home Auditorium 8 Ulcerative colitis of the intestine. Ulcerative colitis of the intestine - symptoms, causes, treatment

Ulcerative colitis of the intestine. Ulcerative colitis of the intestine - symptoms, causes, treatment

Colitis is an inflammation or dystrophic-inflammatory lesion of the colon, leading to atrophy of the mucous membrane and dysfunction of organs. Pathological processes, covering inner surface intestines, are localized in all sections (pancolitis) or in some areas (segmental colitis).

With colitis (inflammation of the intestines), symptoms are characterized by the presence of blood, mucus in the stool, abdominal pain, nausea and false urge to defecate. In most cases, its chronic form develops, as well as nonspecific ulcerative colitis of the intestine of unknown etiology, while the intestinal mucosa becomes prone to ulceration.

Causes

Why does intestinal colitis develop, and what is it? Acute colitis in adults often occurs simultaneously with inflammation small intestines and stomach. Most often, the causative agents of acute colitis are pathogenic microorganisms.

Chronic colitis can develop in the presence of foci of infection in gallbladder, pancreas and other organs anatomically connected with the intestines, as well as with prolonged monotonous nutrition, systematic consumption of large quantities of indigestible food, abuse spicy food, alcohol.

Risk factors that lead to the development of intestinal colitis in adults:

Infection (dysentery, salmonellosis, chronic infections, amoebiasis, ).
Medicines ( long-term use antibiotics, laxatives, medications in the form of suppositories, frequent enemas).
Food or chemical poisoning. Penetration into the blood of components that kill beneficial intestinal microflora.
Stress, disruption of daily routine.
Effect of toxic substances (salts of heavy metals, mercury, lead, arsenic, etc.).
Circulatory disorders. This is also a fundamental reason for the development of manifestations of colitis, because as a result of blood deficiency, the body is often unable to independently overcome the irritant and get rid of harmful components.
Nutritional factor (consumption of rough, insufficiently heat-treated food, irregular and poor nutrition, dry food, insufficient intake of dietary fiber, frequent use spicy, salty, smoked, fatty foods, alcohol).

Exacerbation of colitis is most often caused by: consumption of foods that irritate the colon or cause allergic reactions(marinades, canned food, citrus fruits, cabbage, cucumbers, etc.), overwork, emotional overload, overheating, reception large doses antibacterial drugs.

Classification

Colitis is classified according to etiology:

Ulcerative - a disease with unclear etiology, in the development mechanism of which heredity, autoimmune mechanisms and infection play a role.
Infectious - caused pathogenic microflora, which can be specific (for example, dysenteric colitis), banal (streptococci, staphylococci) and opportunistic (for example, E. coli);
Ischemic - with occlusive lesions of the branches abdominal aorta(for example, with atherosclerosis), supplying blood to the large intestine;
Toxic or medicinal in case of poisoning with certain poisons or medicines(For example, );
Radiation for chronic radiation sickness.

Spastic intestinal colitis

Often spastic colitis intestines is caused by an unhealthy lifestyle, as well as mistakes made in nutrition. Doctors in many cases call this disease irritable bowel syndrome, during which a chronic inflammatory phenomenon is observed in the colon mucosa.

The disease can develop after drinking coffee, soda, alcohol, poor-quality food for a long time, as well as after gastroenteritis.

Ulcerative colitis of the intestine

Ulcerative colitis of the intestine is characterized by a hemorrhagic-purulent inflammatory process of the colon with the development of systemic and local complications. The exact causes and origin of the disease are still unknown.

There are suggestions that the disease may be caused by an unbalanced diet, an unidentified infection, medications, genetic mutations, changes in intestinal flora and stress.

Symptoms of colitis in adults

When intestinal colitis occurs, symptoms will depend on the type of disease that is present, but in general, colitis in adults is most often associated with abdominal pain and diarrhea. Other signs of colitis that may or may not be present.

Symptoms of colitis may include:

Constant or recurrent abdominal pain and...
Chills.
Diarrhea.
Fever.
Constant urge to defecate.
. Diarrhea can sometimes cause diarrhea, which may bleed. However, blood during defecation is not normal occurrence.
Dehydration. Symptoms of dehydration include dizziness, weakness, decreased urination, and dry mouth, eyes, and skin.

In some patients, local manifestations are accompanied by weakness, nausea and vomiting; increased fatigue, weight loss. Symptoms persist for several weeks and disappear with treatment. The transition of the disease to chronic is accompanied by the involvement of ligaments and muscles in the process. In this case, the capillaries expand, ulcers and abscesses form. Patients are concerned about:

pain;
constipation or diarrhea;
tenesmus; flatulence;
pungent odor of feces.

Patients feel satisfactory, but are concerned about malaise, decreased performance, lack of appetite, a feeling of bitterness in the mouth, belching and nausea.

Diagnostics

The diagnosis of colitis begins with a careful history taking. Since symptoms are usually abdominal pain and diarrhea, it is important to inquire about the onset and duration of these pains and any other complaints or symptoms the patient may have. Since most causes of diarrhea are relatively benign and self-limiting, questions may be asked to look for the causes listed above.

Instrumental diagnostic procedures include:

Colonoscopy and sigmoidoscopy. With the help of such studies, it is possible to detect catarrhal or atrophic changes in the intestinal mucosa.
Scatology. This stool test can be used to assess the condition of metabolic processes And digestive system. In chronic form of colitis in stool there is a lot of mucus present. results microscopic examination show the presence of leukocytes and erythrocytes.
Radiography or irrigography. These studies allow us to assess the condition of the intestinal mucosa, localization inflammatory process. They also allow you to determine.

Colitis is very similar in symptoms and clinical picture to malignant neoplasms large intestine, therefore a biopsy of suspicious areas of the intestine should be performed in order to determine or exclude the oncological nature of the changes.

