Chronic colitis symptoms. Chronic colitis of the intestine - what is it, symptoms and treatment? Spastic colitis of the intestine, signs

chronic colitis intestine is characterized by damage to the large intestine. This is an inflammatory disease that has a protracted course. With this pathology, dystrophic changes in the mucous membrane of the colon can be observed. In the structure of similar lesions of the gastrointestinal tract in adults, colitis occupies a dominant place.

Causes of colitis

Lives in the large intestine great amount symbiotic bacteria (up to 5% of a person's weight). In association with them, the processes of digestion, absorption, synthesis and stimulation of the immune systems take place in this section of the gastrointestinal tract. Excreted through the large intestine stool. Chronic colitis is a multifactorial pathology. Violation normal functioning colon occurs for several reasons:

The most common cause of chronic colitis is a combination of factors.

How the disease manifests itself

Depending on the causes of the disease and its localization, complaints may vary. Symptoms can be grouped as follows:

Pain. With colitis, they can be of a different nature. Most often there are pulling, bursting pains in the abdomen. They may decrease or go away after a bowel movement. Spastic colitis will be manifested by sharp pains. The predominant localization is the lateral and lower abdomen.
Chair disorder. Patients complain of diarrhea, constipation or their alternation.
Flatulence. Bloating and flatus may be the main complaints of the patient. Gas formation occurs even when eating foods that do not normally provoke flatulence.
Complaints general. Patients complain of fatigue, irritability, deterioration of health.
Pathological inclusions in the stool that characterize the cause of colitis (fragments or whole helminths) or are the result of an inflammatory process (mucus).

How the disease progresses

The disease has a protracted character. During the entire period of the disease, the appearance of complaints (exacerbation) is replaced by a favorable time for the absence of symptoms (remission). They can alternate after a considerable period of time and mislead the patient. Often the patient does not know what it is: a new disease or an exacerbation of an existing one. Diagnosis is hampered by the delay in going to the doctor.

How to treat chronic colitis

Treatment of chronic colitis is determined by the causes that caused it, the form, prevalence, duration of the disease and the severity of the patient's condition. The more detailed the diagnosis, the better the prognosis for therapy. How to treat colitis, the doctor will decide. It is he who will recommend a set of measures aimed at stopping the exacerbation.

Elimination of the causes of chronic colitis

Eliminating the cause of chronic colitis is the only hope for recovery. In the presence of bacterial infection treated with antibiotics. In secondary colitis, the treatment of the underlying disease is effective. Therapy chronic poisoning(alcohol, nicotine, heavy metals, etc.) will eliminate the cause of intoxication. An allergic disease will require the use of antihistamines.

Diet and Diet

The diet should be balanced, chemically and thermally sparing, fractional, small portions, frequent. Minimal amount meals per day - 5 times.
The composition of the basic diet is poor. Mucous soups with a weak broth, meat or fish are recommended low-fat varieties crushed, steamed. Eggs can be consumed soft-boiled or in the form of a steam omelet. From dairy products fresh cottage cheese is recommended. Whole milk should be avoided. The diet should take into account the features of the manifestation of colitis.

With diarrhea, jelly and jelly are added from astringent fruits and berries (pears, bird cherry, quince), decoctions of oak, burnet, bird cherry, pomegranate peels.
The difficulty is diet for colitis with constipation. An increase in the proportion of vegetables in the diet can exacerbate the condition. Lack of fiber leads to increased constipation and increased inflammation. The way out is to add vegetable oil and boiled ground dried fruits, prunes, plum juice, decoctions of mint, fennel, dill, anise to the basic diet, followed by expansion of the diet.

Symptomatic treatment

Symptomatic therapy will not lead to a cure, but by reducing the manifestations of the disease, it will alleviate the patient's condition and improve the prognosis. Such activities will include the following.

Treatment of flatulence. Bloating can be reduced by defoamers (Espumizan), sorbents (Polysorb) and agents that affect the kinetics of the gastrointestinal tract (especially in atonic forms).
Relief of pain syndrome. This is especially true for spastic colitis. Not NSAIDs, which can aggravate the severity of the condition, but antispasmodics (No-shpa) will have the greatest effect. The use of physiotherapy will also be positive.
Fight against diarrhea. In addition to changing the diet, it is necessary to take drugs that stop diarrhea. It should be noted that drugs such as loperamide can worsen the patient's condition in case of reduced activity of the gastrointestinal tract.
Elimination of constipation. With a decrease in the rate of evacuation of feces, not only laxatives are used. Medications that affect intestinal motility will significantly affect the resolution of constipation.
Normalization of intestinal motility. Depending on the form of chronic colitis, agents are used that increase (Prozerin) or decrease (Papaverin) the rate of contraction of the walls of the gastrointestinal tract.
Elimination of dehydration. Increased fluid intake (oral and intravenous).

