From the Guidelines
For a patient with distal colitis identified on CT scan who presents with diarrhea, the next logical steps involve confirming the diagnosis and initiating appropriate treatment, starting with infectious cause exclusion and considering colonoscopy with biopsies as per the guidelines from the American Gastroenterological Association 1. The patient's symptoms should be graded according to the Common Terminology Criteria for Adverse Events (CTCAE) to determine the severity of colitis, with grade 1 being an increase of less than 4 bowel movements per day above baseline and mild increase in ostomy output compared with baseline, as outlined in the NCCN guidelines 1. While awaiting colonoscopy, obtain stool studies including culture, ova and parasites, Clostridioides difficile testing, and fecal calprotectin to rule out infectious causes, as recommended by the AGA guidelines 1. Blood tests should include complete blood count, comprehensive metabolic panel, C-reactive protein, and erythrocyte sedimentation rate to assess inflammation and rule out complications. For symptom management, consider supportive care with medications such as loperamide if infection has been ruled out, as suggested in the ASCO guideline update 1. The patient should be closely monitored by phone or electronic medical system for symptoms changes by clinical providers every 3 days or more frequently if needed until stabilized, and may obtain gastroenterology consult for prolonged cases and consider endoscopy with biopsies 1. Dietary modifications including avoiding trigger foods, maintaining hydration, and possibly following a low-residue diet during flares should also be recommended. Schedule a follow-up appointment within 2 weeks to assess response to therapy and review test results, allowing for proper diagnosis while providing symptomatic relief and addressing the underlying inflammation that causes distal colitis.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps for Patient with Distal Colitis
The patient presenting with diarrhea and distal colitis on computed tomography (CT) scan requires a thorough evaluation and treatment plan.
- The diagnosis of distal colitis should be confirmed, and the underlying cause of the colitis should be identified 2.
- If the patient has infectious colitis, standard stool culture should be performed, and epidemiologic findings should be considered to determine the need for specialized studies of etiology 2.
- For patients with distal ulcerative colitis, treatment options include corticosteroids, sulfasalazine, and mesalazine (5-aminosalicylic acid, mesalamine) 3.
- If the patient is suspected to have Clostridium difficile-associated diarrhea and colitis, diagnosis should be confirmed by detection of C. difficile toxin in stool, and treatment with oral metronidazole or vancomycin should be initiated 4, 5.
- Discontinuation of antibiotics may be enough to resolve symptoms in some cases, especially if the patient has been taking antibiotics recently 4, 5.
- In severe cases, such as fulminant colitis and toxic megacolon, subtotal colectomy may be required 4.
- The patient's treatment plan should be tailored to their specific needs and underlying condition, and should be guided by clinical data, laboratory stool studies, and endoscopy results 2, 3, 4, 5.