Ulcerative colitis in children. Nonspecific ulcerative colitis

Ministry of Health and Social Development of the Russian Federation

Department of Pediatrics

Teaching aid

for students of pediatric faculties, interns, residents and pediatricians.

Nonspecific ulcerative colitis.

(NJC)

Nonspecific ulcerative colitis (NUC) has now ceased to be a rare childhood disease, as previously thought. The last decades are characterized by a rapid increase in the number of such patients. The incidence of NUC among children in Europe is 1.5-2 children per 100,000 population per year, and among children in the UK it reaches 6.8 per 100,000 children per year. NUC occurs in children of all age groups, but the peak incidence occurs in adolescence and youth. In recent years, there has been a tendency towards an increase in the frequency of UC manifestations at an earlier age, and the proportion of severe total forms is also increasing.

The causes of NUC remain unexplored. So far, it has not been possible to associate the onset of the disease with any one factor, and the multifactorial nature of the etiology of NUC is recognized. Environmental factors (viruses, bacteria, food, neuropsychic overload, etc.) are considered as triggers that cause a chain reaction of the pathological process in individuals with a genetic predisposition of the immune system. Disturbances in immune regulation lead to an autoimmune process that causes local tissue damage and the development of local inflammation, followed by a systemic response. Although specific genes predisposing to UC have not been identified, a number of current studies report that the genetic defect can be localized on chromosomes 2, 6, and 7. An association was also found between the HLA DR2 and, possibly, DR3, DQ2 loci of the HLA major histocompatibility complex and the development of UC.

When studying the autoimmune mechanisms of UC, it has been shown that approximately 70% of patients with ulcerative colitis have special forms of antineutrophil antibodies (AT) - perinuclear antineutrophil antibodies (p-ANCA), directed against a specific autoantigen, histone H1. In patients with UC, antibodies were isolated to a specific protein with a molecular weight of 40kDa from the tropomyosins group, which is part of the cytoskeleton of the membrane of cells of the colon, bile ducts, skin, joints, and eyes. It is a potential autoantigen and the presence of antibodies to it confirms the autoimmune nature of the disease.

Cytokines (interleukins, tumor necrosis factor and interferons), mediating immunological reactions, largely determine the nature of the course of the disease. Cytokines are a group of polypeptides or proteins involved in the formation and regulation of the body's defense responses. At the level of the body, cytokines communicate between the immune, nervous, endocrine, hematopoietic and other systems, providing coordination and regulation of protective reactions. Cytokines are polypeptides or proteins with a molecular weight of 5 to 50 kDa. Most cytokines are not synthesized by cells outside of the inflammatory response and immune response. The expression of cytokine genes begins in response to the penetration of pathogens into the body, antigenic irritation or tissue damage. One of the most powerful inducers of cytokine synthesis are the components of bacterial cell walls: lipopolysaccharides, peptidoglycans, and muramyl dipeptides. The producers of pro-inflammatory cytokines are mainly monocytes, macrophages, T-cells, and other cells. Depending on the effect on the inflammatory process, cytokines are divided into two groups: pro-inflammatory (Interleukin -1, IL-6, IL-8, tumor necrosis factor -α, interferon -γ) and anti-inflammatory cytokines (IL-4, IL-10, factor tumor growth -β).

In chronic nonspecific inflammatory diseases of the colon (UC, Crohn's disease), an antigen that has not yet been identified is presented to intestinal epithelial cells or cells of the lamina propria. After contact with lymphocytes of the lamina propria with the help of adhesion molecules under the influence of IL-1, activation of T-helpers and macrophages occurs, as well as adhesion of granulocytes to the endothelium and transition to the lamina propria. The release of IL-2 activates cytotoxic T cells and B lymphocytes. With the participation of other lymphokines, macrophages are activated. B-lymphocytes, macrophages and granulocytes produce a large number of inflammatory mediators and substances that are toxic to cells (leukotrienes, oxygen radicals, elastase, collagenase, protease, complement factors). Together with cytotoxic T-lymphocytes and secretion products of activated mast cells (histamine, proteases), they contribute to the development of inflammatory changes in the mucous membrane.

According to our data, in UC in children during an exacerbation, the level of pro-inflammatory cytokines IL-1-alpha (approximately 5 times) and IL-8 (9-10 times) increase in UC and CD. During the period of remission, when the process fades, the levels of pro-inflammatory cytokines decrease, but, nevertheless, they do not reach normal values. The level of IL-1-alpha in the blood serum can be considered a marker of the severity of UC. Since both IL-1 and IL-8 characterize the function of macrophages, it can be considered that in UC there is a pronounced stimulation of them, which does not disappear even during the period of clinical remission. According to the literature, UC in adults also increases the levels of IL-4, IL-6 and TNF, which determine the activation of B-lymphocytes and the production of antibodies.

Convincing evidence has been accumulated on the involvement of infectious agents in the pathogenesis of UC development. It is assumed that hydrogen sulfide produced by a number of bacteria blocks the metabolism of short-chain fatty acids, in particular, butyric acid, which leads to disruption of energy supply to the tissues of the colon mucosa and death of the epithelium. Bacteroides can have a direct damaging effect on the intestinal mucosa. Enteropathogenic Escherichia coli can inhibit the production of a number of cytokines, which leads to inhibition of macrophage migration, delayed migration of leukocytes, and blast transformation of lymphocytes. Some strains of E. coli are also able to induce the synthesis of antibodies to the colon mucosa. The measles virus can persist in the lymphoid tissue of the intestine, affecting the small vessels of the endothelium and inducing the development of vasculitis.

Arthritis, hepatitis, dermatitis, uveitis associated with UC are associated with the pathogenic action of the complement system. Its components are deposited in submucosal blood vessels and around ulcers. A number of authors consider the components of the complement system as regulators of an intense immune response.

Currently, there are various options for the classification of UC, in which its various forms are distinguished - according to severity, the nature of the course, the phase of the process and the predominant lesion of various parts of the colon.

O.A. Kanshina (1986) proposed the following classification of UC in children.

Disease phase: active, remission.

The extent of the lesion of the colon: segmental colitis, total colitis.

Form of the disease: mild colitis, moderate colitis, severe colitis.

The course of the disease: acute and chronic, continuous or recurrent.

There are two options for the onset of the disease: gradual and acute. With a gradual onset, the clinical picture develops within 1-3 months, and in some cases for several years. The main symptom is the release of blood and mucus with a decorated or mushy stool. In the case of an acute onset, the clinical picture develops within a few days. According to the literature in adults, such an onset is observed in an average of 7% of patients, in children such an onset of the disease is observed in 30% of cases.

According to O.A. Kanshina (1986), the severity of the condition of a child with UC is determined by the frequency of stools, the amount of blood in the stool, an increase in ESR, the degree of anemia, and the endoscopic activity of the process. According to these criteria, the mild form is characterized by the following features: stool frequency 3-4 times a day, blood in the stool in the form of streaks or separate clots, ESR - 20-30 mm/hour, a slight decrease in hemoglobin, moderate endoscopic activity. In the moderate form, the stool frequency is 5-8 times a day, there is a significant admixture of blood in the stool, subfebrile temperature, cramping abdominal pain, ESR 25-50 mm/hour, hemoglobin 40-50 units, endoscopic activity is more pronounced. In severe form, the stool frequency increases up to 8-10 times a day and more often, there is an abundant admixture of blood in the stool, intense cramping abdominal pain, fever to febrile numbers, ESR 30-60 mm/hour, hemoglobin below 40 units, endoscopic activity is expressed to the maximum extent.

The recurrent course of UC is characterized by periods of exacerbation and remission, which is achieved within 6 months after the first attack and lasts more than 4 months. The frequency of recurrent ulcerative colitis in adults, according to various authors, ranges from 67% to 95%, and in children - from 38% to 68.1% of cases. With a continuous course, 6 months after the first attack, remission does not occur and a progressive, stationary or regressive course of the disease is observed.

The age of manifestation of UC usually ranges from 8 to 16 years, but the average duration of the disease at the time of admission is 12 months. Late diagnosis of UC is due to some features of the clinical picture in children, in particular, the frequent absence of blood in the stool, a symptom that is usually considered the leading clinical sign of the disease. A shorter period of diagnosis verification in patients older than 15 years is due to the fact that the clinical symptoms of UC in this age group differ little from those in adult patients.

In general, all age groups are characterized by a chronic course of UC (88% of patients), however, in children younger than 10 years, the acute course of the disease is more common than in older children. Among patients with a chronic course of the disease in 64% of cases there is a chronic continuous course of ulcerative colitis.

Most children with UC have a total lesion of the colon. However, in children younger than 10 years, a total lesion of the colon is observed more often than in older children. Among children under 10 years old, there are practically no patients with left-sided lesions of the colon, and patients with distal colitis make up only 7%.

The leading clinical symptoms of NUC are chronic diarrhea with blood discharge, abdominal pain, weight loss, asthenic syndrome. The frequency and severity of clinical manifestations of UC is largely determined by the age of patients. So, loose stools are typical for all age groups, but in children under 7 years old it is less common. The same trend is observed in relation to the lack of weight. Blood loss in these patients is minimal, blood in the stool is often absent. There are no age differences in the frequency of pain syndrome, and asthenic syndrome is more typical for children older than 10 years. An increase in body temperature is observed in approximately 40% of patients, regardless of age.