How to treat intestinal colitis in adults

In case of exacerbation of chronic or acute colitis, treatment should be carried out in a hospital setting in the proctology department, if it turns out infectious nature colitis, then in specialized departments of infectious diseases hospitals.

When symptoms of intestinal colitis appear, treatment in adults is carried out comprehensively, prescribing drugs that eliminate the cause of the disease and eliminate its consequences. For all types of colitis, regardless of its cause, diet 4 (a, b, c) according to Pevzner, intestinal adsorbents, drugs that regulate stool (laxatives (Guttalax) or antidiarrheal (Loperamide)), stimulate regeneration (Methyluracil, etc.), restore microflora (prebiotics and), desensitizing and detoxification treatment, vitamins and immunomodulators, mineral water and exercise therapy.

Folk remedies

Treatment of colitis folk remedies also occurs depending on the type of disease. The most common herbal treatment is based on taking infusions of chamomile, centaury and sage. One teaspoon of each herb should be brewed in 200 ml of boiling water. It is necessary to take one tablespoon at an interval of two hours.

About a month after starting to take the infusion, you can either reduce the dose or increase the interval between doses. What are the benefits of herbs for colitis? This infusion can be taken for a long time if you are worried about intestinal colitis, the treatment of which, as a rule, takes quite a long time.

Chronic intestinal colitis: symptoms and treatment

For chronic form Colitis is characterized by a sluggish course, with occasional exacerbations. Pathological changes in the mucosa that occur in the large intestine with this form of the disease are the result of a long-term inflammatory process. Inflammation affects not only the mucous membrane, but also the ligamentous-muscular apparatus; shortening and narrowing of the intestine occurs at the site of the lesion.

General symptoms of chronic colitis can be divided into species depending on morphological changes:

Catarrhal;
Ulcerative;
Erosive;
Atrophic;
Mixed.

All these species have general clinical signs:

These symptoms occur in all nosological forms of the disease, but their severity and combination are individual.

Chronic colitis is one of the few diseases for which the basis of treatment is not medication, but nutrition and diet. Antibacterial drugs and symptomatic remedies for the treatment of chronic colitis, it is used only during the period of exacerbation, under the strict supervision of a doctor. And everything else is in your hands.

During the period of exacerbation, diet No. 4a is prescribed for the treatment of chronic colitis for 2–5 days.
Next, they switch to the main diet for chronic colitis No. 4b.
Outside of an exacerbation, that is, during the period of remission, diet N 4c is recommended.

Approximate one-day diet menu for chronic colitis No. 4b, recommended by the Institute of Nutrition of the Russian Academy of Medical Sciences:

All day:

White bread - 400 g.
Sugar - 50 g (part of it can be replaced with jam, sweets).

Breakfast (7 hours 30 minutes):

Rice porridge with water (300 g) with the addition of 1/3 milk and butter (5 g).
A glass of tea.

Lunch (12 - 13 hours):

A bowl of soup on meat broth with vermicelli.
Steamed meat cutlets (150 g) with carrot puree (150 g).
A glass of apple jelly.

Dinner (17 - 18 hours):

Boiled fish (85 g).
Mashed potatoes (150 g).
Unsweetened bun, Russian cheese (25 g).
A glass of tea.

At night (20 hours):

A glass of non-acidic kefir with white bread or a glass of tea with dry cookies (“School”, biscuits, dried biscuit).

In order to overcome harmful bacteria Antibiotics should be prescribed, and in the presence of dysbacteriosis, drugs that contain bacteria necessary for the microflora. It is worth noting that chronic colitis is often accompanied by spasms. That is why, during the treatment period, a specialist prescribes antispasmodics. But if stool is disrupted, it is necessary to use adsorbent drugs.

Enough frequent method The treatment of this disease can be considered the use of physiotherapeutic procedures. If, for example, an intestinal disorder occurs due to a nervous breakdown or severe overvoltage, then the specialist may prescribe additional psychotherapeutic treatment.

Treatment of ulcerative colitis

Ulcerative colitis intestines are more difficult to treat. More required intensive therapy, which means longer and more expensive. Drugs for treatment of this type pathologies are not only expensive, but also have a lot of side effects, therefore they are used strictly as prescribed by a specialist.

They are produced in the form rectal suppositories, enemas, in tablet form (Salofalk, Pentasa, Mezavant, Mesacol). In some cases, they resort to the use of biological therapy drugs, such as the drugs Humir (Adalimumab), Remicade (Infliximab).
In the most severe cases, the use of corticosteroid medications (Prednisolone, Methylprednisolone, Hydrocortisone) is permissible. The drugs are available in the form of rectal droppers, suppositories, and tablets.

Everyone knows the dangers of nonspecific ulcerative colitis of the intestine, the symptoms and treatment of this disease. This is one of the most common pathologies of the digestive system. The causes may be autoimmune disorders, infection, dysbiosis, poor diet, stress, and diseases of other gastrointestinal organs.

Development of colitis in children and adults

Ulcerative colitis is a chronic inflammatory disease in which defects form in the intestinal mucosa. This pathology It is more often diagnosed in adults aged 20 to 40 years. Ulcerative colitis in children is detected much less frequently. The incidence rate is 50-80 cases per 100 thousand people. The process may involve the cecum, colon, transverse, sigmoid and rectum.

If left untreated, dangerous complications may develop. It is difficult to get rid of this disease forever. It is necessary to constantly adhere to the doctor's recommendations (take medications and follow a strict diet). With ulcerative colitis of the intestine, symptoms depend on the stage of the disease. Colitis occurs with periods of exacerbation. Signs of ulcerative colitis are caused by the following disorders:

bleeding;
swelling and irritation of the intestinal mucosa;
ulcerations;
formation of pseudopolyps;
atrophy of the mucous layer.

If such symptoms of ulcerative colitis of the intestine appear, you should immediately consult a doctor for treatment.

