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   Diameters of the colon

Colonic ulcer can occur at any age, in children however they are rare. Colonic Ulcers are ulcers or sores on the lining of your large intestine. They’re appearance can vary based on multiple irregular shapes but most tend to appear as a red ring that is inflamed tissue. There are multiple causes of Colonic Ulcers but one of the most seen causes is related to Nonsteroidal Anti-Inflammatory Drugs that cause inflammation and ulcerations in the intestine . Some of these NASID ulcers are found in the cecum, ascending colon, and possibly the rectum. Colonic Ulcers can still have a variety of unknown symptoms but some of the most common would be related to lower digestive bleeding also known as Hematochezia, diarrhea, anorexia, lower abdominal pain, etc. Colonic Ulcers are directly related to Isolated Colonic Ulcers but are also related to multiple intestinal inflammatory diseases like Ulcerative Colitis or Crohn’s Disease.

Signs and Symptoms

Signs and Symptoms of Colonic Ulcers can vary depending on the stage they are in. It is possible that some ulcers that go undetected may possibly burst or cause gut perforations due to possible blockages that result from the soreness and inflammation in the intestine. Some common symptoms of Colonic Ulcers would be:

• lower abdominal pain which may be confused with acute appendicitis

• diarrhea
• bloody stool
• rectal pain
• weight loss
• fever
• nausea
• muscle tenderness in the lower abdomen

These symptoms can be related to Colonic Ulcers as well as other similar intestinal inflammatory diseases like Ulcerative Colitis or Crohn’s Disease.

Cause

The main and most common cause of Colonic Ulcers has to do with the usage of Nonsteroidal Anti-Inflammatory Drugs. These drugs are known to have gastrointestinal side effects that lead to Inflammations, Ulcerations, and sometimes Strictures. They block the Cox-1 enzyme and disrupt the production of prostaglandins in the stomach which leads to the ulcers formation and bleeding. Besides NAIDs being the most common causes, there are still multiple unknown causes that lead to Colonic Ulcers.

More research is still being conducted to determine the exact causes like stress induced release of the body's natural steroids. Some research has lead to some generalizations about Colonic Ulcers in horses being caused by Parasitic Migration, Infectious disease, Infiltrative disease and Neoplasia.

Colonic Ulcers are also known to cause other diseases that are related to inflamed intestines like Ulcerative Colitis or Crohn’s Disease.

Mechanism/Pathophysiology

The most common cause known as of today for Colonic Ulcers is related to the NSAIDs. They are well known for their ability to cause gastrointestinal side effects through numerous mechanisms, both systemic by inhibition of prostaglandin synthesis and uncoupling mitochondrial phosphorylation, and also topical by disrupting the epithelial cell barrier due to their weak acid characteristic. NSAIDs colopathy is a frequently unsuspected cause of lower gastrointestinal bleeding, mostly characterized by inflammatory changes, solitary or multiple ulcers, diaphragm-like strictures, ischemic colitis, and eosinophilic colitis after prolonged use of NSAIDs. Although, the majority of mucosal changes can be found in the right colon, all segments are likely to be affected. The prevalence of NSAID-related colon pathology is rising because of the increasing use of NSAIDs, and also due to the increasing use of enteric coated and slow release formulas, which may result in more of the active drug being delivered to the colon.

Diagnosis

Diagnosing the Colonic Ulcers can be a little tricky. Some standard tests can be conducted with the patient in relation to any recurrent colic episodes, intermittent diarrhea, loss of performance, weight loss, changes in blood work (mild anemia, toxic changes in white blood cells, and a high number of white blood cells, low blood proteins and high inflammatory proteins, and low calcium). These simple tests can be used to determine the patients probability of having an ulcer but it will be tough to use these findings to narrow it down to specifically a Colonic Ulcer. Using family history and background can possibly help to see if the patient has any inherited genes to determine their potential chances of obtaining an ulcer, but again it is not enough information to diagnose the patient with Colonic Ulcer. The best test to diagnose Colonic Ulcers would be a colonoscopy with multiple biopsies which usually show nonspecific signs of both acute and chronic inflammation.

Prevention/Treatment

If a patient is diagnosed with Colonic Ulcers, the first step would be to stop the consumption of any NSAIDs if being consumed. The next step on how to treat the ulcer would depend on what stage the ulcer is at. If the ulcer is highly inflamed that shows to be bleeding, perforated, abscess formation, or which have failed to heal on endoscopic examination, a surgical procedure must be conducted to remove the ulcer because if it is left and attempted to be treated with medications, there is a high possibility that it can rupture and lead to patient death. Once it has been surgically removed, the patient should be monitored after a two week, one month, and six month period to confirm the ulcer and any other harmful tissue in relation is gone and the patient is healthy. For patients with uncomplicated ulcers or one that are detected in any early stage, they should be managed conservatively with colonoscopy follow-up every 4-6 weeks and each time multiple biopsies should be taken to ensure healing, and exclude malignancy and infection. They should also be prescribed medications like Mesalazine that belong to a group of medications known as aminosalicylates help decrease the inflammation on the targeted spot. For both scenarios regardless of the ulcer being complicated or uncomplicated, the patient should restrain themselves from any stress or physically straining activities and should drink consistent amounts of water throughout the day, eat smaller meals, and avoid high fiber or fatty foods.

