Treatment of chronic enteritis in adults. Symptoms and treatment of enteritis in adults. Enteral manifestations include

Chronic enteritis- a chronic polyetiological inflammatory disease of the small intestine, characterized by a violation of its functions, primarily digestive and absorption, structural changes in the mucous membrane, and with a long course of the disease - its atrophy.

Treatment program for chronic enteritis

1. Treatment regimen.

2. Medical nutrition.

3. Restoration of intestinal eubiosis.

4. The use of astringent, adsorbent and enveloping drugs and medicinal plants.

5. Improving the processes of digestion and absorption in the intestines.

6. Normalization of the passage of intestinal contents and intestinal motor function.

7. Correction of metabolic, electrolyte disturbances, anemia.

8. Correction of severe endocrine disorders.

9. Immunocorrective therapy.

10. Physiotherapeutic treatment.

11. Sanatorium-resort treatment and treatment with mineral waters.

12. Dispensary observation.

During the period of severe exacerbation of chronic enteritis and in severe cases of the disease (loss of body weight by more than 10 kg, pronounced dystrophic changes in the skin, nails, hair loss, hypovitaminosis, hypoproteinemia, hapoproteinemic edema, anemia, involvement of other organs of the digestive system in the process, endocrine dysfunction) requires hospitalization of the patient in the gastroenterology department and compliance with non-strict bed rest.

In cases where the disease is not severe, patients are treated on an outpatient basis, but they must be given the opportunity to have a regular diet. Patients with chronic enteritis are prohibited from work that requires great physical effort, and psycho-emotional stressful situations should be avoided.

The main goal of therapeutic nutrition is mechanical, chemical and thermal sparing of the intestines. Therapeutic nutrition has a positive effect on the main pathogenetic factors of chronic enteritis and diarrhea.

In case of a sharp exacerbation of the disease, severe diarrhea, 1-2 so-called “fasting” days are recommended. On “hungry” days you should take about 1.5-2 liters of liquid per day in the form of:

Strong, hot, not very sweet tea with lemon 5-6 times 1>/2 glasses with 1-2 crackers;

Divorced boiled water blackcurrant juice, blueberry juice, rosehip decoction.

Instead of "fasting" days, you can use under the control of individual tolerance:

Acidophilus day - 1.5 liters of acidophilus milk per day;

Kefir day - 1.5 liters of three-day old kefir per day;

apple day - 1.5 kg of peeled apples are passed through a meat grinder or finely grated and taken in the form of a homogeneous mass in equal portions throughout the day (mashed apples have an antidiarrheal effect due to the content large quantity pectin);

carrot day - during the day, take 1.5 kg of carrots, prepared in the same way as apples, in equal portions (carrots have antidiarrheal and adsorbent effects).

After 1-2 “hungry” days, they move on to table No. 4 and its variants (46, 4c). These diets provide for the sufficient introduction into the body of all nutrients necessary for normal functioning, primarily proteins, vitamins, and electrolytes; good absorption of food thanks to an adequate set of products and appropriate culinary processing (food is prepared boiled or steamed, served pureed).

2.1. Table No. 4

Indications for purpose: acute and chronic intestinal diseases during the period of profuse diarrhea and pronounced dyspeptic symptoms. This diet option is prescribed for chronic enteritis during an exacerbation in the presence of profuse diarrhea and pronounced dyspeptic symptoms. Table No. 4 can be prescribed after 1-2 “hungry” days or immediately during an exacerbation.

General characteristics: diet with restriction of fats and carbohydrates to the lower limit physiological norm and normal protein content, with a sharp limitation of mechanical and chemical irritants of the mucous membrane and receptors of the gastrointestinal tract, with the exception of foods and dishes that enhance the processes of fermentation and putrefaction in the intestines, as well as strong stimulants of bile secretion, secretion of the stomach and pancreas, substances that irritate liver.

Culinary processing: all dishes are cooked boiled or steamed, pureed.

Energy value n compound: proteins - 100 g, fats - 70 g, carbohydrates - 250 g, salt- 8-10 g, energy value- 2100 kcal. The amount of free liquid is 1.5-2 l.

Diet: fractional (5-6 times a day).

Temperature food: hot dishes - 57-62 "WITH, cold - not lower than 15 "WITH.

bread and bakery products: white bread crackers, thinly sliced ​​and unpressed;

soups: with the addition of mucous decoctions, steam GLI meat or fish dumplings boiled in water, meatballs, boiled pureed meat;

meat dishes and fish. steamed meat and fish cutlets, meatballs, meat souffles, lean meat (beef, rabbit), minced meat is prepared by passing the meat 3-4 times through a meat grinder with a fine grid;

cereal dishes and side dishes: mashed porridge with water or low-fat meat broth- oatmeal, oatmeal, buckwheat, semolina; all legumes and pasta are excluded;

egg dishes: eggs no more than 1 per day only in dishes; if well tolerated, soft-boiled eggs or in the form of steam omelettes are allowed (no more than 2 eggs per day);

sweet dishes, fruits, berries, sugar in limited quantities (up to 40 g per day), jelly, jelly from blueberries, bird cherry, ripe pears, other berries and fruits rich in tannins:

dairy products: freshly prepared cottage cheese, pureed and in the form of a soufflé, all other dairy products are not allowed;

beverages: tea, black coffee, cocoa in water, rosehip, blueberry infusions;

fats: butter (add 5 g per serving to prepared dishes).

Sauces, spices, snacks, and alcohol are prohibited. After 4-5 days, the patient is prescribed diet No. 46.

2.2. Table No. 46

Indications for use: acute and chronic intestinal diseases during periods of exacerbation, as well as a combination of these diseases with damage to the stomach, liver, biliary tract, pancreas.

Special purpose: provide adequate nutrition in conditions of moderately expressed inflammatory process of the gastrointestinal tract, help reduce the inflammatory process in the intestine, normalize its functional state.

General characteristics: a physiologically complete diet with a normal content of proteins, fats, carbohydrates, limiting table salt to the lower limit of normal (8-10 G), with moderate limitation of mechanical and chemical irritants of the mucous membrane and receptors of the gastrointestinal tract, with the exception of products that enhance the processes of fermentation and putrefaction in the intestines, as well as strong stimulants of bile secretion, gastric secretion, and pancreas.

Cooking: All dishes are cooked boiled or steamed, pureed.

