From the Guidelines
Steroid-induced colitis, also known as stercoral colitis, is a serious inflammatory condition of the colon that requires immediate medical attention, and treatment involves administering corticosteroids, such as prednisone 1-2 mg/kg/day, until symptoms improve, and then tapering over 4-6 weeks, as recommended by the most recent guidelines 1.
Diagnosis and Treatment
The diagnosis of steroid-induced colitis is based on clinical presentation, endoscopic evaluation, and laboratory tests, including stool tests for inflammatory markers and imaging studies to rule out other complications.
- The treatment approach depends on the severity of the condition, which can be classified as mild, moderate, or severe, based on the number of stools per day, presence of blood, and systemic symptoms such as fever and abdominal pain.
- For mild to moderate cases, treatment with corticosteroids, such as prednisone, is often effective, and the dose can be tapered over 4-6 weeks once symptoms improve.
- For severe cases, hospitalization may be necessary, and treatment with intravenous corticosteroids, such as methylprednisolone, may be required, along with supportive care, including intravenous fluids and broad-spectrum antibiotics.
- In cases where there is no response to corticosteroids, or in patients with high-risk endoscopic features, biologic agents, such as infliximab or vedolizumab, may be considered as second-line therapy, as recommended by recent guidelines 1.
Prevention and Management
Prevention of steroid-induced colitis involves maintaining regular bowel movements, adequate hydration, and a balanced diet, as well as prompt treatment of constipation and other gastrointestinal symptoms.
- Patients with a history of steroid-induced colitis require vigilant follow-up to prevent recurrence, and early recognition and intervention are crucial to prevent life-threatening complications.
- The management of steroid-induced colitis requires a multidisciplinary approach, involving gastroenterologists, surgeons, and other healthcare professionals, to ensure optimal care and prevent complications, as recommended by recent guidelines 1.
Recent Guidelines and Recommendations
Recent guidelines and recommendations emphasize the importance of early recognition and treatment of steroid-induced colitis, as well as the need for a multidisciplinary approach to management, and highlight the role of biologic agents as second-line therapy in cases where there is no response to corticosteroids, as recommended by the American Gastroenterological Association and other professional organizations 1.
From the Research
Diagnosis of Stercoral Colitis
- Stercoral colitis is a rare but serious diagnosis associated with a high rate of morbidity 2
- The condition is characterized by the accumulation of impacted stool, leading to bowel ulceration, ischemia, perforation, peritonitis, and sepsis 2, 3
- Diagnosis can be secured with cross-sectional radiography, including computed tomography (CT) of the abdomen and pelvis 2, 4
- CT findings may include fecaloma, colonic dilatation, and fat stranding 4, 5
Treatment of Stercoral Colitis
- Emergency department (ED) management includes fluid resuscitation, initiation of a multimodal bowel regimen, and if indicated, initiation of parenteral antibiotics and consultation with a surgical specialist 2
- Treatment depends on the severity of illness, ranging from manual disimpaction and other conservative measures for most cases, to surgical intervention for complicated cases, such as stercoral perforation 4, 5
- Prompt resuscitation and surgical exploration with damage control surgery are recommended for cases with bowel ischemia 5
- Admission to the hospital should be considered for all patients with stercoral colitis 2
Complications and Outcomes
- Stercoral colitis can be complicated by ischemic colitis, stercoral ulcer formation, and subsequent perforation 3
- Patients with stercoral colitis often present in a nonspecific manner, and short-term mortality is substantial 6
- The most common CT findings include fecal impaction, bowel wall inflammation, and fat stranding 6
- Surgical management may be required for related complications, and patients may experience adverse outcomes, including death 6