

Like the other organs of the body, arteries deliver oxygen and nutrients to the colon and veins remove CO2 and lactic acid. If the blood supply of the colon is decreased, it causes inflammation of the colon and thus the colitis.

There are several different types of colitis, each with its different symptoms and causes.

1) Necrotizing Enterocolitis is the death of intestinal tissue. It is a type of colitis common in premature new-borns. The cause is unknown, although prematurity and the bacteria in the gastrointestinal tract present are major risk factors. Reduced blood flow to the bowel is also a risk factor: You need sufficient blood to the colon to keep the bowels producing mucus that protects the gastrointestinal tract. Those who have a higher probability of having this condition are:

– premature infants

– infants who drink formula milk

– infants staying in a nursery where an outbreak has happened, and

– infants who received blood transfusions

2) Allergic colitis is an allergy to cow’s or soy milk. Babies two weeks to 1 year of age are often affected. The baby can be allergic even if the mother is breast feeding. He or she may react to milk protein in the breast milk if the mother ingests cow’s milk.

3) Pseudomembranous colitis is caused by an overgrowth of the C. difficile bacteria. This bacteria is a normal part of the flora of your intestine, but it usually kept in check by the healthy bacteria found in the colon. Antibiotics can change the balance between healthy and unhealthy bacteria. However, if an overgrowth occurs, the C. difficile bacteria produces toxins that can cause colitis. Although antibiotics are by far the drugs most often associated with the development of pseudomembranous colitis, other medications may be responsible. For those undergoing cancer treatment, chemotherapy may sometimes disrupt the bacterial balance within their intestines and trigger the development of pseudomembranous colitis. Pseudomembranous colitis can also develop in people with other forms of colon disease, such as ulcerative colitis or Crohn’s disease.

4) Ulcerative colitis is a disease that causes ulcers in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon. The causes of ulcerative colitis are not known, although researchers theorize that a virus or bacteria may trigger it, or an autoimmune reaction. Researchers no longer believe that stress causes ulcerative colitis, although it can aggravate its symptoms. Ulcerative colitis can happen at any age, but it usually starts between the ages of 15 and 30. It tends to run in families.

5) Ischemic colitis is a condition that develops when blood flow to your colon is reduced. Chronic cases are usually associated with the build-up of fatty deposits (atherosclerosis) in the blood vessels leading to your colon. In some people, ischemic colitis may be caused by or related to other medical conditions, including:

– Inflammation of the blood vessels (vasculitis)

– Hernia

– Diabetes

– Easy blood clotting

– Radiation treatment to the abdomen or

– Recent abdominal surgery

– Colon cancer

– Infections, such as Shigella, Escherichia coli 0157:H7 and Clostridium difficile

6) Collagenous colitis and lymphocytic colitis are inflammatory conditions of the colon that cause persistent watery diarrhea. Some researchers believe that collagenous colitis and lymphocytic colitis are different phases of the same condition rather than separate conditions. It is not clear what causes either condition but researchers theorize that possible causes could include:

– Bacteria that produce toxins that irritate the lining of the colon

– Viruses that trigger inflammation and immune system problems

The symptoms of colitis vary depending on the type.

