Atypical ulcerative colitis of the intestine. Modern aspects of the treatment of nonspecific ulcerative colitis
K51 Ulcerative colitis
K51.0 Chronic ulcerative enterocolitis
K51.1 Chronic ulcerative ileocolitis
K51.8 Other ulcerative colitis
K51.9 Ulcerative colitis, unspecified
What causes ulcerative colitis?
The causes of nonspecific ulcerative colitis are unknown. Presumable etiological factors are infection (viruses, bacteria), malnutrition (a diet low in dietary fiber). Many consider the latter factor as predisposing to the development of the disease.
Ulcerative colitis usually starts in the rectum. The disease may be limited to the rectum only (ulcerative proctitis) or progress proximally, sometimes involving the entire colon. Rarely, the entire colon is affected at once.
Inflammation in ulcerative colitis captures the mucous membrane and submucosal layer, and a clear boundary is maintained between normal and affected tissue. Only in severe cases, the muscle layer is involved in the process. In the early stages, the mucosa appears erythematous, finely granular, and friable with loss of the normal vascular pattern and often with irregular areas of hemorrhage. Large ulcerations of the mucous membrane with copious purulent exudate characterize the severe course of the disease. Islets of relatively normal or hyperplastic inflamed mucosa (pseudopolyps) protrude over areas of ulcerated mucosa. The formation of fistulas and abscesses is not observed.
Fulminant colitis develops in a case of transmural ulceration, in which localized ileus and peritonitis develop. Over a period of hours to days, the colon loses muscle tone and begins to dilate.
Toxic megacolon (or toxic dilatation) refers to an emergency pathology in which severe transmural inflammation leads to colonic dilatation and sometimes perforation. It most often occurs when the transverse diameter of the colon exceeds 6 cm during an exacerbation. This condition usually occurs spontaneously during very severe colitis, but may be triggered by opiates or anticholinergic antidiarrheals. Colon perforation significantly increases mortality.
Symptoms of nonspecific ulcerative colitis
Bloody diarrhea of varying intensity and duration alternates with asymptomatic intervals. Usually, the exacerbation begins acutely with frequent urge to defecate, moderate cramping pain in the lower abdomen, blood and mucus are found in the stool. Some cases develop after infections (eg amoebiasis, bacillary dysentery).
If ulceration is limited to the rectosigmoid, stools may be normal, hard, and dry, but between bowel movements, mucus mixed with red and white blood cells may be excreted from the rectum. General symptoms of nonspecific ulcerative colitis are absent or moderate. If the ulcer progresses proximally, the stool becomes more liquid and becomes more frequent up to 10 times a day or more with severe spastic pains and tenesmus that disturbs the patient, including at night. The stool may be watery and mucus-filled and often consists almost entirely of blood and pus. In severe cases, patients may lose a lot of blood within hours, requiring an urgent transfusion.
Fulminant colitis presents with sudden severe diarrhea, fever up to 40 C, abdominal pain, signs of peritonitis (eg, protective tension, peritoneal symptoms) and severe toxemia.
Common symptoms of non-specific ulcerative colitis are more characteristic of severe disease and include malaise, fever, anemia, anorexia, and weight loss. Extraintestinal manifestations (especially from the joints and skin) always occur in the presence of general symptoms.
Diagnosis of nonspecific ulcerative colitis
Initial manifestations of nonspecific ulcerative colitis
The diagnosis is suggested by the development of typical symptoms and signs, especially if the disease is accompanied by a history of extraintestinal manifestations or similar attacks. Ulcerative colitis must be differentiated from Crohn's disease and from other causes of acute colitis (eg, infection; in older patients, ischemia).
In all patients, it is necessary to examine the stool for intestinal pathogenic infections, and it must be excluded Entamoeba histolytica stool studies immediately after emptying. In case of suspicion of amebiasis in arrivals from epidemiological regions, studies of serological titers and biopsy specimens should be carried out. If prior antibiotic use or recent hospitalization, stool testing for toxin should be performed Clostridium difficile. Patients at risk should be screened for HIV, gonorrhea, herpes virus, chlamydia, and amoebiasis. In patients taking immunosuppressive drugs, opportunistic infections (eg, cytomegalovirus, Mycobacterium avium-intracellulare) or Kaposi's sarcoma. The development of colitis is possible in women using oral contraceptives; such colitis usually resolves spontaneously after cessation of hormonal therapy.
Treatment of nonspecific ulcerative colitis
General treatment of non-specific ulcerative colitis
The exclusion of raw fruits and vegetables limits trauma to the inflamed colonic mucosa and may reduce symptoms. Elimination of milk from food may be effective, but should not be continued if there is no effect. Loperamide 2.0 mg orally 2-4 times daily is indicated for relatively mild diarrhea; higher oral doses (4 mg in the morning and 2 mg after each bowel movement) may be required for more severe diarrhea. Antidiarrheals should be used with extreme caution in severe cases because they may hasten the development of toxic dilatation.
Lesions of the left flank of the colon
For the treatment of patients with proctitis or colitis that extends proximally no higher than the splenic angle, enemas with 5-aminosalicylic acid (5-ASA, mesalamine) are used once or 2 times a day, depending on the severity of the process. Suppositories are effective for more distal lesions and are usually preferred by patients. Glucocorticoid and budesonide enemas are less effective but should also be used if 5-ASA treatment is ineffective and tolerable. When remission is achieved, the dosage is slowly reduced to a maintenance level.
Theoretically, continued oral 5-ASA may be effective in reducing the likelihood of disease spreading to the proximal colon.
Moderate or widespread involvement
Patients with inflammation extending proximal to the splenic angle or the entire left flank, unresponsive to topical agents, should be treated with oral 5-ASA in addition to 5-ASA enemas. High doses of glucocorticoids are added for more severe manifestations; after 1-2 weeks, the daily dose is reduced by about 5-10 mg every week.