For older patients, especially among children older than 15 years, a higher frequency of segmental forms is characteristic. Most patients in this group have moderate blood loss. In these patients, the course of UC can be characterized not only by a lag in physical development with a lack of mass, but also by a lag in growth.

Autoimmune manifestations of UC (erythema nodosum, primary sclerosing cholangitis, autoimmune arthritis, thyroiditis) in children are relatively rare (approximately 4% of patients), and usually over the age of 10 years. Non-autoimmune complications of UC are observed in almost 60% of sick children, with iron deficiency anemia most common (in 34% of patients). Complications such as toxic dilatation of the colon, perforation of the colon are relatively rare. Massive intestinal bleeding, according to our data, occurs in 9% of patients.

NUC can cause the development of colon cancer in 1.5% of patients. These patients are characterized by: late verification of the diagnosis (after 5 and 6 years from the onset of the disease), total damage to the colon, chronic continuous course of ulcerative colitis, achievement of only clinical rather than clinical endoscopic remission during treatment.

The greatest diagnostic value in NUC in children is endoscopic and histological examination. Indicators of ESR, the level of hemoglobin and blood albumin, the number of leukocytes are not very informative, since their changes are observed in less than 50% of patients.

X-ray examination is most informative in patients older than 15 years, since in this group of patients, radiological signs of UC are observed in 93% of cases.

Fibrocolonoscopy (FCS) reveals a polymorphism of macroscopic changes: increased bleeding of the mucous membrane, absence of a vascular pattern, erosion, ulcers, inflammatory polyps (pseudopolyps), mucosal granularity. However, the leading endoscopic markers of UC in all age groups are increased contact bleeding and the absence of a vascular pattern.

When studying biopsy material of the colon mucosa in children with UC, among many histological parameters characterizing changes in the mucosa from the integumentary epithelium to the submucosal layer, the following signs are the most informative: inflammatory lymphoplasmacytic infiltration of the lamina propria, which occurs in 100% of patients, violation configurations of crypts with the expansion of their lumen and a decrease in the number of goblet cells of the crypts.

Thus, the diagnosis of UC in children should be built as follows.

UC should be ruled out if the following symptoms are present:

Loose stools with blood (especially more than 3 times a day, lasting more than 2 weeks)

Stomach ache

Weight loss

Additional signs may be periodic increases in body temperature, asthenic syndrome.

To confirm the diagnosis, a colonoscopy with a biopsy of the colonic mucosa and a mandatory inspection of the terminal ileum should be performed. The biopsy is performed in the area of ​​visible changes or (preferably) segmental (from 7 departments), which is determined by technical capabilities.

Endoscopic signs of NUC are:

lack of vascular pattern of the mucous membrane

increased contact bleeding.

The presence of ulcerative or erosive mucosal defects confirms the diagnosis, but is not mandatory

Histologically, NUC is characterized by the following features:

lymphoplasmacytic infiltration,

broken architectonics of crypts

decrease in the number of goblet cells.

In doubtful cases, it is advisable to prescribe treatment with sulfasalazine for 2 months, followed by dynamic observation and re-examination. Patients with UC show an improvement in the condition during treatment, but after its withdrawal, exacerbations may occur.

Treatment.

When treating children with NUC in the acute period, bed rest and a sparing diet with the exception of dairy products are recommended. The main drugs are aminosalicylates, glucocorticoid hormones, and cytostatic drugs. If conservative therapy fails, patients with UC undergo surgical treatment with resection of the affected area of ​​the colon.

Aminosalicylates are represented by both the relatively old drug sulfasalazine and more modern drugs of 5-aminosalicylic acid (salofalk, pentasa). The active principle in all cases is 5-aminosalicylic acid (mesalazine), which, when using sulfasalazine, is formed in the large intestine with the participation of intestinal microflora, and when using modern drugs, it is delivered to the site of action in tablets coated with a pH-sensitive shell, in capsules, suppositories or enemas. The latter are used to treat distal colitis. The effectiveness of modern drugs is somewhat higher than sulfasalazine, in addition, the smaller number of side effects when using pure 5-aminosalicylic acid, in particular, toxic effects on the liver, is also important. Unfortunately, the cost of 5-aminosalicylic acid preparations is quite high.

Algorithm for choosing tactics for the treatment of UC appears as follows:

Exacerbation treatment.

Mild attack - sulfasalazine 40-60 mg / kg body weight per day or mesalazine in equivalent doses.

The average severity of the attack is sulfasalazine 60-100 mg / kg body weight per day or equivalent doses of mesalazine. If there is no effect within 2 weeks, prednisolone is prescribed at a dose of 1-1.5 mg/kg of body weight.

Severe attack in children under 10 years of age - sulfasalazine 60-100 mg / kg body weight per day or equivalent doses of mesalazine. If there is no effect within 2 weeks, prednisolone is prescribed at a dose of 1-1.5 mg/kg of body weight.

Severe attack in children 10 years of age and older is treated with prednisolone at a dose of 1.5 mg/kg body weight.

Treatment is supplemented by rectal administration of salofalk or corticosteroids (in enemas or suppositories) in the presence of pronounced inflammatory changes in the distal colon.

Treatment with maximum doses of aminosalicylates is carried out for 4 months, followed by a transition to maintenance therapy.

Treatment with prednisolone is carried out for at least 6 weeks, followed by a dose reduction (5 mg 1 time in 10 days) and a transition to maintenance therapy.

If prednisolone is ineffective within 4 weeks, the issue of prescribing cytostatic therapy or surgical treatment should be decided.

Supportive care it is carried out with sulfasalazine or mesalazine (half of the prescribed therapeutic dose) for a long course or prednisolone according to an intermittent scheme, depending on the initial therapy.

If endoscopic remission is not achieved within 2 years, the question of the advisability of surgical treatment should be decided.

Nonspecific ulcerative colitis in children (NUC) is a dangerous pathology, during which the child loses blood along with feces, ulcers form on the intestinal mucosa.

There is no exact information about the causes of the manifestation of the disease. Many doctors have studied the background against which it occurs.

Major changes in health:

• stressful situations;
• decreased performance of the immune system;
• genetics: allergic dependence, the presence of immune abnormalities.

The impetus for the detection of NUC in children is the following disorders and diseases:

1. Psychic trauma.
2. Infectious diseases.
3. Acute respiratory viral infections.
4. OKI: defeat by various types of Salmonella.

Medical scientists-researchers of the state of the intestinal flora believe that the cause of UC is the insufficiency of the content of epithelial cells with energy substances. Confirmation is the result of analyzes for the number of protein cells of the mucous membrane - glycoproteins. Revealed in the study of patients.

Inflammation develops in the lower zone of the intestine. Departments of the large intestine become susceptible to pathological abnormalities.

There are two forms of the disease in a child:

1. Constant (wave-like).
2. Recurrent.

The wave-like appearance does not guarantee complete freedom from the disease. There is an alternation of a decrease in exacerbation and its increase. The recurrent one ends with a remission that lasts for several years, with the right preventive complex it may not happen again at all.

The course of nonspecific ulcerative colitis is also divided into subgroups:

• fulminant;
• spicy;
• chronic.

The first two groups are rare. They are characteristic of a severe course of the disease. The danger lies in frequent deaths in a short period of time - 2-3 weeks.

Signs of clinical forms of leakage are varied. They depend on the age and individual characteristics of the baby's body.

Main symptoms:

• the presence of blood in the stool;
• quickened stool;
• an admixture in the feces in the form of mucus;
• the appearance of purulent discharge from the rectal region.

Often the disease in the early stages passes without pronounced symptoms. Only loose stool appears. Blood begins to be released into the feces after 2-3 months, so the diagnosis of the disease occurs with a delay. Doctors put children with chronic dysentery, leave it under control and strict supervision.

It is extremely rare, but it happens that NUC passes against the background of constipation phenomena.

Other symptoms of the disease are the sensation of pain.

The types of such pain are different:

• fickle;
• cramping;
• long;
• cutting.

Contractions cover a vast area, almost the entire abdomen. The child cannot show a specific focus of pain. He often pinches the navel location. Contractions appear sharply during meals or during bowel movements.

If unpleasant symptoms continue for a long time, this indicates complications of the disease. Ulcerative colitis turned into an acute form with concomitant lesions of the internal systems.

Children may show other signs:

• dyspnea;
• yellow color of the skin;
• joint deformity.

The complications that result from the untimely start of treatment for the baby are frightening.

It is imperative to contact a specialist in such cases:

1. Profuse and extensive bleeding.
2. Colon perforation.
3. Anal fissures and wounds.
4. Fistulous formations in the anus.
5. Paraproctitis.

The child ceases to control the exit of feces. A common symptom of NUC is dysbacteriosis. Doctors conduct an examination for its presence in all children of childhood.

Symptoms of the chronic form of intoxication with ulcerative colitis:

1. Gray skin tone.
2. Bluish circles under the eyes.
3. Dry lips.
4. Brittle, thin nail plates.
5. Dull hair color.

The child begins to lose in physical development compared to peers. The delay is especially noticeable in sexual development. The activity of the heart is affected: systolic murmurs, arrhythmia, irregular heartbeat.

