Patients with colitis usually present with the classic symptoms of stomach pain, diarrhoea, nausea and vomiting. The onset is insidious. Those with necrotising enterocolitis may present with perforation and shock in severe cases which may lead to death. The first sign is abdominal distension with retention followed by vomiting. Infants with allergic colitis present with vomiting, diarrhoea and with blood and mucus in stools [6].

Ulcerative colitis and Crohn’s disease are usually insidious in onset. They present with diarrhoea, occult blood in stools, weight loss and growth failure in children. Adults present with abdominal pain and diarrhoea.

Patients with pseudomembranous colitis present with abdominal cramps, profuse watery or mucoid diarrhoea, tenesmus, fever and tenderness. During the initial attack or relapse of ulcerative colitis, apthous stomatitis is often present.

• Weight Loss

  Other symptoms include fatigue, weight loss, and loss of appetite. Ulcerative colitis tends to become chronic, with sustained fever and weight loss; complications and death may result. [britannica.com]

  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. [icd9data.com]

  Crohn’s disease symptoms vary, but the most common are abdominal pain, diarrhea, and weight loss. [healthmatters.nyp.org]

  Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss. Pancolitis. [mayoclinic.org]

  In addition to bloody diarrhea and abdominal pain on the left side, a patient may also experience weight loss. [self.com]

• Anemia

  This patient was evaluated for iron deficiency anemia and underwent hemicolectomy for extensive right-side predominant inflammatory pseudopolyps. [ncbi.nlm.nih.gov]

  […] associated with ulcerative colitis Hemolytic anemia w ulcerative colitis Hemolytic anemia, with ulcerative colitis Intestinal obstruction due to ulcerative colitis Mild chronic ulcerative colitis Moderate chronic ulcerative colitis Rectal hemorrhage [icd9data.com]

  A low red blood cell count can indicate anemia, from bleeding within the colon and rectum. Elevated white blood cells, which fight infection, indicate inflammation within the colon and rectum. [virginiamason.org]

  Other symptoms may include Anemia Severe tiredness Weight loss Loss of appetite Bleeding from the rectum Sores on the skin Joint pain Growth failure in children About half of people with UC have mild symptoms. [medlineplus.gov]

  anemia, and rapid heart rate After you have talked with your doctor about your symptoms, along with certain other tests and additional information, your doctor will create an appropriate treatment plan for you. [crohnsandcolitis.com]

• Diarrhea

  […] colitis, but the diarrhea tends to recur soon after stopping Entocort. [medicinenet.com]

  Since CCS is very rare, we herein describe a case of MNZ-effective diarrhea after UCBT. KEYWORDS: cord colitis syndrome (CCS); metronidazole (MNZ); umbilical cord blood (UCB); watery diarrhea [ncbi.nlm.nih.gov]

  Watery diarrhea that happens several times a day is one of many signs of a C. diff infection. You can have diarrhea and abdominal cramping even with a mild infection. If you have C. diff, your diarrhea will have a very strong odor. [webmd.com]

  Signs and symptoms include abdominal pain, diarrhea, fever, weight loss, and intestinal hemorrhage Chronic inflammation of the colon that produces ulcers in its lining. [icd9data.com]

  Bloody diarrhea that may be severe, abdominal cramps and pain, fatigue and significant weight loss Fulminant colitis: A rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration [carrolldigestivediseasecenter.com]

• Abdominal Pain

  Signs and symptoms include abdominal pain, diarrhea, fever, weight loss, and intestinal hemorrhage Chronic inflammation of the colon that produces ulcers in its lining. [icd9data.com]

  Bowel rest for 6 days relieved her abdominal pain and hematochezia. CONCLUSIONS: The present case developed AAHC caused by second-line therapy for H. pylori eradication. [ncbi.nlm.nih.gov]

  Other symptoms and signs of Colitis Abdominal Cramps Abdominal Pain Bloating Blood in Stool Canker Sores Chills Diarrhea Fatigue Fever Joint Swelling Malaise Mouth Ulcers Rectal Ulcers Skin Sores Weakness Weight Loss QUESTION Ulcerative colitis affects [medicinenet.com]

  The most common symptoms of ulcerative colitis are bloody diarrhea and abdominal pain. Other symptoms include fatigue, weight loss, and loss of appetite. [britannica.com]

  These include looser and more urgent bowel movements, and persistent diarrhea accompanied by abdominal pain and blood in the stool. Stool is generally bloody. Abdominal pain is common, accompanied by loss of appetite and weight loss. [empowher.com]

