Pancolitis
Pancolitis is a medical condition characterized by inflammation of the entire large intestine, often associated with inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn's disease. Individuals at risk for developing pancolitis include those with existing inflammatory bowel disease, certain gastrointestinal infections, or those who have undergone abdominal or pelvic radiation therapy. The immune system's abnormal response can lead to an influx of white blood cells, causing significant damage and inflammation in the colon. Common symptoms include blood in stool, urgency to defecate, abdominal pain, and unintended weight loss.
Diagnosis typically involves a colonoscopy, which reveals inflamed, bleeding ulcers along the colon, alongside biopsies to determine the underlying cause. Treatment options range from anti-inflammatory medications like 5-aminosalicylic acid (5-ASA) to immune system inhibitors and steroids, with severe cases sometimes requiring surgical intervention to remove the colon. Recent advances in medication, including FDA-approved therapies, offer new hope for managing the condition. Untreated pancolitis can lead to serious complications, including increased risk of colon cancer, making early diagnosis and treatment crucial for improving outcomes.
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Subject Terms
Pancolitis
ALSO KNOWN AS: Universal colitis
RELATED CONDITIONS: Inflammatory bowel diseases, various types of colitis
DEFINITION: Pancolitis is inflammation of the entire large intestine.
Risk factors: People with inflammatory bowel disease, with specific gastrointestinal infections, or who have had abdominal or pelvic radiation therapy or cancer are at risk for developing pancolitis.
Etiology and the disease process: For unknown reasons, the immune system sometimes attacks the digestive tract, resulting in inflammatory bowel disease (IBD). The two main types of inflammatory bowel disease are ulcerative colitis (UC) and Crohn's disease (CD). In these diseases, large quantities of white blood cells migrate into the colon and repeatedly damage it. This can result in inflammation of the entire colon, or pancolitis.
Other causes of pancolitis include the following:
- Infections of the colon with certain microorganisms that cause community-acquired colitis
- Antibiotic-related pseudomembranous colitis which is brought on by treatments with antibiotics such as clindamycin, ampicillin, or cephalosporins that kill off the common microbial occupants of the colon and allow the growth of another microorganism (Clostridium difficile) that damages the colon
- Ischemic colitis, which is caused by blockage of the blood vessels that feed the colon
- Radiation colitis, whereby radiation damage blocks blood flow to the colon
- Cancers that spread to the colon
Incidence: The incidence of ulcerative colitis is between 0.5 and thirty-five cases per 100,000 people, and of Crohn's disease, three to twenty cases per 100,000 people. Between 5 and 15 percent of those who receive abdominal or pelvic radiation therapy suffer from radiation colitis.
Symptoms: The hallmarks of pancolitis are blood discharge after each bowel movement, urgency to defecate, spasm of the anal sphincter (tenesmus), abdominal pain, and rapid weight loss.
Screening and diagnosis: The standard method of diagnosing pancolitis is a colonoscopy, which should show continuous, inflamed, bleeding ulcers on the wall of the colon. Colon biopsies are also necessary to determine the exact cause of pancolitis. X-rays or computed (CT) scans in which contrast is provided by a barium enema are also used to diagnose pancolitis or its complications.
Treatment and therapy: Colonic inflammation is inhibited by 5-aminosalicylic acid (5-ASA) agents such as mesalamine, sulfasalazine, and balsalazide. Other immune system inhibitors, including infliximab, azathioprine, cyclosporine, methotrexate, and 6-mercaptopurine, are used if 5-ASAs are ineffective. Steroids such as prednisone, methylprednisolone, and budesonide quell active episodes. Surgical removal of the colon (colectomy) is recommended in recalcitrant cases. In 2023, the US Food and Drug Administration approved mirikizumab for the treatment of pancolitis. In addition, targeted biologic medicines, including tumor necrosis factor-alpha (TNF-α), interleukin-12 (IL-12), and IL-23, can block inflammation. Medical researchers are studying bioengineered therapies that work to retrain a patient's immune system as well.
Prognosis, prevention, and outcomes: Untreated pancolitis is usually fatal. Inflammatory bowel diseases are usually controlled with therapy, but patients are at increased risk for colon cancer. Colectomy cures many pancolitis cases. For Crohn's disease, therapy becomes less effective with time, and surgery is required in two-thirds of patients.
Bibliography
Bergeron, V., and A. Vienne. "Risk Factors for Neoplasia in Inflammatory Bowel Disease Patients with Pancolitis." Inflammatory Bowel Disease Monitor, vol. 11.4, 2011, pp. 169.
“Crohn's Disease.” MedlinePlus, 3 Jan. 2022, medlineplus.gov/genetics/condition/crohns-disease. Accessed 23 June 2024.
“FDA Approves Mirikizumab, a Promising Induction and Maintenance Therapy for Ulcerative Colitis.” Mount Sinai, 27 Oct. 2023, www.mountsinai.org/about/newsroom/2023/fda-approves-mirikizumab-a-promising-induction-and-maintenance-therapy-for-ulcerative-colitis. Accessed 23 June 2024.
Lyra, Andre C., et al. "Epidemiology, Demographic Characteristics and Prognostic Predictors of Ulcerative Colitis." World Journal of Gastroenterology : WJG, vol. 20, no. 28, 2014, pp. 9458-9467, doi.org/10.3748/wjg.v20.i28.9458. Accessed 23 June 2024.
Mulcare, Yaja ', and Saurabh Sethi. “Pancolitis: Symptoms, causes, and treatment.” MedicalNewsToday, www.medicalnewstoday.com/articles/320064. Accessed 23 June 2024.
Pal, Neelu, and John Geibel. “Radiation Enteritis and Proctitis: Practice Essentials, Pathophysiology, Etiology.” Medscape Reference, 6 Oct. 2023, emedicine.medscape.com/article/197483-overview. Accessed 23 June 2024.