From the Research
The primary treatment for transverse colon diversion colitis is restoration of intestinal continuity through surgical reanastomosis, which resolves symptoms in most patients by restoring normal fecal flow to the diverted segment. When surgical reconnection is not feasible, topical treatments can be administered through the distal stoma or rectum, including short-chain fatty acid (SCFA) enemas or 5-aminosalicylic acid (5-ASA) enemas, as suggested by 1. These provide the diverted colon with nutrients and anti-inflammatory agents it normally receives from fecal matter. For patients with severe symptoms, topical corticosteroid enemas may be used for short courses. Oral probiotics containing Lactobacillus and Bifidobacterium species may help restore normal flora. The underlying mechanism of diversion colitis involves lack of SCFAs and altered microbiota in the diverted segment, leading to inflammation, so treatments aim to either restore normal flow or artificially provide the missing nutrients and anti-inflammatory support.
Some key points to consider in the treatment of diversion colitis include:
- Restoration of intestinal continuity is the primary treatment, as it resolves symptoms in most patients 2
- Topical treatments such as SCFA enemas or 5-ASA enemas can be effective in managing symptoms when surgical reconnection is not feasible 1
- Oral probiotics and regular irrigation of the diverted segment with normal saline may also provide symptom relief 3
- The choice of treatment should be individualized based on patient factors, disease severity, and surgical risk.
It's worth noting that while older studies such as 4 and 5 provide some insight into the treatment of diversion colitis, the most recent and highest quality study 1 suggests that restoration of intestinal continuity and topical treatments remain the primary approaches to management. Additionally, the use of fecal microbiota transplantation (FMT) is emerging as a potential treatment option, although more research is needed to fully understand its efficacy and safety in this context.