Colitis Symptoms and Treatment

Common Symptoms of Colitis

Diarrhea is a primary symptom of colitis, often with blood or mucus, according to the National Comprehensive Cancer Network 1, 2
Rectal bleeding is a common symptom, ranging from streaks to frank bleeding, as reported by the Journal of Crohn's and Colitis 2, 3
Abdominal pain is a symptom, often cramping or discomfort in the lower abdomen, as noted by the Journal of Crohn's and Colitis 2, 3
Fatigue is a common symptom that significantly impacts quality of life, as reported by the Journal of Crohn's and Colitis 2, 3
Fever may indicate more severe inflammation or infection, according to the National Comprehensive Cancer Network 1, 5

Mild colitis is characterized by an increase of <4 bowel movements per day above baseline, with minimal or no systemic symptoms, as defined by the National Comprehensive Cancer Network 1, 5
Moderate colitis is characterized by an increase of 4-6 bowel movements per day, with mild to moderate abdominal pain and blood in stool, as defined by the National Comprehensive Cancer Network 1, 5
Severe colitis is characterized by an increase of >6 bowel movements per day, with severe abdominal pain, significant bleeding, fever, and potentially hemodynamic instability, as defined by the National Comprehensive Cancer Network 1, 5

Stool evaluation is necessary to rule out infectious causes, such as C. difficile, bacterial pathogens, and parasites, as recommended by Gastroenterology 6, 8
Inflammatory markers, such as fecal calprotectin and lactoferrin, help assess inflammation severity, as reported by Gastroenterology 6, 8
Endoscopic evaluation confirms diagnosis and assesses severity, as recommended by Gastroenterology 6, 8

The American Gastroenterological Association recommends treatment for immune checkpoint inhibitor-induced colitis, which can develop 6-8 weeks after starting immunotherapy, with systemic corticosteroids for grade 2 or higher cases 6, 7
The American Gastroenterological Association suggests that refractory cases of immune checkpoint inhibitor-induced colitis may require infliximab or vedolizumab 6, 7
The National Comprehensive Cancer Network recommends avoiding NSAIDs as they can exacerbate colonic inflammation 8