Treatment of ulcerative colitis of the intestine in adults and children. Ulcerative colitis: varieties, diet menu, herbs and medications

Ulcerative colitis is a lifelong disease that affects the mucous membrane exclusively of the colon and is manifested by its destructive and ulcerative inflammation of varying intensity. It always affects the rectum, gradually spreading continuously or immediately affecting the rest of the colon. This disease is also called nonspecific ulcerative colitis (UC).

IN last years This disease has become much more common among our compatriots. To some extent this is due to improved technical equipment medical institutions and increased awareness among doctors and patients themselves. Treatment of identified ulcerative colitis often takes many years, is complex and requires joint efforts of both the doctor and the patient.

Urban residents living in developed countries are more likely to suffer from ulcerative colitis of the intestine. The disease is characterized by a northern gradient (southerners suffer from it less often). It is thought to begin in either young (under 30) or old (over 60) ages, although people can get it throughout their lives.

Symptoms of Ulcerative Colitis

The manifestations of ulcerative colitis and their severity vary greatly. Some patients remain in quite good health for many years, and the disease manifests itself only as blood in the stool. Such patients often associate this symptom with, avoid a full examination and indulge in self-medication on the Internet or traditional medicine. Others, from the very beginning of ulcerative colitis, are hospitalized with repeated bloody diarrhea, fecal incontinence, high fever, abdominal pain, strong heartbeat and general weakness.

The most specific symptoms of ulcerative colitis are:

• blood in the stool (present in more than 90% of patients, its amount varies from barely visible traces on a used napkin or toilet paper to a bloody mess, in which the stool itself can hardly be distinguished);
• mucus and pus in stool;
• diarrhea (characteristic of 65% of patients, not abundant, from 1 to 20 times or even more per day);
• constipation (occurs in 20% of patients, often indicates an inflammatory lesion lower parts colon: rectum and/or sigmoid);
• false urge to have a bowel movement (instead of feces, blood with pus and mucus comes out of the intestine - “rectal spit”);
• nocturnal bowel movements (patients wake up due to an uncontrollable need to empty their bowels);
• fecal incontinence;
• bloating;
• pain (characteristic of only half of the patients, most often moderate, associated with intestinal emptying, localized in the left side of the abdomen);
• signs of intoxication (with severe and widespread inflammation, fever, vomiting, rapid heartbeat, weight loss, dehydration, loss of appetite, etc. appear).

In 10% of cases, in addition to the mentioned intestinal and general symptoms, extraintestinal manifestations occur:

• joint lesions;
• various rashes on the skin and mucous membranes (for example, in the mouth);
• eye disorders;
• damage to the liver and bile ducts;
• thrombus formation, etc.

They may precede intestinal disorders. The severity of extraintestinal manifestations sometimes depends on the activity inflammatory lesion intestines, and in some cases is completely unrelated to it.

Causes

Despite active study and all kinds of Scientific research, the exact origin and causes of ulcerative colitis of the intestine are still unknown. It has been suggested that it may be provoked by:

• some unspecified infection (but ulcerative colitis is not contagious);
• unbalanced diet (fast food, diet lacking fiber, etc.);
• genetic mutations;
• medications (non-hormonal anti-inflammatory drugs, contraceptives, etc.);
• stress;
• changes in intestinal microflora.

As a result, in such patients, the immune system, instead of foreign microbes and viruses, begins to destroy the cells of its own intestinal mucosa, leading to the formation of ulcers.

It is believed that the following protect against the disease:

• removal of the appendix (but not just like that, but for a reason);
• smoking (but if a non-smoking patient with ulcerative colitis begins to smoke, this will only worsen the existing problems).

Diagnostics

Some patients with suspected ulcerative colitis are afraid of instrumental examination of the intestines, so they avoid visiting the doctor, argue with him or neglect the recommended diagnostic procedures. But modern therapeutic tactics are entirely based on the extent and activity of the inflammatory process in the intestine. A lack of necessary information may affect the success of treatment. Many procedures are not so painful, and the “terrible colonoscopy” in decent clinics is often performed under anesthesia (more precisely, in a medicated sleep).

Only a doctor can determine the scope of the required examination.

Treatment

This disease is considered quite serious, it can progress gradually or sharply, some patients initially have resistance to the medications used or it develops during treatment, and life-threatening complications are possible. Therefore, not even all doctors take on such patients. Some do not have the necessary knowledge, others are afraid to prescribe powerful medications.

Patients with mild and moderate variants of ulcerative colitis can be treated on an outpatient basis. Severe patients must be examined and treated in a hospital, since both diagnostic and therapeutic interventions can have serious and even life-threatening complications.

• elimination of coarse fiber ( raw vegetables, berries, fruits, nuts, seeds, poppy seeds, sesame seeds, bran, legumes, etc.);
• products are steamed or boiled;
• warm food is rubbed or (for constipation) boiled vegetables are grated on a coarse grater;
• exclude chemical irritants to the intestinal mucosa (spicy, salty, pickled, sour foods);
• recommended high protein foods(lean meat, turkey, lean river fish, egg white, soy products, cottage cheese, etc.);
• special ones sold in pharmacies medicinal mixtures for food (“Modulen”, etc.).

Depending on the specific clinical situation, non-surgical treatment may consist of:

• drugs containing 5-acetylsalicylic acid (Salofalk, Sulfasalazine, Pentasa, Mezavant, etc.), which can be prescribed both in the form of tablets, granules or capsules, and in the form dosage forms for insertion into the rectum (suppositories, ready-made enemas or foams);
• corticosteroids (Hydrocortisone, Prednisolone, Methylprednisolone) in the form of tablets, regular or rectal (entered through the anus) droppers;
• immunosuppressants (Cyclosporine, Azathioprine, Methotrexate, etc.);
• means of powerful and expensive biological therapy (Infliximab, Adalimumab, etc.).

