Diversion Colitis
Disease Details
Family Health Simplified
- Description
- Diversion colitis is an inflammation of the colon's mucosa that occurs typically in colostomy patients due to the lack of fecal flow.
- Type
- Diversion colitis is not a genetic disorder. It is an inflammation of the colon that occurs when the normal fecal stream is diverted away from a segment of the colon, typically after a surgical procedure like a colostomy or ileostomy.
- Signs And Symptoms
-
Signs and symptoms of diversion colitis may include:
- Abdominal pain
- Diarrhea
- Rectal bleeding
- Mucus discharge from the rectum
- Tenesmus (a sensation of needing to pass stools despite an empty colon)
- Intestinal inflammation noted during endoscopic examination
These symptoms result from inflammation in the diverted segment of the colon, often due to changes in the bacterial flora and a lack of short-chain fatty acids. - Prognosis
- Diversion colitis is generally considered a reversible condition that arises after surgical diversion of the fecal stream, such as in cases of colostomy or ileostomy. The prognosis is usually good, as symptoms typically resolve when the fecal stream is restored to the affected segment of the bowel. In cases where reconnection is not possible, medical treatments such as short-chain fatty acid enemas, topical steroids, or other anti-inflammatory measures can help manage symptoms effectively.
- Onset
- Diversion colitis typically occurs after surgical procedures that divert the fecal stream, such as colostomy or ileostomy. The colitis often develops within a few weeks to months after surgery.
- Prevalence
- The prevalence of diversion colitis is not well-defined, but it is known to occur frequently in patients who have undergone surgical procedures that divert the fecal stream, such as ileostomy or colostomy. It is estimated that up to 100% of patients with a diverted colon may develop some degree of inflammation, although the severity can vary widely.
- Epidemiology
-
Diversion colitis is an inflammation of the colon that occurs in segments of the bowel that are diverted from the fecal stream, typically after surgical procedures like colostomy or ileostomy. It is relatively uncommon and mostly seen in patients who have had bowel surgery leading to diversion of the normal flow of feces. The exact prevalence is hard to determine due to the variability in reporting, but it may affect up to 70% of patients with diverted bowel segments.
Given the nature of the condition, it is more prevalent in populations requiring surgical diversions for conditions such as colorectal cancer, inflammatory bowel disease, or trauma. It affects both genders and all age groups, although the specifics can vary based on the underlying reason for the surgical intervention. - Intractability
- Diversion colitis is generally not considered intractable. It often occurs as a result of a surgical procedure that diverts the normal flow of fecal matter away from a segment of the colon. Symptoms typically improve or resolve once the normal flow is restored or through treatments such as short-chain fatty acid enemas or probiotics. However, persistent or chronic cases may require more intensive management, but full intractability is uncommon.
- Disease Severity
- The severity of diversion colitis can vary. This inflammatory condition occurs in the segment of the colon that is bypassed following surgical diversion, such as an ileostomy or colostomy. Symptoms range from mild, with minor mucous discharge and bleeding, to severe, with significant inflammation, pain, and ulceration. Treatment generally focuses on re-establishing the fecal stream or administering short-chain fatty acids (SCFAs) to the affected segment to alleviate symptoms.
- Healthcare Professionals
- Disease Ontology ID - DOID:0060187
- Pathophysiology
-
Diversion colitis is an inflammation of the colon that occurs after surgical diversion of the fecal stream, such as in the creation of an ileostomy or colostomy. The exact pathophysiology is not fully understood but is believed to involve several factors:
1. **Changes in Microbiota**: The lack of fecal stream alters the normal bacterial flora in the diverted segment of the colon, potentially leading to an imbalance in microbial composition.
2. **Nutrient Deficiency**: The absence of short-chain fatty acids (SCFAs), which are produced by bacterial fermentation of dietary fibers and serve as an energy source for colonocytes, may contribute to mucosal atrophy and inflammation.
3. **Immune Response**: An altered immune response in the absence of normal fecal antigens may lead to an inflammatory state.
4. **Mucosal Hypoxia**: The diversion might cause a reduction in blood flow, leading to local hypoxia and inflammation in the colonic mucosa.
These factors collectively contribute to the development of inflammation and mucosal changes observed in diversion colitis. - Carrier Status
- Carrier status is not applicable to diversion colitis, as it is not a genetic or infectious disease. Diversion colitis occurs due to inflammation in the colon that has been surgically bypassed, typically following a surgery like a colostomy or ileostomy. It is related to changes in the local environment of the colon, such as a lack of short-chain fatty acids, rather than the presence of a carrier state.
- Mechanism
-
Diversion colitis is inflammation of the colon that occurs after surgical diversion of the fecal stream, typically following procedures such as colostomy or ileostomy.
**Mechanism:**
The primary mechanism behind diversion colitis involves the loss of fecal stream through a segment of the colon, resulting in decreased exposure to luminal contents, which include nutrients and commensal bacteria. This lack of regular stimuli disrupts the mucosal environment, leading to inflammation and colitis in the diverted, unused segment of the colon.
**Molecular Mechanisms:**
1. **Short-Chain Fatty Acids (SCFAs) Deprivation:** Commensal bacteria produce SCFAs, such as butyrate, through fiber fermentation. SCFAs are crucial for colonocyte health and energy. Deprivation of these molecules due to fecal diversion impairs colonocyte function, leading to mucosal atrophy and inflammation.
2. **Mucosal Immune Response Alteration:** The absence of luminal antigens and beneficial bacteria can disrupt the mucosal immune balance, shifting towards a pro-inflammatory state. This involves increased infiltration of immune cells like lymphocytes, macrophages, and neutrophils.