Energy value and composition: proteins - 100-120 G(according to A.L. Grebenev, up to 135 g), fats - 100-120 g, table salt - 8-10 g, energy value - 3000-3500 kcal The amount of free liquid

hundred - 1.5 l. The diet includes an increased amount of vitamins, microelements, calcium, phosphorus, iron, and lipotropic substances. Diet: fractional (5-6 times a day).

bread and bakery products: yesterday's wheat bread, dry biscuit, dry biscuits, 1-2 times a week savory buns, pies with apples, jam, cheesecakes with cottage cheese;

soups: in low-fat meat broth with well-cooked cereals, noodles, meatballs, finely chopped vegetables (potatoes, carrots, cauliflower, pumpkin);

meat and fish dishes: lean meat (beef, veal, chicken, turkey, rabbit), tender varieties in the form of a whole piece, chopped beef (cutlets, meatballs, dumplings, soufflé, boiled or steamed rolls), lean fish (pike perch, bream, cod, perch, hake ) in the form of a piece or chopped (boiled or steamed);

Vegetable dishes and side dishes: potatoes, zucchini, pumpkin, carrots, cauliflower, green peas (if well tolerated) boiled and mashed, steamed vegetable souffle; ripe tomatoes no more than 100 g per day (if well tolerated); white cabbage, beets, radishes, turnips, sorrel, spinach, onions, garlic, mushrooms are excluded;

dishes and side dishes from cereals, legumes, pasta: various porridges (except wheat and pearl barley) in water with the addition of 10% fat milk or cream, steam puddings from pureed porridges, boiled vermicelli;

egg dishes: whole eggs (no more than 1 per day) in dishes; dishes made from egg whites: steam omelettes; scrambled eggs;

jelly and mashed compotes, jellies, mousses, souffles from sweet berries and fruits (except melons, apricots, plums), baked apples, pears, marmalade, marshmallows, marshmallows, preserves and jams from sweet berries and fruits; if well tolerated, 100 g per day of raw sweet berries (strawberries, strawberries, raspberries, peeled ripe apples, but pureed); apple, cherry, raspberry, strawberry, tangerine, orange juices with half and half water;

dairy products: unleavened milk only in small quantities in dishes, kefir, acidophilus milk, fermented baked milk; Russian, Yaroslavl cheese; non-acidic sour cream in limited quantities as a seasoning; fresh cottage cheese in the form of pudding, casserole, curd mass;

sauces, spices: bay leaf, dill, parsley, cinnamon, milk sauce, fruit sauces;

snacks: jellied fish and veal, black caviar;

beverages: rosehip decoction, tea with milk, 10% cream, coffee with milk and black coffee (not strong);

fats: add butter to prepared dishes and give in its natural form with bread, no more than 5-15 g per serving.

Diet No. 46 is prescribed for 4-6 weeks until stool is completely normalized and exacerbation of chronic enteritis is eliminated. Then the patient is recommended diet No. 4c.

2.3. Table No. 4v

Indications for use: chronic intestinal diseases in remission, recovery period with acute diseases intestines.

Purpose: to provide adequate nutrition and compensation for chronic intestinal diseases in remission and restoration of impaired functions of the digestive organs during the recovery period for acute intestinal diseases.

General characteristics: a physiologically complete diet with a normal content of proteins, fats, carbohydrates, with some limitation of mechanical and chemical irritants of the mucous membrane and receptors of the gastrointestinal tract, with the exception of foods and dishes that enhance the processes of fermentation and putrefaction in the intestines, as well as strong stimulants of bile secretion, secretions of the stomach and pancreas.

Culinary processing: all dishes are cooked boiled or steamed, and also baked in the oven; food is given mainly in unchopped form.

Energy value and composition: proteins - 120-140 g, fats - 100-120 g, carbohydrates - 400-500 g, table salt - 8-10 g, calorie content - 3000-3500 isal. The amount of free liquid is 1:5 l.

Diet: preferably fractional (5-6 times a day, but at least 4 times).

Food temperature: hot dishes - 57-62 °C, cold dishes - not lower than 15 °C.

bread, bakery products: wheat bread, yesterday's bread, dry biscuit, dry cookies, 1-2 times a week buns, pies with jam, meat, apples, marmalade, jam, cheesecakes with cottage cheese;

soups: on a weak low-fat or fish broth with various cereals (except millet), vermicelli, vegetables (potatoes, carrots, zucchini, pumpkin, cauliflower), if well tolerated, white cabbage, green peas, young beans, beets are allowed;

meat and fish dishes: lean meat (beef, veal, chicken, turkey) in the form of a whole piece, cutlets, steamed or boiled meatballs; boiled lean fish;

Vegetable dishes and side dishes: potatoes, zucchini, carrots, pumpkin, cauliflower, boiled or steamed, ungrated and in puree form, vegetable casseroles, if well tolerated - green peas, White cabbage, beans, ripe tomatoes (100-120 g per day); turnips, radishes, radishes, sorrel, spinach, onions, garlic, mushrooms are excluded;

dishes from cereals, legumes, pasta: various crumbly porridges (except millet and pearl barley) in water with the addition of one-half of milk, steamed and baked puddings, boiled vermicelli;

egg dishes: whole eggs (1 per day) in dishes, steam omelettes, if well tolerated, soft-boiled eggs (no more than 2 per day);

sweet dishes, fruits, berries: jelly, compotes, jellies, mousses, souffles from sweet berries and fruits (except apricots, plums, melons), baked apples, pears, marmalade, marshmallows, marshmallows, and jams from sweet berries and fruits, raw sweet varieties berries (strawberries, wild strawberries, raspberries), ripe soft apples and peeled pears (100-200 g per day), if well tolerated, tangerines and oranges, watermelons, grapes, juices from sweet berries and fruits (apple, strawberry, cherry, tangerine and etc.);

dairy products: unleavened milk in dishes, if well tolerated - in its pure form; kefir, acidophilus milk, fermented baked milk, yogurt; mild cheese (Russian, Yaroslavl), fresh cottage cheese;

sauces and spices: bay leaf, dill, parsley, cinnamon, cloves, milk sauce, fruit sauces;

snacks: jellied fish, veal, doctor's sausage, black caviar, soaked herring, lean ham;

beverages: rosehip decoction, weak coffee and tea;

fats: butter in dishes and in its natural form with bread, no more than 5-15 g per serving, depending on tolerance.

IN therapeutic nutrition For patients with chronic enteritis, nutritional mixtures recommended for baby food (for example, “Baby”, etc.), as well as protein supplements from the Institute of Medical Nutrition, are widely used.

3.1. Antibacterial therapy taking into account the etiological role of infectious pathogens

To combat infection, antibacterial drugs are prescribed, taking into account the microflora isolated from the intestines and its sensitivity to antibacterial agents.

A. I. Parfenov, N. I. Ekisenina, L. M. Krums (1991) recommend prescribing antibacterial drugs according to the following indications:

in order to suppress the growth of any microorganisms in the upper parts of the small intestine, found in an amount of at least 10 14 microbial bodies in 1 ml of intestinal juice;

to suppress the growth of residual flora (staphylococci, Proteus, yeast) and strains of microorganisms with altered properties (hemolytic, enteropathogenic, etc.) in the colon;

With accompanying focal infections- cholecystitis, pyelitis, cystitis, etc.;

For persistent diarrhea that cannot be treated with diet and astringents, exacerbation of foci of infection;

In case of severe dysbacteriosis with activation of pathogenic strains.

E. A. Beyul, M. A. Vinogradova, A. R. Zlatkina, I. A. Morozov (1986) emphasize that antibacterial drugs should be prescribed according to strict indications, their use is justified in acute periods of the disease with an established etiology of the disease and in periods of exacerbation.

Due to this effect on the various flora isolated from the intestines, broad-spectrum drugs are prescribed that act on non-positive and gram-negative microorganisms and do not have an enterotropic property.

Average therapeutic doses are usually used, the course of treatment with one drug is from 5 to 10 days. More if necessary long-term treatment use a different drug.