Suppositories, foams, rectal droppers and enemas are most effective for inflammation lower sections colon (left-sided colitis).

Treatment with hormones, immunosuppressants and biological therapies should be recommended and monitored by a doctor. Indeed, even under his supervision, some patients show initial immunity or gradually develop resistance to them. These drugs have serious side effects(bone marrow damage, hepatitis, etc.).

In addition, even after achieving the long-awaited remission, the patient should not relax, otherwise unpleasant illness will quickly return again in the form of a relapse. Almost all patients need to take anti-relapse therapy prescribed by their doctor. Some of them prevent development.

If medication is ineffective and complications develop (bleeding, perforation, toxic megacolon or colon cancer), radical surgery is performed. Complete removal of the entire colon may cure ulcerative colitis.

Nonspecific ulcerative colitis (UC) is a chronic disease of the gastrointestinal tract of a recurrent nature, in which the mucous membrane of the large intestine becomes inflamed, on which ulcers and areas of necrosis form.

Clinically, ulcerative colitis is manifested by bloody diarrhea, arthritis, weight loss, general weakness, abdominal pain, and this disease increases the risk of developing colorectal cancer. We will tell you more about ulcerative colitis of the intestine - symptoms and treatment of the disease in this article.

Causes of Ulcerative Colitis

The etiology of the disease is considered not fully understood; scientists are still intensively searching for true reasons nonspecific ulcerative colitis. However, the main risk factors for this disease are known, which include:

American experts conducted a large-scale study and found that fungi in the human intestines are associated with inflammatory diseases intestines (Crohn's disease and ulcerative colitis), reports the Los Angeles Times. Experiments conducted on rodents allowed scientists to prove the connection between more than 100 species of various fungi found in their intestines and ulcerative colitis of the intestine.

The presence of fungi in the body of mammals activates the production of dectin-1 protein by leukocytes. In the case where the body in mice could not produce it, the mice become more susceptible to the development of ulcerative colitis than their healthy counterparts. Moreover, the application antifungal drugs helps mitigate the course of this disease in rodents.

In humans, Dectin-1 is encoded by the CLEC7A gene; based on these studies, it turned out that in the presence of a mutant form of this gene, the patient developed ulcerative colitis, which was intractable traditional ways treatment (diet, NSAIDs, corticosteroids). Mutations in the CLEC7A gene contribute to the development of a more severe form of colitis, since this gene is associated with other factors that influence inflammation, and antifungal treatment in this case, it helps to improve the patient's condition.

Symptoms of Ulcerative Colitis

There are main symptoms of ulcerative colitis associated with the gastrointestinal tract (intestinal manifestations) and extraintestinal symptoms.

The main intestinal symptoms of UC are:

• Bloody diarrhea

Diarrhea with blood and mucus (and sometimes even pus) is the main diagnostic sign of the disease. Sometimes the discharge of blood, mucus and pus occurs spontaneously (not during bowel movements). The frequency of bowel movements in patients with UC varies - from several times a day to 15 - 20 times (severe cases). The frequency of stool increases in the morning and at night.

• Pain in the projection of the abdomen

The pain can also have varying degrees of intensity - from mild to severe, accompanied by extreme discomfort. Most often, the pain is localized in the left half of the abdomen. Severe abdominal pain that is not relieved by taking analgesics is a sign of complications of the disease.

• Increase in temperature to low-grade levels.
• Other signs of intoxication of the body: weakness, weight loss, poor appetite, frequent dizziness.
• False urge to defecate (tenesmus). Sometimes a patient may discharge only a fragment of mucus or mucus with pus instead of feces (symptom of “rectal spitting”).
• Bloating ().
• Possible fecal incontinence.
• Sometimes, instead of diarrhea, the patient develops constipation, which is a sign of severe inflammation of the colon mucosa.
• The likelihood of rapid (fulminant, fulminant) development of ulcerative colitis.

This form develops in just a few days, its manifestation is toxic megacolon (expansion or dilatation of the lumen of the large intestine). At the same time, the patient’s temperature rises sharply, reaching over 38°C. The patient is weak, adynamic, rapidly losing weight, he experiences abdominal pain, frequent loose stools with copious amounts of mucus, blood and pus, and abdominal pain. IN terminal stage UC tachycardia occurs, decreases arterial pressure, oliguria appears. The patient has bloating and tenderness of the abdomen, bowel sounds are not heard. Neutrophilic leukocytosis is noted in the blood, and a dilated colon is visible on the x-ray (its diameter exceeds 6 cm). Dilatation of the large intestine is caused by an increase in nitric oxide, which increases the contractile function of intestinal smooth muscles. Excessive expansion of the large intestine is dangerous due to perforation of its wall (rupture).

Extraintestinal manifestations of UC

They occur infrequently - in only 10 - 20% of patients. These include:

• Skin lesions in the form erythema nodosum and gangrenous pyoderma, which is associated with the presence of an increased concentration of bacterial antigens in the blood, immune complexes, cryoproteins.
• Symptoms of damage to the oropharynx. Occurs in 10% of patients. They are associated with the appearance of aphthae - specific rashes on the mucous membrane oral cavity, the number of which decreases as the disease goes into remission.
• Eye damage (occurs even less frequently - in only 5 - 8% of cases), they manifest themselves as: uveitis, episcleritis, conjunctivitis, retrobulbar neuritis, keratitis, choroiditis.
• Articular lesions. Inflammatory processes in the joints are of the nature of arthritis (most common), sacroiliitis, spondylitis. These lesions can be combined with intestinal pathology or precede the main symptoms of ulcerative colitis.
• Pathology of the skeletal system in the form of: osteoporosis (increased bone fragility), osteomalacia (softening of bones), aseptic and ischemic necrosis.
• Damage to the pulmonary system (occurs in 35% of patients with UC).
• Damage to the pancreas, liver and bile ducts. These changes are caused by disturbances in the functioning of the endocrine system.
• The rarest extraintestinal symptoms of ulcerative colitis of the intestine are: and glomerulonephritis.