3. **Cytokine Production:** There is an upregulation of pro-inflammatory cytokines, such as TNF-α, IL-1β, and IL-6, which mediate and perpetuate the inflammatory response in the colonic mucosa.
4. **Epithelial Barrier Dysfunction:** Fecal diversion can compromise the integrity of the epithelial barrier, making it more susceptible to bacterial translocation and further inflammation.
In summary, diversion colitis is primarily driven by the absence of the fecal stream leading to SCFA deprivation, immune dysregulation, increased cytokine production, and epithelial barrier dysfunction, culminating in colonic inflammation. - Treatment
-
In many milder cases after ileostomy or colostomy, diversion colitis is left untreated and disappears naturally. Possible pharmacologic treatments include short-chain fatty acid irrigation, steroid enemas and mesalazine. For surgical candidates, reanastomosis is a reversal procedure carried out to restore bowel continuity that effectively halts the symptoms of diversion colitis.
== References == - Compassionate Use Treatment
-
Diversion colitis is inflammation of the colon that occurs after surgical diversion of the fecal stream, such as with a colostomy or ileostomy. For compassionate use treatment, also known as expanded access, off-label, or experimental treatments, options may include:
1. **Short-Chain Fatty Acid (SCFA) Enemas**: Off-label use of SCFA enemas can provide the colon with nutrients that are lacking due to the diversion. These enemas can help reduce inflammation and promote healing of the colonic mucosa.
2. **5-Aminosalicylic Acid (5-ASA) Enemas**: These can be used off-label for their anti-inflammatory properties, although their effectiveness specifically in diversion colitis needs more research.
3. **Probiotics**: Off-label use of probiotics aims to restore normal flora and improve colon health. Their effectiveness in clinical trials for diversion colitis is still under investigation.
4. **Butyrate Enemas**: Experimental treatment using butyrate, a type of SCFA, aims to reduce inflammation and provide an energy source for colonic cells.
5. **Steroid Enemas**: Off-label use of corticosteroid enemas can reduce local inflammation in the colon.
These treatments should be discussed with a healthcare provider to evaluate their potential benefits and risks in each individual case. - Lifestyle Recommendations
-
For diversion colitis, lifestyle recommendations typically include:
1. **Dietary Adjustments**: Eating a balanced diet rich in fiber may help manage symptoms. Including plenty of fruits, vegetables, and whole grains can support digestive health.
2. **Hydration**: Staying well-hydrated is important as it aids in overall bowel function.
3. **Probiotics**: Incorporating probiotics through supplements or fermented foods can help maintain a healthy gut flora.
4. **Avoiding Irritants**: Limiting intake of foods and beverages that can irritate the bowel, such as spicy foods, alcohol, and caffeine, may alleviate symptoms.
5. **Regular Follow-ups**: Regular medical check-ups to monitor the condition and promptly manage any complications.
Specific individual recommendations may vary, so consulting with a healthcare provider for personalized advice is advisable. - Medication
-
Diversion colitis is an inflammation of the colon that occurs in segments of the bowel that have been diverted from the fecal stream, commonly after surgical procedures such as colostomies or ileostomies.
Medications used to manage diversion colitis include:
1. **Topical 5-aminosalicylic acid (5-ASA)**: These anti-inflammatory drugs can be delivered directly to the affected area via enemas or suppositories.
2. **Short-chain fatty acid (SCFA) enemas**: SCFAs are thought to have a beneficial effect on colonic mucosa and can be administered to provide a direct anti-inflammatory effect.
3. **Corticosteroid enemas**: Topical steroids can help reduce inflammation.
4. **Probiotics**: These can aid in balancing the gut microbiota and may help alleviate symptoms.
Treatment plans should be determined by a healthcare provider based on individual patient needs. - Repurposable Drugs
- Currently, there are no widely accepted repurposable drugs specifically for the treatment of diversion colitis. The management typically involves the restoration of fecal stream continuity, anti-inflammatory treatments like short-chain fatty acid enemas, and symptomatic relief. Consulting a healthcare professional for the most up-to-date and appropriate treatment options is advised.
- Metabolites
-
Diversion colitis is a form of colitis that occurs in segments of the colon that are excluded from the fecal stream, usually after surgical diversion such as a colostomy or ileostomy. One key feature of diversion colitis is an alteration in the metabolic environment of the diverted bowel segment.
Key metabolites involved in diversion colitis include:
1. **Short-chain fatty acids (SCFAs):** The reduction in SCFAs, particularly butyrate, is commonly observed. SCFAs are normally produced by bacterial fermentation of dietary fibers in the colon and play a crucial role in maintaining colonic health.
2. **Bile acids:** Alterations in bile acid metabolism can occur. Normally, bile acids are reabsorbed in the intestine, but in the diverted segment, their metabolism may be disrupted.
These metabolite changes can contribute to inflammation and mucosal damage in the affected bowel segment, leading to the symptoms and histological findings characteristic of diversion colitis. - Nutraceuticals
- For diversion colitis, nutraceuticals like short-chain fatty acids (e.g., butyrate enemas) have shown some promise in alleviating symptoms. There is limited data on the use of nanotechnology-based treatments (nan) specifically for diversion colitis. Most treatment options focus on restoring the microbial environment and providing anti-inflammatory support.
- Peptides
-
For diversion colitis, the use of peptides as a treatment option is being explored in research for their potential to modulate inflammation and promote mucosal healing. Peptides like glucagon-like peptide-2 (GLP-2) have shown promise in reducing inflammation and promoting intestinal mucosal growth in some studies.
Regarding the term "nan," it's unclear in this context. If it refers to "nanotechnology," it hasn't yet become a standard approach in clinical settings for treating diversion colitis. However, research is ongoing to investigate the potential of nanotechnology-based therapies for various inflammatory bowel diseases.