Recurrent chronic pathology of the gastrointestinal tract (GIT), which is characterized by the formation of necrotic areas and ulcers, as well as inflammation of the colon mucosa, is called ulcerative colitis. Its symptoms are manifested by general weakness, bloody diarrhea, pain in the abdomen, etc. Unfortunately, there are no innovative methods of therapy that would radically change the known approaches to the treatment of the disease.
Etiology of disease
The exact cause of ulcerative colitis has not been identified. The following theories deserve attention:
- This is an autoimmune disease. As a result of exposure to some provocative factors, with a genetic predisposition in the body of an individual, a process is activated that is directed against its own antigens.
- Influence of the environment. As the main cause, the infectious nature is considered.
- Ulcerative colitis symptoms are caused by an imbalance of the immune system in the digestive tract. Adversefactors provoke an inadequate inflammatory response, which is formed due to acquired or genetic failures in the mechanisms of immune regulation.
Based on the above, there are several risk factors:
- autoimmune;
- emotional;
- infections;
- heredity;
- chemical, biological, physical and other causes that contribute to inflammation.
Diagnosis
To confirm the pathology, the following types of examinations are carried out:
- Finger.
- The colonoscope is used to examine the intestinal mucosa and take biomaterial for histology.
- Complete blood count showing low red blood cells and high white blood cells.
- When examining feces, the presence of white and red blood cells is detected and a bacterial culture is performed. In addition, this analysis allows you to exclude other pathologies.
- MRI or CT can be used to view the intestines in detail.
- X-ray with contrast agent. This method is done with pronounced symptoms in order to exclude intestinal perforation.
- Ultrasound of the abdominal organs.
- Consultations with an endocrinologist, rheumatologist, gynecologist, dermatologist if necessary.
Classification
Colitis is distinguished by its length:
- total - the colon is completely affected;
- distal - observed proctitis;
- left-sided - affected part (up to the right bend) of the colon.
According to the severity of signs of the course of ulcerative colitis:
- heavy;
- average;
- easy.
According to the nature of the course of the disease, the following forms are distinguished:
- lightning;
- spicy;
- recurrent chronic - exacerbations occur every six months;
- continuous - protracted exacerbation.
Symptoms
The clinic of nonspecific ulcerative colitis is characterized by local and general signs. First appear:
- diarrhea;
- constipation;
- bleeding from the intestines;
- pain in the abdomen;
- involuntary urge to defecate.
From the general symptoms, there are:
- nausea;
- vomit;
- weight loss;
- fever;
- general weakness.
The severity of manifestations of symptoms of ulcerative colitis in adults depends on the severity of inflammation and intestinal damage. With an average degree, the patient has the following symptoms:
- slight increase in temperature;
- fatigue;
- pain in the abdomen of a cramping nature;
- five to six times a day the urge to defecate;
- blood-streaked stool;
- there are manifestations of arthritis, erythema nodosum and some other signs not associated with the underlying disease.
In severe ulcerative colitis of the intestinesymptoms appear as follows:
- diarrhea with lots of bloody or clotted stools;
- pain with cramping character before defecation;
- anemia due to significant blood loss;
- fever;
- weight loss.
Possible development of life-threatening complications - severe bleeding as a result of perforation of the colon. Patients with a fulminant form of the disease have an unfavorable course. For the treatment of moderate forms of nonspecific ulcerative colitis, hormonal drugs with anti-inflammatory effects are used.
Complications
All complications that occur in this pathology are divided into systemic and local. The latter appear:
- Acute toxic dilatation of the colon, which is considered one of the serious consequences of the disease. A prerequisite for the occurrence is toxicosis caused by an ulcerative necrotic process. During the next severe attack, the completely affected intestine or its section expands. In the first stages of acute toxic dilatation, intensive treatment is indicated. Surgery is recommended when conservative therapy fails.
- Intestinal perforation. Such a complication is considered a common cause of death in the fulminant form of the disease, as well as in the addition of acute toxic dilatation. The walls of the intestine become thinner and lose their protective functions under the influence of a massive ulcerative necrotic process. Pathogenic microflorais activated and promotes the formation of perforation. In the chronic stage of ulcerative colitis, such a complication is quite rare. Conservative treatment is not used, surgery is indicated.
- Massive intestinal bleeding. This type of effect is quite rare. With properly selected treatment using hemostatics and anti-inflammatory drugs, it can be managed without surgery. In case of prolonged intestinal blood loss, doctors recommend surgery.
- Neoplasms of the large intestine. According to medical statistics, the risk of cancer increases with the duration of the disease for more than ten years, and especially when the disease is diagnosed in childhood.
Main Therapy
Anti-inflammatory drugs are the basic therapy for the treatment of ulcerative colitis in adults, the symptoms of which were described above. The most common medications are Sulfasalazine, Hydrocortisone, Prednisolone, Budesonide, Fluticasone. The last two drugs give a small number of side effects and, to a lesser extent than other hormonal agents, inhibit the hypothalamic-pituitary-adrenal system. Long-term use of corticosteroids leads to the development of side effects that appear:
- diabetes;
- obese;
- osteoporosis;
- hypertension;
- the formation of erosions and ulcers in the stomach and intestines.