Prognosis

Depending on when the Colonic Ulcer is found and diagnosed, life expectancy can vary. In most cases when the ulcer is uncomplicated and diagnosed on time, the patient is expected to live a long and healthy life. Depending on the state of the ulcer, more than 50% of the time, the patient is expected to live a long healthy life with no problems in the future after proper treatment. In very rare instances, when the ulcer is complicated and has perforated the organ or has bursted, the  patient's life is critical and may lead to an early death.

Epidemiology

Due to lack of enough experience and knowledge about Colonic Ulcers, epidemiology and etiology are still unknown to a certain extent. Coming across Colonic Ulcers are not as common as other ulcers which is why it is hard to diagnose given that there are multiple types of ulcers. There are multiple theories or mechanisms that have been stated but none have had enough success with proper information to be claimed true. No information or experience has been released to determine certain statistics in regards to Colonic Ulcers being related to gender, ethnicity, or age. Currently, it is assumed that Colonic Ulcers can occur at any age. As of 2015, CDC was able to release an estimate of 1.3% of US adults, which is 3 million, were diagnosed with an inflammatory Bowel Disease Prevalence with an age of 20 years old or above. We need to keep in mind that this statistic is provided regarding all types of bowel ulcers and not just Colonic Ulcers. In order to establish statistics involving Colonic Ulcers, more research and exposure to the condition is required at this time.

Research Directions

Not much research has been conducted to make official claims about Colonic Ulcers and their official causes, symptoms, and occurrence stats. Based on the cases that have been seen and diagnosed, certain conclusions have been made like NSAIDs being one of the causes for Colonic Ulcers but it is not determined to be the only cause because of the lack of exposure to cases. Inorder for us to make official claims and be more equipped to handle cases of Colonic Ulcers, more research needs to be conducted regarding the genetic makeup of the inflammations and the different types of ulcers that are formed and they must be compared to the more common ulcers that we know today which are Ulcerative Colitis or Crohn’s Disease. More blood tests need to be conducted to test for any relations with other diseases or ulcers. Currently no clinical trials are being conducted to the lack of patients that have been diagnosed with Colonic Ulcers.

See also

• Large intestine

References

1. RINJA, E., ILIE, M., SANDRU, V., DIACONU, I., PLOTOGEA, O., HORTOPAN, A., OPRITA, R., CHIOTOROIU, A. L., & CONSTANTINESCU, G. (2018). A rare case of multiple colonic ulcers revealed by hematochezia. Romanian Journal of Medical Practice, 13(3), 214–216.
2. (LSU), L. S. (n.d.). Louisiana State University. Retrieved from https://www.lsu.edu/vetmed/ehsp/horse_health/lsu_tips/colonic_ulcers.php
3. Andrews, F. M. (2006). Diagnosis, treatment of colonic ulceration. DVM: The Newsmagazine of Veterinary Medicine, 37(4), 1E–5E.
4. Bhettani, M. K., Rehman, M., Altaf, H. N., & Ahmed, S. M. (2019, July 27). Isolated Nonspecific Colonic Ulcer: A Case Report From a Tertiary Care Hospital in Pakistan. Retrieved from https://www.cureus.com/articles/21504-isolated-nonspecific-colonic-ulcer-a-case-report-from-a-tertiary-care-hospital-in-pakistan
5. "What to Know If You Have Ulcerative Colitis". Healthline. 2020-10-16. Retrieved 2020-11-11.
6. "Data and Statistics". www.cdc.gov. 2020-08-18. Retrieved 2020-11-11.
7. "Ulcers". Wake Gastroenterology. Retrieved 2020-11-11.
8. "Colon Erosions: Ulcers With Many Causes". WebMD. Retrieved 2020-11-11.

Further reading

• Maire, F.; Cellier, C.; Cervoni, J. P.; Danel, C.; Barbier, J. P.; Landi, B. (November 1998). "[Dieulafoy colonic ulcer. A rare cause of lower gastrointestinal hemorrhage]". Gastroenterologie Clinique et Biologique. 22 (11): 958–960. ISSN 0399-8320. PMID 9881274.

Category:Abdominal pain

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