Skip to main content
SpringerLink
Log in

Non-IBD and Noninfectious Colitis

  • Reference work entry
  • First Online:
Geriatric Gastroenterology

  • 203 Accesses

Abstract

Colitis is mucosal inflammation of the colon that may be caused by infection, inflammation, ischemia, medications, or other idiopathic etiologies. The most common symptoms of colitis are diarrhea (which may be bloody) and abdominal pain. While infectious colitis and inflammatory bowel disease are the most common types of colitis, it is important to recognize, test for, and treat noninfectious and noninflammatory colitis, which includes microscopic colitis, drug-induced colitis, ischemic colitis, segmental colitis associated with diverticula, radiation colitis, diversion colitis, eosinophilic colitis, and Behçet’s colitis. We provide a review of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatments for the eight types of noninfectious, noninflammatory colitis listed above.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Alfadda AA, Storr MA, Shaffer EA. Eosinophilic colitis: epidemiology, clinical features, and current management. Ther Adv Gastroenterol. 2011;4:301–9.

    Article  Google Scholar 

  • Babb RR. Radiation proctitis: a review. Am J Gastroenterol. 1996;91:1309–11.

    CAS  PubMed  Google Scholar 

  • Balthazar EJ, Yen BC, Gordon RB. Ischemic colitis: Ct evaluation of 54 cases. Radiology. 1999;211:381–8.

    Article  CAS  PubMed  Google Scholar 

  • Boland K, Nguyen GC. Microscopic colitis: a review of collagenous and lymphocytic Colitis. Gastroenterol Hepatol (NY). 2017;13:671–7.

    Google Scholar 

  • Brandt LJ, Feuerstadt P, Blaszka MC. Anatomic patterns, patient characteristics, and clinical outcomes in ischemic colitis: a study of 313 cases supported by histology. Am J Gastroenterol. 2010;105:2245–52, Quiz 2253

    Article  PubMed  Google Scholar 

  • Brechmann T, Gunther K, Neid M, Schmiegel W, Tannapfel A. Triggers of histologically suspected drug-induced colitis. World J Gastroenterol. 2019;25:967–79.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cappell MS. Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol. 2004;99:1175–90.

    Article  CAS  PubMed  Google Scholar 

  • Cerilli LA, Greenson JK. The differential diagnosis of colitis in endoscopic biopsy specimens: a review article. Arch Pathol Lab Med. 2012;136:854–64.

    Article  PubMed  Google Scholar 

  • Chan JL, Tersmette AC, Offerhaus GJ, Gruber SB, Bayless TM, Giardiello FM. Cancer risk in collagenous colitis. Inflamm Bowel Dis. 1999;5:40–3.

    Article  CAS  PubMed  Google Scholar 

  • Chande N. Microscopic colitis: an approach to treatment. Can J Gastroenterol. 2008;22:686–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chen JH, Pezhouh MK, Lauwers GY, Masia R. Histopathologic features of colitis due to immunotherapy with anti-Pd-1 antibodies. Am J Surg Pathol. 2017;41:643–54.

    Article  PubMed  Google Scholar 

  • Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys. 1995;31:1213–36.

    Article  CAS  PubMed  Google Scholar 

  • Colombel JF, Sands BE, Rutgeerts P, Sandborn W, Danese S, D'haens G, Panaccione R, Loftus EV Jr, Sankoh S, Fox I, Parikh A, Milch C, Abhyankar B, Feagan BG. The safety of vedolizumab for ulcerative colitis and Crohn’s disease. Gut. 2017;66:839–51.

    Article  CAS  PubMed  Google Scholar 

  • De Cassan C, De Vroey B, Dussault C, Hachulla E, Buche S, Colombel JF. Successful treatment with adalimumab in a familial case of gastrointestinal Behcet’s disease. J Crohns Colitis. 2011;5:364–8.

    Article  PubMed  Google Scholar 

  • Deshpande V, Hsu M, Kumarasinghe MP, Lauwers GY. The clinical significance of incidental chronic colitis: a study of 17 cases. Am J Surg Pathol. 2010;34:463–9.

    Article  PubMed  Google Scholar 

  • Dhakal PG, Pathak R, Smith G, Bhatt VR. Mycophenolate mofetil (Mmf)-induced colitis. Washington, DC: American Society of Hematology; 2016.

    Book  Google Scholar 

  • Diaz Del Arco C, Taxonera C, Olivares D, Fernandez Acenero MJ. Eosinophilic colitis: case series and literature review. Pathol Res Pract. 2018;214:100–4.