Severe course of the disease
Patients with bloody stools more than 10 times a day, tachycardia, high fever and severe abdominal pain should be hospitalized for IV treatment with high doses of glucocorticoids. Treatment of non-specific ulcerative colitis with 5-ASA can be continued. Intravenous fluids are needed for dehydration and anemia. Patients should be monitored for the development of toxic megacolon. Parenteral increased nutrition is sometimes used as nutritional support but is of no value as primary therapy; patients who do not have food intolerance should be fed orally.
Patients who do not respond to treatment within 3-7 days are shown intravenous cyclosporine or surgical treatment. If the treatment is effective, patients are transferred within approximately one week to oral prednisolone 60 mg 1 time per day, while, depending on the clinical effect, the dose can be gradually reduced when transferring to outpatient treatment.
Fulminant colitis
With the development of fulminant colitis or suspected toxic megacolon:
- all antidiarrheal drugs are excluded;
- food intake is prohibited and intestinal intubation is performed with a long probe with periodic aspiration;
- active intravenous transfusion of fluids and electrolytes is prescribed, including 0.9% NaCl solution and potassium chloride; if necessary, blood transfusion;
- high doses of intravenous glucocorticoids and
- antibiotics (eg, metronidazole 500 mg IV every 8 hours and ciprofloxacin 500 mg IV every 12 hours).
The patient should be turned over in bed and changed to a prone position every 2 to 3 hours to redistribute gas throughout the colon and prevent progression of distention. Insertion of a soft rectal tube may also be effective, but the manipulation must be done with extreme care so as not to cause intestinal perforation.
If intensive therapy does not lead to significant improvement within 24-48 hours, surgical treatment is necessary; otherwise, the patient may die from sepsis as a result of perforation.
Maintenance therapy for non-specific ulcerative colitis
After effective treatment of an exacerbation, the dose of glucocorticoids is reduced and, depending on the clinical effect, is canceled; they are ineffective as maintenance therapy. Patients should take 5-ASA orally or rectally, depending on the location of the process, as interruption of maintenance therapy often leads to relapse of the disease. The intervals between rectal administration of the drug can be gradually increased up to 1 time in 2-3 days.
Patients who cannot be stopped from glucocorticoids should be switched to azathioprine or 6-mercaptopurine.
Surgical treatment of nonspecific ulcerative colitis
Almost 1/3 of patients with advanced ulcerative colitis eventually require surgical treatment. Total colectomy is a cure: life expectancy and quality of life are restored to the statistical norm, the disease does not recur (unlike Crohn's disease), and the risk of developing colon cancer is eliminated.
Emergency colectomy is indicated for massive bleeding, fulminant toxic colitis, or perforation. Subtotal colectomy with ileostomy and rectosigmoid end closure or fistula excision are the usual procedures of choice, as most critically ill patients will not be able to tolerate more extensive intervention. The recto-sigmoid fistula can be later closed according to indications or used to form an ileorectal anastomosis with an isolated loop. An unaffected area of the rectum cannot be left indefinitely without control due to the risk of disease activation and malignant degeneration.
Elective surgery is indicated for high grade mucosal dysplasia confirmed by two pathologists, overt cancer, symptomatic whole bowel stricture, growth retardation in children, or, most commonly, severe chronic disease leading to disability or dependence on glucocorticoids. Occasionally, severe colitis-related extraintestinal manifestations (eg, pyoderma gangrenosum) are also an indication for surgical treatment. The elective procedure of choice in patients with normal sphincter function is reconstructive proctocolectomy with ileorectal anastomosis. This operation creates an intestinal reservoir in the pelvis or sac from the distal ileum, which is connected to the anus. An intact sphincter maintains an obturator function, usually with 8-10 bowel movements per day. The inflammation of the created sac is a consequence of the inflammatory response observed after this intervention in approximately 50% of patients. This is thought to be due to bacterial overgrowth and should be treated with antibiotics (eg quinolones). Probiotics have protective properties. Most cases of inflammation of the sac respond well to treatment, but in 5-10% of cases there is no effect due to intolerance to drug therapy. Alternative surgical methods include an intestinal reservoir ileostomy (according to Beds) or, more commonly, a traditional ileostomy (according to Brooke).
Patients with localized ulcerative proctitis have a better prognosis. Severe systemic manifestations, intoxication complications, and neoplastic degeneration are unlikely, and in the long-term period, the spread of the disease is observed in only about 20-30% of patients. Surgery is rarely required, and life expectancy is within the statistical norm. The course of the disease, however, may be stubborn and unresponsive to treatment. In addition, since the advanced form of ulcerative colitis can begin in the rectum and progress proximally, proctitis cannot be considered a limited process for more than 6 months. A limited process that progresses later is often more severe and more intolerant to treatment.
colon cancer
The risk of developing colon cancer is proportional to the duration of the disease and the extent of colon damage, but not necessarily the activity of the disease. Cancer usually begins to appear 7 years after the onset of the disease in patients with widespread colitis. The overall likelihood of cancer is approximately 3% at 15 years from onset, 5% at 20 years, and 9% at 25 years, with an annual increase in cancer risk of approximately 0.5-1% after 10 years of illness. Most likely, the risk of developing cancer among patients suffering from colitis since childhood is not, despite the longer period of the disease.
Regular colonoscopy, preferably during remission, is indicated for patients with a disease duration of more than 8-10 years (with the exception of isolated proctitis). Endoscopic biopsy should be performed every 10 cm along the entire length of the colon. Any degree of established dysplasia within the area affected by colitis tends to progress to more advanced neoplasia and even cancer and is a strong indication for total colectomy; if dysplasia is strictly limited to a separate zone, the polyp is subject to complete removal. It is important to differentiate established neoplastic dysplasia from reactive or secondary regenerative atypia in inflammation. However, if dysplasia is well defined, delaying colectomy in favor of follow-up is a risky strategy. Pseudopolyps have no prognostic value, but may be difficult to differentiate from neoplastic polyps; thus, any suspicious polyp is subject to excisional biopsy.
