Chronic colitis: causes, symptoms and treatments

What it is

Chronic intestinal colitis is an inflammatory process that affects the mucous membrane and submucosal layer of this organ. The disorder is equally common in both women and men, but in the latter it manifests itself at a later age.

The chronic form of colitis involves phases of exacerbation and remission phases, when there are no signs. Symptoms with this form are less pronounced than with acute colitis. The pathology is diagnosed simply and treated comprehensively.

Risk factors

Risk factors for the occurrence of colitis are as follows:

• reduced immunity;
• poor nutrition;
• frequent stress;
• alcohol abuse;
• a history of autoimmune diseases;
• abnormal structure of blood vessels in the intestine.

Enteral nutrition for ulcerative colitis

Ulcerative colitis (ICD-10 code K51) is a chronic inflammatory disease of the colon of unknown etiology, characterized by ulcerative-necrotic changes in the mucous membrane and a continuous inflammatory process.

The peak incidence of ulcerative colitis occurs at a young age, the prevalence of the disease is about 40 cases per 100 thousand population.

The disease can affect the entire colon - total colitis (18% of cases), left-sided lesions occur in 28% of cases and proctosigmoiditis occurs in 54% of cases.

The main symptoms of ulcerative colitis include primarily intestinal bleeding and constant loss of blood in the stool, diarrhea and abdominal pain. Extraintestinal manifestations of the disease are also common - fever, arthralgia, erythema nodosum, changes in the visual organs, and the development of anemia is typical.

The severity of ulcerative colitis is assessed by stool frequency, degree of blood loss, fever and laboratory parameters (ESR, albumin level).

For ulcerative colitis, various classes of drugs are used in therapy, primarily 5-aminosalicylic acid drugs (mesalazine, sulfasalazine), systemic and topical glucocorticoids (prednisolone, budesonide), immunosuppressants (azathioprine). Treatment tactics depend both on the severity of the disease and on the extent of damage to the large intestine.

Nutrition for patients with ulcerative colitis

Nutrition for patients suffering from ulcerative colitis presents significant difficulties for both the doctor and the patient. There is no clear formula for dietary nutrition for this disease. Patients are advised to avoid spicy, fatty, fried foods, give up rough foods, eat vegetables and fruits, limit simple carbohydrates and fats in their diet and focus on the protein component of the diet.

In practice, it can be difficult for patients to adhere to dietary recommendations, which is especially typical at the onset of the disease, when the patient has to reconsider most of his food preferences and permanently give up a number of favorite foods. Over time, each patient is forced to carefully expand his diet and introduce new foods into it, and this is often done by trial and error, often provoking an exacerbation of the disease. Over time, the patient develops his own diet and, provided he regularly takes the prescribed medications, does not experience any serious inconveniences associated with the disease, and his quality of life remains at a fairly high level.

Types of malnutrition in ulcerative colitis

Malnutrition is common both during exacerbation of ulcerative colitis and during remission. Loss of body weight is observed in more than half of the patients, hypoalbuminemia occurs in 25–50% of cases, anemia in 66% of patients, the vast majority have iron deficiency, there is clear evidence of insufficiency in this group of patients of folic acid, cyanocobalamin, calcium, magnesium, potassium, vitamin D, copper and zinc.

The main types of malnutrition that occur in ulcerative colitis are:

• depletion of muscle protein and fat reserves while maintaining the visceral protein pool (marasmus, ICD-10 code E41);
• depletion of the visceral protein pool while maintaining fat reserves and muscle protein, while body weight can remain normal (kwashiorkor, code E40 according to ICD-10);
• depletion of both visceral and somatic protein reserves (mixed type of malnutrition - marasmic kwashiorkor, code E42 according to ICD-10).

Depletion of both the visceral and somatic pools of protein occurs, as a rule, with severe exacerbations that cannot be stopped for a long time.

Causes of malnutrition in patients with ulcerative colitis

There are several causes of malnutrition in ulcerative colitis. First of all, in patients, together with discharged mucus and as a result of bleeding, there is a large loss of proteins, electrolytes and microelements in the stool, especially pronounced with repeated non-fecal bloody and mucous stools, and this leads to a decrease in the amount of transport albumin, which leads to disruption of the delivery of nutrients to tissues. On the other hand, acute and chronic inflammation leads to a change in metabolism towards catabolism and, as a result, increases the body's needs for energy and building material. At the same time, quite often in this category of patients there is a sharp decrease in appetite, up to anorexia. Patients often deliberately limit the amount of food they eat, since an increase in the amount of content in the large intestine causes increased pain. It should also be noted that systemic glucocorticoids used in standard therapy for ulcerative colitis further increase the body's needs for energy and proteins. And the gentle nutrition traditionally used in the clinic is not always able to satisfy all the demands that the body makes.

Result of malnutrition

Malnutrition leads to a decrease in the body's adaptive capabilities and thereby complicates the treatment of the patient and leads to prolongation of the exacerbation of the disease.

