Summary about Disease
Indeterminate colitis (IC) is a form of inflammatory bowel disease (IBD) where the inflammation in the colon cannot be definitively classified as either ulcerative colitis (UC) or Crohn's disease (CD) after standard diagnostic tests, including endoscopy and biopsy. It represents a small percentage of IBD cases. Patients with IC have inflammation and symptoms similar to UC or CD, but the disease characteristics don't meet the diagnostic criteria for either specifically. Over time, some cases of IC may evolve into a clear diagnosis of UC or CD. Others remain indeterminate.
Symptoms
Symptoms of indeterminate colitis are similar to those seen in UC and CD, and may include:
Abdominal pain
Diarrhea (may be bloody)
Rectal bleeding
Urgency to defecate
Weight loss
Fatigue
Fever
Loss of appetite
Tenesmus (feeling of incomplete emptying after bowel movement)
Causes
The exact cause of indeterminate colitis is unknown. Like UC and CD, it is believed to be multifactorial, involving:
Genetic predisposition: Individuals with a family history of IBD are at higher risk.
Immune system dysfunction: The immune system inappropriately attacks the lining of the colon.
Environmental factors: These may include diet, exposure to certain microbes, smoking, and medications. The specific environmental triggers are not well defined.
Gut microbiome: Imbalances in the gut bacteria composition may contribute.
Medicine Used
Medical treatment for indeterminate colitis aims to reduce inflammation and control symptoms. Medications used may include:
Aminosalicylates (5-ASAs): Such as mesalamine, sulfasalazine; used to reduce inflammation in the colon.
Corticosteroids: Such as prednisone or budesonide; used for short-term relief of severe inflammation.
Immunomodulators: Such as azathioprine, 6-mercaptopurine, methotrexate; used to suppress the immune system and maintain remission.
Biologic therapies: Such as anti-TNF agents (infliximab, adalimumab, golimumab), anti-integrins (vedolizumab), or anti-IL-12/23 antibodies (ustekinumab); used to target specific parts of the immune system involved in inflammation.
Antibiotics: May be used if there are signs of bacterial infection or abscess.
Symptom management medications: Anti-diarrheal medications, pain relievers.
Is Communicable
Indeterminate colitis is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent getting indeterminate colitis, given its unknown cause. However, individuals with a family history of IBD should be aware of the potential risk and report any symptoms to their doctor. General health precautions, such as maintaining a balanced diet, managing stress, and avoiding smoking, may be beneficial for overall gut health.
How long does an outbreak last?
The duration of an outbreak (or flare-up) in indeterminate colitis can vary significantly from person to person. Some flares may be short-lived, lasting a few days or weeks, while others can persist for months. The length and severity of the outbreak depend on factors such as the extent of inflammation, response to treatment, and individual health. Remission periods (periods with no or minimal symptoms) can also vary in length.
How is it diagnosed?
Indeterminate colitis is diagnosed when the characteristics of the inflammation in the colon do not clearly fit the criteria for ulcerative colitis or Crohn's disease. Diagnostic methods include:
Colonoscopy with biopsies: A scope is inserted into the colon to visualize the lining and collect tissue samples for microscopic examination.
Imaging studies: Such as CT scans or MRI, to assess the extent of inflammation and rule out complications.
Blood tests: To check for inflammation markers (e.g., C-reactive protein, erythrocyte sedimentation rate), anemia, and other abnormalities.
Stool tests: To rule out infection and assess inflammation markers (e.g., fecal calprotectin).
Upper endoscopy: May be performed to evaluate the upper gastrointestinal tract. The diagnosis is often made after a period of observation and monitoring the disease course, as some cases may eventually evolve into a more definitive diagnosis of UC or CD.
Timeline of Symptoms
The timeline of symptoms in indeterminate colitis can vary.
Initial presentation: Symptoms may develop gradually over weeks or months, or may appear more suddenly.
Flare-ups: Periods of active symptoms (flare-ups) may be interspersed with periods of remission (few or no symptoms). The frequency and duration of flare-ups are unpredictable.
Disease progression: In some cases, the disease may remain relatively stable over time. In other cases, the inflammation may worsen, or the disease may evolve into a more definite diagnosis of UC or CD.
Important Considerations
Long-term monitoring: Regular follow-up with a gastroenterologist is crucial to monitor the disease course and adjust treatment as needed.
Risk of complications: Indeterminate colitis can increase the risk of complications such as toxic megacolon, bowel obstruction, and colorectal cancer.
Impact on quality of life: The symptoms of indeterminate colitis can significantly impact quality of life. Psychological support and stress management techniques may be beneficial.
Potential for reclassification: The diagnosis of indeterminate colitis may change over time as more information becomes available.
Surgical options: In severe cases where medical therapy fails, surgery (colectomy) may be considered.