Local clinical symptoms

Signs of colitis in children and adults are divided into local and general.

Local (local) symptoms of ulcerative colitis include abdominal pain, stool disturbances, false urges to bowel movements, flatulence, stool disturbances, the presence of blood or pus in the stool. All these signs are not specific and occur in other diseases (infectious enterocolitis, gastritis, peptic ulcer stomach and duodenum, Crohn's disease).

Most frequent symptoms diseases - pain and stool disturbances. Their severity depends on the size of the affected area and the location of inflammation. The pain can be mild or severe. With diffuse inflammation of the colon, it is constant and intense. Most often it is stabbing. In severe cases, it may appear pain syndrome according to the type of colic.

The pain is localized in the lower abdomen, in contrast to gastritis, in which the pain is felt at the top. Chronic ulcerative colitis is characterized by bowel dysfunction. Most patients develop diarrhea. The average frequency of bowel movements is 5 times a day. In severe cases, the number of urges to go to the toilet reaches 15-20. Tenesmus occurs mainly in the morning and at night.

In ulcerative colitis, symptoms include rectal bleeding caused by damage to blood vessels at the site of the ulcers. There is an admixture of blood in the stool. She bright red and is located on top of feces. Sometimes blood is released from the anus regardless of bowel movements. If the inflammation affects only the rectum, then the movement of feces may be impaired. Often, along with blood, other pathological impurities (pus and large amounts of mucus) are found.

General symptoms of the disease

Patients with nonspecific ulcerative colitis (UC) also experience complaints general. These include rapid heartbeat, pale skin, weakness, elevated temperature, weight loss, muscle and joint pain. These symptoms of ulcerative colitis of the intestine appear during an exacerbation. In severe cases of colitis, the body temperature rises to +38 ºC and higher. Blood loss due to internal bleeding leads to anemia.

Patients with this diagnosis are characterized by pale skin of the face and entire body, dizziness, weakness, and loss of strength. A sick child or adult loses weight. This happens due to lack of appetite. Weight loss is partly due to protein loss from diarrhea. Total damage to the intestines can cause dehydration. Patients often feel thirsty.

Signs of complicated colitis

The large intestine takes a long time to heal against the background of inflammation and the formation of ulcers. If left untreated, the disease progresses and leads to complications. The following consequences of this pathology are possible:

If treatment is not carried out, other organs may be involved in the disease. Inflammatory eye diseases are often observed. These include uveitis, iridocyclitis, and episcleritis. The condition of the oral mucosa largely depends on the functioning of the intestines. Colitis is often accompanied by stomatitis. Extraintestinal manifestations of the disease are very different. These include inflammation of the joints and muscles. Colitis is often combined with osteoporosis, glomerulonephritis and vasculitis.

After 50 years, all patients should undergo a colonoscopy.

This is due to the fact that long-term ulcerative colitis can lead to colon cancer.

Treatment of ulcerative colitis

For nonspecific ulcerative colitis, treatment should be comprehensive. It is carried out after the following studies:

In most cases, treatment is conservative. In case of exacerbation of the disease, bed rest is required. Hospitalization is carried out in case of massive bleeding and the development of other complications. Only the doctor knows how to cure the sick. There are conservative and radical methods of therapy.

The following groups of drugs are used to treat nonspecific ulcerative colitis:

Corticosteroids (Metypred, Dexamethasone).
Immunosuppressants (Methotrexate, Cyclosporine, Azathioprine).
Anticytokines (Infliximab).
Aminosalicylic acid derivatives (Sulfasalazine).
Analgesics.
Antispasmodics.
Antidiarrheal medications (Loperamide, Imodium).

The drugs are used in the form of tablets, solutions and suppositories. Local treatment with suppositories is effective for ulcerative lesion rectum and sigmoid colon. The dosage and frequency of administration are determined by the doctor. Systemic glucocorticoids have a pronounced anti-inflammatory effect and have many side effects, so they are prescribed only in severe cases.

To improve metabolic processes in the colon, vitamins are prescribed. They strengthen the mucous membrane and speed up the healing process. If there is constant bleeding, the attending physician may prescribe iron supplements to the patient, which are effective in treating anemia. According to indications, medications are used to stop bleeding. This group includes Vikasol, Dicinone, Aminocaproic acid.

In the event of the development of purulent complications or the addition of an infection, systemic antibacterial drugs. Medicines alone cannot cure a person. In the remission phase, in the absence of pain and bleeding, physiotherapeutic procedures are prescribed. Most often carried out:

Exposure to alternating current.
Diadynamic therapy.
Interference therapy.

Principles of nutrition for patients

Treatment of nonspecific ulcerative colitis necessarily involves nutritional therapy. Diet is the best remedy from of this disease. In the remission phase with severe inflammation, table No. 4a is prescribed. Gradually, patients are transferred to diet No. 4b. During the period of remission, table No. 4c is prescribed. Subsequently, foods that are poorly tolerated by the patient are excluded from the diet.

A specialist knows whether ulcerative colitis can be cured by following proper nutrition. Only an integrated approach, including diet, medication, physical therapy and normalization of lifestyle, allows success. Treatment of peptic ulcers with diet includes the following aspects:

complete abstinence from alcohol;
drinking plenty of water;
increasing the amount of protein in the diet;
enrichment of dishes with vitamins and microelements;
increasing calorie intake;
adherence to food intake;
fractional meals 5-6 times a day;
exclusion from the consumption of prohibited foods and dishes;
proper cooking.

It is necessary that vitamins be present in large quantities in foods. To do this, you need to enrich your diet with berries, vegetables and fruits. In order for treatment to be effective for ulcerative colitis of the intestine, you should avoid foods that increase peristalsis, irritate the mucous membrane and increase fermentation in the intestines.

