Ileocolitis is the inflammation of the ileum and colon. Improper diet to infants below 5 years is the main reason for ileocolitis to be common among children. Also, artificial food and contaminated milk affect the children of this age group more.
Hot weather and sudden changes in temperature could bring outbreaks of ileocolitis in some demographic locations. Also, ileocolitis could be secondary to acute infectious diseases like measles.
Children with deficiency to the immune system are the most affected by ileocolitis. The milk being the basic food is the main cause of ileocolitis when the child is unable to digest milk. Continue reading to safeguard your children and yourself from ileocolitis.
50 % of Chron’s disease affected people are diagnosed with ileocolitis. It is part of the inflammatory bowel disease for which the exact cause is not found till date. It could only be treated to reduce the symptoms and pain.
More than 45,000 deaths have been reported due to Crohn’s disease in the year 2015. The developed countries are more affected by this, which affects every 3 out of 1000 person in the world. Out of the total people affected by Crohn’s diseases, 80 % are smokers.
Ileocolitis is one of the five types of Crohn’s disease and is also caused by infections, ischemia and infiltrative diseases like enteritis. Crohn’s disease is a type of IBD or inflammatory bowel disease.
Teens and age group below 20 years are the most affected by Ileocolitis and is more common with children. Crohn’s disease affects also others of any age group
Ileocolitis involves IBD, Crohn’s disease, both the ileum, the small intestine, and the colon, the big intestine and also called Crohn enterocolitis. Hence to know more about ileocolitis we have to understand ileum and colon and their functions and disorders due to IBD and Crohn’s disease.
IlEUM:
The ileum is the last and third part of the small intestine. It is the junction of jejunum and the large intestine or the colon. The ileum is 2 – 4 m long and separates the jejunum from the cecum by the ICV or Ileocecal valve. The function of the ileum is to absorb the Vitamin B12 and other bile salts apart from the final part of the protein and carbohydrate digestion.
COLON:
Colon is the largest part of the Gastrointestinal tract and hence known as the large bowel or large intestine. Unlike the small intestine, it is not responsible for absorption of the food and the nutrients but extracts water and salt from solid wastes. About 1.5 liters of water arrives in the colon each day.
CROHN’S DISEASE:
There are 5 types of Crohn’s disease and the most affected is ileocolitis. It is named after the American doctor who first diagnosed the disease in 1932. This type of Crohn’s disease affects the ileum, the lower part of the small intestine and the colon, the large intestine.
IBD:
IBD or the Inflammatory bowel disease is a complex disease caused by genetic and environmental factors. This leads to immunological responses and inflammation in the intestines.
The main types of IBD are the CD or Crohn’s disease and UC or the Ulcerative Colitis. CD affects the full digestive system or part of it and the UC mainly affects the colon and the rectum. IBD is a chronic disease without any proper complete cure till date.
IBD has resulted in 51,000 deaths in 2013 and 55,000 in 1990. The animal protein intake is considered as the main reason for IBD
SYMPTOMS OF ILEOCOLITIS:
Symptoms of ileocolitis depend on the underlying cause of CD or infections.
Common symptoms of ileocolitis:
- Diarrhea
- Fatigue
- Significant weight loss
- Fever
- Hematochezia
Symptoms of ileocolitis caused by Crohn’s disease:
- Fistulas
- Bowel obstruction
- Abscess formation
- Mouth sores
- Blood in the stool
- Anemia
- Skin changes with reddish tender bumps under the skin
- Inflammation of skin, eyes an joints
- Delayed growth or sexual development in children
- Inflammation of the live or bile ducts
- Cramping and pain in the right lower or middle part of the abdomen and the periumbilical region or the belly point
Symptoms of ileocolitis in children:
- Diarrhea with five or six times in a day
- Greenish-yellow stools with considerable mucus and undigested food
- Abdominal pain
- Severe tenesmus
- High fever
- Sordes coated the dry tongue
- Severe toxemia
- Anorexia
COMPLICATIONS OF ILEOCOLITIS:
Due to the inflammation of both the ileum and colon the following complications can be formed by ileocolitis.
- Megacolon
- Ruptures of the intestine
- Painful eye conditions
- Arthritis
- Inflammation of the low back and spine
- Hepatitis
- Cirrhosis
- Jaundice
Strictures:
Due to the chronic inflammation, over a period the wall of the colon gets thickened due to the scar tissues. This causes the blockage of the intestine either partially or completely. This slows down or stops the movement of food or stool through the intestines. A complete bowel obstruction could be life-threatening and needs immediate medical care including surgery.
Fistulas:
Fistulas can be formed due to ileocolitis on the lower part of the abdomen. Fistulas are caused by the inflammation which connects one organ to the other. Fistulas due to ileocolitis is caused in the anus part between the anus or rectum with skin which is called perianal fistulas. Out of 3 people affected by ileocolitis by Crohn’s disease develop a fistula at some point of time.