],The digestive organ rightfully occupies a top place in the list of vital and significant human organs.
Therefore, if for some reason this organ is sick in a person, then the quality of life is rapidly falling, and the whole body begins to suffer due to a lack of useful substances.
Nonspecific ulcerative colitis (NSA) belongs to the group of ulcerative inflammatory diseases. It leads to damage to the mucous membrane of the human large intestine. Pathology almost always proceeds with local or systemic complications.
This article is devoted to answers to common questions related to this disease.
The large intestine, how does it work?
The digestive organ is one of the largest organs, all consumed products pass through it. The size of the organ varies from 4 to 8 m in length.
It is in this department that the absorption of useful substances and vitamins, the processing of carbohydrates and fats, which are necessary for the body to work, take place.
It produces more than 10 types of hormones necessary for the functioning human body. However, this is not all areas of responsibility of the digestive organ.
This organ is extremely important in the process of immunity, as various bacteria live there, for example: bifidobacteria and lactobacilli. They act as the first step in the body's defense when an infection enters it.
Nonspecific ulcerative colitis affects the large intestine. In diameter, this department is from 4 to 10 cm, and its length is 2 meters.
The main functions of the large intestine are:
- Digestion of leftover food
- Water absorption (up to 90%);
- Formation and withdrawal of feces;
There are several departments:
- Blind. In this department is the appendix, in which the development of beneficial microflora occurs;
- Colonic. The main department, its peculiarity lies in the fact that there is no partition, and the department itself is not involved in the process of digestion. The main function is water absorption and recycling liquid food. The length of the department is about 1.5 m, the department itself is divided into subsections:
- Ascending, 20 cm long;
- Transverse, 56 cm long;
- Descending, 22 cm long;
- Warm sigmoid colon;
- Rectum (rectum) 14 - 16 cm;
Quite common is the focus of ulcerative colitis in the rectum, the main function of which is the promotion and removal of food debris from the body.
Those. it serves as a kind of reservoir that does not allow feces to come out arbitrarily.
What is UC disease?
The abbreviation NUC stands for non-specific ulcerative colitis.
The disease is ulcerative-inflammatory and chronic. The main lesion may be in the rectum or colon of the large intestine.
There are no known cases of ulcerative colitis of the small intestine.
- The disease develops gradually and it can take a long time before its detection, especially if the patient does not undergo periodic medical examinations.
- The disease proceeds cyclically, i.e. exacerbations may occur periodically, followed by remission.
- The most common symptoms are diarrhea with blood, as well as cramping pain.
Classification
NUC is usually classified according to severity. What it is? The degree of severity is an assessment of the harm caused to a person, which is established according to special standards.
According to the severity is classified into 3 categories:
- Light. Characterized by:
- Hyperemia (diffuse). Overflow of vessels with blood;
- The presence of erosion;
- The presence of a small number of ulcers;
- The main lesion is located in the rectum.
- Average. Characterized by:
- Change in the structure of the mucous membrane of the large intestine to granular;
- The appearance of bleeding on contact;
- Ulcers that have irregular shape located on the surface and do not merge with each other. At the same time, they are covered with pus, mucus or fibrin;
- The site of the lesion is located mainly in the left part of the large intestine.
- Severe form. Characterized by:
- The presence of pseudopolyps;
- Isolation of purulent fluid;
- The presence of microabscesses;
- Presence of spontaneous bleeding
- A pronounced process of necrosis (death) of inflamed areas of the colon mucosa;
- Lesions are located throughout the large intestine.
Reasons for the appearance
The causes of this disease are still not exactly known to medicine. However, there are theories and statistics.
According to theoretical data, there are several causes of ulcerative colitis:
- genetic predisposition;
- Immune system error.
According to statistics, it has been established that if a person's blood relatives suffered from NUC, then the probability of the occurrence of this disease increases by at least 15%, and the total percentage of the sick population of the Earth is approximately 0.01%.
And if there is not much controversy on the first point, then the second one still causes heated debate.
According to research, pathology appears if the immune system fails, and it begins to destroy intestinal cells, mistakenly mistaking them for foreign ones. In place of dead cells, numerous ulcers form.
According to other data, the immune system also does not work quite correctly, but it does not perceive the cells of the intestine itself as alien, but the beneficial bacteria that live in it.
Another rather interesting point is that, according to statistics, the disease is much more common in men than women.
The most common disease is among people aged 20 to 30 years.
Most often leading not quite healthy lifestyle life or having bad habits. In older people (from 50 years), the disease is extremely rare.
Symptoms of UC
Depending on the severity of the disease, the symptoms and treatment of the disease will differ.
Like all diseases, ulcerative colitis has characteristic symptoms:
- Cramping attacks of pain, which are accompanied by a desire to empty the intestines;
- Diarrhea with blood (may be both long-term and short-term);
- The presence of a feeling of fatigue, as well as weight loss due to a violation of the absorption mechanism;
- Increased body temperature (more than 37.5 ° C) for a long time;
- Cutting pains in the anus;
- Bloody discharge, regardless of the presence of defecation (traces on paper, linen, etc.);
- constipation or severely difficult bowel movements;
All of the above symptoms can be not only with NUC, but also with some other diseases, both less and more serious, for example:
- oncology,
- cracks anus and etc.
An accurate diagnosis is possible only in a medical institution and after all the necessary studies have been carried out.
Complications are possible if the disease was discovered late and the degree of damage is high or if it developed quickly.
