Why do I treat my own ulcerative colitis (UC)? Nonspecific ulcerative colitis. Inflammatory Bowel Disease

Nonspecific ulcerative colitis(NUC) is a disease of unknown etiology, characterized by a chronic inflammatory process in the colon with the development of hemorrhage, ulceration and purulence.

The main pathogenetic mechanisms of the disease are: immunological disorders and autoimmunization; development of dysbacteriosis; allergic reactions; genetic factors; neuropsychiatric disorders; an increase in the level of pro-inflammatory prostaglavdins and leukotrienes in the colon mucosa, which contributes to the development of an intense inflammatory process in it.

Treatment program for non-specific ulcerative colitis

1. Medical nutrition.

2. Basic therapy (treatment with drugs containing 5-amino-salicylic acid, glucocorticoids, cytostatics).

3. The use of astringents, adsorbents and anti-diarrheals.

4. Correction metabolic disorders and anemia.

5. Detoxification therapy.

6. Antibacterial therapy and treatment of intestinal dysbiosis.

7. Local therapy of proctosigmoiditis.

8. Normalization functional state central nervous
systems.

Patients with UC mild degree can be treated on an outpatient basis, with a moderate severity of the disease, hospitalization is necessary, with a severe degree, emergency hospitalization and intensive treatment.

For proper differentiated treatment, it is necessary to determine the severity of NUC.

Light form has the following characteristic features:

The frequency of bowel movements does not exceed 4 times a day with a small amount of blood in the feces;

Increased fatigue;

Fever and tachycardia are absent;

Examination of the abdomen reveals only slight pain.
ness along the colon;

Extraintestinal symptoms of the disease are manifested by symmetrical synovitis large joints, erythema nodosum and other skin manifestations;

Slight anemia (Hb > W g / l), a slight increase in ESR (up to 26 mm / h);

the process is localized mainly in the rectum and sigmoid colon (edema, hyperemia of the mucous membrane, superficial, often numerous erosions, transient ulcerations, uneven thickening of the mucous membrane).

The form of moderate severity is characterized by the following manifestations:

In the acute phase, stool 4-8 times a day with blood;

There is an increase in body temperature, lack of appetite, weight loss, weakness, intestinal colic, signs of dehydration, pallor, tachycardia, decreased blood pressure;

When examining the abdomen - soreness and rumbling in the colon, but there is no distension of the colon;

Often there is anemia (Hb 105-111 g / l), leukocytosis, an increase in ESR (26-30 mm / h);

Systemic manifestations: jaundice, defiguration of large joints, various skin manifestations, eye damage;

At endoscopy of the colon, pronounced hyperemia, swelling of the mucous membrane, multiple erosions, ulcers covered with mucus, pus, fibrin are found.

The severe form has the following clinical manifestations:

Stool more than 8 times a day with blood, mucus, often with impurities of pus;

Body temperature above 38 °C;

Tachycardia (at least 90 beats per minute);

Abdominal pain, lack of appetite; bloating;

Decrease in body weight by more than 10%;

Severe anemia (Hb< 105 г/л), увеличение СОЭ (>30 mm/hour),
hypoalbuminemia;

At endoscopic examination, sharp hyperemia, swelling of the mucous membrane, multiple erosions, ulcers covered with pus, fibrin are determined; at long course disappearance of folding of an intestine is possible.

1. Medical nutrition

At mild form disease significant dietary restrictions are not required. However, it is not recommended to use very sharp, irritating gastrointestinal tract products, as well as limiting the use of milk for diarrhea.

With a pronounced exacerbation of the disease, diet No. 4 is prescribed (chapter "Treatment of chronic enteritis") with changes (A.R. Zlatkina, 1994):

Increase the protein content to an average of 110-120 g (65% of animal origin) due to the development of protein deficiency in patients; lean meat, fish (in the form of steam cutlets, dumplings, meatballs, boiled meat, boiled fish), soft-boiled eggs and in the form of steam omelettes, as well as low-fat, lactose-free, anti-anemic enshpas; dairy products in the period of exacerbation are not recommended;

Limit the amount of fat to 55-60 g and add 5-10 g of butter to dishes;

As the patient's condition improves, they are gradually transferred to diet No. 46, 4c (chap. "Treatment of chronic enteritis") with an increase in protein content up to 110-130 g per day.

In case of severe exacerbation of UC, the most sparing ballast-free, slag-free diet is used. It does not consist of products (in the usual sense of the word), but of vital, easily digestible substances (amino acids, glucose, minerals, multivitamins, peptides, a small amount vegetable fat). These substances are almost completely absorbed in upper divisions small intestine.

In case of loss of more than 15% of body weight, parenteral nutrition by catheterization subclavian vein through which essential amino acids, protein preparations, fat emulsions are administered (ttraligshd, lipofundin, vitalipid), solutions glucose, electrolytes.

2. Basic therapy

Means of basic therapy affect the main pathogenetic mechanisms: synthesis of inflammatory mediators and immune disorders including autoimmune reactions.