The doctor begins by examining the appearance of the abdomen, it is often swollen, in the direction of the intestine, you can listen to the rumbling and splashing noise. In children, the liver and spleen increase in size. The sigmoid colon, when palpated, gives pain.

Nonspecific ulcerative colitis can be diagnosed at a doctor's appointment. But any decision to start treatment is made after diagnostic measures. An experienced specialist of any qualification will not treat a baby with an unspecified diagnosis.

Children are hospitalized for laboratory tests. The verification complex is based on the use of modern equipment and simple medical devices.

Additional research options for NUC:

• blood content analysis. Confirm the development of inflammation, the severity of blood pathologies, anemic abnormalities;
• biochemical blood test. It will show the level of compliance with the normal functioning of the liver and pancreas. Reflects the activity of the development of the inflammatory process. It will become clear whether there are violations of the electrolyte content of blood vessels;
• coprogram. It will check the content of feces, help to see the presence of inflammation in the intestines, understand the cause of mucus secretion;
• bacteriological examination of feces. Needed to exclude the possibility of the presence of an ulcerative colitis infection;
• radiography. An examination of the abdominal cavity will check for toxic intestinal infections, perforation of the walls. Detects intestinal complications;
• irrigography. The procedure is based on filling the thick part of the intestine with a special liquid. Fluid is injected through the anus. For nonspecific colitis, a rapid filling of the cavity is characteristic, the folds have an elongated appearance, the walls of the organ thicken, the loop forms swell;
• ultrasound. The abdominal area is examined. Changes in the size of the intestinal lumen become visible: narrowing or increase. The method allows you to check the liver, bile excretion pathways, kidneys and gland under the stomach;
• colonoscopy. The camera allows you to see the condition of the mucous membrane of the large intestine. It becomes clear the activity of the development of inflammation, the number and volume of ulcers, the reasons for the release of blood. A biopsy is taken to confirm the diagnosis.

Nonspecific colitis in children is a dangerous lesion that requires urgent intervention.

The therapeutic complex is built taking into account the activity and the affected area.

Components of medical measures:

1. Therapeutic mode. Doctors' recommendations determine the baby's daily routine. Physical activity is limited, rest and sleep time is increased. When the inflammation enters the stage of reduction, therapeutic exercises, water exercises, and peritoneal massage are introduced.
2. Diet food. The menu should be gentle for the intestines, but complete for the age of the baby. In young children, milk mixtures are changed, formulations on hydrolysate are suitable. In the older age category, the menu excludes products that activate gas formation, increase (inflate) fecal masses. Reduce milk intake.

The choice depends on the doctor. It will take into account the age, shape, rate of development and prevalence of the lesion. The drugs must reach the small intestine. There they are broken down into components that move to the large intestine.

Types of medicines:

• corticosteroids;
• 5-ASA;
• glucocorticosteroids (for severe types of the disease).

A separate type of drug treatment is immunosuppressive therapy. The hormonal complex is used only in patients with a stable type of reaction to drugs of this nature.

In the absence of results of treatment, they proceed to surgical intervention. Doctors remove the affected part of the colon, and an anastomosis is applied instead. Nonspecific ulcerative colitis requires constant monitoring of the baby's condition.

The sooner assistance to the growing body begins, the faster the child will return to a healthy lifestyle. Symptoms that do not stop with treatment lead to disability of the baby.

The role of parents is not to miss the period of deterioration, to show the timeliness of the reaction and referral to a specialist.

Nonspecific ulcerative colitis- chronic inflammatory-dystrophic disease of the colon with recurrent or continuous course, local and systemic complications.

Nonspecific ulcerative colitis is predominantly common among the population of industrialized countries (prevalence among adults is 40-117:100,000). In children, it develops relatively rarely, accounting for 8-15% of the incidence of adults. In the last two decades, there has been an increase in the number of patients with ulcerative colitis, both among adults and among children of all age groups. The onset of the disease can occur even in infancy. The gender distribution is 1:1, and at an early age, boys are more likely to get sick, in adolescence, girls.

Etiology and pathogenesis

Despite many years of study, the etiology of the disease remains unclear. Among the various theories of the development of nonspecific ulcerative colitis, the most widespread are infectious, psychogenic and immunological. The search for any single cause of the ulcerative process in the colon is still unsuccessful. As etiological factors, viruses, bacteria, toxins, some food ingredients that can, as triggers, cause the onset of a pathological reaction leading to damage to the intestinal mucosa are suggested. Great importance is attached to the state of the neuroendocrine system, local immune protection of the intestinal mucosa, genetic predisposition, adverse environmental factors, psychological stress, iatrogenic drug effects. In ulcerative colitis, a cascade of self-sustaining pathological processes occurs: first non-specific, then autoimmune, damaging target organs.

Classification

The modern classification of nonspecific ulcerative colitis takes into account the length of the process, the severity of clinical symptoms, the presence of relapses, and endoscopic signs.

Working classification of ulcerative colitis

Localization	Activity	Flow	Phase	Degree
Distal left hand total colitis Extraintestinal manifestations and complications	Minimum Moderate pronounced	Lightning Chronic Recurrent continuous	Remission Aggravation	Medium heavy

Clinical picture

The clinical picture is represented by three leading symptoms: diarrhea, blood in the stool, and abdominal pain. In almost half of the cases, the disease begins gradually. With mild colitis, single streaks of blood in the stool are noticeable, with severe - a significant admixture of it. Sometimes the stool takes on the appearance of a foul-smelling liquid bloody mass. Most patients develop diarrhea, stool frequency varies from 4-8 to 16-20 times a day or more. In liquid stools, in addition to blood, there is a large amount of mucus and pus. Diarrhea with an admixture of blood is accompanied, and sometimes preceded by abdominal pain, more often during meals or before defecation. The pains are cramping, localized in the lower abdomen, in the left iliac region or around the navel. Occasionally, a dysentery-like onset of the disease develops. Very characteristic of severe ulcerative colitis is an increase in body temperature (usually not higher than 38 ° C), a decrease in appetite, general weakness, weight loss, anemia, and delayed sexual development.

Complications of nonspecific ulcerative colitis are systemic and local.

Systemic complications are diverse: arthritis and arthralgia, hepatitis, sclerosing cholangitis, pancreatitis, severe lesions of the skin, mucous membranes (erythema nodosum, pyoderma, trophic ulcers, erysipelas, aphthous stomatitis, pneumonia, sepsis) and eyes (uveitis, episcleritis).

Local complications in children are rare. These include profuse intestinal bleeding, intestinal perforation, acute toxic dilatation or stricture of the colon, damage to the anorectal region (fissures, fistulas, abscesses, hemorrhoids, weakness of the sphincter with fecal and gas incontinence), colon cancer.

Laboratory and instrumental research

A blood test reveals leukocytosis with neutrophilia and a shift of the leukocyte formula to the left, a decrease in the content of erythrocytes, hemoglobin, serum iron, total protein, dysproteinemia with a decrease in albumin concentration and an increase in y-globulins; possible violations of the electrolyte composition of the blood. According to the severity and phase of the disease, the ESR and the concentration of C-reactive protein increase.

A decisive role in the diagnosis of nonspecific ulcerative colitis is played by endoscopic research methods. During colonoscopy in the initial period of the disease, the mucous membrane is hyperemic, edematous, easily injured. In the future, a picture of a typical erosive-ulcerative process is formed. During the period of manifest manifestations, the circular folds of the mucous membrane thicken, the activity of the sphincters of the large intestine is disturbed. With a long course of the disease, folding disappears, the intestinal lumen becomes tubular, its walls become rigid, and the anatomical curves are smoothed out. Hyperemia and edema of the mucous membrane increase, its granularity appears. The vascular pattern is not determined, contact bleeding is pronounced, erosions, ulcers, microabscesses, pseudopolyps are found.

X-ray reveals a violation of the gaustral pattern of the intestine: asymmetry, deformation or its complete disappearance. The intestinal lumen has the appearance of a hose with thickened walls, shortened sections, and smoothed anatomical curves.

Diagnosis and differential diagnosis

The diagnosis is established on the basis of clinical and laboratory data, the results of sigmoidoscopy, sigmoid and colonoscopy, irrigography, as well as histological examination of biopsy material.

Differential diagnosis is carried out with Crohn's disease, celiac disease, diverticulitis, tumors and polyps of the colon, intestinal tuberculosis, Whipple's disease, etc.

Treatment

Diet is of the utmost importance in the treatment of nonspecific ulcerative colitis in children. Assign a dairy-free table No. 4 according to Pevzner, enriched with protein due to meat and fish products, eggs.

The basis of basic drug therapy is sulfasalazine and 5-aminosalicylic acid preparations (mesalazine). They can be taken by mouth and administered as medicated enemas or suppositories into the rectum. The dose of drugs and the duration of treatment is determined individually. In severe cases of nonspecific ulcerative colitis, glucocorticoids are additionally prescribed. According to strict indications, immunosuppressants (azathioprine) are used. Symptomatic therapy and local treatment (microclysters) are also carried out.

An alternative to conservative treatment is surgical - subtotal resection of the intestine with the imposition of an ileorectal anastomosis.

