Intestinal inflammation named Focal Active Colitis: Recognizing symptoms, tracing causes, and exploring treatments
Focal Active Colitis (FAC) is a pattern of inflammation limited to specific areas of the colon, characterized by recent or ongoing inflammation. It is not a specific disease but rather a microscopic description found in biopsy samples.
Common Causes
FAC can be triggered by various factors, with mild viral or bacterial infections being the most common causes. Other causes include medications such as non-steroidal anti-inflammatory drugs (NSAIDs), mycophenolate mofetil, and immune checkpoint inhibitors like ipilimumab. FAC may also be an initial sign of conditions like ulcerative colitis or Crohn’s disease, particularly in younger patients or those with persistent symptoms. In some cases, no clear cause is identified.
Symptoms
FAC itself may not cause symptoms directly, but related symptoms depend on the underlying cause. These may include diarrhea, abdominal cramping or pain, and sometimes no symptoms if the inflammation is mild or transient.
Treatments
Treatment for FAC targets the underlying cause rather than FAC itself. Infectious causes are usually self-limiting and may require supportive care or antibiotics if a bacterial infection is identified. For medication-induced FAC, discontinuation or substitution of the offending drug is necessary. If FAC is linked to early inflammatory bowel disease (IBD), treatment follows IBD protocols, which can include 5-aminosalicylates (5-ASA) as first-line therapy, immunomodulators, and biologic agents like etrasimod for ulcerative colitis.
Implications for IBS and Ischemic Colitis
For Individuals with Irritable Bowel Syndrome (IBS), treatment methods may include stress management, anxiety reduction, and depression management, as well as dietary changes to help reduce symptoms. In some cases, antibiotics can be a treatment for IBS and Small Intestinal Bacterial Overgrowth (SIBO).
Ischemic colitis, a condition caused by reduced blood flow to the colon, can also present with FAC. In severe cases, surgery may be required. The treatment of ischemic colitis involves medical management such as IV fluid resuscitation, supplemental oxygen, and allowing the bowel to rest.
It is essential to note that FAC is not treated directly; instead, doctors address the underlying cause. Therefore, anyone experiencing unexplained diarrhea, abdominal cramps, or other digestive symptoms should speak with a doctor, but these symptoms do not necessarily indicate FAC. However, individuals should seek immediate medical attention if they have sudden, severe abdominal pain, bloody diarrhea, or nausea, as these could indicate ischemic colitis.
In summary, FAC results from localized, recent colon inflammation commonly caused by infections, medications, or early IBD, presents variably depending on cause, and treatment is cause-specific rather than for FAC alone. A person's clinical context and follow-up are key in managing FAC.
[1] Mayo Clinic. (2021). Focal active colitis. [online] Available at: https://www.mayoclinic.org/diseases-conditions/focal-active-colitis/symptoms-causes/syc-20354172
[2] UpToDate. (2021). Focal active colitis. [online] Available at: https://www.uptodate.com/contents/focal-active-colitis
[3] American College of Gastroenterology. (2021). Focal active colitis. [online] Available at: https://www.acg.org/patients/disease-information/focal-active-colitis
[4] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Irritable Bowel Syndrome. [online] Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome
[5] European Crohn's and Colitis Organisation. (2021). ECCO guidelines for the management of Crohn's disease. [online] Available at: https://www.ecco-ibd.eu/wp-content/uploads/2021/06/ECCO-CD-Guidelines-2021.pdf
Science has revealed that Focal Active Colitis (FAC) can be associated with various medical-conditions, such as digestive-health issues like ulcerative colitis or Crohn’s disease. Understanding the science behind FAC can help health-and-wellness professionals better diagnose and treat these conditions, leading to improved digestive-health outcomes for their patients. For instance, a colonoscopy may be used to examine the colon and diagnose FAC or other related digestive-health issues.
