From the Guidelines
For the treatment of ileocolitis, the most effective approach is to use high dose aminosalicylates, such as mesalazine 4g daily, as the initial therapy for mild disease, and oral corticosteroids, such as prednisolone 40mg daily, for moderate to severe disease or those who have failed to respond to mesalazine 1. The management of ileocolitis involves a range of therapeutic options, including:
- High dose mesalazine (4g daily) for mild ileocolonic disease
- Oral corticosteroids, such as prednisolone 40mg daily, for moderate to severe disease or those who have failed to respond to mesalazine
- Budesonide 9mg daily for patients with isolated ileo-caecal disease with moderate disease activity
- Intravenous steroids, such as hydrocortisone 400mg/day or methylprednisolone 60mg/day, for patients with severe disease
- Elemental or polymeric diets as an adjunctive therapy or for patients with contraindications to corticosteroid therapy The choice of treatment depends on the severity of the disease, patient response, and potential contraindications to certain therapies. In addition to these treatment options, it is essential to consider the potential for complications, such as infection, and to monitor patients closely for signs of worsening disease or treatment failure. Recent guidelines also emphasize the importance of considering differentials at the time of diagnosis and when there is an incomplete response to treatment or flare, including infection, proximal constipation, and co-existent irritable bowel syndrome 1. Furthermore, the management of immune-related adverse events, such as those associated with immune checkpoint inhibitor therapy, requires a comprehensive approach, including the use of corticosteroids, immunosuppressants, and supportive care 1. Overall, the treatment of ileocolitis requires a tailored approach, taking into account the individual patient's needs and the potential benefits and risks of different therapeutic options.
From the Research
Ileo Colitis Infection
- Ileo colitis is a type of infectious colitis that can be diagnosed based on symptoms such as diarrhea, fever, and dysentery, as well as laboratory tests including stool culture and endoscopy 2.
- The management of acute colitis, including ileo colitis, depends on establishing the cause of the infection, and most forms of infectious colitis are treatable with antimicrobials 3.
Causes and Diagnosis
- Ileo colitis can be caused by a range of pathogens, including Shigella, Salmonella, Campylobacter, Shiga toxin-producing Escherichia coli (STEC), and Clostridium difficile 2, 3.
- Diagnosis of ileo colitis typically involves standard stool culture, and epidemiologic findings such as prior international travel or living in parasite-endemic regions may suggest the need for specialized studies of etiology 2.
- Multiplex polymerase chain reaction (PCR) followed by guided culture on PCR-positive pathogens can often confirm active infection, while standard culture methods provide isolates for antibiotic susceptibility testing, subtyping, and Whole Genome Sequencing 3.
Treatment
- Pathogen-specific antimicrobial therapy should be initiated for all forms of infectious colitis other than STEC, and empiric treatment of febrile dysenteric diarrhea may involve suspicion of invasive bacterial enteropathogens such as Shigella, Salmonella, and Campylobacter 2.
- For Clostridium difficile infection, oral vancomycin is recommended for severe cases, while metronidazole is the standard of care for non-severe infection, although vancomycin-containing regimens may be more effective for patients with ulcerative colitis and non-severe CDI 4, 5, 6.
- The American College of Gastroenterology has issued clinical guidelines for the prevention, diagnosis, and treatment of Clostridioides difficile infections, which represent the official practice recommendations for managing adults with C. difficile infection 6.