Prevention

Prevention is aimed primarily at preventing relapse. After discharge from the hospital, all patients should be recommended courses of maintenance and anti-relapse treatment, including basic drug therapy, diet, and a protective and restorative regimen. Patients with nonspecific ulcerative colitis are subject to mandatory dispensary observation. Preventive vaccination is carried out only according to epidemiological indications with weakened vaccine preparations. Children are exempted from exams, physical activities (physical education classes, labor camps, etc.). It is desirable to conduct training at home.

Forecast

The prognosis for recovery is unfavorable, for life it depends on the severity of the disease, the nature of the course, and the presence of complications. Regular monitoring of changes in the mucous membrane of the colon is shown due to the possibility of its dysplasia.

Polyetiological disease of the colon, accompanied by its inflammatory-dystrophic changes. Colitis in children occurs with abdominal pain, nausea, changes in the frequency and nature of the stool, and malaise. Diagnosis of colitis in children includes coprological and bacteriological examination of feces, irrigography, rectosigmoscopy and colonoscopy, endoscopic biopsy of the intestinal mucosa. Treatment of colitis in children largely depends on its pathogenetic form and includes diet therapy, antibacterial and symptomatic therapy, herbal medicine, restoration of normal intestinal microflora.

General information

Colitis in children is an inflammation of the large intestine, characterized by pain and functional disorders of the large intestine. At least 10% of all cases of chronic colitis begin in childhood, so colon diseases, their diagnosis and treatment are one of the most difficult problems in pediatric gastroenterology. Due to the anatomical and physiological characteristics of the digestive system of young children, the inflammatory process, as a rule, proceeds with the simultaneous involvement of the small and large intestines (enterocolitis). In school-age children, an isolated lesion of various parts of the intestine is usually found - enteritis and colitis.

Causes of colitis in children

Acute colitis in children, as a rule, develops against the background of an intestinal infection (salmonellosis, shigellosis, escherichiosis, yersiniosis, food poisoning, rotavirus infection, etc.) and in most cases is combined with acute gastritis, acute enteritis or gastroenteritis. Sometimes the cause of acute colitis in children is individual intolerance to certain food components, gross violations of the diet, and radiation exposure.

The implementation of inflammation of the intestinal mucosa is facilitated by psychogenic factors, vegetative-vascular dystonia in children, aggravated heredity, congenital features of intestinal development (dolichosigma, megacolon), sedentary lifestyle, bad habits in adolescence. Secondary colitis in children occurs with endocrine diseases (hypothyroidism, myxedema), diseases of the central nervous system (myasthenia gravis, cerebral palsy).

Classification

Inflammatory changes in the colon may be widespread or limited to one or more segments. In accordance with this, an isolated inflammation of the caecum (typhlitis) is isolated; inflammation of the blind and ascending colon (typhlocolitis); inflammation of the transverse colon (transversitis); inflammation of the transition of the transverse colon to the descending colon (angulitis); inflammation of the sigmoid colon (sigmoiditis); inflammation of the rectum and sigmoid colon (proctosigmoiditis); inflammation of the rectum (proctitis); generalized inflammation (pancolitis).

Based on the endoscopic picture and morphological features, catarrhal, atrophic and erosive-ulcerative colitis in children are distinguished. By the nature of the clinical course of colitis in children are divided into acute and chronic; according to the type of flow - into monotonous, recurrent, progressive, latent; according to the severity of the course - light, moderate, severe.

Depending on the state of motility of the colon and the predominant functional disorders of the intestine, colitis is distinguished in children with a predominance of constipation or diarrhea, alternating constipation and diarrhea. In the clinical course of colitis in a child, a phase of exacerbation, clinical remission, clinical endoscopic (histological) remission is distinguished.

The main clinical forms of colitis occurring in children are acute colitis, chronic colitis, ulcerative colitis, and spastic colitis.

Symptoms of colitis in children

Acute infectious colitis occurs against the background of severe toxicosis and exicosis: fever, anorexia, weakness, vomiting. As a result of intestinal spasm, the child is worried about pain in the iliac region, tenesmus. The chair becomes more frequent from 4-5 to 15 times a day; stools are watery, frothy, character; greenish color, an admixture of mucus and streaks of blood. During bowel movements, rectal prolapse may occur. When examining a child with acute infectious colitis, attention is paid to signs of dehydration: decreased tissue turgor, dry mucous membranes, sharpening of facial features, oliguria.

Chronic colitis in children has an undulating course with alternating exacerbations and remissions. The main clinical manifestations of colitis in children are pain and impaired stool. Pain is localized in the navel, right or left iliac region; have a whining character; occur after eating, worse during movement or before defecation.

Stool disorder in chronic colitis in children can be expressed by diarrhea, constipation, or their alternation. Sometimes there is an increase in the urge to defecate (up to 5-7 times a day) with the release of feces of a different nature and consistency (liquid, with mucus or undigested food, "sheep" or ribbon-like feces, etc.). Constipation in children with subsequent passage of hard stools can lead to anal fissures and a small amount of red blood in the stool.

Children with chronic colitis complain of bloating and distension of the abdomen, rumbling in the intestines, increased gas discharge. Sometimes in the clinic of colitis in children, psychovegetative disorders dominate: weakness, fatigue, irritability, sleep disturbance, headache. The long course of colitis in children can lead to a delay in weight gain and growth, anemia, hypovitaminosis.

Chronic colitis in children requires differentiation from celiac disease, cystic fibrosis, intestinal dyskinesia, chronic appendicitis, enteritis, diverticulitis, Crohn's disease.

Diagnostics

The diagnosis is based on the data of the anamnesis, clinical picture, physical, laboratory, instrumental (X-ray, endoscopic) examination.

In the study of blood in children suffering from colitis, anemia, hypoalbuminemia, and a decrease in the level of electrolytes in the blood serum are detected. A coprological examination reveals the presence of leukocytes, mucus, steatorrhea, amylorrhea, and creatorrhea in the feces. Bacteriological examination of feces makes it possible to exclude the infectious nature of acute and chronic colitis in children. An analysis of feces for dysbacteriosis, as a rule, demonstrates a change in the microbial landscape of the intestine due to an increase in opportunistic agents - staphylococci, proteus, candida.

An endoscopic examination of the intestine (colonoscopy, rectoscopy) in children often reveals a picture of catarrhal colitis: the mucous membrane of the colon is hyperemic, edematous; lymphoid follicles are enlarged; a large amount of mucus, petechial hemorrhages, mucosal vulnerability upon contact are found. Endoscopic biopsy of the intestinal mucosa and morphological examination of the biopsy contribute to the differential diagnosis of various forms of colitis in children.

In order to clarify the degree and severity of inflammation in colitis in children, irrigography is performed. To study the functional state of the colon, a barium passage x-ray is performed.

Treatment of colitis in children

Treatment of colitis in children is aimed at eliminating the pathogen, restoring bowel function, preventing relapse or exacerbation. In all cases of colitis in children, a mechanically and chemically sparing diet is prescribed: weak broths, mucous decoctions, steam dishes, omelettes, cereals, kissels. Therapy of acute infectious colitis in children is carried out according to the rules for the treatment of intestinal infections (antibiotic therapy, oral rehydration, taking bacteriophages, enterosorbents, etc.).

In chronic colitis in children, in addition to therapeutic nutrition, the intake of enzyme preparations (pancreatin), prebiotics and probiotics, enterosorbents, prokinetics (loperamide, trimebutine) is indicated. Antibacterial drugs are prescribed according to strict indications. As part of the treatment of colitis, children are recommended to use mineral water without gas, infusions and decoctions of medicinal herbs. If necessary, the complex of therapeutic measures includes IRT by a pediatric gastroenterologist. Preventive vaccinations are allowed during the period of persistent remission of chronic colitis in children.

Nonspecific ulcerative colitis (NUC) is a severe chronic pathology of the large intestine of an inflammatory-dystrophic nature, which has a continuous or recurrent course and leads to the development of local or systemic complications.

The process is localized in the rectum (ulcerative proctitis) and spreads through the large intestine. With the defeat of the mucosa throughout the large intestine, they speak of pancolitis.

The prevalence of the disease among the population of industrialized countries prevails. Over the past 20 years, there has been an increase in the incidence not only in adults, but also in children of all ages.

NUC can develop at any age in children, accounting for 8 to 15% of the total incidence. Babies rarely suffer from this pathology. At an early age, boys are more likely to get sick, and in adolescence, the disease affects girls more often.

Scientists have not been able to establish the exact cause of the development of NUC. There are many theories about the etiology of the disease. Among them, the most recognized are:

1. Infectious: according to it, the onset of UC can be provoked by:

• bacteria (for intestinal infections such as salmonellosis, dysentery, coli infection);
• microorganism toxins;
• viruses (with ARVI, scarlet fever, influenza).

1. Psychogenic: the development of ulcerative lesions of the intestine is provoked by stressful situations, psychotrauma.
2. Immunogenic: the disease is caused by underdevelopment or failure of the immune system.

According to some experts, hereditary predisposition plays an important role - the presence of immune or allergic diseases in close relatives.

Damage to the mucosa by some food ingredients, the iatrogenic effect of certain drugs is also not ruled out.

With UC, a whole chain of pathological processes arises that are self-sustaining in the body: at first they are nonspecific, and then they turn into autoimmune, damaging target organs.

