Histopathology of Infectious Colitis

Histopathology can play an important role in diagnosing infictious colitis for several reasons. First, colonic mucosal biopsy can often reliably differentiate acute self limited colitis (ASLC). or infectious type colitis, from idiopathic inflammatory bowel disease (IBD). In ASLC, crypt architecture is normal and the inflammatory infiltrate in the lamina propria predominantly acute, ie, polymorphonuclear cells. In IBD, in contrast, crypt architecture is often abnormal nd the inflammatory infiltrate in the lamina propria in both acute and chronic, ie, polymorphonuclear cells, plasma cells ,and lymphocyte are present in increased numbers. Second, biopsy may give a clue to the specific infection. Biopsy may reveal the presence of specific parasites such as Entamoeba histolytica, cryptosporidia or schistosomiasis. Viral inclusions are seen when cytomegalovirus or herpes simplex type II virus infect the colon. Granulomas usually indicate Crohn's disease but can he seen with infections due to Chlamydia trachomatis, Treponema pallidum and Mycobacterium tuberculosis. Both chlamydial and syphilitic proctitis are rare and usually seen in homosexually active men. Finally, pseudomembranes, when present, suggest pseudomembranous colitis due to an overgrowth of toxigenic Clostridium difficile. In summary, mucosal biopsy is helpful in differentiating ASLC from IBD in most cases. Sometimes, it provides a clue to the specific infection

Updates on treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder characterized by abdominal pain and discomfort in association with altered bowel habits. It is estimated to affect 10%-15% of the Western population, and has a large impact on quality of life and (in)direct healthcare costs. IBS is a multifactorial disorder involving dysregulation within the brain-gut axis, and it is frequently associated with gastrointestinal motor and sensory dysfunction, enteric and central nervous system irregularities, neuroimmune dysregulation, and post-infectious inflammation. As with other functional medical disorders, the treatment for IBS can be challenging. Conventional therapy for those with moderate to severe symptoms is largely unsatisfactory, and the development of new and effective drugs is made difficult by the complex pathogenesis, variety of symptoms, and lack of objective clinical findings that are the hallmark of this disorder. Fortunately, research advances over the past several decades have provided insight into potential mechanisms responsible for the pathogenesis of IBS, and have led to the development of several promising pharmaceutical agents. In recent years there has been much publicity over several of these new IBS medications (alosetron and tegaserod) because of their reported association with ischemic colitis and cardiovascular disease. While these agents remain available for use under restricted prescribing programs, this highlights the need for continued development of safe and effective medication for IBS. This article provides a physiologically-based overview of recently developed and frequently employed pharmaceutical agents used to treat IBS, and discusses some non-pharmaceutical options that may be beneficial in this disorder