This problem is most significant in the surgical treatment of ulcerative colitis, when the body's adaptive capabilities can determine the prognosis and outcome of surgical treatment and greatly affect the patient's condition in the postoperative period.

Malnutrition significantly complicates the treatment of young patients, who need energy and nutrients not only for the functioning of the body, but also for growth and development.

Enteral and parenteral nutrition for ulcerative colitis

Adequate intake of nutrients and energy can be achieved through parenteral and enteral nutrition.

At the same time, the possibility of widespread use of parenteral nutrition is limited by technical difficulties in implementation, the need for careful monitoring of nutritional support, and the high cost of such treatment. In this regard, parenteral nutrition is used, as a rule, in severe exacerbations, when, against the background of moderate or severe malnutrition, there is a need for complete functional rest of the large intestine and the entry of any nutrients into the lumen of the colon should be excluded in order to avoid provoking a deterioration of the condition patient. Parenteral nutrition should also be used when the degree of malnutrition becomes more severe in the absence of the ability to meet the body's needs naturally through the gastrointestinal tract.

The most appropriate way to adequately provide this category of patients with nutrients and energy is nutritional support in the form of enteral nutrition. Enteral nutrition mixtures contain all the necessary macro- and micronutrients and, due to this, can act as the only source of nutrition for a long time.

Nutritional support in the form of enteral nutrition has several important effects. First of all, the functional load on the large intestine is reduced, additional trauma to the inflamed mucosa is reduced and a rest regime is created for the distal parts of the gastrointestinal tract, since the absorption of the components of the mixtures occurs in the small intestine. In contrast to enteral nutrition, the intake of regular food causes the formation of feces, the movement of which in the affected colon leads to additional trauma to the mucous membrane, which contributes to prolonging the exacerbation of the disease. Secondly, food antigens that may contribute to the maintenance of inflammation are removed from the lumen of the digestive tract. It is important to note that enteral nutrition formulas do not contain lactose or gluten, which cause diarrhea.

Thus, when using enteral nutrition, two main tasks are solved: it ensures the replenishment of the energy and plastic needs of the body, as well as a rest regime for the large intestine, which helps reduce the inflammatory process.

But, despite the advantages of using enteral nutrition, at present there is not yet a sufficient evidence base regarding the effect of enteral nutrition on the course of the inflammatory process in ulcerative colitis. Recent guidelines from the European Society for Parenteral and Enteral Nutrition (ESPEN) recommend the use of enteral nutrition in ulcerative colitis if the patient is nutritionally deficient.

There are two ways to use enteral nutrition formulas. Firstly, they can serve as an additional source of nutrition and be used in addition to the diet being used. Secondly, they can act as the main source of nutrition in patients with severe exacerbation of ulcerative colitis.

Enteral nutrition is divided into oral and tube feeding. In the case of oral nutrition, the sip feeding method is recommended, when the patient takes the prescribed volume of the mixture in small sips throughout the day.

There is a wide range of enteral nutrition formulas available that can be used to provide nutritional support to patients with ulcerative colitis. The choice of a particular mixture can be determined both by the characteristics of its composition and by the economic capabilities and taste preferences of the patient himself, which also plays an important role. The mixtures most often used in clinical practice are “Clinutren”, “Nutrizon”, “Nutricomp standard”, “Nutrien standard”, “MD mil Clinipit” and others.

Both balanced and semi-element mixtures can be used. In the complex therapy of nutritional deficiency in ulcerative colitis, the semi-element mixture “Peptamen” has proven itself well. The advantage of this mixture is that the proteins in its composition are broken down into peptides, are easily digested and absorbed in the upper parts of the small intestine, and fats are medium-chain (50–80%) and are digested without lipase.

Some mixtures contain dietary fiber, which makes it possible to correct dysbiotic changes that always occur with ulcerative colitis (Nutricomp Fiber).

In most cases, enteral nutrition formulas should not replace the patient’s overall diet, but should serve as an additional source of nutrients and energy. According to the latest ESPEN recommendations, those patients with ulcerative colitis who have nutritional deficiency are advised to receive additional enteral nutrition with an energy value of 500–600 kcal per day.

In practice, it is possible to quickly teach the patient how to prepare the mixture and how to take it. The sipping method, when the patient consumes the formula, is the most effective, since it first of all helps to avoid diarrhea, a fairly common complication of enteral nutrition. For the same purpose, it is advisable to gradually introduce the mixture into the patient’s diet in such a way that the required energy value of 500–600 kcal per day is achieved within several days.

Enteral nutrition as a “drug”

Enteral nutrition can act not only as a source of nutrients and energy, but also as a therapeutic option. For this purpose, the enteral nutrition mixture “Modulen IBD” is used, specially developed for the treatment of inflammatory bowel diseases.

“Modulen IBD” is a dry, complete, balanced mixture based on casein; it contains proteins, fats and carbohydrates in an optimal ratio, as well as all the necessary vitamins, macro- and microelements.