Some scientists consider energy deficiency in the epithelial cells of the intestinal mucosa to be the basis for the development of UC, since patients have a changed composition of glycoproteins (special proteins).

Classification

According to the localization of the intestinal lesion, colitis is distinguished:

• distal (damage to the colon in the final sections);
• left-sided (the process is localized in the descending colon and rectum);
• total (the large intestine is affected throughout);
• extraintestinal manifestations of the disease and complications.

There are forms of NUC in children:

• continuous, in which complete recovery does not occur, only a period of improvement is achieved, followed by exacerbation;
• recurrent, in which it is possible to achieve a complete remission, lasting for some children for several years.

There are such variants of the course of ulcerative colitis:

• lightning fast (fulminant);
• acute;
• chronic (wave-like).

Acute and fulminant course are characteristic of severe UC. Moreover, lightning can be fatal in 2-3 weeks; Fortunately, it rarely develops in children.

The severity of NUC can be mild, moderate and severe. The activity of the process can be minimal, moderately pronounced and pronounced. The disease can be in the phase of exacerbation or remission.

Symptoms

the main symptom of UC is loose, fetid stools with a frequency of up to 20 times a day.

The manifestations of the disease depend on the form and course, the severity of colitis, the age of the children. The most characteristic symptoms of UC are diarrhea, blood in the stool, and abdominal pain.

The onset of the disease can be gradual or acute, sudden. Almost every second child develops UC gradually. In most cases, the stool is liquid and fetid, with impurities of mucus, blood (sometimes also pus). The frequency of the chair is different - from 4 to 20 or more times a day, depending on the severity.

With a mild degree of colitis, streaks of blood are noted in the stool, with a severe degree, there is a significant admixture of blood, the stool may look like a liquid bloody mass. Diarrhea with blood is accompanied by pain in the lower abdomen (more on the left) or in the navel. Tenesmus (painful act of defecation), frequent stools at night are characteristic.

Pain can spread throughout the abdomen. They may be cramping in nature, precede or accompany a bowel movement. Some children feel pain while eating.

Sometimes UC begins with the appearance of loose stools without impurities, and blood and mucus are found in the stool after 2-3 months. With severe ulcerative colitis, body temperature rises within 38 ° C, symptoms of intoxication appear. Sometimes a child is mistakenly diagnosed with dysentery. Exacerbations of the disease are regarded as chronic dysentery, and UC is diagnosed late.

In children with UC, there is a decrease in appetite, severe weakness, bloating, anemia, and weight loss. On examination, rumbling is noted, a painful spasmodic sigmoid colon is palpated. The liver increases in almost all children, and an increase in the spleen is sometimes noted. In rare cases, constipation occurs with this disease. As the disease continues, abdominal pain is less likely to bother. Persistent pain syndrome is observed in the complicated course of UC.

Complications

NUC with a long course can lead to local and systemic complications.

Local complications include:

1. The defeat in the anus and rectum:

• haemorrhoids;
• insolvency of the sphincter (incontinence of gases and feces);
• fistulas;
• cracks;
• abscesses.

1. Perforation of the intestine and the subsequent development of peritonitis (inflammation of the serous membrane of the abdominal cavity).
2. Intestinal bleeding.
3. Stricture (narrowed lumen) of the colon due to scarring of ulcers.
4. Acute toxic dilatation (expansion) of the large intestine.
5. Colon cancer.

In children, local complications develop in rare cases. The most common in any form of NUC is dysbacteriosis (imbalance of beneficial microflora in the intestine).

Extraintestinal, or systemic, complications are diverse:

• skin lesions (pyoderma, erysipelas, trophic ulcers, erythema nodosum);
• mucosal damage (aphthous stomatitis);
• hepatitis (inflammation of the liver tissue) and sclerosing cholangitis (inflammation of the biliary tract);
• pancreatitis (inflammatory process in the pancreas);
• arthritis (joint inflammation, arthralgia (joint pain));
• pneumonia (inflammation of the lungs);
• eye damage (episcleritis, uveitis - inflammation of the membranes of the eye);

When examining a child, manifestations of hypovitaminosis and chronic intoxication can be detected:

• pale, with a grayish tinge of the skin;
• blue circles near the eyes;
• dull hair;
• zaedy;
• dry cracked lips;
• brittle nails.

There is also an increase in heart rate, arrhythmias, a heart murmur can be heard, and shortness of breath often occurs. With active hepatitis, yellowness of the skin and mucous membranes appears. The child lags behind not only in physical, but also in sexual development. In adolescent girls in the active phase of the disease, the menstrual cycle may be disturbed (secondary amenorrhea occurs).

In a chronic process, erythropoiesis (production of red blood cells) is inhibited, which, in addition to bleeding, contributes to the development of anemia.

After 8-10 years from the onset of the disease, the risk of a malignant tumor in the rectum increases by 0.5-1% annually.

Diagnostics

The doctor has to differentiate UC with diseases such as Crohn's disease, intestinal polyposis, diverticulitis, celiac disease, intestinal tuberculosis, colon tumor, etc.

NUC is diagnosed on the basis of complaints of the child and parents, examination results, data from additional examination methods (instrumental and laboratory).

Instrumental research:

1. The main method confirming the diagnosis of UC is endoscopic examination of the intestine (sigmoidoscopy, colonoscopy) with targeted biopsy for histological examination of the collected material.

The mucosa on examination is easily injured, edematous. At the initial stage of the disease, there is reddening of the mucous membrane and contact bleeding, which is called a symptom of "bloody dew", thickening of the folds, insolvency of the sphincters.

Subsequently, an erosive-ulcerative process is revealed on the colonic mucosa, folding disappears, anatomical curves are smoothed, redness and swelling increase, the intestinal lumen turns into a tube. Pseudopolyps and microabscesses may be found.

1. X-ray examination of the large intestine, or irrigography, is performed according to indications. It reveals a violation of haustration (circular protrusions of the colon wall) - deformation of the haustra, asymmetry or complete disappearance, as a result of which the intestinal lumen takes the form of a hose with smoothed bends and thick walls.

Laboratory research:

• a general blood test reveals reduced hemoglobin and a decrease in the number of erythrocytes, an increased number of leukocytes, accelerated ESR;
• biochemical analysis of blood serum detects a decrease in total protein and a violation of the ratio of its fractions (decrease in albumin, increase in gamma globulins), a positive C-reactive protein, a reduced level of serum iron and a change in the electrolyte balance of the blood;
• analysis of feces for a coprogram reveals an increased number of erythrocytes and leukocytes, undigested muscle fibers, mucus;
• analysis of feces for dysbacteriosis shows a reduced amount of Escherichia coli, a reduction or complete absence of bifidobacteria.

Treatment

Types of UC depending on the level of colon damage.

Treatment of NUC has to be carried out for a long time, sometimes several years. Conservative and operative methods are used.

Conservative treatment should be comprehensive. The goal of the therapy is to transfer the severe form of the disease to a milder one and achieve a long-term remission.

For the effectiveness of treatment are important:

• adherence to the recommended diet;
• exclusion of hypothermia;
• limitation of loads;
• prevention of infectious diseases;
• psycho-emotional peace without stress;
• exclusion of fatigue.

Since children with NUC develop a protein deficiency (due to blood loss), weight loss, the diet should provide the body with proteins to make up for its deficiency. Moreover, 70% of them should be animal proteins. The diet is recommended in accordance with table number 4 according to Pevzner.

The optimal composition of the daily diet:

• proteins - 120-125 g;
• fats - 55-60 g;
• carbohydrates - 200-250 g.

The food consumed should be mechanically gentle. The intake of proteins will be provided by fish and meat dishes (in the form of soufflés and casseroles), fermented milk products, and eggs. Many children with UC develop food allergies (most often to cow's milk). In these cases, all dairy products are excluded from the diet, only melted butter is allowed.

It is recommended to cook food by steaming or by boiling in water or in a weak broth (fish or meat). Mucous soups are used as the first course. You can add meatballs, boiled meat, potatoes, rice to the soup.

The child should be fed 5-6 times a day with warm food. From the menu, you need to exclude foods rich in fiber, which increase intestinal motility, gas formation. Spicy dishes and seasonings are also prohibited.

Kissels, fruit and berry decoctions (from pears, bird cherry, quince, dogwood, blueberries), strong tea (black, green) will be useful, as they contain tannins and astringents. Coffee and cocoa are excluded.

With persistent remission, a small amount of vegetables (zucchini, carrots, cauliflower, broccoli) is introduced into the diet. Excluded from the use of tomatoes, melons, watermelons, citrus fruits, grapes, strawberries. With good tolerance, you can give your child baked pears and apples, blackberries, blueberries, pomegranates, cranberries. The juice of chokeberry is very useful.

For a side dish, you can cook potatoes, porridge (wheat, rice), pasta. Eggs (2-3 per week) can be given in the form of an omelette (steamed) or soft-boiled. Allowed the use of white bread (yesterday's pastry), biscuit cookies. Fresh pastries, sweets should be excluded.

Expand the diet should only be agreed with the attending physician. The criterion for a correct diet and the effectiveness of therapy is the addition of body weight in a child.

