Colitis is characterized by an acute or chronic inflammation of the inner lining of the large intestine. It can be caused by colon infections, loss of blood supply, cancer, inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). IBD includes ulcerative colitis and Crohn’s disease which are autoimmune diseases characterized by white blood cells that invade the colon wall. Symptoms of colitis include acute or chronic diarrhea, mucus and blood in stool, abdominal pain and distention, as well as colon ulceration in severe cases. Colitis can also cause constipation when the muscle contraction is affected.
Appendicitis is the inflammation of the appendix caused by infection or blockage by stool trapped inside. It can be acute or chronic. Symptoms include lower abdominal pain which can be severe in acute situations, diarrhea or constipation. Intestinal obstructions include transient ischemia, stricture, volvulus, intussusception or cysts. The mechanical issues involved in these conditions can affect colon muscle contractions and cause symptoms of constipation and abdominal pain.
1) Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease (IBD) involves the chronic inflammation of the digestive tract. Both ulcerative colitis and Crohn’s disease are classified as a type of IBD. Ulcerative Colitis is a chronic disease of the large intestine in which the lining of the colon becomes inflamed and develops ulcers. Crohn’s disease is chronic inflammation of the entire gastrointestinal tract. Although they can have similar symptoms, such as diarrhea, ulcerative colitis only affects the inner lining of the colon and large intestine whereas in Crohn’s disease inflammation can occur anywhere in the digestive tract and most commonly affects the last part of the small intestine (called the terminal ileum) and parts of the large intestine. Inflammation in Crohn’s disease generally extends much deeper and affects all the layers of the bowel walls. Patients may develop colon ulcers, fissures and/or fistulas due to severe damage to the bowel walls.
Symptoms:
While both ulcerative colitis and Crohn’s disease involve inflammation of the digestive tract, their symptoms can be similar but there are also distinguishable differences. Since ulcerative colitis involves inflammation as well as ulcers in the innermost lining of the large intestine, rectal bleeding is a common symptom. Ulcerative colitis also involves symptoms of lower left-sided abdominal pain, frequent stools, and mucous discharge. While ulcerative colitis is often associated with diarrhea, some individuals, however, may experience constipation, especially if the inflammation is primarily on one side of the colon when the inflammation affects colon muscle movement.
Crohn’s disease involves symptoms of reoccurring abdominal pain and diarrhea usually followed by remission of symptoms. These conditions also share similar symptoms such as diarrhea, bloating, abdominal cramps, nausea, weight loss. Mucus and blood can also be found in the stool if the lining of the colon is damaged.
Causes:
Although the exact cause of IBD is unknown, researchers have tied the condition to a flawed immune system. It is
thought that IBD can be caused by either an immune-mediated response, in which our immune system is working but working overtime or from an autoimmune condition, in which the immune system is defective and starts attacking healthy tissues. An autoimmune condition in IBD can come from the body making a specific type of antibody that attacks normal colonic proteins, like p40. The p40 protein helps aid in normal colon function. When the p40 protein and others like it get destroyed by the immune system, symptoms of IBD arise such as discomfort and distress. More recent research shows another mechanism that may be involved in the pathogenesis of IBD. The body may be developing an intolerance to an important colonic auto-antigen called hTM5. If this occurs, when the body develops intolerances to crucial colonic cells it causes an initiation of an expansive immune response in healthy tissues which leads to the destruction of parts of the epithelial cells in the colon and causes them to lose their function.
Toxicity may also be a cause of IBD. Mycobacterium avium, subspecies paratuberculosis (MAP) has been consistently identified in biopsies of the intestinal lining of Crohn's disease patients. Research results also suggest that ulcerative colitis may be caused by MAP. Some people are not susceptible; their immune systems can fight off MAP and they never get sick. Others are susceptible; their immune system cannot fight MAP due to their genetic factors (P40 protein) and/or triggers (stress, major illness) which alters the immune system. 92% of Crohn’s disease patients test positive for MAP.
Although the mechanism on how this gram-positive intracellular pathogen triggers autoimmunity is not fully understood, MAP has been viewed as the common culprit for both Crohn’s disease and ulcerative colitis. Infection of MAP causes a chronic intestinal immune inflammatory response which results in intestinal ulcerations. MAP is harbored in the ileocolonic mucosa of a proportion of normal people and can be detected in a high proportion of full thickness samples of inflamed Crohn's disease gut samples. Humans can get MAP infection through consumption of contaminated milk, products made from contaminated milk, or via contaminated water caused by facet from infected cattle, cows, pigs and other domestic animals. MAP is more robust than tuberculosis, and therefore the risk conveyed to human populations in retail milk and domestic water supplies are high.