  • Necrotizing Enterocolitis: An infant with the condition may have abdominal distention, blood in the stool, diarrhea feeding intolerance, lethargy, temperature instability, vomiting. This disorder usually develops in an infant that is already ill or premature, and most often develops while the infant is still in the hospital.
  • Allergic colitis: a baby with allergic colitis seems extremely fussy, difficult to console and has bloody stools. Some infants also have diarrhea vomiting, and some may show other signs of allergies, such as nasal congestion or eczema.
  • Pseudomembranous colitis: symptoms include watery or bloody diarrhea, fever, abdominal cramp and pain, pus or mucus in the stool, nausea, dehydration. Symptoms of pseudomembranous colitis can begin within one to two days after you begin receiving an antibiotic, or they may not occur until several weeks after you discontinue the antibiotic.
  • Ulcerative colitis: The most common symptoms are pain in the abdomen and bloody diarrhea. Other symptoms may include anemia, severe tiredness, weight loss, loss of appetite, bleeding from the rectum, sores on the skin and joint pain. Children with the disease may have growth problems.
  • Ischemic colitis: symptoms include abdominal pain, tenderness or cramping, usually localized to the lower left side of your abdomen bright red or maroon-colored blood in your stool or, at times, passage of blood alone without stool, a feeling of urgency to move your bowels, diarrhea, nausea vomiting. The risk of severe complications from ischemic colitis increases when signs and symptoms affect the right side of your abdomen. That’s because the arteries that feed the right side of your colon also feed part of your small intestine. When blood flow is blocked on the right side of your colon, it’s likely that part of your small intestine also isn’t receiving adequate blood supply. Pain tends to be more severe with this type of ischemic colitis and it may lead to the death of intestinal tissue. If this life-threatening situation occurs, usually in elderly people, you’ll need surgery as soon as possible.
  • Collagenous and lymphocytic colitis: symptoms include chronic, watery diarrhea, abdominal pain or cramps, weight loss, nausea, fecal incontinence.

Diagnostic tests
A health care provider will ask a series of questions to get your medical history and symptoms. The questions will include the time period of your symptoms, the pain intensity, the frequency of pain, presence of diarrhea, travel history. A physical examination will also be done.

Aside from these, a health care provider may diagnose colitis through colonoscopy or flexible sigmoidoscopy. These procedures will help evaluate the areas of your colon. A biopsy may also be done to help evaluate the colon inflammation. Other imaging studies that can aid in the diagnosis of colitis are:

  • Abdominal X-ray
  • Abdominal MRI
  • Abdominal CT scan, and
  • Barium enema

Treatment options

  • Treatment depends upon the etiology. For some forms of colitis, e.g. Collagenous and lymphocytic colitis, the condition may resolve itself without treatment.
  • Treatment of Pseudomembranous colitis typically involves stopping the current antibiotic being used to treat C. difficile and starting another that does not irritate your colon.
  • Some forms, such as ischemic colitis and ulcerative colitis, may be treated with drugs or even surgery. In some cases, e.g. severe forms of ulcerative colitis, the disease can be difficult to completely eradicate and may require lifestyle changes, help and guidance from support groups.

Alternative Therapies

  • Ayurveda defines colitis as a disease caused by variations in the Pitta dosha involving varying degrees of Vata dosha as well [1]. Ayurveda has outlined two major treatment methods for the treatment of colitis, Vasti therapy (Enema therapy) and oral ayurvedic medications. Vasti therapy helps in eliminating the excess Vata dosha from the body which is found to be elevated in case of colitis.
  • Ayurveda also advocates eliminating Pitta aggravating foods in the case of ulcerative colitis to relieve inflammation and edema [2]. Scientific research studies have highlighted the use of natural remedies like Aloe vera, Boswellia serrata, Licorice, Slippery elm, Curcumin (Turmeric, Ginger), Psyllium, Tormentil extracts, Wheat grass, Bromelain and Ginkgo biloba in the treatment of mild to acute colitis [3]. The anti-inflammatory and anti-microbial properties of these herbs help in relieving colitis complications.
  • Nutritional supplements like fish oil which is rich in omega-3 fatty acids exhibit anti-inflammatory effect which is found to relieve intestinal inflammation in Crohn’s disease [4,5]. Studies have also confirmed the benefits of probiotics in improving the remission rates for Crohn’s disease and ulcerative colitis [6]. Probiotics help in restoring the balance of good gut bacteria thereby helping in relieving colitis related diarrhea [7].
  • Homeopathic remedies follow a medicine to patient relationship, and believe that when the right dose of the correct remedy is given a natural cure follows. It considers colitis as an autoimmune ailment of the large intestine primarily target to treat the various symptoms of colitis. Arsenicum album [8], Carbo vegetabilis, Colocynthis, Ignatia, Nux vomica [9], Crotalus etc. are all seen to be useful in eliminating diarrhea, repairing and rebuilding the mucosal lining of the digestive tract as well as improve the digestive function and initiate healing.
  • Traditional Chinese medicine (TCM), regards acupuncture as a very important modality in the treatment of colitis, especially ulcerative colitis [11]. A randomized clinical trial has been successful in outlining the efficacy of acupuncture in combination with moxibustion in the treatment of colitis [10]. These therapeutic benefits are extended by both traditional and sham acupuncture techniques.
  • Research has concluded the usefulness of Mindfulness-based stress reduction (MBSR) as an additional therapeutic treatment to improve the remission associated with mild to severe colitis [12]. MBSR is a type of meditation and shows some promise as a complementary approach to improve quality of life (QOL) and decrease perceived stress in people with ulcerative colitis.