A feature of this mixture, due to which its therapeutic properties are realized, is the presence in its composition of a natural anti-inflammatory growth factor (TGF-beta2). The anti-inflammatory activity of this factor is realized by reducing the level of pro-inflammatory cytokines in the intestinal mucosa - primarily interleukin-1, interleukin-8 and interferon gamma.

Modulen IBD has demonstrated high effectiveness in the treatment of Crohn's disease and is used in pediatric practice as a monotherapy for this disease. In accordance with the ECCO statement 10B of the European Consensus on the Diagnosis and Treatment of Crohn's Disease adopted by the European Association of Crohn's and Colitis, this enteral nutrition in Crohn's disease is effective in achieving remission, regardless of the activity of the process and the location of the lesion.

While the effectiveness of using Modulen IBD in the treatment of Crohn's disease has been studied quite well, the effectiveness of this mixture in the treatment of ulcerative colitis has not yet been sufficiently studied. Our clinic has experience using the Modulen IBD mixture in the complex treatment of patients with ulcerative colitis and is currently conducting a pilot study of the effectiveness of Modulen IBD in patients with moderate forms of the disease.

According to preliminary data, the period of relief of exacerbation when using this mixture is shorter than with standard therapy, which indicates the influence of therapy with the Modulen IBD mixture on the course of the inflammatory process. There is a positive dynamics in body weight and indicators of the nutritional status of patients: an increase in the total thickness of skin-fat folds, albumin levels, and the absolute number of lymphocytes. In the case where patients lost weight quickly enough during the last weeks, the use of the mixture significantly reduced the rate of progression of malnutrition, and in the future, after the disease went into remission, there was a tendency to increase body weight. Additional enteral nutrition with the Modulen IBD mixture was well tolerated by patients; some patients experienced flatulence, which was quickly eliminated by adjusting the volume of the mixture taken.

Thus, the use of Modulen IBD in the treatment of patients with ulcerative colitis allows us to solve three problems:

• ensure adequate energy supply;
• replenish nutrient deficiencies;
• reduce inflammation in the intestinal mucosa.

To summarize, it should be said that, despite the fact that at present there is no strict evidence base showing a decrease in inflammation in the colon through enteral nutrition, the feasibility of its widespread use in the complex treatment of ulcerative colitis is obvious. Currently, Modulen IBD is one of the most promising mixtures for nutritional support of patients with ulcerative colitis.

For questions regarding literature, please contact the editor.

E. I. Tkachenko , Doctor of Medical Sciences, Professor S. V. Ivanov T. N. Zhigalova , Candidate of Medical Sciences, Associate Professor S. I. Sitkin , Candidate of Medical Sciences, Associate Professor of St. Petersburg State Medical Academy named after. I. I. Mechnikova , St. Petersburg

Causes

According to statistics, when visiting a gastroenterologist, 40% of patients are diagnosed with a chronic form of the disease. In approximately 30% of patients, intestinal inflammation is a consequence of intestinal infections (dysentery, salmonellosis). Less commonly, the reason is long-term treatment with antibiotics, which disrupt the normal balance of intestinal microflora.

Causes may also be related to alcohol abuse and poor diet, which contribute to inflammation. In some cases, chronic colitis is a complication of other gastrointestinal diseases, such as chronic gastritis , hepatitis, pancreatitis, as well as a consequence of abnormalities in the development or functional insufficiency of the intestine.

Forms of chronic colitis

The disease comes in several types:

• Spastic. It manifests itself as severe pain that occurs in various parts of the intestine, so the dislocation of pain sensations changes.
• Nonspecific ulcerative colitis. This disease is characterized by the spread of pain throughout the intestines. Ulcers and bleeding are also possible.

Depending on the cause, chronic colitis can be allergic, infectious, ischemic, radiation, toxic, or combined. In the latter case, several etiological factors are combined.

According to the prevalence of the lesion, colitis is:

• segmental - when only a specific part of the intestine is involved in the pathological process;
• total - the entire colon is affected.

By severity:

• mild degree - when it is easy to achieve remission;
• moderate severity - to ensure long-term relief of symptoms, medications and diet are needed;
• severe degree - exacerbation prevails over remission, and it is difficult to achieve the latter.

Variants of localization of the inflammatory process in chronic colitis.

Chronic colitis

The disease is characterized by a pain syndrome in the form of aching and dull pain, localized in any part of the abdomen, having both a cramping and diffuse character. Abnormal bowel movements, rumbling, flatulence, painful tenesmus or dyspeptic disorders are a number of specific symptoms characteristic only of pathological processes affecting the gastrointestinal tract.

A distinctive symptom of chronic colitis, which allows us to differentiate it from other pathologies, is increased pain immediately after eating, cleansing enemas, abdominal tension and relief after bowel movements, release of accumulated gases or the use of antispasmodics. Quite often, with this pathology, the process of defecation occurs 6-7 times a day with the release of mucus or streaks of blood. During palpation of the abdominal organs, pain is determined along the course of the colon.