The basis of drug treatment of NUC is 5-aminosalicylic acid derivatives - Salofalk, Sulfasalazine, Salazopyridazine. A more modern drug is Salofalk (Mesacol, Mesalazine), which can also be used topically in the form of enemas or suppositories. As a basic therapy, a long course of Salofalk in combination with Wobenzym can be used. Doses of drugs and the duration of the course are determined by the attending physician.

In case of intolerance to these drugs and in severe cases of the disease with extraintestinal manifestations, glucocorticosteroid drugs (Metipred, Prednisolone, Medrol) may be prescribed. With contraindications in a child to the use of hormonal drugs, cytostatics (Azathioprine) can be used.

If purulent microflora is sown from the intestine, then antibacterial drugs are prescribed. To normalize intestinal dysbiosis, bacterial preparations are used (Bifiform, Hilak-forte, Bifikol, etc.).

As a symptomatic therapy, Smecta, iron preparations, wound healing agents (topically, in microclysters) can be prescribed. Herbal remedies, homeopathic remedies (Coenzyme compositum, Mucosa compositum) can be used in the treatment.

Indications for surgical treatment are:

• complications that have arisen (intestinal perforation, severe bleeding, intestinal obstruction);
• fulminant UC that does not respond to ongoing therapy;
• failure of conservative treatment.

A subtotal resection of the large intestine is performed and an ileorectal anastomosis is applied (connection of the small intestine to the rectum).

Forecast

The prognosis for complete recovery is poor. Most children manage to achieve stable remission and prevent the development of relapse during puberty.

The prognosis for life depends on the severity of NUC, its course and the development of complications.

Prevention

Preventive measures are aimed at preventing the recurrence of the disease. It is necessary to try to prevent the infection of the child with intestinal infections that can provoke an exacerbation of NUC.

You can not take medicines without a doctor's prescription. Experts believe that drugs from the NSAID group contribute to the development of relapse.

An indispensable condition is the observance of the diet. Children should be provided with a protective regime: they are exempted from physical education lessons, labor camps and other burdens. Homeschooling is the best option. Vaccination is carried out only according to epidemiological indications (after consultation with an immunologist) with weakened vaccines.

After discharge from the hospital, the child is under dispensary registration with a pediatric gastroenterologist. With a disease duration of more than 10 years, an annual colonoscopy with a biopsy is indicated for the timely detection of malignant degeneration of the intestinal mucosa.

Summary for parents

It is difficult to prevent this serious disease, moreover, its exact cause is unknown. It is necessary to try to exclude the factors provoking the occurrence of NUC, established by scientists. In the case of the development of ulcerative colitis, it is important to follow the doctor's prescriptions in order to achieve a long-term remission of the disease.

• Causes
• Symptoms
• Classification
• Diagnostics
• Treatment and prevention
• Complications and prognosis

Colitis is an inflammatory bowel disease in which the epithelial layer of its mucous membrane gradually degenerates. The process of dystrophy is manifested in the thinning and weakening of the mucosa, as well as in the deterioration of its regenerative properties.

Due to the peculiarities of nutrition and development, children of middle and senior school age are more likely to suffer from colitis, but the risk of its occurrence remains in infants and kindergarteners.

Causes

The development of the disease is influenced by a combination of negative, both exogenous (external) and endogenous (internal) factors.

Colitis in children under one year of age most often develops against the background of congenital malformations of the organs of the gastrointestinal tract with the addition of frequent viral infections, a tendency to allergies and lactose intolerance. In the case of formula-fed babies, the risk factors also include the wrong choice of formula.

Symptoms

It is more difficult to determine inflammation of the intestine, the younger the child. Often, the manifestations of the disease are taken by parents for a temporary problem. This is especially true for infants - in their case, the symptoms are blurred and may resemble a common indigestion due to a mild intestinal infection or a violation of the diet by a nursing mother. This picture misleads not only parents, but also pediatricians.

In children older than one year, it is easier to determine the disease, since the symptoms become more pronounced and it is easier to determine from the behavior of the child at this age what exactly worries him.

Common symptoms for children of all ages include:

1. Intestinal disorder. Digestive disorders can manifest themselves in different ways and alternate with each other: from watery frequent stools to constipation lasting several days.
2. Increased gas formation. Due to the violation of the structure of the mucosa, intestinal immunity suffers, which causes an imbalance of microflora. It notes the predominance of pathogenic microorganisms, the result of whose vital activity is an increase in the volume of gases in the intestine. The child's belly becomes swollen, the skin on it is stretched, belching appears, frequent gas discharge.
3. Nausea and vomiting occur at stages when the child's colitis is at the stage of development - this is how the body signals the onset of the pathological process in the gastrointestinal tract (GIT). Also, vomiting can be a companion of chronic colitis during periods of exacerbation.
4. Admixture in the feces - pus, blood, bile, mucus. Sometimes the number of inclusions is so insignificant that it is possible to determine their presence only with the help of a laboratory analysis (coprogram).
5. Dehydration appears with frequent loose stools. In this case, along with feces, the body leaves a large amount of water. You can determine dehydration by dry, flaky skin, the smell of acetone from the mouth, pallor, lethargy.
6. Pain in the abdomen below the umbilicus.

Note. The intestinal mucosa is of great functional importance - with its help, the absorption of nutrients takes place. Therefore, dystrophic changes in this organ are fraught with beriberi, which is manifested by a deterioration in the condition of the skin, hair loss, brittle nails. In children of preschool and school age, the lack of vitamins and nutrients also affects mental activity: they become forgetful, inattentive, restless.

In babies up to a year, frequent regurgitation, anxiety, crying, refusal to eat, pressing the legs to the stomach are added to the symptoms.

Classification

Intestinal colitis has a complex classification. When making an accurate diagnosis, a pediatric gastroenterologist considers such factors as the course of the disease, the causes of its occurrence and development, and the location of the site that has undergone dystrophy. The correct definition of the form of colitis allows you to prescribe effective treatment and quickly save the child from painful manifestations.

Colitis classification:

Acute colitis

In the acute form, the child suffers from severe cutting pain in the abdomen, the body temperature may rise to febrile (38.5-39 ° C). The disease is accompanied by pronounced intestinal symptoms - frequent stools (3-6 times a day), liquid, frothy, it may contain the remains of undigested food, as well as bloody-mucous blotches. Sometimes the clinical picture is complicated by nausea and vomiting.

This condition is typical for the early stage, as well as for periods when the chronic form of the disease is aggravated due to the influence of external and internal factors. The cause of the appearance is often infection of the digestive tract with the pathogenic bacterium Helicobacter pylori.

Spastic colitis, a condition in which the intestine spasms more often than other types of the disease, also belongs to acute forms. In this regard, the nature of pain changes - they become paroxysmal. Among the symptoms of the disease is also present "sheep" feces - hard, with pronounced separate segments.

chronic colitis

Even with timely and adequate treatment, the acute form in most cases flows into a chronic one. At the same time, the symptoms become more blurred - the pains become dull, become aching, vomiting and nausea stop. After eating, belching appears, in very young children - regurgitation. There are signs of increased gas formation: a swollen abdomen, a feeling of fullness, periodic discharge of gases.

If the patient systematically undergoes treatment and follows a diet under the supervision of parents, chronic colitis may be asymptomatic, with rare exacerbations or without them at all. In this case, the intestinal mucosa is gradually restored, although complete regeneration is impossible.

Nonspecific ulcerative colitis

The most common form of the disease, the causes of which often remain unclear. Usually, ulcerative colitis in children develops as a result of a combination of genetic predisposition and malnutrition. Often the picture is enhanced by other diseases of the gastrointestinal tract - gastritis, stomach ulcers, duodenitis, problems with the pancreas.

The name of the disease was due to the similarity of its clinical picture with peptic ulcer of the stomach and duodenum, namely: degeneration of the mucosa, on which in some places the affected areas are converted into ulcers. Sometimes these areas capture a large area of ​​the intestine, but in most cases they are fragmented. Ulcerative colitis can occur in chronic and acute forms.

• acute form

It is characterized by pronounced manifestations of the disease: severe pain in the left side of the abdomen, an increase in body temperature to a febrile and subfebrile level. During periods of exacerbation, ulcerated areas open and begin to bleed. As a result, a laboratory analysis shows the presence of blood in the feces of a sick child, and his general condition worsens: weakness, apathy appear, appetite worsens, weight loss, joint pains are observed.

• Chronic form

Unlike acute, it proceeds more gently, since during remission the intestinal mucosa tends to partially recover, ulcerative areas are covered with a new layer of epithelium. The disease can be exacerbated due to inappropriate use of medications, non-compliance with the diet, stressful situations, and overwork. Chronic colitis can be manifested by difficulties in emptying the intestines - constipation, false urge to defecate, sensations of incomplete bowel movements.

The danger of this form of the disease lies in the fact that with the disappearance of severe symptoms, the child's parents may mistakenly think that he has fully recovered, stop dieting and undergo examinations.

Examination of the patient reveals swelling of the affected areas of the intestine, destruction at different depths of the mucosa, in rare cases reaching the submucosal layer. Sometimes the inflammatory process is accompanied by the formation of polyposis growths.

Infectious (allergic) colitis

This type of disease occurs as a complication of acute intestinal infections (most often when the gastrointestinal tract is affected by salmonella, shigella, streptococci), helminthic invasions, and fungi. The disease is characterized by a rapid onset and development, accompanied by vomiting, diarrhea, and sharp pains in the abdomen. Among the reasons provoking this pathology of the mucosa, there is a long-term use of antibacterial drugs, especially in children under 6 years of age.

