Specialty

Irritable bowel treatment in CDMX Mexico Col del Valle

Doctor:

Octavio Rojas Diaz

Specialty

Gastrosurgeon / Irritable Bowel

Address

Av. Coyoacan 715

Cp 03100 Col Del Valle CDMX

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Irritable Bowel Colitis

Irritable bowel syndrome is a very common chronic clinical condition, although poorly understood and with no known cure at present. Despite this, most doctors are familiar with the symptoms associated with this condition. The syndrome can inexplicably affect anyone, regardless of age or gender, and can predominate in any part of the gastrointestinal tract, although it is most common in the large intestine.

It is often known as colitis, nervous colitis, irritable bowel, spastic colitis, although this name is incorrect, since it has been shown that the alterations can affect all areas of the digestive tract, including the esophagus.

Irritable bowel syndrome is characterized by an alteration in intestinal motility, although the structure of the intestine is normal. Common symptoms include bloating, abdominal pain or discomfort, and changes in bowel habits that can decrease quality of life.

This functional condition is considered the most common in intestinal activity and occurs in all continents with a similar incidence. In Mexico, it is estimated that 20% of the population suffers from this disorder.

Various causes have been attributed to the origin of the symptoms, including psychosocial disorders, gastrointestinal motility disturbances, visceral hypersensitivity, autonomic nervous system dysfunctions, and abnormalities in sensory and brain perceptions.

Recently, it has been suggested that the activation of inflammatory cells in the epithelium of the colon and in the myenteric nerve plexus of the jejunum may be an immunological basis. The role of gastrointestinal infections in the development of this functional condition is currently being investigated. In addition, cases of familial presentation have been reported, suggesting a possible genetic origin.

All these factors point to a multifactorial pathophysiology in the presentation of these functional bowel disorders, although the influence of each of these mechanisms in each patient has not yet been defined.

The emotional factor plays an important role in triggering painful episodes and intestinal motility disorders. It is essential to make an accurate diagnosis for proper management, due to the diversity of symptoms and their dominance in each particular patient.

In general, the diagnosis is established after having excluded organic pathologies that may present similar symptoms.

Types according to intestinal motility patterns

Criteria for evaluating intestinal motility patterns include:

Less than three bowel movements a week.
More than three bowel movements a day.
hard stools
Loose stools or diarrhea.
Difficulty defecating.
Urgency to defecate.
Sensation of incomplete evacuation.
evacuation with mucus
Abdominal distension and flatulence.

Diarrhea predominance: occurs when one or more criteria from numbers 2, 4 and 6 are met, and the criteria 1, 3 and 5 are absent.

Predominance of constipation: it occurs when one or more criteria from numbers 1, 3, 5 and 6 are met, and the criteria 2, 4 and 6 are absent.

Alternating diarrhea and constipation: There is no strict definition for this pattern.

In addition, it is important to consider the presence of "alarm symptoms" and carry out basic studies such as a complete blood count with erythrocyte sedimentation rate, blood chemistry, stool stool, stool culture, stool, occult blood and antibodies for celiac disease, as well as a colon for enema or a colonoscopy. These studies are useful to rule out organic diseases of the gastrointestinal tract, but they can increase the economic burden.

For this reason, many physicians choose to follow the symptom-based approach, only resorting to testing if warning symptoms such as atypical pain, weight loss, change in predominant symptoms, blood in the stool, or abnormal clinical examination occur.

Symptom Interpretation

Abdominal pain that is relieved by food
The pain could be related to the stomach
Diarrhea and abdominal pain
Bowel function is impaired
Constipation and abdominal pain
Bowel function is impaired
Bloating after eating
The disease is not likely to be organic
Anal burning sensation
The rectum is irritated
Rectal bleeding
The rectum is irritated

To address the treatment of irritable bowel syndrome, it is essential to alleviate the symptoms and provide the patient with adequate psychological support, promoting understanding of the emotional aspects involved in this functional disorder.

It is important to rule out organic diseases and explain to the patient the pathophysiological mechanisms that cause intestinal motility disorders or visceral hypersensitivity, so that they can accept that it is a functional disorder and achieve rational and effective management.

Medical therapy

There are various treatment options for irritable bowel syndrome, including medical drug therapy and psychological therapy.

