What to know about enterocolitis

There are several different types of enterocolitis, with each having distinct symptoms and causes.

Necrotizing enterocolitis

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Necrotizing enterocolitis occurs when tissue death in the intestinal lining accompanies the inflammation. The condition is most common in premature newborns or infants who become ill.

Doctors do not yet understand the cause of necrotizing enterocolitis. Some suggest that premature babies have an undeveloped immune system and are more prone to bacterial attack. Excess bacteria in the intestines appear to make the problem worse.

Other theories suggest that a loss of blood flow or oxygen to the bowels causes the original inflammation that bacterial infection then worsens.

Some believe that in overfeeding an infant, a parent places too much bacteria in their intestines before they are ready for it, leading to enterocolitis.

Symptoms of necrotizing enterocolitis include:

• a bloated, swollen, or discolored abdomen
• bloody stools
• diarrhea
• vomiting

The infant may also not eat correctly or want food at all. Necrotizing enterocolitis may also produce symptoms of bacterial infection, such as:

• fever
• disrupted breathing
• extreme tiredness

Necrotizing enterocolitis can be fatal without treatment. People should seek immediate medical treatment for a baby with necrotizing enterocolitis.

Antibiotic associated enterocolitis

It is also possible for symptoms of enterocolitis to develop after a course of antibiotics.

In a healthy person’s intestines, bacteria fight for a place on the intestinal wall, where they help break down and digest foods. When a person takes antibiotics, most of these bacteria die.

This leaves a perfect environment for more harmful bacteria, such as Clostridium difficile (C.difficile) to cause an infection.

As C. difficile bacteria spread, they release toxins into the body. These toxins damage and inflame the inner wall of the intestines and cause symptoms, including:

• cramps and bloating
• the urge to use the bathroom more frequently
• watery diarrhea
• fever
• tiredness
• a general ill feeling or malaise
• severe stomach pain

This type of enterocolitis may also progress into another form that doctors call pseudomembranous enterocolitis.

Pseudomembranous enterocolitis

Pseudomembranous enterocolitis involves inflammation in the lining of the bowel as well as the intestines.

It typically occurs due to a bacterial infection and after a person takes antibiotics. This link means that many people with pseudomembranous enterocolitis probably also had antibiotic associated enterocolitis. However, this is not always the case.

Specific symptoms of pseudomembranous enterocolitis include:

· persistent, watery diarrhea with a particularly foul smell

· fever

· painful cramping

This form of enterocolitis also leads to collections of white blood cells, mucus, and the release of proteins from the intestinal wall. These materials are visible during a bowel movement upon inspection of the stool.

Hemorrhagic enterocolitis

Hemorrhagic enterocolitis is another type of inflammation that occurs due to a bacterial infection. Certain strains of the Escheria coli (E. coli) bacterium infect the intestines, producing a toxin that causes problems in the body.

Hemorrhagic enterocolitis typically leads to severe cramps and watery, bloody diarrhea. Some people may also experience a fever.

Hemorrhagic enterocolitis can pose a severe risk if a person does not receive treatment. If bacteria enter the bloodstream, the infection may spread to and damage other organs.

In severe cases, people may develop a disease called hemolytic-uremic syndrome. This disease puts them at risk for other conditions, such as kidney failure, nerve damage, and stroke.

Find out more about E. coli here.

The symptoms of enterocolitis may vary, depending on the individual and the type of enterocolitis.

Enterocolitis affects the lower end of the digestive system, and all forms of the disease share some symptoms.

Some of the most common symptoms are:

• fever
• swelling near the stomach
• nausea
• vomiting
• diarrhea
• tiredness
• a general feeling of being unwell

Some people with particular types of enterocolitis may experience additional symptoms, such as rectal bleeding.

It can take several different tests to diagnose enterocolitis. A doctor will take down a person’s medical history and give them a physical exam.

The doctor is likely to order various tests, such as:

• a complete blood count (CBC) test
• a blood culture test
• a stool sample

Inspecting the stool helps doctors rule out pseudomembranous colitis or other types of enterocolitis that stem from severe infection.

In some cases, doctors will order imaging tests, such as CT or MRI scans. These images can highlight signs of inflammation in the intestines and show other markers of the disorder.

Ultrasounds are also useful for diagnosing enterocolitis in many people. An abdominal ultrasound allows doctors to see if the walls of the colon have thickened or if the intestines have dilated or filled with fluid.

Each type of enterocolitis requires different treatment and considerations. After a diagnosis of enterocolitis, a doctor will discuss the options.

Treatment options can vary between people and largely depend on the type of enterocolitis and how far it has progressed.

Many people will need to go to the hospital for treatment, and so doctors can monitor their progress. The individual may receive intravenous fluids through a vein if they are losing too much liquid in their diarrhea. Others may require blood or platelet transfusions.

In people with recurrent enterocolitis, doctors may perform fecal microbial transplantation (FMT). In this procedure, they replace disrupted gut microorganisms with live bacteria from a healthy donor.

However, FMT carries a risk of severe infection.

In 2019, the Food and Drug Administration (FDA) ruled that pretransplant checks needed to be more rigorous, following the death of an individual with a compromised immune system who received an FMT.

Treatments do not include antidiarrheal drugs, as these can make the disease worse and do not significantly improve symptoms.

Doctors rarely prescribe antibiotics to people with enterocolitis, as these can promote infection and lead to further complications. This is especially true in those with hemorrhagic and antibiotic associated enterocolitis.

A doctor may prescribe antibiotics to some people to prevent life threatening sepsis, however.

Some individuals with enterocolitis require surgery. A person with torn tissues in the intestines is likely to need urgent surgery. They may be less likely to respond to conservative treatment and could be more prone to hemorrhaging or sepsis.

Surgery typically involves draining infected areas and removing infected parts of the intestines.

People can support their treatment by changing their diet. Possibly the most important dietary consideration for someone with enterocolitis is water.

Enterocolitis typically causes persistent, watery diarrhea. This deprives the body of water and electrolytes, which a person must regularly replenish.

Drinking extra water throughout the day can reduce the chances of dehydration. High-liquid foods can also be an excellent addition, as they can provide various nutrients and electrolytes to the body alongside water.

Enterocolitis is a gut disorder, so eating to improve gut health is vital. People may be able to include probiotics and prebiotics in the diet, such as live yogurts, to help establish healthful microorganisms in the intestines.

A 2019 review claims, however, that prebiotic supplements cause no significant drop in the progression of necrotizing enterocolitis.

More research is necessary to confirm the benefits of prebiotics in cases of enterocolitis.

People should discuss the ideal diet for supporting enterocolitis treatment with a qualified healthcare practitioner. A doctor or dietician may be able to provide recommendations based on a person’s health needs and current symptoms.