Proctitis and proctosigmoiditis are common forms of chronic colitis that occur as a result of chronic constipation, regular mechanical irritations of the mucous membrane and bacterial dyskinesia. These forms of the disease are accompanied by the presence of pain localized in the iliac region, severe flatulence, general malaise, nausea and often a slight increase in body temperature. With an exacerbation of the pathological process, specific false urges to defecate, the release of accumulated gases and feces in the form of “sheep feces”, covered with mucus and streaks of blood discharge, are noted. On palpation, pain is localized in the area of ​​the sigmoid colon.

In addition to specific symptoms, chronic colitis is accompanied by general malaise, dizziness, decreased performance, weakness, weight loss, and astheno-neurotic syndrome. The psychological status of the patient is also disturbed: this manifests itself in the form of a characteristic feeling of anxiety, inexplicable panic, excessive irritability and anxiety, disruption of sleep and wakefulness.

1. With mild colitis, “intestinal” symptoms are almost not expressed, while the general condition of the patient is satisfactory; painful sensations are noted upon palpation of only some parts of the intestine.
2. The average degree of the pathological process is clinically more pronounced. This degree is characterized by a detailed manifestation of the “intestinal” symptom complex, loss of body weight, rumbling, bloating, splashing in the area of ​​the cecum; Palpation pain is noted in any part of the large intestine.
3. The severe degree is characterized by significant signs indicating the involvement of other organs of the gastrointestinal tract in the inflammatory process. Manifests itself in the form of severe bloating, malabsorption syndrome, and frequent diarrhea. On palpation, pain is spread throughout the abdomen, most focused in the peri-umbilical region.

Symptoms

Since in a chronic course the phase of retreat of symptoms and exacerbation alternate, most often patients turn to the doctor precisely when the symptoms acutely make themselves felt. During remission, they are absent altogether or are expressed very weakly.

The main symptoms of chronic colitis are as follows:

• pain that manifests itself in the lateral parts of the abdomen (the nature of the pain can be either acute or aching);

  
  Manifestations of chronic colitis.

• rumbling in the intestines;
• belching, often with an unpleasant odor;
• measuring the abdomen in size;
• increased gas formation;
• false urge to defecate, which can occur every few days;
• nausea and weakness;
• unpleasant taste in the mouth;
• increased fatigue;
• sleep disorder;
• pale skin;
• brittle nails and hair loss;
• change in eating habits.

With nonspecific ulcerative colitis, the following symptoms are possible:

• impurities of pus or blood in the stool;
• frequent diarrhea;
• mild tingling pain in the lower abdomen;
• loss of appetite;
• inflammation of the organs of vision (extremely rare);
• pain in the joints;
• muscle weakness.

With an exacerbation of the symptoms of this form, changes in the intestinal mucosa are possible, such as swelling, bleeding, the appearance of small ulcers and formations similar to polyps.

Chronic colitis of a spastic nature manifests itself as follows:

• painful spasms that worsen with hunger or at night;
• bloating;
• flatulence;
• alternating diarrhea and constipation;
• insomnia and, as a result, constant fatigue;
• headache of varying intensity;
• complete bowel movement is often possible only the second or third time, and the process of excreting feces occurs only once a few days;
• rumbling in the stomach.

To reduce the symptoms, a constant diet is needed, but it must be taken into account that certain foods can cause constipation.

Colitis

Chronic colitis during an exacerbation period is advisable to treat in a hospital, in the proctology department. Colitis of an infectious nature is treated in specialized infectious diseases departments. A significant element in the treatment of chronic colitis is adherence to a therapeutic diet. At the same time, all products that can mechanically or chemically irritate the intestinal mucosa are excluded from the diet; food is consumed pureed, with a frequency of at least 4-5 times a day. In addition, to eliminate lactic acid fermentation, patients are advised to give up milk; in order to reduce gas formation, they limit cabbage and legumes.

Dried unsweetened wheat bread is allowed for baked goods. It is advisable to consume low-fat meat and fish steamed. When severe clinical symptoms subside, the diet is gradually expanded. To combat constipation, it is recommended to include boiled vegetables, fruit purees (jelly), and bran bread in the diet. Vegetable oil and a sufficient amount of fluid consumed per day contribute to improving the passage of intestinal masses. It is undesirable to consume fruits and vegetables raw during the acute period of the disease. You should also avoid chilled foods, dairy products and foods high in acid. To regulate fluid secretion in the intestines, limit the use of table salt.

In the case of the infectious nature of colitis and to suppress the pathogenic bacterial flora that has developed as a result of dysbacteriosis, short courses of antibiotic therapy are prescribed (drugs ciprofloxacin, Nifuroxazide, rifaximin). Prescriptions of medications are made only by a specialist. Detection of worm eggs is an indication for the prescription of anthelmintic drugs. To relieve pain, antispasmodics (drotaverine, papaverine) are prescribed.