Dairy products, spices, carbonated water, mayonnaise, chips, popcorn, smoked meats, pickles, etc. are prohibited. Exotic fruits(kiwi, pineapple), plum, chocolate, coffee, seeds, legumes, mushrooms, fatty meat and fish, corn, ketchup and sauces, spicy cheese, raw vegetables.

Breakfast and lunch should include most of food eaten. Dinner is made light. It is recommended to cook food by steaming. Spicy and fried foods have a bad effect on the gastrointestinal tract.

For ulcerative colitis, it is allowed to eat seafood, boiled vegetables, fruits, lean meat and fish, boiled eggs, slimy porridge, mild cheese, liver, tomato juice.

Surgical treatment of colitis

If you do not inject medications and do not adhere to a diet, complications develop. In this case conservative therapy will not help. Specialists know how to treat ulcerative colitis surgically. Highlight the following readings for the operation:

Ineffectiveness of conservative therapy.
Blood loss of 100 ml per day or more.
Perforating damage to the colon.
Suspicion of malignancy.
Abscess formation.
Intestinal obstruction.
Fistula formation.
Formation of toxic megacolon.

If drug treatment for ulcerative colitis does not give the expected result, then radical measures are required. Currently held the following types surgical interventions on the colon:

Resection.
Colectomy.
Ileostomy placement.

In advanced cases, the only curative method is removal of the entire colon followed by anastomosis. If only a limited area is affected, then segmental resection is performed. Similar treatment ulcerative colitis of the intestine is organized only according to strict indications. This is rarely observed.

Traditional methods of treatment and prevention

Treatment of ulcerative colitis with folk remedies is effective only for early stages illness, it is carried out at home only after consultation with a doctor. To treat ulcerative colitis using folk remedies:

oak bark;
aloe juice;
goldenrod;
horsetail;
Chinese bitter gourd.

To speed up the healing of ulcers and eliminate inflammation, it is useful to drink fresh aloe juice. This must be done 2 times a day, 0.5 cups.

For ulcerative colitis, treatment with folk remedies involves the use herbal infusions. It is recommended to infuse chamomile along with sage and centaury.

It is useful to take infusions and decoctions based on herbs that have a hemostatic (hemostatic) effect. One such remedy is horsetail. It heals ulcers, helps stop bleeding and prevents constipation. When identifying ulcerative colitis in children and adults, you need to remember that traditional methods treatments are not basic. This is an addition to drug therapy and diet.

Prevention of the development of this intestinal pathology is proper nutrition and periodic examination. It is important to treat promptly chronic diseases digestive tract. The prognosis for ulcerative colitis in the absence of complications is favorable.

The risk of ulcer degeneration cancerous tumor is 3-10%.

Thus, colitis is common and dangerous disease among adults. Early diagnosis and proper drug treatment can reduce the risk of complications and reduce the frequency of exacerbations of this disease.

Ulcerative nonspecific colitis(syn. hemorrhagic purulent rectocolitis) – chronic illness large intestine, characterized by hemorrhagic inflammation large intestine.

Most often, the disease affects young people (from 20 to 40 years old). Women get sick more often than men. Incidence of ulcerative nonspecific colitis higher in cities than in rural areas.

Etiology
The etiology (cause) of the disease still remains unknown. Autoimmune damage to the tissues of the walls of the large intestine is assumed. This assumption is based on the fact that in most cases, ulcerative colitis is associated with other autoimmune diseases (systemic vasculitis, systemic connective tissue lesions, autoimmune thyroiditis, etc.).

Pathogenesis
The pathogenesis (mechanism of disease development) of ulcerative colitis has not been sufficiently studied. People suffering from this disease, as a rule, have impaired immune system function: even mild irritants cause unusually strong inflammatory reaction leading to damage to the body's own tissues. Important role dysfunction of the hypothalamic-pituitary system (the central link in the regulation of the functioning of internal organs and endocrine glands), chronic stress and overexertion, poor nutrition. However, the main role is played by the genetic predisposition of the immune system to a hyperergic (unusually strong) response. As a result of the above-mentioned disorders, increased sensitivity body to various kinds irritants: microbes, allergens, toxins, etc. In the case of ulcerative colitis, foci of inflammation are localized at the level of the walls of the large intestine. The chronic course of the disease leads to the development of local and general complications, which will be discussed below (see Clinical manifestations).

Pathological anatomy
The pathological anatomy (morphological substrate of the disease) of ulcerative colitis is represented by diffuse superficial damage to the walls of the large intestine. In the vast majority of cases, the disease is localized in the terminal (final) parts of the large intestine: the sigmoid and rectum. Involvement of the entire large intestine is much less common. Involvement of the final portion of the small intestine is very rare.

Morphologically, lesions in ulcerative nonspecific colitis are represented by small ulcerations of the mucous membrane of the large intestine. The mucous membrane itself is full of blood. Areas of preserved epithelium undergo hypertrophy (increase in size) and protrude above the surface of the mucous membrane (pseudopolyposis). As a rule, ulcers do not penetrate deeper than the mucous membrane. At chronic course diffuse thickening of the walls of the large intestine is observed. The addition of infection manifests itself in the formation of a purulent inflammatory process. Bleeding in ulcerative colitis occurs from damaged areas of the mucous membrane. The intestinal mucosa is extremely sensitive and begins to bleed even with slight mechanical stress.

Clinical manifestations of ulcerative colitis

Symptoms of the disease depend on the stage of development of the disease. The first symptoms may be abdominal pain (especially in the left side of the abdomen), constipation, a slight increase in temperature, and joint pain. Usually patients do not attach any importance to these symptoms. Next, rectal (from the rectum) bleeding or bloody purulent discharge. The amount of blood released per day can vary from a few drops to 20 milliliters. Sometimes there is diarrhea mixed with fresh blood. In cases acute development ulcerative nonspecific colitis, may resemble dysentery - there is a strong increase in temperature, frequent diarrhea with bloody impurities, fever.