2.1. Treatment with drugs containing S-ACK

Sulfasalazine(sadazosulfapyridine, salazopyridine) - is a compound of sulfapyridine and 5-aminosalicylic acid (5-ASA). Influenced" intestinal flora sulfasalazine breaks down into sulfapyridine and 5-ASA, which is an effective component of the drug, and sulfapyridine is only its carrier. 5-ASA inhibits the synthesis of leukotrienes, prostaglandins and inflammatory mediators in the colon, resulting in a pronounced anti-inflammatory effect. P. Ya. Grigoriev and E. P. Yakovenko (1993) indicate that, perhaps, sulfasalazine also exhibits antibacterial effect in the intestine, inhibiting the growth of anaerobic flora, especially clostridia and bacteroids, mainly due to unabsorbed sulfapyridine.

Sulfasalazine should be taken in divided intervals between meals. The drug can be taken orally, as well as injected into the rectum in the form of a therapeutic enema or suppository. The daily dose of sulfasalazine depends on the severity of the disease, the severity of inflammation, the extent pathological process in the gut.

In mild forms of the disease and in forms of moderate severity, sulfasalazine is prescribed 3-4 g per day, with severe forms- 8-12 g per day. On the first day, it is recommended to take 1 tablet (0.5 g) 4 times a day, on the second day - 2 tablets (1 g) 4 times a day, and on subsequent days, if the drug is well tolerated, 3-4 tablets 4 times a day , bringing the dose in severe form to 8-12 g per day.

After the onset of remission, treatment should be continued at the same dose for another 3-4 weeks, and then gradually reduce the dose every 3-5 weeks to a maintenance dose (1-2 g per day), which should be taken for at least a year and canceled while maintaining remission (P. Ya. Grigoriev, 1993).

Treatment with sulfasalazine in 10-30% of cases is accompanied by the development side effects:

gastrointestinal manifestations (anorexia, nausea, vomiting, epigastric pain);

General symptoms ( headache, fever, weakness, "arthralgia);

Hematological disorders (agranulocytosis, pancytopenia, anemia, methemoglobinemia, hemorrhagic syndrome);

Granulomatous hepatitis;

Oligospermia and male infertility.

With the development side effects the drug is canceled until they disappear completely, then you can re-assign the drug at half the dose and try to increase it to the optimal one.

Sulfasalazine inhibits absorption in small intestine folic acid therefore, patients receiving sulfasalazine should also take folic acid 0.002 g 3 times a day.

With left-sided distal localization of UC (proctitis, procto-sigmoiditis), sulfasalazine can be used in the form of microclysters and suppositories.

With enema administration, sulfasalazine is used as a suspension of 4-6 g in 50 ml of isotonic sodium chloride solution or boiled water daily for 1-1.5 months.

Sulfasalazine suppositories are injected into the rectum 2 times a day. One suppository contains 1 g of sulfasalazine and 1.6 g of cocoa butter.

Salofalk(tidocol, mesacol, mesalazine) - a drug containing only 5-aminosalicylic acid and devoid of sulfapyridine. It is believed that the side effects of sulfasalazine are primarily due to the presence of sulfapyridine in its composition. Salofalk does not contain sulfapyridine in its composition, therefore, it causes side effects much less often, its tolerance is better than sulfasalazine. Salofalk is prescribed for intolerance to sulfasalazine.

A. R. Zlatkina (1994) recommends that in mild forms of NUC appoint salofalk 1.5 g (6 tablets of 0.25 g) daily. In moderate forms, the dose is doubled. In acute attacks of proctosigmoiditis, salofalk enemas are more effective, containing 4 g of the drug in 60 g of suspension, which are done once after a stool for 8-10 weeks.

For treatment distal forms NUC also use suppositories: 2 suppositories (500 mg) 3 times a day (morning, afternoon, evening), daily.

Salazopyridazine, salazodimethoxine - 5-ASA-containing preparations of domestic production, they are less toxic and better tolerated. The mechanism of action is the same as sulfasalazine. The activity of these drugs is higher than that of sulfasalazine. Salazopyridazine and salazodimethoxine are available in tablets of 0.5 g. Treatment with these drugs is carried out mainly with light medium severity forms of chronic ulcerative colitis.

P. Ya. Grigoriev and E. P. Yakovenko (1993) in the active stage of the disease prescribe these drugs in daily dose 2 g (0.5 g 4 times a day) for 3-4 weeks. In case of occurrence therapeutic effect Christmas tree doses are reduced to 1-1.5 g (0.5 g 2-3 times a day) and continue treatment for another 2-3 weeks. In severe forms of the disease, it is possible to increase the daily dose to 4 g.

2.2. Treatment with glucocorticoid drugs

Glucocorticoid drugs accumulate in the area of inflammation in the colon in UC and block the release arachidonic acid, prevent the formation of inflammatory mediators (prostaglandins and leukotrienes), reduce capillary permeability, i.e. have a powerful anti-inflammatory effect. In addition, glucocorticoids have an immunosuppressive effect.

Indications for the appointment of glucocorticoids in NUC are as follows (A. R. Zlatkina, 1994):

Left-sided and total forms of ulcerative colitis with severe course, With III degree activity of inflammatory changes in the intestine (according to endoscopic examination);

Acute severe and moderate forms of the disease in the presence of extraintestinal complications;

Lack of effect from other treatments chronic forms ulcerative colitis.

Glucocorticoids can be used orally, intravenously and rectally.