At staphylococcal against dysbacteriosis, erythromycin or oleandomycin 0.25 g 3-4 times a day for 7-10 days is effective. These drugs have low toxicity and are quickly absorbed in the intestine. Tetracycline, ampicillin, kanamycin are prescribed in tablets of 0.2 g 4-5 times a day. Sigmamycin (tetraolean) is effective against staphylococcal dysbiosis resistant to erythromycin and tetracycline. Along with these antibiotics, staphylococcal toxoid is recommended. It is also possible to use Biseptol-480 1 tablet 2 times a day, phthalazole 1-2 g 4-6 times a day.

When identifying yersiniosis Levomyceginum is prescribed 0.5 g 3 times a day for 7-10 days, then Biseptol-480 1 tablet 2 times a day for 10-12 days. According to A. S. Loginov (1985), during an exacerbation of diarrhea, yersiniosis is diagnosed in 20% of patients with chronic enteritis and colitis.

At Proteaceae dysbacteriosis, 8-hydroxyquinoline derivatives, which have wide range antibacterial action: intesgopan 1 tablet 3 times a day after meals for 7-10 days, enteroseptol, mexaform, enterosediv are recommended in the same dose. For persistent diarrhea, you can successfully use the first generation quinolone drug - nevigramon (negrom) 0.5 g 4 times a day for 5 days with a week break and repeated courses.

Preparations of the nitrofuran series are also very effective: furazonal, furazolin, furagin, furazolidone, furakrilin in tablets of 0.15 g 4 times a day for 7-10 days. The advantage of nitrofuran compounds is the slow development of microflora resistance to them. Proteus bacteriophage 25 mg 2 times a day orally for 3 cycles of 4 days with a break of 3 days is effective.

At Pseudomonas aeruginosa infections are prescribed polymyxin M sulfate in tablets of 500,000 units 6 times a day for 10 days, gentamicin intramuscularly 40-80 mg 3 times a day, carbenicillin 1-2 g 4 times a day intramuscularly.

If stool culture reveals Helicobacter, erythromycin, gentamicin, tetracycline, furazolidone are prescribed.

For the treatment of chronic enteritis associated with giardiasis, metronidazole (Trichopol) 0.25 g 3-4 times a day for 2-3 weeks or furazolidone 0.15 g 4 times a day for 10-14 days is used.

When chronic enteritis is combined with chronic cholecystitis against the background of hypochlorhydria, it is advisable to prescribe nihodin 1 g 4 times a day after meals for 10-14 days; the drug has a bactericidal, bacteriostatic, choleretic effect. If necessary, you can repeat 2-3 courses with a 10-day break.

At anaerobic flora is effective Lincomycin in capsules 0.5 g 4 times a day orally, Clindamycin 0.30-0.45 g orally 4 times a day, metronidazole 0.25 g 4 times a day; Sulfonamides and nitrofuran agents are also effective. However, hydroxyquinoline derivatives should not be prescribed to patients with diseases optic nerve, peripheral nervous system, liver, kidneys, iodine intolerance.

When found pathogenic fungi(especially for candidiasis), nystatin or levorin 500,000 units are prescribed 3-4 times a day for 10-14 days.

If it is impossible to determine the type intestinal flora, which caused an exacerbation of chronic enteritis, but if there are clinical indications for antibacterial therapy, it is advisable to use broad-spectrum drugs (nitrofuran, hydroxyquinoline compounds, \% chlorophyllipt solution 30 drops 3 times a day).

IN last years wide use received the drug t-tetrix. It consists of 3 active antiseptics: Tiliquinol - 50 mg, Tiliquinol-N-dodecyl sulfate - 50 mg, Tilbroquinol - 200 mg, which potentiate each other's action. The drug is a bactericidal intestinal antiseptic, which in therapeutic doses does not change the normal composition of the intestinal flora. By acting on pathogenic bacteria, intet-rix protects the physiological activity of saprophytic flora. In-Tetrix has a wide range antimicrobial action, suppresses most intestinal bacteria, gram-positive and non-negative, and also has an antifungal (anticandidiasis) and amebocidal effect (suppresses vegetative forms).

It is prescribed for acute diarrhea, 2 capsules 3 times a day for 3-5 days, for intestinal dysbacteriosis - 2 capsules 2 times a day for 10 days.

The presence of methyl groups and the absence of chlorine and iodine halogens in the integrix molecule, unlike other hydroxyquinolines, ensures its good tolerability and the absence of side effects.

3.2. Reimplantation of normal intestinal flora

In patients with chronic enteritis and chronic colitis In almost all cases, intestinal dysbacteriosis is detected varying degrees and character. Dysbacteriosis often precedes the development pathological process in the intestine or occurs against the background of an already formed disease, aggravating its course (A. L. Grebenev, L. P. Myagkova, 1994)

After the use of antibacterial agents and suppression in the intestines pathogenic microorganisms restoration of normal intestinal flora is carried out - reimplantation. For this purpose, the following drugs are used:

Concentrated lyophilized colibacherin, 2-4 doses 4 times a day;

Bifidumbacherin 1 ampoule (5 doses) 2-3 times a day;

Bificol 1 bottle (5 doses) 2 times a day;

Lactobacherin 3-6 doses 3 times a day;

Lyophilized culture of aciudophilic bacilli, 2 doses 3 times

Bayuisubtil 0.2 g 3 times a day;

Biosporin (contains 2 strains of saprophytic bacteria - Bac. subtilis and Bac. licheniformis), the drug also stimulates the production of endogenous interferon.

Treatment with these drugs continues for 1-1.5 months. These drugs are cultures of normal intestinal flora; they promote the engraftment of normal flora, reduce dysbiosis, help stop relapse of the disease and achieve more complete remission.

There was an opinion that bacterial drugs should not be combined with antibacterial agents. However, there are reports (N.P. Milonova, 1985) that colibacterin does not interact with oleacdomycin, and bifidumbacterin and lactobacterin do not interact with kanamycin, monomycin, chloramphenicol, salazopyridazine enhances the effect of colibacterin, bifidumbacterin. The possibility of combined use of some antibacterial and bacterial drugs is explained by their action in different parts of the intestine.

All patients with chronic enteritis during exacerbations of diarrhea should be prescribed astringent, enveloping, and adsorbent agents.

4.1. Astringents and enveloping agents

The astringent effect of the drugs is associated with their ability to precipitate proteins with the formation of dense albuminates; they cause partial coagulation of mucus proteins, inflammatory exudate and lead to the formation of a protective film and a decrease in inflammation.

The following are used as astringents:

tanalbsh(a product of the interaction of tannins from the leaves of mackerel and sumac with the protein casein) - prescribed in tablets of 0.5 g 3-4 times a day before meals;

bismuth nitrate basic - prescribed orally in powders of 0.5 g 3-4 times a day 30 minutes before meals;

calcium carbonate - prescribed in powders of 0.5 g 3 times a day 30 minutes before meals.