In the rhythm of today's life, it is often impossible to keep track of the quality and regularity own food. From this, the main problems arise in the stomach area, complaints about pain.

Chronic intestinal colitis is a disease associated with the appearance of inflammatory processes in the layers of the large intestine. It is always accompanied by a violation of the functions of motility and secretion. This problem is most susceptible to people who have previously encountered disorders in the field of digestion.

Causes of chronic colitis

There are various causes of chronic colitis, among which gastroenterologists put a violation of the regimen and diet in the first place.

and intestinal dysbiosis, including that provoked by the misuse of antibacterial drugs;
Consequences and complications intestinal infections(, cholera, viral colitis, and others);
Secretory and enzymatic insufficiency against the background, and;
Prolonged penetration into the digestive tract of toxic and toxic substances that can have Negative influence on the mucous membrane of the large intestine (arsenic, acetic acid, lead, manganese, mercury).

In patients aged 30 to 45 years, primary forms of alimentary chronic gastritis. The main cause of pathology is not correct mode nutrition, deficiency of fiber and trace elements in the diet. Eating refined and low fat foods causes an achilic state in which the cells of the mucous membrane stop producing mucus. There is a delay of fecal masses, which lead to primary catarrhal inflammation.

Another cause of chronic colitis in children and adults is nutritional allergies, which can be combined with galactosemia and gluten intolerance. To identify such a pathology is possible only with the help of special tests. Consultation of the allergist is necessary.

In women, chronic intestinal colitis can develop due to regular fasting in order to reduce body weight. Great danger are enemas and the use of laxatives, including those of plant origin. Many components of weight loss products cause irreparable harm to the colon mucosa, paralyzing its normal secretory work.

Disease classification

AT medical practice The classification of chronic colitis helps to correctly determine the tactics of treatment, assess the prognosis of the disease, possible consequences and complications.

According to the etiological (causal) factor, colitis happens:

infectious - due to intestinal infection;
alimentary - against the background of malnutrition;
allergic - due to allergization of the body;
intoxication - as a result of poisoning;
radiation - after exposure to ionizing radiation;
congenital - due to congenital anomalies colon development.

According to the pathomorphological (structure of the intestinal wall) sign:

chronic catarrhal colitis - inflammation of the intestinal mucosa;
chronic atrophic colitis - thinning of the mucosa, dysfunction of the secretory glands;
chronic erosive colitis- mucosal defects prone to bleeding;
chronic ulcerative colitis- ulcers of the mucosa, leading to intestinal bleeding.

Functionally:

chronic spastic colitis - causes a tendency to diarrhea;
chronic atonic colitis- calls out the tendency to constipation.

According to statistics, at the appointment with a gastroenterologist, 40% of patients are diagnosed with a chronic form of the disease.

Symptoms

In order to fully appreciate the seriousness this disease for the body and to understand what chronic colitis is, it is necessary to understand the overall picture of its symptoms.

Most often, the disease is accompanied by sensations of dull, aching or cramping pains in the abdomen, which are localized in its lower and lateral sections, and may not have a specific location. Pain intensifies, as a rule, after eating, or before defecation. Sometimes after this, they weaken for a short time, especially if gases have passed or an enema has been given.
Symptoms of the disease are accompanied by dyspeptic disorders, there is a lack of appetite, the appearance of belching and nausea,. With prolonged periods of the disease, a decrease in body weight was noticed.
Patients often suffer from flatulence caused by disorders in the process of digestion of food. The main symptom is a violation of the stool, accompanied by diarrhea (it can become more frequent up to 15 times a day), or vice versa, the appearance of constipation. These states may alternate. Complaints of patients come to the presence of sensations incomplete emptying. There is mucus in the feces. Possible false urges, they are accompanied by the passage of gases, the release of small lumps of feces, as well as mucus containing streaks of blood.

People with chronic colitis in general can feel quite satisfactory, but with a severe course of the disease, signs of malaise, weakness, and reduced ability to work may appear.