Inside, glucocorticoids are prescribed for a common process (prednisolone - 40-60 mg per day, and according to A. R. Zlatkina - 1-2 mg / kg, but not more than 120 mg per day), and in severe cases, if it does not occur significant improvement within 4-5 days from taking salicylic sulfonamides, P. Ya. Grigoriev recommends intravenous administration of hydrocortisone hemisuccinate (initial dose of 200-300 mg, and then 100 mg every 8 hours). After 5-7 days, the introduction of hydrocortisone is stopped and treatment is continued by taking oral prednisolone at a dose of 40-60 mg per day, depending on the patient's condition. After the onset of clinical remission, the dose of prednisolone is gradually reduced (no more than 5 mg per week). Full course glucocorticoid therapy lasts from 10 to 20 weeks, depending on the form of ulcerative colitis. When the patient's condition improves, it is advisable to include sulfasalazine or salofalk and take prednisolone until complete withdrawal.

In patients with UC, limited direct and sigmoid colon, glucocorticoids can be administered in suppositories or enemas. Hydrocortisone is prescribed rectally by drop of 125 mg, and prednisolone - 30-60 mg in 120-150 ml of isotonic sodium chloride solution 1-2 times a day. Prednisolone suppositories are also used, 1 suppository 2 times a day (1 suppository contains 5 mg of prednisolone).

It should be remembered about the possibility of developing side effects of glucocorticoid therapy: systemic osteoporosis, steroid diabetes, arterial hypertension, Cushingoid syndrome, development of a stomach ulcer, or duodenum. The development of steroid gastric ulcers and bleeding from them require the abolition of glucocorticoids, the rest side effects corrected by symptomatic therapy.

2.3. Treatment CYTOstatics (non-hormonal immunosuppressants)

The question of the advisability of treating patients with UC with cytostatics has not been finally resolved.

P. Ya. Grigoriev (1993) believes that cytostatic 6-mercaptopurine is not indicated for exacerbations of UC, it is preferable to use it in cases where the patient is in remission and it is desirable to reduce the dose of glucocorticoids or stop treatment with them.

Cytostatics have a pronounced immunosuppressive effect, suppress immune mechanisms pathogenesis of UC.

When azathioprine (Imuran) is combined with prednisolone, remission occurs faster. With such complex therapy manages to reduce large dose glucocorticoids. Azathioprine is recommended at an average dose of 150 mg per day (2-2.5 mg/kg).

Due to the high risk of side effects in the treatment of non-hormonal immunosuppressants (pancytopenia, anemia, leukopenia, the development of pancreatitis, the combination of infectious and inflammatory diseases, etc.), short courses of treatment (3-4 weeks) are recommended, followed by a decrease and cancellation of cytostatics.

IN last years data have appeared on the possibility of using an immunosuppressant in the treatment of UC cyclosporine. It has the main effect on the cellular link of immunity, suppressing the synthesis and release of interleukin-2, inhibiting the function of T-lymphocytes-helpers and the production of autoantibodies. Interleukin-2 plays important role in the progression of UC. Treatment with cyclosporine is indicated when all previous treatments have failed (i.e., cyclosporine is a "last line" drug). Assign treatment with doses of 15 mg / kg per day for 2 weeks, then reduce the dose to a maintenance, individually selected, which can be used for many months (up to a year). The drug does not affect Bone marrow, but may provide toxic effect on the kidneys.

3. Application of astringents, adsorbents and antidiarrheals

These funds, providing an astringent, enveloping action, contribute fastest improvement functional state of the intestine and relief of the inflammatory process. Antidiarrheals are prescribed to patients who have stools more than 4 times a day.

On the use of astringents, adsorbents, antidiarrheals in Ch. "Treatment of chronic enteritis".

4. Correction of metabolic disorders and anemia

Correction of metabolic disorders and anemia is the most important medical event in patients with a severe form of the disease and less often - with a form of moderate severity. Used intravenously

albumin, amino acid mixtures, plasma, intralipvda, saline solutions, glucose. Transfusion therapy promotes detoxification, improves the state of the microcirculation system. It is also necessary to provide for measures to correct the level of electrolytes in the blood.

Correction of anemia is performed by intravenous drip infusion of polyfer (400 ml drip), intramuscular injection iron-containing preparation ferrum-lek, with severe anemia - by transfusion of erythrocyte mass.

Details on how to complete this section treatment program in ch. "Treatment of chronic enteritis".

5. Detoxification therapy

At NUC, especially in the severe course of the disease, toxemia syndrome develops due to a violation of the barrier functions of the colon.

To combat intoxication, the following are used: intravenous drip infusion of glucose solutions, electrolytes, hemodez, isotonic sodium chloride solution, Ringer's solution. Hemosorption is very effective in terms of detoxification, in addition, this method has an immunomodulatory effect, helps to remove immune complexes.

6. Antibacterial therapy and treatment
intestinal dysbanteria

Antibacterial therapy for UC is prescribed when there is a threat of developing toxic megacolon, septicopyemia, secondary purulent infection. Appointed antibacterial agents necessarily taking into account the type of fecal flora and its sensitivity to antibiotics. Semi-synthetic antibiotics, cephalosporins, metronidazole, biseptol, etc. are used. For staphylococcal dysbiosis, you can use ampiox, erythromycin, oleavdomycin, for yersiniosis - chloramphenicol, for anaerobic flora (clostrvdia, bacteroides) - metronidazole, for proteic dysbiosis - nevigramon, furazolidone.

After suppression pathogenic flora reimgatantation of the normal intestinal flora is performed by using colibutrin, bifiko-la, bactisubtil and other drugs for 2-3 months.