4.2. Adsorbents

Adsorbent agents are used during periods of severe exacerbation of chronic eigeritis, accompanied by significant symptoms of intoxication:

enterodesis - low molecular weight polyvinylpyrrolidone preparation with molecular weight 1260012700; enterodesis taken orally binds toxins entering the gastrointestinal tract or formed in the body and removes them through the intestines; taken orally in a dose of 5 g 1-2 times a day for 2-7 days (until intoxication disappears); before use, enterodesis is dissolved in 100 ml of boiled water;

activated carbon(carbolene) - adsorbs gases (therefore especially indicated for flatulence), toxins; prescribed in tablets of 0.5 g - 2-3 tablets 3-4 times a day for 3-5 days;

activated carbon vegetable - 2 capsules 2-3 times a day orally;

polyphepan - a preparation obtained by processing lignin - a product of hydrolysis of carbohydrate components of wood; has a high adsorbing capacity, adsorbs toxins and bacteria in the gastrointestinal tract, reduces flatulence, general intoxication, promotes the sorption of bile acids and reduces cholagenic diarrhea. Prescribed orally in the form of granules before meals, 1 tablespoon in 1D-1 glass of boiled water 3 times a day for 5-7 days;

belasorb - activated carbon preparation, use 1 teaspoon in 7-2 glasses of water three times a day.

4.3. Herbal medicine for chronic enteritis

In the treatment of chronic enteritis the following are used: medicinal plants with bactericidal and bacteriostatic effects: blueberries, rose hips, raspberries, wild strawberries, cranberry and pomegranate juice (diluted with water);

medicinal plants with antispasmodic, analgesic properties

overall effect: chamomile, mint, yarrow, sage, calendula, St. John's wort;

medicinal plants with astringent, antidiarrheal and anti-inflammatory effects: oak bark, St. John's wort, burnet rhizomes and roots, alder fruit, bird cherry and blueberry fruits.

Herbal medicine helps normalize intestinal function, improve digestion, restore normal intestinal microflora and eliminate dysbiosis, has an anti-inflammatory effect on the intestinal mucosa, and has a beneficial effect on the patient’s nervous system.

The ones that most strongly inhibit intestinal motility, and also have an anti-inflammatory and accelerating effect, are snakeweed, oak, burnet, cinquefoil, alder, bird cherry, and blueberry.

Simultaneously with charges 1-3, to enhance their effect or separately from them (for enterocolitis with diarrhea), the following drugs are used.

Powder of rhizome of snakeweed - prescribed according to 0.5-1 g to take 3-4 times a day 20-30 minutes before meals. The course of treatment is from 2-3 weeks to 2-5 months.

The most effective remedy at chronic diarrhea - root decoction burnets. It is prepared as follows: 2 tablespoons of raw materials are poured into 0.5 liters of boiling water, boiled for 20 minutes. Take 2 tablespoons 5-6 times a day 30 minutes before meals. The course of treatment is 1.5-2 or more months.

Prepare in the same way decoction of oak bark, cinquefoil, alder fruit and taken in the same doses.

Bird cherry berries - used both fresh and dried. 4 tablespoons of dry berries are boiled with 0.5 liters of water. Drink the entire decoction throughout the day.

Blueberries - prepared and taken in the same way as bird cherry berries. Fresh blueberries are an effective remedy for chronic enterocolitis. Even with a severe course of the disease, a noticeable improvement in the well-being of patients occurs if in the summer season they eat 2-3 cups of blueberries daily (2 cups of berries 4-6 times a day 30 minutes before meals). Blueberry jelly and blueberry infusion (1-2 teaspoons of berries per glass of boiling water) are also useful.

For chronic gastrointestinal diseases accompanied by diarrhea, use decoctions from oat grains. Oat decoction is a nutritious, appetite-improving, body weight-restoring agent that has a good enveloping and anti-diarrheal effect. One glass of unpeeled oats is boiled for 2 hours over low heat in 1 liter of water. The resulting decoction is filtered and drunk during the day 20-30 minutes before meals. The course of treatment is 1-1.5 months, it is repeated 3-4 times a year.

Chamomile flowers - contain essential oil, azulene, anthemisic acid and other substances. Azulene has anti-inflammatory properties, reduces allergic reactions, and enhances the regeneration processes of the intestinal mucosa. The substance apigenin, isolated from chamomile, has an antispasmodic effect.

Chamomile flowers are used in the form of tea (brew 1 tablespoon of chamomile with a glass of boiling water, cool, filter) or infusion orally, 2-5 tablespoons 3-4 times a day. You can use chamomile flowers as a preparation Romazulon, containing chamomile extract and essential oil. The drug is taken orally ½ teaspoon diluted in 1 glass hot water.

When treating patients with chronic enteritis, it is necessary to pay attention to functional state other digestive organs - stomach, pancreas. Normalization of the function of these organs or replacement therapy in case of secretory insufficiency of the stomach and pancreas, it helps improve digestion in the intestines.

For gastric secretory insufficiency, they are prescribed gastric juice 1 tablespoon per 1 / 2 a glass of water with each meal, pepsidil - in the same dose, less often - acidin-nencm or betacid by 1-2 tablets per 1 / 2 a glass of water during meals, used to stimulate gastric secretion lemontar 1 tablet per 1 / 2 a glass of water before meals (chapter “Treatment of chronic gastritis”).

Exocrine pancreatic insufficiency is compensated by using 2-3 tablets of drugs containing pancreatic enzymes during meals: pancreatin, digestal, mezima-forte, solizym, somilase, oraza, nigedase, panzinorm, festal, enzistal(for more details about these drugs, see chapter “Treatment of chronic gastritis”). It should be noted that the use of enzyme preparations containing bile (panzinorm, fesgal, enzistal, digestal) may increase diarrhea, since bile acids enhance intestinal motor function.

For patients with chronic enteritis who simultaneously suffer from chronic cholecystitis with concomitant pshomotor dyskinesia, choleretic agents containing bile are indicated (cholenzyme, allohol, lyobil), however, if diarrhea worsens, choleretic agents that do not contain bile should be prescribed instead (flamin, corn silk, immortelle, tashtsehol, oxafenamide, nicotine, berberine etc.) - details about these drugs in chap. "Treatment of chronic cholecystitis."

In chronic enteritis, especially with a severe degree of the disease, the secretory, motor-evacuation and absorption functions of the small intestine are significantly impaired. When the absorption capacity of the small intestine is reduced, but still preserved, the use of drugs that stimulate absorption function is indicated.

According to A.V. Frolkis (1989), it was established positive influence ephedrine (0.025-0.05 g 3 times a day), L-DOPA (levodopa) - 100-200 mg 2-3 times a day for the absorption function of the small intestine in patients with chronic enteritis. A.I. Parfenov (1981) recommends taking long-acting nitrates - sustak or nitrong - 1 tablet 2-3 times a day for 10-15 days to stimulate absorption in the small intestine. The absorption function of the intestine is also stimulated by anabolic steroids (V.V. Trusov, 1981), aminophylline (A.V. Frolysis, 1981). Treatment with anabolic steroids will be discussed below. Treatment of chronic enteritis with aminophylline has not received widespread clinical use due to severe dyspeptic symptoms when taking the drug orally.

At the end of this section, we provide data on the mutual influence of drugs (Table 35).

The table shows, in particular, that it is not advisable to simultaneously take Panzinorm, Festal, Pancreatin with bismuth preparations as astringent with chronic enteritis. Panzinorm inactivates colibacterin, so they should not be combined.