Medical therapy is based on the use of antispasmodics and agents that modify intestinal motility. Psychological therapy seeks to reduce emotional stress and teach the patient resources to manage their condition.

Diet also plays an important role in the treatment of irritable bowel syndrome. It is recommended to avoid foods that are irritating to the colonic mucosa, those that are difficult to digest and those that cause excess gas, such as refined sugar, caffeine, fats, dairy products, soft drinks, spicy foods and seasonings.

Instead, you should eat a diet rich in fiber, fluids, and exercise regularly. However, it is important to keep in mind that each patient may react differently to certain foods and a detailed questioning is necessary to determine the content of the diet and its relationship with the irritable bowel syndrome.

Colitis

Colitis is a condition that occurs due to acute or chronic inflammation of the colon. It is a disease that can manifest itself in different ways, from mild and self-limited to toxic colitis that can be very serious. Unlike Irritable Bowel Syndrome or Irritable Colitis, there is a known causative factor that triggers colitis.

We will analyze the varieties of Colitis, excluding Crohn's disease.

Etiologies:

The causes of colitis fall into three categories: infectious, miscellaneous, and other. Within the infectious, we can find bacteria, viruses, parasites and fungi. Miscellaneous causes include ischemic, radiation, microscopic (collagenous and lymphocytic), eosinophilic, shunt, drug/chemical, and neutropenic typhlitis. In addition, there are other causes, such as hemolytic uremic syndrome, connective tissue disease, vasculitis, amyloidosis, Behcet's syndrome, chronic lymphocytic leukemia, lymphoma, and allergic proctocolitis, among others.

Colitis has infectious, miscellaneous, and other causes. Within the infectious, bacteria, viruses, parasites and fungi are included. Miscellaneous causes are ischemic colitis, radiation colitis, microscopic (collagenous and lymphocytic), eosinophilic colitis, shunt colitis, drug or chemical colitis, and neutropenic typhlitis. Other causes of colitis include hemolytic uremic syndrome, connective tissue disease, vasculitis, amyloidosis, Behcet's syndrome, chronic lymphocytic leukemia, lymphoma, and allergic proctocolitis, among others.

The causes of colitis are classified as infectious, miscellaneous, and others. Infectious are bacterial, viral, parasitic and fungal (fungi). Miscellaneous causes include ischemic, radiation, microscopic (collagenous and lymphocytic), eosinophilic, shunt, drug/chemical, and neutropenic typhlitis. The other causes of colitis are hemolytic uremic syndrome, connective tissue disease, vasculitis, amyloidosis, Behcet's syndrome, chronic lymphocytic leukemia, lymphoma, and allergic proctocolitis, among others.

Evaluation and diagnosis

Because colitis can have a variety of causes, symptoms vary in intensity and presentation. Common symptoms include abdominal pain, diarrhea with or without blood and runny nose, and signs of dehydration. It is important to know in the clinical history the duration and onset of symptoms, as well as the characteristics of the diarrhea.

You should ask about a history of travel abroad, contact with pets and previous illnesses, such as cardiovascular diseases or previous radiotherapy, as well as the intake of medications such as immunosuppressants and antibiotics, among others.

A complete physical examination that includes a detailed examination of the abdominal cavity, anus, and rectum is essential. Complementary tests for the diagnosis of colitis include colonoscopy, X-rays, and stool tests such as stool cultures, stool samples, and stool tests, as well as blood tests and biopsies.

Colonoscopy is the ideal method to establish the diagnosis and the extent of damage to the colon. During this procedure, tissue samples may be taken for analysis. However, it is contraindicated in cases of acute and severe colitis due to the risk of perforation. X-rays can also help visualize the morphology and integrity of the colon.

Bacterial colitis

It is an infectious process caused by bacteria:

Escherichia coli:

It is one of the main components of the intestinal microflora. As for the endoscopic findings, focal redness, swelling, ulcerations, and sometimes pseudomembranes can be observed. Fecal leukocytes are positive.

Diagnosis can also be made by the presence of toxins and by culture. Generally, the clinical picture is self-limited, so treatment is supportive; In the most serious cases, antibiotics can be used, with quinolones being the first option.

