COLITIS
Tips for Colitis Colitis is best managed when its cause is known and specific therapy can be instituted. When this is not possible, symptomatic management is often attempted. The following are therapeutic medications and strategies that can be helpful in the treatment of colitis. Metronidazole and Tylosin: These medications have anti-inflammatory properties in the large intestine as well as ability to kill harmful organisms. Sulfasalazine: This medication consists of a sulfa antibiotic bound to a salicylate anti-inflammatory. The sulfa bond protects the anti-inflammatory medication until it gets to the large intestine, thus saving the anti-inflammatory effect for the disease of the large intestine. This is an effective medication but is typically given three times a day, which is an inconvenience. Cats are sensitive to salicylates, thus this medication is primarily used in dogs. Dietary Fiber: The role of fiber in colitis is confusing as there is an assortment of fiber preparations (soluble fibers, insoluble fibers, and mixtures). In general, colitis is felt to be a fiber-responsive disease. Fibers are broken down into nutrients for colon cells and also for food for beneficial colon bacteria. Fructooligosaccharides (FOS): Some of the commercial therapeutic diets emphasize the addition of FOS to its formulation. FOS's are carbohydrates involving fructose (fruit sugar) units attached to glucose (starch sugar) units. Most carbohydrates are digested by the bacteria of the small intestine, leaving only the undigested fibers and other dregs for the teeming masses of the large intestine. FOS's are not fibers but they are digested in the large intestine (not the small intestine) in the same way that fibers are, yielding the same biochemicals that fibers do. Why is this good? Tests in healthy cats indicate that this will help remove pathogenic bacteria from the large intestine and promote the growth of helpful bacteria. Think of it as an anti-crime program in the New York City of bacteria. Diets that contain FOS's may be helpful in the management of colitis. Probiotics: A probiotic is a protected culture of live helpful bacteria that can colonize the patient's intestine. The bacteria must be protected from the acid of the stomach so as to survive to the lower intestine. Once there, the bacteria make a home and make by-products that are nourishing to the intestinal and local immune system cells. There are numerous products on the market for both humans and animals; the problem is that since these products are not regulated as drugs by the FDA, they are required only to be safe (not necessarily effective). In fact, a recent study found that most such products do not actually contain the live cultures they are advertised to contain. If you want to add a probiotic to a pet's regimen, we recommend sticking to well-established companies. Elimination Diet: Colitis can result from a food intolerance (an example would be lactose intolerance from which numerous people suffer). Intolerances can result from dyes, preservatives, contaminants or even natural proteins in the food. Similarly, colitis can result from an actual food allergy. The solution for these intolerances is the feeding a "pure" diet, ideally a home-cooked food made with carbohydrates and proteins that are novel or new to the patient. An 8 to 10 week diet course is typically needed and no other chews or treats can be eaten during the trial. Food allergy cannot be diagnosed by blood test or skin test. At this time, response to elimination diet is the only test for food allergy or intolerance. Most people are not in a position to home cook an appropriate food for their pet. Fortunately, several novel protein diets and hydrolyzed protein diets have been developed. For more details on using an elimination diet, please visit our food allergy page. Treating for Clostridium: Clostridial organisms are a group of anaerobic bacteria responsible for such unpleasant conditions as tetanus, botulism, and gangrene. There are Clostridial organisms that normally live in the large intestine but they do not cause any trouble unless some stressful event or diet change allows them to over grow. If there are a lot of them, the toxins they produce become significant and can cause colitis. (Think of these organisms as the criminal element in the New York City of colon bacteria. In the absence of opportunity for trouble, these bacteria behave themselves; however, when there is a blackout in the city, large scale looting occurs with these bad eggs leading the way.) The diagnosis of Clostridial disease is complicated. A fecal smear may show Clostridial organisms but that doesn't mean they are producing toxin. Further tests (the reverse passive latex antigen test and the ELISA test) may be needed but the accuracy of these tests is in dispute. Often a course of a Clostridium-killing antibiotic can be used as a test. Such antibiotics include: amoxicillin, tylosin, metronidazole (which has other colitis-helping properties as well), and clindamycin. Prednisone: Prednisone is the cornerstone of treatment for inflammatory bowel disease, which must be diagnosed by biopsy. Sometimes a trial course of this medication is suggested for colitis. Histiocytic Ulcerative Colitis: A Special Form of Colitis This condition is also called Boxer colitis because the Boxer breed seems predisposed. This form of colitis is particularly ulcerative and involves infiltration of the tender colon lining with cells called histiocytes. These cells are the cells that are normally called into the scene of inflammation relatively late so that they can absorb the dead cells and debris that have been created by the inflammatory event. Dogs with this condition typically show symptoms at an early age (less than 2 years) and become more debilitated than typical colitis patients. It is currently believed that this condition results from an inappropriate immune response against the common bacteria of the colon. Dogs with this form of colitis do not respond well to the usual remedies listed above but instead seem to show an excellent response to the antibiotic enrofloxacin. This antibiotic is particularly effective against gram negative bacteria (so classified because their cell wall's staining properties when tested). It has thus been inferred that these bacteria are at the root of the problem. |