    Article  PubMed  Google Scholar 

  • Ebert EC. Gastrointestinal manifestations of Behcet’s disease. Dig Dis Sci. 2009;54:201–7.

    Article  PubMed  Google Scholar 

  • Faucheron JL, Parc R. Non-steroidal anti-inflammatory drug-induced colitis. Int J Color Dis. 1996;11:99–101.

    Article  CAS  Google Scholar 

  • Ferguson CM, Siegel RJ. A prospective evaluation of diversion colitis. Am Surg. 1991;57:46–9.

    CAS  PubMed  Google Scholar 

  • Fernandez-Banares F, Esteve M, Salas A, Forne TM, Espinos JC, Martin-Comin J, Viver JM. Bile acid malabsorption in microscopic colitis and in previously unexplained functional chronic diarrhea. Dig Dis Sci. 2001;46:2231–8.

    Article  CAS  PubMed  Google Scholar 

  • Fernandez-Banares F, Esteve M, Espinos JC, Rosinach M, Forne M, Salas A, Viver JM. Drug consumption and the risk of microscopic colitis. Am J Gastroenterol. 2007;102:324–30.

    Article  PubMed  Google Scholar 

  • Fine KD, Lee EL. Efficacy of open-label bismuth subsalicylate for the treatment of microscopic colitis. Gastroenterology. 1998;114:29–36.

    Article  CAS  PubMed  Google Scholar 

  • Fine KD, Seidel RH, Do K. The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. Gastrointest Endosc. 2000;51:318–26.

    Article  CAS  PubMed  Google Scholar 

  • Geraghty JM, Talbot IC. Diversion colitis: histological features in the colon and rectum after defunctioning colostomy. Gut. 1991;32:1020–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN. The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. Q J Med. 1983;52:40–53.

    CAS  PubMed  Google Scholar 

  • Glotzer DJ, Glick ME, Goldman H. Proctitis and colitis following diversion of the fecal stream. Gastroenterology. 1981;80:438–41.

    Article  CAS  PubMed  Google Scholar 

  • Gorbach SL. Bismuth therapy in gastrointestinal diseases. Gastroenterology. 1990;99:863–75.

    Article  CAS  PubMed  Google Scholar 

  • Gore S, Shepherd NA, Wilkinson SP. Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance. Int J Color Dis. 1992;7:76–81.

    Article  CAS  Google Scholar 

  • Greenberger NJ, Blumberg R, Burakoff R. Current diagnosis & treatment: gastroenterology, hepatology, & endoscopy. New York, NY: Mcgraw-Hill; 2019.

    Google Scholar 

  • Harig JM, Soergel KH, Komorowski RA, Wood CM. Treatment of diversion colitis with short-chain-fatty acid irrigation. N Engl J Med. 1989;320:23–8.

    Article  CAS  PubMed  Google Scholar 

  • Hokama A, Kinjo F, Tomiyama R, Maeda K, Saito A, Matayoshi M. Progression of diverticular colitis to ulcerative colitis. Inflamm Bowel Dis. 2005;11:618.

    Article  PubMed  Google Scholar 

  • Hourmand-Ollivier I, Bouin M, Saloux E, Morello R, Rousselot P, Piquet MA, Dao T, Verwaerde JC. Cardiac sources of embolism should be routinely screened in ischemic colitis. Am J Gastroenterol. 2003;98:1573–7.

    Article  PubMed  Google Scholar 

  • Hreinsson JP, Gumundsson S, Kalaitzakis E, Bjornsson ES. Lower gastrointestinal bleeding: incidence, etiology, and outcomes in a population-based setting. Eur J Gastroenterol Hepatol. 2013;25:37–43.

    Article  PubMed  Google Scholar 

  • Ideguchi H, Suda A, Takeno M, Miyagi R, Ueda A, Ohno S, Ishigatsubo Y. Gastrointestinal manifestations of Behcet’s disease in Japan: a study of 43 patients. Rheumatol Int. 2014;34:851–6.

    Article  PubMed  Google Scholar 

  • Imperiali G, Terpin MM, Meucci G, Ferrara A, Minoli G. Segmental colitis associated with diverticula: a 7-year follow-up study. Endoscopy. 2006;38:610–2.

    Article  CAS  PubMed  Google Scholar 

  • Jarnerot G, Tysk C, Bohr J, Eriksson S. Collagenous colitis and fecal stream diversion. Gastroenterology. 1995;109:449–55.