It is customary to distinguish several types of complications:
- Local, affecting the large intestine;
- Are common. They can appear in any area, they are called extraintestinal;
Complications and consequences
Types of complications in NUC:
- Profuse bleeding. According to experts, such bleeding from the rectum can cause a decent blood loss. Profuse bleeding occurs due to the fact that the intestinal wall is already severely affected, and a large blood vessel is destroyed. Treated either with hemostatic agents or transfusion, or by resection (removal) of the affected area;
- Expansion or contraction in various areas. The probability of occurrence of complications exceeds 50% in moderate and severe forms of UC. It occurs due to dysfunction of the muscles of the large intestine, accompanied by toxic poisoning of the body due to obstruction of the masses of feces, as well as its dehydration;
- Toxic dilatation (stretching due to pressure). With this complication, cavities appear in areas of the large intestine in which feces collect. It begins to rot, the patient begins to become intoxicated with all the consequences: deterioration, fever, vomiting, watery stools and, if there is no help, death;
- Damage (perforation) of the intestine. This type is considered the most severe and requires immediate surgical intervention. Due to the fact that this complication is not common, the percentage of deaths is high (more than 75%). Accompanied by toxic poisoning of the body, acute pain and fever;
- (local inflammation) can occur at perforation sites, as well as with toxic dilatation. Mortality due to this complication is high due to the fact that the diagnosis is usually made too late;
- Oncology. According to statistics, the number of cases of NUC flowing into oncology varies from 4 to 5%. The determining factors are: the duration of the UC disease (usually at least 10 years) and the chronic form of the disease. Predictions for the detection of this complication depend on the time of detection of the tumor, the number of metastases, etc.;
- (inflammation). Occurs in severe forms of UC with the presence of other, above complications. Antibiotics are used for treatment;
- Pseudopolyps. A fairly common complication. This term refers to the process of proliferation of mucous tissues in the area of ulcers or scars. The probability of occurrence with NUC is 50 - 60%. Occurs due to strong inflammatory processes. Pseudopolyps are benign oncological neoplasms;
- Arthritis. The dependence of the occurrence of complications on the severity of NUC has not been established so far. It is chronic, has the property of migration (affects the joints). Arthritis most commonly affects the knees and elbows;
- (inflammatory process inside the veins with the formation of a blood clot). Appears due to the fact that the blood clotting system is disturbed, usually in the lower body. The complication is more common in women than in men;
- Diseases of the skin. Appearance probability is about 20%. Perhaps the appearance of eczema, dermatitis and rashes, as well as gangrene;
- Secondary amyloidosis (general disease with disruption of all organs). Occurs less frequently than all of the above complications. On this moment no more than 17 cases have been registered;
How is the diagnosis carried out?
Diagnosis of nonspecific ulcerative colitis is carried out using a number of laboratory and instrumental studies. Namely:
- Blood test (general). One of characteristic features pathology is considered with varying degrees of severity. And with massive bleeding, it takes the form of acute post-hemorrhagic. If the disease is accompanied by constant, but small blood loss, then the person will have a chronic iron deficiency. It is also possible the development of autoimmune anemia (the formation of antibodies to blood cells). And in the acute form or exacerbation of the chronic form, leukocytosis is characteristic;
- (general). Informative only in severe NUC. In this case, protein and red blood cells can be found in the urine;
- Blood test (biochemical). With NUC, the results of the analysis will show a reduced content of total protein, albumin, as well as a decrease in the amount of iron;
- Fecal analysis (scatological and bacterial). With UC, the stool sample will have an increased number of epithelial cells, leukocytes and erythrocytes, the microflora of the digestive organ will be severely disturbed, and the Triboulet reaction (to search for soluble protein) is positive. A structural change in feces is also recorded, pus, blood, mucus may be present;
- Endoscopy. Examination of the organ visually with the help of special instruments, as well as taking a sample of the tissues of the large intestine for analysis (histological examination);
- X-ray of the colon. Characteristic phenomena are swelling, altered relief of the mucosa, ulcers;
Histological examination is intended to study a tissue sample of the digestive organ. With mild severity in the sample will be found a large number of lymphocytes.
With more severe - plasma cells and eosinophils. And in a sample taken from an ulcer, fibrin (a protein formed during blood coagulation) and granulation tissues.
With some complications, conducting research is simply dangerous for the patient's life. For example, with dilatation, X-rays (irrigoscopy) are not performed, since there is a high probability of intestinal perforation. Instead, a general x-ray of the abdominal cavity is performed, on which the lesions are almost always visible.
Treatment of nonspecific ulcerative colitis
The main goal of the course of treatment is to suppress inflammation, relieve symptoms, prevent exacerbations and improve the overall quality of human life.
The therapy is based on the following means:
- Sulfasalazine;
- Mesalazine;
- Corticosteroid group;
- immunosuppressive group;
According to research, some medicines, for example, sulfasalazine causes side effects in almost half of the cases of use.
The reason is sulfapyridine in the composition of the drug.
The principle of action is based on the fact that when it is broken down by bacterial waste products, 5-aminosalicylic acid has an anti-inflammatory effect.
Mesalazine works a little differently, but is highly effective.
When ingested, the components of the drug block the synthesis of leukotrienes, which are active mediators of inflammation (leukotriene B4, prostaglandins, etc.).
Modern medicine successfully uses several forms of the drug with the active ingredient 5-aminosalicylic acid (5-ASA), but without the use of sulfapyridine. This is required to reduce the manifestation of side effects.
Drugs have different release mechanisms active substance. As a rule, they are all available in the form of tablets, the dissolution rate of which directly depends on the acidity of the stomach. These drugs include:
- salofalk,
- pentas,
- mesacol,
- salozinal.
To suppress symptoms, a high dosage of the drug is initially prescribed, but the course of administration is limited and should not exceed 10 weeks. In order to maintain the state of the body in remission, the drug is not stopped, and its dosage does not exceed 2 mg. The course of admission is several years.
Doctors separately allocate drugs in the form of suppositories (candles), considering them more effective than tablets due to a longer effect on the affected organ.
It is also possible to prescribe a combination of a course of tablets, suppositories or enemas, for example, with left-sided colitis.
If the prescribed course of treatment is not effective, then the attending physician changes the drugs, form or dosage and prescribes drugs of the glucocorticosteroid group (synthesized hormones), as a rule, this is prednisolone.
