Colitis is an inflammation of the lining of the large intestine. This condition is a form of chronic inflammatory disorder of the colon referred to as chronic nonspecific ulcerative colitis. Another, less common type of inflammatory bowel condition is called Crohn's disease of the colon. In both, small ulcers form throughout the lining of the colon, but they tend to be deeper in Crohn's disease. The incidence of ulcerative colitis is not high; about 250,000 Americans suffer from it. Colitis occurs across all ages from children to older adults but is most common in people aged 15 to 40.
The major symptom of colitis is frequent bloody diarrhea, which may be accompanied by stomach pain or cramps, fever, fatigue, and loss of weight. Complications may be local, such as perforation of the wall of the colon, or systemic, such as anemia, vitamin deficiencies, arthritis, or skin lesions.
The causes of colitis are unknown. Possibilities are genetic, bacterial, or viral, allergic reactions, immune mechanisms, or most likely, some combination of these factors. Many people with colitis are depressed and have feelings of hopelessness and despair. They may exhibit underlying hostility with unexpressed chronic resentment. It is not clear whether these emotions contribute to the development of colitis or whether they may be a response to being ill.
Mild attacks of colitis can be treated on an outpatient basis; acute attacks are usually treated in the hospital, where the inflammation can be controlled and nutritional losses can be replaced. In addition to bed rest, treatment often includes only clear liquids for food and intravenous feedings to replace lost fluids. This also allows the bowel to rest. In order to correct anemia, blood transfusions are required for those who have extensive bleeding.
Corticosteroids are sometimes administered to reduce inflammation, pain, and fever. Steroid medication is gradually reduced over a two- to six-month period, although some people need to take it indefinitely. Sulfasalazine is given concurrently with the steroid medication. Surgery is required for perforation, severe bleeding, or failure to improve after two to three weeks of intensive medical treatment. Psychotherapy is sometimes prescribed to provide emotional support and to treat depression if it is present.
Colitis is a highly variable condition. About three-fourths of the people who develop colitis have recurrences, with 10 to 15 years elapsing before the next attack. Others have chronic and unremitting symptoms over long periods of time. Most have periods of good health interspersed with intermittent symptoms. If the condition is properly treated, the prognosis is favorable.