Treatment of Diffuse Enterocolitis in the Descending Colon

Evaluation and Diagnosis

The American Gastroenterological Association recommends ruling out infectious causes through stool tests for Clostridioides difficile, bacterial cultures, and parasites before starting anti-inflammatory treatment 2, 3
The American Gastroenterological Association suggests requesting inflammatory markers in stool, such as lactoferrin and calprotectina, to stratify risk and determine the need for endoscopic evaluation 4
Consider blood tests, including complete blood count, C-reactive protein, erythrocyte sedimentation rate, and thyroid function tests, as part of the initial evaluation 4
Evaluate the possibility of pancreatic insufficiency through fecal elastase if there is steatorrhea or lack of response to initial treatment 2

The European Society of Gastrointestinal Endoscopy recommends starting mesalazine oral 2-4 g daily combined with mesalazine topical 1 g daily for diffuse enterocolitis in the descending colon 5, 1
Maintain adequate hydration and consider dietary modifications (low-residue diet) to reduce symptoms 4
Treat proximal constipation, if present, with bulk-forming agents or laxatives to improve intestinal transit 5
Monitor clinical response every 3-7 days by evaluating stool frequency and consistency 4

If there is no adequate response after 7-14 days of mesalazine treatment, start prednisone oral 40 mg daily 5
Gradually reduce the prednisone dose over 8 weeks according to clinical response 5
Consider budesonide for microscopic colitis if endoscopic findings are compatible 3, 6
In cases refractory to corticosteroids for more than 3 days, consider biologic therapy with infliximab or vedolizumab 7, 6

Avoid the use of non-steroidal anti-inflammatory drugs (NSAIDs) as they can exacerbate colonic inflammation 8
In cases of severe abdominal pain, fever, or rectal bleeding, consider abdominal imaging (CT or MRI) to rule out complications such as perforation or abscess 2, 7
Long-term maintenance therapy with aminosalicylates should be considered to prevent relapses once remission is achieved 5, 1

Persistent symptoms despite initial treatment for 2-4 weeks 2, 3
Persistently elevated inflammatory markers in stool 4
Presence of alarm symptoms such as rectal bleeding, significant weight loss, or severe abdominal pain 7
Flexible sigmoidoscopy is generally sufficient to evaluate inflammation in the descending colon, with biopsies to confirm diagnosis and assess severity 7

Monitor response to treatment through clinical evaluation of symptoms and inflammatory markers in stool 4
Consider follow-up endoscopy to confirm mucosal remission in moderate to severe cases 6
Maintain maintenance therapy with aminosalicylates to prevent relapses 5, 1