Ulcerative colitis has an acute phase and a remission phase. The disease begins gradually at first, but quickly gains momentum when the signs of ulcerative colitis become more pronounced.

Sometimes the symptoms weaken, but then intensify again. With constant treatment, the disease takes on the character of recurrent chronic ulcerative colitis, the symptoms of which weaken with long-term remission. The frequency of relapses in patients with nonspecific ulcerative colitis most often depends not on the degree of intestinal damage, but on supportive treatment (non-steroidal anti-inflammatory drugs, antibacterial, antiviral agents).

During the acute phase of the disease colon looks like this: hyperemia and swelling of the mucous membrane occur, intestinal bleeding and ulcers appear. The process of remission, on the contrary, is accompanied by atrophic changes in the mucous membrane - it becomes thinner, its function is impaired, and lymphatic infiltrates appear.

Diagnosis of the disease

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

• diarrhea mixed with blood, mucus and pus
• abdominal pain; arthritis
• eye disorders due to general intoxication of the body

Laboratory diagnostics.

• IN general analysis In the blood of a patient with ulcerative colitis, anemia is noted (the number of red blood cells and hemoglobin decreases), and there is leukocytosis. In a blood test for biochemistry, an increase in the content of C in the blood is noted - reactive protein, which is an indicator of the presence of inflammation in the human body. In addition, the concentration of albumin, magnesium, calcium decreases, and the amount of gamaglobulins increases, which is associated with the active production of antibodies.
• In an immunological blood test, most patients show an increase in the concentration of cytoplasmic antineutrophil antibodies (they appear due to an abnormal immune response).
• A stool analysis of a patient with ulcerative colitis shows blood, pus and mucus. Pathogenic microflora is sown in feces.

Instrumental diagnosis of UC.

Endoscopy (rectosigmoidoscopy, reveals in the patient a complex of symptoms characteristic of the disease:

• swelling and hyperemia, granulosa of the mucous membrane
• pseudopolyps
• contact bleeding
• the presence of pus, blood and mucus in the intestinal lumen
• During the remission phase, pronounced atrophy of the mucous membrane of the large intestine is observed.

("video pill") in the near future, it will be performed on those patients who, due to the pain of the procedure and discomfort, refuse to undergo a colonoscopy. However, capsule endoscopy will not replace traditional endoscopic examination, since the image quality is inferior to direct visualization. approximate cost such a capsule will cost about $500.

X-ray examination is also an effective method for diagnosing ulcerative colitis. In this case, a barium mixture is used as a contrast. An X-ray of a patient with ulcerative colitis shows an expansion of the intestinal lumen, the presence of polyps, ulcers, and shortening of the intestine. This type examination helps prevent intestinal perforation.

Treatment of ulcerative colitis

There is no etiological treatment that can address the cause of ulcerative colitis. Treatment of the disease is symptomatic and is aimed at: eliminating the inflammation process, maintaining remission and preventing complications. If drug therapy does not have an effect, the patient is indicated for surgical treatment.

Conservative treatment methods for UC include:

Diet therapy. During periods of exacerbation, the patient is advised to refrain from eating. You can only drink water. During the period of remission, the patient is recommended to reduce the amount of fat in the diet and increase the protein content (low-fat fish and meat, cottage cheese, eggs). It is recommended to avoid coarse fibrous fiber, which can injure the delicate intestinal mucosa. The following carbohydrates are recommended: porridge, honey, jelly, jelly, berry and fruit compotes and decoctions. The patient is recommended to take vitamins: A, K, C, as well as calcium. IN severe cases artificial nutrition is recommended - parenteral and enteral.

NSAIDs (non-steroidal anti-inflammatory drugs) salofalk, mesalazine, sulfasalazine and corticosteroids - prednisolone, methylprednisolone. The dosage of drugs is selected by the doctor individually.

Antibiotics. In case of exacerbation of the disease, antibiotics are also recommended: ciprofloxacin, tsifran, ceftriaxone, tienam.

Surgical intervention

Surgical treatment of ulcerative colitis is indicated for patients who are not helped conservative methods. Indications for surgery for ulcerative colitis are:

• perforation (perforation of the intestinal wall);
• signs of intestinal obstruction;
• abscess;
• presence of toxic megacolon;
• profuse bleeding;
• fistulas;
• bowel cancer.

Main types surgical intervention are:

• Colectomy (excision of the colon).
• Proctocolectomy (removal of the rectum and colon) with preservation of the anus.
• Proctocolectomy followed by ileostomy. In this case, the rectum and colon are excised, after which an ileostomy (permanent or temporary) is applied, through which natural waste is removed from the human body. Subsequently, the patient undergoes reconstructive surgery, the ileostomy is removed and restored natural way defecation.

Nonspecific ulcerative colitis is a disease, the basis of which is an inflammatory process in the intestines that occurs in chronic form. UC in most cases develops in males aged from 20 to 40 years or from 50 to 70 years. The clinical picture of ulcerative colitis manifests itself in the form of abdominal pain, bloody diarrhea, bleeding in the intestines and other signs. The diagnosis of the disease is established by endoscopic sampling of material, irrigoscopy, CT and colonoscopic examination. Treatment can be carried out in two ways - therapy and surgery.

