Diversion Colitis Treatment
Diversion colitis is an inflammatory condition that affects some patients who have undergone an ileostomy or colostomy to divert stool from the normal intestinal path. The condition typically manifests within a year. While it does bear some similarity to irritable bowel syndrome in symptoms, they are separate conditions with separate causes and require different treatment methods.
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Digestive Structure
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To understand diversion colitis, it is useful to have a basic understanding of the digestive tract structure. The digestive tract starts at the mouth. Food travels down the esophagus to the stomach, where most digestion occurs. The solid matter remaining from stomach digestion (stool) moves into the small intestine and then into the large intestine. The stool is removed from the body through the rectum and anus.
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Ileostomy and Colostomy
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Ileostomies and colostomies are surgical procedures that attach a portion of the intestines to exterior of the abdominal wall. Both are used to divert stool away from a portion or the entirety of the large intestine. An ileostomy attaches the end of the small intestine to the outside of the abdominal wall, while a colostomy does the same for the large intestine. These procedures are used in conjunction with cancer treatments or as a treatment for digestive disorders such as diverticulitis. It is common for a part or the entirety of the large intestine to be left in place below the point of diversion.
Symptoms
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The Merck Manual's Online Medical Library reports that about one-third of patients that retain a portion of the large intestine, following an ileostomy or colostomy, will develop diversion colitis symptoms. These symptoms can include mucus discharge and bloody discharge from the rectum. Abdominal pain is frequently a symptom of diversion colitis. In the majority of cases, no medical intervention is required to manage the symptoms.
Causes
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While an ileostomy or colostomy is a prerequisite for diversion colitis, the condition itself has an internal cause. A study published in the New England Journal of Medicine with the title, Treatment of diversion colitis with short chain fatty acids, tentatively concluded that the condition is the result of a nutritional deficiency. In this case, it is a deficiency of short-chain-fatty acids that are normally acquired from digestion of dietary fiber.
Treatment
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The first line treatment for patients exhibiting diversion colitis is to return the movement of stool through the large intestine. This is a process that is sometimes called reanastomosis. This allows for the regular absorption of short-chain-fatty acids which resolves the cause of the condition. Another treatment option is to directly apply a solution with short-chain-fatty acids to the large intestine through irrigation.
References
Resources
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