Gastric emptying and passage of food into the intestines are regulated by the humoral and nervous systems. Contractions of the stomach and small intestine are coordinated with each other. This process can be represented as the following diagram. Swallowed food, previously crushed in the oral cavity and mixed with saliva, enters the cardiac part of the stomach. Due to constant peristaltic movements, the food bolus moves to the distal section. The distal part of the stomach grinds food into small particles and acts as a gate, allowing only liquid and small particles to enter the duodenum, and preventing the return of food. Peristaltic contractions of the proximal and distal parts

The secretions of the stomach are under the control of the vagus nerve, the main neurotransmitter of which is acetylcholine. Acetylcholine interacts with the receptors of smooth muscle cells of the stomach, thereby stimulating their contraction and relaxation during the act of swallowing. In addition, a number of hormones also influence stomach contractions, strengthening or weakening them. For example, cholecystokinin reduces peristalsis of the proximal stomach while stimulating contractions of the distal stomach, and secretin and somatostatin weaken contractions of both sections.

Gastric evacuation It takes the time during which the stomach is freed from its contents, which then enter the duodenum. Deviation from the normal gastric evacuation time in the direction of increase contributes to the development of a delay in the onset of action of certain xenobiotics and/or various dosage forms of drugs. According to the theory of the dependence of absorption capacity on the dissociation constant, weakly basic drugs awaiting transition to an ionized form in the stomach, with a slow rate of gastric evacuation, could delay the onset of action of the main drugs. The speed of gastric evacuation is influenced by the following factors.

Drugs that block acetylcholine receptors of gastric smooth muscle cells, delaying the evacuation of gastric contents (for example, propantheline ¤).

The high acidity of gastric chyme also delays the evacuation of stomach contents.

The chemical composition of the chyme within the stomach determines the time of gastric evacuation. In humans, liquids are cleared in approximately 12 minutes and solids in approximately 2 hours, depending on the chemical composition of the chyme. Carbohydrates are evacuated faster than proteins, and proteins faster than fats.

Gastric emptying corresponds to the caloric content of the stomach contents so that the number of calories transferred to the small intestine remains constant for various nutrients over time, but the evacuation of contents from the stomach is slower the more calorie rich the food.

The rate of gastric evacuation depends on the amount of food consumed. For example, changing the amount of solid food from 300 to 1692 g increases the gastric emptying time from 77 to 277 minutes. The size of food particles also matters because

large food particles put pressure on the walls of the stomach, thereby stimulating the evacuation of stomach contents.

Simulation of small intestinal receptors (eg, duodenal osmotic pressure-sensitive receptors) with hypertonic or hypotonic saline slows gastric emptying.

The temperature of solid or liquid foods can affect the rate of gastric emptying. Temperatures above or below the physiological norm (37 ° C) can proportionally reduce the evacuation of gastric contents.

Other factors such as anger or agitation may increase the rate of gastric emptying, while depression or trauma appear to decrease it. Body position also matters. For example, standing or lying on the right side can facilitate the passage of contents into the small intestine by increasing pressure in the proximal part of the stomach.

Description:

Disorders of gastric motility include disturbances in the tone of the SMC of the muscular lining of the stomach (including muscular sphincters), gastric motility and evacuation of gastric contents.
- Violations of the tone of the muscular lining of the stomach: excessive increase (hypertonicity), excessive decrease (hypotonicity) and atony - lack of muscle tone. Changes in muscle tone lead to disturbances in the peristole - the envelopment of food masses by the wall of the stomach and the formation of a portion of food for intragastric digestion, as well as its evacuation into the duodenum.
- Disorders of the activity of the muscular sphincters of the stomach in the form of a decrease (up to their atony; causes a prolonged opening - “gaping” of the cardiac and/or pyloric sphincters) and an increase in the tone and spasm of the sphincter muscles (lead to cardiospasm and/or pylorospasm).
- Disorders of gastric motility in the form of its acceleration (hyperkinesis) and slowdown (hypokinesis).
- Evacuation disorders. Combined and/or separate disorders of the tone and peristalsis of the stomach wall lead to either an acceleration or a slowdown in the evacuation of food from the stomach.

Symptoms:

As a result of gastric motility disorders, the development of early satiety syndrome, heartburn, nausea, etc. is possible.
- Early (rapid) satiety syndrome. It is the result of decreased tone and motility of the antrum of the stomach. Eating a small amount of food causes a feeling of heaviness and fullness in the stomach. This creates a subjective feeling of satiety.
- - a burning sensation in the lower part of the esophagus (the result of a decrease in the tone of the cardiac sphincter of the stomach, the lower sphincter of the esophagus and the reflux of acidic gastric contents into it).
- . With subthreshold stimulation of the vomiting center, nausea develops - an unpleasant, painless subjective sensation that precedes vomiting.

Causes:

Disorders of the nervous regulation of the motor function of the stomach: increased influence of the vagus nerve stimulates its motor function, and activation of the effects of the sympathetic nervous system suppresses it.
- Disorders of humoral regulation of the stomach. For example, a high concentration of hydrochloric acid in the stomach cavity, as well as secretin and cholecystokinin, inhibit gastric motility. On the contrary, gastrin, motilin, and a reduced content of hydrochloric acid in the stomach stimulate motility.
- Pathological processes in the stomach (erosions, ulcers, scars, tumors can weaken or enhance its motility, depending on their location or severity of the process).

