| Theme | Infectious Enterocolitis | |
|---|---|---|
| Title | Differential Diagnosis of Infectious Colitis: Ischemic Colitis, Drug-induced Colitis, IBD | |
| Publish Date | 2004/07 | |
| Author | Ichiro Hirata | The Second Department of Internal Medicine, Osaka Medical College |
| Author | Kenichi Katsu | The Second Department of Internal Medicine, Osaka Medical College |
| [ Summary ] | This paper mainly discussed colonoscopy findings which can be used to differentiate infectious colitis from other types of colitis, e.g., ischemic colitis, drug-induced colitis, and IBD. It is important to differentiate colitis caused by Campylobacter, Salmonella, and Enterohemorrhagic E.coli (EHEC) from ischemic colitis. All of these diseases can produce longitudinal lesions (mucosal redness or ulcers), but the susceptible regions are different in each type. For example, Campylobacter and Salmonella colitis usually affects the terminal ileum, but EHEC is likely to involve the ascending colon, in contrast with the ischemic colitis mostly involving the sigmoid colon and the descending colon. Drug-induced colitis is represented by hemorrhagic colitis, pseudomembranous colitis, and NSAIDs colitis. EHEC colitis and bacillary dysentery are examples of infectious colitis which need to be differentiated from drug-induced hemorrhagic colitis. Compared to drug-induced hemorrhagic colitis, mucosal inflammation from the former appears to be more severe. Also, in bacillary dysentery, the distal colon is more likely to be involved. Amebic dysentery With thick, white plaques over ulcers can mimic pseudomembranous colitis, endoscopically. In this instance, the presence of a verrucous ulcer favors the former diagnosis. Yersinia and Salmonella enterocolitis are examples of infectious colitis that need to be distinguished from NSAIDs colitis. More often, mucosal lesions is more pronounced in infectious colitis. Bacillary dysentery, Salmonella, Campylobacter, and EHEC colitis can mimic ulcerative colitis. Yersinia, amebic dysentery, and CMV colitis can resemble Crohn's disease, endoscopically. It is also important to note that superimposed CMV infection during the course of ulcerative colitis is not a rare occurrence. |
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