    Article  CAS  PubMed  Google Scholar 

  • Kasahara Y, Tanaka S, Nishino M, Umemura H, Shiraha S, Kuyama T. Intestinal involvement in Behcet’s disease: review of 136 surgical cases in the Japanese literature. Dis Colon Rectum. 1981;24:103–6.

    Article  CAS  PubMed  Google Scholar 

  • Kelly JK. Polypoid prolapsing mucosal folds in diverticular disease. Am J Surg Pathol. 1991;15:871–8.

    Article  CAS  PubMed  Google Scholar 

  • Kennedy GD, Heise CP. Radiation colitis and proctitis. Clin Colon Rectal Surg. 2007;20:64–72.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kim DH, Cheon JH. Intestinal Behcet’s disease: a true inflammatory bowel disease or merely an intestinal complication of systemic vasculitis? Yonsei Med J. 2016;57:22–32.

    Article  CAS  PubMed  Google Scholar 

  • Kimura T, Shinji A, Horiuchi A, Tanaka N, Nagaya T, Shigeno T, Nakamura N, Komatsu M, Umemura T, Arakura N, Matsumoto A, Tanaka E. Clinical characteristics of young-onset ischemic colitis. Dig Dis Sci. 2012;57:1652–9.

    Article  CAS  PubMed  Google Scholar 

  • Kountouras J, Zavos C. Recent advances in the management of radiation colitis. World J Gastroenterol. 2008;14:7289–301.

    Article  PubMed  PubMed Central  Google Scholar 

  • Koutroubakis IE, Antoniou P, Tzardi M, Kouroumalis EA. The spectrum of segmental colitis associated with diverticulosis. Int J Color Dis. 2005;20:28–32.

    Article  CAS  Google Scholar 

  • Lazenby AJ, Yardley JH, Giardiello FM, Jessurun J, Bayless TM. Lymphocytic (“Microscopic”) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol. 1989;20:18–28.

    Article  CAS  PubMed  Google Scholar 

  • Lazenby AJ, Yardley JH, Giardiello FM, Bayless TM. Pitfalls in the diagnosis of collagenous colitis: experience with 75 cases from a registry of collagenous colitis at the Johns Hopkins Hospital. Hum Pathol. 1990;21:905–10.

    Article  CAS  PubMed  Google Scholar 

  • Lindstrom CG. ‘Collagenous colitis’ with watery diarrhoea – a new entity? Pathol Eur. 1976;11:87–9.

    CAS  PubMed  Google Scholar 

  • Ludeman L, Shepherd NA. What is diverticular colitis? Pathology. 2002;34:568–72.

    Article  CAS  PubMed  Google Scholar 

  • Madisch A, Bethke B, Stolte M, Miehlke S. Is there an association of microscopic colitis and irritable bowel syndrome – a subgroup analysis of placebo-controlled trials. World J Gastroenterol. 2005;11:6409.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mann NS, Hoda KK. Segmental colitis associated with diverticulosis: systematic evaluation of 486 cases with meta-analysis. Hepato-Gastroenterology. 2012;59:2119–21.

    PubMed  Google Scholar 

  • Mansoor E, Saleh MA, Cooper GS. Prevalence of eosinophilic gastroenteritis and colitis in a population-based study, from 2012 to 2017. Clin Gastroenterol Hepatol. 2017;15:1733–41.

    Article  PubMed  Google Scholar 

  • Marginean EC. The ever-changing landscape of drug-induced injury of the lower gastrointestinal tract. Arch Pathol Lab Med. 2016;140:748–58.

    Article  CAS  PubMed  Google Scholar 

  • Martinez CA, De Campos FG, De Carvalho VR, De Castro Ferreira C, Rodrigues MR, Sato DT, Pereira JA. Claudin-3 and occludin tissue content in the glands of colonic mucosa with and without a fecal stream. J Mol Histol. 2015;46:183–94.

    Article  CAS  PubMed  Google Scholar 

  • Masugi J, Matsui T, Fujimori T, Maeda S. A case of Behcet’s disease with multiple longitudinal ulcers all over the colon. Am J Gastroenterol. 1994;89:778–80.

    CAS  PubMed  Google Scholar 

  • Mcnally PR. Gi/liver secrets plus. Philadelphia: Mosby/Elsevier; 2010.

    Google Scholar 

  • Miller AR, Martenson JA, Nelson H, Schleck CD, Ilstrup DM, Gunderson LL, Donohue JH. The incidence and clinical consequences of treatment-related bowel injury. Int J Radiat Oncol Biol Phys. 1999;43:817–25.

