Enterocolitis involves simultaneous inflammation of the small intestine and large intestine. A distinction is made between different forms.
What is enterocolitis?
Doctors refer to enterocolitis or colenteritis when inflammation occurs in both the small intestine and large intestine. Inflammation of the small intestine is called enteritis, while inflammation of the large intestine is called colitis. In the case of enterocolitis, it is important to distinguish between infectious and non-infectious forms. While infectious enterocolitis is caused by pathogens such as bacteria, viruses, fungi and parasites, non-infectious forms are mainly caused by other causes that are not always known. The most common infectious enterocolitis include pseudomembranous enterocolitis, yersinia enterocolitis, and staphylococcal enterocolitis. Among the non-infectious enterocolitides, necrotizing enterocolitis is best known and is seen in babies. Other forms represent eosinophilic enterocolitis and enterocolitis regionalis, which is better known as Crohn’s disease.
Causes
The causes of enterocolitis vary and depend on the particular trigger of the inflammation. For example, infectious enterocolitis results from certain pathogens. In most cases, these are bacteria. For example, pseudomembranous enterocolitis is caused by the bacterial species Clostridium difficile. This bacterial strain multiplies preferentially after prolonged treatment with antibiotics. Thus, the clostridia can multiply because the antibiotic agents also kill off parts of the beneficial intestinal flora. When colonizing the intestine, the clostridia release toxins, which then cause an inflammatory reaction. The process is similar in staphylococcal enterocolitis. Other bacterial triggers for enterocolitis include Yersinia, Escherichia coli, Shigella and Salmonella. However, viruses can also cause enterocolitis. These include primarily adenoviruses and enteroviruses. The same applies to yeasts such as Candida species and parasites such as Entamoeba histolytica and Giardia lamblia. Non-infectious enterocolitis such as necrotizing enterocolitis (NEK) is a special case. However, the exact trigger of the necrotizing form has not yet been determined. It is assumed that pre-damage of the intestinal wall is responsible for local ischemia with bacteria. The germs then cause inflammatory changes. In addition, risk factors such as peridural anesthesia, volume deficiency shock, low blood pressure, and cardiac defects play some role in the development of the disease. Necrotizing enterocolitis occurs in approximately 12 percent of all premature births and in two percent of all newborn infants.
Symptoms, complaints, and signs
Symptoms of enterocolitis can vary widely, depending on how the disease develops. However, cramping pain in the abdomen occurs in all forms. In addition, the affected persons suffer from diarrhea, which is not infrequently bloody, as well as nausea and vomiting. Furthermore, there is a general feeling of illness. Bloody diarrhea is particularly evident in infections with shigella, campylobacter, and amoebae. Infectious enterocolitis is usually accompanied by chills, feelings of weakness and fever. Enterocolitis caused by clostridia usually sets in two to ten days after treatment with antibiotics. Those affected suffer from pulpy, watery and bloody diarrhea accompanied by intestinal cramps. In the worst case, there is a risk of intestinal rupture, which in turn can trigger life-threatening blood poisoning. Electrolyte imbalance and hypoproteinemia are also possible. In necrotizing enterocolitis, the abdomen of the affected child distends and dilated loops of intestine become visible below the abdominal wall. The baby can no longer tolerate food and vomits bloody gastric juice. In the further course, life-threatening blood poisoning is imminent.
Diagnosis
To diagnose enterocolitis, the physician needs a detailed medical history of the patient. Important criteria in this include the occurrence and duration of the disease, as well as the use of medications and possible concomitant diseases. Most enterocolitis is caused by specific pathogens.For this reason, microbiological examination of a stool sample must be performed. Since the patient also loses copious amounts of electrolytes and fluids, these factors are checked by blood tests in a laboratory. Colonoscopy is considered a useful examination method in cases of suspected enterocolitis regionalis or a chronic course. For the diagnosis of necrotizing enterocolitis, an X-ray examination and sonography (ultrasound examination) are performed. The course of the necrotizing form depends on how quickly therapy is started. If the blood poisoning can be brought under control with drugs, the prognosis is considered relatively favorable. However, death occurs in about five to ten percent of all babies with the disease.
When should you go to the doctor?
