Spastic colitis

Spastic colitis (also known as nervous colitis or irritable bowel syndrome IBS) is a very common gastrointestinal disorder.
It is estimated that 15-20% of the American population (about 55 million people) is affected by a spastic colon.

This disease is more common in adults, while in children it is very rare.

It can lead to restrictions in daily life because patients often avoid leaving the house due to the symptoms. However, it has no serious complications or consequences.

Possible causes of spastic colitis

1. A serotonergic problem: serotonin is a substance that helps transmit impulses from one nerve to another, and is abundant in the gastrointestinal system. Serotonin is involved in intestinal peristalsis (muscle activity). Two serotonergic drugs were developed and had a positive effect on spastic colitis. This is seen as evidence of the significant role serotonin plays in this condition.
2. A genetic problem: Comprehensive examinations of families and twins show the frequent occurrence of the disease within the same family. The studies have examined the genes associated with serotonin, but have not shown any useful conclusions for the patients with spastic colitis.
3. An inflammatory condition: Irritable bowel syndrome is also characterized by inflammation. Marker of this inflammation is the mast cell and several of these cells are found in patients with spastic colitis, especially near the nerve endings. The idea is to develop drugs that stabilize these mast cells to reduce symptoms of the condition (as happens in patients suffering from asthma).
4. Bacterial growth and alteration of the intestinal flora (or microbiota): From the moment of birth and with the first breath of the newborn, bacteria colonize the intestine. At this moment, the immediate environment plays an important role in the nature of the intestinal flora.
   Unfortunately, you can not choose the environment at birth and a large part of the intestinal flora is obtained from your mother.
   Disturbances of the intestinal flora (for example, by taking an antibiotic) can cause problems such as diarrhea. The movements of peristalsis (wave movements, propulsions) of the intestine are important for maintaining a healthy bacterial intestinal flora. In spastic colitis, movement is disturbed and many of these patients have a proliferation of bacteria in the small intestine. This can cause symptoms such as bloating, abdominal pain and diarrhea.
   Recently, it has been discovered that not only the number but also the type of bacteria is important. In patients with a large number of Lactobacillus and Veillonella, large amounts of acetic acid, propionic acid and organic acids are found.

Spastic colitis also has a nervous or psychosomatic origin, the intestine is strongly affected by stress and anxiety. In fact, strong emotions can cause tachycardia (accelerated heartbeat), as well as contractions of the intestinal muscles. The result is an exacerbation of symptoms.

Symptoms of spastic colitis

The signs and symptoms of irritable bowel syndrome are individually different and often they are similar to those of other diseases.

The most common in the acute phase are:

– abdominal pain, right or left flank pain – abdominal cramps
– back pain (not common) – bloating – meteorism or bloating (air in the abdomen)

– diarrhea or constipation — sometimes alternating constipation and diarrhea
– mucus in the stool
– nausea and vomiting – white tongue – stomach pain

– fatigue

For many people, irritable bowel syndrome is a chronic condition, even if there are moments when the signs and symptoms are more severe and moments when they improve or even disappear completely.

What diseases must be excluded when diagnosing spastic colitis?

Diagnosis of spastic colon is a process of exclusion. There is no medically positive test for the spastic colon. The doctor, on the other hand, can examine the patient for all other diseases similar to spastic colitis. If these tests remain negative and the symptoms meet the Rome II criteria (criteria adopted by an international commission to define the diagnosis of functional disorders of the digestive system), this determines the diagnosis of spastic colitis.

It is important to rule out the following conditions before the diagnosis of spastic colitis is recognized:

• Colorectal tumor
• Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
• Ileus
• Diverticulosis and diverticulitis
• Gall stones
• Food allergy
• Celiac disease (a genetic autoimmune disease that causes gluten intolerance)
• Bacterial infection
• Intestinal parasites
• Endometriosis
• Ovarian cancer

Are the symptoms reliable?
These symptoms are very reliable. If any of the following symptoms occur in addition to the typical ones, it is not irritable bowel syndrome:

– Detection of any physical abnormalities during the medical examination
– Increased BKS (erythrocyte sedimentation). It must be emphasized that a person with spastic colitis can also develop other diseases that increase BKS. However, if a patient shows increased BKS along with new symptoms indicating nervous colitis, it will be another condition (for example, Crohn’s disease or celiac disease). 65% of patients with Crohn’s disease have spastic colitis due to inflammatory damage to nerve endings.
– Elevated white blood cells (white blood cells serve to protect us from infection)
– Anemia (low in red blood cells in the blood).
– Blood in the stool
– Weight loss
– Fever
– The appearance of symptoms suggesting the onset of IBS after the age of 35. Nervous colitis can begin at an advanced age, but this is very rare. In this case, it could also be caused by antibiotics for gastroenteritis.
– A family history of colorectal cancer or inflammatory bowel disease.
– Nocturnal symptoms of abdominal pain or malaise
– Fecal incontinence (unintentional leakage of feces)

Treatment and medications for spastic colitis

Since it is not clear what the cause of irritable bowel syndrome is, treatment focuses on relieving symptoms to increase the patient’s quality of life.