Treatment:

For treatment the following is prescribed:

Drug therapy for diseases accompanied by weakening of the tone and peristalsis of various parts of the gastrointestinal tract (gastroesophageal reflux disease and reflux-like and dyskinetic variants of functional, hypomotor dyskinesia of the duodenum and biliary tract, hypomotor variant, etc.), includes the use of drugs that enhance motility digestive tract.
Medicines prescribed for this purpose (these drugs
called prokinetics), they exert their effect either by stimulating cholinergic receptors (carbacholin, cholinesterase inhibitors) or by blocking dopamine receptors. Attempts to use the prokinetic properties of the antibiotic erythromycin, which have been made in recent years, are faced with a high frequency of side effects due to the main (antibacterial) activity of the drug, and remain at the stage of experimental research. Also, we have not yet gone beyond the scope of experimental work.
studies of the prokinetic activity of other groups of drugs: 5-HT3 receptor antagonists (tropisetron, ondansetron), somatostatin and its synthetic analogues (octreotide), cholecystokinin antagonists (asperlicin, loxiglumide), kappa receptor agonists (fedotocin), etc.
As for carbacholin and cholinesterase inhibitors, due to the systemic nature of their cholinergic action (increased saliva production, increased secretion of hydrochloric acid, bronchospasm), these drugs are also used relatively rarely in modern clinical practice.

Metoclopramide remained the only drug from the group of dopamine receptor blockers for a long time. Experience with its use has shown, however, that the prokinetic properties of metoclopramide are combined with its central side effect (the development of extrapyramidal reactions) and a hyperprolactinemic effect, leading to the occurrence of and, as well.
Domperidone is also a dopamine receptor blocker, however, unlike metoclopramide, it does not cross the blood-brain barrier and thus does not cause central side effects.

The pharmacodynamic effect of domperidone is associated with its blocking effect on peripheral dopamine receptors localized in the wall of the stomach and duodenum.

   Domperidone increases the tone of the lower esophageal sphincter, enhances the contractility of the stomach, improves the coordination of contractions of the antrum of the stomach and duodenum, and prevents the occurrence of duodenogastric reflux.

   Domperidone is currently one of the main drugs for the treatment of functional dyspepsia. Its effectiveness in this disease was confirmed by data from large multicenter studies conducted in Germany, Japan and other countries. In addition, the drug can be used to treat patients with reflux esophagitis, patients with secondary gastroparesis that occurs due to systemic gastroparesis, as well as after gastric surgery. Domperidone is prescribed in a dose of 10 mg 3 to 4 times a day before meals. Side effects from its use (usually general weakness) are rare, and extrapyramidal disorders and endocrine effects occur only in isolated cases.

   Cisapride, which is now widely used as a prokinetic drug, is significantly different in its mechanism of action from other drugs that stimulate the motor function of the gastrointestinal tract.

   The exact mechanisms of action of cisapride remained unclear for a long time, although they were assumed to be realized through the cholinergic system. In recent years, it has been shown that cisapride promotes the release of acetylcholine due to the activation of a recently discovered new type of serotonin receptors (5-HT4 receptors) localized in the neuronal plexuses of the muscular lining of the esophagus, stomach, and intestines.

   Cisapride has a pronounced stimulating effect on esophageal motility, increasing tone to a greater extent than metoclopramide
lower esophageal sphincter and significantly reducing the total number of episodes of gastroesophageal reflux and their total duration. In addition, cisapride also potentiates propulsive motility of the esophagus,
thus improving esophageal clearance.

   Cisapride enhances the contractile activity of the stomach and duodenum, improves gastric emptying, reduces duodenogastric bile reflux and normalizes antroduodenal coordination. Cisapride stimulates the contractile function of the gallbladder, and, by enhancing the motility of the small and large intestines, accelerates the passage of intestinal contents.

   Cisapride is currently one of the main drugs
used in the treatment of patients with gastroesophageal reflux
illness. In the initial and moderate stages of reflux esophagitis, ukzapride can be prescribed as monotherapy, and in severe forms of mucosal damage - in combination with antisecretory drugs (H2 blockers or proton pump blockers). IN
Currently, experience has been accumulated in long-term maintenance administration of cisapride to prevent relapses of the disease.

Multicenter and meta-analytic studies have confirmed the good results of using cisapride in the treatment of patients with functional
dyspepsia. In addition, the drug was effective in treating
patients with idiopathic, diabetic and post-vagotomy gastroparesis, patients with dyspeptic disorders, duodenogastric reflux and sphincter of Oddi dysfunction that arose after cholecystectomy.

   Cisapride gives a good clinical effect in the treatment of patients with irritable bowel syndrome, which occurs with a picture of persistent constipation, resistant to therapy with other drugs, as well as patients with
intestinal pseudo-obstruction syndrome (developing, in particular, against the background of systemic scleroderma, etc.).

   Cisapride is prescribed in a dose of 5 - 10 mg 3 - 4 times a day before meals. The drug is usually well tolerated by patients. The most common side effect is, occurring in 3–11% of patients, usually not requiring cessation of treatment.
If patients have signs of increased motility in certain parts of the digestive tract, drugs with an antispasmodic mechanism of action are prescribed. Traditionally, in our country, myotropic antispasmodics are used for this purpose: papaverine, no-shpa, halidor. Abroad, in similar situations, preference is given to butylscopolamine, an anticholinergic drug with antispasmodic activity exceeding that of myotropic antispasmodics. Butylscopolamine is used for various types of esophagospasm,
hypermotor forms of dyskinesia of the duodenum and biliary tract, irritable bowel syndrome, occurring with the clinical picture of intestinal colic. The drug is prescribed in a dose of 10–20 mg 3–4 times a day. Side effects characteristic of all anticholinergic drugs (tachycardia, decreased blood pressure, accommodation disorders) can be pronounced during treatment
butylscopolamine to a much lesser extent than with atropine therapy, and occur mainly with its parenteral use.

   For manifestations of esophagospasm, a certain clinical effect can be achieved by the use of nitrates (for example, nitrosorbide) and calcium channel blockers (nifedipine), which have a moderate antispasmodic effect on the walls of the esophagus and the tone of the lower esophageal sphincter.