• Abdominal Cramps

  Bloody diarrhea, abdominal cramping and pain on the left side and unintentional weight loss. Pancolitis: Affects more than the left colon and often the entire colon. [carrolldigestivediseasecenter.com]

  Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss. Pancolitis. [mayoclinic.org]

  Other symptoms and signs of Colitis Abdominal Cramps Abdominal Pain Bloating Blood in Stool Canker Sores Chills Diarrhea Fatigue Fever Joint Swelling Malaise Mouth Ulcers Rectal Ulcers Skin Sores Weakness Weight Loss QUESTION Ulcerative colitis affects [medicinenet.com]

  Abdominal cramps and diarrhea may be helped by medications to reduce inflammation in the colon. Abdominal cramps and diarrhea may be helped by medications to reduce inflammation in the colon. [texaschildrens.org]

• Chronic Diarrhea

  The primary symptom of microscopic colitis is chronic, watery diarrhea. Individuals with microscopic colitis can have diarrhea for months or years before the diagnosis is made. [medicinenet.com]

  Colitis Symptoms The main symptom of microscopic colitis is chronic diarrhea. This disease is referred to as microscopic because inflammation cannot be seen unless a tissue sample is examined under a microscope. [susquehannahealth.org]

  IBD is a general term for noninfectious conditions that involve chronic inflammation of the intestines, causing symptoms such as diarrhea, abdominal pain, fevers, bleeding and growth problems. [ucsfbenioffchildrens.org]

  Clinically patients have chronic diarrhea (sometimes bloody) associated with tenesmus, pain and fever 1. C-reactive protein levels are usually normal 6. [radiopaedia.org]

• Abdominal Distension

  Resulting abdominal distension can be severe, and patients should seek medical attention immediately. The goal of treatment is to prevent the bowel from rupturing. [gwhospital.com]

  The first sign is abdominal distension with retention followed by vomiting. Infants with allergic colitis present with vomiting, diarrhoea and with blood and mucus in stools. Ulcerative colitis and Crohn’s disease are usually insidious in onset. [symptoma.com]

  During a physical exam, the health care provider most often checks for abdominal distension, or swelling listens to sounds within the abdomen using a stethoscope taps on the abdomen to check for tenderness and pain Lab Tests A health care provider may [niddk.nih.gov]

• Tachycardia

  Patients with > 10 bloody bowel movements per day, tachycardia, high fever, or severe abdominal pain require hospitalization to receive high-dose IV corticosteroids. 5-ASA may be continued. [msdmanuals.com]

  Severe disease is defined by bowel frequency greater than 6 times a day in conjunction with fever, tachycardia, anemia, or an elevation in ESR. [journals.lww.com]

  Predictive factors for failure to respond to CSA include persistent fevers, tachycardia, elevated C-reactive protein, hypoalbuminemia, and deep colonic ulcerations (277, 278). [gi.org]

• Oral Ulcers

  Patients with a delayed diagnosis of CD were associated with a 3-stage procedure (P < 0.0001, OR = 2.8) (95% CI = 1.8-4.4), colonic stricture (P = 0.04, OR = 2.9 [95% CI = 1.1-7.4]), perianal fistula (P = 0.02, OR = 2.9 [95% CI = 1.2-7.2]), oral ulceration [ncbi.nlm.nih.gov]

  Patients with a delayed diagnosis of CD were associated with a 3‐stage procedure ( P P = 0.04, OR = 2.9 [95% CI = 1.1–7.4]), perianal fistula ( P = 0.02, OR = 2.9 [95% CI = 1.2–7.2]), oral ulceration ( P = 0.009, OR = 3.8 [95% CI = 1.2–9.6]) and younger [doi.org]

• Arthralgia

  Extra-intestinal symptoms may appear: in the joints (arthralgia, low back pain), on the skin (erythema nodosum), sometimes in the eyes or the liver. In children, ulcerative colitis leads to malnutrition, which may cause severe failure to thrive. [digestscience.com]

  Allergic reactions occur in approximately 2–5% of patients and usually present as some combination of fever, rash, myalgias, or arthralgias. [gi.org]

• Flushing

  Flush the feeding tube before and after this drug is given. Chewable tablet: Chew or crush well. Mix crushed tablet with food. Do not swallow it whole. Long-acting products: Swallow whole. Do not chew, break, or crush. [medplusmart.com]

  Do not flush medications down the toilet or pour them into drainage unless instructed to do so. Medication discarded in this manner may contaminate the environment. [tabletwise.com]

