Thứ Hai, 13 tháng 1, 2014

Pancolitis

Pancolitis Pancolitis is a type of ulcer affecting the large intestine. The disease spreads throughout the large intestine from Cecum to rectum and is of very severe type. Individuals affected with pancolitis have greater chance for developing colon cancer in future. It is chronic in nature involving ten years or even more.


Pancolitis can also be called as chronic inflammatory disorder of colon which inflames the entire lining of the colon. It begins as ulcerative colitis and can spread to the entire large intestine if left untreated for long. Exact cause of pancolitis is not known but it is believed to be a type of autoimmune disorder. It can also affect people who have genetic predisposition for the disease. There will be intense abdominal pain, diarrhea and extreme tiredness. This inflammatory disorder can be corrected by taking anti-inflammatory drugs and pain relievers but for long term (chronic) problem, surgery is the best choice.


Symptoms :


Blood discharge in stool, severe pain in the abdomen, rectal bleeding (often), cramps in the abdomen, and urgency and tenesmus are some of the common signs of pancolitis. In severe case, there will be sudden weight loss. In addition the disorder will also manifest in the form of several type of ulcerslike erythema nodosum, sacrolitis, pyoderma gangrenosum and aphthous ulcers.


Causes :


Pancolitis or inflammatory disorder of the entire colon can be caused by several factors.


Intestine Conditions :


Any disease or disorder affecting the normal function of small intestine and large intestine can cause pancolitis. Intestine can be affected through infection and inflammation caused by variety of factors like viral or bacterial infection, birth defects and congenital disorders. Intestinal obstruction, irritable bowel syndrome, gastroenteritis, food poisoning, appendicitis and toxic ingestion are some of the major causes affecting the intestine.


Abdominal Conditions :


Any medical conditions that causes problem in the abdomen can lead to ulcerative colitis or pancolitis affecting the entire colon.


Digestive Problems :


Medical conditions and disorders affecting the digestive tract like duodenal ulcer, fecal incontinence, dysentery, esophageal achalasia and Whipple disease can lead to pancolitis in the colon. Digestive tract begins from the stomach and passes till the mouth of the rectum which comprises esophagus, stomach and intestine. It also has link with vital organs like liver and pancreas. Hence any abnormality in the liver or pancreas or the digestive tract can affect the functioning of intestine.


When the soft mucous membrane or lining of the stomach is affected and left untreated for long it can cause ulcers.


Non pathogenic inflammatory conditions :


Smoking, working in unsafe environment, immune related disorder, and genetic predisposition falls under this category.


Tests :


When you have the above symptoms like abdominal pain, and bloody discharge in the stool you can consult your doctor. Since many medical conditions can cause similar symptoms it is necessary for your doctor to make right diagnosis of the disease before giving treatment.


Home colorectal cancer test and home fecal bleeding tests can be conducted for diagnosing pancolitis. He would order for blood culture for testing the number of white blood cells. Any increase in WBC can be sign of inflammation of colon. He would also order for stool sample for testing the presence of any infectious organisms. Endoscopy methods like colonoscopy and sigmoidoscopy are useful for diagnosing colitis and pancolitis. Long tubing is inserted through the rectum for examining the lining of the colon. Both the above procedure can be conducted without sedation at doctor’s office. Barium enema X-ray is also taken for the patient for examining the small intestine and analyzing any inflammation is there or not.


Treatment :


Treatment for pancolitis is complex and varies widely from one person to another. Your doctor will devise the plan for treatment after taking into considerations the type of inflammation, intensity of disease and severity of symptoms etc. He would also check whether specific area of the colon is affected or the entire colon is affected. Combination of medications and dietary changes are vital for treating pancolitis. Medications are given either orally or through rectum if the inflammation is very severe.


Dietary Changes :


Eat balanced healthy diet that includes calories, essential nutrients and proteins from wide range of food sources. Protein is rich in meat, fish, soy foods and dairy products. Take plenty of fruits and vegetables. Based on the anemic condition your doctor may prescribe iron supplement pill.


Avoid eating foods that induces gas which will worsen the symptoms. Eat frequent (small amounts) of food instead of taking hefty meals. Drink plenty of water to keep yourself hydrated. Avoid taking spicy and hot foods and include soft and bland foods. Reduce the intake of high fiber foods like beans, bran, nuts and seeds. Avoid taking fried items and fatty foods.


Medical Treatment :


Corticosteroids, TNF inhibitors and immune suppressant drugs are given either alone or in combined form. Aminosalicylates like sulfasalazine are widely used for preventing relapses. This medicine is given through rectum for treating mild to moderate pancolitis. For some patients oral pills are enough to manage ulcer. Corticosteroids are effective in controlling inflammation but it cannot be used for long owing to its side effects. For severe cases, steroid injection is given through veins.


In case if the pancolitis inflammation does not respond to the above drugs, immunosuppressant drugs like Azathioprine, cyclosporine A and Methotrexate are prescribed. Biologic drugs are effective for treating this chronic disorder since it interferes with cytokines that causes inflammation. Infliximab is an effective biologic medicine used for treating pancolitis. For managing diarrhea loperamide is given. The condition of the patient is monitored to check whether the symptoms has improved or not.


Surgery :


For about 25-35% of patients drugs are not effective for treating pancolitis. In case of severe damage and inflammation to the colon, surgical intervention is necessary. Depending on the intensity of the disorder, restorative proctolectomy or total proctolectomy (removal of entire colon) is done. Both forms offer definite cure for the disease.


In ileostomy, the surgeon will make a small perforation (stoma) in the wall of the abdomen for allowing the waste materials. He would then connect the opening to the end of small intestine. Maintaining flatulence will be a big task after surgery. Patients should follow the instructions of the doctor for choosing right set of foods and avoid high fiber foods that could cause gas.


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