Its dosage is no more than 60 mg for an average dosage and no more than 100 mg for a high one. The same treatment plan is prescribed if the form of ulcerative colitis is severe or there are extraintestinal complications. The disadvantage of taking corticosteroids are strong side effects such as increased pressure or glycemia.
To block them, additional drugs are prescribed that do not affect the effectiveness of the main drugs.
With any treatment plan, the dosage of all drugs is reduced gradually and only under the supervision of a doctor.
In addition to the above drugs, a list of drugs is additionally prescribed to help eliminate symptoms:
- painkillers;
- antidiarrheal;
- and iron-containing.
As an addition to the course of drugs, a course of physiotherapy procedures can be used:
- Diadynamic therapy. Impact with an electric current with a low frequency and a constant force. It has an analgesic, anti-edematous stimulating effect;
- Interference therapy. Exposure using alternating current with constant and variable frequencies. It can be addictive, so the course of treatment is carried out with a long break;
- Amplipulse therapy. Exposure using alternating modulated current with a high frequency. Depending on the frequency, it can have an analgesic or vasodilating effect. It is forbidden for thrombophlebitis.
Surgical intervention for NUC is performed:
- In emergency cases or in case of serious complications (perforation, stenosis, massive bleeding) that threaten the patient's life.
- If long-term use of prescribed drugs (with the appointment of additional procedures and diet) does not bring results;
- In oncology, if the tumor is malignant.
The most common treatment method is considered to be resection (removal of the damaged area) and the connection of the free edge and the anal canal. If there are not many damaged areas or the lesion is small, then its local removal is performed (segmental resection).
With a severe degree of the disease and exacerbation of symptoms, the attending physician may prescribe fasting (only liquid intake is allowed), as a rule, at the time of exacerbation, the patient almost completely loses his appetite and this method of treatment passes without much difficulty.
For all patients with ulcerative colitis, a change in diet is recommended. The diet is primarily aimed at eliminating some of the symptoms that cause inconvenience, such as diarrhea.
When it is observed, all foods that have a coarse structure or dietary fiber, fiber are removed from the diet, and all foods and drinks that cause irritation of the mucous membrane, such as spicy, sour, salty foods and carbonated drinks, are also excluded. And preference is given to products that have an enveloping effect, for example: kissels, cereals and soups with a puree-like consistency.
Also, one of the key points of the diet is to increase the amount of protein to at least 2 g per 1 kg of body weight per day.
In the initial stage, nonspecific ulcerative colitis is very similar in its symptoms to other pathologies that do not pose a danger (, etc.), but the disease is life-threatening.
Therefore, if there are symptoms that cause inconvenience, or phenomena that should not normally occur, you should immediately consult a doctor.
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Interesting
Ulcerative nonspecific colitis refers to severe pathologies. It affects only the mucous membrane of the large intestine in the form of destructive inflammatory and ulcerative processes of varying intensity. Pathology affects the rectum and gradually spreads to all parts of the large intestine. It starts slowly and the first sign of its development may be bleeding from the rectum. The complexity of the treatment of this disease is in its little known and, as a rule, it lasts quite a long time.
This disease is most often found in residents of megacities. It usually manifests in the elderly (after 60 years) or at a young age up to 30 years and is not contagious.
Table of contents:Causes of nonspecific ulcerative colitis
Scientists have not established the exact cause of ulcerative colitis, but they identify a number of causative factors. These include:
- hereditary predisposition;
- infection of unknown origin;
- genetic mutations;
- Not proper nutrition;
- violation of the 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 its own intestine, which in turn leads to its 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 the 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 severe flow patterns. 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 state of health of the patient. The disease itself greatly depletes the patient's body. If the patient's condition reaches critical, then a mandatory surgical operation is indicated. When such colitis has a compensated form, it can last for many years. At the same time, conservative therapy improves the patient's condition and gives a good effect.
acute form nonspecific ulcerative colitis is characterized by a rather sharp and stormy onset. Inflammatory and ulcerative processes in the large intestine develop from the very beginning of the disease, so it is quite difficult, but it 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 proceeds with phases of remission and exacerbation. In some cases, seizures 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 have varying degrees of severity depending on the severity of the disease and its form. In this regard, in one part of patients throughout life, normal health remains, and among the symptoms only blood in the stool appears (which is often incorrectly associated with hemorrhoids). Other patients have a more severe 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);
- spasmodic abdominal pain;
- (it happens very rarely, diarrhea is usually observed);
- lack of appetite;
- rise in body temperature;
- weight loss due to persistent diarrhea;
- a decrease in the level of hemoglobin in the blood (due to constant bleeding);
- blood in feces(this symptom occurs in 9 out of 10 patients and can look like a bloody spot on toilet paper or massive bloody stools);
- an admixture of mucus in the feces;
- frequent false urge to defecate - "rectal spitting" (when pus and mucus come out of the rectum instead of feces);
- defecation at night (the patient wakes up at night due to an irrepressible 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 pathology;
- liver disease;
- 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 non-specific 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 allows you 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. Digital rectal examination allows the doctor to determine the presence of such pathologies as thickening of the rectal mucosa, anal fissures, rectal fistulas, abscess, sphincter spasm, etc. The doctor must prescribe all the necessary studies in order to eventually conduct a differential diagnosis with pathologies in the form of irritable bowel syndrome, diverticulitis, colon cancer, Crohn's disease.
When examining the material taken, a lesion of the intestinal mucosa is found in the form of ulcers that penetrate deep into the submucosal layer, sometimes even to the muscular one. 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. Also often found feature in the form of "crypt-abscesses".
Treatment of nonspecific 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 taking special drugs to correct diarrhea and the digestive process. In more severe cases, they resort to taking additional medications and surgical treatment.