  […] aminosalicylates corticosteroids immunomodulators biologics, also called anti-TNF therapies other medications Depending on the location of the symptoms in the colon, health care providers may recommend a person take medications by enema, which involves flushing [niddk.nih.gov]

  Most infusion reactions are mild–moderate and consist of flushing, headaches, dizziness, chest pain, cough, dyspnea, fevers, chills, and pruritus. [gi.org]

• Withdrawn

  Patients who cannot be withdrawn from corticosteroids are usually given azathioprine. Nearly one third of patients suffering from ulcerative colitis require surgery. [symptoma.com]

  Withdrawing from Corticosteroids Once remission is achieved and the intestinal inflammation has subsided, steroids must be withdrawn very gradually. [mountsinai.org]

  Patients who cannot be withdrawn from corticosteroids should be given thiopurines (azathioprine or 6-mercaptopurine), anti-TNF drugs, or a combination. [msdmanuals.com]

• Confusion

  State: Scouting report, prediction," 30 Aug. 2019 She and Michael Docktor, the clinical director of innovation, have created Health Voyager, an app that uses virtual reality to create a personalized Magic School Bus-like experience for patients feeling confused [merriam-webster.com]

  They are: ulcerative colitis Crohn's disease IBD should not be confused with irritable bowel syndrome (IBS), which is a different condition and requires different treatment. [nhs.uk]

  […] anus Most commonly occurs at the end of the small intestine May appear in patches May extend through entire thickness of bowel wall About 67% of people in remission will have at least 1 relapse over the next 5 years IBD is not IBS It’s important not to confuse [crohnsandcolitis.com]

  Diagnosis is often delayed because IBD is confused with other conditions, such as lactose intolerance, a stomach virus or school avoidance behavior. The condition can be inherited and is common in some families. [ucsfbenioffchildrens.org]

  While both ulcerative colitis and Crohn’s disease are types of inflammatory bowel diseases (IBD), they should not be confused with irritable bowel Syndrome (IBS), a disorder that affects the muscle contractions of the colon. [crohnscolitisfoundation.org]

• Stroke

  One recent case involved a patient who experienced an arterial stroke as a result of his ulcerative colitis. [ 17 ] Inflammation and internal bleeding can increase chances of developing blood clots. [globalhealingcenter.com]

  They have the potential to become narrow due to atherosclerosis (just like blood vessels in the heart, which can cause angina, or narrowed vessels in the brain can cause a stroke). [emedicinehealth.com]

  As ischaemic colitis is caused due to the narrowing of the blood vessels supplying the colon, taking care of other types of circulatory problems such as peripheral vascular diseases and stroke can also reduce the risk for ischaemic colitis. [symptoma.com]

  This is the same mechanism that can cause a stroke in patients with AFib. [medicinenet.com]

• Seizure

  He had a past history of alcohol abuse with withdrawal seizures. An abdominal computed tomography scan showed thickened bowel loops but no obvious ischaemic changes, and a blood culture yielded a pure growth of Escherichia coli. [ncbi.nlm.nih.gov]

  These include wheezing; chest tightness; fever; itching; bad cough; blue or gray skin color; seizures; or swelling of face, lips, tongue, or throat. Back pain, belly pain, or blood in the urine. May be signs of a kidney stone. Any rash. [medplusmart.com]

  If you have a chronic illness that requires taking medicine constantly such as heart condition, seizures, and life-threatening allergies, you are much safer keeping in touch with your primary health care provider so that you can have a fresh supply of [tabletwise.com]

  Cyclosporine High blood pressure, nausea, vomiting, diarrhea, kidney failure, tremors, infections, seizures, neuropathy, and development of lymphomas (cancers of the lymphatic system) Side effects become more likely with long-term use. [msdmanuals.com]

• Apathy

  You’re worrying about how you look Running to the loo, dehydration, a lack of appetite, and general apathy can take its toll on your body – both on the inside and outside. [metro.co.uk]

Laboratory tests should be done to rule out anemia, electrolyte abnormalities and hypoalbuminaemia. There might also be leucocytosis, thrombocytosis and elevated ESR and C-reactive protein. Liver function tests should be done as well. Elevated levels of alkaline phosphatase and γ-glutamyl transpeptidase suggest the possibility of primary sclerosing cholangitis.

Perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) are relatively specific (60 to 70%) for ulcerative colitis. Anti–Saccharomyces cerevisiae antibodies (ASCA) are fairly specific for diagnosing Crohn’s disease. However, they are not reliable for differentiating between the two.

Abdominal X-rays are not diagnostic but can help assist for the same as it may show any abnormalities in the diseased bowel. Barium enema also helps in showing similar changes occurring in the lining of the colon.