   With hypermotor variants of irritable bowel syndrome, the so-called functional diarrhea, which, unlike organic (for example, infectious) diarrhea, is observed mainly in the morning, is associated with psycho-emotional factors and is not accompanied by

pathological changes in stool tests, the drug of choice is loperamide. By binding to opiate receptors in the colon, loperamide inhibits the release of acetylcholine and prostaglandins in the colon wall
intestines and reduces its peristaltic activity. The dose of loperamide is selected individually and is (depending on stool consistency) from 1 to 6 capsules of 2 mg per day.

   Thus, as data from numerous studies show, motility disorders of various parts of the digestive tract are an important pathogenetic factor in many gastroenterological diseases and often determine their clinical picture. Timely detection of motor disorders of the gastrointestinal tract using special instrumental diagnostic methods and the use of adequate drugs that normalize gastrointestinal motility can significantly improve the results of treatment of such patients.

Contractions of the stomach muscles move food from the stomach to the intestines. The surface layer of food entering the stomach moves, which is directed along the lesser curvature, reaches the pyloric part and leaves the stomach through the sphincter opening.

Rapidity passage of food from the stomach to the intestines, i.e., the speed of evacuation of food from the stomach, depends on the quantity, composition and consistency of food and the amount of gastric juice released. Food stays in the stomach for up to 6 and even 10 hours. Carbohydrate foods are evacuated faster than protein-rich foods; fatty foods stay in the stomach for 8-10 hours. Liquids begin to pass into the intestine almost immediately after they enter the stomach.

Until recently, the mechanism of food evacuation from the stomach was explained by the fact that sphincter pylori is open when the stomach is empty, but during digestion it periodically closes and opens. The opening of the pyloric sphincter occurs due to irritation of the mucous membrane of the outlet part of the stomach by hydrochloric acid of gastric juice.

Part of the food at this time passes into the duodenum, and the reaction of its contents becomes acidic instead of normal alkaline. The acid, acting on the mucous membrane of the duodenum, causes a reflex contraction of the pyloric muscles, i.e., closing the sphincter and, therefore, stopping further passage of food into the stomach intestines. When, under the influence of secreted juices (pancreatic, intestinal and bile), the acid is neutralized and the reaction in the intestines becomes alkaline again, the whole process is repeated again. Since the alkaline reaction in the intestine occurs after a rather long digestion of food, a new portion comes from the stomach to the intestines after sufficient processing of the previous one.

The closure of the exit from the pylorus when hydrochloric acid enters the duodenum is called the obturator pyloric reflex. The obturator reflex is also observed when fat is introduced into the duodenum. This explains why fatty foods remain in the stomach for a long time due to the closure of the pyloric sphincter caused by fats.

It has now been shown that the acidity of the gastric and duodenal contents is not the only and decisive factor determining passage of food from the stomach to the intestines. If you maintain an acidic reaction in the duodenum for a long time (by introducing acid through a fistula), then food still passes from the stomach. The introduction of alkalis into the duodenum does not change the rhythmic nature of gastric emptying. Similar observations have been made on people.

An X-ray study showed that in people who had the pyloric part of the stomach removed, the time it took for the stomach to empty was almost the same as normal. All these data led to the conclusion that the evacuation of food from the stomach is caused not so much by periodic openings of the sphincter, but by contractions of antrum pylori and the muscles of the stomach as a whole.

The following factors are important in the passage of food into the intestines:

1. consistency of gastric contents,
2. its osmotic pressure,
3. degree of filling of the duodenum.

The contents of the stomach go into the intestine when its consistency becomes liquid or semi-liquid. The role of osmotic pressure is evident from the fact that hypertonic solutions delay evacuation and leave the stomach only after diluting them with gastric juice to the concentration of an isotopic solution. When the duodenum is stretched, evacuation is also delayed and may even temporarily stop completely. The evacuation of food from the stomach is regulated by the nervous system and the humoral pathway. The presence of humoral regulation is proven by the fact that enterogastron, formed in the intestinal mucosa under the influence of fat and fatty acids, inhibits the movements of the stomach and the evacuation of food from it.

DIGESTION IN THE STOMACH

Evacuation of stomach contents into the duodenum

The rate of evacuation of food from the stomach depends on many factors: volume, composition and consistency (degree of grinding, liquefaction), osmotic pressure, temperature and pH of the stomach contents, pressure gradient between the cavities of the pyloric stomach and duodenum, the state of the pyloric sphincter, appetite, which food was taken, the state of water-salt homeostasis and a number of other reasons. Food rich in carbohydrates, other things being equal, is evacuated from the stomach faster than food rich in proteins. Fatty foods are evacuated from it at the slowest speed. Liquids begin to pass into the intestine immediately after they enter the stomach.

The time for complete evacuation of mixed food from the stomach of a healthy adult is 6-10 hours.

The evacuation of solutions and chewed food from the stomach occurs exponentially, but the evacuation of fats does not obey an exponential dependence. The speed and differentiation of evacuation are determined by the coordinated motility of the gastroduodenal complex, and not only by the activity of the pyloric sphincter, which mainly plays the role of a valve.

The rate of evacuation of food contents of the stomach has wide individual differences, which are accepted as the norm. The differentiation of evacuation depending on the type of food taken appears as a pattern without significant individual characteristics and is disrupted in various diseases of the digestive organs.

Regulation of the rate of evacuation of gastric contents. It is carried out reflexively when the receptors of the stomach and duodenum are activated. Irritation of the mechanoreceptors of the stomach accelerates the evacuation of its contents, and that of the duodenum slows it down. Of the chemical agents acting on the mucous membrane of the duodenum, acidic (pH less than 5.5) and hypertonic solutions, 10% ethanol solution, glucose and fat hydrolysis products significantly slow down the evacuation. The rate of evacuation also depends on the efficiency of nutrient hydrolysis in the stomach and small intestine; insufficient hydrolysis slows down evacuation. Consequently, gastric evacuation “serves” the hydrolytic process in the duodenum and small intestine and, depending on its progress, “loads” the main “chemical reactor” of the digestive tract - the small intestine - at different rates.

