What Is a Colon Ulcer?

Colonic ulcer is an acute or chronic inflammation confined to the colonic mucosa and submucosa, which can be manifested as localized defects and ulcers, mostly caused by infection, ischemia, inflammation, tumors, and drugs. Its size, The shape, depth, and development process are also inconsistent. Due to different causes, the distribution of lesions varies, and some lesions can affect the entire colon. Common diseases are: Ulcerative colitis (UC), Crohn's disease (CD), Ischemic colitis, Colon tumor, drug-induced enteritis, and infectious diseases Enteritis (Infective enteritis), including Clostridium difficile infection (CDI), Intestinal tuberculosis (IT), Amoebae, Antibiotic-associated diarrhea (AAD) )Wait.

Colonic ulcer is an acute or chronic inflammation confined to the colonic mucosa and submucosa, which can be manifested as localized defects and ulcers, mostly caused by infection, ischemia, inflammation, tumors, and drugs. Its size, The shape, depth, and development process are also inconsistent. Due to different causes, the distribution of lesions varies, and some lesions can affect the entire colon. Common diseases are: Ulcerative colitis (UC), Crohn's disease (CD), Ischemic colitis, Colon tumor, drug-induced enteritis, and infectious diseases Enteritis (Infective enteritis), including Clostridium difficile infection (CDI), Intestinal tuberculosis (IT), Amoebae, Antibiotic-associated diarrhea (AAD) )Wait.

Western Medicine Name

Colon ulcer

English name

Colonic Ulcer

Affiliated Department

Internal Medicine-Gastroenterology

Disease site

Anywhere in the whole colon

The main symptoms

Abdominal pain, diarrhea

Main cause

Infections, antibiotics, immune disorders, intestinal flora disorders, ischemia, colon tumors, drugs

Multiple groups

Low immunity, long-term use of antibiotics, autoimmune diseases, old age and frailty

Contagious

Non-contagious

Whether to enter health insurance

Yes

The main symptoms

Diarrhea, abdominal pain, mucus, pus and blood

Causes of Colon Ulcer

The causes of colon ulcers include:

1. Infectious enteritis, according to the pathogen can be divided into:

viral enteritis, bacterial enteritis, fungal enteritis, amoeba enteritis. Colonic ulcers caused by viral enteritis are more common in patients with low immunity, such as Cytomegalovirus (CMV) and Epstein-Barr virus infection.

Bacterial enteritis, including dysenteriae, Escherichia coli, salmonella, Campylobacter jejuni, Yersinia, etc. Long-term use of antibiotics is easy to be combined with Bacillus difficile infection and antibiotic-associated enteritis caused by other resistant bacteria.

Fungal enteritis, mainly caused by histoplasma, algal fungus, Aspergillus, Candida albicans, etc., more common Candida albicans, mainly occurs in patients with immune deficiency or immune damage.

Amoeba enteritis, etc.

2. Autoimmune-related diseases, including inflammatory bowel disease (IBD) such as Crohn's disease, ulcerative colitis, Behcet's diseae, and allergic purpura (Anaphylactoid purpura).

3. Ischemic bowel disease, intestinal wall ischemia, hypoxia, and infarction caused by mesenteric arteries, venous occlusion or stenosis, are more common in elderly patients with atherosclerosis and cardiac insufficiency.

4. Colon tumors.

5. Drug-induced enteritis is more common in taking NSAIDs, and there are cases of colon ulcer caused by taking weight-loss drugs ^[1] .

6. Radiation enteritis, intestinal complications caused by radiation therapy of pelvic, abdominal, and retroperitoneal malignancies, which can affect the small intestine, colon, and rectum. Endoscopy can be characterized by intestinal wall congestion and edema, ulcers, stenosis, perforation, and fistula.

Clinical manifestations of colon ulcer

The clinical manifestations can be different due to different causes. The main manifestations are: abdominal pain, diarrhea, mucus, pus and blood. According to the onset of the disease can be divided into acute and chronic, infectious, ischemic, drug-induced and other manifestations of acute onset, some diseases can repeatedly occur into chronic processes. Inflammatory bowel disease, Behcet's disease, and other diseases often have chronic onset and persist.

1. Most infectious diseases have a short course and an acute onset. They are mainly abdominal pain, diarrhea, mucus pus and blood, which can be up to 10 times per day. Abdominal cramps, combined with fever, chills and other systemic symptoms such as nausea, Vomiting, loss of appetite, etc. Some patients have a clear history of eating unclean food, long-term use of antibiotics, hormones, and immunosuppressants.

