Colitis K52.9

Colitis is a form of diarrhea that can occur acutely (less than 2 weeks) or chronically (longer than 4 weeks) (Suttorp 2004).

In the case of colitis, we differentiate between:

• Infectious form
• Non-infectious form (Herold 2023)

• I. Infectious colitis can be caused by:
  • 1. acute form caused by:
    • Campylobacter
    • Shigella
    • Salmonella
    • E. coli
    • Yersinia
    • Exclusively in immunocompromised patients: Cytomegalovirus (Herold 2023)
  • 2. antibiotic-associated pseudomembranous colitis:
    • Clostridioides difficile toxins (Herold 2023)
  • 3. sexually transmitted:
    • Chlamydia
    • gonococci
    • HSV- 2 (Herold 2023)
  • 4. parasitic infections:
    • Balantidium coli
    • Entamoeba histolytica
    • Giardia
    • Schistosomiasis (Herold 2023)
  • 5. colitis in the context of an AIDS disease:
    • Infectious through e.g.: Cytomegaloviruses (CMV) Cryptosporidia, Microsporidia, Mycobacterium avium intracellulare
    • Medication through antiviral therapy
    • HIV enteropathy as a direct viral infection

• II: Causative agent of non-infectious colitis
  • - 1. diversion colitis: This can occur as hemorrhagic colitis in surgically removed intestinal segments. It is caused by a deficiency of short-chain fatty acids. Treatment consists of surgical repositioning of the anus praeter or enemas with short-chain fatty acids (Herold 2023).
  • - 2. immunologically mediated colitis: This is caused by new immunotherapeutic agents such as checkpoint inhibitors (Overkamp 2016).
  • - 3. ischemic colitis: This particularly affects older people > 65 years of age. The disease is usually caused by non-occlusive damage to the blood vessels (Neuhaus 2021). The onset is usually very acute with colicky pain predominantly in the left lower middle abdomen (Herold 2023).
  • - 4. microscopic colitis: This is an increasingly recognized cause of chronic watery diarrhoea, especially in middle-aged women or those taking statins, proton pump inhibitors, SSRIs or NSAIDs (Kasper 2015).
  • - 5 Drug-induced toxic colitis: Nowadays usually caused by NSAIDs, previously also by gold or ergotamine (Herold 2023).
  • - 6. radiation colitis: Radiation colitis occurs as an acute or chronic form and is caused by irradiation of the pelvis. An irradiation dose of approx. 50 Gy is considered to be a harmful threshold dose (Stallmach 2003). It is often associated with rectal bleeding (Herold 2023).

• III: Other diseases as causative factors such as:
  • Diverticulitis
  • appendicitis
  • Colon carcinoma
  • carcinoid
  • Colon polyps
  • Crohn's disease
  • Food allergy
  • M. Whipple's disease
  • Malignant lymphomas of the ileum
  • Irritable bowel syndrome
  • Coeliac disease (Herold 2023).

Macroscopically, a distinction is made between the following distribution patterns:

1. Diffuse (the entire colon from the caecum to the anus is affected)
2. Regional (starting from the anus, the inflammation spreads to varying degrees)
3. Segmental (there are inflammatory sections that merge into non-inflammatory sections both orally and aborally)
4. Discontinuous (there are small and larger non-inflamed areas within the inflamed area)
5. Continuous (here a closed area is affected, within which there are no inflammation-free sections)

(Thomas 1996)

Clarification of infectious colitis, in particular by:

• Tropical anamnesis
• Bacteriological diagnostics
• Parasitologic diagnostics (Herold 2023)

Clarification of non-infectious colitis, in particular by:

• Radiation history
• Drug history
• Colonoscopy with biopsies (Herold 2023)

In acute colitis, five main patterns are found in the colon biopsies:

• Acute colitis
• Focal active colitis
• Pseudomembranous colitis
• Hemorrhagic colitis
• Ischemic colitis (Jessurun 2017)

Chronic diarrhea is predominantly characterized by:

• Collagenous colitis
• Lymphocytic colitis
• Eosinophilic colitis
• Cryptal lymphocytic colitis
• Microscopic colitis with giant cells
• Unspecified microscopic colitis (Classen 2004)

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