This article will cover in detail such issues as the causes of the disease, how to cure ulcerative colitis in adults and children, symptoms and other features of the course of ulcerative colitis. Reading the article will allow many patients to understand what preventive measures should be used to avoid the disease.

Causes

Research in this area shows that the main cause of colitis lies in the increased sensitivity of the immune system to various bacteria that penetrate the intestines. It is known that the colon contains many microorganisms that in healthy people do not conflict with the immune system. In patients diagnosed with UC, antibodies are found in the blood that act against intestinal tissue.

There is another assumption that nonspecific ulcerative colitis develops in those people who are genetically predisposed to it. For example, if a blood relative in the family had UC, then the family suffers from this disease 15 times more often.

The following lifestyle can stimulate the development of the acute phase of colitis:

• systematic consumption of alcoholic beverages in large quantities;
• frequent overeating of spicy foods;
• nervous tension;
• intestinal infections;
• power failure.

These factors influence the development of the inflammatory process, which will increase due to an innate tendency. Colitis in nonspecific ulcerative form is rare disease. Statistics are such that out of 100,000 people examined, UC is diagnosed in 80-90 people, that is, less than 1%. There is also information that overuse For an adult, dairy products can become, if not the cause of the onset of the disease, then certainly an exacerbation of it. Thus, we can conclude that scientists have not fully identified the nature of the occurrence of nonspecific colitis. However, this does not diminish the ability of modern medicine to treat the disease.

Symptomatic picture

Symptoms of nonspecific ulcerative colitis of the intestine directly depend on the form and course of the disease. There are acute and chronic type diseases. The acute phase is accompanied by pronounced symptoms, but is diagnosed only in 5-7%. The clinical picture of manifestation is divided into local and general.

The local course of intestinal colitis makes itself felt as follows:

1. Feces accompanied by blood, mucus and pus. Often, blood is not part of the bowel movement, but merely covers it. Color varies from rich red to dark tones. In other diseases, such as ulcers, the blood is black.

2. Loose stool and constipation. In 90% of cases, it is diarrhea that accompanies UC. Stool passes no more than four times a day. This symptom is characterized by false urges, which can reach 30 times a day. Constipation is observed only if the inflammatory focus is located in the rectum.

3. Pain syndrome in the lower abdomen. Cramping spasms can be both intense and expressed in tingling. If this symptom intensifies, this indicates deep damage to the intestines.

4. Bloating.

Common symptoms of ulcerative colitis of the intestine include:

• Body temperature increases to 38-39 degrees, but this is only possible in severe forms of the disease.
• High fatigue, apathy, weight loss - this sign indicates a rapid loss of proteins.
• Violations visual function. At this symptom inflammation of the iris and mucous membrane of the eye and blood vessels is observed. However, such manifestations of the disease are rare.
• Laboratory analysis shows narrowing of the intestine, and the intestines have a “pipe” type.
• The intestinal mucosa secretes blood, the presence of ulcers of various shapes, and more.
• Pain in joints and muscles.

The course of UC is caused by the proliferation of inflammatory foci in the colon. Ulcerative colitis is characterized by a phase manifestation, that is, exacerbation is replaced by remission and vice versa. If the disease is not treated, it will begin to spread further and further through the intestines. The relapse state will increase over time. There is also a risk of complications that make the situation worse. However, if you consult a specialist in a timely manner and receive correct treatment, the patient has every chance of achieving long-term remission.

Consider the forms of colitis:

1. Mild – bowel movements no more than three times a day, with minor bleeding, the indicators are normal.

2. Moderate – stool 6 times a day, severe bleeding, elevated temperature body, increased heart rate, decreased hemoglobin levels.

3. Severe – defecation 6 times or more during the day, profuse bleeding, body temperature is above 38 degrees, hemoglobin is 105.

UC in children most often manifests itself in adolescence. The main symptoms of intestinal disease are severe diarrhea and delayed skeletal growth. Therefore, the child has developmental delays for unknown reasons. As a result, it is necessary to make an appointment with a doctor and carry out full examination to exclude nonspecific ulcerative colitis.

Diagnostic methods

If you detect the above symptoms of UC, you should immediately contact a gastroenterologist. If a child has these signs of intestinal colitis, then it is necessary to visit a therapist’s office.

Diagnosis at a doctor’s appointment occurs as follows:

1. Conversation. Allows you to identify complaints. Of particular interest is the presence of blood and its quantity during bowel movements, as well as color.

2. Inspection. Because symptoms appear in eyeballs, first of all inspect them. If necessary, an ophthalmologist may be involved in the diagnosis.

3. Palpation. With UC, the large intestine is sensitive to palpation. And upon deep examination, an increase in the intestine in areas of inflammation is noticeable.

If the doctor confirms suspicions of nonspecific ulcerative colitis, the patient is referred for tests:

1. Blood. Helps calculate low content hemoglobin and high white blood cell count.

2. Biochemical blood sampling. With a positive UC, the results are as follows: an increase in C-reactive protein, a decrease in the level of calcium, magnesium, albumin, and a high amount of gamaglobulins.

3. Immune test. If the patient is sick, the amount of antineutrophil antibodies will be increased.

4. Stool examination. In the laboratory, the mass is examined for the presence of mucus and pus.

To make a correct diagnosis, in addition to the symptoms and examination findings, doctors recommend additional types of diagnostics for colitis. These include:

• endoscopy;
• rectosigmoidoscopy;
• colonoscopy.

Before endoscopy, the patient undergoes preparatory stage, which consists of:

• 12-hour diet before the study;
• refusal of food for 8 hours;
• colon cleansing (enemas or taking special medications);
• moral preparation, doctor's consultation.