Features of diagnostics. Accurate diagnosis of infectious colitis is difficult due to the frequent mixed etiology of the disease - chronic diseases of the digestive organs usually join a viral or bacterial infection. To complete the picture, a wide range of laboratory analyzes is required, as well as a number of hardware studies.

One of the most severe types of infectious colitis is pseudomembranous colitis (PMC), which is caused by the bacterium Clostridium difficile. As with other pathogenic microorganisms, MVP is characterized by an increase in the number of leukocytes in the blood, diarrhea of ​​varying severity, a state of dehydration, and other manifestations of intoxication.

Diagnostics

During the examination, the differential diagnosis of colitis in children is of great importance, since it is very important to exclude the possibility of more serious diseases, such as diverticulitis and intestinal tuberculosis, neoplasms (polyps, malignant and benign tumors, cysts), Crohn's disease, celiac disease.

To confirm the established chronic colitis in a child, as well as other types of inflammation of the intestinal mucosa, a number of laboratory and hardware examinations are prescribed:

1. A detailed blood test: leukocytosis is detected, a decrease in hemoglobin and the number of red blood cells in the blood, an increase in ESR and protein levels.
2. Colonoscopy: at the initial stage of the disease, swelling, mucosal sensitivity, and an increase in local temperature are detected; at later stages, a characteristic picture is found with the presence of erosive and ulcerative lesions that begin to bleed if they are touched by a solid object. There is no vascular pattern on the surface of the epithelial layer.
3. An analysis of feces for colitis shows the presence of mucus, blood, and sometimes bile in the feces.

If during the examination of the intestine a neoplasm is found in its cavity - single or multiple polyps, cysts - then they are removed, followed by sending the biological material for histology and biopsy. This eliminates the possibility of a malignant origin of neoplasms.

Treatment and prevention

Treatment of colitis in children under three years of age and older is carried out to a large extent by normalizing the diet and diet. To alleviate the condition of the child and reduce the intensity of the manifestation of symptoms, a dairy-free diet enriched with meat, fish dishes, and eggs is prescribed. Artificial children up to a year are transferred to lactose-free hypoallergenic milk formula.

In the case of breastfed children, identification of the etiology of the disease is of great importance, since some cases of allergic colitis require an urgent transfer of the child to artificial nutrition or a strict diet of the nursing mother.

From the diet of older children during periods of exacerbation, it is necessary to exclude all products that impede the process of digestion, corrode the walls of the mucosa, and contribute to an increase in gas formation.

Such products include flour sweets, chips, crackers, salty and spicy crackers, all fast food, sweet carbonated drinks, mayonnaise, ketchup, purchased and homemade pickles and canned food, cocoa, coffee, chocolate. It is necessary to minimize the consumption of legumes, raw fruits and berries (apples, grapes, plums, peaches, bananas, currants, raspberries, etc.), fatty meats, yeast baked goods, corn and rice cereals.

The basis of the menu should be soups based on boiled vegetables and meat, stewed and boiled beef, rabbit, chicken, turkey, cereals (especially oatmeal, buckwheat, pearl barley). From flour products, you can use hard varieties of pasta, rye and slightly dried white bread, buns with bran. Herbal drinks, jelly, black and green teas are useful.

Drug treatment of colitis is reduced to taking oral drugs that improve digestion, protect and restore the intestinal mucosa. Local therapy in the form of therapeutic enemas helps well. Taking painkillers, laxatives or fixatives, antiviral and antibacterial drugs, glucocorticoids, and antipyretics will help relieve symptoms. In the most severe cases that are not amenable to conservative therapy, a resection is performed - removal of a section of the intestine.

Preventive measures include annual medical examination with mandatory drug treatment, maintaining proper nutrition, and moderate physical activity.

Complications and prognosis

Acute colitis in a child can be complicated by such local manifestations as the formation of hemorrhoids, anal fissure, weakening of the sphincter, resulting in gas incontinence and involuntary defecation during exercise, coughing, sneezing.

More severe consequences include intestinal cancer and diverticulitis, intestinal bleeding, inflammation of the gallbladder and pancreas, liver disease, and trophic ulcers. Infectious colitis often entails the spread of infection through the digestive tract and throughout the body, as a result of which the child may experience complications in the form of stomatitis, tonsillitis, bronchitis, pneumonia.

Colitis is a serious disease, often aggravated, difficult to treat, entailing many complications, requiring systematic examination and treatment. However, with the right approach and the implementation of all the doctor's recommendations, inflammation becomes chronic, which may not appear for several years. In general, the prognosis for life is conditionally favorable, but a complete recovery is impossible.

Nonspecific ulcerative colitis in children is an inflammatory chronic bowel disease of unknown etiology, characterized by ulcerative-destructive changes in the colon mucosa.

Literally, colitis is an inflammation of the large intestine. Since the disease is chronic, it proceeds with exacerbations and periods of remission (recovery).

"Ulcerative" - ​​characterizes the nature of inflammation, when ulcers form on the colon mucosa. Nonspecific - emphasizes the ambiguity of the cause of the disease and excludes other colitis, the etiology of which is known.

Nonspecific ulcerative colitis (NUC) is considered a common disease and occurs in almost all countries of the world. Its frequency is also very high among children, recently there has been a "rejuvenation" of the disease.

In order not to miss NUC in children, the manifestations of which are similar to an intestinal infection, it is necessary to become more familiar with this disease.

Causes of nonspecific ulcerative colitis

Despite numerous studies, the etiology of the disease remains unknown. Ulcerative colitis is now considered to be a multifactorial disease.

At the heart of the development of necrotic inflammation of the mucosa are:

• genetic predisposition;
• violation of the immune function of the intestine;
• the influence of environmental factors, especially intestinal microflora.

All these factors together lead to a violation of the protective function of the intestinal epithelium, resulting in the formation of chronic inflammation.

6 Possible Signs of Ulcerative Colitis in Children

Nonspecific ulcerative colitis is characterized by intestinal symptoms and general manifestations of the disease.

Intestinal symptoms

1. Diarrhea- most often it is the debut of the disease. Initially, there is multiple loose stools, frequent false urge to defecate. The frequency of bowel movements can reach 20 times per day. Then impurities of mucus and blood begin to appear in the stool. Gradually, the amount of blood in the stool increases, and can even reach 50-100 ml. Sometimes there is a discharge of blood without feces. An increase in stool is observed mainly at night and in the early morning, when feces enter the lower intestines, where the inflamed part of the intestine is the most excitable and stimulates emptying. The intensity of diarrhea depends on the severity of the disease and the prevalence of the inflammatory process.
2. Pain- a symptom that is not observed in all children and does not have distinctive features from pain in intestinal infections. Most often, there are acute pains in the abdomen, localized in the left lower sections.
3. Pain is not constant, spastic in nature, intensifies before defecation, and after emptying the intestines - subsides. Pain in the abdomen is also accompanied by general anxiety, capriciousness of the child.
4. constipation- a very rare, but still sometimes occurring symptom. The disease begins with constipation when the lowest parts of the intestine are affected and the soreness of the inflamed mucosa prevents the release of feces. At first, the stool will be decorated with an admixture of blood, later it will become mushy, and after 3-6 months it will change to liquid.
5. Common symptoms of non-specific ulcerative colitis: loss of appetite, general weakness, fatigue, progressive weight loss, intoxication (pallor of the skin, dry mucous membranes, nausea, vomiting). The appearance of general symptoms will depend on the prevalence of colitis and the activity of the inflammatory process. To assess ulcerative colitis activity, doctors use a special pediatric ulcerative colitis activity index. Important! This index is calculated in points that take into account the intensity of abdominal pain, the frequency and consistency of the stool, the severity of blood in the stool, the number of nightly bowel movements and the general activity of the child. Depending on the points obtained, the severity of ulcerative colitis is set, on which the tactics of treatment and possible complications of the disease depend.

Extraintestinal manifestations

In addition to the main symptoms, ulcerative colitis can have extraintestinal manifestations. Manifestations from other organs and systems may occur as a result of impaired bowel function, and may also be in no way associated with manifestations of the underlying disease.

For extraintestinal manifestations include several features.

• Anemia. It can be posthemorrhagic (as a result of blood loss with stool) or autoimmune (as a result of a systemic disorder of hematopoiesis).
• skin symptom. Various changes appear on the skin of the body and limbs (rash, vasculitis, necrotic gangrene).
• Articular syndrome(joint pain, synovitis).
• Damage to the liver and biliary tract(hepatitis, hepatosis, cholangitis).
• Pathology of the pancreas(acute pancreatitis).
• Kidney damage(nephropathy).
• Eye damage(conjunctivitis).
• Delayed physical and sexual development, decreased intelligence.
• Thyroid damage(autoimmune thyroiditis).

Most often, a combination of several extraintestinal manifestations is noted at once, and sometimes they are so pronounced that they come to the fore and make it difficult to diagnose the underlying disease.

Possible complications of NUC in children

Nonspecific ulcerative colitis in itself is a serious disease, in addition, it has formidable complications. You need to know about possible complications in order to be able to recognize them in time.