A stool culture and microscopy can help to exclude the presence of Entamoeba histolytica and other infectious causes. A sigmoidoscopy along with a biopsy of the affected areas may also be done. Colonoscopy is not really necessary but may be done electively [7].

Loperamide is used to treat the diarrhoea along with dietary management to relieve the symptoms [7]. Anticytokine drugs, corticosteroids are usually the drugs of choice. The symptoms of colitis can be improved if raw fruits and vegetables are avoided thus, also lessening the trauma to the inflamed colonic mucosa.

At times, it is noted that a milk and gluten free diet greatly helps reduce the symptoms thus promoting the overall well-being of the patient. Corticosteroids are tapered based on the response. Patients who cannot be withdrawn from corticosteroids are usually given azathioprine [8].

Nearly one third of patients suffering from ulcerative colitis require surgery. It has been proved that total proctocolectomy is curative and the quality and expectancy of life is restored to normal.

The prognosis of colitis is good if attended well. However, if diarrhoea is not treated in time, it can lead to death. It is the leading cause of mortality and morbidity in children.

Necrotising enterocolitis with pneumatosis intestinalis does not have a good prognosis as medical treatment fails in 20% of patients. 70% of children with ulcerative colitis go in to remission within 3 months of initial therapy [9].

Depending upon the duration and the extent of the disease, the risk for developing adenocarcinoma increases. Hence, surveillance colonoscopy should be performed once a year or twice a year 8-10 years after the first diagnosis. Almost all patients respond to medical treatment and stay in remission.

The exact cause of colitis is not known. A commonly accepted hypothesis suggests that for genetically predisposed persons, exogenous factors (e.g., infectious agents, normal lumenal flora) as well as host factors (e.g., vascular supply, intestinal epithelial cell barrier function, neuronal activity) produce a state of chronically dysregulated mucosal immunity that is modified further by environmental factors like smoking. However, some studies have identified a gene (NOD2) that can complicate the situation and is involved in the affection of the terminal ileum [2].

Inflammation of the colon may also be caused due to infection, ischaemia, hypersensitivity to various allergens, or several drugs. Some evidence even suggests a genetic predisposition to colitis which includes ethnic differences, etc.

Parasitic infections are the common causes for colitis in developing countries whereas in USA, bacterial and viral infections are the main causes. Infectious colitis is caused due to bacteria like Shigella, E.coli and Salmonella.

The arteries supplying to the colon have the potential to get narrow because of atherosclerosis. When the arteries become narrow, the colon becomes inflamed because of the loss in blood supply leading to ischaemic colitis. Ulcerative colitis is an autoimmune illness. Inflammation of the colon can also occur if chemicals are instilled into it for e.g. during an enema.

Psychosocial factors may contribute to the worsening of symptoms. Stress factors are associated with an increase in colitis symptoms such as abdominal pain, diarrhoea and bleeding per rectum. IBD patients have been hypothesized to have a characteristic personality that renders them susceptible to emotional stresses. However, emotional dysfunction could also be the result of chronic illness rather than a cause.

Irritable bowel disease usually affects adolescents and young adults. It is more commonly seen in males. The prevalence of ulcerative colitis in the United States is estimated to be 100-200 per 100,000 populations and the incidence of Crohn’s disease is estimated to be about 3-4 per 100,000 populations. Ulcerative colitis is highest in the United States and Northern Europe and is lowest in Japan and South Africa. Amoebic infections are highest in frequency amongst tropical climates [3].

Necrotizing enterocolitis is commonly seen in newborns with very low birth weight. Pre-term infants are susceptible to it as well. IBD is also more commonly seen in children aged 5-16 years. It either occurs between the ages of 15-25 years or 50-80 years. The prevalence of irritable bowel disease is more amongst the European Jewish people of Ashkenazi descent [4].

In colitis (ulcerative colitis and Crohn’s disease), activated CD4 cells of the lamina propria and peripheral blood secrete inflammatory cytokines. Some activate other inflammatory cells such as macrophages and B cells.

They act indirectly and recruit other inflammatory leukocytes, mononuclear cells and lymphocytes from the peripheral vasculature into the colon via interactions between homing receptors on leukocytes (e.g., α4β7 integrin) and addressins on vascular endothelium (e.g., MadCAM1). CD4 T cells are of two major types: TH1 cells [interferon (IFN) γ, tumor necrosis factor (TNF)] and TH2 cells (IL-4, IL-5, IL-13). TH1 cells appear to induce transmural granulomatous inflammation that resembles Crohn’s disease, and TH2 cells appear to induce superficial mucosal inflammation resembling Ulcerative Colitis. The TH1 cytokine pathway is initiated by interleukin-12, an important cytokine in the pathogenesis of mucosal inflammation [5].