The drug "Sulfasalazine" was first used fortreatment of ulcerative colitis of the intestine in the forties of the last century. The drug not only removes the inflammatory process, but also has a warning effect. In the body of an individual, "Sulfasalazine" breaks down into sulfapyridine and 5-aminosalicylic acid, which blocks inflammatory mediators and modulates immune responses. Thanks to the use of this remedy, epithelial intestinal functions are restored, and the damaging effect on intestinal tissues is reduced. In addition to Sulfasalazine, doctors actively prescribe a drug with the active ingredient mesalazine, which has different trade names and types of coatings that ensure its release in different parts of the digestive system. The most effective, according to doctors, is Salofalk. During the period of active inflammation, a large dose is prescribed, then it is reduced to a maintenance dose. The duration of the reception is set individually. The use of the above drugs is the main therapy that can be used to eliminate the symptoms of ulcerative colitis and treat mild to moderate disease in adults.
Alternative medicine
As an additional method, you can use decoctions from medicinal plant materials, which have a hemostatic and anti-inflammatory effect:
- lichen;
- burnet;
- licorice;
- grey alder;
- nettle.
In some cases, the use of folk methods prolongs remission. In addition, it is possible to take fish oil orally and use it forenema.
Other medicines to relieve symptoms and treat ulcerative colitis
For these purposes, antibacterial agents are used that are able to modulate the body's immune response and have a depressing effect on the anaerobic intestinal flora. These requirements are met by Metronidazole. However, prolonged oral medication increases the risk of adverse reactions. The safest is the use of the drug in the form of a suspension administered rectally. If a complication occurs in the form of toxic dilatation of the intestine, the following medications are recommended: Ampicillin, Clindamycin, Cefobid. Of the immunosuppressants, Cyclosporine is used to treat the disease. It has been proven that intravenous administration of a high dose of this drug causes remission in almost 80% of individuals with severe disease. Most of the side effects of the drug are mild and are minimized when the dosage is reduced. However, when applied, the development of herpetic lesions of the esophagus, convulsions, lung abscess, etc. is possible. Supportive treatment with this drug is not carried out.
From monoclonal antibodies to TNF-α, the drug "Infliximab" is prescribed.
Diet therapy
Treatment of ulcerative colitis of the intestine, the symptoms of which we have already considered, is carried out against the background of dietary nutrition, which has a number of features:
- the food consumed by the sick should be gentle and not contain coarse fiber;
- excluded all dairy products, fresh vegetables and fruitsform, any canned food, pickles and marinades;
- the diet should contain a balanced amount of carbohydrates, fats, proteins, vitamins and trace elements;
- prefer to give fractional meals - take small portions of food every two to three hours;
- food temperature should be between 30 - 35 degrees;
- all food should be steamed;
- grind food before eating;
- when in a hospital setting, a fourth-table diet is prescribed.
In case of impaired absorption of trace elements and an imbalance of vitamins in the patient's body, it is recommended to take vitamin-mineral complexes. Parenteral nutrition is indicated in the treatment of severe forms of the disease.
Peculiarities of treatment of ulcerative colitis in adults
Depending on the form of the disease, there are different treatment regimens:
- With mild - Prednisolone is prescribed for a month, and then, gradually reducing the dosage, it is canceled. Microclysters with hormonal preparations are carried out in a short weekly course. Sulfasalazine or Mesalazine taken by mouth over a long period.
- With moderate - treatment, as in the previous form, but drugs are used in higher dosages. In addition, a strict diet is shown, which implies the rejection of dairy and high-protein foods, and fiber restriction.
- In severe cases, infusion-transfusion therapy is used using drugs for parenteral nutrition, albumin, plasma, red blood cells, salinesolutions and glucose.
The big problem in the treatment of ulcerative colitis is resistance (resistance) and dependence on hormones. In such patients, there is a low effectiveness of conservative therapy. In all forms, antibacterial agents and concomitant treatment are indicated. Among the main directions in the treatment of the disease are the following:
- restoration of immune balance;
- increasing stress tolerance;
- normalization of neuroendocrine regulation;
- restoration of intestinal microflora.
Surgical treatment
This type of treatment is recommended by the doctor in the absence of the effect of drug therapy, in emergency conditions and fulminant forms of pathology.
Indications for surgical intervention in ulcerative colitis are divided into absolute and relative. The latter include a continuously relapsing, chronic course of the disease for many years. Absolute are:
- intestinal bleeding;
- severe toxic bowel dilatation;
- suspected perforation;
- colon cancer and other conditions.
Peculiarities of treatment in children
Symptoms of ulcerative colitis of the intestine appear in the younger generation. The disease in children is characterized by a progressive course and severe complications leading to disability. Despite common approaches, there are some differences in the treatment of pathology in adults and children. They are related to the characteristics of the development of the baby,insufficient experience in the clinical use of drugs in this category of patients. Comprehensive treatment includes:
- diet food;
- basic therapy with sulfonamides, salicylates and hormones;
- antibacterial drugs;
- immunosuppressants;
- immunomodulators;
- symptomatic remedies.
One of the conditions for successful treatment of children is physical and psychological peace. Outdoor games should be limited. Walking outdoors is encouraged. Bed rest is indicated for exhaustion, metabolic disorders, weakness, temperature.
Surgical treatment is carried out according to the following indications:
- colonic perforation;
- bleeding profusely;
- colon carcinoma;
- stunting of the child against the background of the therapy used, which does not bring effect;
- prolonged colitis.
Conclusion
The symptoms of ulcerative colitis of the intestine are mainly manifested in adults aged 20 to 40 years, and the female population is diagnosed with this disease more often than the stronger sex. Diarrhea and frequent urge to defecate significantly reduce the quality of life of an individual and may be the cause of disability due to disability. In most cases, the disease is accompanied by dysbacteriosis. Treatment is individual, complex, aimed at preventing complications and achieving remission.