Effects

Complications can cause only nonspecific ulcerative colitis. The consequences may be:

infection of the blood or the spread of infection to other organs;
bleeding in the intestines - this indicates chronic ulcerative colitis;
the appearance of an oncological neoplasm;
gangrene of the affected areas of the intestine and colon. In this case, a person is tormented by low blood pressure, weakness and high fever;
perforation of the ulcer, which often causes peritonitis. Symptoms of chronic colitis in this case will be expressed in severe swelling and tension of the abdominal muscles, chills, accompanied high temperature, plaque on the tongue and weakness of the body.

Diagnostics

In order to determine how to treat the chronic form of colitis, it is necessary to accurately establish the diagnosis, severity and form of the course of the disease. To do this, experts the following types diagnostic studies:

General and biochemical analysis blood.
Coprological research.
Radiography of the large intestine.
Irrigography.
Colonoscopy.
Sigmoidoscopy.
Anoscopy.

Only after a thorough diagnosis based on the results obtained, the collected history and the overall clinical picture, the specialist will be able to prescribe the optimal treatment that will be most adequate and effective for the patient in a particular case.

How to treat?

Therapeutic treatment of chronic colitis is divided into the following stages:

Suppression of signs of exacerbation.
Maintenance therapy during the period of remission of the disease.

With exacerbation of chronic colitis, hospital treatment is simply necessary. Fasting is recommended for the first few days, after the patient is transferred to diet No. 4.

Eating should be frequent, the products are carefully chopped. Spicy and salty dishes, marinades, flour products, smoked products and fatty meat, dairy products, millet and barley cereals, vegetables and fruits in fresh, soda and sweet treats.

Medical treatment

It also helps with drug treatment, which is also used during the remission stage:

Intestinal motility stimulants (Docuzat);
Saline laxatives (Bisacodyl, magnesium sulfate).
Laxatives of plant origin (Senade).
Antispasmodics (Papaverine hydrochloride, No-shpa, Duspatalin).
Enzyme preparations to improve digestion (Creon 10000, Mezim).
Adsorbents for excretion from the body toxic substances (Activated carbon, Smecta and Neosmectite).
Nicotinic acid and B group vitamins to accelerate the renewal of damaged tissues.
Anti-inflammatory drugs and antimicrobial action(Loperamide, Furozolidone, Tetracycline, Enterofuril).
Cholagogues in the pathology of the gallbladder and a lack of bile acids in the digestive system (Holosas, Hofitol, Allochol).

Non-drug treatments

In chronic colitis, spa treatment is indicated. The best resorts for the treatment of the digestive organs are considered to be the sanatoriums of Pyatigorsk, Essentuki, Kislovodsk. In them, in addition to taking mineral waters, baths, intestinal lavages, treatment with microclysters enriched with active biological substances are used.

From folk recipes are shown:

From inflammation - decoctions of sage, mint, St. John's wort, cumin.
Nettle, motherwort and mint help with increased gas formation.
To relieve spasms in the intestines, microclysters with a decoction of chamomile and calendula are recommended.
With ulcerative colitis, sea buckthorn oil is shown in a microclyster for the night.

All auxiliary methods require a long time, are held in courses with interruptions. It is better to consult with your doctor first.

Diet for chronic colitis

The diet for chronic intestinal colitis is called "treatment table No. 4". It implies fractional (small portions) meals - up to 7 times a day.

Prohibited Products:

eggs;
muffin;
barley, barley, millet porridge;
smoked meats, canned food;
fatty sea fish;
pork, beef;
sour cream, milk;
strong coffee, tea, carbonated drinks.

For chronic colitis, you can eat foods such as:

boiled chicken, rabbit, veal;
non-sour cottage cheese;
white crackers;
non-greasy River fish boiled or steamed;
liquid cereals on the water;
vegetable broths;
jelly, rosehip broth, weak green tea.

The basic principle of nutrition in chronic colitis is the exclusion of foods and dishes that cause mechanical and chemical irritation of the intestinal mucosa.

Prevention

To avoid complications and serious health problems, timely treatment is necessary, as well as preventive measures:

conducting healthy lifestyle life;
use of personal household items;
strict compliance with the prescribed nutrition, diet;
timely eating (you can not ignore breakfast);
compliance elementary rules hygiene (washing, washing hands);
exclusion of raw water intake and thorough washing of vegetables and fruits before consumption;
visits to doctors, regular check-ups at the dentist, family doctor, gastroenterologist.