Pseudomembranous enterocolitis is mainly caused by Bacillus difficile. Diarrhea is the main symptom, and the degree and frequency of diarrhea vary. Lighter stools can be healed 2 to 3 times a day, and heal itself after stopping antibiotics. In severe cases, a large amount of watery diarrhea can be seen 30 times a day. Some patients can discharge plaque-like pseudomembrane. Often accompanied by abdominal pain, mostly in the lower abdomen, with dull, bloating or spasmodic pain, but also accompanied by abdominal distension, nausea, vomiting, fever, etc., severe and violent patients may appear water and electrolyte disorders, hypoproteinemia, moderate Toxicity and hypovolemic shock.

2. Many cases of inflammatory bowel disease have a long history, recurrent attacks, and a small number of patients have a rapid attack.

Ulcerative colitis is mainly caused by abdominal pain, diarrhea, mucus pus and blood, mostly with left lower quadrant tenderness, and the number of stools can be up to more than ten times / day. After severe urgency, defecation is not felt. Patients with severe ulcerative colitis may suffer from anemia due to anemia. Weakness, weight loss and fever.

Crohn's disease is mainly manifested by abdominal pain, abdominal mass, and weight loss. Abdominal pain is mostly located in the right lower abdomen. Peri-umbilical pain can occur in patients with small bowel disease. Some patients have symptoms such as diarrhea and constipation. The stool has mucus or blood. May have hypothermia, hypoproteinemia, and perianal lesions (anal fistula, perianal abscess) are common. Intestinal obstruction can occur due to intestinal stenosis, upper abdominal pain, upper abdominal pain, burning sensation, vomiting and other symptoms can occur, and some patients have perforation or intestinal fistula.

Crohn's disease and ulcerative colitis can appear extra-intestinal manifestations, bone disease is the most common off-site manifestations, including peripheral joint pain, osteomalacia, ankylosing spondylitis, sacral arthritis, the severity of which can be related to the gastrointestinal tract Symptoms related. Skin manifestations: nodular erythema, gangrenous pyoderma and so on. Eye damage: conjunctivitis, iritis, uveitis, etc. Kidney stones: Calcium oxalate stones are associated with CD fat malabsorption, and uric acid stones are associated with malnutrition. Other parenteral manifestations include: primary sclerosing cholangitis, thrombophlebitis, vascular embolism, peripheral neuropathy caused by vitamin B12 deficiency, oral ulcers, etc.

3. Behcet's disease mostly relapses with oral ulcers as the first symptom. About 60% of patients develop genital ulcers, and gastrointestinal damage accounts for 8.4% -27.5%, which can be caused by abdominal pain, diarrhea, constipation, blood in the stool, and perforation of ulcers. Sudden and severe abdominal pain, intestinal ulcers are more common in the ileocecal, transverse colon, and ascending colon, and a few can be found in the stomach and lower esophagus. The typical manifestation is a single or multiple round or quasi-circular ulcers with clear boundaries. In addition, Behcet's disease will also be accompanied by skin damage, eye lesions, and joints, large blood vessels in the heart, nerves, lungs, kidneys, testes and other multi-system lesions.

4. Skin purpura is most common in allergic purpura, with symmetrical distribution, which is more common in the lower extremities and hips. Abdominal pain occurs in 50% of patients. Intestinal mucosal purpura and deep ulcers can be seen under endoscopy. In severe cases, vomiting and gastrointestinal bleeding may be combined. Intestinal necrosis and intestinal perforation are rare.

5. The most common manifestation of ischemic bowel disease is sudden spastic pain in the left lower abdomen, accompanied by obvious infestation. In the next 24 hours, the blood in the stool is bright red or dark red, the blood and stool are mixed, and the amount of bleeding is not large. Blood transfusions are rarely required. Intestinal dysfunction due to intestinal ischemia can cause symptoms such as nausea, vomiting, belching, bloating, and diarrhea. With the progress of the disease course and the exacerbation of the lesion, the surface layer of the mucosa is necrotic and the ulcer forms. In severe cases, the entire intestinal wall is necrotic, which may even cause rupture of the intestinal wall, peritonitis, and shock. Those with a small infarct size may not penetrate the intestinal wall and localized fibrosis. Intestinal stenosis can be caused by scar formation after the lesion has healed.