Regulatory influences on the motor function of the gastroduodenal complex are transmitted from intero- and exteroceptors through the central nervous system and short reflex arcs that close in the extra- and intramural ganglia. Gastrointestinal hormones take part in the regulation of the evacuation process, affecting the motility of the stomach and intestines, changing the secretion of the main digestive glands and, through it, the parameters of the evacuated gastric contents and intestinal chyme.

Vomit

Vomiting is the involuntary expulsion of the contents of the digestive tract through the mouth (sometimes through the nose). Vomiting is often preceded by an unpleasant feeling of nausea. Vomiting begins with contractions of the small intestine, as a result of which some of its contents are pushed into the stomach by antiperistaltic waves. After 10-20 s, contractions of the stomach occur, the cardiac sphincter opens, after a deep inhalation, the muscles of the abdominal wall and diaphragm strongly contract, as a result of which the contents are expelled through the esophagus into the oral cavity at the moment of exhalation; the mouth opens wide and vomit is removed from it. Their entry into the airways is usually prevented by stopping breathing, changing the position of the epiglottis, larynx and soft palate.

Vomiting has a protective significance and occurs reflexively as a result of irritation of the root of the tongue, pharynx, gastric mucosa, biliary tract, peritoneum, coronary vessels, vestibular apparatus (with motion sickness), and brain. Vomiting can be caused by the action of olfactory, visual and gustatory stimuli that cause a feeling of disgust (conditioned reflex vomiting). It is also caused by certain substances that act humorally on the nerve center of vomiting. These substances can be endogenous and exogenous.

The center of vomiting is located at the bottom of the IV ventricle in the reticular formation of the medulla oblongata. It is connected with the centers of other parts of the brain and the centers of other reflexes. Impulses to the center of vomiting come from many reflexogenic zones. Efferent impulses that provide vomiting follow to the intestines, stomach and esophagus as part of the vagus and splanchnic nerves, as well as nerves innervating the abdominal and diaphragmatic muscles, muscles of the trunk and limbs, which provides basic and auxiliary movements (including characteristic posture). Vomiting is accompanied by changes in breathing, coughing, sweating, salivation and other reactions.

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Colitis: characteristics, symptoms, treatment

Characteristics of the disease

Colitis is a group of inflammatory diseases of the colon and rectum, caused by various causes, having different mechanisms of occurrence and development, but having a large number of similarities in their clinical manifestations.

This similarity is due to the structure and functions of the large intestine: the initial part of the large intestine is the cecum, located in the lower right abdominal cavity; Next comes the ascending colon, located vertically along the right wall of the abdominal cavity.

In the subhepatic space, the intestine bends to the left (the so-called hepatic angle), passing into the transverse colon. The latter is located horizontally, sagging somewhat in its middle part (sometimes the sagging is so pronounced that this in itself can lead to pathological conditions of the large intestine), making a downward bend in the left upper abdominal cavity (splenic angle) and turning into a vertically located descending section of the colon.

At the border of the middle and lower left sections of the abdominal cavity, the descending section passes into the sigmoid or, otherwise, S-shaped colon, which, in turn, passes into the rectum. In the right half of the large intestine (up to the middle of the transverse colon) water is absorbed from liquid feces, in the left half (up to the sigmoid colon) dense feces are formed, and the sigmoid and, to an even greater extent, the rectum expel the latter from the body.

Thus, the inflammatory process that occurs in various parts of the colon can cause a violation of the reabsorption of water, which will lead to loose stools; spasm or, on the contrary, expansion of a section of the intestine, which will lead to disruption of the passage of feces through the intestine, possibly accompanied by bloating, pain of various types and positions, constipation; the appearance of various pathological discharges with feces (for example mucus), etc.

According to the modern classification, colitis is divided depending on the nature of the course - into acute and chronic, depending on the cause of occurrence - into:

2. nonspecific, among which nonspecific ulcerative colitis, granulomatous colitis and ischemic colitis are distinguished;

3. functional lesions of the colon:

a) irritable bowel syndrome,

b) spastic constipation,

c) atonic constipation and

d) functional diarrhea;

according to the extent of the lesion, i.e., depending on whether the entire colon or only some of its parts are involved in the pathological process; according to the severity of the disease; by stage of the disease; by the nature of the flow; on the development of the disease, etc.

Symptoms, diagnosis, treatment methods

For most forms of colitis, the most characteristic symptoms are stool disorders (in various forms), abdominal pain, and signs of intoxication.

It should be noted that the diagnosis of “colitis” (as, indeed, any other diagnosis) is established only by a doctor - coloproctologist, gastroenterologist-infectious disease specialist or therapist on the basis of examination data, which necessarily includes sigmoidoscopy and irrigoscopy or fibrocolonoscopy, which is absolutely necessary to assess the condition of the mucous membrane intestines, the tone of the intestinal wall and its elasticity, the state of the evacuation (expulsion) function of the colon.

It is also advisable to examine stool for flora - in some cases, the cause of colitis is not an intestinal infection, but a violation of the qualitative composition of the intestinal microflora (dysbacteriosis): normally, lactic acid fermentation bacteria predominate; when unfavorable conditions arise (for example, long-term use of antibiotics, increased body temperature, etc.), these bacteria are the first to die.

The vacated “niche” is quickly filled by putrefactive fermentation bacteria and various opportunistic bacteria (cocci, etc.). In such a situation, further fight against the “wrong” bacteria will not only not contribute to the normalization of the intestinal microflora, but can also significantly worsen the patient’s condition.

