From the Research
Diversion colitis should be treated with restoration of intestinal continuity whenever possible, and for patients who cannot undergo reversal surgery, fecal microbiota transplantation (FMT) may be a promising treatment option, as suggested by the most recent study 1.
Treatment Options
The primary goal in managing diversion colitis is to restore intestinal continuity, allowing the normal fecal stream to flow through the diverted segment again. However, for patients who are not candidates for reversal surgery, several topical treatments can help manage symptoms. These include:
- Short-chain fatty acid (SCFA) enemas, which provide nutrients to the colonic mucosa, typically administered at 60-100mL twice daily for 2-4 weeks
- Mesalamine enemas (4g/60mL) once daily or hydrocortisone enemas (100mg/60mL) once daily for 2-4 weeks to reduce inflammation
- Fecal microbiota transplantation (FMT), which has emerged as a promising treatment for diversion colitis, with low medical costs, ease of use, and minimal side effects 1
Pathophysiology
Diversion colitis occurs due to the lack of exposure to short-chain fatty acids (SCFAs) normally produced by bacterial fermentation of dietary fiber, leading to nutritional deficiency of colonocytes and subsequent inflammation. The condition is characterized by mucosal inflammation in the defunctioned segment of the colon following a colostomy or ileostomy.
Clinical Presentation
Symptoms of diversion colitis can vary, but common presentations include tenesmus, rectal discharge, bleeding per rectum, and abdominal pain. Endoscopic features may include mucosal nodularity, erythema, and friability, while microscopic features are predominantly those of lymphoid follicular hyperplasia, aphthous ulceration, and chronic inflammatory changes.
Management
For asymptomatic patients, periodic endoscopic surveillance is recommended. For symptomatic patients, treatment with SCFA enemas, mesalamine enemas, or hydrocortisone enemas may be effective. In severe cases, systemic corticosteroids like prednisone may be necessary. FMT may become the first choice of treatment for some patients in the future due to its potential benefits and minimal side effects 1.