Violation of the passage of intestinal contents and intestinal motor function in chronic enteritis most often manifests itself as diarrhea. Four mechanisms are involved in the development of diarrhea: intestinal hypersecretion, increased osmotic pressure in the intestinal cavity, intestinal hyperexudation, and impaired transit of intestinal contents (A.I. Parfenov, 1991). Intestinal motility disorders are of great importance in the development of diarrhea. In a large proportion of patients with diarrhea, the acceleration of transit of intestinal contents is not due to an increase in the petal activity of the intestine, but to a weakening of motility, especially in the distal parts of the small intestine (A. V. Frolkis, 1989). The rectosigmoid region plays the role of a kind of functional sphincter; with diarrhea, it relaxes, and its insufficiency occurs; cessation or weakening of segmenting contractions leads to the fact that feces move passively through the large intestine, without encountering the resistance that under normal conditions the segmenting movements of the intestine provide it, mixing the contents and forming a “fecal column”. However, in some patients, diarrhea can also be caused by a significant increase in intestinal motor function.

6.1. Treatment of diarrhea, use of antidiarrheals

6.1.1. Including foods that delay bowel movements in your diet
intestines

Products containing tannin delay bowel emptying: blueberries, strong tea, cocoa; writing in pureed form; porridges: semolina and ovoya: slimy soups: jelly; warm and hot dishes.

6.1.2. Antibacterial therapy

Antibacterial therapy helps eliminate diarrhea. It is known that in the development of hypersecretion, one of the mechanisms of diarrhea, bacterial contamination of the small intestine and accumulation of long-chain fatty acids in the intestinal cavity associated with the vital activity of microorganisms play a major role.

Antibacterial drugs help suppress intestinal hypersecretion and reduce diarrhea.

6.1.3. The use of medicinal plants that have astringent properties
enveloping effect

6.1.4. Use of antidiarrheals
Antidiarrheals can be divided into five groups:

Inhibitors of the parasympathetic nervous system (atropine and other anticholinergic drugs) and adrenergic agents;

Drugs that directly affect intestinal motility;

Means that promote compaction of stool;

Drugs that promote the excretion of bile acids in feces;

Drugs that have a predominantly antisecretory effect.

Parasympathetic nervous system inhibitors and adrenergic agonists

Anticholinergics and adrenomimetics reduce intestinal motor activity and reduce diarrhea.

From anticholinergics most often used belladonna extract 0.015 g 3 times a day, tatifillin 0.003 g 3 times a day or 0.2% solution 0.5-1 ml subcutaneously 2-3 times a day, less often - 0.1% solution atropine 0.3-0.5 ml subcutaneously 1-2 times a day. It is advisable to combine Holi-nolytics with phenobarbital, which potentiates the effect of anticholinergics on the intestines and also stimulates intestinal enzymes. The following formula can be recommended:

Belladonna extract - 0.015 G Phenobarbital - 0.04 g

1 Zaraza powder per day

From adrenergic agonists most commonly used as an antidiarrheal agent ephedrine at a dose of 0.025-0.05 g 3 times a day orally. He

inhibits intestinal motor function and improves the absorption function of the small intestine. Ephedrine goes well with anticholinergics. the addition of ephedrine to bismuth and calcium preparations enhances their antidiarrheal effect. The following recipes can be recommended:

Ephedrine hydrochloride - 0.025 g Extract belladonna - 0.015 g Phenobarbital - 0.04 g 1 powder 3 times a day.

Ephedrine hydrochloride - 0.025 g Belladonna extract - 0.015 g Calcium carbonate - 0.5 g 1 powder 3 times a day.

Ephedrine hydrochloride - 0.025 g Belladonna extract - 0.01 g Ppathifilpine hydrotartrate- 0.02 g 1 powder 3 times a day.

Drugs that directly affect intestinal motility

Codeine - enhances non-propulsive intestinal motility, inhibits propulsive contractions, increases the tone of the intestine and its sphincters, thereby helping to slow down the transit of intestinal contents and has an antidiarrheal effect. However, due to the possible development of parasites, codeine is almost never used as an antidiarrheal agent.

Reasek - combination drug. This difenoxate in combination with atropine, it enhances the segmenting contractions of the small intestine, and has a normalizing effect on the motor activity of the large intestine: with reduced motility it increases it, with increased motility it decreases, which allows us to consider this drug as a universal antidiarrheal agent that can be used for diarrhea with weakened and increased intestinal motor activity.

The drug is prescribed 1-2 tablets (2.5 mg) 3 times a day, up to 4 tablets can be prescribed for the first dose.

Loperamide(imodium) is a synthetic opioid receptor agonist. The drug is practically devoid of narcotic properties, is not addictive and is well tolerated even with long-term use. Loperamide inhibits propulsive petalism, enhances non-propulsive contractions, increases the tone of the intestine and its sphincters, inhibits the secretion of water and electrolytes; All these properties of the drug lead to an antidiarrheal effect. Loperamide is available in capsules of 0.002 g and in bottles in the form of a 0.002% solution of 100 ml. Prescribed orally for acute diarrhea, initially 0.004 g (2 capsules), then after each loose stool, 0.002 g (1 capsule). For chronic diarrhea, give first 0.004 g, then 0.002 g 1 to 6 times a day.

Constipation, nausea, and dizziness may occur when using loperamide. In these cases, treatment with the drug is stopped. Does not recommend -

It is recommended to prescribe loperamide simultaneously with anticholinergics (to avoid mutually reinforcing effects).

Nufenoxol- also stimulates opioid receptors, enhances absorption and inhibits the secretion of water and salts, and has a pronounced antidiarrheal effect.

Means that promote compaction of stool

This group of drugs has an antidiarrheal effect due to the fact that it significantly reduces secretion in the intestines and thickens the stool.

Calcium carbonate - used as one of the most effective antidiarrheal agents at a dose of 0.5-1 g 3-4 times a day. Calcium ions suppress the activity of adenylate cyclase and activate phosphodiesterase, thereby promoting the breakdown of cyclic adenosine monophosphate, which causes an antisecretory effect.

At the same time, there is evidence that calcium antagonists, which are blockers of slow calcium channels and inhibit the entry of calcium ions into cells, stimulate the absorption of water in the intestine and have an antidiarrheal effect.

An antidiarrheal effect was experimentally discovered due to increased absorption of water in the intestine in nifedipine (Corinfar), verapamil, and diltiazem.

Bismuth preparations - have a local astringent, enveloping and adsorbing effect. In addition, they can also reduce secretion in the ileum.

Of the bismuth salts, the most commonly used is bismuth subnitrate, 0.5 g 4 times a day. The drug combines well with calcium carbonate in the same dose, which enhances the antidiarrheal effect.

Drugs that promote the excretion of bile acids in feces

It is known that unabsorbed bile acids significantly increase intestinal secretion and cause diarrhea. As with chronic enteritis, this factor is important in the development of “bilious diarrhea” in diseases and resections of the ileum, primary malabsorption of bile acids, conditions after cholecystectomy, vagotomy.

Drugs that adsorb bile acids and promote their excretion in feces have an antidiarrheal effect, since they eliminate the effect of bile acids that stimulate intestinal motility.