Once initiated, the immune inflammatory response is perpetuated as a consequence of T cell activation. A sequence of inflammatory mediators acts to extend the response. Inflammatory cytokines, such as Interleukins 1 & 6, Tumour Necrosis Factor alpha have diverse effects on tissue. They promote collagen production, fibrogenesis, production of other inflammatory mediators and activation of tissue metalloproteinases. They activate the chain of coagulation in surrounding blood vessels (e.g., increased production of von Willebrand’s factor).

In colitis, the activity of the cytokines is dysregulated, resulting in the imbalance between the pro-inflammatory and anti-inflammatory mediators.

Exogenous factors may have an as yet undefined infectious etiology. The immune response to a specific organism could be expressed differently, depending upon the genetic makeup of a particular individual. Multiple pathogens (e.g., Salmonella, Shigella sp., Campylobacter sp.) may initiate colitis by triggering an inflammatory response that the mucosal immune system cannot control.

Colitis, especially the inflammatory bowel variant is difficult to prevent at the present time because the likely causes are hereditary or an auto-immune response to an unknown stimulus. However, infectious colitis is an ailment caused due to the lack of proper hygiene, lack of clean drinking water and sanitation. This can be prevented if proper care is taken. As ischaemic colitis is caused due to the narrowing of the blood vessels supplying the colon, taking care of other types of circulatory problems such as peripheral vascular diseases and stroke can also reduce the risk for ischaemic colitis [10].

Colitis is a term used to indicate the inflammation of the colon. Colitis could be associated with enteritis which is the inflammation of the intestine and proctitis which is the inflammation of the rectum.

Crohn’s disease, ulcerative colitis and indeterminate colitis are three idiopathic disorders associated with inflammation of the intestinal lining [1].

Colitis can cause pain, diarrhoea and bleeding from the rectum. Patient’s suffering from colitis and inflammatory bowel diseases are at high risk of developing colorectal cancer.

Colitis is a term used to indicate inflammation of the colon. It is usually seen in adolescents and young adults. There is no known cause for colitis although some studies attribute it to hereditary factors and the fact that colitis is an auto-immune disease. Infective colitis is caused by micro-organisms such as E.coli, Salmonella and Shigella and this is the type of colitis that can be prevented by maintaining a clean environment with proper hygiene and sanitation. The other variants of colitis such as ulcerative colitis and Crohn's disease cannot be prevented because of their auto immune nature.

Colitis presents with symptoms such as abdominal pain, bowel dysfunction and bleeding. Daily stress can also affect the intestine causing an aggravation of the symptons. It is diagnosed with the help of lab-tests and X-rays which may show abnormalities in the bowel. A biopsy will show changes in the mucosal lining. Psychosocial support and education about the illness to the family will help in achieving positive long term goals where treatment is concerned.

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2. Hugot JP, Chamaillard M, Zouali H et al. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn’s disease. Nature. 2001 May 31;411(6837):599-603.
3. Higuchi LM. Epidemiology and diagnosis of inflammatory bowel disease in children and adolescents. UpToDate. 2005;12.3. Last accessed: Dec 12, 2013.
4. Hou JK, El-Serag H, Thirumurthi S. Distribution and Manifestations of Inflammatory Bowel Disease in Asians, Hispanics, and African Americans: A Systematic Review. Am J Gastroenterol. 2009 Aug; 104(8):2100-9
5. Friedman S, Rubin H, Bodian C et al. Screening and surveillance colonoscopy in chronic Crohn’s colitis: Results of a Surveillance Program Spanning 25 Years. Clin Gastroenterol Hepatol. 2008;6(9):993-98.
6. Bousvaros A, Leichtner A. Overview of the management of Crohn's disease in children and adolescents. UpToDate. 2005;13.2. Last accessed: Mar 12, 2014.
7. Navarro F, Hanauer SB. Treatment of inflammatory bowel disease: Safety and tolerability issues. Am J Gastroenterol. 2003 Dec;98(12 Suppl:S18-23
8. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults. Am J Gastroenterol. 1997:92:204-11.
9. Hyams JS. Inflammatory bowel disease. Pediatr Rev. 2005 Sep;26(9):314-20.
10. Hanauer SB, Sanborn W. Management of Crohn’s disease in adults. Am J Gastroenterol. 2001;96:635-43.