Diversion colitis

Abstract

Diversion colitis is an inflammatory bowel disease (IBD) that has attracted considerable clinical and scientific interest during the past 15 years. Indeed, the histologic features of this entity were recognized only 28 years ago [1] and in that time it has acquired several names, including bypass colitis, exclusion colitis, and disuse colitis. Since its first clinical description in 1981 [2], a number of case reports and series have been published [2-30]. Certain observations have sparked the current curiosity: 1. It is the only model of non-infectious 'experimental' colitis in humans, with the possible exception of radiation colitis. It occurs in 50-100% of cases following exclusion of the distal colorectum and is predictably reversible by surgical reanastomosis [2, 17, 18, 21]. 2. It is caused by diversion of the fecal stream, most likely by deprivation of short-chain fatty acids (SCFA) [13], the preferred metabolic substrate of the colonic epithelium [31-33]. 3. This 'nutritional deficiency' leads to an inflammatory process similar to that of other colitides [34-36]. 4. The disease has recently been reproduced in laboratory animals [37]. Thus, diversion colitis presents an ideal opportunity to study the pathophysiology of an IBD in humans: its occurrence after surgical bypass of normal colon is frequent, characteristics of inflammation may be studied as they develop, and successful treatment by either surgical or medical means can be monitored. (Table presented). © 2005 Springer Science+Business Media, Inc.