In the treatment of proctosigmoiditis, local therapy is useful: microenemas with decoctions of chamomile, calendula, tannin or protargol. For proctitis, rectal suppositories with belladonna, anesthesin to relieve severe pain, and astringents (zinc oxide, xeroform) are prescribed. For diarrhea, astringents and enveloping agents are prescribed orally (tannin + albumin, bismuth nitrate, white clay, oak bark decoction, other decoctions and infusions of herbs containing tanning components). For constipation, colon hydrotherapy is indicated. Severe spasms during colitis may be an indication for the prescription of anticholinergic drugs.

In addition to the above remedies, enterosorbents (to combat flatulence), enzyme preparations (for digestive disorders as a result of enzyme deficiencies), and eubiotics (to correct dysbiosis) can be prescribed for colitis. A good effect in the treatment of chronic colitis is achieved by regular spa treatment and balneotherapy.

Diagnostics

To diagnose chronic colitis, you will need to consult a therapist and gastroenterologist. Its measures are as follows:

• 
  Results of irrigoscopy. conversation with the patient, during which he must talk about all the symptoms he has;

• examination of the patient: palpation of the abdomen and eye examination. In the presence of inflammation of the latter, diagnosis is also carried out by an ophthalmologist;
• blood test (acute and biochemical);
• immunological analysis;
• stool analysis;
• colonoscopy (helps distinguish exacerbation from remission);
• X-ray using a contrast agent;
• Ultrasound.

Treatment of chronic colitis

Treatment for chronic colitis differs depending on the phase of the disease. At the remission stage, following a diet is sufficient; in case of exacerbation, drug therapy is needed. Treatment should be individualized, taking into account the type of disorder, severity of symptoms and general condition of the patient

Drug treatment

Typically, the following groups of medications are used for chronic colitis:

• 
  Antibacterial therapy and abuse of laxatives can lead to exacerbation of chronic colitis. Antibiotics;

• probiotics - aimed at restoring the number of beneficial microorganisms in the intestinal microflora;
• antispasmodics - reduce pain;
• laxatives or fastening agents depending on the symptoms (diarrhea or constipation);
• medications containing enzymes;
• corticosteroids, immunosuppressants (for nonspecific ulcerative colitis);
• enveloping medications and sedatives (for spastic colitis).

Non-drug treatments

Among non-drug methods for chronic colitis, sanatorium-resort treatment may be indicated. Mineral waters, baths, microenemas, and intestinal lavage are useful.

Sometimes doctors recommend courses of physiotherapeutic procedures, such as magnetic therapy, acupuncture, and mud applications. Surgical intervention may be required if there are urgent indications in case of complicated colitis.

Some folk recipes can also be used:

• A decoction of sage, St. John's wort, caraway, and mint helps to cope with inflammation.
• For increased gas formation, mint, motherwort, and nettle are useful.
• To eliminate spasms in the intestines, microenemas with a decoction of calendula or chamomile can be performed.
• For ulcerative colitis, a microenema with sea buckthorn oil at night is useful.

Additional treatment methods are carried out in courses. It is recommended to consult a doctor before using them.

Diet for chronic colitis

Therapy will not be effective if the patient does not comply with a special diet. The rules of the diet for chronic colitis are as follows:

• The diet should contain a lot of fiber. It is found in vegetables, cereals, and bread.
• Food should be consumed 4-6 times a day.
• Lean fish and meat are consumed boiled. You can also eat boiled eggs.
• The diet should include many first courses cooked in vegetable broths.
• Seafood is healthy.
• Fruits and vegetables must be peeled.
• Foods that irritate the intestines should be eliminated from the diet. These include dairy and fermented milk products, legumes, spicy and salty foods, nuts, and alcohol.

Nutrition should be high in calories and include a large amount of substances needed by the body: vitamins, proteins, etc.

Diet for colitis is one of the measures included in the complex treatment of the disease

Publications in the media

Nonspecific ulcerative colitis (UC) is a chronic inflammatory disease of the colon of unknown etiology, characterized by ulcerative-necrotic changes in its mucous membrane.

The disease always begins in the rectum and spreads proximally. Total damage to the colon occurs in 25% of cases. In severe cases, the damage can spread to the submucosa, muscular and serous membranes of the intestinal wall. Characterized by the formation of ulcers in the colon and rectum, bleeding, abscessation of the crypts of the mucous membrane and inflammatory pseudopolyposis. The disease often causes anemia, hypoproteinemia and electrolyte imbalance, and, less frequently, can lead to perforation or colon cancer.

Frequency - 2-7: 100 000. Two peaks of incidence - 15-30 years (larger peak) and 50-65 years (smaller). The predominant gender is female.

Classification • By clinical course •• acute form •• Chronic recurrent •• Chronic continuous • By severity •• Mild severity ••• Stool 4 times a day or less, pasty ••• Small amounts of blood in the stool •• • Fever, tachycardia, anemia are uncharacteristic; body weight does not change, ESR is not changed •• Severe course ••• Stool 20–40 r/day, liquid ••• Stool in most cases contains an admixture of blood ••• Body temperature 38 °C and above ••• Pulse 90 V minute or more ••• Decrease in body weight by 20% or more ••• Severe anemia ••• ESR more than 30 mm/h •• Moderate severity includes indicators that are between the parameters of mild and severe degrees.