These include:

• heavy bleeding which will lead to the development of severe anemia;
• perforation of the intestine with the development of peritonitis(output of intestinal contents into the abdominal cavity);
• sepsis- against the background of reduced immunity, the spread of pathogenic flora throughout the body is possible;
• development of intestinal obstruction- against the background of chronic inflammation and disturbance of the intestinal microflora, even with the subsidence of inflammation, chronic constipation may develop;
• colon cancer- chronic inflammation of the intestinal mucosa is a predisposing factor for the development of the oncological process.

8 methods for diagnosing nonspecific ulcerative colitis

When making a diagnosis, complaints, the development of the disease and the patient's examination data are taken into account. But in order to confirm the diagnosis, additional examination methods are needed, which are carried out for children during hospitalization in any Russian children's clinical hospital.

In the diagnosis of the disease, not only high-tech modern methods are important, but also simple laboratory tests.

To additional methods of examination for nonspecific ulcerative colitis include the following procedures.

1. General blood analysis- will show the activity of the inflammatory process in the body (the number of leukocytes, leukocyte formula, ESR) and the severity of anemia (hemoglobin and erythrocyte levels).
2. Blood chemistry- will reflect the functioning of the liver and pancreas, which will help to exclude extraintestinal manifestations. C-reactive protein will show inflammation activity. In addition, there may be violations of the electrolyte composition of the blood.
3. Coprogram- the presence in the feces of a large number of leukocytes, erythrocytes and mucus will confirm the inflammatory process in the large intestine.
4. Bacteriological examination of feces- eliminate the infectious nature of colitis.
5. Plain radiography of the abdominal cavity- eliminate the development of formidable intestinal complications: toxic expansion of the large intestine and its perforation.
6. Irrigography- filling the sections of the large intestine with a radiopaque substance through the anus. There are signs characteristic of NUC: accelerated filling of the affected area of ​​the intestine with contrast, smoothness of the intestinal folds (haustrations), thickened walls of the affected intestine, swollen intestinal loops.
7. abdominal ultrasound- a non-specific method that will show thickening of the intestinal wall and narrowing or expansion of the intestinal lumen. But this method is good for excluding concomitant damage to the liver, biliary tract, pancreas and kidneys.
8. Colonofibroscopy- is the "gold standard" for the diagnosis of nonspecific ulcerative colitis. In this study, the mucosa of the entire large intestine is examined using a camera. This method will accurately establish the activity of the inflammatory process, its extent and the presence of bleeding ulcers. In addition, colonoscopy allows you to take a biopsy of the affected intestinal mucosa for histological examination, which will accurately confirm the diagnosis.

Treatment of nonspecific ulcerative colitis in children

NUC is a very serious disease for children and requires an integrated approach. Therapy is chosen depending on the activity of inflammation and the prevalence of the affected parts of the intestine.

Treatment of NUC includes several points.

• Therapeutic and protective regime- in the acute period, it is important to limit physical activity, increase night and daytime sleep. When the inflammation subsides and the general condition improves, physiotherapy exercises, water procedures, massage of the anterior abdominal wall are prescribed.
• Diet- the goal is thermal and mechanical sparing of the affected intestine. Nutrition depends on the age of the child. In young children, special mixtures based on a split protein (hydrolysate) are used. For older children, foods that promote increased gas formation, increase peristalsis and intestinal secretion, and increase and compact feces are excluded from the diet. Limit dairy products.
• Medical therapy- The choice of drug depends on the age of the patient and the severity of colitis. The drugs of choice are 5-ASA (5-aminosalicylic acid) and corticosteroids. 5-ASA preparations, due to their components, do not break down in the small intestine and reach the large intestine, where they directly have an anti-inflammatory effect on the large intestine. Systemic glucocorticosteroids have a general anti-inflammatory effect and are prescribed for patients with severe UC or those who are not helped by 5-ASA drugs. Second-line therapy is immunosuppressive therapy - these are drugs that suppress the immune activity of body cells. This treatment helps with ulcerative colitis in hormone-resistant patients, but has many side effects.
• Colectomy- if long-term drug treatment of the child is ineffective or there are serious intestinal complications (perforation, massive bleeding, toxic megacolon), surgical treatment is resorted to - the affected area of ​​the colon is removed with an anastomosis.

Nonspecific ulcerative colitis, as previously mentioned, is a chronic disease and even in the presence of remission, many years of medical supervision are necessary. The child should be under dynamic observation, as constant monitoring of tests and regular colonoscopy is necessary. In the absence of remission for a long time, children are issued a disability.

Ulcerative colitis is a severe bowel disease (rectum, sigmoid, and colon) that occurs in adults and children. The exact causes of this pathology have not been established. However, according to gastroenterologists, this diagnosis appears more and more often in the clinic. This article will discuss the features of the manifestation of ulcerative colitis in childhood, its treatment and prevention.

What is this disease?

Ulcerative colitis is the collective name for pathologies that affect the intestines. These diseases are similar in symptoms. These include:

1. nonspecific ulcerative colitis (NUC);
2. Crohn's disease (CD);
3. undifferentiated colitis.

From the term itself, it can be understood that the disease is accompanied by the formation of ulcerations of the mucosa. Most often, ulcers occur in the rectum, but different forms of the disease cause different localization of the lesion.

The term "colitis" stands for inflammation of the intestine. In this case, mucosal edema, the formation of submucosal infiltrates, abscesses and the appearance of pus occur.

Ulcerative colitis in children is a rare disease. At this age, the disease has a widespread prevalence (not limited to the rectum and sigmoid colon), moderate or severe course. The frequency of surgical interventions in young patients exceeds that in adults. That is why it is important to recognize the disease as early as possible and begin its treatment.

Why does colitis occur in children?

The exact mechanisms of the onset and development of the disease have not been studied. And yet, scientists have some hypotheses that reveal the secret of the origin of this disease.

1. Viruses. Doctors noticed that the first symptoms of ulcerative colitis were observed after viral infections. This provoking factor could be SARS, rotavirus infection, measles or rubella. Viruses disrupt the stable functioning of the immune system. This failure and generates the aggression of cells-defenders against the intestinal tissue.
2. Heredity. A patient whose relatives had UC was 5 times more likely to get sick.
3. Diet features. Scientists say that the lack of plant fibers and the high content of dairy products can stimulate the development of colitis.
4. Intestinal bacteria. Due to gene mutation, patients with colitis overreact to the normal microflora of the colon. This failure triggers the inflammation process.

There are many theories, but no one knows for sure what will trigger the development of this disease. Therefore, adequate measures to prevent ulcerative colitis do not exist.

Symptoms

In this part of the article, we highlight the most striking signs of ulcerative colitis that occur in childhood. The appearance of these signs should encourage parents to take action. After all, children's colitis progresses very quickly.

Pain. Abdominal pains vary in intensity. Some babies do not pay any attention to them, but for most children they cause severe discomfort. Localized pain in the left abdomen, in the left iliac region, sometimes diffuse soreness covers the entire abdominal wall. As a rule, the pain goes away after a bowel movement. The occurrence of pain is not associated with eating.

Very often colitis is accompanied by gastritis and peptic ulcer. Therefore, the presence of pain after eating does not exclude the diagnosis of UC.

Pain in the rectum appears before and after the stool. The disease most often begins in the rectum, so ulcers, cracks, tears and erosion appear in this place. The passage of feces causes severe pain.

Discharge of blood from the anus. The symptom is often present in UC and CD. This sign characterizes the severity of the course of the disease. With bleeding from the rectum, scarlet blood, and dark altered blood is released from the upper gastrointestinal tract.

Diarrhea. Liquid and frequent stools appear at the beginning of colitis. This sign can easily be mistaken for infectious diarrhea.

Tenesmus. These are false urges to defecate. Sometimes tenesmus is accompanied by mucus or pus.

Secondary symptoms of emaciation: weight loss, pallor and weakness. In children, these signs appear quite early. This is due to the increased need for nutrition in a growing organism. And during illness, the intake of nutrients is disrupted.

Lag in development.

During an exacerbation of colitis, children often have a fever. It, as a rule, does not reach high numbers, as with infectious diarrhea, but it lasts for a long time.

How to make a correct diagnosis?

Diagnosis of ulcerative colitis is very difficult. It requires careful history taking, laboratory and instrumental studies. To begin with, the doctor conducts a long conversation with the patient. Given the age, the parents of the child should take an active part in this conversation. Here is a list of questions to which it is recommended to know the answers:

1. Does the child have abdominal pain? Where are they most often located? How does the child react to them (the severity of pain is assessed)?
2. How often does the patient have a stool (once a day)? Its consistency? Presence of impurities?
3. Is a bowel movement accompanied by bleeding? What is the rate of bleeding?
4. Is there a chair at night?
5. Is the child active during an exacerbation?

Further management of the patient consists in the appointment of instrumental studies. In children, a colonoscopy with a biopsy, gastric probing, and ultrasound of the abdominal organs are mandatory.

Endoscopy of the stomach distinguishes UC from CD and often reveals comorbidities.

Laboratory tests include total blood, liver enzymes, erythrocyte sedimentation rate, reactive protein, ANCA antibody test. With severe pallor and anemia, tests for ferritin, serum iron are prescribed. The doctor must examine the stool for infection.