Diagnosis | Colitis

Diagnosis

Due to the usually harmless, short and self-limiting course of acute colitis, a diagnosis beyond the medical history and physical examination is usually not necessary. If the symptoms are very severe, a stool and blood test for pathogens can be performed. The method of choice for the diagnosis of Crohn’s disease is endoscopy of the colon and ileum with simultaneous tissue sampling, which is examined under the microscope.Further diagnostic measures may include an extended endoscopy of the esophagus, stomach and small intestine, as well as an X-ray or ultrasound examination of the abdomen.

Blood tests of Crohn’s disease patients may reveal increased inflammation and anemia due to iron and/or folic acid deficiency. The same applies to the diagnosis of ulcerative colitis. Ischemic colitis is usually diagnosed by colonoscopy (colonoscopy), but extended x-rays of the abdomen as well as x-rays of the colon and/or the intestinal vessels using contrast medium can also be used here.

Acute colitis is characterized by a sudden onset and short course of approximately 2-4 days, whereby the infection limits itself. The affected person usually suffers from severe diarrhea, which is usually thin to watery. In more severe cases, mucus, blood or pus in the stool may also be noticeable.

Fever, nausea and vomiting as well as cramp-like abdominal pain may accompany the diarrhea. The common symptoms of chronic inflammatory bowel disease are also diarrhea, nausea, loss of appetite, fever and weight loss. The slow and gradual onset and intermittent (alternating symptom-free and symptom-rich intervals) progression of the disease are also characteristic.

Very rarely, however, periods of constipation or normal stool may occur. This fact does not rule out colitis. 90% of Crohn’s disease patients suffer from abdominal pain on the right side or near the navel, fever, flatulence and mostly bloodless diarrhea.

30% of those affected also have a lactose intolerance (lactose intolerance). In contrast, ulcerative colitis is characterized by bloody-mucus diarrhea (up to 20/day) accompanied by cramping abdominal pain. Side effects such as reddening of the skin, joint pain and inflammation of the eyes can rarely accompany ulcerative colitis, but significantly more frequently Crohn’s disease.

Ischaemic colitis is characterized by abdominal pain in episodes and bloody or bloodless diarrhea. Complete occlusion of the colon vessels can lead to a bowel infarction (mesenteric infarction), which leads to death of the affected intestinal segment and can become life-threatening. Frequently, affected patients also show calcifications in other parts of the body, which can lead to circulatory disorders in the legs or coronary vessels, for example.

The danger with all forms of inflammation lies above all in the high loss of fluid and electrolytes caused by the diarrhea. Due to the inflammation of the mucous membrane, the colon is no longer able to absorb salts and water, so that these are lost. The result can be a lack of fluid in the body, which is called dehydration.

Those affected can be noticed by weight loss and significant reduction in their physical performance. In chronic colitis, another complication is primarily intestinal wall rupture, which results from increasing inflammatory destruction of the intestinal wall. Consequences such as bleeding and an expansion of the inflammation to the entire abdominal cavity up to blood poisoning are possible.

In addition, the inflammations can lead to adhesions of the intestine, which can possibly lead to a flow disorder with accumulation of feces. Patients with Crohn’s disease, but even more so with ulcerative colitis, have an increased risk of developing a malignant colon tumor (colorectal carcinoma) in the course of life, depending on the duration and severity of the disease. Approximately 2% of ulcerative colitis patients develop colon carcinoma after 10 years of disease progression, and approximately 30% after 30 years of disease progression. A further complication, especially in ulcerative colitis, is the development of an acute dilatation of the colon (toxic megacolon), which can result in shock and multiple organ failure.