Salmonella:

Treatment generally consists of adequate hydration and supportive measures, although in severe cases the use of antibiotics may be necessary.

Salmonella:

It is a bacterium that can cause infection in the intestinal tract of people. The main mode of transmission is through contaminated food. Symptoms include fever, abdominal pain, diarrhea, and vomiting. In some cases, the infection can be severe and require hospitalization. Treatment generally consists of adequate hydration and supportive measures, although in severe cases the use of antibiotics may be necessary.

Campylobacter:

Campylobacter jejuni is a bacterium that mainly causes gastroenteritis in humans. In 90% of cases, it presents with fever and diarrhea, in 70% with abdominal pain and in 50% there are bloody stools.

Contagion occurs through the consumption of contaminated food, especially raw or undercooked poultry. Treatment consists of adequate hydration and in some cases, antibiotic therapy can be administered.

Yersinia:

Yersinia enterocolitica is capable of causing from simple gastroenteritis to invasive ileitis and colitis. It has the ability to invade the epithelium, including the terminal ileum, and produces an enterotoxin.

The picture of enterocolitis is more common in children under 5 years of age, while in children older than this age it can present as a mesenteric adenitis that resembles acute appendicitis. Fecal leukocytes are usually positive. Diagnosis can be made by culture or serologic testing.

In general, treatment for Yersinia enterocolitica is supportive, as it is usually a self-limited disease. However, in severe cases or in patients with weakened immune systems, antibiotics may be used.

Clostridium:

One of the best known types of Clostridium is Clostridium difficile, a gram-positive anaerobic bacillus that spores. This microorganism produces two enterotoxins that can trigger a series of symptoms in the colon. The best-known clinical picture is pseudomembranous colitis, an infection that is related to the use of antibiotics and that can appear after one or three weeks of its intake. Symptoms include diarrhea, crampy abdominal pain, tenesmus, nausea, vomiting, fever, dehydration, and in severe cases, toxic megacolon and colonic perforation.

Diagnosis of Clostridium difficile infection is difficult because it is a difficult organism to culture. However, a toxin test can be performed and is positive in more than 90% of cases. An abdominal x-ray may also be used to rule out complications such as megacolon or colonic perforation.

Treatment is based on stopping the use of antibiotics, if possible, and providing supportive measures to control symptoms. In addition, contacts must be isolated, since the infection is highly contagious through spores. Metronidazole is the treatment of choice for Clostridium difficile infection.

Aeromonas:

It is a very common microorganism in the aquatic environment, which produces an enterotoxin. In general, it causes self-limited diarrhea, although in some cases it can evolve into chronic diarrhea with the presence of blood, in 22% of cases. Treatment includes supportive measures and, in severe cases, antibiotics may be given.

Spirochetes The most common is Treponema pallidum. It works by attacking the apical epithelial surface of the appendix, cecum, colon, and rectum. Inflammation occurs by penetration into the mucosa. It is a sexually transmitted disease. Clinical manifestations can range from asymptomatic cases to low-volume diarrhea, bleeding, mucus or pus, and tenesmus. Treatment consists of high doses of antibiotics.

colonic tuberculosis:

Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis that can affect any part of the digestive system. Immunosuppression, especially by HIV/AIDS, has led to an increase in the incidence of the disease.

The most important differential diagnosis is with Crohn's disease. The most common symptoms are abdominal pain and bloody diarrhea in 90% of cases. In two thirds of cases, a mass can be felt in the right lower quadrant of the abdomen. Complications include hemorrhage, obstruction, perforation (rare), fistulae, and malabsorption. Less than 50% of patients with gastrointestinal tuberculosis also have pulmonary tuberculosis due to ingestion of the bacteria.

The usual treatment is combination therapy for 12 months that includes isoniazid, pyrazinamide, and rifampicin. Surgery is done when there is obstruction or cancer is suspected. Fistulas generally respond well to medical treatment.