When diagnosing UC using rectosigmoidoscopy, the patient is prepared in the same way as endoscopically. The examination involves examining the rectum using a special instrument equipped with a microcamera. Due to the visual projection on the monitor screen, the doctor can examine inflammatory foci. Thanks to this study, in 90% of cases it is possible to diagnose UC, as well as other intestinal diseases.

A colonoscopy examination examines the upper region of the large intestine. It is used infrequently, unlike the previous method. Necessary to determine the extent of colitis, as well as to exclude other diseases, for example. During diagnosis, the doctor takes tissue samples for subsequent examination.

The first diagnosis of UC should be made no later than 7 years after the diagnosis of colitis. In the future, it must be repeated once every 2 years, depending on the course of the disease.

Treatment with medications

Effective treatment of ulcerative colitis is possible only with a qualified doctor. In case of acute ulcerative colitis, the patient is in the hospital, where he adheres to strict bed rest until the intensity of symptoms decreases. At the time of remission, the person continues to lead a normal lifestyle, taking into account the recommendations of the attending physician regarding medication and diet.

Drug therapy for colitis includes:

• Drugs of the aminosalicylate category, namely Sulfasalazine in the acute phase, 1 g four times a day. During remission of UC - 0.5 g in the morning and evening.
• Treatment of colitis with Mesalazine is often prescribed in acute form 1 g three times a day.
• To cure UC, suppositories and enemas are additionally used.
• At severe course for colitis use Prednisolone 50-60 milligrams per day, a course of 3-4 weeks.

In some cases, the doctor prescribes Cyclosporin-A, which is relevant for the rapid development of UC in the acute phase. A dose of 4 mg per 1 kg of human weight is administered intravenously. Symptomatic treatment of nonspecific colitis involves taking painkillers (Ibuprofen, Paracetamol and others) and vitamins B, C.

UC in a child can be cured by following a diet. Doctors in 95% prescribe “dairy-free table No. 4 according to Pevzner.” The menu mainly consists of protein through the consumption of meat, fish and eggs.

basis drug treatment colitis in children is Sulfasalazine and other medications that contain Mesalazine. The drugs are taken orally or administered through enemas or suppositories. Dosage and course are determined on a strictly individual basis. Along with these measures, symptoms are eliminated.

However, if adequate therapy is not available, then there is a risk of developing complications of colitis, which occur as follows:

• severe form intestinal bleeding;
• perforation of the intestine resulting in peritonitis;
• formation of purulent wounds;
• dehydration;
• blood infection;
• stones in the kidneys;
• increased risk of cancer.

If you do not start treating the disease in a timely manner, then in 7-10% of cases this leads to death, and in 45-50% - to disability.

The main rule of preventive treatment is diet. Undoubtedly, important has an annual intestinal examination and tests.

The main principles of the diet for UC:

• eating steamed or boiled food;
• dishes are consumed warm;
• fractional portions, 4-5 times a day;
• do not overeat;
• last meal – no later than 7 pm;
• high-calorie foods;
• the diet should also contain plenty of proteins and vitamins.

It is necessary to avoid the following products due to the fact that they irritate the colon mucosa. This in turn leads to stimulation of the inflammatory process. And some make diarrhea worse. These tips are also relevant for children, as they are the basis for the treatment of UC.

List of prohibited products:

2. fermented milk products;

4. fatty meat;

6. spices in any form;

7. cocoa, strong brewed tea;

8. raw tomatoes;

10. raw vegetables;

11. nuts, seeds and corn (aka popcorn);

12. plants of the legume family.

The diet should include:

• fresh fruits and berries;
• porridge;
• boiled eggs;
• chicken and rabbit meat;
• tomato and orange juice;
• lean fish;
• liver;
• cheeses;
• seafood.

Proper nutrition and healthy image life allows patients to increase the remission phase, reduce pain and increase body tone. Treat initial stage UC is needed only in combination, following the diet and doctor’s recommendations regarding therapeutic methods.

Forecast and prevention of UC

Specific preventive methods regarding of this disease currently no. This is due to the fact that the source of the disease is still unknown. However, there are preventative treatments for colitis that can reduce the risk of relapse. To do this, you must act as the doctor tells you. This applies to both adults and children.

The main advice from doctors for the prevention of UC is:

• follow nutritional instructions;
• reduce stressful situations;
• do not overexert yourself physically;
• make an appointment with a psychotherapist to relieve psychosomatic causes;
• See a gastroenterologist regularly;
• practice spa therapy.

Almost every person suffering from this disease asks two questions: is it possible to cure the disease forever, and what is the life expectancy. Answering the first question, it should be noted that everything depends on the form of UC, complications and timely treatment. In other words, yes, following the instructions of doctors.

Regarding the second question, you need to understand that colitis in a nonspecific ulcerative form can be observed in a person throughout his life. And how long people with this diagnosis live depends primarily on the patient. If you follow all the recommendations, monitor your health and observe correct image life, then the patient has every chance of dying of old age. The prognosis of the disease is favorable if all modern techniques. Relapses then occur at least a couple of times in 5-7 years and in optimal timing treated with medications.

To summarize the review, we note that colitis is treatable, but requires a person to adhere to preventive courses. There’s no point in letting the disease get worse – the consequences of this are already known. We remind you that an annual examination of the body, regardless of whether a person is sick or healthy, allows us to identify ailments on early stages, which greatly simplifies life for patients.

Chronic inflammatory disease of the colon, characterized by ulcerative-destructive changes in its mucous membrane. Prevalence is 60-220 cases per 100,000 people.

Everyone is susceptible to disease age groups, but the predominant number of cases falls on 25 years. Men and women get sick with equal frequency. The causes of ulcerative colitis still remain unknown.

