Colitis is a particularly frequent reason for consultation, whether it is with the attending physician or the gastroenterologist. It is not a disease strictly speaking but a “syndrome” ie a set of manifestations linked to inflammation of the colon. This inflammation can have many and very different causes, whether in terms of the mode of occurrence, colonic lesions responsible for the inflammation, the treatments, the evolution and the outcome of colitis. 

Colitis is therefore an inflammation of the colon wall which can manifest itself acutely or chronically.

Acute colitis can be linked to:

• infection by a virus, bacteria, fungus or parasite, for example bacteria such as salmonella, shigella, cholera, staphylococci, escherichia coli, or even parasitoses such as amoebiasis or bilharzia intestinal. In these cases, they can be transmitted by direct human-to-human or food contamination. Infectious colitis can also be linked to colon disease (cancer, ulcerative colitis (UC), Crohn’s disease, colonic diverticulosis, etc.) of which they are then a complication.
• drug colitis after taking antibiotics for example, or an excess of laxatives.
• Ischemic colitis is linked to poor blood supply, more or less brutal, of the colon, due to arterial lesions such as atheroma plaque or thrombosis which reduce the diameter of the arteries supplying and oxygenating the colon.
• Some treatments to fight cancer can cause colitis. Thus colitis occurring after radiotherapy of the abdomen (we start with “radiation colic”) or certain drug treatments for cancer (chemotherapy).

Chronic colitis:

• spasmodic colitis, better known as “irritable bowel syndrome” or functional colopathy.
• two major “Chronic Intestinal Inflammatory Diseases” (or IBD) such as UC (RectoColitis Haemorrhagic or ulcerative colitis) or Crohn’s disease have a less well-known origin. They can manifest as acute colitis during a disease flare.

 All colitis is manifested by transit disorders (diarrhea or constipation), abdominal pain, more or less severe, permanent or not, often bloating (abdominal meteorism). Depending on the cause, they can be accompanied by an impairment of the general condition, fever, weight loss, fatigue or extra-digestive manifestations.

The digestive or extra-digestive manifestations vary depending on the cause of the disease:

• infectious colitis is accompanied by fever and rapidly dehydration.
• colitis after antibiotics (lincomycin, clindamycin, ampicillin, cephalosporins, tetracyclines, etc.), result in diarrhea which is often ocher or green-orange in color. There are severe forms, such as pseudomembranous colitis, linked to superinfection by a germ, “Clostridium difficile”. The diarrhea is severe, sometimes bloody with severe abdominal pain and high fever.
• Ischemic colitis manifests itself by often brutal and intense pain in the abdomen with sometimes bloody diarrhea.
• Post-radiotherapy colitis: they occur several months or even years after radiotherapy of the abdomen. Pain and transit problems are often accompanied by bleeding or mucus in the stool and sometimes urinary abnormalities.
• Chronic Inflammatory Bowel Disease (IBD) results in diarrhea, abdominal pain, often permanent or intermittent bloody stools. Other organs can be affected. IBD can occur at any age but usually affects young people and often appears before the age of 30. We often find in the family a history of IBD or other pathologies such as rheumatoid arthritis or ankylosing spondylitis. These pathologies are still imperfectly known but they are linked to abnormal immune reactions, the body developing defenses with respect to its own tissues.
• Irritable bowel syndrome (IBS) combines abdominal pain, bloating (meteorism), diarrhea or constipation or alternation of the two and often other digestive manifestations in the stomach or esophagus with sensations of difficult digestion . There is no intestinal lesion (colonoscopy is normal) but an abnormal functioning of the intestine, without immediate or long-term seriousness. Very common, it affects twice as many women as men.

Complications

The course of colitis obviously depends on its cause and the quality of its treatment. Severe diarrhea puts you at risk of dehydration, especially in younger children and the elderly; when it persists, it can lead to vitamin deficiencies and weight loss due to poor absorption of nutrients in the colic.

When should you consult?

• When transit disorders or pain persist
• in case of bloody stools
• in case of fever or weight loss

The diagnosis

The diagnosis is guided by the digestive and non-digestive symptoms, the history of the person.

When faced with acute diarrhea, especially after returning from a trip, the first thought is a bacterial, viral or parasitic infection which can be identified by an examination of the stool. Similarly, after antibiotic treatment, it is necessary to evoke a superinfection of the colon by a bacterium, Clostridium difficile.

In the face of chronic colitis, an endoscopy of the colon and rectum is generally performed, which can detect a possible non-digestive cause of the pain, and which may or may not find lesions of the lining of the colon. This examination also allows biopsies to be taken to determine whether or not it is IBD for example.

People at risk and risk factors

         The risk factors are very different depending on the cause:

• food poisoning
• stay in a country with poor hygiene
• treatment with antibiotics, anticancer drugs, radiotherapy
• personal or family history of autoimmune disease

Likewise, the prevention of colitis differs greatly depending on their cause.

In general, good hygiene must be observed (wash your hands before meals and after having a bowel movement, consume food before their expiry date and never when you have doubts about respecting the cold chain. , avoid tap water, ice cream, dairy products or raw vegetables in some countries.

To limit pain and transit disorders, it is best to limit very fatty or very spicy foods, coffee, tea, carbonated drinks and alcohol. The role of fibers is discussed. They are recommended in constipation but could also promote bloating and intestinal discomfort.

It is advisable to take Ultra-yeast® which contains a microscopic fungus (a yeast), Saccharomyces boulardii, in case of treatment with antibiotics. The interest of probiotics in other indications is discussed, but it seems preferable in the event of transit disorders to consume fermented dairy products rather than raw milk.

To avoid colitis due to laxatives, it is recommended to limit stimulating laxatives to prefer ballast laxatives or osmotic laxatives (see sheet). Constipation).

The specific treatment for acute colitis depends on its cause. It will always be necessary to combine rehydration in the event of severe diarrhea and compensation in vitamins and other nutrients in the event of prolonged diarrhea. 

 Infectious colitis

They benefit from a specific anti-infective treatment once the germ has been identified by stool culture (stool culture).

Post-antibiotic colitis

They usually disappear spontaneously after stopping the antibiotic. Healing can be accelerated by compensating for probiotics such as Ultra-yeast®.

The severe forms linked to superinfection with “clostridium difficile” can now be treated with “faecal transplantation” or “faecal bacteriotherapy”. It consists of transplanting the intestinal flora of a healthy person to the patient.

 Ischemic colitis

These are emergencies. They must lead to rapid hospitalization in a unit specializing in the management of intestinal pathologies by vascular obstruction in order to restore circulation as quickly as possible and / or remove the necrotic colonic or intestinal area (damaged area due to lack of oxygen. ).

Chronic Inflammatory Bowel Disease (IBD)

Although there is no real cure that can permanently cure IBD, there are more and more treatment options to reduce inflammation in the gut, reduce symptoms, and achieve remission. The management of these diseases has clearly progressed with the provision of biotherapies.

• the RCH (see file).
• Crohn’s disease (see fact sheet)

These approaches do not replace specific treatments for colitis but may be suitable when used in addition to medical treatments. Do not hesitate to talk to your doctor about them, some of which may have side effects or interact with the therapies prescribed for the treatment of cancer. 

Thermal cures

They can be useful in chronic colitis. These are generally drink cures from the thermal spring.

Honey could have some effectiveness on the symptomatology of spasmodic colitis or even UC

Some plants could calm intestinal symptoms, such as black radish, sage, lemon balm, passionflower. 

Stress management is always helpful in dealing with intestinal discomfort.