Let us immediately make a reservation that the treatment of acute colitis, regardless of the cause of its occurrence, as well as the treatment of all types of nonspecific colitis is not only impossible without the use of medications, but also completely unacceptable without the participation of a doctor - self-medication in such a situation can lead (in addition to the lack of therapeutic effect or even deterioration of the patient’s condition) to a distortion of the picture of the disease.

So, functional disorders of the colon are divided into four groups:

1. irritable bowel syndrome;
2. functional diarrhea;
3. spastic constipation (sometimes the diagnosis is formulated as spastic colitis);
4. atonic constipation (can also be referred to as atonic colitis).

The first two groups are characterized by accelerated evacuation of intestinal contents, while the subsequent ones, as their names suggest, are characterized by slow evacuation, and the reasons for the slowdown in evacuation are so different that these differences are reflected in the clinical manifestation of the disease and in the methods of treatment.

The function of the colon is to accumulate food residues that are not absorbed by the body and their subsequent removal from the body. Thus, disruption of these processes causes a violation of the consistency of contractions of the intestinal wall and, as a consequence, the rhythm of bowel movements; irritation of the intestinal mucosa; changing the conditions of existence of intestinal microflora.

All of these factors, with a certain duration of existence and degree of severity, contribute to the occurrence of secondary inflammatory changes in the intestinal wall. It is the changes in the intestinal mucosa and changes in the intestinal wall, detected during sigmoidoscopy and irrigoscopy, respectively, that become the basis for establishing the diagnosis of “colitis”.

The normal contractile activity of the colon is considered to be one contraction per minute, with a duration of the peristaltic wave of 40-50 seconds (peristalsis is a wave-like contraction of the intestine that carries out a unilaterally directed movement of intestinal contents, its appearance is comparable to the “flowing” of an earthworm).

If the coordination of contractions is disrupted, the activity of the muscles of the intestinal wall is disrupted, leading to increased or slower contractions. The development of changes in the intestinal wall also leads to a change in its tone - a decrease or increase. With a decrease in tone, the intestinal wall is flaccid and easily overstretched.

A patient in this condition may not experience any changes in his condition for several days, but gradually develop a feeling of heaviness and fullness in the abdomen, weakness, and increased fatigue. When the tone of the intestinal wall increases, the latter usually reacts with spasms to various irritants. The spasm is accompanied by pain, sometimes so severe that patients can hardly bear it.

Irritable bowel syndrome is characterized by abdominal pain and frequent bowel movements, which can be quite painful. Most often, pain is felt around the navel or throughout the abdomen, in the left iliac region, in the right hypochondrium. The stool, as a rule, is initially formed or even with a dense fecal plug, then unformed or liquefied. Most often, stool is repeated, with each subsequent urge more painful and more painful than the previous one, while the stool is liquid, often mixed with mucus. Functional diarrhea is characterized by frequent loose stools with a sudden strong urge to do so, aching pain in the abdomen, usually located around the navel or along the colon; the pain is not spastic in nature; bloating and rumbling along the colon.

Spastic constipation is characterized by retention of stool for up to 2-3 days, accompanied by sharp spastic pain, bloating, profuse gas formation, rumbling in the abdomen, and the release of a significant amount of mucus with feces. Atonic constipation is characterized not only by the absence of independent stool for 3 or more days, but also by the absence of the urge to do so, gradually increasing bloating, lethargy, and fatigue; Cases of formation of fecal stones are very common.

Treatment in this case will consist of the following main complementary components: diet; drug treatment; herbal medicine; therapeutic enemas. When choosing a diet, we must consider the following points:

1. Food should not contain irritating ingredients, either natural (for example, spicy seasonings) or artificial (for example, preservatives in carbonated soft drinks).

2. Food should be sufficiently high in calories, but easily digestible. At the same time, at the beginning of treatment, boiled or steamed food is preferable; in the future, fried (but not fried to an anthracite state) is also acceptable. Smoked meats are undesirable.

3. The ratio of plant and animal products is directly dependent on the type of intestinal disorder. If we are dealing with irritable bowel syndrome or functional diarrhea, i.e. the disorder occurs as an accelerated bowel movement, the patient’s diet should be dominated by protein products, mainly of animal origin, with the exception of whole milk. Other fermentable products (such as grape or plum juice) are also undesirable. Often, consuming fermented milk products has a very good effect. Plant foods should not contain coarse fiber and must be subjected to heat treatment.

If we are dealing with intestinal disorders that occur with delayed bowel movement, it is necessary to accurately establish the nature of constipation, i.e., whether it is spastic or atonic, since the ratio of animal and plant components in the diet depends on this.

For spastic constipation, food should contain approximately equal amounts of animal protein and fiber, while coarse fiber may be present in small quantities. For atonic constipation, which is characterized by reduced activity of intestinal contractions, it is advisable to eat a significant amount of fiber: fresh fruit and vegetable juices, fresh vegetable salads, boiled vegetables; bread made from wholemeal flour or mixed with bran.

For atonic constipation, the use of steamed bran before meals often gives a good effect (1 tablespoon of bran is poured with boiling water and left covered for 5 minutes, after which it is necessary, after draining the water, to eat the bran with the first portion of food - the first sip of morning kefir, the first spoon soup, etc.). Boiled or, better yet, steamed peeled pumpkin and boiled beets stimulate the intestines very well. The consumption of dried fruits such as prunes, figs and, to a slightly lesser extent, dates also helps to activate the intestines. The effect of their intake is explained by the ability to swell in the intestinal lumen, prompting their accelerated expulsion.

Drug treatment prescribed for colitis depends on the type of intestinal disorder. For irritable bowel syndrome, treatment is aimed at reducing peristaltic activity. In addition, during an exacerbation, it is advisable to use intestinal antiseptics: phthalazole, sulfasalazine, salazopyridazine, etc.