Ulcerative nonspecific colitis is a chronic disease. Periods of exacerbation of the disease alternate with periods of remission (the time interval during which the clinical manifestations of the disease subside). During the period of exacerbation, significant digestive disorders are observed: diarrhea, abdominal pain. The patient loses weight and anemia develops. Bloody or bloody-purulent discharge is discharged from the rectum. During the period of remission, the symptoms of the disease can practically disappear, and the patient’s well-being improves significantly.

With a long course of the disease, the development of various complications is typical. Local complications represented by toxic dilatation (expansion) of the intestine, internal bleeding, perforation (perforation) of the intestinal wall with the development of peritonitis, stenosis (narrowing) of the intestinal lumen in the development intestinal obstruction, colon polyposis. Also, after 8-10 years of illness, the risk of developing infiltrative colon cancer increases significantly. When the rectum is affected, the development of hemorrhoids and anal fissures is observed.

General complications of ulcerative colitis include damage to various internal organs: pneumonia, pancreatitis, hepatitis, pyelonephritis, urolithiasis, amyloidosis of internal organs, joint damage, pyoderma, conjunctivitis, keratitis, mental disorders.

In some cases, the disease can develop in children and older people. In childhood, the symptoms of the disease are mild, and periods of remission can last several years. In elderly patients, the disease develops sluggishly (this is explained age-related decline functions of the immune system), complications develop much less frequently than in young patients.

Diagnosis of ulcerative colitis

Diagnosis of ulcerative nonspecific colitis begins with an analysis of anamnestic data and a clinical examination of the patient. From the anamnesis (the history of the patient’s life and illness, told by him) the doctor learns the main symptoms characteristic of the disease. To establish the form of the disease, attention is paid to the evolution of the disease from the moment the first symptoms appear until the moment you consult a doctor. The doctor is obliged to clarify whether any treatment was undertaken, and if so, what kind. Of particular importance is the establishment of the hereditary type of the disease and the detection of other autoimmune pathologies.

General inspection The patient reveals signs of anemia - pallor and dry skin, fragility and loss of shine in hair, splitting of nails, the appearance of cracks in the corners of the mouth, etc. When palpating the abdomen, as a rule, pain is established in the left part of the abdomen, and sometimes in the entire abdomen.

Anamnestic data in most cases are sufficient to suspect ulcerative nonspecific colitis, however, in order to differentiate this disease from other diseases with a similar course, they are prescribed additional methods research.

X-ray examination is intended to clarify the localization and extent of the pathological process, identify the presence of complications, and also carry out periodic monitoring of the development of the disease. Plain radiography of the abdominal cavity with ulcerative colitis shows uneven filling of the large intestine with gas, thickening and an uneven internal contour of the intestinal walls. To clarify the structure of the mucous membrane, an x-ray is taken with the introduction of a contrast mass of barium sulfate suspension into the intestinal cavity. As a rule, this research method makes it possible to identify ulcerations of the intestinal mucosa in the form of “flaps” or “double contours”. The development of complications is manifested by the presence of air in the peritoneal cavity or penetration of the contrast mass outside the intestine (in case of perforation of the intestinal walls), the presence of a “filling defect” or local rigidity of the intestinal walls (in case of intestinal cancer), or an obstacle to the advancement of the radiopaque mass (in case of intestinal stenosis).

Colonoscopy- is one of the most informative methods research in diseases of the large intestine. The essence of the method is to examine the condition of the mucous membrane and intestinal walls using a special fiber-optic imaging system. Colonoscopy reveals several signs characteristic of ulcerative nonspecific colitis: the presence of regeneration of the intestinal mucosa in the form of pseudopolyps, contact bleeding when moving the colonoscopy apparatus along the intestinal walls, the diffuse nature of ulcerations. To clarify the diagnosis, during a colonoscopy, intestinal tissue is collected for histological analysis. Histological analysis allows you to definitively differentiate ulcerative nonspecific colitis from diseases with similar manifestations (for example, Crohn's disease).

Diet therapy involves appointment normal nutrition, excluding coffee and fruits in large quantities. Adding dietary fiber to a patient's diet reduces the severity of diarrhea.

Anti-inflammatory treatment carried out with drugs 5-aminosalicylic acid (Mesalamine). The drug is prescribed in the form of rectal suppositories for lesions of the rectum or as an enema for lesions sigmoid colon. For more extensive damage to the large intestine, the drug is taken internally.

Treatment with corticosteroids (Prednisolone) is less effective than 5-aminosalicylic acid drugs. In some cases (in severe cases of the disease), immunosuppressants (Cyclosporine) are used.

If complications develop (internal bleeding, perforation of the intestinal wall, suspected tumor, intestinal stenosis), surgical removal of the affected intestinal segment is performed.

Disease prognosis
Properly planned and carried out treatment in most cases helps to achieve stable remission of the disease. In such cases, patients with ulcerative colitis can lead an active lifestyle. With rapidly progressing forms of the disease, as well as with the onset of complications, the prognosis of the disease is less favorable.

Bibliography:

Kanshina O.A. Nonspecific ulcerative colitis in children and adults, M.: Bioinformservis, 2002
Khalif I.L. Inflammatory diseases intestines: (Nonspecific ulcerative colitis and Crohn's disease). Clinic, diagnosis and treatment, M, 2004
Mayevskaya M.V. Gastroenterology, M., 1998

Ulcerative nonspecific colitis is a severe pathology. It affects only the mucous membrane of the large intestine in the form of destructive inflammatory and ulcerative processes varying intensity. The pathology affects the rectum and gradually spreads to all parts of the large intestine. It begins slowly and the first sign of its development may be bleeding from the rectum. The difficulty of treating this disease is that it is poorly understood and, as a rule, it lasts quite a long time.

This disease most often occurs in residents of megacities. It usually manifests itself in the elderly (after 60 years) or at a young age up to 30 years and is not contagious.