    Article  CAS  PubMed  Google Scholar 

  • Munch A, Langner C. Microscopic colitis: clinical and pathologic perspectives. Clin Gastroenterol Hepatol. 2015;13:228–36.

    Article  PubMed  Google Scholar 

  • Munch A, Aust D, Bohr J, Bonderup O, Fernandez Banares F, Hjortswang H, Madisch A, Munck LK, Strom M, Tysk C, Miehlke S, European Microscopic Colitis G. Microscopic colitis: current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohns Colitis. 2012;6:932–45.

    Article  CAS  PubMed  Google Scholar 

  • Naylor AR, Pollet JE. Eosinophilic colitis. Dis Colon Rectum. 1985;28:615–8.

    Article  CAS  PubMed  Google Scholar 

  • O’neill S, Yalamarthi S. Systematic review of the management of Ischaemic colitis. Colorectal Dis. 2012;14:E751–63.

    Article  PubMed  Google Scholar 

  • Pardi DS. Diagnosis and management of microscopic colitis. Am J Gastroenterol. 2017;112:78–85.

    Article  PubMed  Google Scholar 

  • Pardi DS, Kelly CP. Microscopic colitis. Gastroenterology. 2011;140:1155–65.

    Article  PubMed  Google Scholar 

  • Pardi DS, Loftus EV Jr, Smyrk TC, Kammer PP, Tremaine WJ, Schleck CD, Harmsen WS, Zinsmeister AR, Melton LJ 3rd, Sandborn WJ. The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota. Gut. 2007;56:504–8.

    Article  PubMed  Google Scholar 

  • Park T, Cave D, Marshall C. Microscopic colitis: a review of etiology, treatment and refractory disease. World J Gastroenterol. 2015;21:8804–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Prieux-Klotz C, Dior M, Damotte D, Dreanic J, Brieau B, Brezault C, Abitbol V, Chaussade S, Coriat R. Immune checkpoint inhibitor-induced colitis: diagnosis and management. Target Oncol. 2017;12:301–8.

    Article  PubMed  Google Scholar 

  • Puzanov I, Diab A, Abdallah K, Bingham CO 3rd, Brogdon C, Dadu R, Hamad L, Kim S, Lacouture ME, Leboeuf NR, Lenihan D, Onofrei C, Shannon V, Sharma R, Silk AW, Skondra D, Suarez-Almazor ME, Wang Y, Wiley K, Kaufman HL, Ernstoff MS, Society for Immunotherapy of Cancer Toxicity Management Working, G. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (Sitc) Toxicity Management Working Group. J Immunother Cancer. 2017;5:95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rampton DS. Diverticular colitis: diagnosis and management. Color Dis. 2001;3:149–53.

    Article  CAS  Google Scholar 

  • Riviere P, Munch A, Michetti P, Chande N, De Hertogh G, Schoeters P, Ferrante M, Vermeire S, Van Assche G. Vedolizumab in refractory microscopic colitis: an international case series. J Crohns Colitis. 2019;13:337–40.

    Article  PubMed  Google Scholar 

  • Roediger WE. The starved colon – diminished mucosal nutrition, diminished absorption, and colitis. Dis Colon Rectum. 1990;33:858–62.

    Article  CAS  PubMed  Google Scholar 

  • Rothenberg ME. Eosinophilic gastrointestinal disorders (Egid). J Allergy Clin Immunol. 2004;113:11–28, Quiz 29

    Article  CAS  PubMed  Google Scholar 

  • Schembri J, Bonello J, Christodoulou DK, Katsanos KH, Ellul P. Segmental colitis associated with diverticulosis: is it the coexistence of colonic diverticulosis and inflammatory bowel disease? Ann Gastroenterol. 2017;30:257–61.

    PubMed  PubMed Central  Google Scholar 

  • Schultheiss TE, Lee WR, Hunt MA, Hanlon AL, Peter RS, Hanks GE. Late Gi and Gu complications in the treatment of prostate cancer. Int J Radiat Oncol Biol Phys. 1997;37:3–11.

    Article  CAS  PubMed  Google Scholar 

  • Sleisenger MH, Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology, diagnosis, management. Philadelphia: Saunders/Elsevier; 2010.

    Google Scholar 

  • Stewart M, Andrews CN, Urbanski S, Beck PL, Storr M. The association of coeliac disease and Microscopic colitis: a large population-based study. Aliment Pharmacol Ther. 2011;33:1340–9.

