Pancolitis, or extensive colitis, is a form of ulcerative colitis (UC) in which inflammation involves the entire large intestine (colon). This inflammation disrupts the function of the large intestine and causes ulcers on its lining. Symptoms include loss of appetite, abdominal pain, bloody diarrhea, rectal pain, and unwanted weight loss.
Between 14% and 35% of people with ulcerative colitis — a type of inflammatory bowel disease (IBD) — have pancolitis. Pancolitis and UC are different; UC can present as pancolitis, but not all cases of pancolitis are also UC.
Pancolitis is a chronic condition that requires lifelong treatment. Treatment methods include lifestyle modifications, medications, biological therapies, and, in some cases, surgery.
Symptoms of pancolitis usually come and go. You may experience periods of remission – when symptoms disappear for months or years – and periods when symptoms reappear, called flares or flare-ups.
Depending on the severity of the inflammation and ulceration (open sores) in your colon, the symptoms of pancolitis can range from mild to severe and may include:
- Frequent diarrhea, which may contain blood or mucus
- Abdominal pain and cramps
- Urgent need to have a bowel movement
- Feeling of incomplete bowel movement (tenesmus)
- Rectal pain
- Rectal bleeding or pus-like discharge
- Fatigue
- Unexpected weight loss
- Fever
- Night sweats
Some people with pancolitis have symptoms that affect other parts of the body outside of the gastrointestinal (GI) tract. These extraintestinal symptoms can develop due to systemic (body-wide) inflammation, which is common in people with pancolitis. These symptoms sometimes develop before bowel-related symptoms and are often a sign of an impending flare-up.
Extraintestinal symptoms include eye redness or pain, vision changes, joint pain, and swelling. People may also experience mouth sores, skin rashes, and painful ulcers.
Pancolitis develops when inflammation affects the entire large intestine (colon), from the rectum to the cecum (the beginning of the large intestine). The inflammation causes ulcers on the lining of the large intestine, leading to symptoms of pancolitis.
Researchers are still investigating what causes pancolitis, but several factors likely play a role in its development, including:
- Abnormal immune response: Pancolitis can develop when your immune system mistakenly attacks the lining of the colon (the protective lining). When a virus or bacteria causes an infection in the colon, your immune system releases immune cells to fight the infection, causing inflammation. The inflammation usually goes away after the infection clears. With UC, your immune system keeps sending immune cells into your colon, leading to chronic inflammation and ulcers.
- dysbiosis: The gut microbiome contains trillions of microorganisms, including bacteria, viruses and fungi, that play a role in digestive and immune function. Dysbiosis, an imbalance of these microorganisms, can contribute to colon inflammation and ulcerative colitis.
- Environmental triggers: Certain environmental factors, including air pollution, cigarette smoking, vitamin D deficiency, and stress, can contribute to the development of pancolitis.
- genetics: Certain inherited mutations (changes) in genes involved in the protective intestinal barrier and immune system function are associated with an increased risk of pancolitis.
Risk factors
Certain risk factors can increase your likelihood of developing pancolitis, including:
- Age: Pancolitis can develop at any age, but symptoms are likely to first appear during two peak periods: between the ages of 15 and 30 and between the ages of 50 and 70.
- Family history: Your risk of pancolitis increases by 1.6-30% if you have a first-degree relative, such as a parent or sibling, with inflammatory bowel disease.
- Ethnicity: People of all racial and ethnic groups can develop pancolitis, but people of Jewish descent have a higher risk than other ethnic groups.
- Lifestyle: Smoking, oral contraceptives, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), and a Western diet high in sugar, fat, and animal protein and low in fiber can increase your risk.
Diagnosing pancolitis involves a medical history, physical exam, and diagnostic tests to help identify inflammation in the colon and rule out other potential causes of your symptoms.
During a physical exam, your health care provider will check your vital signs, including your heart rate, body temperature, and blood pressure. They will press on your abdomen to check for tenderness and use a stethoscope to listen for sounds in your digestive tract.
Diagnostic tests can help rule out other possible causes of your symptoms, such as infection, and diagnose pancolitis. These tests include:
- Blood tests: A complete blood count (CBC) and other blood tests can check for signs of infection, evaluate for anemia, and measure markers of inflammation in the blood.
- Stool tests: Your doctor will ask you to take a stool sample and send it to a lab for testing to check for inflammatory markers in the stool.
- Colonoscopy: An endoscopy involves inserting a long, flexible tube with a light and camera into your anus, allowing healthcare professionals to look inside your colon and look for inflammation and ulcers.
- biopsy: During an endoscopy, your healthcare provider may take a small tissue sample (biopsy) of your colon and send it to a lab to be examined under a microscope.
The primary goal of pancolitis treatment is to achieve remission, a period when symptoms are minimal or absent. Treatment can also help manage symptoms, reduce the frequency and severity of attacks, and help prevent complications.