However, despite the noticeable effect of taking them, these drugs should not be abused, since they have an effect not only on pathogenic bacteria, but also on the normal intestinal microflora, so the duration of their use should not exceed 10-14 days. In order to weaken violent peristalsis and relieve the intestinal spasms that often accompany it, it is necessary to use mild antispasmodics, such as no-spa (1-2 tablets 2-3 times a day).

A number of authors indicate the high effectiveness of the use of cholinergic drugs and adrenergic blockers, but their use is only possible under the supervision of a doctor in a hospital - they may be far from harmless from the point of view of cardiovascular and some other diseases.

It should also be noted that the cells of the intestinal mucosa, responsible for the production of mucus, begin to intensively produce mucus under conditions of inflammation. A large amount of mucus in the intestinal lumen in itself is a strong irritant, prompting the intestine to accelerate the expulsion of contents, but, in addition, this mucus is chemically somewhat different from normal, it is more “aggressive”, which also has an irritating effect on the intestinal wall, which occurs "vicious circle".

In order to break this circle, it is necessary to use astringents and enveloping agents to protect the intestinal mucosa from the irritating effects of mucus, which should result in a decrease in irritation and a decrease in the production of this same mucus. The best remedies are calcium carbonate and a number of herbal products. Take calcium carbonate 1-1.5 g orally 1.5-2 hours after meals.

If a patient with irritable bowel syndrome has a proven decrease in the acidity of gastric juice, it is advisable to take hydrochloric acid or acidin-pepsin with meals; if there is no reliable data for reducing acidity, it is preferable to take enzyme preparations, for example Panzinorm-Forte.

Considering that the normal intestinal microflora dies both as a result of unfavorable living conditions and as a result of antibacterial treatment, it is necessary to replenish it by taking bacterial preparations (for obvious reasons, they should be started after taking antiseptics).

It is better to start bacterial therapy with colibacterin (5 doses 2 times a day for a month, then to consolidate the effect you can switch to bifidumbacterin or bificol). Since frequent diarrhea, accompanied by excruciating abdominal pain, has a very depressing effect on the patient’s psyche, it is advisable to use mild sedatives. Treatment for functional diarrhea is not fundamentally different from what was described above. The main difference is the shorter time of taking intestinal antiseptics - 3-5 days and, possibly, shorter periods of taking bacterial drugs.

For spastic colitis, drug treatment consists of taking antispasmodics (no-spa 1-2 tablets 2-3 times a day), vitamin therapy (alternating injections of vitamins B1 and B6 every other day, 7-10 injections per course, or taking multivitamin preparations "Dekamevit" or “Kombevit” 1 tablet 2-3 times a day for 10-14 days), the use of laxatives (of which, in the author’s opinion, oil and herbal laxatives are preferable, since they, being quite effective, do not, unlike from chemical laxatives, irritating effects on the mucous membrane).

Of the oil laxatives, Vaseline oil is preferable (used orally, 1-2 tablespoons per day; without irritating the intestinal wall, lubricates it, softens the stool, thereby helping to accelerate the movement of stool “to the exit”), olive oil (taken orally 50-100 ml on an empty stomach followed by 200-300 ml of mineral water), taking 15-30 ml of castor oil orally has a very good effect, however, with prolonged use, the intestines stop responding to it, so the use of castor oil is more advisable for periodic constipation .

For atonic colitis, it is also necessary to use vitamins B1 and B6, as well as pantothenic and folic acids, possibly in combination with B vitamins, and the use of oil and herbal laxatives. In general, atonic colitis requires drug treatment less than other types of colitis.

In the treatment of colitis, cleansing and medicinal enemas are used. Cleansing enemas are divided into immediate action and subsequent action. With enemas that act immediately, stimulation of intestinal activity occurs due to the temperature and volume of the liquid. For such enemas, from 1/2 to 1 liter of water is used at a temperature of 22-23 degrees.

When using cleansing enemas that act immediately, you need to take into account that cold water enemas can cause intestinal spasms, so for spastic constipation, warmer enemas (up to 35-36 degrees) should be prescribed. Water must be introduced gradually, evenly, not under high pressure in order to avoid intestinal spasm and rapid eruption of incompletely administered fluid.

With enemas with subsequent action, the liquid introduced into the intestine remains in it and its effect is felt only after some time. To achieve this effect, vegetable oil (in an amount of up to 150-200 ml) or a water-oil suspension (in a volume of 500 ml or more) is used as a working fluid, at room temperature or heated to 30 degrees. The oil introduced into the rectum, due to the negative pressure in the colon, gradually spreads up the colon, separating dense feces from the intestinal walls, and at the same time gently stimulating peristalsis.

The purpose of medicinal enemas is to deliver a locally active substance directly to the inflamed surface. Most often and with the greatest effect, infusions or other preparations of medicinal plants that have an astringent, enveloping or local anti-inflammatory effect are used as a working fluid. Unlike cleansing enemas, which are used primarily for spastic and atonic colitis, local exposure gives a good effect for all types of colitis.

Perhaps the most pronounced therapeutic effect is exerted by infusions of chamomile or calendula administered in enemas (their combined use is possible) and an aqueous solution of the drug “Romazulan”. The recommended volume of enemas is 500-700 ml, while the temperature of the working fluid should correspond to body temperature - 36-38 degrees, which will ensure optimal absorption of the fluid by the inflamed intestinal wall, while at a lower temperature the absorption will be much worse, and at a higher temperature - possible burn of the mucous membrane. Dilution of the drug "Romazulan" is made in the proportion of 1.5 tbsp. l. drug per 1 liter of water.

Preparation of chamomile infusion: 1 tbsp. l. dried chamomile flowers per 200 ml of water. Pour boiling water over the required amount of chamomile in compliance with this proportion (do not boil!), leave, strain. After administration, try to hold it for 5 minutes.