Clinical picture

• The onset of the disease may be acute or gradual.

• The main symptom is repeated watery stools mixed with blood, pus and mucus, combined with tenesmus and false urge to defecate. During the period of remission, diarrhea may completely stop, but the stool is usually pasty, 3-4 times a day, with a slight inclusion of mucus and blood.

• Cramping pain in the abdomen. Most often this is the area of ​​the sigmoid, colon and rectum, less often - the area of ​​the navel and cecum. Typically, the pain intensifies before defecation and decreases after bowel movement. The localization of pain depends on the level of the lesion. Typically, the pain intensifies before defecation and decreases after bowel movement.

• Possible damage to other organs and systems •• Skin and mucous membranes: dermatitis, aphthous stomatitis (5–10%), gingivitis and glossitis, erythema nodosum (1–3%) and erythema multiforme, pyoderma gangrenosum (1–4%), ulcers lower extremities •• Arthralgia and arthritis (in 15–20% of cases), incl. and spondylitis (3–6%) •• Ophthalmological complications (4–10%): episcleritis, uveitis, iridocyclitis, conjunctivitis, cataracts, retrobulbar optic neuritis, corneal ulcers •• Liver: fatty hepatosis (7–25%), cirrhosis (1–5%), amyloidosis, primary sclerosing cholangitis (1–4%), chronic active hepatitis.

Laboratory tests • Analysis of peripheral blood •• Anemia (post-hemorrhagic - as a result of blood loss; bone marrow reaction to latent inflammation; malabsorption of iron, folic acid, vitamin B12) •• Leukocytosis of varying severity •• Increased ESR •• Hypoprothrombinemia •• Hypoalbuminemia due to malabsorption of amino acids •• Increased content of a1- and a2-globulins •• Hypocholesterolemia • Electrolyte disturbances •• Hypokalemia as a result of decreased absorption of both ions directly and vitamin D •• Hypomagnesemia.

Special studies • Sigmoidoscopy during an exacerbation is carried out without preliminary bowel preparation • Colonoscopy is prescribed after the acute phenomena have subsided, because in severe cases of the disease, perforation of the ulcer or toxic dilation is possible •• Mild UC - granularity of the mucous membrane •• Moderate UC - the mucous membrane bleeds on contact, there are ulcerative lesions and mucous exudate •• Severe UC - spontaneous bleeding from the intestinal mucosa , extensive ulcerative lesions and the formation of pseudopolyps (epithelium-covered granulation tissue) • Irrigography •• Reduced severity or absence of haustration •• Uniform narrowing of the intestinal lumen, its shortening and rigidity of the walls (the appearance of a “water pipe”) •• Longitudinal orientation of the folds of the mucous membrane with changes their structure according to the type of small and large retina •• Jagged and unclear contours of the intestinal tube due to the presence of ulcers and pseudopolyps (in the acute phase) •• The procedure is contraindicated in the development of toxic megacolon • Plain radiography of the abdominal organs is especially important in cases of severe UC, when colonoscopy and irrigography are contraindicated •• Shortening of the colon •• Lack of haustration •• Irregularity of the mucous membrane •• Dilatation of the colon (toxic megacolon) •• Free gas under the dome of the diaphragm during perforation.

Differential diagnosis • Acute dysentery • Crohn's disease • Intestinal tuberculosis • Diffuse familial polyposis of the colon • Ischemic colitis.

TREATMENT

Diet. Various diet options No. 4. You should avoid eating raw fruits and vegetables for the purpose of mechanically sparing the inflamed mucous membrane of the colon. In some patients, a dairy-free diet can reduce the severity of clinical manifestations, but if it is ineffective, it should be abandoned.

Lead tactics

• For sudden exacerbations, bowel emptying with intravenous fluids for a short period of time is indicated. Total parenteral nutrition allows for long-term rest for the intestines.

• Salicylosulfonamide drugs are effective for all degrees of severity of the disease, causing remission and reducing the frequency of exacerbations •• Sulfasalazine 0.5–1 g 4 times a day until clinical manifestations subside, then 1.5–2 g/day for a long time (up to 2 years ) for the prevention of relapses, or •• Salazodimethoxin 0.5 g 4 times / day for 3-4 weeks, then 0.5 g 2-3 times / day for 2-3 weeks •• Mesalazine - 400– 800 mg 3 times a day orally for 8–12 weeks; for the prevention of relapses - 400–500 mg 3 times a day if necessary for several years. The drug should be taken after meals with plenty of water. For left-sided UC, the drug can be used rectally (suppositories, enema). Indicated in cases of insufficient effectiveness and poor tolerability of sulfasalazine.