Table of contents:

Causes of ulcerative colitis

Scientists have not established the exact cause of ulcerative colitis, but they have identified a number of causative factors. These include:

hereditary predisposition;
infection of unknown origin;
genetic mutations;
poor nutrition;
disturbance of intestinal microflora;
taking certain medications (contraceptives, some anti-inflammatory drugs);
frequent

In a patient with ulcerative nonspecific colitis, it begins to work not against pathogenic microbes, but against the cells of the mucous membrane of his own intestines, which ultimately leads to ulceration. The immune mechanism of this pathology gradually spreads to other organs and systems. This is manifested by lesions and inflammation of the eyes, skin, joints, mucous membranes.

Taking into account clinical picture The following forms of this pathology are distinguished:

chronic ulcerative colitis;
spicy;
chronic relapsing type.

Chronic ulcerative colitis has a constant course, without periods of remission. At the same time, it can have both compensated and difficult character currents. The severity of this disease directly depends on the extent of damage to the healthy intestinal mucosa. This form proceeds sluggishly and continuously, the duration depends on the patient’s state of health. The disease itself greatly depletes the patient’s body. If the patient’s condition reaches critical level, then mandatory surgery. When such colitis has a compensated form, it can last for many years. In this case, conservative therapy can improve the patient’s condition and gives a good effect.

Acute form Nonspecific ulcerative colitis has a rather abrupt and violent onset. Inflammatory and ulcerative processes in the large intestine develop from the very beginning of the disease, so it is quite severe, but is very rare in practice. Pathological processes develop at lightning speed and spread to the entire intestine, which is called total colitis. It is very important to start treatment immediately.

Recurrent form Nonspecific ulcerative colitis occurs with phases of remission and exacerbation. In some cases, attacks stop spontaneously and do not appear for a long time.

Symptoms of nonspecific ulcerative colitis

There are many signs of ulcerative colitis and they can be varying degrees severity depending on the severity of the disease and its form. In this regard, some patients remain in normal health throughout their lives, and among the symptoms only blood appears in the stool (which is often incorrectly associated with hemorrhoids). In another part of patients there is more serious condition With bloody diarrhea, fever, abdominal pain, etc.

Specific symptoms of ulcerative colitis include the following complaints:

bleeding from the rectum, accompanied by pain, diarrhea;
(up to 20 times per day);
cramping pain in the abdomen;
(happens very rarely, diarrhea is usually observed);
lack of appetite;
increased body temperature;
weight loss due to persistent diarrhea;
decreased hemoglobin levels in the blood (due to constant bleeding);
blood in the stool (this symptom occurs in 9 out of 10 patients and can take the form of either a bloody stain on toilet paper or massive bloody stool);
an admixture of mucus in the stool;
frequent false urge to defecate - “rectal spitting” (when instead of feces, pus and mucus come out of the rectum);
defecation at night (the patient wakes up at night due to an uncontrollable desire to defecate);
flatulence (bloating);
intoxication of the body (tachycardia, dehydration, fever).

There are a number of extraintestinal symptoms of ulcerative colitis that are not related to the gastrointestinal tract:

joint pain;
eye pathologies;
liver diseases;
the appearance of a rash on the body and mucous membranes;
blood clots

These signs may appear even before the symptoms of colitis itself, depending on its severity.

Complications

As a result of nonspecific ulcerative colitis, patients may develop the following complications:

intestinal perforation;
intestinal profuse bleeding;
toxic megacolon (a fatal complication, as a result of which the large intestine in a certain place increases in diameter up to 6 cm);
rupture of the intestinal wall;
anal passage;
fistula or abscess;
narrowing of the lumen of the colon;
colon (the risk of developing it in a patient with colitis increases every year after 10 years of illness).

Confirmation of the diagnosis requires a very thorough examination of the patient. First of all, this makes it possible to distinguish ulcerative colitis from other intestinal pathologies that have similar symptoms.

Inspection

During an objective examination, the doctor can both note the presence of typical signs of the disease and their absence. Finger rectal examination allows the doctor to determine the presence of pathologies such as thickening of the rectal mucosa, anal fissures, rectal fistulas, abscess, sphincter spasm, etc. The doctor must prescribe everything necessary research, in order to ultimately carry out a differential diagnosis with pathologies in the form of irritable bowel syndrome, diverticulitis, colon cancer, Crohn's disease.

When examining the material taken, damage to the intestinal mucosa is detected in the form of ulcers penetrating deep into the submucosal layer, sometimes even to the muscular layer. The ulcers have undermined, smooth edges. In those areas of the intestine where the mucous membrane has been preserved, excessive regeneration of the glandular epithelium can be detected, resulting in pseudopolyps. A characteristic sign in the form of “crypt abscesses” is also often detected.

Treatment of ulcerative colitis

The type of therapy for nonspecific ulcerative colitis depends entirely on its severity and the patient’s condition. In most cases, it involves receiving special drugs, for the correction of diarrhea, the digestive process. In more severe cases, they resort to taking additional medications and surgical treatment.

Hospitalization is extremely necessary when diagnosed for the first time, this allows doctors to determine the amount of necessary treatment for concomitant hematological and metabolic disorders. Among them, the most common are hypovolemia, acidosis, and prerenal azotemia, which develop as a result of large losses of electrolytes and fluid through the rectum. Because of this infusion therapy and blood transfusions are simply mandatory for such patients.

The goal of treating nonspecific ulcerative colitis:

Elimination of complications (anemia, infectious inflammation).
Prescribing special nutritional supplements (they make it possible to ensure normal sexual development and children's growth).
Relieving and eliminating the symptoms of the disease.
Controlling and preventing seizures.