2) Colitis Caused by Toxins, Infections, Ulcers and Cancer
Colitis can be caused by toxins from food, bacteria or a consequence of cancer growth within the colon. Colitis can range from a mild case to a severe condition. Symptoms vary but commonly include diarrhea, abdominal pain, and rectal bleeding.
2.1 Acute Colitis due to Bacterial Infections
Acute colitis can be caused by the most common four types of gram-negative bacteria Campylobacter, Salmonella, Shigella, and E. coli. Campylobacter are typically curved or spiral-shaped rods, while Salmonella, Shigella, and E. coli are generally rod-shaped. Infection of the large intestine by these four types of bacteria can cause acute colon inflammation with severe diarrhea, fever, abdominal cramps, and vomiting. The infection can also cause symptoms of blood in the stool and lower abdominal pain especially on the left side.
2.2 Irritable Bowel Syndrome (IBS), Small Intestinal Bacterial Overgrowth (SIBO) and Bacterial Infections
IBS is a disorder of the large intestine characterized by symptoms of abdominal pain or cramping, changes in bowel movements including diarrhea, constipation, or both, bloating, gas, and whitish mucus in the stool. One of the major causes of IBS is small intestinal bacterial overgrowth (SIBO) or bacterial infections of the GI tract. Studies have found an increased abundance of Staphylococcus aureus and Streptococcus agalactiae in the gut of individuals with IBS compared to healthy individuals. These bacteria produce superantigens that trigger severe immune responses causing intestinal inflammation, affecting the enteric neural function and disrupting the intestinal muscle contractions leading to symptoms of abdominal pain and irregular bowel movement. Pathogenic bacterial infections and toxins in the gut can also cause symptoms of brain fog, anxiety and depression through the brain-gut axis.
Gram-positive bacteria such as Clostridium perfringens and Bacillus cereus can produce toxins which cause acute gastroenteritis with symptoms of watery diarrhea and abdominal cramping that usually resolve within a day or two. However, 10-15% of individuals develop post-infectious irritable bowel syndrome (PI-IBS) following the acute infection. Studies have found a close similarity in the microbial dysbiosis between PI-IBS and D-IBS patients.
2.2 C. diff and Toxic Megacolon
Pathogenic gram-positive Clostridioides difficile, often referred to as C. difficile or C. diff, is an antibiotic-resistant bacterium that can cause antibiotic-associated diarrhea. Symptoms typically occur after the use of antibiotic medications that range from mild to severe diarrhea with fever, abdominal pain, and potentially more serious complications. Some people carry C. diff in their intestines but never become sick. These individuals are carriers of the bacteria and may spread infection.
Intestinal inflammation due to C. diff can also cause the colon to form patches of raw tissue that bleed or produce pus. When the infection becomes severe, patients can experience symptoms of severe diarrhea 10 to 15 times a day, severe abdominal cramping and pain, nausea, stomach upset, loss of appetite, abdominal swelling, blood or pus in the stool and weight loss. Signs and symptoms usually develop within 5 to 10 days after starting a course of antibiotics. However, they may occur as soon as the first day or up to 3 months later.
Intestinal inflammation due to C. diff can also lead to enlargement of the colon, called toxic megacolon when the deeper layers of the colon including the muscles becoming inflamed and the structural integrity of the colon begins to break down. Deep inflammation disables the muscles in the colon wall which become unable to contract and move substances through. Food and gas build up in the colon while the walls weaken, stretch, and dilate. Ultimately, toxic substances may leak through the thinning walls into the bloodstream causing systemic toxicity leading to sepsis, a life-threatening condition due to an extreme response to the infection.
2.3 Chronic Colitis due to Overgrowth of Anaerobic Bacteria
Overgrowth of certain commensal anaerobic bacteria such as Bacteroides fragilis can cause colitis and diarrhea. Bacterial toxins can also cause tissue damage and colon ischemia with symptoms of abdominal pain especially in the right side near the appendix.
