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Acute and Chronic Colitis: Changing Causes and TherapiesColitis is the irritation or inflammation of the colon. The colon, shaped like a large horseshoe in an upside-down configuration, is divided into three parts (right colon, transverse or connecting colon and left colon, including the descending and sigmoid segments and rectum). It is responsible for processing and removing considerable quantities of water and some salts after normal digestion and absorption of nutrients is completed in the 20-foot long small intestine.
Even though the causes of the inflammatory bowel diseases (IBDs) remain unknown, a great deal of effort has been devoted to clinical trials of newer forms of anti-inflammatory and immunosuppressant drugs in the last few years.
If, because of a distinct change in bowel habits, you suspect you might have this disease, the most useful way for the doctor to make the diagnosis and treat IBD will begin with a detailed discussion. More than most intestinal or colonic conditions, a careful and thorough approach, either in the physician's office or at the hospital bedside, often provides the special insight necessary to the correct diagnosis and proper therapy.
Frequency and Quantity of Stool OutputThe normal range of stool pattern varies from one passage every other day to two to three per day. When this pattern changes for a particular individual, both you and your physician should become concerned. Patients with an increase in the number and amount of stool passages, without substantial fever or constitutional symptoms, can be followed for a week or so before proceeding with a comprehensive evaluation.
For short-term, so-called acute episodes, it is usually not possible to determine the cause but this does not affect the outcome. Many acute intestinal infections by bacteria or viruses are self-limiting and do not require drug therapy. In fact, sometimes treating them may actually worsen the situation because some medications promote the growth of other microscopic organisms, such as Clostridium difficili, which itself produces a toxin that causes diarrhea and, occasionally, even a kind of temporary inflammation of the large intestine.
When the change in stool excretion persists for longer than seven to ten days, an evaluation is in order. Freshly collected stool should be submitted or properly preserved for analysis for ova and parasites. Bacterial culture for common offenders, such as Salmonella, Shigella, Campylobacter jejuni and special strains of E. coli, is recommended. If persistent diarrhea is caused by one of these organisms, appropriate antibiotic or antiparasitic therapy is indicated.
When No Common Infection Is Found and Diarrhea PersistsIf your stool analyses are negative and the diarrhea has persisted for more than one week, further evaluation is necessary. It is not advisable to take bowel-slowing agents such as diphenoxylate-atropine (Lomotil®) or loperamide (Immodium®) or get a prescription for tincture of opium at this stage, but, instead, you need to see your doctor and schedule an internal exam of your lower bowel. A sigmoidoscopy with a flexible fiberoptic endoscope allows the doctor to see the rectum and sigmoid colon. If the doctor notices that the surface pattern of the colon is altered, a biopsy will be taken, the surfaces swabbed for ova and parasites and all specimens sent to the laboratory.
When Biopsies Are Always NeededPatients who have had prolonged, unexplained diarrhea, what we call chronic inflammation, may need a biopsy. Weakened patents, the elderly, those with a suppressed immune system from a disease such as AIDS, or patients who have been taking high dosage coriticosteriods, azathioprine or cyclosporin to maintain a transplanted bone marrow or solid organ, should have stool and biopsy specimens submitted.
In the portion of patients in whom the loose stools persist, even though the laboratory cannot find an infectious cause, chronic conditions of the colon and small intestine must then be considered. At this point, further examination of the remainder of the colon, either with a barium enema contrast X-ray series or a complete colonoscopy and a small intestinal contrast exam, may be indicated.
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