    Article  CAS  PubMed  Google Scholar 

  • Szczepkowski M, Banasiewicz T, Kobus A. Diversion colitis 25 years later: the phenomenon of the disease. Int J Color Dis. 2017;32:1191–6.

    Article  Google Scholar 

  • Tong J, Zheng Q, Zhang C, Lo R, Shen J, Ran Z. Incidence, prevalence, and temporal trends of microscopic colitis: a systematic review and meta-analysis. Am J Gastroenterol. 2015;110:265–76, Quiz 277

    Article  PubMed  Google Scholar 

  • Tripodi J, Gorcey S, Burakoff R. A case of diversion colitis treated with 5-aminosalicylic acid enemas. Am J Gastroenterol. 1992;87:645–7.

    CAS  PubMed  Google Scholar 

  • Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Lecca PG, Di Cesare L, Inchingolo CD, Aiello F. The endoscopic spectrum of segmental colitis associated with diverticulosis. Color Dis. 2010;12:464–70.

    Article  CAS  Google Scholar 

  • Vallet H, Riviere S, Sanna A, Deroux A, Moulis G, Addimanda O, Salvarani C, Lambert M, Bielefeld P, Seve P, Sibilia J, Pasquali J, Fraison J, Marie I, Perard L, Bouillet L, Cohen F, Sene D, Schoindre Y, Lidove O, Le Hoang P, Hachulla E, Fain O, Mariette X, Papo T, Wechsler B, Bodaghi B, Rigon MR, Cacoub P, Saadoun D, French Behcet N. Efficacy of anti-Tnf alpha in severe and/or refractory Behcet’s disease: multicenter study of 124 patients. J Autoimmun. 2015;62:67–74.

    Article  CAS  PubMed  Google Scholar 

  • Velazquez OC, Lederer HM, Rombeau JL. Butyrate and the colonocyte. Production, absorption, metabolism, and therapeutic implications. Adv Exp Med Biol. 1997;427:123–34.

    Article  CAS  PubMed  Google Scholar 

  • Vodusek Z, Feuerstadt P, Brandt LJ. Review article: the pharmacological causes of colon Ischaemia. Aliment Pharmacol Ther. 2019;49:51–63.

    Article  CAS  PubMed  Google Scholar 

  • Whelan RL, Abramson D, Kim DS, Hashmi HF. Diversion colitis. A prospective study. Surg Endosc. 1994;8:19–24.

    Article  CAS  PubMed  Google Scholar 

  • Yadav S, Dave M, Edakkanambeth Varayil J, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sweetser SR, Melton LJ 3rd, Sandborn WJ, Loftus EV Jr. A population-based study of incidence, risk factors, clinical spectrum, and outcomes of ischemic colitis. Clin Gastroenterol Hepatol. 2015;13:731–8. E1–6; Quiz E41

    Article  PubMed  Google Scholar 

  • Yan BM, Shaffer EA. Primary eosinophilic disorders of the gastrointestinal tract. Gut. 2009;58:721–32.

    Article  CAS  PubMed  Google Scholar 

  • Yen EF, Pokhrel B, Du H, Nwe S, Bianchi L, Witt B, Hall C. Current and past cigarette smoking significantly increase risk for microscopic colitis. Inflamm Bowel Dis. 2012;18:1835–41.

    Article  PubMed  Google Scholar 

  • Yuste C, Merida E, Hernandez E, Garcia-Santiago A, Rodriguez Y, Munoz T, Gomez GJ, Sevillano A, Praga M. Gastrointestinal complications induced by sevelamer crystals. Clin Kidney J. 2017;10:539–44.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zeidan MJ, Saadoun D, Garrido M, Klatzmann D, Six A, Cacoub P. Behcet’s disease physiopathology: a contemporary review. Auto Immun Highlights. 2016;7:4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Alpert Medical School of Brown University, Providence, RI, USA

    Chung Sang Tse, Abbas Rupawala, Osman Yilmaz & Samir A. Shah

  2. Gastroenterology Associates Inc, The Miriam Hospital, Providence, RI, USA

    Samir A. Shah

Authors
  1. Chung Sang Tse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abbas Rupawala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osman Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samir A. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samir A. Shah .

Editor information

Editors and Affiliations

  1. Department of Medicine, Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Department of Medicine, Division of Geriatrics, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Tse, C.S., Rupawala, A., Yilmaz, O., Shah, S.A. (2021). Non-IBD and Noninfectious Colitis. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-030-30192-7_67

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-30192-7_67

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-30191-0

  • Online ISBN: 978-3-030-30192-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation