Pancolitis

Descripción general

Pancolitis is a form of ulcerative colitis in which inflammation affects the entire colon. Ulcerative colitis is a chronic inflammatory bowel disease that causes inflammation in the lining of the colon and rectum. It usually starts in the rectum and can extend through part or all of the colon. Pancolitis also may be called ulcerative pancolitis, pan-ulcerative colitis or extensive colitis. The name describes the extent of ulcerative colitis, not a separate disease.

The term pancolitis also can describe inflammation throughout the colon caused by conditions other than ulcerative colitis. These can include Crohn's disease, infections such as C. difficile and graft-versus-host disease. Causes also can include reduced blood flow to the colon and the effects of certain medicines or radiation treatment.

The exact cause of ulcerative colitis is not known. Genes, the immune system, bacteria in the gut and environmental factors all may play a role.

Ulcerative colitis often has periods when symptoms get worse, called flare-ups or flares, and periods when symptoms improve or go away, called remission. Medicines can reduce inflammation and help keep the disease in remission. Surgery to remove the colon and rectum may be needed in some situations.

Pancolitis can be mild, moderate or severe. Having inflammation throughout the colon does not by itself mean the disease is severe. To understand how severe the disease is, healthcare professionals consider symptoms, the amount of inflammation and how the disease affects daily life.

Types of ulcerative colitis

Ulcerative colitis often is described by how much of the colon is inflamed:

• Ulcerative proctitis affects only the rectum, the last part of the large intestine.
• Left-sided colitis affects the rectum and the left side of the colon.
• Pancolitis affects the entire colon.

Síntomas

Symptoms of pancolitis can vary depending on how active the inflammation is. Some people have mild symptoms, while others have more frequent or severe symptoms during a flare.

Common symptoms of pancolitis include:

• Loose stools, also called diarrhea.
• Blood or mucus in the stool.
• A sudden need to have a bowel movement.
• Frequent bowel movements.
• Stomach pain or cramping.
• Feeling as though you still need to have a bowel movement after using the bathroom.
• Bowel movements during the night.
• Fatigue.
• Weight loss.
• Fever, especially with more severe inflammation.

Pancolitis flare-ups

A flare is a period when ulcerative colitis becomes active and symptoms worsen. During a pancolitis flare, diarrhea may become more frequent, and stools may contain blood or mucus. Stomach pain or cramping, urgency, and fatigue also may increase. More severe flares can cause fever, dehydration, weight loss and frequent bloody stools.

How a flare is managed depends on how severe it is and which treatments you are already using. The healthcare team may review your symptoms and use blood tests, stool tests or imaging, such as a CT scan, to check for inflammation. Sometimes, the colon also may be examined. Treatment may include starting a new medicine or changing a medicine you already take. Severe flares may need treatment in a hospital.

When to seek care

See a healthcare professional if you have ongoing changes in your bowel habits or symptoms such as:

• Belly pain.
• Blood in the stool.
• Diarrhea that does not improve.
• Diarrhea that wakes you from sleep.
• An unexplained fever.

If you have already been diagnosed with pancolitis, contact your healthcare team if your symptoms suddenly become much worse or you have heavy bleeding, severe belly pain or signs of dehydration. Severe ulcerative colitis can cause life-threatening complications.

Causas

The exact cause of pancolitis and other forms of ulcerative colitis is not known. Researchers think several factors may work together, including genes, the immune system, the gut microbiome and environmental exposures. Some genes can raise the risk of ulcerative colitis, but genes alone do not determine who develops the disease.

Ulcerative colitis is an immune-mediated condition. This means the immune system contributes to ongoing inflammation in the colon. It is not clear why this immune response develops in some people.

Stress does not cause ulcerative colitis. But stress may make symptoms worse. Some research suggests that people with ulcerative colitis who feel more stressed may be more likely to have a flare, although it is not clear whether stress directly increases inflammation in the colon.

Factores de riesgo

There are no known risk factors that specifically predict who will develop pancolitis rather than another form of ulcerative colitis. Risk factors are generally described for ulcerative colitis as a whole.

Factors linked with a higher chance of developing ulcerative colitis include:

• Genetics. Many gene changes have been linked with ulcerative colitis and other forms of inflammatory bowel disease, although genes alone do not determine who develops ulcerative colitis.
• Age. Ulcerative colitis can begin at any age, but it is most often diagnosed in younger adults.
• Environmental factors. Researchers have identified several environmental factors that may affect the risk of ulcerative colitis, but their exact roles are still being studied.

Complicaciones

Pancolitis can cause complications, especially during a severe flare-up or when inflammation has been present for many years. Possible complications include:

• Heavy bleeding from the colon.
• Anemia, which means the blood does not carry enough oxygen to the body.
• Dehydration from frequent diarrhea.
• A severely swollen colon, called toxic megacolon.
• A hole or tear in the colon.
• Blood clots.
• Inflammation outside the colon, such as in the joints, skin or eyes.
• Liver and bile duct conditions.

Colon cancer

Having ulcerative colitis that affects a large part of the colon raises the risk of colorectal cancer. The risk rises the longer a person has the disease and when inflammation remains active over time. People with pancolitis have a higher risk of colorectal cancer than people whose ulcerative colitis affects only a small part of the colon.