This section is described in detail in Chap. "Treatment of chronic enteritis".

7. Local treatment proctosigmoiditis

In addition to microenemas with preparations of 5-aminosalicylic acid, hydrocortisone, other types of local treatment described in Chap. "Treatment of chronic colitis".

8. Normalization of functional
conditions of the central nervous system

This direction of the treatment program is carried out jointly with a psychoneurologist, a psychotherapist. It is necessary to create a favorable psychological climate, elimination stressful situations, the introduction of

rity in the success of treatment. Also apply sedatives, tranquilizers, antidepressants.

9. Surgical treatment

Surgical treatment is carried out according to strict indications: perforation of ulcers of the large intestine; toxic dilatation of the colon (in the absence of the effect of treatment within 24 hours); suspicion of malignancy of the process; detection of pronounced dysplastic changes in several biopsies taken from various places large intestine; severe course of the disease with severe bleeding, not amenable to complex vigorous treatment using basic agents (colleotomy is performed).

10, differentiated treatment

Light form NUC - sulfasalazine is prescribed - 3-6 g per day orally or 1.5-2 g rectally (sulfasalazine enemas), sulfasalazine suppositories at night for 3-4 weeks; antidiarrheals are used

facilities.

prednisone inside at 20 mg / day for a month, then gradual withdrawal of the drug (5 mg per week);

Microclysters with hydrocortisone (125 mg) or prednisolone (20 mg) twice a day;

Sulfasalazine inside 2 g or salazodine 1 g per day, with intolerance - mesalazine (mesacol, salofalk) 1 g per day.

Moderate form- Patients need hospitalization. A diet is prescribed, fluid, electrolyte, and protein losses are corrected.

Treatment is with prednisolone (40-60 mg per day orally), sulfasalazine in enemas (1-3 g per day). When remission occurs, the dose of prednisolone is reduced and sulfasalazine is simultaneously prescribed (initially 1 g per day, then the dose is increased to 2 g per day, and later to 4 g per day in the absence of adverse reactions). With intolerance to sulfasalazine, salofalk is used. Usually, prednisolone is prescribed at 40 mg per day for a month or more, gradually reducing the dose until it is completely canceled over the next 2-4 months. Dysbacteriosis is also treated.

Severe form- Patients are urgently hospitalized. Parenteral nutrition is given with high content protein (up to 1.5-2 g / kg per day) against the background medical nutrition. Glucocorticoids are administered intravenously - 125 mg of hydrocortisone 4 times a day for 5 days, prednisolone is also used orally at a dose of 1-2 mg / kg per day, followed by a decrease as the condition improves. Prednisolone is also administered rectally (above). The issue of the use of non-hormonal immunosuppressants is being resolved, antibiotic therapy is being carried out, followed by the treatment of dysbacteriosis, as well as vigorous correction of metabolic disorders and anemia. When the patient's condition improves, sulfasalazine or salofalk is additionally prescribed.

11. Dispensary observation

Clinical examination is carried out by an infectious disease specialist or a district therapist.

In a state of remission, sigmoidoscopy and a full examination (coprocytogram, stool cultures for flora, weighing of the patient) should be performed once a year. If there are complaints, sigmoidoscopy is performed more often. It is advisable colonoscopy 1 time per year (especially with total damage to the colon).

With a long history of the disease, it is recommended to perform a colonoscopy once a year with a biopsy of various parts of the mucous membrane for timely detection dysplasia. If dysplasia is detected, colonoscopy is performed once every 6 months and the issue of surgical treatment. .

Patients with a moderate form are examined by a doctor 2-3 times a year, with a severe form, examinations are carried out 3-4 times a year and more often. The issue of colonoscopy is decided individually.

After discharge from the hospital, all patients receive courses of maintenance and anti-relapse treatment. Sulfasalazine or 5-ASA are prescribed at a dose of 1.5-2 g / day, salazopyridazine and salazodimethoxine - at a dose of 0.5-1 g / day continuously for 2 years. In addition, general restorative treatment is carried out, as well as astringents and antidiarrheal agents (according to indications). If necessary, glucocorticoids are used.

Modern medicine offers many drugs in the fight against various ailments. But for them to give positive result, a person should in no case self-medicate, but simply find a good specialist, which will take control of your drug therapy.

Candles Salofalk is prescribed for:

Crohn's disease
ulcerative colitis
diverticulitis

They can also be used as a prophylaxis for colon cancer in people who are prone to this disease.

However, there are a number of contraindications in which you will have to look for an analogue of Salofalk with another active substance.

Among them:

high sensitivity to salicylic acid
disorders in the functioning of the kidneys and liver
peptic ulcer and duodenal ulcer in acute form
age up to 2 years

As you can see, the drug cannot be used independently. In addition, in pharmacies it is sold only by prescription.

Ulcerative colitis refers to chronic illness, which affects the mucous membrane of the colon. At the same time, it swells, becomes inflamed, and ulcers form on it.

If we talk about the causes of ulcerative colitis, then scientists put forward a number of theories. Some are inclined to believe that ulcerative colitis is infectious disease, but the pathogen has not yet been installed.

Other physicians believe that this disease acts as an autoimmune the immune system a person produces antibodies that destroy the lining of the colon. And, of course, we must not forget about the genetic factor.