It is very important to know and understand how to treat chronic colitis, but the most important thing is not to get involved in self-medication, but still resort to the help of qualified specialists. Do not avoid hospitalization in severe stage and acute manifestation ailment. AT stationary conditions relief and improvement of health occurs much faster than at home.

Most people lead an active lifestyle and spend most of their time at work, forgetting to eat properly and fully.

This often leads to the development of various diseases. gastrointestinal tract. One of the most common ailments is chronic colitis, an inflammatory bowel disease.

This pathology most often occurs in a long form and is accompanied by various symptoms negatively affecting the quality of life.

Characteristics of the disease

Chronic intestinal colitis is an inflammation in which the lining of the large intestine is affected. At the same time, a person begins to suffer not only from constant pain in the abdominal region, but also from constipation, diarrhea.

Doctors classify this disease into several forms. Colitis happens:

Infectious. It is provoked by infection in the intestines.
Allergic. It develops due to the excessive presence of the allergen in the body.
Alimentary. Its primary source is malnutrition.
Intoxication. Develops due to poisoning of the body.
Congenital. It occurs due to the presence of congenital anomalies leading to improper development of the colon.

Depending on what type of pathology the patient has encountered, the appropriate treatment method is selected.

Also, the disease is classified according to the degree of its effect on the intestinal wall. Have colitis:

. Its main symptom is inflammation of the intestinal mucosa.
Erosive. This lesion usually results in bleeding.
. Causes thinning of the mucosa and disrupts the functioning of the secretory glands.
Ulcerative. The formation of small ulcers on the intestinal mucosa, leading to bleeding.

Causes

Gastroenterologists say that in 80% of cases the primary source of this disease is a long-term failure in diet and diet.

If a person continues to use junk food, this will not only lead to a lack of vitamins and minerals, but also provoke inflammation in the walls of the large intestine. At the same time, the likelihood of developing dysbacteriosis and Escherichia coli increases several times.

Also, the main causes of chronic colitis include the following:

abuse of fatty, fried and spicy food, as well as flour products and alcoholic products;
a rare meal (only in the morning and evening);
food allergy;
intoxication, since this disease can occur in people whose activities are associated with chemical products and toxic substances;
exposure to radiation;
congenital anomalies in the development of the intestine;
bad habits.

Symptoms

Chronic colitis is characterized by an undulating course. Sometimes the disease can fade away and practically do not make itself felt, but at certain periods the patient's condition will deteriorate sharply. Clinical signs of the disease will be especially aggravated during the progression of the pathology.

The main symptoms of chronic colitis are:

bloating due to large cluster gases in the intestines;
stupid aching pain in the abdominal cavity after eating;
constant rumbling in the stomach and intestines;
pain in the lower abdomen and in the sides;
the appearance of problems with the stool (constipation will be replaced by bouts of diarrhea);
mucus, blood will be present in the feces;
stools will be accompanied by a strong stench;
the appearance of rashes on the skin;
a slight increase in body temperature (up to 37.5 degrees);
loss of appetite;
weight loss;
general weakness and deterioration in performance.

If the pathology is provoked by an infectious disease, the person will suffer from cramping pains in the abdominal cavity and persistent diarrhea(up to 15 times a day).

Chronic colitis in children

Despite the fact that the disease is most often diagnosed in people middle age, sometimes colitis can also occur in children (at 2-3 years).

The danger of this disease lies in the fact that in the absence of timely treatment it can lead to dystrophic changes in the body and cause malfunctions in the functioning of the entire digestive system. In this case, the child will suffer from intense pain, stool disorders and fever.

If you let this disease take its course or do not cure it to the end, it will take a chronic course and complicate later life baby. Unlike adults, in children the symptoms of pathology are quite pronounced:

severe pain in the lower abdomen;
flatulence and bloating;
false urge to go to the toilet;
nausea and vomiting;
constipation and diarrhea;
dehydration of the body;
fever and general weakness.

If any of these symptoms occur, it is necessary to immediately register the child for examination by a gastroenterologist and make all the necessary tests.

Chronic colitis during pregnancy

In pregnant women, this pathology is not so common, while potentially dangerous. Nevertheless, doctors say that this pathology is not an indication for termination of pregnancy and does not pose a direct threat to the life of the baby.