Autoimmune damage to the tissues of the walls of the large intestine is assumed. This hypothesis is based on the fact that most often ulcerative nonspecific colitis associated with others autoimmune diseases(systemic vasculitis, systemic lesions connective tissue, autoimmune thyroiditis, etc.).

Colitis

Colitis is an inflammatory-dystrophic lesion of the colon. Acute colitis most often caused by pathogenic microorganisms (dysenteric bacteria, salmonella, staphylococci, streptococci, Proteus, amoebas, balantidia and others), arise as a result of allergic factors, food and other allergens, certain medications, nutritional disorders, infectious and viral diseases(for example, for influenza, malaria, pneumonia, sepsis and others).

Chronic colitis may be a consequence of acute colitis in cases of insufficient effective treatment, as well as in patients with reduced general body resistance.

Most often, chronic colitis is caused by dysentery bacteria, although other microbes (Salmonella, Staphylococcus, Proteus, pathogenic strains coli, amoeba, balantidia, trichomonas, lamblia) can also cause the development of chronic colitis.

Chronic colitis is often caused by helminthiasis. It can also develop in the presence of foci of infection in the body, especially in organs anatomically associated with the intestines (in gallbladder, pancreas and others); In women, the cause of colitis may be an inflammatory process of the pelvic organs.

Causes of Ulcerative Colitis

It has not yet been established exactly what causes the development of this disease. But there is an assumption that it is called:

Triggers for ulcerative colitis are:

• dysbacteriosis;
• sedentary lifestyle;
• poor dietary fiber and a carbohydrate-rich diet;
• dysbacteriosis;
• neuropsychic overload.

It has been established that people who have undergone surgery to remove the appendix are less susceptible to ulcerative colitis.

Classification of ulcerative colitis

Depending on the location of UC, it can be:

Depending on the severity of the disease, there are three forms:

Depending on the nature of its course, nonspecific ulcerative colitis is divided into:

Symptoms of Ulcerative Colitis

IN clinical picture define three main syndromes: stool disorders, hemorrhagic and pain. Then added general symptoms ulcerative colitis:

• anorexia;
• nausea and vomiting;
• weakness;
• weight loss;
• fever;
• anemia.

The onset of the disease can be slow or acute. The most severe type is the rapid type of ulcerative colitis. It is almost always determined by general damage to the colon, the formation of severe complications (toxic dilatation of the colon, perforation) and most often requires urgent surgical intervention. The disease occurs quickly, and within 1-2 days a pronounced clinical picture matures.

You also need to keep in mind the possibility of immune-related extraintestinal manifestations: articular syndrome (including sacroiliitis), erythema nodosum, uveitis, episcleritis, iridocyclitis, primary sclerosing cholangitis, fatty liver, urolithiasis (urates, oxalates), hypercoagulation, amyloidosis.

Symptoms of ulcerative colitis, which progresses slowly, are manifested exclusively by rectal bleeding. Bleedings, for the most part, begin from small ulcers of the colon.

The disease is accompanied heavy bleeding if inflammation extends proximally to a significant segment of the colon. A significant proportion of patients have an increase in the frequency of bowel movements (in especially serious cases, up to 15 times a day). Often, when you urge, only bloody mucus comes out.

At the onset of the disease, which occurs in the form of proctosigmoiditis, there is constipation, most often due to contractions sigmoid colon. Pain occurs in 2/3 of patients and, as a rule, is aching in nature.

The location of the pain is determined by the extent pathological process(usually on the left side of the abdomen). In most patients, the severity of pain intensifies 40-80 minutes after eating.

Subsequently, the dependence of pain on food intake disappears (the gastrocolytic reflex fades, when intense intestinal peristalsis begins immediately after a meal). Bad feelings in patients are caused by tenesmus, characterized by pain in the rectum along with incomplete bowel movement.

Treatment of ulcerative colitis

When treating ulcerative colitis, various diets that inhibit intestinal transit are prescribed (4, 4a, 46), rich in protein, with limited fat. With a rapid progression of the disease, the patient needs parenteral nutrition.

There are three main groups of drugs:

• aminosalicylic acid derivatives (sulfasalazine, mesalazine);
• glucocorticoids;
• immunosuppressants.

For non-severe types, the average dose of sulfasalazine is 4-8 g/day, mesalazine - 2-4 g/day. When the effect is achieved, the dose is reduced. Patients continue to take a maintenance dose (1.5 g/day) (up to 2 years).

Taking mesalazine is better due to a small number of side effects (mainly with long-term use). Medicines can be taken topically, in suppositories and microenemas.

At severe form or the absence of action of aminosalicylic acid derivatives, hormones are prescribed, for example prednisolone orally at a dose of 1 mg/kg. In acute cases, prednisolone (at a dose of up to 240-360 mg/day) or hydrocortisone (at a dose of up to 500 mg/day) is prescribed parenterally for 5-7 days with a further transition to oral administration.

For resistant forms of ulcerative colitis, immunosuppressants are used - methotrexate (25 mg intramuscularly 2 times a week), azathioprine (2 mg/kg/day) or mercaptopurine (50 mg/day). The duration of the course is usually 12 weeks.

There are different views on the use of antidiarrheal drugs. Some researchers do not recommend them due to the likelihood of toxic dilatation of the colon and low therapeutic effect.

When treating nonspecific ulcerative colitis, dysbiotic disorders are corrected. Hyperbaric oxygenation, plasmapheresis and hemosorption are successfully used.