Hospitalization is extremely necessary at the first diagnosis, this allows doctors to determine the amount of necessary treatment for concomitant hematological and metabolic disorders. Among them, most often there is hypovolemia, acidosis, prerenal azotemia, which develop as a result of a large loss of electrolytes and fluid through the rectum. Because of this, infusion therapy and blood transfusions are simply mandatory for such patients.
Treatment goals for non-specific ulcerative colitis:
- Elimination of complications (anemia, inflammation of an infectious nature).
- The appointment of special nutritional supplements (they make it possible to ensure normal sexual development and growth of children).
- Relief and elimination of the symptoms of the disease.
- Seizure control and prevention.
Conservative treatment includes, in addition to drugs, also a diet. It should be gentle mechanically, contain an increased amount of easily digestible proteins in the form of cottage cheese, meat and fish (low fat). But the use of fresh fruits and vegetables is prohibited. You should eat fractionally, in small portions. The food must be normal temperature not cold and not hot. Parenteral nutrition is indicated in case of severe disease.
Medical therapy includes:
- Intravenous infusions to relieve intoxication of the body, normalize water-electrolyte and protein balances.
- . Drugs are prescribed taking into account the sensitivity of the microflora of the large intestine.
- Tranquilizers. For the purpose of a sedative effect, Seduxen, Elenium are prescribed.
- Antidiarrheals. The scheme includes anticholinergic drugs (Platifillin, Krasavka tincture, Solutan), herbal astringents (decoction of pomegranate peel, blueberry, alder).
- Sulfosalazine (Saloftalk) is a drug that is absorbed in the terminal colon. It is administered topically or systemically and (suppositories, enemas).
- Hormones are corticosteroid. They are administered systemically or as an enema in case of a severe form.
Surgery
It is resorted to with the addition of complications in the form of severe bleeding, colon cancer, the absence of a therapeutic effect from conservative methods, intestinal obstruction, fulminant forms of ulcerative colitis with tolerance to treatment, perforation.
Nonspecific ulcerative colitis (NSA)- a chronic inflammatory disease of the colonic mucosa resulting from the interaction between genetic factors and factors external environment characterized by exacerbations. It is found in 35 - 100 people for every 100,000 inhabitants, that is, it affects less than 0.1% of the population. Currently, in the English-language literature, "ulcerative colitis" is considered a more accurate term.
Etiology
The etiology of NUC is not exactly known. The following reasons are currently being considered:
1) Genetic predisposition (the presence of relatives of Crohn's disease or ulcerative colitis increases the risk of developing ulcerative colitis in a patient). A large number of genes are being studied for which an association with the development of the disease is revealed. However, at present, the role of only genetic factors has not been proven, that is, the presence of mutations in a particular gene will not necessarily cause the development of ulcerative colitis;
2) The use of non-steroidal anti-inflammatory drugs for a long time increases the risk of developing the disease. Short courses of these drugs are probably safe;
3) Bacteria, viruses? - the role of these factors is not completely clear, but there is no evidence at the moment; Food allergies (milk and other products), stress can provoke the first attack of the disease or its exacerbation, but do not play the role of an independent risk factor for the development of ulcerative colitis. Immunological disorders and autoimmunization - one of the factors in the pathogenesis of the disease
protective factors.
1) It is believed that active smoking reduces the risk of developing ulcerative colitis and the severity of the disease. It has been proven that people who quit smoking have a 70% increased risk of developing ulcerative colitis. In these patients, the severity and prevalence of the disease is greater than in smokers. However, when relapsed into smoking in those with advanced disease, the benefit of smoking is questionable.
2) Appendectomy at a young age for "true" appendicitis is considered a protective factor that reduces the risk of developing ulcerative colitis.
3)Scientists have proven that a high intake of oleic acid in food reduces the risk of developing the disease by 90%. According to gastroenterologists, oleic acid prevents the development of ulcerative colitis by blocking chemical substances in the intestines, which exacerbate inflammation in the disease. Doctors have suggested that if patients received large doses of oleic acid, about half of the cases of ulcerative colitis could be prevented. Two or three tablespoons olive oil per day is enough to show the protective effect of its composition, clinicians say.
Symptoms
- Frequent diarrhea or mushy stools mixed with blood, pus and mucus.
- "False urge" to defecate, "mandatory" or obligatory urge to defecate.
- pain in the abdomen (more often in the left half).
- fever (temperature from 37 to 39 degrees, depending on the severity of the disease).
- decreased appetite.
- weight loss (with prolonged and severe course).
- water and electrolyte disturbances of varying degrees.
- general weakness
- joint pain
It should be noted that some of these symptoms may be absent or minimally expressed.
Diagnostics
Diagnosis of ulcerative colitis in most cases is not difficult. Clinically, it is manifested by the presence of blood and mucus in the stool, frequent stools, and abdominal pain. Objective confirmation of the diagnosis occurs after fibroileocolonoscopy with examination of the ileum and histological examination of biopsy specimens, until this moment the diagnosis is preliminary.
- In a clinical blood test, there are signs of inflammation (an increase in the total number of leukocytes, stab leukocytes, platelets, an increase in ESR) and anemia (a decrease in the level of red blood cells and hemoglobin).
- In the biochemical analysis of blood - signs of an inflammatory process (increased levels of C-reactive protein, gamma globulins), anemia (decrease in serum iron), immune inflammation (increased circulating immune complexes, class G immunoglobulins).
One of the modern markers for the diagnosis of inflammatory bowel diseases (including ulcerative colitis) is fecal calprotectin. With an exacerbation, its level rises (above 100-150).
In some cases, the diagnosis of ulcerative colitis can be misdiagnosed. Other pathologies imitate this disease, in particular, acute intestinal infections (dysentery), protozoal invasions (amebiasis), Crohn's disease, helminthic invasions, colon cancer.
To exclude infections, it is necessary to obtain a negative stool culture tank, the absence of antibodies to pathogens in the blood. A number of intestinal infections are determined or excluded by determining the pathogen by PCR in feces. The same method determines the presence of helminths in the feces (it is also desirable to carry out the determination of antibodies to helminths in the patient's blood). It must be remembered that the detection of helminths does not exclude the diagnosis of ulcerative colitis.