Since physical immunosuppression occurs during childbearing, the body of a pregnant woman becomes more vulnerable and prone to various diseases. It is because of this that, in the presence of a predisposition, the expectant mother appears increased likelihood occurrence of colitis.

Chronic colitis during pregnancy is treated by taking modern medicines while following a specific diet. Also expectant mother bed rest is recommended.

How to relieve pain during an exacerbation of the disease

Although chronic colitis usually progresses in waves, rare cases the patient may suffer from an exacerbation of the disease. At the same time, a person experiences severe pain localized in the abdomen, and it is difficult for him to move once again.

With an exacerbation of the disease, the most reasonable option is to call a medical team, and before their arrival, you can take the following measures:

A heating pad can be applied to the site of pain hot water and wrap yourself in a warm blanket.
If the attack is accompanied by diarrhea or vomiting, activated charcoal will help to remove toxins from the body.
If the attack has just begun to intensify, the patient needs to do an enema with corticosteroids. These substances will help minimize the risk of further complications.
When the temperature rises, the patient should observe bed rest.
It is possible to alleviate the condition before the arrival of doctors with the help of modern anabolic steroids.

If there is an exacerbation of colitis, it is strongly not recommended to eat any food, since the intestines may simply not be able to cope with their functions.

Diagnostics

The above details what chronic colitis is. If you suspect the presence of this disease, first of all, you need to sign up for a consultation with a gastroenterologist, in last resort You can also seek help from a general practitioner.

An experienced doctor should not only carefully examine the patient, but also conduct an anamnesis: find out what the nature of the pain is, whether any of the relatives had a similar disease.

Confirm or refute the presence of pathology will help complex diagnostics, it includes laboratory and instrumental methods examinations.

First of all, the patient will need to general analysis blood, which will show whether the content of ESR and leukocytes is increased. You will also need:

Analysis of urine.
Biochemistry of blood. Gives information about the work of the liver, kidneys, pancreas and metabolism.
Immunological analysis.
Fecal analysis. Lets reveal it chemical composition and the presence of substances such as fiber, protein, organic acids, and ammonia. It also shows the presence of blood and purulent impurities.

Instrumental diagnostics includes the following methods:

Ultrasound examination of the abdominal organs.
Colonoscopy. it endoscopic examination large intestine, which allows to detect the focus of inflammation, the presence of erosion and the severity of the vascular pattern.
FGDS. Examination of the stomach and duodenum.
Irrigoscopy. It is carried out with the use of contrast agents, gives specialists the opportunity to assess the condition of the colon visually. Shows a change in the relief of the mucous membrane and a violation of peristalsis.
Sigmoidoscopy. It is prescribed for a complete assessment of the rectum;

Only after all these studies have been carried out, the doctor will be able to assess the overall clinical picture and select the optimal treatment method.

Medical tactics

It is necessary to deal with the treatment and elimination of pain in chronic colitis at the initial stage of the disease. Timely initiated therapy minimizes the risk of complications and irreversible changes in the body.

If the doctor selects a competent and appropriate method of treatment, the patient will be able to protect himself from the recurrence of the pathology for a long time and significantly improve his general condition.

The main method of treatment is drug therapy, while it is desirable for the patient to be in the hospital. In addition, an essential condition for recovery is the observance of a special diet.

Medical treatment

Despite the fact that on sale you can find many drugs designed to treat this scourge, you should never choose drugs on your own. Only an experienced specialist should calculate the duration of the course of treatment and dosage.

In most cases, drug treatment is carried out by taking such means as:

probiotics that help restore and normalize the intestinal microflora (the most popular are Acipol and Bificol);
antibacterial drugs (tetracycline, loperamide);
antibiotics;
choleretic agents (rosehip syrup and Allohol);
anabolics that fight pain;
drugs that have an astringent effect (are prescribed only if colitis is accompanied by diarrhea);
funds aimed at eliminating flatulence (activated charcoal, peppermint).

In addition, to speed up the recovery process, the patient will also need to drink a course of multivitamins.

Treatment with folk remedies

Many are interested in whether chronic colitis can be cured. folk remedies. Doctors say that with an exacerbation of the disease, the best option would be to contact a specialist who will prescribe the intake of modern medicines.

enjoy folk recipes possible after the end of treatment and the onset of remission. Such funds are excellent prevention. The most effective of them:

Alder infusion. A tablespoon of the crushed product should be poured with a glass of boiling water and infused for about 4 hours. After that, the liquid must be filtered and drunk three times a day, half a glass before meals. The course of treatment is 2 weeks.
Sage tea. A small amount of dry crushed plant (a tablespoon) is poured into 400 ml of boiling water and covered with a lid. After an hour, the liquid must be filtered. This remedy is taken three times a day for a tablespoon. To achieve maximum results, you need to use sage infusion within a month.

