Diagnosing colitis involves a systematic approach by medical professionals to identify the underlying cause of the inflammation and tailor appropriate treatment. The diagnostic process typically includes the following steps:

1. Detailed Medical History and Physical Examination:The diagnostic journey begins with a thorough medical history and physical examination. The healthcare provider will inquire about the patient’s symptoms, including the onset, duration, and severity of abdominal pain, diarrhoea, and any presence of blood in the stool. They will also ask about other relevant factors, such as recent travel, dietary habits, medication use, and family history of gastrointestinal diseases. During the physical examination, the doctor will check for abdominal tenderness, distension, and any signs of systemic illness, such as fever or weight loss.

2. Laboratory Tests:Several laboratory tests are performed to support the diagnosis of colitis. A complete blood count (CBC) can reveal signs of infection or inflammation, such as an elevated white blood cell count or anaemia. Stool samples are analysed for the presence of pathogens (bacteria, viruses, or parasites), blood, and inflammatory markers like calprotectin or lactoferrin, which can indicate inflammation in the gastrointestinal tract. Additionally, blood tests may include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to assess the level of systemic inflammation.

3. Imaging Studies:Imaging techniques are often utilised to visualise the colon and detect abnormalities. An abdominal X-ray can identify signs of obstruction or perforation, while more detailed imaging, such as a CT scan or MRI, can provide comprehensive views of the bowel and surrounding tissues. These imaging studies help to identify areas of inflammation, thickening of the bowel wall, and other structural abnormalities that may suggest colitis.

4. Endoscopic Procedures: Endoscopy is a crucial tool in the diagnosis of colitis. Colonoscopy, which involves inserting a flexible tube with a camera into the colon, allows direct visualisation of the entire colon and the distal part of the small intestine. During a colonoscopy, the gastroenterologist can observe inflammation, ulcerations, and other pathological changes in the mucosal lining. Biopsies (tissue samples) are often taken during the procedure to be analysed under a microscope, providing definitive information about the type and extent of inflammation. In some cases, a sigmoidoscopy, which examines only the lower part of the colon, may be sufficient for diagnosis.

5. Specialised Tests:Depending on the clinical presentation and initial findings, additional specialised tests may be required. For instance, serological tests for specific antibodies (such as pANCA and ASCA) can help differentiate between types of inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease. Capsule endoscopy, where the patient swallows a small capsule with a camera, may be used to examine the small intestine more thoroughly if Crohn’s disease is suspected.

By combining information from the medical history, physical examination, laboratory tests, imaging studies, and endoscopic findings, healthcare professionals can accurately diagnose colitis and determine its underlying cause.

Treating colitis involves a multifaceted approach tailored to the specific type and severity of the condition, as well as the individual patient’s needs. Here’s an overview of how colitis treatment is typically managed by medical professionals:

1. Medication:The cornerstone of colitis treatment is medication aimed at reducing inflammation, controlling symptoms, and achieving and maintaining remission. Common medications include:

• Aminosalicylates (5-ASAs):These anti-inflammatory drugs, such as mesalamine, are often used as first-line treatments for mild to moderate ulcerative colitis. They can be administered orally or rectally, depending on the location of the inflammation.
• Corticosteroids:For moderate to severe colitis, corticosteroids like prednisone can help rapidly reduce inflammation. However, due to their side effects, they are generally used for short-term flares rather than long-term management.
  
• Immunomodulators:Medications like azathioprine and methotrexate help suppress the immune system to reduce inflammation. These are often used for patients who do not respond to 5-ASAs or who require long-term therapy to maintain remission.
  
• Biologics:Biologic therapies, such as infliximab and adalimumab, target specific components of the immune system. These drugs are typically reserved for moderate to severe cases and those who do not respond to conventional therapies.
  
• Antibiotics:</ In cases of infectious colitis or when secondary infections are suspected, antibiotics may be prescribed to target the specific pathogens.
  

2. Diet and Lifestyle Modifications: While there is no specific diet that cures colitis, dietary modifications can help manage symptoms. Patients are often advised to avoid foods that exacerbate symptoms, such as high-fibre foods, dairy products, and spicy foods. A dietitian can help develop a personalised nutrition plan. Stress management techniques and regular exercise are also recommended as they can improve overall well-being and help reduce the frequency of flare-ups.

3. Surgical Intervention:In severe cases or when medical management fails, surgery may be necessary. For ulcerative colitis, a common surgical procedure is a colectomy, which involves removing the colon and rectum. This can be followed by the creation of an ileoanal pouch (J-pouch) to restore bowel function. Crohn’s disease surgery typically involves resecting the affected portions of the intestine. Surgical options are considered based on the specific complications and the patient’s overall health.

4. Supportive Care and Monitoring: Regular follow-up appointments are essential to monitor the disease’s progression and adjust treatments as needed. Blood tests, stool tests, and periodic endoscopic evaluations help assess the effectiveness of the treatment and detect any complications early. Psychological support, including counselling and support groups, can also play a crucial role in managing the emotional and psychological aspects of living with a chronic condition like colitis.

5. Complementary and Alternative Therapies: Some patients find relief with complementary therapies such as probiotics, acupuncture, and herbal supplements. While these should not replace conventional treatments, they can be integrated into the treatment plan with a healthcare provider’s guidance.

BThe goal of colitis treatment is to induce and maintain remission, minimise symptoms, and improve the quality of life.