There is no evidence that IBDs are caused by diet. But changes to your diet may help you manage your symptoms or increase the time between flare-ups. Limiting dairy products or cutting down on high-fiber foods may reduce inflammation of the colon. If raw fruits and vegetables bother you, try steaming, baking or stewing them. Try eliminating any foods that seem to make your symptoms worse.

Colitis can occur for several reasons. Treatment, prognosis and complications depend on the etiology of colitis. It is advised to consult one’s health care provider for the right diagnosis and treatment.

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2. Patel KB, Patel M, Mehta CS, Gupta S, Kessler CS. Ayurvedic management of ulcerative colitis–a non-randomized observational clinical study. Forsch Komplementmed. 2013;20(2):144-7. doi: 10.1159/000350832. Epub 2013 Apr 12. PubMed PMID: 23636034.

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6. AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis  in preterm infants. Evid Based Child Health. 2014 Sep;9(3):584-671. doi: 10.1002/ebch.1976. PubMed PMID: 25236307.

7. Marteau PR, de Vrese M, Cellier CJ, Schrezenmeir J. Protection from gastrointestinal diseases with the use of probiotics. Am J Clin Nutr. 2001 Feb;73(2 Suppl):430S-436S. Review. PubMed PMID: 11157353.

8. Ive EC, Couchman IM, Reddy L. Therapeutic Effect of Arsenicum album on Leukocytes. Int J Mol Sci. 2012;13(3):3979-87. doi: 10.3390/ijms13033979. Epub 2012 Mar 22. PubMed PMID: 22489193; PubMed Central PMCID: PMC3317753.

9. Eldahshan OA, Abdel-Daim MM. Phytochemical study, cytotoxic, analgesic, antipyretic and anti-inflammatory activities of Strychnos nux-vomica. Cytotechnology. 2014 Apr 8. [Epub ahead of print] PubMed PMID: 24711053.

10. Schneider A, Streitberger K, Joos S. Acupuncture treatment in gastrointestinal diseases: a systematic review. World J Gastroenterol. 2007 Jul 7;13(25):3417-24.  Review. PubMed PMID: 17659687; PubMed Central PMCID: PMC4146776.

11. Joos S, Wildau N, Kohnen R, Szecsenyi J, Schuppan D, Willich SN, Hahn EG, Brinkhaus B. Acupuncture and moxibustion in the treatment of ulcerative colitis:  a randomized controlled study. Scand J Gastroenterol. 2006 Sep;41(9):1056-63. PubMed PMID: 16938719.

12. Jedel S, Hoffman A, Merriman P, Swanson B, Voigt R, Rajan KB, Shaikh M, Li H, Keshavarzian A. A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis.Digestion. 2014;89(2):142-55. doi: 10.1159/000356316. Epub 2014 Feb 14. PubMed PMID: 24557009; PubMed Central PMCID: PMC4059005.

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