BAM:
BAM or bile acid malabsorption could be caused when the ileum is damaged or by surgery is done to it. The main symptom of BAM is diarrhea.
- Malnutrition:
Due to the lack of appetite apart from weight loss, malnutrition occurs with nutritional deficiencies.
Spinchter swelling:
The circular muscle in the anus to help defecation is called sphincter. The swelling of it causes serious pain and troubles while defecating.
Ulcers and fissures or long ulcers are developed within the anal sphincter. These also cause pain and blood while defecation.
Abscesses:
Perirectal abscesses can be formed around the anus. Abscesses are pocket of pus caused by bacterial infection can be formed on the intestinal wall. This sometimes bugles out with mucous and pus draining out from openings of the fistulas on the skin and cause serious damages.
Colon Cancer:
This is the life-threatening complication of ileocolitis. With ileocolitis, there is more risk of developing colon cancer.
CAUSES OF ILEOCOLITIS:
Since ileocolitis is the major type of Crohn’s disease. Hence all the causes of Crohn’s disease may cause ileocolitis also. Apart from Crohn’s disease ileocolitis could be due to infections, secondary to acute infectious diseases like measles and many others.
Causes due to infections:
Ileocolitis can be caused by numerous bacterias. They include:
- Shigella
- Campylobacter
- Salmonella
- Mycobacterium tuberculosis
- Invasive Escherichia coli and Yersinia
- Cytomegalovirus can cause ileocolitis in immuno-deficiency persons
Bowel Ischemia:
Ischemia is local anemia in any part of the body. This is caused by a shortage of oxygen due to restriction in blood supply to tissues. When this is caused in the bowels it is called bowel ischemia. It could occur in both the intestines.
When ischemia affects the larger intestine it results in an inflammatory process known as Ischemic colitis and if it happens in the small intestine or bowel is called Mesenteric ischemia.
Enteritis:
Enteritis is the inflammation of the small intestine. This is commonly caused by pathogenic microbes such as Serratia. These microbes are in the contaminated food or drink which we drink.
This is also caused by medications like NSAIDs, cocaine, radiation therapy and autoimmune conditions like Crohn’s disease and celiac disease.
Causes of ileocolitis due to Crohn’s disease:
Even after its diagnoses in the year 1932, still, the exact cause of Crohn’s disease is not ascertained. Experts in the medical field point to the following factors which play a vital role in causing Crohn’s disease.
Immune system:
The immune system is an integral part of our body for its smooth functioning. The immune system is a complex network of cells that defends the body against foreign invaders by interacting with each other.
Blood cells are the captains which circulated in the blood checking for a foreign intrusion. The foreign invaders are the microbes like bacteria, parasite, and virus. However, the immune system is clever enough to not attack the good foreign invasion. These are the microbes which help the digestive progress.
When a foreign body like a virus or bacteria is attacking the body the immune system is triggered. The cells, fluids, and chemicals rush to the affected part to counter the foreign invasion. This creates an immune response called “inflammation” to destroy and remove the bacteria and virus.
This inflammation if the root cause of IBD or Inflammatory bowel diseases. Chron’s disease is one of the IBD diseases and Ileocolitis is one type of Crohn’s disease. So all this is concerned only with this inflammation.
This inflammation is the technique of the immune system to enlarge the affected portion to reduce the attack of the bacteria and virus. The swelling, pain, and redness are all indications of this inflammation.
The white blood cells release molecules called “cytokines” which are the chemical messengers that promote inflammation. inflammation is also a weapon to fight the attack of the bacteria and virus. This limits the effects of the invader to not spread to other parts of the body.
But once the foreign invasion is stopped and destroyed the weapon should recede and the technique should stop. But due to some immune system disorder, the inflammation does not reduce even after microbes are destroyed. This causes chronic inflammation. This is the basic cause of IBD diseases.
Overacting of the immune system:
Due to the overacting of the immune system, the inflammatory response will not stop. This in spite of the complete elimination of the harmful microbes. This permanent inflammation becomes chronic inflammation and when it happens in the ileum and colon it is called ileocolitis.
Auto-immune disorder:
Auto-immune disorder happens when the immune system starts attacking good microbes entering into the body or even the other body cells within the body. This causes the inflammation to be permanent and becomes a chronic condition. This chronic inflammation in the digestive system leads to ulcers and other injuries to the intestines.
Excess inflammation:
This is another condition for IBD. During the attack of the foreign microbes, the inflammation to counter the attack is more than the normal. This excess inflammation makes the lining of the intestinal tract abnormal. This abnormal lining leads to the body’s excessive reaction to environmental things.
What is considered as normal to the body without the abnormal lining of the intestinal tract is considered abnormal with it. This triggers the immune system by mistake when certain protein or carbohydrate structures on some foods for an invading microbe or even the own body’s cells and tissues.
This also causes continuous inflammation and with it various IBD diseases along with Crohn’s and ileocolitis.