• GK - for acute forms of the disease, severe relapses and moderate forms, resistant to other drugs •• For distal and left-sided colitis - hydrocortisone 100-250 mg 1-2 times a day rectally by drip or in microenemas. If effective, the drug should be administered daily for 1 week, then every other day for 1–2 weeks, then gradually, over 1–3 weeks, the drug is discontinued •• Prednisolone orally 1 mg/kg/day, in extremely severe cases - 1.5 mg/kg/day In case of an acute attack, it is possible to prescribe 240–360 mg/day intravenously, followed by switching to oral administration. 3-4 weeks after achieving clinical improvement, the dose of prednisolone is gradually reduced to 40-30 mg, then sulfasalazine can be added, and then the reduction is continued until complete withdrawal.

• As an adjuvant in combination with sulfasalazine or GC - cromoglycic acid in an initial dose of 200 mg 4 times a day 15 minutes before meals.

• For mild to moderate manifestations without signs of toxic megacolon, a consolidative (eg, loperamide 2 mg) or anticholinergic drugs are cautiously prescribed. However, the use of drugs that actively inhibit peristalsis can lead to the development of toxic dilatation of the colon.

• Immunosuppressants, such as mercaptopurine, azathioprine, methotrexate (25 mg IM 2 times a week), hydroxychloroquine.

• If there is a risk of developing anemia, take iron supplements orally or parenterally; in case of massive bleeding - blood transfusion.

• For toxic megacolon •• Immediate withdrawal of consolidating and anticholinergic drugs •• Intensive infusion therapy (0.9% sodium chloride solution, potassium chloride, albumin) •• Corticotropin 120 units/day or hydrocortisone 300 mg/day intravenous drip •• Antibiotics (eg, ampicillin 2 g or cefazolin 1 g IV every 4–6 hours).

Contraindications • Sulfasalazine is contraindicated in case of hypersensitivity, liver or kidney failure, blood diseases, porphyria, glucose-6-phosphate dehydrogenase deficiency, breastfeeding • Mesalazine is contraindicated in case of hypersensitivity to salicylates, blood diseases, liver failure, gastric and duodenal ulcers, children under 2 years old, breastfeeding.

Surgical treatment • Indications •• Development of complications ••• Toxic megacolon with ineffective intensive drug therapy for 24–72 hours ••• Perforation ••• Excessive bleeding with unsuccessful conservative therapy (rare) ••• Carcinoma ••• Suspicion of carcinoma with intestinal strictures •• Lack of effect from conservative therapy, rapid progression of the disease •• Growth retardation in adolescents, not corrected by conservative treatment •• Dysplasia of the mucous membrane •• Disease duration of more than 10 years (increased risk of cancer) • The following groups of surgical interventions are distinguished • • Palliative (disconnection operations) - the application of a double-barreled ileo- or colostomy •• Radical - segmental or subtotal resection of the colon, colectomy, coloproctectomy •• Restorative-reconstructive - the application of an ileo-rectal or ileo-sigmoid anastomosis end to end.

Complications • Acute toxic dilatation (toxic megacolon) of the colon (up to 6 cm in diameter) develops in 3–5% of cases. It is probably caused by severe inflammation with damage to the muscular lining of the colon over a large area and disruption of the nervous regulation of intestinal functions. A certain role belongs to the inadequate prescription of anticholinergics and fixative drugs. The condition is usually severe, with high fever, abdominal pain, significant leukocytosis, exhaustion, and death is possible. Treatment is intensive drug therapy for 48–72 hours. Failure to respond to treatment is an indication for immediate total colonectomy. Mortality is about 20% with a higher rate in patients over 60 years of age • Major bleeding. The main symptom of UC is bleeding from the rectum (up to 200–300 ml/day). Massive bleeding is considered to be blood loss of at least 300-500 ml/day • Perforation of colon ulcers in UC occurs in approximately 3% of cases and often leads to death • Strictures in UC - 5-20% of cases • Colon cancer. Patients with subtotal or total colon disease and a disease duration of more than 10 years have an increased risk of colon cancer (at 10 years, the risk of carcinoma is 10% and can increase to 20% after 20 years and to 40% after 25–30 years) • • Colon cancer arising in the context of UC is usually multifocal and aggressive •• In patients with UC more than 8–10 years old, annual colonoscopy examinations with biopsies every 10–20 cm should be performed. In the presence of high-grade dysplasia, the possibility of prophylactic total colonectomy.

Synonyms • Ulcerative-hemorrhagic colitis, nonspecific • Ulcerative-hemorrhagic colitis, idiopathic • Ulcerative-trophic colitis • Ulcerative proctocolitis • Ulcerative-hemorrhagic rectocolitis • Purulent hemorrhagic rectocolitis.

Reduction. UC - nonspecific ulcerative colitis.