Special diet

In chronic colitis, a person will have to radically revise their diet. If you continue to eat, the effect of the treatment will be short-lived. The diet for chronic colitis is based on the following rules:

The patient will need to include as much fiber in the diet as possible. It can be found in cereals, fresh vegetables and bread. Fiber will not only saturate the body valuable elements but also normalize the activity of the gastrointestinal tract.
It is recommended to eat boiled meat and lean fish 2-3 times a week.
The diet should be dominated by dishes cooked in vegetable broth.
Before eating fruits and fresh vegetables, they must be peeled.
You will need to eat food in small portions (5-6 times a day).
The use of alcoholic beverages and carbonated drinks is strictly contraindicated. You also need to refrain from dairy products.
In chronic colitis, it is not recommended to eat salty food and dishes with spices.

In medicine, such a nutrition system is known as "Diet No. 4", it is prescribed for the treatment of chronic diseases of the stomach and intestines.

Such a diet is especially necessary during an exacerbation of the disease.. The menu can be quite varied, you need to prepare dishes based on the list of allowed and prohibited foods.

For chronic colitis, you can eat foods such as:

lean fish, steamed (or boiled);
vegetable broths;
porridge on the water;
boiled chicken breast, veal;
white bread crackers;
cottage cheese.

Prohibited Products:

pork;
high-fat fermented milk products;
eggs;
sweet pastries;
smoked products and canned food;
strong coffee.

The diet should be high in calories and contain a large amount of vitamins and valuable trace elements.

Possible Complications

If colitis is not treated, the disease can become more severe and cause ulcers and erosions on the intestinal mucosa. In this case, a person will suffer not only from severe pain, but also from the following pathologies:

Peritonitis.
collateral cancer.
Formation.
chronic intoxication.

Preventive measures

Is it possible to somehow protect yourself from this disease? Doctors say that the correct diet and restriction will help reduce the likelihood of developing pathology. harmful products and fast food.

In order for all body systems to function properly, you need to have at least minimal physical activity and exercise. The best option- exercise in the morning and several times a week to jog in the park.

If you have problems with the intestines, it is necessary to sign up for an examination with a doctor in a timely manner.

This disease is quite unpleasant and can lead to serious complications. The most reasonable option would be to simply prevent its occurrence and constantly monitor your health.

Chronic colitis is a disease characterized by inflammatory lesion mucous membrane of the colon, in the clinical picture of which pain and dyspeptic syndromes predominate, and the morphological basis is a combination of elements of inflammation with signs of epithelial dystrophy, a decrease in the depth of crypts and the development varying degrees manifestations of lymphoplasmacytic infiltration.

In cases where inflammatory changes in the colon are combined with damage to the small intestine, the term " chronic enterocolitis". The term "chronic colitis" is used when the colon is predominantly affected.

EPIDEMIOLOGY. In recent years, chronic colitis has become a frequent pathology in children, combined with other gastroenterological pathologies. The frequency of chronic colitis is from 5 to 12 cases per 1000 children and about 20% of chronic pathology of the digestive system.

In addition, many factors of both the external and internal environment of the body can contribute to the development of chronic colitis: psycho-emotional stress leading to the appearance of functional disorders in the intestines (irritable bowel syndrome), and subsequently to the development of chronic colitis; dietary disorders; previously transferred infectious diseases, with particular importance attached to the aggressiveness of the pathogen, belated and improper treatment, reduce the reactivity of the child's body. In the development of the disease, an increased allergization of the body plays a role, which can be both the cause of the disease and accompany it due to a lack of local funds protection.

Of significant importance is various gastroenterological pathologies, which have a reflex effect from the focus of the primary lesion against the background of a violation of neurohumoral regulatory mechanisms; congenital pathology and anomalies in the development of the intestine, transferred somatic and surgical diseases. PATHOGENESIS. In the pathogenesis of the disease, damage to the mucous membrane of the colon as a result of prolonged exposure to mechanical, toxic and allergic factors is essential. The nervous apparatus of the intestine is involved in the pathological process, which leads to a violation of the motor and secretory functions of the colon and exacerbates trophic disorders in the intestinal wall. Of great importance is dysbiosis, characterized by a decrease in the number of microorganisms that are constantly present in the intestine (bifidobacteria, coli, lactobacilli), a violation of the ratio of bacteria in various departments intestines, increased reproduction of opportunistic and the appearance of pathogenic flora. There is a secondary fermentopathy, digestion processes are disturbed. AT in large numbers metabolites such as indole and skatole are formed, which are of pathogenetic importance in the development of the inflammatory process of the intestinal mucosa.

