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Tuesday, 3 December 2013

Diversion colitis - Treatments in Conventional medicine

Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.
Treatments
A. In conventional medicine perspective
Iatrogenic colitis
A.3.1. Diversion colitis 
1. Short-chain-fatty acid irrigation
A condition known as diversion colitis frequently develops in segments of the colorectum after surgical diversion of the fecal stream. In the study of four patients with diversion colitis, none of whom had evidence of Crohn's, idiopathic ulcerative, or infectious colitis, found that diversion colitis may represent an inflammatory state resulting from a nutritional deficiency in the lumen of the colonic epithelium, which is effectively treated by local application of short-chain fatty acids, the missing nutrients(86a).


2.  5-aminosalicylic acid (Rowasa) enemas
a. There is a report of an 85-yr-old female presented with diversion colitis after surgery with a resultant colostomy and excluded rectal segment. Treatment with 5-aminosalicylic acid (Rowasa) enemas resulted in both endoscopic and histological resolution. This is the first case of diversion colitis treated with 5-aminosalicylic acid enemas, according to the study by Winthrop University Hospital(86b).

b.  Side effects are not limit to severe stomach pain, cramping, fever, headache, and bloody diarrhea

3. Corticosteroids
a. According to the study by, Short-term corticosteroid use is associated with generally mild side effects, including cutaneous effects, electrolyte abnormalities, hypertension, hyperglycemia, pancreatitis, hematologic, immunologic, and neuropsychologic effects, although occasionally, clinically significant side effects may occur. Long-term corticosteroid use may be associated with more serious sequel, including osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations(81a).
b. Side effects, According to the study by, Short-term corticosteroid use is associated with generally mild side effects, including cutaneous effects, electrolyte abnormalities, hypertension, hyperglycemia, pancreatitis, hematologic, immunologic, and neuropsychologic effects, although occasionally, clinically significant side effects may occur. Long-term corticosteroid use may be associated with more serious sequel, including osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations(81a)

4. Surgery
a. Colectomy
Colectomy  is a surgical treatment in removing the colon. In the study using the University of Manitoba Inflammatory Bowel Disease Epidemiology Database, a population-based data set including UC patients with up to 25 years of post diagnosis follow-up, found that the cumulative incidence of colectomy in UC is lower than previously reported, and appears to be decreasing further among more recently diagnosed cohorts of patients. Male sex and hospitalization at the time of diagnosis are major risk factors for EC and LC(83)
But according to the study by Division of Gastroenterology and Hepatology, Mayo Clinic, patients with moderately to severely active ulcerative colitis treated with infliximab were less likely to undergo colectomy through 54 weeks than those receiving placebo(84).

b. Proctocolectomy and Ileostomy
Proctocolectomy is a surgical procedure to remove the entire colon and rectum. Ileostomy is a surgical opening constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin(85).
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Sources
(81) http://www.ncbi.nlm.nih.gov/pubmed/22767007
(81a) http://www.ncbi.nlm.nih.gov/pubmed/11588541
(82) http://www.ncbi.nlm.nih.gov/pubmed/23034604
(83) http://www.ncbi.nlm.nih.gov/pubmed/22613902
(84) http://www.ncbi.nlm.nih.gov/pubmed/19596014
(85) http://en.wikipedia.org/wiki/Ileostomy