From the Guidelines
Ileocolitis treatment should prioritize supportive care, including hydration and pain management, alongside targeted antibiotic therapy, with the most recent and highest quality study recommending vancomycin 125 mg qid orally for 10 days for severe cases 1.
Key Considerations
- The treatment approach depends on the severity of the disease and the causative organism.
- For mild ileocolonic Crohn's disease, high-dose mesalazine (4 g/daily) may be sufficient as initial therapy 1.
- In cases of moderate to severe disease, or when mild to moderate disease fails to respond to oral mesalazine, oral corticosteroids such as prednisolone 40 mg daily are appropriate 1.
- For severe disease, intravenous steroids and metronidazole may be necessary 1.
- The role of surgery should be considered for those who have failed medical therapy or as primary therapy in selected cases 1.
Management Strategies
- Supportive Care: Adequate hydration, pain management with acetaminophen, and a temporary low-fiber diet can help reduce symptoms.
- Antibiotic Therapy: The choice of antibiotic depends on the causative organism, with vancomycin being recommended for severe cases of Clostridioides difficile infection 1.
- Immunosuppressive Therapy: May be necessary for patients with inflammatory bowel disease, with options including azathioprine, mercaptopurine, and biologics like infliximab 1.
- Surgical Intervention: Should be considered for complications such as perforation, abscess, or failure of medical therapy 1.
Diagnostic Approach
- Stool Tests: For infectious causes, including C. difficile toxin assay 1.
- Endoscopy: For direct visualization and biopsy to assess disease severity and rule out other causes 1.
- Imaging: CT scan or MRI to evaluate for complications such as abscess or perforation 1.
From the Research
Ileo Colitis Infection
- Ileo colitis infection can be caused by various factors, including Clostridioides difficile infection (CDI) 2, 3, 4.
- Patients with inflammatory bowel disease (IBD) are at increased risk of developing CDI, which can worsen the underlying IBD and increase the risk of treatment failure, hospitalization, and surgery 2, 3, 4.
- The clinical presentation of CDI in IBD patients can be atypical, and diagnosis may require a two-step approach to stool testing 2.
- Treatment of CDI in IBD patients typically involves oral vancomycin or fidaxomicin, and fecal microbiota transplant (FMT) may be considered for recurrent CDI 2, 4.
Diagnosis and Management
- Diagnosis of infectious colitis, including CDI, involves standard stool culture and multiplex polymerase chain reaction (PCR) followed by guided culture on PCR-positive pathogens 5, 6.
- Treatment of infectious colitis depends on the establishment of the cause, and most forms of infectious colitis are treatable with antimicrobials 5, 6.
- Patients with IBD and CDI may require escalation of immunosuppression and appropriate antimicrobial treatment to improve outcomes 2, 4.
Risk Factors and Complications
- Patients with colonic involvement of their IBD are at higher risk for CDI, and colonization may be more common than in the general population 2.
- CDI can complicate the course of IBD, leading to worsening of underlying IBD, increased risk of treatment failure, and higher rates of colectomy and death 3, 4.
- Recurrence of CDI is higher in IBD patients compared to non-IBD patients, and microbiota restoration therapies may be effective in preventing recurrent CDI in IBD patients 4.