In most cases, one can successfully control the milder symptoms and signs of irritable bowel syndrome by learning to manage stress and changing one’s diet and lifestyle.

Drug therapy for irritable bowel syndrome
Two drugs are currently approved in the U.S. for certain cases of IBS:

– Alosetron (Lotronex). Alosetron is used to reduce intestinal tension and slow down the movement of stools through the colon. The Food and Drug Administration (FDA) had temporarily withdrawn the drug from the market, but then approved the sale of Alosetron again.
This drug is not approved for male patients.

– Lubiprostone (Amitiza). Lubiprostone works by increasing fluid secretion in the small intestine and supports the sliding of feces. It has been approved for women aged 18 and over who suffer from irritable bowel syndrome with constipation. Its efficacy in men and its long-term safety have not yet been established. The most common side effects include nausea, diarrhea and abdominal pain.

Medication for the symptoms

• Fiber supplement. Taking fiber such as psyllium husks (metamucil) along with fluid can help reduce constipation.
• Antidiarrheal drugs. Over-the-counter medications such as loperamide (Imodium) may help treat diarrhea.
• Anticholinergics and antispasmodics. These medications, such as atropine (atropine sulfate) and butylscopolamine (Buscopan ®), can reduce the painful intestinal spasms. They can be used by people with seizure-like diarrhea, but they can worsen constipation and cause other symptoms, such as difficulty urinating.
  Patients who have glaucoma should talk to their doctor before taking these medications.
• Antidepressants. If symptoms also include suffering or depression, the doctor may recommend tricyclic antidepressants or a serotonin uptake inhibitor (SSRI). These drugs help reduce depression and inhibit the activity of the neurons that control the intestines.
• Antibiotics. Some patients with symptoms caused by an accumulation of bacteria in the gut may benefit from antibiotic therapy. There is evidence that patients with the symptom of diarrhoea improved with rifaximin (Xifaxan), but more research is needed.

Natural remedies for spastic colitis

Vitamin B6 supplements: Foods that contain vitamins and essential nutrients are beneficial for the digestive system. One should include foods rich in vitamin B6 in the diet, such as carrots, beans and peas, to reduce the severity of symptoms of spastic colitis and aid digestion.

Folic acid: Whole wheat bread, cereals and other foods rich in folic acid are important for maintaining the health of the colon.

Magnesium: A rich source of magnesium is legumes.
These serve to maintain the health of the colon and digestion.

Drink plenty of water: among the proven home remedies, it is said that you should drink at least eight glasses of water a day. This increases the stool mass in the intestine, causes the soluble fiber to swell and thus supports the regulation of the intestine.

Nutrition and proper diet in spastic colitis

Increased fiber intake: The recommended diet should include a higher amount of fiber. A high-fiber diet improves the functioning of the intestines and facilitates the painful bowel movements caused by irritable bowel syndrome. There are two types of fiber: soluble and insoluble. Soluble fiber is the one that dissolves in water and forms a gel, while insoluble fiber regulates constipation by increasing stool mass. Sources of soluble fiber include citrus fruits, beans and apples, while insoluble fiber is found in wheat bran, whole grains and vegetables.

Recommended foods:

– fruit and vegetables, such as tomatoes, aubergines, walnuts, carrots, chard, zucchini and lemons;
– Rice, oats, barley and wheat, if you do not suffer from gluten intolerance.

Foods to avoid in spastic colitis

There are certain foods that can significantly aggravate the disease. These include foods high in fat and spicy foods. Other foods to avoid for spastic colitis include:

– Milk and dairy products (excluding probiotic yogurt)
– Substances that irritate the intestines such as caffeine, spicy foods and carbonated drinks
– Alcohol – Ready meals or canned food

– Some fruits and vegetables, such as pumpkin, plums, figs and grapes.
– Flatulent foods, such as onions, garlic, lentils, beans and cabbage
– Fructose: natural sugar derived from fruits. Fructose is often used as a substitute for cane sugar. Those who suffer from spastic colon and fructose intolerance should avoid eating fruits and fruit juices that are high in fructose.
– Dietary fats: A fatty or spicy meal can cause worsening of symptoms. People suffering from spastic colitis should avoid ready-made foods, fried foods, creamy sauces and dishes with fatty meat.

How long does the disease last? How long does recovery take?

The prognosis is difficult because it is a chronic disorder that rarely heals.
You can keep the symptoms under control to improve the quality of life.

• Nutrition for colitis
• Inflammation of the colon: causes and symptoms
• Treatment of irritable bowel syndrome