In addition, as a result of the vital activity of opportunistic microorganisms, the amount of histamine increases, which entails sensitization of the body, weakening of the cellular and humoral protection. Having a good ability to adapt to the conditions environment, opportunistic pathogens create competition normal microflora intestines. Deficiency of bifidoflora entails a violation of the processes of digestion, absorption, absorption of nutrients.

Of great importance in the pathogenesis of chronic colitis are violations nervous regulation intestines. These phenomena are based on a weakening of the inhibitory effects of the cerebral cortex on the underlying sections with a significant decrease in reactivity sympathetic department vegetative nervous system, and an increase in the content in the blood of biologically active substances- serotonin and histamine.

They also play an undeniable role immune mechanisms. With an increase in the level of immunoglobulins in the blood of patients, autoantibodies to antigens of the colon mucosa are detected. This indicates that in the pathogenesis of the disease there is a sensitization to its own tissue antigens.

Significant changes occur in the circulatory system: the permeability blood vessels, signs of DIC develop - activation of the blood coagulation system and the formation of microthrombi, which leads to circulatory disorders and the formation erosive defects intestinal mucosa.

All this leads to the development of intestinal dyspepsia, immune disorders with the appearance of autoantibodies to the antigens of the colon mucosa. The probability of autoimmunization in the progression and chronicity of the process is quite high. At the same time, productive inflammation is combined with a violation of the regeneration of the epithelium and ends with sclerosis and atrophy of the colon mucosa. There are chronic colitis without mucosal atrophy and chronic atrophic colitis.

CLASSIFICATION. According to the recommendations of Yu.V. Belousova (2000), in pediatric practice the classification of chronic colitis can be used, which provides for the allocation of the main parameters of the disease. When forming a diagnosis, one should reflect: the localization of the process - right-sided, left-sided, total colitis, transversitis; phase or period of the process - exacerbation, remission; the nature of motor disorders of the colon - hypo-, hypermotor, mixed dyskinesia. In the presence of intestinal dysbiosis, it should also be reflected in the diagnosis.

CLINIC AND DIAGNOSIS. Chronic colitis in children often occurs with poor clinical symptoms, especially in the early stages of the development of the disease, and is characterized by a long, prone to recurrence course, which creates certain difficulties in timely diagnosis.

Among the complaints, a change in the well-being of a sick child is characteristic: fatigue, weakness, deterioration in school performance, sleep disturbance, loss of appetite, headache, subfebrile condition. Frequent vegetative disorders. At the same time, stool disorders are noted: constipation, diarrhea or unstable chair(alternating diarrhea with constipation). With constipation - defecation is not daily, usually 1 time in 2-3-4 days, with a small amount of feces. With prolonged stool retention, pain appears in the left iliac region associated with overflow of the large intestine and disappearing after defecation. The fecal masses depart in the form of "sheep" feces or "nuts", sometimes at the end of the act of defecation, an admixture of scarlet blood appears, which is usually the result of an anal fissure. With severe pain, the child suffers, tries to avoid the act of defecation, thereby provoking prolonged retention of feces in the intestines.

With prolonged constipation, complaints of nausea and vomiting appear due to fecal intoxication developing in the child.

The course of chronic colitis may be accompanied by an increase in stool up to 3-5 times a day with a change in its consistency (liquid or mushy), an admixture of mucus, flatulence, pain in lower sections abdomen along the large intestine. Some children have alternating constipation with diarrhea.

Chronic colitis is characterized by a syndrome of incomplete emptying of the intestine: usually in the morning immediately or 20-30 minutes after eating, the patient has an urge to re-defecate. The stool can be repeated several times during the day, usually in small portions.

The child's complaints of abdominal pain are quite constant. They can be of a varied nature - from sharp cramping to aching, constant. They increase or appear before the act of defecation, decrease or disappear after defecation and gas discharge. Localization of pain in the left hypochondrium, especially aggravated by physical activity(running, jumping), is often associated with a violation of the passage in the region of the splenic angle of the intestine, especially when sagging transversely colon, which is often interpreted as pain due to damage to the stomach or pancreas. Flatulence, splashing noise in the intestines, noisy rumbling are possible.