Predisposing factors:

compliance, poor in proteins but rich in carbohydrates
stress
passive lifestyle

According to statistics, people who have had their appendix removed are much less likely to develop ulcerative colitis. With what it is connected, nobody knows.

Ulcerative colitis varies from patient to patient, but common symptoms can be distinguished: malaise, fever, weakness, cramping abdominal pain, frequent stool(up to 5 times a day). There may be blood in the stool.

As you can see, you should not hesitate to contact a doctor using. This is fraught with serious complications that are much more difficult to cure.

Chronic inflammatory disease The crown is characterized by the fact that it completely affects the entire gastrointestinal tract, starting from the oral cavity and ending anus. In this case, as a rule, inflammation begins in ileum, and then goes to the rest of the intestines.

Predisposing factors:
measles transmission
food allergy
stress
smoking
heredity

IN clinical picture allocate local, general and extraintestinal symptoms manifestations of Crohn's disease.
Symptoms:
common symptoms appear due to a disorder of the immune system and the presence of

Hello! Went to the hospital with complaints of burning sensation, pain in anus, secretion of mucus. A diagnosis of proctitis was made. What suppositories will be more effective for this disease? Is this treatment enough, or do you need to take additional antibiotics?

Natalia, 27 years old.

In any case, treatment should be etiological, that is, act on the cause. An inflammatory process develops in the rectum, which is accompanied by pain, problems with defecation, and redness of the mucosa. Rectal suppositories, for example, salofalk, contain wound healing, anti-inflammatory substances, which speed up the healing process. Also, treatment depends on the severity of the patient, morphological changes with proctitis. Catarrhal disorders can be managed conservatively. Ulcerative, phlegmonous form require surgical intervention.

Treatment tactics

The choice of drug is influenced by the cause of proctitis, the presence of complications. The disease may occur due to:

infections. streptococci, staphylococci, coli cause inflammation in a weakened immune system. Mycobacteria enter the rectum with the blood stream. Gonococci seep through the vaginal wall. In such cases to rectal suppositories(salofalk, sea buckthorn suppositories) add an antibiotic to fight the pathogen.
Injuries. Prolonged constipation, hemorrhoids, anal sex, eating bones, rough food, swallowed small items lead to cracks. Treatment is based on wound healing therapy, and a provoking factor is also excluded.
Features of nutrition. Too spicy, spicy, smoked, sour food mucosal damage. Main recommendation- Dieting.
Diseases of the digestive tract (colitis, gastritis, hepatitis, cholecystitis, pancreatitis).
Oncological pathology.

Sea buckthorn suppositories

Candles are indicated for inflammatory changes in the colon (hemorrhoids, proctitis). The components of the drug envelop the mucosa, contribute to its rapid healing. Recovery occurs at the cellular level, biologically active substances promote membrane renewal. The circulation improves. Sea buckthorn suppositories cover the surface of the rectum, preventing trauma from feces.

Method of application: the intestines are emptied beforehand, you can go to the toilet or make a cleansing enema. It is advisable to lie on your left side, bend your knees, insert the candle as deep as possible. It is recommended not to get up for half an hour, as the contents may leak out.

Influence sea buckthorn candles on pregnancy is ambiguous. Only a doctor can choose the right dose, evaluate possible risk for good health.

Salofalk

In the treatment of proctitis, many doctors prefer salofalk. This drug reduces inflammatory response. The migration of leukocytes, phagocytes slows down, as a result of which pain, swelling, redness are minimally expressed.

Apply salofalk 3 times a day, one suppository. In especially severe cases, the dose is increased to 2 suppositories per dose.

Contraindications are ulcerative, hemorrhagic disease, acute renal or liver failure. Children under 2 years of age should not use the drug.

Relief

This drug, unlike salofalk, presented in the form of suppositories or rectal ointment. Active ingredients reduce itching, pain, swelling in the rectum, and also stop bleeding when ulcerative forms proctitis. The composition includes shark liver oil, which has a pronounced analgesic effect.

Maximum allowable amount receptions - 4 times a day.

Candles with propolis

This effective remedy in the treatment of proctitis. The active ingredient is propolis mixed with cocoa butter. IN pure form the main ingredient is not useful, since all the components are tightly interconnected, they cannot be absorbed into the blood. Only in combination with refractory fat, these bonds are destroyed, causing a therapeutic effect.

Basic actions:

Antibacterial.
Anti-inflammatory.
Antioxidant.
Antitumor.
Antiallergic.
The activity of phagocytosis increases.

One suppository is inserted into the rectum at bedtime. 30-40 minutes active substance blood is absorbed, so no discharge is observed.

Ultraproject

Rectal suppositories, unlike salofalk, are easy to use, one suppository at night is enough to achieve a therapeutic effect. After regular use, itching, pain, discomfort during a bowel movement.

Candles with potatoes

Traditional medicine has many ways to treat proctitis. One of them has candles with potatoes. In adults, sticks or grated raw materials are used for this purpose.

Raw potatoes are peeled, cut into pieces 3 cm long. In the position on the left side, it is introduced into the rectum. It is undesirable to take out the leftovers in the morning, they will come out on their own during a trip to the toilet. You can also rub it on a grater, make gauze swab, enter inside.

2. Basic therapy

Means of basic therapy affect the main pathogenetic mechanisms: the synthesis of inflammatory mediators and immune disorders, including autoimmune reactions.