Mycobacterium avium intracellulare:

It is a common cause of acute diarrhea in gay men with HIV. It produces colicky abdominal pain, bloody diarrhea, fever, and weight loss. Endoscopically, a fragile mucosa can be observed, with linear or oval ulcerations. The glandular architecture, in general, is maintained. Histology reveals a PAS-positive histiocytic interstitial infiltrate. Treatment includes a combination of specific antibiotics to fight the infection.

viral colitis

Cytomegalovirus:

Belonging to the herpesviridae family, it is the most important viral cause of opportunistic infections in immunosuppressed patients, especially those with AIDS. This sexually transmitted infection can affect any organ, although gastrointestinal involvement is rare and manifests as ulcerative proctocolitis. Among its symptoms are bloody diarrhea, fever, colicky abdominal pain, weight loss and even perforation. Treatment consists of the use of ganciclovir and in cases of severe enterocolitis, surgery may be necessary.

parasitic colitis

Amoebiasis

Entamoeba histolytica is the most common amoeba and can affect various organs. The clinical picture can vary from asymptomatic carrier to producing a serious disease. Transmission is fecal-oral.

When cysts are found in the stool, the patient is an asymptomatic carrier; On the other hand, when trophozoites with intracytoplasmic erythrocytes are observed, it indicates an active infection. It produces abdominal pain and bloody diarrhea. In 10% of cases, it produces toxic colitis.

There may also be systemic dissemination, in which there is often liver involvement. In some cases, amebomas occur, which are dense, fibrous, granulomatous masses capable of causing obstruction and intussusception.

The parasitological examination of the feces is positive in more than 90% of the patients. Serological tests such as indirect hemagglutination and ELISA can be performed. Treatment depends on the severity of the disease.

Cryptosporidium:

It is seen more frequently in contact with animals. It attacks the intestinal epithelium and can cause low-grade fever, abdominal cramps, profuse watery diarrhea, and light rectal bleeding. Treatment includes hydration and antibiotics.

Balantidiasis:

This infectious entity is rare. What is relevant about this microorganism is that it is treatable, but it can have a severe evolution. It is a ciliated protozoan and due to its size it can be visible to the naked eye. Its transmission occurs through infected pigs, and there may be carriers without symptoms.

Symptoms can range from mild diarrhea or constipation to bloody diarrhea, abdominal pain, tenesmus, and dehydration. It can even cause shock and death. The recommended treatment is metronidazole.

Whipworm:

The parasite in question is Trichuris trichiura, which is acquired by ingesting infected eggs. The adult can measure between 3 and 5 cm, and affects the mucosa of the cecum, where it can remain for years. In severe cases, it can spread throughout the colon.

Some patients may be asymptomatic carriers, while others may present with right lower quadrant pain. Clinical symptoms may include bloody stools, diarrhea, anemia, emaciation, and, in some cases, appendicitis and rectal prolapse.

In addition, peripheral eosinophilia is often seen, and eggs can be seen in the stool. The recommended treatment is mebendazole.

Lymphogranuloma venereum:

The causative agent is Chlamydia trachomatis, an obligate intracellular parasite that is transmitted through sexual contact. The infection develops in several stages: first, a painless ulcer appears that disappears; then inguinal adenopathy may present, along with fever, abscesses, and fistulas; later, fibrotic changes are generated that can lead to rectal strictures.

Diagnosis is made by cultures and serology (complement fixation and microimmunofluorescence). The recommended treatment is the use of antibiotics.

Fungal (fungal) colitis

Candidiasis or moniliasis:

The Candida sp. It is an infection that usually occurs in immunosuppressed patients (due to chemotherapy, HIV/AIDS or steroid treatment) or in those who have been subjected to prolonged treatment with broad-spectrum antibiotics.

This infection can cause bloodless diarrhea and abdominal pain. The recommended treatment is the use of antifungals.

Histoplasmosis:

This organism produces a subclinical infection in healthy people, but in those with compromised immune systems, it can manifest as disseminated disease.

Most frequently, it presents as pulmonary involvement, although it can also affect the terminal ileum and the right colon. Symptoms include diarrhea, bleeding, intestinal obstruction due to narrowing, and perforation. The recommended treatment is the use of antifungals.

miscellaneous colitis

Ischemic colitis:

It is a syndrome that occurs as a consequence of a vascular disease, both occlusive and non-occlusive, that affects the colon. This diagnosis should be suspected especially in patients with cardiovascular disease, arrhythmias, vasculitis, or who have undergone aortic surgery.