It is difficult to carry out differential diagnosis between ulcerative colitis and Crohn's disease. Ulcerative colitis affects only the colon (in rare cases, with a total lesion of the colon, retrograde ileitis is observed, when non-specific inflammation of the ileum mucosa is detected during ileocolonoscopy). Ulcerative colitis is characterized by a continuous lesion of the colonic mucosa, while in Crohn's disease it is most often segmental (eg, sigmoiditis and ileitis). It is also important to conduct a histological examination taken from different parts of the colon and ileum. Determination of specific antibodies often helps to distinguish ulcerative colitis from Crohn's disease. For example, antibodies to the cytoplasm of neutrophils with a perinuclear type of luminescence (p-ANCA) are characteristic of ulcerative colitis (detected in 35-85% of patients). In Crohn's disease, their frequency is 0-20%, more often in Crohn's colitis.
Treatment
In the period of mild or moderate exacerbation, outpatient treatment is indicated. Diet for ulcerative colitis. From the moment of exacerbation, diet No. 4a is prescribed. With the subsidence of inflammatory processes - diet 4b. During remission - diet 4b, then a regular diet with the exception of foods that are poorly tolerated by the patient. In case of severe exacerbation of ulcerative colitis - the appointment of parenteral (through a vein) and / or enteral nutrition.
Medical treatment. The main drugs for the treatment of ulcerative colitis are preparations of 5-aminosalicylic acid. These include sulfasalazine and mesalazine. These drugs have an anti-inflammatory effect and have a healing effect on the inflamed colon mucosa. It is important to remember that sulfasalazine can cause large quantity side effects than mesalazine and is often less effective in treatment. In addition, drugs containing mesalazine as an active ingredient (salofalk, mesacol, samezil, pentasa) have an effect in different parts of the colon. So, pentas begins to act in the duodenum, mesacol - starting from the colon.
Hormones - prednisolone, dexamethasone - are prescribed with insufficient effectiveness of 5-ASA drugs or with a severe attack of ulcerative colitis. They are usually combined with sulfasalazine or mesalazine. In cases of moderate and / or severe disease, prednisolone or its analogues are administered intravenously at doses of 180 to 240 mg per day or more, depending on the activity of the disease. After 3-5-7 days, if there is a therapeutic effect, hormones are administered orally in tablet form. Usually the starting dosage is 40-60 mg per day, depending on the activity of the disease and the patient's body weight. Subsequently, the dose of prednisolone is reduced by 5 mg per week. Hormonal drugs do not heal the colonic mucosa, they only reduce the activity of exacerbation. Remission (inactive disease) is not maintained when hormones are prescribed for a long time.
Biological preparations - remicade, humira - are prescribed for hormone-resistant forms of the disease.
Notes
Sources
- Nonspecific ulcerative colitis
- Ulcerative Colitis and Pregnancy Consilium medicum
- Modern aspects of the treatment of non-specific ulcerative colitis: results of evidence-based medicine Consilium medicum
- Clinical-endoscopic-morphological dissociations in children with inflammatory bowel diseases Consilium medicum
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Synonyms:See what "Ulcerative Colitis" is in other dictionaries:
Exist., Number of synonyms: 1 disease (995) ASIS Synonym Dictionary. V.N. Trishin. 2013 ... Synonym dictionary
Nonspecific ulcerative colitis ICD 10 K ... Wikipedia
Chronic inflammatory disease of the colon and rectum (see Intestine) with damage to the mucous membrane and submucosal layer of the intestine and the formation of ulcers. In its emergence and development, stressful conditions, perverted ... ...
Nonspecific chronic relapsing disease characterized by severe inflammatory lesions of the colon with abdominal pain, diarrhea (abundant bloody purulent discharge), painful urge to defecate ... Big encyclopedic Dictionary
Nonspecific, chronic relapsing disease characterized by severe inflammatory lesions of the colon with abdominal pain, diarrhea (abundant bloody purulent discharge), painful urge to defecate. * * * ULCER… … encyclopedic Dictionary
Nonspecific, chronic relapsing disease characterized by severe inflammation. colon damage with abdominal pain, diarrhea (abundant bloody purulent discharge), painful urge to defecate ... Natural science. encyclopedic Dictionary
ULCERATIVE COLITIS, NON-SPECIFIC- honey. Non-specific ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology involving the mucosa of the distal part (always the rectum) or the entire colon (25% of cases). In heavy... Disease Handbook
Pseudomembranous Colitis- honey. Pseudomembranous colitis is an acute, potentially severe disease of the large intestine associated with the use of antibiotics and characterized by the formation and release with feces of membranous material of structures represented by fibrin and mucus. Disease Handbook
A; m. [from Greek. kolon colon] Inflammation of the colon. Acute, chronic to. * * * colitis (from the Greek kólon colon), acute and chronic inflammatory diseases of the colon caused by infection, gross errors in ... ... encyclopedic Dictionary
- (from the Greek. kólon large intestine) inflammation of the large intestine. One of the most common diseases of the gastrointestinal tract. The causes of K. can be an infection (dysenteric bacillus, salmonella, amoeba, balantidia and ... ... Great Soviet Encyclopedia
Books
- Internal illnesses. Diseases of the gastrointestinal tract. Textbook , Shamov Ibragim Akhmedkhanovich , V study guide diseases of the gastrointestinal tract are considered in detail: irritable bowel syndrome, which is related to functional pathology, and rather severe ... Category: Gastroenterology Series: Higher education: Specialist Publisher:
2. Massive bleeding from the colon. Given a complication leads to anemia (decrease in the number of red blood cells and hemoglobin), as well as hypovolemic (reduced blood volume) shock.