Surgical treatment of ulcerative colitis

Indications for surgical treatment ulcerative colitis is proven clinical features suspicion of intestinal perforation, impossibility of targeted complex therapy toxic dilatation of the colon, infrequent cases of profuse intestinal bleeding, ineffectiveness of persistent complex conservative treatment, cancer in a chronic inflammatory process.

Complications of ulcerative colitis

Most patients can have long-term remissions. In patients with generalized bowel disease, the risk of colon cancer increases after 10 years of illness. The probability assessment is serious for complications of ulcerative colitis.

Local complications:

• perforation;
• profuse bleeding;
• toxic dilatation of the colon;
• strictures;
• malignancy.

General (systemic) complications:

• reactive arthritis;
• stomatitis;
• ankylosing spondylitis;
• hepatitis.

Diet for ulcerative colitis

Nonspecific ulcerative colitis is characterized by inflammation of the rectum and colon with frequent bleeding, impaired absorption in the intestine, and large loss of protein in feces. Patients often experience anemia (anemia), disorders metabolic processes, exhaustion of the body, allergic reactions and other changes.

The nutrition of patients depends on the manifestations and nature of the disease. During the acute stage, calorie content daily ration limited by fats and carbohydrates while maintaining normal content proteins and increased amounts of B vitamins, ascorbic acid, vitamins A and K, potassium salts, calcium. For intestinal bleeding, it is necessary to introduce foods rich in vitamin K and calcium.

In case of exacerbation of the disease, a diet is recommended that helps reduce the inflammatory process in the intestines and restore its impaired functions, as well as those organs that are more often involved in the pathological process. Food is boiled, steamed, eaten 4–5 times a day, the temperature of hot dishes is 57–62 °C, cold dishes are not lower than 15 °C.

In general, diet therapy for exacerbation of chronic colitis and nonspecific ulcerative colitis corresponds to that for chronic enteritis, tables No. 4b, 4, 4c are used. Prescribe fractional meals 6-7 times a day; in case of severe exacerbation, therapeutic fasting can be carried out during the first 1-2 days in the hospital.

And at home therapeutic nutrition includes slimy soups, weak meat broths, pureed porridge in water, boiled meat in the form of steam cutlets and meatballs, soft-boiled eggs, boiled river fish, jelly, sweet tea.

Gradually, as the condition improves, boiled and crushed vegetables and fruits (puree) are introduced into the diet, which are then replaced with fresh ones.

• White cabbage;
• beet;
• Bell pepper;
• eggplant;
• radish;
• radish;
• sorrel;
• spinach;
• mushrooms;
• carbonated drinks.

During the period of subsidence of exacerbations, nutrition should be complete, with increased content proteins, a normal amount of carbohydrates, rich in vitamins, potassium and calcium salts.

For nonspecific ulcerative colitis, the diet should be moderately mechanically gentle, satisfy the body’s needs, contain increased amount squirrel. The latter is necessary to eliminate protein deficiency in the body, which often occurs with this disease.

Sample diet menu

Prevention of ulcerative colitis

Since this disease has serious complications It should not be taken lightly. It’s worth protecting yourself from this kind of trouble in advance. Proper nutrition is the key to health. So in this case, it is the best prevention of colitis.

The question involuntarily arises, what is possible then? Products useful for any type of colitis:

• Meat - lamb and chicken.
• Boiled or baked vegetables.
• You can only eat yesterday's bread, not fresh.
• Soups cooked with low-fat broth.
• Fruits - apples, pears without peel, raw or baked in the oven.
• Dairy products – kefir, sourdough, bifidok.
• During the day you need to drink 2 liters, but singing while eating is strictly prohibited.
• You need to drink water 15-20 minutes before meals or 2 hours after meals.
• Strong tea and coffee should also be excluded from the diet.

Proper nutrition allows you not only to stay healthy, but also to support an already weakened body from the onset of illness. If you do not follow nutritional prevention measures, you can pay a fairly high price for it.

Questions and answers on the topic "Ulcerative colitis"

Question:Hello, I'm 18 years old. I have nonspecific ulcerative colitis. Tell me, can malaise and general poor health often occur with this disease? And is it possible to live a full life with this disease?

Answer: During an exacerbation of nonspecific ulcerative colitis, it is possible bad feeling and malaise. Modern methods UC treatments allow you to achieve long-term remission or completely stop the disease, so you have every chance to live a long and fulfilling life.

Question:Hello, I have ulcerative colitis, mild course. I was prescribed to take Salofalk in microgranules. Tell me, can salofalk cause side effects such as nausea and headache?

Answer: Yes, Salofalk can cause these side effects, but they should go away soon.

Question:Good afternoon, I am asking for help in solving a problem, but I have this: for a week, a 27-year-old man has had bloody stools, while the temperature is normal 36-6, there is no vomiting or nausea, periodically there is short-term pain in the lower abdomen, after going to the toilet it passes. Stool color varies from normal to dark. Activated carbon and tetracycline were used for treatment for the last two days. Please advise medications for treatment.

Answer: The situation you described requires immediate medical attention: bloody or black stools are signs of intestinal bleeding. The patient must be examined. There is no point in treating it if the diagnosis is not known. He may have dysentery, ulcerative colitis, stomach ulcer, etc.

Question:I am 47 years old. Over the past month, pronounced blood has appeared in the stool three times. The last time blood was present was for several hours (in the evening). In the morning there were no traces. What could it be? What measures can you take on your own?

Answer: The presence of blood in the stool may be a sign of hemorrhoids, anal fissure, intestinal tumors, or ulcerative colitis. You should see a proctologist as soon as possible (don’t waste a day!) and undergo an examination. Any delay can be very dangerous.