2.4 Chronic Colitis due to Slow Growth Pathogenic Gram-negative Bacteria
There are certain types of pathogenic gram-negative bacteria that grow slowly in the colon. Examples include anaerobic gram-negative bacilli, such as Fusobacterium species, Desulfovibrio, Bilophila wadsworthia, and certain pathogenic strains of E. coli. These low virulence slow growth pathogenic bacteria usually form colonies 5 to 10 times smaller than the typical colony size and cause less symptoms or delayed symptoms. A subpopulation of the bacteria can form persister cells that enter a dormant, non-dividing state and is highly tolerant to antibiotics. The slow growth also helps them evade the host's immune system. Although the growth of these pathogenic gram-negative bacteria is slow, they are impactful and can cause damage to the intestines. Patients may gradually develop abdominal pain especially when applying pressure. Research has found that the anaerobic fusobacterium species have been linked to the development and progression of colorectal cancer. Desulfovibrio and Bilophila wadsworthia are sulfidogenic bacteria that produce hydrogen sulfide and cause DNA damage leading to the development of colorectal cancer.
2.5 Protozoan Infections and Amebiasis
Several different types of protozoa can infect the digestive tract and cause diarrhea. The most common culprits are Entamoeba histolytica, Giardia duodenalis, and Cryptosporidium spp. Entamoeba histolytica infection is also called amebiasis where the protozoa infect the colon. Symptoms include acute or chronic diarrhea, abdominal pain, excessive gas or blood in stool in severe cases.
Giardia duodenalis, also known as Giargia lamblia or Giardia intestinalis, primarily infects the duodenum and jejunum causing colitis with symptoms of acute or chronic diarrhea, abdominal pain, excessive gas, bloating, distended abdomen, blood in stool in severe cases as well as poor appetite, tasteless, nausea, vomiting, heartburn, body heaviness and sluggishness.
Cryptosporidium spp. primarily infects the small intestine causing cryptosporidiosis with symptoms of watery diarrhea, abdominal cramps, nausea and vomiting, loss of appetite, fatigue and fever. Cryptosporidium spp. can also infect the bile duct and gallbladder, particularly in immunocompromised individuals. The infection of the bile duct can cause blockage in the bile duct and lead to cholangiopathy with inflammation and scarring of the biliary tract, and ultimately obstruction of the bile ducts. Infection of the gallbladder can cause cholecystitis with inflammation of the gallbladder, thickening of the gallbladder wall, and sometimes sclerosing cholangitis. Symptoms include a dull ache or a feeling of pressure in the upper right quadrant, insomnia, bloating, poor digestion, greasy stool, and malabsorption of lipids.
2.6 Fungal Infections and Candida Overgrowth
Fungal infections or candida overgrowth in the large intestines can cause diarrhea or constipation and other symptoms including abdominal pain or intestinal cramps, gas, stools that contain mucous substance with a milky or cream-like color, or thin pieces, or possess film like materials, or oily mucus that tends to float. Recent research has found that colon fungal infections or candida overgrowth can also lead to the development of colon cancer due to the carcinogenic toxic substances produced by the fungi or candida.
2.7 Colon Ulcers, Anal Fissures and/or Fistula
Colon ulcers are open sores in the lining of the large intestine. It usually occurs in the descending colon. Several conditions can cause the formation of colon ulcers. In IBD, especially in ulcerative colitis, the immune system attacks the intestinal lining resulting in intestinal inflammation and ulcer formation. Some types of intestinal infections can inflame the colon and trigger the formation of ulcers. Blockage in blood flow to the colon, or certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can also lead to colon ulcers. These ulcers can cause symptoms of pain in the lower left quadrant of the abdomen, general abdominal pain, diarrhea or loose stools, bloody or black stool, mucous in stool, chills, or fever, loss of appetite, nausea, ulcers in the mouth, and weight loss. Other complications include anemia, mineral imbalance, anxiety, hepatitis, heart palpitations, cold sensitivity, headache, and dizziness.
A fistula is an abnormal tube-like connection between two organs or vessels. An anal fistula is an abnormal passageway formed from the upper part of the anus where the anal glands are located to the skin outside. An anal fistula is commonly caused by anal abscess when the gland becomes infected with bacteria and pus.
2.8 Colitis and Colon Cancer
Chronic inflammation of the colon increases the risk of colon cancer development. On the other hand, the presence of cancer itself can exacerbate existing inflammation in the colon. Colon cancer can also cause diarrhea and constipation due to tumor itself obstructing the colon and affecting normal bowel function.