6. Colon tumors, the main symptoms: changes in bowel habits or characteristics, abdominal pain, abdominal mass, intestinal obstruction, systemic symptoms including anemia, weight loss, low fever, fatigue, tumor metastasis may appear lumbosacral soreness, bloating.

7. Drug-induced enteritis, there is a clear history of drug use.

8. Radiation enteritis, see Encyclopedia entry for radiation enteritis.

Clinical diagnosis and differential diagnosis of colon ulcer

Diagnosis can be aided by medical history, laboratory tests, imaging CT or MRI.

Endoscopy is the main diagnostic criterion:

1. Most infectious enteritis is a segmental or continuous distribution of irregular deep ulcers, mainly circular ulcers.

Pseudomembrane enteritis often affects the left hemicolon, and the rectum can be disease-free. Endoscopic macroscopic observation: only mild mucosal congestion and edema, unclear blood vessel texture, and non-specific enteritis; milder cases can be seen with superficial erosion, pseudomembranous distribution and peripheral hyperemia; in severe cases, pseudomembranous patches Or map-like, the pseudomembrane is not easy to fall off, and ulcers can be seen in some of the falloff areas. Pseudomembrane is characteristic and has great significance for clinical diagnosis.

Intestinal tuberculosis is often combined with symptoms of low-temperature fever and night sweats in the afternoon. Endoscopic lesions are mainly in the ileocecal area. Endoscopic findings show that the intestinal mucosa is congested, edema, and ulcers are formed. Intestinal cavity becomes narrow and so on. A biopsy, if it can find caseous necrotizing granulomas or Mycobacterium tuberculosis, is of diagnostic significance.

2. Ulcerative colitis lesions are mostly confined to the rectum, sigmoid colon, or left semicolon. Patients with diffuse lesions spread from the rectum, sigmoid colon to the entire colon, showing a continuous distribution. Most of them are superficial ulcers, some are severe or have intestinal infections. Patients may present with deep ulcers.

Crohn's disease ulcers have a jumpy distribution, with ileocecal lesions predominantly affecting the entire digestive tract. Mild lesions are mostly point ulcers and ulcers. In moderate to severe patients, irregular deep ulcers are present after fusion of ulcers, which are mostly distributed vertically.

3. Behcet's disease intestinal ulcer is more common in the ileocecal, transverse and ascending colons, and a few can be found in the stomach and lower esophagus. The typical manifestation is a single or multiple round or quasi-circular ulcers with clear boundaries.

4. Radiation enteritis must have a history of tumor radiotherapy. A few days after irradiation, there will be acute and severe cases, mucus discharge, abdominal pain, etc., and there will be clinical intestinal dysfunction (constipation or diarrhea), abdominal pain of varying degrees in several weeks or even within six months. Rectal reactions such as blood in the stool, anal tingling, and falling pain in stool. Fiber enteroscopy: mucosal edema, congestion, bleeding, erosion, and even necrosis.

Differential diagnosis of colon ulcer

Differential diagnosis should be made based on medical history, laboratory test results, and endoscopic findings.

Colon Ulcer Treatment

1. Infectious enteritis needs to find the pathogen and carry out targeted anti-infective treatment.

The antibiotics of choice for Bacillus difficile infection are metronidazole, vancomycin, and fidaxomycin. Fecal microbiota transplantation (FMT) is more than 90% effective in treating Bacillus difficile infections, and has been included in the US clinical medical guidelines for the second relapse of antibiotic treatment ineffective for Bacillus difficile infections. the treatment. Other antibiotic-related diarrhea is also an effective indication for FMT treatment. At present, the "Chinese faeces bank" has carried out emergency rescue treatments for Clostridium difficile infections, antibiotic-related diarrhea, and refractory drug-resistant infections nationwide ^[2] .

2. The treatment of ulcerative colitis and Crohn's disease should be based on the severity of the disease and the location of the disease. Conventional treatment protocols include 5-ASAs preparations, hormones, immunosuppressive agents, biological agents and so on. FMT has also been proven by clinical studies to have good therapeutic value for inflammatory bowel disease. FMT treatment can be considered for patients with refractory inflammatory bowel disease that are ineffective in conventional treatment and hormone-dependent. Studies have reported that ingestion of swine whipworm eggs can induce clinical relief of ulcerative colitis and Crohn's disease. The mechanism may be related to the regulation of intestinal immunity, but more clinical studies are needed to confirm.

3. Colon ulcers caused by other reasons need targeted treatment according to different causes.