Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.
Treatments
A. In conventional medicine perspective
A.6. Indeterminate colitis and Atypical colitis
A.6.1. Indeterminate colitis
Indeterminate colitis (IC) originally referred to those 10–15% of cases
of inflammatory bowel disease (IBD) in which there was difficulty
distinguishing between ulcerative colitis (UC) and Crohn’s disease (CD)
in the colectomy specimen(104). Other researchers defined that a
diagnosis of indeterminate colitis (IC) is based on endoscopic, histologic, and radiologic findings when the criteria for either Crohn's colitis or ulcerative colitis
(UC) cannot be definitively established(105). Others indicated that
most cases of IC represent UC upon long-term clinical follow-up.
Although, in some instances, serologic testing for ANCA or ASCA may be
helpful in separating UC from CD in patients with IC, there is much
overlap in the results of these assays for cases in which CD involves
the colon in a UC-like pattern. Approximately 20% of IC patients develop
severe pouch complications, which is intermediate in frequency between
that seen in ulcerative colitis (UC) or CD. The risk of pouch
complications, such as perianal
fistulas or abscesses, and the risk of pouch breakdown is, overall,
quite similar between IC and UC patients, supporting the notion that
most patients with IC probably have UC and can safely undergo an ileal
pouch-anal anastomosis (a procedure involves the creation of a pouch of
small intestine to recreate the removed rectum) procedure and have a
reasonably good chance of
having a good outcome(106).
According to the study by Center for Crohn's and Colitis, Brigham and Women's Hospital, no studies have been undertaken to determine the optimum treatment
regimen for IC. Recent studies have shown that patients with IC are
still appropriate candidates for ileal pouch anal anastomosis. In
conclusion, the current data support the premise that IC may be a
separate entity, but future studies will have to focus on the genotypic
and phenotypic characterization of these patients(107).
1. Medical therapy
Medication used to treatment commonly in treating IBD, is also being used in IC.
2. Surgical therapy
Total proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become
the surgical treatment of choice for a large number of patients with
UC(108).
A.6.2. Atypical colitis
Treatment of atypical colitis is dependence to the differentiation
1. C. difficile colitis
According to the study by St. Thomas' Hospital, Guy's & St Thomas'
NHS Foundation Trust, in patients with cystic fibrosis, imaging findings
of a pancolitis should raise the possibility of C. difficile colitis despite the lack of watery diarrhea. Anticlostridial treatment can be initiated before bacteriologic confirmation is obtained(109).
2. Atypical forms of microscopic colitis
Microscopic colitis
is defined as a syndrome of chronic watery diarrhea with a chronic
inflammatory cell infiltrate in the colonic mucosa but without
significant abnormalities at colonoscopy. According to the study by St. Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, by considering the clinical history and symptoms, the pathologist should
be able to reach the correct diagnosis in most cases. However, the
spectrum of morphologic changes associated with watery diarrhea syndrome
appears to be broader than originally thought. Morphologic changes more
often associated with chronic inflammatory bowel disease or even
chronic ischemic or infectious colitis have been noted in patients with clinically established microscopic colitis. The data presented in this article suggest that microscopic colitis is a heterogeneous entity, which includes both classic and "atypical" forms(110).
3. Atypical allergic colitis
There is a report of 2 atypical cases of colitis
due to cow's milk protein intolerance (CMPI) are reported, affecting
preterm infants. One developed a toxic dilatation of the colon and
responded well to a casein hydrolysate based feed. The second presented
insidiously and failed to tolerate a casein hydrolysate, but responded
well to a chicken-based modular feed(111)
4. Etc.
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Sources
(107) http://www.ncbi.nlm.nih.gov/pubmed/15115931
(108) www.annalsgastro.gr/index.php/annalsgastro/article/download/681/497
(109) http://www.ncbi.nlm.nih.gov/pubmed/9930816
(110) http://www.ncbi.nlm.nih.gov/pubmed/16096382
(111) http://www.ncbi.nlm.nih.gov/pubmed/1750352
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