2.1. Treatment with drugs containing S-ACK

Sulfasolozin (salazosulfapyridine, salazopyridine) - is a compound of sulfapyridine and 5-aminosalicylic acid (5-ASA). Under the influence of the intestinal flora, sulfasalazine breaks down into sulfapyridine and 5-ASA, which is an effective component of the drug, and sulfapyridine is only its carrier. 5-ASA inhibits the synthesis of leukotrienes, prostaglandins and inflammatory mediators in the colon, resulting in a pronounced anti-inflammatory effect. P. Ya. Grigoriev and E. P. Yakovenko (1993) indicate that, perhaps, sulfasalazine also exhibits an antibacterial effect in the intestine, inhibiting the growth of anaerobic flora, especially clostridia and bacteroids, mainly due to unabsorbed sulfapyridine.

In mild forms of the disease and in forms of moderate severity, sulfasalazine is prescribed 3-4 g per day, in severe forms - 8-12 g per day. On the first day, it is recommended to take 1 tablet (0.5 g) 4 times a day, on the second day - 2 tablets (1 g) 4 times a day, and on subsequent days, if the drug is well tolerated, 3-4 tablets 4 times a day , bringing the dose in severe form to 8-12 g per day.

Treatment with sulfasalazine in 10-30% of cases is accompanied by the development of side effects:

gastrointestinal manifestations (anorexia, nausea, vomiting, epigastric pain);

general symptoms (headache, fever, weakness, arthralgia);

hematological disorders (agranulocytosis, pancytopenia, anemia, methemoglobinemia, hemorrhagic syndrome);

granulomatous hepatitis;

oligospermia and male infertility.

With the development of side effects, the drug is canceled until they disappear completely, then you can re-assign the drug at a half dose and try to increase it to the optimal one.

Sulfasalazine inhibits the absorption of folic acid in the small intestine, so patients receiving sulfasalazine should also take folic acid 0.002 g 3 times a day.

With left-sided distal localization of UC (proctitis, proctosigmoiditis), sulfasalazine can be used in the form of microclysters and suppositories.

With enema administration, sulfasalazine is used as a suspension of 4-6 g in 50 ml of isotonic sodium chloride solution or boiled water daily for 1-1.5 months.

Sulfasalazine suppositories are injected into the rectum 2 times a day. One suppository contains 1 g of sulfasalazine and 1.6 g of cocoa butter.

Salofalk (tidocol, mesacol, mesalazine) is a drug containing only 5-aminosalicylic acid and devoid of sulfapyridine. It is believed that the side effects of sulfasalazine are primarily due to the presence of sulfapyridine in its composition. Salofalk does not contain sulfapyridine in its composition, therefore, it causes side effects much less often, its tolerance is better than sulfasalazine. Salofalk is prescribed for intolerance to sulfasalazine.

A. R. Zlatkina (1994) recommends that in mild forms of UC, prescribe Salofalk 1.5 g (6 tablets of 0.25 g) daily. In moderate forms, the dose is doubled. In acute attacks of proctosigmoiditis, salofalk enemas are more effective, containing 4 g of the drug in 60 g of suspension, which are done once after a stool for 8-10 weeks.

For the treatment of distal forms of UC, suppositories are also used: 2 suppositories (500 mg) 3 times a day (morning, afternoon, evening), daily.

Salazopyridazine, salazodimetoksin - 5-ASA-containing preparations of domestic production, they are less toxic and better tolerated. The mechanism of action is the same as sulfasalazine. The activity of these drugs is higher than that of sulfasalazine. Salazopyridazine and salazodimethoxine are available in tablets of 0.5 g. Treatment with these drugs is carried out mainly with mild to moderate forms of chronic ulcerative colitis.

P. Ya. Grigoriev and E. P. Yakovenko (1993) in the active stage of the disease prescribe these drugs in a daily dose of 2 g (0.5 g 4 times a day) for 3-4 weeks. In the event of a therapeutic effect, the daily doses are reduced to 1-1.5 g (0.5 g 2-3 times a day) and continue treatment for another 2-3 weeks. In severe forms of the disease, it is possible to increase the daily dose to 4 g.

2.2. Treatment with glucocorticoid drugs

Glucocorticoid drugs accumulate in the area of inflammation in the large intestine in UC and block the release of arachidonic acid, prevent the formation of inflammatory mediators (prostaglandins and leukotrienes), reduce capillary permeability, i.e. have a powerful anti-inflammatory effect. In addition, glucocorticoids have an immunosuppressive effect. Indications for the appointment of glucocorticoids in NUC are as follows (A. R. Zlatkina, 1994):

left-sided and total forms of ulcerative colitis with severe course, with III degree of activity of inflammatory changes in the intestine (according to endoscopic examination);

acute severe and moderate forms of the disease in the presence of extraintestinal complications;

lack of effect from other methods of treatment in chronic forms of ulcerative colitis.

Glucocorticoids can be used orally, intravenously and rectally.