Conservative treatment includes, in addition to medications, diet. It must be mechanically gentle and contain increased amount easily digestible proteins in the form of cottage cheese, meat and fish (low-fat). But the consumption of fresh fruits and vegetables is prohibited. You should eat in small portions. Food must be normal temperature, not cold and not hot. Parenteral nutrition indicated in cases of severe disease.

Drug therapy includes:

Intravenous infusions to relieve intoxication of the body, normalize water, electrolyte and protein balances.
. The drugs are prescribed taking into account the sensitivity of the microflora of the large intestine.
Tranquilizers. For the purpose of sedation, Seduxen and Elenium are prescribed.
Antidiarrheals. The regimen includes anticholinergic drugs (Platifillin, Belladonna tincture, Solutan), herbal astringents(decoction of pomegranate, blueberry, alder peels).
Sulfosalazine (Saloftalk) is a drug that is absorbed in the terminal colon. It is administered locally or systemically (suppositories, enemas).
Corticosteroid hormones. They are administered systemically or as an enema in severe cases.

Surgery

It is resorted to when complications arise in the form of heavy bleeding, colon cancer, absence therapeutic effect from conservative methods, intestinal obstruction, fulminant forms of ulcerative colitis with tolerance to treatment, perforation.

Nonspecific ulcerative colitis is a chronic disease of the gastrointestinal tract that has a relapsing nature. With this pathology, inflammation of the mucous membrane of the large intestine is observed, which is covered with ulcers and areas of necrosis.

Clinical manifestations of ulcerative colitis are abdominal pain, general weakness, weight loss, arthritis, bloody diarrhea, and the disease significantly increases the risk of developing colorectal oncology.

Causes of ulcerative colitis

The etiology of the disease today is not fully understood, but scientists are intensively searching for the true causes of ulcerative colitis. Despite the lack of accurate data on the causes of the pathology, the main risk factors for this disease have been identified, which include:

exposure to inflammatory factors (during the formation of an antigen-antibody complex, which is released during the body’s immune response);

autoimmune factors - inflammation occurs due to massive death of cells that contain antigens;

influence of infection - the intestine is a place of accumulation large quantity microorganisms that, under certain conditions, can cause inflammation;

genetic factors - the risk of ulcerative colitis increases if a person has a family history of patients with this pathology;

Scientists also highlight eating disorders and psychotraumatic factors.

American researchers, in the course of a large-scale experiment, found that fungi present in the intestines are associated with inflammatory pathologies intestines (ulcerative colitis and Crohn's disease). Studies in rodents have helped prove that there is a connection between ulcerative colitis and various fungi in the intestines.

Fungi that are present in the body of mammals activate the production of the protein dectin-1 by leukocytes. When the body is unable to produce this protein in mice, ulcerative colitis of the intestine develops. Application antifungal drugs makes it possible to mitigate the course of this pathology even in rodents.

IN human body Dectin-1 is encoded by the CLEC7A gene; research has found that the presence of a mutant form of the above-mentioned gene in the body leads to the development of ulcerative colitis, which cannot be treated with traditional methods (corticosteroids, NSAIDs, diet). Mutations in this gene contribute to the development of a more severe form of pathology, since the gene is associated with other factors that influence inflammation. It is worth noting that treatment with antifungal drugs in this case gives a positive result.

Symptoms of Ulcerative Colitis

There are quite a lot of symptoms of ulcerative colitis, and there are intestinal symptoms and signs associated with intestinal manifestations.

The main intestinal symptoms of nonspecific ulcerative colitis:

Diarrhea with bloody impurities.

Diarrhea with mucus and blood, and in some cases even pus, is the main diagnostic sign of this disease. In some cases, the discharge of pus, mucus and blood occurs spontaneously (regardless of bowel movements). The frequency of bowel movements in patients with ulcerative colitis varies and can range from several times a day to 15-20 times in severe cases of the disease. The frequency of bowel movements increases in the morning and at night.

Pain in the projection of the abdomen.

The pain can have varying degrees of intensity - from mild to severe, creating significant discomfort. In most cases, the localization of pain is associated with the left half of the abdomen. Severe abdominal pain is not relieved by analgesics and is a sign of the development of complications of the pathology.

possible fecal incontinence;

bloating;

Tenesmus is a false urge to defecate. In some cases, instead of feces, only mucus with pus or fragments of mucus may be released;

signs of body intoxication: frequent dizziness, poor appetite, weight loss, weakness;

increase in temperature to low-grade fever;

the likelihood of rapid (fulminant, fulminant) development of ulcerative colitis;

This form can develop over several days and is manifested by toxic megacolon (dilatation of the lumen of the large intestine). Happening sharp increase temperatures exceeding 38 degrees. The patient becomes adynamic, weak, rapidly loses weight, and appears painful sensations in the stomach, frequent loose stool with the presence of impurities of pus, blood, mucus. On terminal stage Nonspecific ulcerative colitis symptoms include oliguria, low blood pressure, and tachycardia. The patient experiences abdominal pain and bloating, bowel sounds are not bugged.

A blood test shows neutrophilic leukocytosis, an x-ray shows expansion of the colon to a diameter of over 6 cm. Dilatation is observed in the large intestine, which is caused by an increase in the level of nitric oxide, and the smooth muscles of the intestine undergo increased contractile function. Significant expansion of the large intestine is dangerous due to the possibility of perforation of its wall (perforation).