Cancer cells attract inflammatory cells like macrophages and neutrophils which release pro-inflammatory cytokines such as IL-6, IL-17, and TNF-α that create an inflammatory tumor microenvironment (TME) which propagate the growth and progression of the tumor. Chronic inflammation can also lead to the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS), which can damage DNA and contribute to mutations that drive cancer progression. Cancer and inflammation form a vicious cycle where each promotes the other, worsening the overall disease.
Diarrhea is also a common side effect of colon cancer treatment, including surgery and the use of Gold formula from Wei Labs. Patients may also experience pain and bleeding due to open wounds and increased inflammation in the colon especially after the shedding of the cancer tissues.
3) Appendicitis
The appendix is a small, finger-like tube that is connected to the large intestine. A healthy appendix makes mucus that drains into the large intestine. Current understanding is that the appendix plays a role in the immune system and contains lymphatic tissue which houses white blood cells to fight infections. It may also serve as a reservoir for beneficial gut bacteria. When the gut microbiome is disrupted, bacteria from the appendix can repopulate the digestive tract.
Appendicitis, the inflammation of the appendix, is a common condition caused by infection or blockage by stool or parasites trapped inside. When the appendix becomes blocked, mucus can build up and harden preventing blood flow through the appendix causing inflammation. It usually begins with subclinical chronic conditions which can be easily ignored. Over time, the infection and swelling can cause the appendix to perforate (burst or rupture) leading to acute flare ups. Symptoms include lower abdominal pain which can be severe in acute situations, chronic diarrhea or constipation. Other symptoms of acute appendicitis include nausea and vomiting, loss of appetite, and sometimes fever.
The infection of the appendix is typically caused by a mix of aerobic and anaerobic bacteria that is part of the commensals or variant strains that are pathogenic. E. coli and Bacteroides fragilis are the most common bacteria that are associated with a potentially serious inflammation of the appendix. Streptococcus anginosus can also be involved in an acute condition. Other bacteria such as Klebsiella pneumoniae, and Pseudomonas aeruginosa can also be involved in both acute and chronic appendix inflammation. The infection usually arises when the appendix becomes blocked, leading to overgrowth of bacteria that may be part of the commensals or variant strains. In addition, some slow-growth anaerobic gram-negative bacilli, such as Fusobacterium species, Desulfovibrio, Bilophila wadsworthia can also cause acute and chronic appendicitis.
4) Intestinal Obstructions
4.1 Intestinal Circulation Blockage and Transient Intestinal Ischemia
Chronic intestinal inflammation due to conditions such as gut dysbiosis, intestinal infections, IBS, or IBD can affect the intestinal blood vessels and cause poor blood circulation as well as blood clot formation resulting in circulation blockage. A block in circulation can result in reduced intestinal muscle contraction with stool retention and constipation. In addition, patients may also experience abdominal pain and hard nodules in the lower abdomen with increased belly weight. In severe cases, inflammation can cause intestinal ischemia which requires immediate medical attention. However, in most cases, it involves frequent transient blockage. Retention of blood and a blood clot can cause the production of toxins that further decrease circulation causing more frequent transient blockage with increased blood accumulation in the intestine. These toxins can also affect neurological function, and patients may have symptoms of insomnia, irritability, and confusion which is worse at night. In severe cases, it can cause mania, depression and even dementia.
4.2 Intestinal Structure Obstructions: Stricture, Volvulus, Intussusception or Cysts
An intestinal stricture is a narrowing of the large intestine, often caused by inflammation or scar tissue. This narrowing can restrict the passage of stools, causing symptoms of severe abdominal pain, nausea, vomiting, and an inability to pass gas or stool.
Volvulus is a twisting or knotting of the intestinal tract causing intestinal blockage and obstruction of blood flow. It most commonly occurs in the sigmoid colon although it can occur in other parts of the intestine. Volvulus is most seen in newborns due to a birth defect during fetal development. It can also occur in older adults with constipation. Symptoms include belly pain and bloating, nausea, bloody stools, and constipation.
Intussusception is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This telescoping action often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected leading to a tear in the bowel (perforation), infection and death of bowel tissue. Intussusception is the most common cause of intestinal obstruction in children younger than 3 years old.
Gastrointestinal cysts are fluid filled sacs that may appear anywhere in the digestive tract including the mouth, esophagus, stomach, small intestine, large intestine, and anus. Gastrointestinal cysts, also known as enteric or intestinal duplication cysts, are most often seen in the ileum of the small intestine, esophagus, and stomach. The cyst can block the movement of food causing constipation.