Symptoms can range from painless bleeding to abdominal pain, bloody bowel movements, fever, and tenesmus. Treatment includes bowel rest, hydration, and the use of broad-spectrum antibiotics. In case of perforation or narrowing, surgical intervention may be necessary.

Radiation colitis:

This condition can have both short- and long-term effects, and can lead to proctitis, colitis, and proctocolitis (presenting months to years after treatment). Symptoms include low-volume, bloody stools, as well as mucorrhea, tenesmus, incontinence, strictures, obstruction, and fistulas.

Collagenous and lymphocytic colitis:

This picture is common in middle-aged women and is characterized by producing watery, voluminous diarrhea (more than 2 liters per day) and without blood. In most cases, patients are in good general condition, which makes the differential diagnosis with irritable bowel syndrome difficult.

The lymphocytic variety is much more frequent than the collagen, and the etiology of these diseases is unknown. Often the condition resolves on its own, making it difficult to determine the efficacy of treatment. The therapeutic approach is staggered, beginning with antidiarrheals such as loperamide, followed by sulfasalazine or 5-ASA derivatives, steroids, and immunosuppressants.

Eosinophilic colitis:

It is a rare pathology that causes the infiltration of eosinophils in the wall of any part of the gastrointestinal tract. If the colon is affected, it is usually more common for it to occur in the right colon.

The clinical picture is characterized by abdominal pain, diarrhea, bleeding and weight loss. Patients usually have a history of allergy or food intolerance. Peripheral eosinophilia can be found in 80% of cases.

On endoscopy, the disease is indistinguishable from Crohn's disease, but biopsy shows a larger eosinophilic inflammatory infiltrate in the mucosa and submucosa.

Treatment is based on the use of steroids and immunosuppressants. Surgery is only done in very rare cases of intestinal perforation. It has a good prognosis and there is no increased risk of cancer.

Shunt colitis:

It occurs in patients who have undergone intestinal transit bypass surgery, and is characterized by inflammation of the distal segment of the intestine. Symptoms vary from asymptomatic patients to those with abdominal pain, tenesmus, purulent or bloody rectal discharge.

It is believed to occur as a result of a deficiency of intraluminal nutrients for the colonocytes, such as short-chain fatty acids. The ideal treatment is the restoration of intestinal transit; if this is not possible, short-chain fatty acid or steroid enemas have been used and appear to be effective.

Neutropenic typhlitis:

Symptoms include severe right lower quadrant pain, watery diarrhea with or without blood, and in some cases sepsis and shock. Necrosis can progress to gangrene and perforation, increasing the mortality rate to 50%.

Although the exact cause is unknown, neutropenia is considered an important risk factor. Treatment focuses on life support, including hydration and bowel rest, along with broad-spectrum antibiotic therapy. In addition, it is essential to address neutropenia. In cases of perforation, surgery with resection of the affected segment may be required.

Chemical or drug colitis:

Cases of colitis secondary to the use of soapy enemas, hydrogen peroxide, herbal medicines, vinegar, potassium permanganate, and meglumine diatrizoate (Hypaque) have been reported.

The severity of the condition will depend on the type and concentration of the caustic agent, the contact time, and the presence or absence of a previous colonic disease. Treatment is based on support measures and enemas with corticosteroids. In severe cases, broad-spectrum antibiotic therapy should be administered for a period of four to six weeks.

Ulcerative or ulcerative colitis (UC):

Ulcerative colitis is a chronic inflammatory disease of the large intestine whose cause is still unknown. This pathology has an immunological, genetic and psychological basis, and affects the mucosa of the rectum and a variable portion of the colon. Although there is no medical cure for the disease, medical treatment can improve the quality of life for most patients.

There are genetic factors that predispose the individual to their immune system responding exaggeratedly and uncontrollably to trigger factors not yet identified.

The actions of the immune system cause multiple non-specific mechanisms of inflammation, which permanently damage intestinal tissue due to the constant activation and amplification of these non-specific immunological and inflammatory cascades. The main symptoms are diarrhea with the presence of mucus and blood, and rectal tenesmus.

It is essential to know the extent of mucosal damage, which is determined by colonoscopic examination with visual inspection to observe the division between the healthy mucosa and the injured mucosa.