Question:Hello, Doctor. I am 28 years old. Seven months ago I gave birth to my second child. A month ago I was diagnosed with ulcerative colitis-proctitis (20 cm). And to be honest, this is like a death sentence for me. I would really like to know: 1. Is it true that this cannot be cured and will need to be treated for the rest of my life. Now I am taking PENTAS suppositories. 2. Does medicine even have anything to offer that could help me (for example, surgery) or at least keep this disease under control (so that it doesn’t get worse). 3. What kind of prospects do people with this disease have? To be honest, I’m very worried - I can’t find a place for myself.

Answer: This diagnosis is not a death sentence. It is often possible to choose a treatment in such a way that you can forget about the disease for a long time. long years. However, you just can’t forget about it - if you don’t follow your lifestyle and diet, it will immediately make itself known. The problem is that the exact cause of this disease is still not known. it is believed that this is due to serious violations immune system, however this is not 100% proven. Until the cause of the disease is found, you understand, it will not be possible to eliminate it. Today, only stable remission can be achieved. However, the causes of this disease and new drugs are constantly being sought. Cheer up!

Treatment of nonspecific ulcerative colitis depends on the localization of the pathological process in the intestine, its extent, the severity of the attacks, and the presence of local and systemic complications.

The main goals of conservative therapy:

• pain relief,
• prevention of relapse of the disease,
• preventing the progression of the pathological process.

Ulcerative colitis of the distal intestine: proctitis and proctosigmoiditis are treated on an outpatient basis, as they have a milder course. Patients with total and left-sided lesions of the colon are treated in a hospital setting, since they have more pronounced clinical manifestations and there are great organic changes.

Nutrition of the sick

The diet for ulcerative colitis should spare the intestines, help increase its regenerative abilities, eliminate fermentation and putrefactive processes, and also regulate metabolism.

Sample menu for ulcerative colitis:

• Breakfast - rice or any other porridge with butter, steamed cutlet, tea;
• Second breakfast - approximately forty grams boiled meat and berry jelly;
• Lunch - soup with meatballs, meat casserole, dried fruit compote;
• Dinner - mashed potatoes with fish cutlet, tea;
• Snack - baked apples.

Drug treatment

Treatment of ulcerative colitis of the intestine is carried out in three main directions:

• preventing or stopping internal bleeding;
• restoration of water-salt balance in the body;
• cessation of pathogenic effects on the intestinal mucosa.

Phytotherapy

Infusions from medicinal herbs have a mild restorative effect: they envelop the damaged intestinal mucosa, heal wounds, and stop bleeding. Herbal infusions and decoctions can replenish fluid loss in the body and restore water and electrolyte balance.

The main components of medicinal herbal mixtures are:

1. The leaves and fruits of currants, raspberries and strawberries help the liver fight any acute inflammatory process in organism.
2. Dried blueberries cleanse the intestines of putrefactive microorganisms and help in the fight against cancer cells.
3. Nettle improves blood clotting, relieves inflammation, and cleanses the intestines of decay and putrefaction products.
4. Peppermint fights emotional lability, diarrhea, relieves inflammation and spasms, and has a pronounced antimicrobial effect.
5. Chamomile – powerful herbal antibiotic, which can also relieve spasms.
6. Yarrow stops diarrhea, has bactericidal properties and cleanses the intestines of pathogenic microorganisms.
7. St. John's wort stimulates intestinal motility and has an anti-inflammatory effect.

These herbs are used to treat ulcerative colitis in the form of infusions and decoctions. They are combined into collections or brewed separately.

• Dry raspberry leaves and branches are poured with boiling water and left for half an hour. Take one hundred milliliters four times a day before meals.
• A collection of medicinal herbs is prepared as follows: mix a teaspoon of centaury grass, sage leaves and flowers pharmaceutical chamomile. Then pour a glass of boiling water and leave for thirty minutes. Drink one tablespoon every two hours. After three months, the intervals between doses of the infusion are lengthened. This treatment is harmless and can last for a long time.
• Leaves peppermint pour boiling water and leave for twenty minutes. Take a glass twenty minutes before meals. An equally effective remedy for colitis is an infusion of strawberry leaves, which is prepared in a similar way.
• Fifty grams of fresh pomegranate seeds are boiled over low heat for half an hour, poured with a glass of water. Take two tablespoons twice a day. Pomegranate decoction- enough effective remedy for allergic colitis.
• One hundred grams of yarrow herb is poured with a liter of boiling water and left for a day in a closed container. After straining, the infusion is boiled. Then add one tablespoon of alcohol and glycerin and stir well. Take thirty drops half an hour before meals for a month.
• Mix equal quantities of sage, peppermint, chamomile, St. John's wort and cumin. This mixture is placed in a thermos, poured with boiling water and left overnight. Starting from the next day, take the infusion regularly, half a glass three times a day for a month.

Folk remedies

• Dried watermelon rinds in the amount of one hundred grams, pour two glasses of boiling water and take one hundred milliliters six times a day.
• Eight grams of propolis should be eaten daily to reduce the symptoms of colitis. It must be chewed for a long time on an empty stomach.
• Squeeze the juice from onions and take one teaspoon three times a day. This folk remedy is very effective in the treatment of ulcerative colitis.
• The whey obtained by squeezing feta cheese is recommended to be taken twice a day.
• Walnut kernels are eaten regularly for three months. Positive results will become noticeable within a month from the start of treatment.
• How to cure ulcerative colitis using microenemas? For this, starch microenemas are shown, prepared by diluting five grams of starch in one hundred milliliters of cool water.
• Microenemas made from honey and chamomile, which are pre-brewed with boiling water, are considered effective. One enema requires fifty milliliters of solution. The duration of treatment is eight procedures.
• Viburnum berries are poured with boiling water and viburnum tea is drunk immediately before eating.