Medicines
Medications are the cornerstone of pancolitis treatment, helping to control inflammation and control symptoms. The medications your healthcare provider prescribes depend on the severity of the inflammation and how your body responds to treatment.
Medications to treat pancolitis include:
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- Aminosalicylates (5-ASA): Aminosalicylates target inflammation in the lining of the gastrointestinal tract to help achieve and maintain remission in people with mild to moderate pancolitis. 5-ASAs are available in oral or rectal forms, including enemas and suppositories.
- corticosteroids: These powerful anti-inflammatory drugs suppress the body’s immune response to reduce inflammation in people with moderate to severe pancolitis during flare-ups. Your doctor may prescribe oral corticosteroids or rectal foams, enemas, or suppositories to reduce inflammation in the rectum and colon.
- Immunosuppressants: When other treatments are ineffective or you often need corticosteroids to control attacks, your doctor may prescribe immunomodulators. These drugs work by suppressing the body’s immune response, reducing inflammation.
- biological drugs: Biological therapies suppress specific proteins involved in the inflammatory process. These drugs, such as Humira (adalimumab), Ustekinumab (Stelara), and Entivio (vedolizumab), require regular injections or intravenous (IV) infusions. They help reduce gut inflammation and promote healing.
- Targeted synthetic small molecules: These drugs, such as Rinvok (upadacitinib) and Zeposia (ozanimod), are oral medications that suppress certain parts of the immune system that cause inflammation of the gut. They can help prevent and reduce inflammation and promote intestinal healing in people with moderate to severe pancolitis.
Dietary changes
Dietary changes and a balanced diet are essential in the treatment of pancolitis. Certain foods can worsen or trigger symptoms, so it’s important to identify and avoid these triggers to avoid symptoms.
Intestinal inflammation and frequent diarrhea can lead to difficulty absorbing essential nutrients, putting people with pancolitis at risk of vitamin, mineral, and electrolyte deficiencies. A balanced, nutritious diet rich in fruits, vegetables and whole grains helps your body get the nutrients it needs.
Surgery
If medications are ineffective and your symptoms interfere with your quality of life, or if you develop complications, your doctor may recommend surgery. Up to one-third of people with pancolitis require surgery.
The type of surgery your healthcare provider recommends depends on the severity of the inflammation and damage to the bowel and your overall health. Two surgeries can help treat pancolitis:
- Proctocolectomy with ileal pouch-anal anastomosis: This procedure involves removing the colon and rectum, creating an internal pouch using the end of the small intestine (ileum) and connecting it to the anus. The internal pouch mimics the function of the colon and rectum, allowing the normal passage of stool through the anus.
- Proctocolectomy with end ileostomy: This procedure involves removal colon, rectum and anus and attaching the end of the small intestine (ileum) to the opening in your stomach (stoma). The stool passes through the ileum into a stoma bag that attaches to the stoma outside your body.
Unfortunately, there is currently no guaranteed way to prevent pancolitis. You can reduce your risk of developing the condition or reduce the frequency and severity of your symptoms through healthy lifestyle habits.
Make dietary changes
A diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats can help reduce gut inflammation and promote gut health. Limiting your intake of processed foods, red meat, full-fat dairy, and alcohol can also help reduce inflammation.
Manage stress
Chronic stress can cause or worsen the symptoms of pancolitis. Relaxation techniques, such as breathing exercises, yoga or mindfulness meditation, can help manage stress and improve general well-being.
Follow the treatment plan
If you have pancolitis, taking your medications as prescribed by your doctor and having routine checkups can help keep you in remission, prevent flare-ups, and catch potential problems early.
While pancolitis causes inflammation that affects the colon and rectum, people with this condition can also experience systemic inflammation (throughout the body) that causes other chronic conditions. Almost 44% of people with ulcerative colitis have another diagnosis due to shared inflammatory processes, genetic factors, or immune system dysfunction.
Common conditions include:
- ,Primary sclerosing cholangitis (PSC): This is a chronic liver disease in which inflammation causes scarring and narrowing of the bile ducts.
- Ankylosing spondylitis: This is a form of arthritis that primarily affects the spine, causing severe inflammation and pain.
- Colon cancer: Chronic inflammation from pancolitis increases the risk of developing colorectal cancer.
- Sacroiliitis: People with pancolitis are three times more likely than the general population to develop sacroiliitis, inflammation of the sacroiliac (SI) joint (where the spine meets the pelvis).
With unpredictable symptoms that disrupt your daily routine, living with pancolitis can take a toll on your physical and emotional well-being. Following treatment and focusing on healthy lifestyle choices, including eating a nutritious diet and managing stress, can help you achieve and maintain remission.
Talk to your healthcare provider if you have symptoms of pancolitis or have been diagnosed with it and notice your symptoms are getting worse. Many treatment options are available to help manage symptoms, promote remission, and help you live well.