Aluminum hydroxide - applied orally in the form of a 4% suspension, 1 teaspoon in 2 glasses of water 4-6 times a day. The drug actively binds bile acids and is one of the best for the treatment of “bilious diarrhea”, but can be used to treat diarrhea of ​​any origin.

Polyphepan - a preparation obtained from the processing of lignin - pro-. hydrolysis product of carbohydrate components of wood. Polyphepan adsorbs approximately 40" bile acids, as well as intestinal bacteria. It is prescribed orally in the form of granules, 1 tablespoon 3 times a day before meals in 1 glass of water. Treatment lasts about 5-7 days.

Bshshgnin - a drug plant origin, which is a modified lignin (an organic polymer compound contained in cell membranes). Actively binds bile acids in the intestines. Take 5-10 g (1-2 teaspoons) orally 3 times a day, 30-40 minutes before meals, with water.

Cholestyramine - ion exchange resin, forms non-absorbable complexes with bile acids in the intestine, which are secreted with the cap. Prescribed orally 3-4 g 3-4 times a day in a glass of water.

All of the above drugs that adsorb bile acids should not be taken simultaneously with other medicines, since the absorption of the latter will be greatly hampered.

Drugs that have a predominantly antisecretory effect

Antidiarrheal drugs that have a predominantly antisecretory effect include inhibitors of the enzyme prostaglandin synthetase, which ensures the synthesis of prostaglandins. With a number of intestinal diseases accompanied by diarrhea, the content of prostaglandins in the feces and blood increases.

Antidiarrheal drugs - prostaglandin synthetase inhibitors - include salazole drugs (chapter "Treatment of nonspecific ulcerative colitis"), indomethacin, acetylsalicylic acid. However, acetylsalicylic acid and indomethacin have not received widespread clinical use for the treatment of diarrhea due to their effect on the stomach.

An antisecretory effect was detected in the herbal choleretic agent - berberine, as well as in nicotinic acid and neuroleptics (triftazine, aminazine, halopervdol, chlorprothixene).

Normalization of intestinal motor function

When the hypermotor component predominates and the pain syndrome is severe, myotropic antispasmodics are effective: no-spa 0.04 g 3 times a day, halidor 0.1 g 3 times a day, phenicaberan 0.02 g 3 times a day.

To reduce the rate of evacuation, atropine, platiphylline, and metacin are prescribed for 2 weeks.

Constipation in patients with chronic enteritis is much less common than diarrhea. For constipation, it is recommended to use laxatives (chapter “Treatment of constipation”).

To stimulate intestinal motility, Cerucal (metoclopramide) is used in tablets of 0.01 g 3 times a day. Cerucal is a specific dopamine receptor blocker 7. Correction of metabolic and electrolyte disturbances

Metabolic and electrolyte disturbances are usually observed in patients with severe clinical manifestations of the disease, i.e. at III, less often at II degree, and are a reflection of malabsorption syndrome.

7.1. Correction of protein metabolism disorders

To correct protein metabolism disorders, the following is necessary: ​​1. Increasing the amount of protein in the diet to 120-130 g, using fine protein products balanced in amino acid and mineral composition (protein enpit).

2. The use of anabolic steroid drugs that stimulate protein synthesis. Appointed Nerobol (methandrostenolone) 0.005 g 2-3 times a day, methylandrostenediol 0.01 g 2-3 times a day for 1 month, Nerobolil.retabolil 1-2 ml each 5% solution intramuscularly 1 time every 7-10 days for 3-4 weeks. Long-term use of anabolic agents is not recommended, since they have some androgenic properties and can cause hypertrichosis and menstrual irregularities in women, and nerobol, in addition, suppresses the production of monoglyceride lipase in the small intestine. For women, it is more advisable to prescribe extended-release anabolic steroid drugs (retabolil), since they have a less pronounced androgenic effect. Anabolic steroid drugs help eliminate protein deficiency, impaired metabolic processes, improve the regeneration of the intestinal mucosa and improve its absorption function. The action of anabolic steroids is realized at the level of the cell membrane with increased enzymatic activity, which facilitates the passage of amino acids through the cellular barrier.

3. Enteral protein nutrition - protein hydrolysates (casein, aminazole) are injected into the stomach drip through a tube (A. S. Loginov, 1985) at a rate of 60 drops per minute, 250 ml daily for 18-20 days, a total of 3.5 per course -5 l of casein hydrolyzate or aminazole.

A. R. Zlatkina (1994) recommends administering protein preparations (plasma, aminazole, alvezin, mixtures of pure amino acids) alternately with a probe into the duodenum. The advantage of Engeral nutrition is the absence of PYROGENIC and allergic reactions, which often occurs with intravenous administration of protein preparations. However, intravenous drip infusion of protein drugs is also used for the most severe degrees of malabsorption.

4. Intravenous drip infusion of 10% albumin solution - 100-150 ml, fresh frozen plasma - 200 ml once a week.

5. Intravenous drip infusion of mixtures of pure amino acids, balanced in amino acid composition. This route of entry of amino acids into the body is convenient because it does not require the participation of the intestinal mucosa; in addition, amino acids are used faster and better for protein synthesis. Treatment with amino acid preparations by intravenous drip is carried out daily for 10-15 days.

Polyamine - aqueous solution of 13 amino acids, of which 8 are essential; the drug is administered intravenously, starting with 10-20 drops per minute (the first 30 minutes), then 25-35 drops per minute. The daily dose of the drug is about 400 ml per day. Simultaneously with polyamine, a solution of glucose (up to 0.5 g per 1 kg of body weight per hour) and vitamins should be administered. A.L. Grebenev and L.P. Myagkova (1994) recommend administering polyamine 250 ml once a day for 20 days.

Alvezin "New" - an aqueous solution containing 14 amino acids, sorbitol, potassium, magnesium, chlorine ions. Administer intravenously from 200 to 400 ml per day. Unlike the previously released drug, Alvezin “New” additionally contains alanine, glutamic, aspartic acids, and the glycol content is reduced.

Aminoplaemol - a solution containing 21 amino acids, including tryptophan, as well as sorbitol and sodium, potassium and magnesium salts. It is administered in the same way as polyamine.

6. Intravenous infusion of protein hydrolysates.

Aminocrovin - a drug obtained by acid hydrolysis of human blood proteins with the addition of glucose. Contains free amino-

noacids (40 g per 1000 ml) and low molecular weight peptides. It is administered intravenously, the daily dose is about 300-400 ml per day.

Casein hydrolyzate - the preparation obtained by acid hydrolysis of milk protein - casein, contains a solution of amino acids and simple peptides. It is administered intravenously, starting from 20 drops per minute; if well tolerated, the rate of administration can be increased to 40-60 drops per minute. The daily dose is about 450 ml.

Aminotroph - compositionally improved casein hydrolysate. 1000 ml of the drug contains 50 g of amino acids, including 0.5 g of L-tryptophan, as well as potassium, calcium, and magnesium ions.

Infusamine - a drug obtained by deep hydrolysis of human blood proteins with the addition of the amino acids L-tryptophan and L-isoleukin. 1000 ml of solution contains 45 g of amino acids, as well as sodium, potassium, chlorine, and D-sorbitol ions.