Inside, glucocorticoids are prescribed for a common process (prednisolone - 40-60 mg per day, and according to A. R. Zlatkina - 1-2 mg / kg, but not more than 120 mg per day), and in severe cases, if it does not occur significant improvement within 4-5 days from taking salicylic sulfonamides, P. Ya. Grigoriev recommends intravenous administration of hydrocortisone hemisuccinate (initial dose of 200-300 mg, and then 100 mg every 8 hours). After 5-7 days, the introduction of hydrocortisone is stopped and treatment is continued by taking oral prednisolone at a dose of 40-60 mg per day, depending on the patient's condition. After the onset of clinical remission, the dose of prednisolone is gradually reduced (no more than 5 mg per week). A full course of glucocorticoid therapy lasts from 10 to 20 weeks, depending on the form of ulcerative colitis. When the patient's condition improves, it is advisable to include sulfasalazine or salofalk and take prednisolone until complete withdrawal.

In patients with UC, limited to the rectum and sigmoid colon, glucocorticoids can be administered in suppositories or enemas. Hydrocortisone is prescribed rectally by drop of 125 mg, and prednisolone - 30-60 mg in 120-150 ml of isotonic sodium chloride solution 1-2 times a day. Prednisolone suppositories are also used, 1 suppository 2 times a day (1 suppository contains 5 mg of prednisolone).

It should be remembered about the possibility of developing side effects of glucocorticoid therapy: systemic osteoporosis, steroid diabetes mellitus, arterial hypertension, cushingoid syndrome, the development of a stomach or duodenal ulcer. The development of steroid gastric ulcers and bleeding from them require the abolition of glucocorticoids, other side effects are corrected by symptomatic therapy.

2.3. Treatment with cytostatics (non-hormonal immunosuppressants)

The question of the advisability of treating patients with UC with cytostatics has not been finally resolved.

P. Ya. Grigoriev (1993) believes that the cytostatic 6-mercaptopurine is not indicated for exacerbations of UC, it is preferable to use it in cases where the patient is in remission and it is desirable to reduce the dose of glucocorticoids or stop their treatment.

Cytostatics have a pronounced immunosuppressive effect, suppress the immune mechanisms of the pathogenesis of UC.

When azathioprine (Imuran) is combined with prednisolone, remission occurs faster. With such complex therapy, it is possible to reduce a large dose of glucocorticoids. Azathioprine is recommended at an average dose of 150 mg per day (2-2.5 mg/kg).

Due to the high risk of side effects in the treatment of non-hormonal immunosuppressants (pancytopenia, anemia, leukopenia, the development of pancreatitis, the addition of infectious and inflammatory diseases, etc.), short courses of treatment (3-4 weeks) are recommended, followed by a decrease and cancellation of cytostatics.

In recent years, data have appeared on the possibility of using the immunosuppressant cyclosporine in the treatment of UC. It has the main effect on the cellular link of immunity, suppressing the synthesis and release of interleukin-2, inhibiting the function of T-lymphocytes-helpers and the production of autoantibodies. Interleukin-2 plays an important role in the progression of UC. Treatment with cyclosporine is indicated when all previous treatments have failed (i.e. cyclosporine is a "last line" drug). Assign treatment with doses of 15 mg / kg per day for 2 weeks, then reduce the dose to a maintenance, individually selected, which can be used for many months (up to a year). The drug does not affect the bone marrow, but may have a toxic effect on the kidneys.

3. Application of astringents, adsorbents and antidiarrheals

These funds, having an astringent, enveloping effect, contribute to the rapid improvement of the functional state of the intestine and the relief of the inflammatory process. Antidiarrheals are prescribed to patients who have stools more than 4 times a day.

For the use of astringents, adsorbents, antidiarrheals, see "Treatment of chronic enteritis".

4. Correction of metabolic disorders and anemia

Correction of metabolic disorders and anemia is the most important therapeutic measure in patients with a severe form of the disease and less often - with a form of moderate severity. Intravenous administration of albumin, mixtures of amino acids, plasma, intralipid, saline solutions, glucose is used. Transfusion therapy promotes detoxification, improves the state of the microcirculation system. It is also necessary to provide for measures to correct the level of electrolytes in the blood.

Correction of anemia is carried out by intravenous drip infusion of polyfer (400 ml drip), intramuscular injection of the iron-containing drug ferrum-lek, in case of severe anemia - transfusion of erythrocyte mass.

For details on the implementation of this section of the treatment program, see "Treatment of chronic enteritis".

5. Detoxification therapy

With UC, especially in severe cases of the disease, toxemia syndrome develops due to a violation of the barrier functions of the colon.

6. Antibacterial therapy and treatment of intestinal dysbacteriosis

Antibacterial therapy for NUC is prescribed when there is a threat of development of toxic megacolon, septicopyemia, secondary purulent infection. Antibacterial agents are prescribed, taking into account the type of fecal flora and its sensitivity to antibiotics. Semi-synthetic antibiotics, cephalosporins, metronidazole, biseptol, etc. are used. For staphylococcal dysbiosis, you can use ampiox, erythromycin, oleandomycin, for yersiniosis - levomycetin, for anaerobic flora (clostridia, bacteroids) - metronidazole, for proteic dysbiosis - nevigramon, furazolidone.

After the suppression of the pathogenic flora, the normal intestinal flora is reimplanted by using colibacterin, bificol, bactisubtil and other drugs for 2-3 months.

This section is described in detail in "Treatment of chronic enteritis".

7. Local treatment of proctosigmoiditis

In addition to microenemas with preparations of 5-aminosalicylic acid, hydrocortisone, other types of local treatment described in Chap. "Treatment of chronic colitis".