ICD-10 • K51 Ulcerative colitis

Possible complications and consequences

If the disease is not treated, it can cause a number of complications. This mainly concerns ulcerative colitis. The consequences may be as follows:

• Perforation of the ulcer, which often results in peritonitis. In this case, the symptoms will be manifested by severe bloating and tension in the abdominal muscles, high fever, chills, a coating on the tongue, and general weakness.
• Gangrene of the colon and affected areas of the intestine. In this case, you may feel weakness, high temperature, and decreased blood pressure.
• Blood poisoning or spread of infection to other organs.
• Bleeding in the intestines (with chronic ulcerative colitis).
• The appearance of an oncological tumor is also possible.

Video - Chronic intestinal colitis: causes, symptoms, treatment of colitis.

Colitis - symptoms and treatment

Colitis (Latin colitis, from the Greek kolon (large intestine) and itis (inflammation) is a collective concept that includes a large group of diseases with one common feature: inflammation of the large intestine.

The main signs of colitis: frequent loose stools with blood, abdominal pain and high fever.

Colitis is encountered in the practice of gastroenterologists, infectious disease specialists, therapists, coloproctologists, surgeons and other specialists.

Etiology of colitis

The main forms of colitis can only be described separately, depending on the etiological factor. The size of the article does not allow us to touch on all types of colitis. Let's consider only the main ones.

Infectious colitis is an intestinal disease that occurs due to the activation of opportunistic microorganisms in the intestine or the entry of new pathogenic microbes from the external environment.[1]

Infectious colitis is very widespread: there is no person who has never suffered from this disease. The number of cases increases during hot periods, when favorable conditions are created for the spread of infection. Therefore, people in regions with hot climates (Africa, Southeast and Central Asia) get sick more often. The disease is more common in childhood, especially in children attending educational institutions (kindergartens, schools, etc.). Gastroenterologists and proctologists may encounter patients with this pathology in their practice, but it is not their specialty. The disease is usually treated by infectious disease specialists.

Causes of infectious colitis:

• bacteria (Shigella, Escherichia, Salmonella, Clostridia, Yersinia, Typhoid Bacillus, Campylobacter, Proteus, Staphylococcus);
• viruses (adenovirus, enterovirus, rotavirus);
• protozoa (amoeba, lamblia, etc.);
• pathogens of tuberculosis and syphilis;
• fungi (candida, actinomycetes). The occurrence of fungal colitis indicates a decrease in immunity and often occurs in people suffering from AIDS receiving chemotherapy and steroid hormones;
• dysbiosis.

Forms of infectious colitis:

• catarrhal;
• fibrous;
• catarrhal-hemorrhagic;
• phlegmonous;
• phlegmonous-gangrenous;
• necrotic.

Inflammatory phenomena can have a staged nature, or they can immediately have a picture of advanced inflammation. Its severity directly depends on the nature of the infection. Necrotic and phlegmonous-gangrenous inflammation occurs with clostridial infection. Catarrhal-hemorrhagic - for dysentery. Catarrhal inflammation occurs more often in viral diseases.[2]

Ischemic colitis is an inflammation of the wall of the large intestine that occurs due to disruption of circulatory processes. There are chronic and acute circulatory disorders.[3]

The cause of circulatory disorders is a complete cessation or critical decrease in blood flow to the colon, resulting in inflammation. In severe cases, it can lead to necrosis of the intestinal wall. The cause of blockage of blood vessels can be blood clots, but most often atherosclerotic plaques lead to narrowing of the lumen of the vessel. Therefore, the disease more often manifests itself in older people. About 79% of patients with ischemic colitis are over 48 years of age.[4] The frequency of occurrence has no connection with gender and region. First opened in 1966. Ischemic colitis is a specialized disease for coloproctologists, but it is also dealt with by general surgeons and gastroenterologists.[5]

Causes of ischemic colitis:

• vascular atherosclerosis;
• blockage of mesenteric vessels due to embolism or thromboembolism (as a result of allergic reactions, injuries, complications of operations, systemic vasculitis, DIC syndrome);
• a decrease in blood pressure can lead to malnutrition of the intestinal wall.

Blockage of the lumen of the vessel leads to ischemia of the intestinal wall, and as a consequence, to necrosis and further perforation.[6]

The volume of the lesion depends on the size of the feeding artery and the duration of the blockage. If blockage of a vessel occurs gradually (with the formation of atherosclerotic plaques in the vessels), then they speak of a chronic circulatory disorder, which in turn leads to strictures.

In critical conditions and a decrease in blood pressure (for example, anaphylactic shock, disseminated intravascular coagulation syndrome, etc.), centralization of blood circulation occurs, while blood flow to the intestines sharply decreases, which leads to ischemia and necrosis.

With atherosclerosis, the sigmoid and transverse colon are most often affected. Inflammation begins with the mucous membrane, then spreads to all layers.[7]

Based on the nature of the lesion, the following are distinguished:

• transient form (when ischemic processes are reversible);
• stenotic (when strictures form);
• gangrenous (when ulcers form with further development of necrosis, the damage is irreversible).[8]

Radiation colitis - is formed as a result of ionizing effects on the wall of the large intestine .