During treatment with both amino acid mixtures and protein hydrolysates, it is necessary to continue taking anabolic steroids to improve protein synthesis. We must remember that with intravenous administration of protein hydrolysates, severe allergic reactions, even shock, are possible. Therefore, when treating protein deficiency syndrome, preference should be given to mixtures of amino acids that are better absorbed by the body and rarely cause allergic reactions.

7.2. Correction of fat metabolism disorders

One of the main methods of normalizing fat metabolism is therapeutic nutrition with a physiological fat norm of 100-115 g, the use of foods rich in fatty acids with short and medium chain lengths of carbon atoms (olive and sunflower oil, margarine).

It is advisable to include in complex therapy essentiale intravenously, 5 ml daily for 20 days (A. S. Loginov, 1985), which leads to an increase in the content of polyunsaturated fatty acids in the blood - linoleic, arachdonic acid, as well as phospholipids and increases lipase activity.

If there is a significant drop in body weight and a decrease in phospholipids in the blood, intravenous drip infusion can be recommended lipofundine(intralipid).

Lipofuvdin is a fat emulsion prepared from purified soybean oil and containing fat particles ranging in size from 0.1 to 1 microns, which corresponds to the size of chylomicrons in human blood. The drug is administered intravenously in a dose of 250-500 ml daily for 5-7 days. The initial infusion rate is 15-20 drops per minute during the first 10-15 minutes, then it is gradually (over 30 minutes) increased, but not more than 60 drops per minute.

7.3. Correction of carbohydrate metabolism disorders

Disorders of carbohydrate metabolism in chronic enteritis are less pronounced and less frequent than disturbances of protein and fat metabolism. Clinically, malabsorption of carbohydrates is manifested by intestinal dyspepsia in the form of bloating, rumbling, diarrhea, severe flatulence, and hypoglycemia is possible.

To correct disorders of carbohydrate metabolism, it is advisable to administer a 5-10% glucose solution intravenously - 1 liter per day under the control of glycemic levels.

7.4. Correction of electrolyte disturbances, micronutrient deficiencies

Most often, patients with chronic enteritis experience hypokalshemia, a decrease in the content of magnesium, phosphates, iron and other microelements in the blood. At the same time, there is often a tendency to sodium retention due to increased mineralocorticoid function of the adrenal glands.

With the development of hypokalishemia, it is recommended to take calcium gluconate 0.5-1 g 3-4 times a day or calcium glycerophosphate at the same dose. In case of very severe hypocalcemia, calcium preparations are administered intravenously in 10-20 ml of a 10% solution of calcium chloride or gluconate, preferably in 300-500 ml of isotonic sodium chloride solution drops 4-5 times a week for 25-30 days.

If hypokalemia develops, it is advisable to administer intravenously 30-40 ml of a 4% solution of potassium chloride in 500 ml of a 5% glucose solution once a day for 4-5 days. Potassium administration should be carried out with careful monitoring of potassium levels in the blood. In less severe cases of potassium deficiency, it is possible to use panangin internally, 2-3 tablets 3 times a day. However, it should be remembered that the potassium content in panangin is low - 1 tablet of panangin contains only 36.2 mg of potassium ion and 11.8 mg of magnesium ion. For mild hypokalemia, intravenous drip administration of 20-30 ml of panangin in 300-500 ml of isotonic sodium chloride solution or 5% glucose solution is possible. 10 ml of panangin contains 103.3 mg of potassium ion and 33.7 mg of magnesium ion. Close to panangin is the domestic drug asparkam.

With severe chronic enteritis and the development of severe malabsorption syndrome, with persistent diarrhea, along with electrolyte disturbances, significant dehydration is possible. In this case, intravenous drip infusion of saline solutions "Disol", "Tol", 5% glucose solution, isotonic sodium chloride solution, Ringer's solution is recommended. The amount of fluid administered per day depends on the degree of dehydration and can be 3-4 liters. These fluids should be administered intravenously while simultaneously monitoring central venous pressure.

When correcting water and electrolyte disorders, the state of acid-base balance should be taken into account. In case of metabolic acidosis, before infusion of electrolyte solutions, acidosis is corrected with 150-200 ml of 4% sodium bicarbonate solution, then 40 ml of panangin, 3-4 g of calcium gluconate, 1-1.5 g of magnesium sulfate in 500 ml of isotonic sodium chloride solution are injected intravenously. For metabolic alkalosis, 2-4 g of potassium chloride, 3 g of calcium chloride, 1-1.5 g of magnesium sulfate are administered in 500 ml of isotonic sodium chloride solution (A.I. Parfenov, 1991). For severe hyponatremia (less than 125 mmol/l), add 20-50 ml of 10% sodium chloride solution or 1 ml of 0.5% DOC-SA solution subcutaneously. Polyelectrolyte solutions, if necessary, in case of severe malabsorption syndrome, can be administered for 20-30 days.

Deficiencies of microelements are compensated with the help of rational therapeutic nutrition, as well as the use of balanced multivitamin complexes with microelements.

7.5. Correction of vitamin deficiency

To compensate for vitamin deficiency, it is recommended to take balanced multivitamin complexes (undevit, decame-vit, pzhsavit) orally. as well as multivitamin complexes with a set of microelements (oligovit. Duovit - preparations containing 10 vitamins and 10 microelements). In severe cases of impaired absorption capacity of the small intestine, parenteral administration of vitamins B 1 (B*. C, PP.

7.6. Correction of anemia

With malabsorption syndrome in patients with chronic enteritis, hypochromic anemia most often develops. The development of anemia is caused primarily by iron deficiency, protein deficiency and also a lack of vitamin C, which promotes the transition of iron into an easily digestible ferrous form,

It is possible to develop B12-deficiency anemia, which is caused by impaired absorption of vitamin B2 and folic acid in the small intestine, as well as a deficiency of protein, copper, manganese, vanadium, nickel, and chromium.

In many patients, simultaneous deficiency of iron and vitamin B 12 (multifactorial anemia) plays a role in the development of anemia.

To relieve iron deficiency anemia, iron supplements are prescribed orally before meals. (ferroplexpo 2 tablets 3 times a day, conference 1 capsule per day, ferrograduate 1 tablet 1-2 times a day). In case of intolerance to oral administration of these drugs (nausea, vomiting, increased diarrhea), as well as in cases of severe iron deficiency anemia, iron supplements are administered parenterally - ferrum-lek 2 ml intramuscularly or intravenously every other day, 10-15 injections. Iron supplements are taken in the indicated doses until hemoglobin levels normalize, and then long-term treatment is continued in maintenance doses.

For B 12-deficiency anemia, vitamin B 12 is administered intramuscularly at 500 mcg daily for 3-4 weeks, in the future it is possible to administer 500 mcg once a week until stable remission is obtained, and then 400-500 mcg twice a week. month for life.