Preparation of calendula infusion: 1 tsp. for 200 ml of water. Infuse similarly with chamomile infusion.

After administering the enema, it is advisable to hold the working fluid for up to 5 minutes for more complete absorption. Remember that it is preferable to use soft enema tips, which, although they may cause some difficulties with administration, eliminate the possibility of injury to the intestinal wall, which is not uncommon when using hard tips (plastic or glass), especially when performing enemas on your own. Typically, the course of medicinal enemas ranges from 7 to 21 days, depending on the patient’s condition, 2-3 times a day.

Additional treatments

A number of medicinal plants can be used as additional methods of treatment to provide laxative, carminative, antiseptic, anti-inflammatory, astringent, enveloping or restorative effects.

Brittle buckthorn (alder) - Frangula alnus Mill. The medicinal raw material is the bark. The bark is consumed after 1-2 years of storage or after heating for an hour to 100 degrees. It is used as a mild laxative for atonic and spastic colitis, and also as a stool softener for rectal fissures, hemorrhoids, etc. It is prescribed in the form of decoctions, liquid and thick extracts. The effect usually occurs within 8-10 hours.

Decoction Prepared as follows: 1 tbsp. l. dry bark, pour 1 glass (200 ml) of boiled water, boil for 20 minutes, strain when cooled. Take 1/2 cup at night and in the morning. Buckthorn extracts are sold in the form of finished dosage forms and are prescribed as follows: thick buckthorn extract - 1-2 tablets per night. Liquid buckthorn extract - 30-40 drops in the morning and evening.

Laxative buckthorn (joster) - Rhamnus cathartica. Medicinal raw materials are fruits collected without stalks and dried first in the shade and then in a drying oven or in the sun.

Used as a mild laxative and antiseptic for chronic constipation. The effect occurs 8-10 hours after administration. Prescribed in the form of infusions and decoctions.

Infusion: 1 tbsp. l. pour 1 cup of boiling water over buckthorn fruit, leave for 2 hours, strain. Take 1/2 cup at night. Decoction: 1 tbsp. l. pour 1 cup of boiling water over buckthorn fruit, boil for 10 minutes, strain. Take 1/3 cup at night.

Common fennel - Foeniculum vulgare Mill. Ripe fennel fruits are used as medicinal raw materials. Reduces gas formation in the intestines and improves peristalsis. It is used for spastic and atonic constipation in the form of infusion: 1 tsp. pour 1 cup of boiling water over fennel fruits, strain when cooled, take 1 tbsp orally. l. 3-4 times a day.

Used as a decoction: 1 tbsp. l. pour the herbs into 1 glass of water, boil for 10 minutes, cool, strain. Take 1/2 cup 3 times a day 30 minutes before meals.

Calendula (marigold) - Calendula officinalis. Baskets collected during flowering and dried in the attic or in a dryer are used as medicinal raw materials. It has a pronounced anti-inflammatory and antibacterial effect. Used as an infusion.

Burnet (pharmaceutical) - Sanguisorba officinalis. Medicinal raw materials are rhizomes with roots, collected in the fall, washed in cold water and dried in air. Final drying is carried out in drying ovens. It has a powerful anti-inflammatory, analgesic, astringent, and disinfectant effect. It has the property of inhibiting intestinal peristalsis, which is especially valuable for use in cases of diarrhea.

Prescribed as a decoction: 1 tbsp. l. pour chopped burnet roots with 1 cup of boiling water, boil for 30 minutes, let cool, strain. Take 1 tbsp. l. 5-6 times a day.

Cinquefoil erect (kalgan) - Potentilla erecta. The medicinal raw material is the rhizome, dug out in the fall or spring before the leaves grow. It is washed in cold water, cleared of stems and roots, and dried in a dryer. It has antimicrobial, astringent and antispastic effects. It is advisable to use it for irritable bowel syndrome, accompanied by spastic phenomena.

Used as a decoction: 1 tbsp. l. Pour boiling water over chopped rhizomes, boil for 30 minutes, strain. Take 1 tbsp. l. orally 4-5 times a day.

Sticky alder (black) - Alnus glutinosa. The medicinal raw materials are fruits - alder cones and bark. It is used as an astringent for diarrhea in the form of infusion and tincture. Infusion of cones: pour 8 g of fruits with 1 glass of boiling water, leave, take 1/4 glass 3-4 times a day.

Infusion of bark: 20 g of crushed bark, pour 1 glass of boiling water, leave, take 1 tbsp. l. 3-4 times a day. The tincture is sold in the form of a finished dosage form, take 30 drops 2-3 times a day with water or sugar.

Great plantain - Plantago major. Plantain seeds are used in the treatment of colitis. An infusion of plantain seeds is used as an anti-inflammatory and enveloping agent for the treatment of irritable bowel syndrome.

For this you need 1 tbsp. l. seeds, pour 1/2 cup boiling water and leave for 30 minutes. Take 1 tbsp. l. 30 minutes before meals 3-4 times a day. Whole or crushed seeds, 1 tbsp each, are used as a laxative for constipation. l. before bed or in the morning before meals. Before eating, the seeds should be poured with boiling water and drained immediately. Some authors recommend another method of administration: 1 tbsp. l. seeds, brew 1/2 cup of boiling water, let cool and drink along with the seeds.

Chamomile (medicinal) - Matricaria chamomilla. Medicinal raw materials are well-bloomed flowers in baskets without pedicels. It has a strong calming, antispastic, antiseptic and anti-inflammatory effect. In the treatment of colitis, it can be used both orally and in enemas, which gives an even better effect. Used as an infusion.

