Hemorrhagic Colitis

Hemorrhagic colitis is an acute form of gastroenteritis resulting from a bacterial infection in the large intestine caused by a specific strain of Escherichia coli. It is a self limiting disease characterized by bloody diarrhea accompanied by abdominal cramps, and occasionally low grade fever.

This illness mostly affects children below 5 years as well as older people, but it may occur at any age. The strain E. coli O157:H7 is the usual cause of Hemorrhagic colitis in North America. Cattle are natural reservoirs of these bacteria and the infection does not produce any symptoms in them. The bacteria infect people when they consume under cooked beef, especially ground meat, or unpasteurized milk. Water and juice contaminated by the infective organism also can cause infection. An infected individual can transmit the disease through person to person contact and often an infection leads to an outbreak of hemorrhagic colitis. It usually spreads rapidly among young children who are in diapers.

Damage to the intestinal lining caused by the toxins produced by E. coli is the cause of the diarrhea. If the toxins reach the blood, other organs may be affected, mainly the kidneys.

Symptoms Of Hemorrhagic colitis

The onset of the disease is marked by sudden diarrhea accompanied by severe abdominal pain and cramping. Low grade fever may be present, but in many cases it is absent. Temperatures above 1020 F are rare.   The stools are watery but traces of blood may not be seen in the first one or two days. But by the third day, the stools may have become bloody and it may remain like that for up to 8 days after which it resolves by itself.

Hemolytic-uremic syndrome is a serious complication which arises in 2% to 7% of patients who have developed hemorrhagic colitis. The symptoms of developing hemolytic-uremic syndrome are thrombocytopenia or low platelet count, excessive breakdown of red blood cells called hemolytic anemia as well as the usual symptoms of anemia such as weakness, giddiness and fatigue. It may lead to sudden kidney failure.    Hemolytic-uremic syndrome in some cases may lead to further complications such as strokes or seizures due to nerve damage or damage to the brain. An increase in fever as the illness enters the second week may be an indication of complications developing. Complications like hemolytic-uremic syndrome usually develop in young children below the age of 5 years. It is frequent in older people also. Hemorrhagic colitis can have a fatal outcome in older people even when they have not developed hemolytic-uremic syndrome or other complications arising from it.

Diagnosis

Diarrhea with bloody stools is the typical symptom which alerts the doctor to the possibility of hemorrhagic colitis. Stool samples are tested for the presence of E. coli bacteria. The stool may be tested for the specific toxin (shiga toxin) which the E. coli bacteria produce. If any other reason for bloody diarrhea is suspected, a viewing test called colonoscopy may be done to examine the interiors of the large intestine.

Treatment

Keeping the patient rehydrated is the most crucial part of the treatment. The fluid lost through frequent watery bowel movements should be replenished as much as possible. In case of severe dehydration, intravenous administration of electrolyte solution may be necessary. Antibiotic therapy to treat the infection is not advisable as the chances of developing complications like hemolytic-uremic syndrome may be increase by those drugs. Intensive care treatment and kidney dialysis may be necessary for patients developing this complication.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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