3. Malignancy (malignancy)- the appearance of a malignant tumor at the site of inflammation.
4. Secondary intestinal infections. Inflamed mucosa is a good environment for development intestinal infection. This complication significantly worsens the course of the disease. Diarrhea gets worse, stools 10-14 times a day, heat, dehydration.
5. Purulent complications. For example, paraproctitis is an acute inflammation of fatty tissue near the rectum. This purulent complication is treated surgically.
Treatment of UC
Effective treatment only possible with a specialist doctor. Exacerbation of the disease is treated only in the hospital.
Diet for NUC
Diet principles1. All food should be boiled or baked.
2. Dishes should be consumed warm. Meal frequency - 5 times a day.
3. The last meal no later than 19.00.
4. The diet should be hypercaloric (high in calories) 2500-3000 calories per day. The exception is obese patients.
5. The diet should be hyperprotein (high protein content)
6. Must contain an increased amount of vitamins and minerals
Prohibited Products
The following products cause chemical, mechanical irritation of the colon mucosa. Irritation enhances the inflammatory process. Also, some foods increase peristalsis (movement) of the large intestine, which increases diarrhea.
- alcohol
- carbonated drinks
- dairy
- mushrooms
- fatty meats (duck, goose, pork)
- kiwi, plum, dried apricots
- any kind of spice
- coffee, cocoa, strong tea, chocolate
- ketchup, mustard
- any peppery and highly salted dishes
- chips, popcorn, crackers
- raw vegetables
- nuts
- seeds
- legumes
- corn
Products to be consumed:
- fruits
- berries
- various mucous porridges
- boiled eggs
- non-fatty meats (beef, chicken, rabbit)
- juice from tomatoes and oranges
- non-fatty fish
- liver
- cheese
- seafood
Medical treatment
Apply drugs from the group of aminosalicylates. Sulfasalazine during exacerbation is used orally 1 gram 3-4 times a day, until remission appears. Dose in remission 0.5-1 grams 2 times a day.
Mesalazine - 0.5-1 gram 3-4 times a day during exacerbation. In remission, 0.5 grams 2 times a day.
For the treatment of ulcerative colitis in the rectum and sigmoid colon, suppositories or enemas with salofalk or mesalazole are used.
Corticosteroids are used in severe forms of the disease. Prednisolone is administered orally at 40-60 milligrams per day, the duration of treatment is 2-4 weeks. After that, the dose of the drug is reduced by 5 mg per week.
Recently, topical corticosteroids have been used. Budesonide 3 mg 3 times a day for 12 months, then 2 mg 3 times a day for another 6 weeks and then 1 mg 3 times a day for 6 weeks.
Immunosuppressants are also sometimes used. Cyclosporine A - is used in acute and fulminant forms of the disease at a dose of 4 mg per kilogram of body weight intravenously. Or azathioprine orally at a dose of 2-3 mg per kilogram of body weight.
symptomatic treatment. Different kinds anti-inflammatory drugs with analgesic effect, such as ibuprofen or paracetamol.
Vitamin therapy (vitamins B and C)
Prevention of UC
One of the most important preventive measures is diet. It is also important to visit a general practitioner and take blood and stool tests.
What are the alternative methods of treatment of NUC?
In the treatment of UC ethnoscience uses a number of food products of plant (and not only) origin, as well as decoctions and infusions prepared from these products.- Bananas
- Reverse
- Apples
- Rice congee
There is another effective recipe for the treatment of UC using rice:
you need to cook five tablespoons of rice in a small amount of water, until the consistency of porridge-slurry. Mix received rice porridge with a glass of skim milk and a mashed ripe banana. With an exacerbation of the disease, you should eat such a dish twice a day on an empty stomach.
- Decoction of wheat
To prepare a decoction you will need:
- 1 tablespoon whole grains of wheat;
- 200 ml of water.
Wheat broth can also be used for setting enemas.
- Turnip decoction
To prepare this tool, you will need:
- a few turnip leaves;
- vegetable juice (from the same turnip, or from carrots, zucchini, cabbage, etc.).
This decoction contains ingredients that prevent constipation, improve digestion, and soften stools.
- Decoction of watermelon peels
What is the prognosis for patients with UC?
The probability of cure of nonspecific ulcerative colitis depends on the severity of the disease, on the presence of complications, as well as on the timeliness of the start of treatment.In the absence of adequate treatment in patients suffering from nonspecific ulcerative colitis, secondary diseases (complications) develop very quickly, such as:
- severe intestinal bleeding;
- Perforation (perforation) of the colon with subsequent development of peritonitis;
- Formation of abscesses (abscesses) and fistulas;
- severe dehydration;
- Sepsis ("blood poisoning");
- Liver dystrophy;
- The formation of kidney stones due to impaired absorption of fluid from the intestine;
- Increased risk of developing colon cancer.
However, with mild and moderate, uncomplicated course of the disease, with timely treatment started using all modern methods, subject to the patient's diet and preventive measures, the prognosis of the disease is quite favorable. Relapses after properly conducted treatment occur every few years and are quickly stopped by the use of drugs.
How to treat UC with herbs?
Here are some recipes for using medicinal plants in the treatment of ulcerative colitis:- Infusion of oak bark
To prepare the infusion, a teaspoon of crushed dry oak bark is poured into half a liter of cold boiled water and infused at room temperature for 8-9 hours. Drink the resulting infusion throughout the day in equal portions.
- aloe vera juice
- Goldenrod tincture
The infusion is prepared as follows: 20 g of dry goldenrod herb, poured with a glass of boiling water, is kept in a boiling water bath for 15 minutes. Then the fire is turned off, but the infusion is not removed from the water bath for another 45 minutes. After that, the infusion is filtered and boiled water is added to 200 ml. Take three times a day for 2 tables. spoons before meals.
- Infusion of horsetail
- Chinese bitter gourd infusion
To prepare the infusion you will need:
- 1 tablespoon dry crushed bitter gourd leaves
- 200 ml of boiling water.
- Herbal infusion
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