Common flax - Linum usitatissivum. The medicinal raw materials are flax seeds. For chronic constipation infusion is used, prepared from 1 tsp. flaxseed per 1 cup boiling water. Drink without straining along with the seeds. For diarrhea, enemas with a strained decoction of flaxseed are used as an enveloping agent: 1 tbsp. l. seeds for 1.5 cups of water, cook over low heat for 12 minutes. Administer at room temperature.

Lungwort - Pulmonaria officinalis. Medicinal raw materials are herbs collected before the flowers bloom and dried in the shade in the air. It has a strong anti-inflammatory and mild astringent effect. Used internally as an infusion(30-40 g per 1 liter of water). More effective for diarrhea as part of a complex water tincture: 40 g of lungwort herb, 1 tbsp. l. flaxseed, 1 tbsp. l. crushed comfrey root and 100 g of rose hips, pour 1 liter of water in the evening, grind the swollen rose hips in the morning, strain twice. The entire portion is taken one sip at a time throughout the day.

Spotted orchis - Orchis maculata. Tubers are medicinal raw materials. Has an enveloping and softening effect. It is used for irritable bowel syndrome and functional diarrhea orally and in enemas. In both cases, a decoction of tubers is used, prepared at the rate of 10 g of dried tuber powder per 200 ml of water.

Polygonum persicaria. Medicinal raw materials are herbs collected during flowering, dried in the shade or in a dryer. It is used for spastic and atonic constipation due to its mild laxative effect.

Used as an infusion and also as part of official laxative fees. Preparation of infusion: pour 20 g of herb with 1 glass of boiling water, leave for 30-40 minutes. Take 1 tbsp. l. 3-4 times a day.

In addition, as an auxiliary measure for atonic colitis, physical therapy, abdominal massage and breathing exercises often provide good help. Therapeutic exercise increases the overall psycho-physical tone of the body, improves the functions of the gastrointestinal tract, creates better conditions for blood circulation in the abdominal cavity, and strengthens the abdominal muscles.

As therapeutic exercise for atonic colitis (note that for spastic colitis, physical therapy is not indicated - due to the high risk of increased spasms), various authors have recommended more than 20 special exercises, however, to select the most suitable for the patient, it is advisable to consult the patient with a specialist in physical therapy, which are now available in every hospital and every clinic.

According to statistics, a 100% and final cure for chronic colitis is quite rare. With a timely visit to a doctor, with a sufficiently attentive attitude of the patient to his condition, with the correct observance of all treatment conditions, a lasting improvement can be achieved, in which the patient will feel normal for a long time and, with timely implementation of preventive measures, this is quite realistic.

The choice of method of traditional and non-traditional therapy should be strictly individual and carried out under the supervision of a physician.

Source: http://1000-recept0v.ru/zdorove/kolit.html

Main symptoms of intestinal diseases

Patients with intestinal diseases often experience bloating (flatulence). This name refers to the bloating of the abdomen with gases found in the stomach or intestinal loops. The volume of the abdomen during flatulence is not always proportional to the amount of gases accumulated in the intestines, since it depends more on the state of the muscles of the abdominal wall. With highly developed abdominal muscles, which have much greater tone than the diaphragm, the accumulation of gases in the intestines protrudes the abdomen less, but instead raises the diaphragm. On the contrary, in people with trophic and flaccid muscles of the abdominal wall, the abdomen can be sharply swollen even with a moderate accumulation of gases.

The name rumbling refers to noises in the abdomen that occur from the collision of gases and liquids while simultaneously passing through a narrow place, audible not only by patients, but also by others. They can be heard when the stomach and intestines are empty; in this case, they coincide with the usual time of eating and the associated habitual peristalsis. Usually they occur with abundant gaseous fermentation or excessive swallowing of air. Finally, rumbling is observed when the intestines are spastic or incompletely blocked.

Diarrhea, or diarrhea, is characterized by frequent and more or less loose stools. Diarrhea is based on the accelerated passage of food and feces through the intestines. Often it is a protective act, throwing out toxic and generally irritating substances that have entered the intestines from the stomach or blood. Diarrhea always depends on motor and secretory disorders of the large intestines. As long as their function is correct, there is no diarrhea; as soon as their function is impaired, the contents of the intestines quickly move through the large intestines, and the stool becomes liquid. Normally, upon exiting the stomach, food masses reach the large intestines within 1-4 hours; from here begins a slower progression throughout the colon - 20-24 hours, the further, the slower. But in cases of dysfunction of the large intestines, food residues can pass through them in 1/2-1/4 hours; in other words, in these cases, diarrhea may appear 3-4 hours after eating.

Constipation is based on a slowdown in the passage of its contents through the intestines and a delay in its emptying (defecation).

The source of intestinal bleeding is most often ulcerative processes in the intestinal wall (duodenal ulcer, typhoid, dysentery, tuberculosis and other ulcers), circulatory disorders in it (varicose veins, for example, rectum, blockage of mesenteric vessels, volvulus), general hemorrhagic diathesis (purpura, thrombopenia). If the bleeding is acute and profuse, characteristic general symptoms quickly develop: dizziness, tinnitus, general weakness, sudden pallor, a drop in cardiac activity, and fainting. Such a symptom complex in the absence of bleeding outside should lead the doctor to think about internal bleeding. Bloody stools with heavy intestinal bleeding are usually very characteristic, and from its characteristics one can most likely draw conclusions about the location of the bleeding. Thus, black, tarry stool, as if with a varnish sheen, indicates a high-lying source of bleeding (the blood undergoes significant changes, and hemoglobin turns into hematin, which colors the stool black). The lower the source of bleeding is located and the faster the blood moves through the intestines (increased peristalsis), the more and more color the stool acquires, which is typical for the admixture of fresh blood. Finally, during bleeding from the lower segments of the intestine and especially from the rectum, blood is released unchanged (scarlet) or very slightly changed and mixed with normally colored feces.