Without similar drugs can be done by identifying spastic colitis, with other forms of inflammation, antibiotic therapy is necessary.

Patients are prescribed sulfonamides like Sulgin or Ftalazol, as well as Enterol, Metronidazole, Enterofuril or De-nol. special attention deserve preparations with oxyquinoline. They are able to influence the microflora, which is resistant to other antibiotics. These drugs include Enteroseptol, Intestopan, etc.

Patients note the effectiveness of the drug Sulfasalazine in the treatment of intestinal colitis.

Somehow I earned myself ulcerative colitis - terrible pains appeared, the doctors even had to hospitalize me. It turned out that I brought myself malnutrition, stress and even a hereditary tendency to such a disease. The specialist prescribed a bunch of drugs, but Sulfasalazine was the basis of therapy. I drank it simply in incredible quantities and every day in different ways - this is how the treatment regimen suggests. Once I even had to take 12 pieces, but the tablets are quite large. But my torment was not in vain, at the end of the course of ulcerative colitis, only bad memories. Effective drug and inexpensive.

Painkillers

Since the disease often proceeds with severe pain syndrome, then painkillers are prescribed during the treatment.

Especially often in such situations, eubiotics are prescribed, such as Enteroseptol, Mexase or Intestopan, Enterofuril, etc.
These funds contain oxyquinoline in the composition, due to which their effectiveness is significantly increased.
They normalize stools, reduce bloating and eliminate abdominal pain.

Such drugs are practically devoid of adverse reactions if taken in a short course, only a small number of patients experienced headache and unobtrusive nausea. But at long-term therapy possible development or damage ophthalmic nerves etc.

Therefore, you should not get carried away with these drugs, they are usually prescribed in 10-day courses. If the treatment needs to be repeated, then at least a month should pass between the courses.

Rectal suppositories

Quite widely used in the treatment of colitis and suppositories, as they have a powerful local anti-inflammatory effect. Rectal suppositories are quite convenient to use at night.

Such drugs help to achieve rapid healing and tissue regeneration.

Influenced rectal suppositories going on fast healing wounds and microcracks in the rectum are eliminated inflammatory processes and swelling of the tissues, pain is stopped and the processes of bowel movement are facilitated.

The drug should be prescribed only by a specialist, taking into account the form and severity of colitis.

Among the most effective rectal suppositories, Salofalk can be distinguished, this drug is also effective for proctosigmoiditis or proctitis.
Also effective are suppositories Ultraprok, Natalsid, suppositories with propolis or sea buckthorn, methyluracil suppositories, etc.
Suppositories with propolis are distinguished by a pronounced analgesic and wound healing, regenerating and anti-inflammatory effect.
Methyluracil suppositories stimulate protection at the cellular level, help stop bleeding, relieve inflammation, which is very important in the development of intestinal colitis.
Candles with sea buckthorn provide antibacterial, wound healing and anti-inflammatory effects, help relieve swelling and itching.

Restoration of microflora

Antibiotic therapy causes a very significant blow to the intestinal microflora, therefore, after such therapy, beneficial microorganisms need powerful support. For this, patients are prescribed drugs to eliminate dysbacteriosis and violations of enzymatic activity.

These properties are possessed by probiotics, which are not considered drugs, however, they successfully restore the microflora and remove toxic substances. Also, the funds of this group help restore stool, improve appetite and eliminate excessive gas formation.

Today, many effective probiotics are known, but their action is the same, and they differ only in dosage. active ingredients and additives, as well as the manufacturer.

Therefore, the drug must be chosen, focusing on prices and medical recommendations. by the most known means similar action are Probifor and Bifidumbacterin, Bifiliz and Lactobacterin, Laktofiltrum, etc.

At enzymatic disorders shows the reception of pancreatin-containing drugs like Mezim, Panzinorm or Festal. Also restores well. intestinal microflora drug Lineks.

Normalization of motor skills

Colitis of any etiology is accompanied by spasms of the intestinal muscles. To eliminate them, a method is shown antispasmodic drugs like No-shpa, Papaverine, Drotaverine, Platyfillin.

You can restore motor skills by taking Cerucal or Motilium.
It also helps in the elimination of spasms and the drug Duspatalin, which, in addition to stopping painful symptoms, accelerates the regeneration processes in the intestinal tissues.
Perfectly restore peristalsis Resolor or Trimedat.

If the need arises, the specialist prescribes bismuth or calcium carbonate preparations, which have antidiarrheal and enveloping properties.

Vitamins and antidepressants

Colitis negatively affects not only the condition of the intestine, but also the well-being of the patient as a whole. Internal discomfort and soreness cause irritation and weakness, insomnia and chronic fatigue.

Experts recommend combining these drugs with B group vitamins, especially B 6 and B 12. Such injections are quite painful, therefore it is recommended to take them in tablet form or in the form of capsules. These are preparations Magnikum, Magne-B6 or Neurovitan, etc.

When will it be finished drug treatment, the patient needs a sufficiently long recovery period, during which you need to take vitamin preparations, immuno-fortifying agents and procedures necessary to maintain a weakened body. Probiotics are recommended to be taken until final restoration microflora.

In addition to traditional methods treatments can be used and, but only any remedy needs to be discussed with a specialist.

It is very useful for patients with colitis after a course of therapy to continue rehabilitation in a sanatorium, where patients receive the necessary diet food and restorative physiotherapy.