The colon is a common site of infection for a heterogeneous group of bacterial pathogens. The presentation of disease in the colon is generally in the form of distinct syndromes, and it is important for physicians to recognize the causative organisms, because specific treatment is highly effective. The flouroquinolones have emerged as the treatment of choice for most food-borne bacterial pathogens. Resistance to these agents is not a major issue at present except in Campylobacter. Clostridium difficile remains sensitive to both metronidazole and oral vancomycin.
Even though there are different types of colitis with different causes, most of the symptoms are the same:
- diarrhea with or without blood
- abdominal pain and cramping
- urgency to have a bowel movement
- weight loss
The route of treatment depends on what is causing colitis. Many cases require little more than symptomatic care, including clear fluids to rest the bowel and medications to control pain. Patients who have become acutely ill often need intravenous fluids and other intervention.
- Infection: Infections that cause diarrhea and colitis may potentially require antibiotics, depending on the cause. Viral infections require fluids and time. Some bacterial infections, such as Salmonella, do not need antibiotic therapy; the body is able to get rid of the infection on its own. Other bacterial infections, such as Clostridium difficile, require antibiotic treatment.
- Inflammatory Bowel Disease (IBD): Medications are often used to control IBD. Anti-inflammatory medications may be used initially and medications that suppress the immune system can be added if necessary. Surgery may be an option in severe cases, including removal of the colon and small intestine.
- Ischemic colitis: Treatment for ischemic colitis begins with intravenous fluids to rest the bowel and prevent dehydration. If sufficient blood supply is not restored, surgery may be needed to remove parts of the bowel that lost blood supply.
- Diarrhea and abdominal pain: Diarrhea and abdominal pain are the primary symptoms of colitis. Initial treatment at home may include a clear fluid diet for 24 hours, rest, and Tylenol for pain. If symptoms resolve quickly, no further care is needed.