If severe gastrointestinal symptoms, fever, chills and other signs of enterocolitis are suddenly noticed, a doctor should be consulted quickly. If serious complications such as intestinal cramps, bloody diarrhea or symptoms of blood poisoning become apparent, this requires immediate evaluation and treatment by an emergency physician. If fever increases and there are signs of electrolyte imbalance or hypoproteinemia, the affected person is best taken to a hospital. Parents who notice a distended abdomen and vomiting in their child should consult emergency medical services. Medical evaluation and treatment is required in any case of enterocolitis. People who experience said symptoms after prolonged antibiotic therapy should speak with the appropriate physician. People who have previously had another bacterial illness are also susceptible to inflammation of the large and small intestines and should seek immediate medical attention. In addition to the primary care physician, a gastroenterologist or internist may also be consulted. In any case, in a medical emergency, the emergency medical services should be called.
Treatment and therapy
Treatment of enterocolitis depends on the triggering cause. If it was caused by clostridia, the responsible antibiotic must be discontinued or replaced. In severe cases, the patient receives drugs such as metronidazole or vancomycin for about two weeks. Nevertheless, relapses can sometimes occur. If it is uncomplicated enterocolitis, it is usually sufficient to treat the symptoms and provide the patient with sufficient fluids and electrolytes. In the case of autoimmune enterocolitis, immunosuppressants must be administered. In the case of necrotizing enterocolitis, it is necessary to interrupt the child’s gastrointestinal nutrition for up to ten days and resort to infusions instead. Blood poisoning is treated with antibiotics. If peritonitis occurs, surgical intervention must take place.
Outlook and prognosis
Enterocolitis is a serious complication, but it can be well treated. If it is caught early, there is a high chance of complete recovery. The patient must change his or her diet (a break in feeding is indicated for newborns) and take antibiotics. If the cause of the condition is identified and corrected at the same time, there is about a 60 percent chance of recovery in the lightest birth weight group. In the most severe birth weight group, about 85 percent of infants survive. So the outlook for recovery is relatively good. Still, enterocolitis can cause long-term health problems. For example, the dilated intestinal loops can cause problems with feeding. Affected newborns vomit frequently and also have no bowel movements. This can lead to constipation, anemia and other complications, some of which can be life-threatening. In the worst case, sepsis can occur, which is often fatal for the newborns. Other possible complications include respiratory, skin and circulatory problems. A hole may form in the intestinal wall, possibly resulting in gastrointestinal distress. The prognosis depends on which of these symptoms and complaints occur and how the child responds to the prescribed medications. In general, however, a good to very good prognosis is possible with enterocolitis.
Prevention
Preventing enterocolitis is difficult. In the case of the necrotizing form, prevention can be done with antibiotics. However, it is rarely used because of the risk of resistance.
Aftercare
In cases of enterocolitis, the activities of follow-up care are very limited. First and foremost, immediate treatment by a physician is necessary to prevent further complications and, in the worst case, death of the child. For this reason, early diagnosis of this disease is also very important. The earlier the enterocolitis is diagnosed, the better is the prognosis and the cure of this disease. In some cases, however, this disease also reduces the life expectancy of the affected person. The children are often dependent on taking antibiotics. Care must be taken to take the medication regularly in order to completely relieve the symptoms. It is not uncommon for part of the intestine to have to be removed. In any case, the child should rest after the surgical procedure, taking care of the body. Effort or other activities should be refrained from. The parents and relatives also very often need psychological support from friends or from a professional doctor. Contact with other affected parents of enterocolitis can also be useful in this process and lead to an exchange of information.
What you can do yourself
Simultaneous inflammation of the small intestine and colon is a very serious condition. Although mild forms can be treated by a patient himself, since in these cases it is enough to supply sufficient fluids and electrolytes. However, self-treatment is not recommended, as inadequately treated enterocolitis can very quickly lead to life-threatening complications. An affected person should promptly consult a physician and follow his or her instructions. Infectious enterocolitis often requires treatment with antibiotics. Since these drugs kill not only harmful pathogens but also beneficial bacteria in the intestine, severe diarrhea often occurs as a result. A sufferer can prevent these side effects by supporting the intestinal flora by eating probiotic foods, such as yogurt. Even more effective is the direct intake of beneficial bacterial strains. Appropriate preparations are available in pharmacies and health food stores. The manufacturers of these products pack the lactic acid bacteria in enteric-coated capsules so that they can actually enter the intestine in large numbers and settle there. Vaginal suppositories with lactic acid bacteria, which are available over-the-counter in pharmacies, help against antibiotic-induced colonization of the vagina with yeast fungi.