Hereditary or genetic causes:
Hereditary and genetic causes are also considered as the main reason for IBD diseases including Crohn’s and ileocolitis. 10 – 20 % of IBD affected patients have a family member with IBD. Also, some ethnic groups like Jews and Caucasians have this common IBD condition.
Also, Scientists have found a gene associated with Crohn’s disease. This is the gene which decides how the body should react to certain microbes. When this gene has changed or mutated in some way than the body’s reaction to the microbes also changes from the normal reaction. Overtime Chron’s disease and IBD develop. It is found from research that people with IBD have this mutated gene twice than normal people.
Environment causes for Crohn’s disease:
Environment playing an important role in Crohn’s disease and other IBD diseases could be ascertained from the following facts.
IBD is most common in the following places:
- Industrialized and developed nations
- Western countries with more meat-eating diet and smoking
- Urban areas with more pollutants, and stressors
- People living in northern climates
These kinds of environmental factors which trigger the immune system to overact and without stopping it. Also, it creates create autoimmune disorder and even makes the abnormal lining of the abdomen skin to cause the false trigger of inflammation. The inflammation which never subsides even when the trigger stops makes it chronic and the base for IBD diseases.
Cigarette smoking:
Several studies have shown that smoking is the main cause of IBD diseases like Crohn’s disease. The following are the study results on smoking and Crohn’s disease:
- A 10-year study on the patients with chronic disease found the surgery rate on the smoking patients are 29 % more than non- smoking patients.
- Another study emphasis on the fact that smoking increases the possibility of developing chron’s disease and mostly double’s the chance of getting chron’s disease.
DIAGNOSIS OF ILEOCOLITIS:
Depending on the severity of the symptoms you should visit the doctor. The doctor will examine your abdomen physically and ask a few questions to ascertain the severity of the disease. The doctor may ask your family history of diseases including your medical history.
The symptoms should be clearly told to the doctor to prescribe the right tests for finding out the right treatment plan to subsidize the effects of ileocolitis.
Tests to diagnose ileocolitis:
- Blood tests
- Stool tests
- Endoscopy
- Capsule endoscopy for small bowel check
- Deficiency in Vitamin B12 and folate are checked
- Barium enema and barium x-ray of the small bowl
- Colonoscopy is conducted to check the inner part of the colon
- CT and MRI scans
After proper diagnose the severity of the ileocolitis is found along with a proper cause for its symptoms. Then the perfect treatment plan for a normal living by reducing the symptoms of ileocolitis could be formed.
TREATMENT OF ILEOCOLITIS:
Treatments to ileocolitis are only medications and surgery. Since the cause of ileocolitis could not be exactly ascertained even now, it is only taking proper medications and living a proper lifestyle can treat ileocolitis.
The complications are too many due to ileocolitis. Hence according to the complications including cancer the treatment will be prescribed by the specialist doctor. Some common medications which reduce the symptoms of ileocolitis can be had for treatment.
Medications:
- 5-ASA compounds
- Corticosteroids
- Topical antibiotics
- Immunomodulators
- Biosimilars drugs for suppressing inflammation or the immune system
- Belladonna for control outpour of mucus
- Gelsemium for severe tenesmus
pH modified Budesonide:
A German study of 6 weeks treatment of budesonide, a topical steroid gave favorable results. Budesonide on absorption is rapidly degraded into inactive metabolites in the liver. 67 % reported clinical remission and only one reported side effects.
Hence Budesonide is preferred over other typical steroids for treatment of ileocolitis for its fewer side effects rather than the efficiency which is nearly equal to the others.
TNF:
Another study on the important gene associated with ileocolitis is TNF. Turnor Necrosis Factor with its related pathways are NF-KappaB Signaling and TH17 cell differentiation. The drugs Azathioprine and Certolizumab Pegol have been used to rectify the disorder of this gene to help treat ileocolitis.
Ipilimumab:
This is a monoclonal antibody that activates the immune system by targeting CTLA-4. This is a protein receptor which downregulates the immune system. Cytotoxic T lymphocytes can recognize and destroy cancer cells.
A study conducted on the usage of ipilimumab for ileocolitis proves to be refractory to the steroid.
Treatments could help but for some people with severely inflamed or damaged parts of their bowels, it does not work. Surgery is the only option. But even after the surgery and removal of the part, there is a risk of it returning to another part of the GI I tract in the future.
So it is very important to maintain a healthy lifestyle along with treatment. This should be done even after remission for a long period of time. This includes
- Proper exercise is done regularly
- Improving the quality of sleep
- Reducing stress
- Good eating habits
- Total avoidance of smoking
Since ileocolitis has a number of complications associated with it and the cause still not properly known, it is safe to have a safe life.
https://www.malacards.org/card/ileocolitis
https://www.ncbi.nlm.nih.gov/pubmed/7610691
https://www.hindawi.com/journals/crigm/2018/2431503/