Endocrine dysfunction in patients with chronic enteritis is observed in 37% of cases, mainly in cases of moderate or severe disease. Endocrine disorders are manifested by a decrease in glucocorticoid function of the adrenal glands, hypofunction of the gonads, hypothyroidism, deficiency of antidiuretic hormone (diabetes insipidus), and hypoparathyroidism. Functional failure of the endocrine system organs is closely related to a deficiency of proteins and microelements and often disappears or decreases as these disorders are eliminated and the general condition improves. However, in case of severe endocrine insufficiency, replacement therapy is prescribed:

" at hypothyroidism - thyroid drugs trust, thyrocomb 1 tablet 1-3 times a day, L-thyroxine 100-150 mcg once a day, triiodothyronine 25-50 mcg per day;

at glucocorticoid deficiency - prednisolone or methi-pred 5 mg 2-3 times a day;

at hypoparathyroidism - calcium supplements orally, tachistine 20 each

drops 3 times a day after meals (increases the absorption of calcium in the intestines), parathyroidin 1-2 ml intramuscularly every other day;

at diabetes insipidus - adiurecrine 0.03-0.05 g 2-3 times a day inhaled through the nose.

It is rare to prescribe treatment with sex hormones for hypofunction of the gonads, since with the improvement of the general condition of patients, the functional state of the gonads, as a rule, significantly improves.

Chronic enteritis is accompanied by a violation of humoral and cellular immunity with the development of a secondary functional immunodeficiency state: as a rule, there is a decrease in the functional state of T-lymphocytes and increased activity of B-lymphocytes (E. A. Beyul, 1985). The development of immunodeficiency is promoted by insufficient absorption of proteins and other components of food. Immunocorrective therapy is recommended to be carried out as follows.

9.1. Use of the immunomodulatory effect of therapeutic
nutrition

A protein-enriched diet (up to 135 g of protein in the daily diet) increases the functional capacity of T-lymphocytes. In addition, it is necessary to include vitamins A, E, B2 in the diet. Vitamin A increases lysosome lability in the immune response. Vitamin E regulates the function of T-helper cells, inhibits the synthesis of prostaglandins by macrophages and reduces their suppressive effect on T-lymphocytes. Vitamin B 12 has a normalizing effect on the function of B and T lymphocytes. It is necessary to include a sufficient amount of zinc in the diet, since thymus hormones manifest their effect in the presence of this trace element. Zinc is found in chicken meat and liver.

9.2. Treatment with immunomodulatory agents

With a reduced content of T-lymphocytes and a decrease in their activity, treatment is advisable prodigiosan. It is administered intramuscularly at intervals of 4-5 days, a total of 4 injections in increasing doses: 12.5-12.5-25-50 mcg.

With reduced activity of natural killer cells and increased activity of T-suppressors, it is recommended to use zyxorina 0.1 g 3 times a day. It is an inducer of cytochrome P 450, stimulates microsomal oxidation, with which the work of immune mechanisms is closely related. In addition, the drug is an inducer of intestinal enzymes.

They also have a normalizing effect on the function of T- and B-lymphocytes. sodium nucleinate, prescribed orally at 0.1-0.2 g 3 times a day for 2-3 weeks; preparations containing biologically active substances of the thymus - Thymalin 20 MG intramuscularly 1 time per day for 5-6

days, T-activin 100 mcg intramuscularly 1 time per day for 5-7 days.

For chronic enteritis, various methods of physiotherapy are indicated. They are especially effective in cases of severe pain, which is observed when enteritis is complicated by solaritis, nonspecific mesadenitis and the presence of adhesions in the abdominal cavity. Thermal procedures help reduce inflammatory changes in the intestines and have a beneficial effect on absorption processes in the intestines. A. R. Zlatkina (1986), F. I. Komarov, A. I. Parfenov (1992) recommend the following types of therapy.

Patients are prescribed semi-alcoholic warming compresses at night on the umbilical area (projection of the small intestine). Compresses help relieve pain and normalize intestinal motor function.

Anti-inflammatory and antispastic effects are exerted by applications of paraffin, ozokerite at a temperature of 46-48 "C (daily for 30-40 minutes, 12-15 procedures per course of treatment), electrophoresis of anesthesin or dicaine on the stomach (mainly on the umbilical area) for 20-30 minutes (10-15 procedures).

UHF therapy for the intestinal area (power 30-40 W, duration 10-12 minutes daily, 10-15 procedures per course), inductothermy, diadynamic Bernard currents, UHF electric field are also very effective.

During the period of remission of the disease, mud therapy is indicated. Mud applications on the stomach are prescribed segmeitarno every other day, the course of treatment is 8-10 procedures. Initially, the temperature of the mud is 38 °C (for 15-20 minutes), with subsequent procedures - 40 °C and even 42 °C.

Therapeutic exercise for chronic enteritis aims to stimulate metabolic processes and restore impaired intestinal regulation. Therapeutic complexes are prescribed after the cessation of diarrhea, since physical activity stimulates the motor activity of the gastrointestinal tract. Exercises for the core are shown - turns, bends, exercises that strengthen the abdominal press, stimulate diaphragmatic breathing, breathing exercises. After intestinal symptoms subside, walking and exercises with moderate stress on the abdominals and increased stress on the limbs are recommended.

To the sanatorium-resort treatment Patients with chronic enteritis of mild to moderate severity in the remission phase are referred. Treatment is contraindicated for patients in the acute phase of the disease with severe exhaustion.

The recommended resorts are Belokurikha, Dorokhove, Skhodnya, Kashin, Monino, Essentuki, Borjomi, Odessa, Jurmala, in the Republic of Belarus - sanatoriums "Belarus" and "Naroch" (Minsk region), sanatorium "Porechye" (Grodno region), sanatorium " Bobruisk" (Mogilev region).

The main therapeutic factors at resorts are mineral waters, balneotherapy, physiotherapy, nutritional therapy, exercise therapy, and herbal medicine.

Mineral water in case of chronic enteritis, it should be taken with great caution in the absence of diarrhea, warm, without gas, no more than “D-”/e glass per dose. We can only recommend low-mineralized waters: “Slavyanovskaya”, “Essentuki” No. 4, “Izhevskaya”, “Narzan”. The time for taking mineral water depends on the state of the acid-secretory function of the stomach: with low acidity - 15-20 minutes before meals, with normal acidity - 40-45 minutes before meals, with high acidity - 1.5 hours before meals.

Clinical examination of patients is carried out by a therapist, patients are examined 2 times a year, consulted with a gastroenterologist once a year and undergo a gastroenterological examination (FGDS, ultrasound of the abdominal organs, study of the secretory function of the stomach, the absorption capacity of the intestine, the state of protein, lipid, carbohydrate, mineral metabolism, coprocytogram , functional state of the liver, bacteriological examination of stool). When severe symptoms of chronic colitis appear, indications for sigmoidoscopy and colonoscopy may appear.

In the remission phase the following are prescribed:

Medical nutrition;

If dysbiosis is detected - correction of the microbial composition of intestinal contents within 2.5-3 months;

Repeated courses of enzyme therapy (2-3 monthly courses throughout the year);

Medicines to normalize intestinal motor function;

Phytotherapy;

Physiotherapy;

Treatment in a dispensary;

Treatment with multivitamin complexes.

During clinical observation, issues of the patient’s ability to work are also resolved. Patients with mild chronic enteritis are able to work during a period of remission, but they are not recommended to work that does not allow them to maintain a proper diet. Patients with moderate severity have limited ability to work; heavy physical labor, work associated with frequent and long business trips and the inability to maintain the correct therapeutic diet are contraindicated for them. Patients with severe chronic enteritis, with severe malabsorption syndrome, and exhaustion are unable to work.