Pancolitis is an inflammation of the entire colon. The most common cause is ulcerative colitis (UC). Pancolitis can also be caused by infections like C. difficile, or can be associated with inflammatory disorders like rheumatoid arthritis (RA). UC is a chronic condition that affects the lining of your large intestine, or your colon. UC is caused by inflammation that leads to ulcers, or sores, in your colon. In pancolitis, inflammation and ulcers have spread to cover your entire colon.
Other types of ulcerative colitis include:
- proctosigmoiditis, in which a section of your colon known as the sigmoid colon has inflammation and ulcers
- proctitis, which affects just your rectum
- left-sided, or distal, ulcerative colitis, in which inflammation stretches from your rectum to a curve of your colon found near your spleen, on the left side of your body
UC causes symptoms that can be uncomfortable or painful. The more of your colon that’s affected, the worse your symptoms usually are. Because pancolitis affects your whole colon, its symptoms can be worse than symptoms for other forms of UC.
Common mild and moderate symptoms of pancolitis include:
- feeling exhausted
- abnormal weight loss (without exercising more or dieting)
- pain and cramps in the area of your stomach and abdomen
- feeling a strong, frequent urge for bowel movements, but not always being able to control the bowel movements
As your pancolitis gets worse, you’ll likely have more severe symptoms. These may include:
- pain and bleeding from your rectum and anal area
- unexplained fever
- bloody diarrhea
- diarrhea filled with pus
Children with pancolitis may not grow properly. Take your child to see a doctor immediately if they have any of the above symptoms.
Some of these symptoms may not necessarily be a result of pancolitis. Pain, cramping, and a powerful urge to pass waste can be caused by gas, bloating, or food poisoning. In these cases, the symptoms will go away after a short period of discomfort.
But if you have the following symptoms, you should see your doctor right away:
- blood or pus in your diarrhea
- diarrhea that lasts for more than a few days without responding to medication
It’s not known what exactly causes pancolitis or other forms of UC. As with other inflammatory bowel diseases (IBDs), pancolitis may be caused by your genes. One theory is that the genes that are thought to cause Crohn’s disease, another type of IBD, may also cause UC. There is research on how genetics may cause UC and other IBDs. This research includes how your genes interact with the bacteria in your GI tract.
Researchers think immune system responses to bacteria or viruses in your GI tract may cause pancolitis and other IBDs. It’s thought that the immune system may mistakenly target your colon while attacking bacteria or viruses that cause infections in your colon. This can cause inflammation and damage to your colon, which can lead to ulcers. It can also make it harder for your body to absorb certain nutrients.
In some cases, if you don’t get treatment for mild or moderate forms of UC, your condition can become worse and become a case of pancolitis.
Some people believe that stress and anxiety can lead to UC and pancolitis. Stress and anxiety may trigger ulcers and cause pain and discomfort, but these factors don’t actually cause pancolitis or other IBDs.
Your doctor may want to do a physical examination to get an idea of your overall health. Then, they may ask you for a stool sample or do blood tests in order to rule out other causes of your symptoms, such as bacterial or viral infections.
Your doctor will also likely ask you to do a colonoscopy. In this procedure, your doctor inserts a long, thin tube with a light and camera on the end into your anus and up into your colon. Your doctor can then examine the lining of your large intestine to look for ulcers as well as any other abnormal tissue.
During a colonoscopy, your doctor may take a tissue sample from your colon to test it for any other infections or diseases. This is known as a biopsy. A colonoscopy can also allow your doctor to find and remove any polyps that may be in your colon. Tissue samples and polyp removal may be necessary if your doctor believes that tissue in your colon may be cancerous.
Treatments for pancolitis and other forms of UC depend on how severe the ulcers in your colon are. Treatment may also vary if you have any underlying conditions that caused pancolitis or if untreated pancolitis has caused more severe conditions.
The most common treatments for pancolitis and other forms of UC are anti-inflammatory drugs. These help treat the inflammation in your colon. These include medications such as oral 5-aminosalicylates (5-ASAs) and corticosteroids.
You may receive corticosteroids, such as prednisone, as injections or as rectal suppositories. These kinds of treatments may have side effects, including:
- increased risk of diabetes
- increased risk of high blood pressure
- weight gain
Immune system suppressors are also common treatments for pancolitis and UC. These help keep your immune system from attacking your colon in order to reduce inflammation. Immune system suppressors for pancolitis include:
- azathioprine (Imuran)
- adalimumab (Humira)
- vedolizumab (Entyvio)
These can have serious side effects, such as infections and an increased risk for cancer. You may also need to follow up with your doctor frequently to make sure that the treatment is working.
In very severe cases, a surgeon can remove your colon in a surgery known as a colectomy. In this procedure, your surgeon will create a new pathway for your bodily waste to exit your body. This surgery is the only cure for UC, and is usually only a last resort. Most people manage their UC through a combination of lifestyle changes and medications.
The following lifestyle changes can help relieve your symptoms, avoid triggers, and make sure that you’re getting enough nutrients:
- Eat less dairy.
- Reduce your fiber intake.
- Avoid caffeinated beverages like coffee and alcohol.
- Drink plenty of water per day (around 64 ounces, or eight 8 ounce glasses of water).
- Take multivitamins.
- Reduce your stress.
There’s no cure for any form of UC aside from surgery to remove your colon. Pancolitis and other forms of UC are chronic conditions, although most people experience symptoms in highs and lows. You may experience flare-ups of symptoms as well as symptom-free periods known as remissions. Flare-ups in pancolitis may be more severe than in other forms of UC, because more of the colon is affected in pancolitis.
If UC is left untreated, potential complications include:
You can improve your outlook and help reduce complications by following your treatment plan, avoiding potential triggers, and getting frequent checkups.
What diet should I follow if I have pancolitis?
There is no one specific diet that has been studied. One of the few studies I found was looking at patients with ulcerative colitis from 2013, in the Journal of Human Nutrition and Dietetics. Researchers found that patients with UC were taking in low levels of fiber, all the fat soluble vitamins, vitamin C, calcium, and magnesium. They thought some of that might have been from patients eating a low-residue diet which is low in fruits, vegetables, and fiber. We are not clear on what these kind of diets do long term, but the authors said there were other studies that had linked lack of nutrients to flare-ups of UC.Suzanne Falck MD FACPAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.