Enterocolitis

Enterocolitis – General Information

The disease, also known as coloenteritis, affects both the large and the small intestine, causing inflammation. This medical condition is generally referred to as Enteritis when it causes severe swelling of the patient’s small intestine and as Colitis when it is the case of the acute swelling of the patient’s large intestine. Colitis generally affects the Colon region of the large intestine. There are several types of Enterocolitis that include the necrotizing form of this disorder, present at premature infants, and autistic form of this disease -  an intestinal medical condition that is present in some autistic children. There is also more types of Colitis, including ulcerative colitis, infectious colitis, diversion colitis, ischemic colitis, fulminant colitis, lymphocytic colitis, chemical colitis, microscopic colitis (parasitic nature infection), Crohn's colitis, andatypical colitis. Pseudo membranous colitis is a well-known colitis results from the infection with Clostridium difficile, or c-diff.

Unrestrained antibiotic usage is one of the possible causes of Enterocolitis. Patients who undergo abdominal surgery can sometimes develop postoperative pseudo membranous colitis. This may be described as the replacing of necrotic mucosa with staphylococci, leukocytes, mucus, fibrin, and inflammatory cells. The antibiotic-caused Colitis appears in 5-39% of the antibiotic treated patients, depending on the antibiotic. So, Colitis is rather well spread among patients suffering from other diseases. Pseudo membranous colitis may appear in 10% of other disease treated patients. Ampicillin, its pediatric type, of course, is the most common antibiotic that causes the pseudo membranous colitis for children.

Enterocolitis - Symptoms

Symptoms for Enterocolitis may include abdominal pain, bloody diarrhea, abdominal distension, increased gastric residue, colonic perforation, electrolyte imbalance, hypotension, shock, lethargy, jaundice, bradycardia, disseminated intravascular coagulation, fever, nausea, rectal bleeding, sluggishness, vomiting and hematochezia. The perforation of the intestine is the most severe symptom for one of the two types of the disease, and requires surgery. The presence of vomiting may be a sign of gastroenteritis. The best way to diagnose a type of the disease is keeping a good medical history. Symptoms like dehydration, the presence of blood in the faeces, cutaneous eruptions, and other food-link exposure symptoms may announce the disease. Recent traveling to endemic areas can be a good reason for inducting a medical investigation. Bacteria or viruses are usually the reason for acute enteritis. There is also a chance for Enteritis or Colitis to appear if another member of the family is affected. Crohn's disease, celiac disease, tuberculosis, giardiasis, or rarely Whipple's disease, may cause Chronic Enteritis.

Necrotizing Enterocolitis, or NEC, usually occurs in low birth weight infants (less than 2.3 kg) or in premature neonates. The cause for the appearance of NEC is unknown, but is often related to an insufficient blood or oxygen flow, or the added stress supported by the intestines when first fed. Some predisposing factors may be the premature birth itself, or the reduced weight of the child. Blood exchange transfusions, the feeding initiation, respiratory failure, hypothermia, infectious causes, acidosis, sepsis, drug exposure during the fetus development and indomethacin treatment may provoke the disease. Infants develop NEC after the milk feeding had begun, and represent a rate of 1 to 5 % of the new born. The fact that these symptoms are very common for other diseases too, mean that only a doctor can study these symptoms and pronounce a diagnosis regarding Enterocolitis.

Enterocolitis – Treatment

Persons diagnosed with Enterocolitis should discontinue other antibiotic therapy as a way for slowing down the progress of the disease. Enterocolitis can be treated with the use of some antibiotics or other general anti-inflammatory medications such as Mesalamine or its derivates; steroids can also be used in the treatment of the disease; there are a number of other drugs that ameliorate the inflammation of the intestines. Treatment by surgery is needed in severe colitis or enteritis cases, such as the perforation of an intestine shown as free intraperitoneal air on X-ray. Surgery in these cases mean removing the colon or a portion of the damaged intestine and creating a “pouch” by using portions of the small intestine, meaning removing the necrotic and swollen bowel and creating a temporary ileosomy, or colostomy. Colostomy is a surgical procedure involving the connection of colon onto the anterior abdominal wall, therefore leaving the patient with a stoma, an opening in the abdomen. The stoma results from the colon being drawn out through the incision in the abdomen and sutured to the skin. The stoma becomes the passageway for faeces leaving the patient’s body. Most cases of surgery are demanded by Necrotizing Enterocolitis, the most common and serious gastrointestinal disorder among hospitalized preterm children.

Non-drug methods of treating the Enterocolitis propose changes in diet for easing the side effects and reducing the progress of the disease. This may be accomplished by reducing the daily dose of carbohydrates, lactose products, fuzzy and soft drinks and caffeine. Metronidazole (250 mg’s) is the most effective treatment for the basic stages of the disease. In more severe or resistant cases, oral vancomycin is used. Pseudo membranous Enterocolitis suffering patients are given anion exchange resins, like cholestyramine for neutralizing the toxin produced by Clostridium Difficile. The supportive treatment must ensure and maintain the fluid balance and the blood electrolyte balance. Dopamine and levarterenol are used to combat shock and hypotension. In the case of NEC, it is necessary to stop oral intake in order to rest the injured intestine. Intra venal fluids like total parental nutrition help maintaining fluid and electrolyte balance during the time the newborn suffers from NEC. There is also the need for the correction of acidosis, hypotension, hypoxemia or other medical problems that can be reversed. The cardiac performance of the newborn must be optimized. Progressive sepsis can be indicated after inducting physical examinations, platelet counts, measuring lactate levels and ABG levels, frequent examinations and X-rays of the abdomen. Some products related to treatments for Enterocolitis are: Fivelac (which helps to provide ideal intestinal micro-flora, and provides a temporary relief from yeasts and fungus overgrowth), Candidate (an effective herbal treatment for Candidiasis and its prevention), Garlicine (lowers serum cholesterol).