Extraintestinal manifestations of ulcerative colitis

Such symptoms occur much less frequently in 10-20% of cases. These include:

skin lesions - pyoderma gangrenosum and erythema nodosum. This is due to the fact that there is an increased concentration of cryoproteins, immune complexes, and bacterial antigens in the blood;

symptoms of oropharynx damage. Associated with the appearance of aphthae - these are specific rashes on the mucous membrane oral cavity, the volume of which decreases in proportion to the transition of the pathology to a state of remission. Occurs in 10% of patients;

eye lesions manifest themselves in the form of: choroiditis, keratitis, retrobulbar neuritis, conjunctivitis, episcleritis, uvetitis. Occurs in 5-8% of cases;

joint lesions - inflammatory processes of the joints are present in the form of spondylitis, sacroiliitis, arthritis (most often). Such lesions can be combined with intestinal pathology or be precursors to ulcerative colitis;

bone pathologies - ischemic necrosis, aseptic necrosis, softening of bones (osteomalacia), increased bone fragility (osteoporosis);

in 35% of cases there are pulmonary lesions;

damage to the biliary tract, liver, pancreas. These changes are due to the presence of disturbances in work endocrine system body;

The most rare extraintestinal symptom of ulcerative colitis is: glomerulonephritis, myositis, vasculitis.

Pathology is characterized by the presence acute phase and remission phases. The disease begins gradually, but quickly gains momentum, and, after some time, the symptoms of ulcerative colitis become pronounced.

In some cases, symptoms may subside, but then intensify again. With constant therapy, the disease becomes a state of recurrent chronic ulcerative colitis; with long-term remission, its symptoms weaken. The frequency of relapses in patients with ulcerative colitis in most cases depends not on the degree of damage to the large intestine, but on maintenance therapy ( antivirals, antibacterial drugs, non-steroidal anti-inflammatory drugs).

During the acute phase of the disease colon has the following appearance: intestinal ulcers and bleeding, hyperemia and swelling of the mucous membrane appear. During remission, on the contrary, atrophic changes appear in the mucous membrane, it begins to thin out, lymphatic infiltrates and dysfunction appear.

Diagnosis of the disease

The treatment and diagnosis of nonspecific ulcerative colitis is carried out by a gastroenterologist or a therapeutic specialist. Suspicion of this disease is caused by the presence of a complex of symptoms:

disruption of eye function due to general intoxication of the body;

arthritis, abdominal pain;

diarrhea mixed with mucus, blood, pus (in some cases).

Laboratory diagnostics:

A general blood test of a patient with ulcerative colitis of the intestine is characterized by the presence of anemia (decreased levels of red blood cells and hemoglobin), and the presence of leukocytosis. IN biochemical analysis blood present increased content C-reactive protein, which is a sign of the presence of an inflammatory process in the body. In addition, the level of calcium, magnesium, albumin decreases, and the level of gamaglobulins increases. This is due to the active process of antibody production;

an immunological blood test differs from the norm in the increased concentration of cytoplasmic antineutrophil antibodies (formed against the background of an abnormal immune response);

stool analysis notes the presence of mucus, blood and pus. Pathogenic microflora is sown in feces.

Instrumental methods for diagnosing nonspecific ulcerative colitis

Endoscopic examinations (colonoscopy, rectosigmoidoscopy) make it possible to identify a complex of symptoms characteristic of the pathology in the patient:

the presence of mucus, blood, pus in the intestinal lumen;

contact bleeding;

pseudopolyps;

granulosa, hyperemia and swelling of the mucous membrane;

in the remission phase, atrophy of the intestinal mucosa is noted.

The colonoscopy procedure can be partially replaced by capsule endoscopy. In the foreseeable future, this procedure will be performed for those patients who, due to discomfort and pain, refuse to undergo a standard colonoscopy. But it is worth noting that capsule endoscopy is not able to replace traditional endoscopic examination, since the quality of the image is significantly inferior to direct visualization. Moreover, the approximate cost of the capsule is within five hundred dollars.

X-ray examination also applies to effective methods for the diagnosis of ulcerative colitis. As contrast agent In this procedure, a barium mixture is used. An X-ray of a patient with ulcerative colitis clearly visualizes expansion in the lumen of the large intestine, shortening of the intestine, and the presence of ulcers and polyps. This study helps prevent possible intestinal perforation.

Treatment of ulcerative colitis

There is currently no etiological treatment that could affect the cause of the development of ulcerative colitis. Therapy is symptomatic in nature and is aimed at preventing the development of complications, maintaining a state of remission, and eliminating the inflammatory process. If there is no effect from use drug therapy, the patient is indicated for surgical treatment.

Among the methods conservative treatment Nonspecific ulcerative colitis is divided into:

Diet therapy.

During periods of exacerbation of the disease, the patient should refrain from eating food. You can only drink water. During the period of remission, you should reduce the amount of fat in the diet and increase the amount of foods containing protein (eggs, cottage cheese, low-fat varieties fish and meat). It is also recommended to avoid consuming coarse fiber, as it can injure the intestinal mucosa. To obtain carbohydrates you should consume: fruit and berry decoctions and compotes, jelly, jelly, honey, porridge. It is also recommended to take vitamins: C, K, A and calcium. In particularly severe cases, it is advisable to switch to artificial nutrition: enteral and parenteral.

Non-steroidal anti-inflammatory drugs (NSAIDs) - corticosteroids (Metyprednisolone, Prednisolone), Sulfasalazine, Mesalazine, Salofalk. The dosage is selected by the doctor on an individual basis.

Antibiotics. When exacerbations of the disease develop, it is recommended to take antibiotics: Tienam, Ceftriaxone, Cifran, Ciprofloxacin2.

Surgical intervention

Surgical methods for the treatment of ulcerative colitis are required for those patients who have a negative response to therapy conservative methods. The main indications for surgery for nonspecific ulcerative colitis are:

bowel cancer;

profuse bleeding;

presence of toxic megacolon;
signs of intestinal obstruction;

perforation (break in the wall of the colon).

The main types of surgical intervention include:

proctocolectomy (resection of the colon and rectum) – while the anus is preserved;

colectomy – resection of the colon;

proctocolectomy with subsequent ileostomy. In this case, an excision of the colon and rectum is performed, and after that a permanent or temporary ileostomy is applied. Through it, natural human waste is removed from the intestines. In the future, the patient undergoes reconstructive surgery. The ileostomy is removed and the natural system for bowel movements is restored.