An objective examination of a child usually always reveals symptoms of chronic intoxication and polyhypovitaminosis. Particular attention should be paid to the condition of the mucous membrane of the tongue - during the period of exacerbation, it is covered with a white coating, often has imprints of molars along the edges. With symptoms of dysbacteriosis digestive tract - bad smell from the mouth, belching. Examination of the abdomen reveals swelling of its various departments.

On palpation, the abdomen is painful in the area of the sigmoid and descending colon, which is due mainly to the left-sided localization of the inflammatory process. In addition to pain along the large intestine, the presence of positive symptoms of Obraztsov, Hertz, "air column" is characteristic. In addition, rumbling and splashing noise along the colon, a symptom of "croaking frogs" in the ileocecal region, is determined on palpation.

Features of the course of chronic colitis in children are largely determined by the nature of the violation of the motility of the colon. Depending on the type of dyskinesia, stool and abdominal pain have a number of features. When colitis is combined with enteritis, the stool is more often plentiful, liquid, flatulence is significantly expressed, Obraztsov's symptom and pain at the Porges point are often determined.

Important in the diagnosis of chronic colitis is an extended coprological study, which makes it possible to judge the processes of digestion and absorption in the intestine, and according to the Triboulet-Vishnyakov reaction, the presence of an inflammatory process. Usually in the coprogram with inflammatory changes in the colon mucosa, mucus, leukocytes, less often erythrocytes, iodophilic flora, undigested fiber and intracellular starch are detected.

A study on dysbacteriosis makes it possible to identify a violation of the intestinal biocenosis, opportunistic flora is often found (Proteus, Klebsiella, Citrobacter, Enterococci, Hemolyzing Escherichia coli, Staphylococcus aureus).

Have the greatest value endoscopic methods bowel examinations - sigmoidoscopy and colonoscopy; they allow revealing superficial (with or without atrophy) and destructive-inflammatory changes (hemorrhages, erosions). It should be noted that in children there are practically no significant changes in the intestinal mucosa: it is more tender, thin, with minor inflammatory changes in the form of moderately pronounced proctosigmoiditis. For a more detailed study, a biopsy of the colon mucosa is performed. In the morphological study of biopsy specimens, changes of a proliferative nature are recorded: a decrease in the height of the surface and cryptal epithelium, the presence of a dense lymphohistiocytic infiltrate with a large number of lymphocytes and eosinophils in it. The phenomena of edema are characterized by increased functional disorder epithelium of the crypts, a decrease in vascular tone, an increase in their blood supply. It should be emphasized that in modern conditions the diagnosis of chronic colitis should be based on histological data, since endoscopic and X-ray studies do not always allow to verify the presence of inflammation. At the same time, a morphological study of the intestine should be carried out according to strict indications in a specialized department.

An x-ray examination of the intestine (irrigography) shows some narrowing of the affected areas, haustras become asymmetric, uneven, sometimes smoothed. After the evacuation of the barium suspension, the relief of the mucous membrane is affected: the folds lose their usual direction, become discontinuous, expanded, and thickened. Be sure to identify symptoms of impaired motor function of the colon by hypermotor or hypomotor type.

Chronic colitis has to be differentiated from chronic enteritis and irritable bowel syndrome (Table 80).

TREATMENT of patients with chronic colitis should be differentiated, complex and include diet therapy, drug therapy, local rectal procedures, as well as physio- and balneotherapy. In the period of exacerbation, a sparing diet is essential. To reduce intestinal motility and irritant food on its mucous membrane is assigned fractional nutrition 6-8 times a day. With a tendency to diarrhea, a table with mechanical and chemical sparing of the mucous membrane is recommended (diet No. 4 and its variants - 46 and 4c). The presence of flatulence is eliminated by the restriction of carbohydrates, milk, dairy products. For colitis accompanied by constipation, beets, carrots, pumpkins, prunes, apricots, vegetables and fruit juices. Effective appointment of bran. In the period of remission, it is advisable to appoint a common table with an exception fatty meat, spicy and salty dishes, extractives, pastry.

The drug complex is prescribed taking into account the nature of inflammatory changes, the type of dysbacteriosis, and the variant of motor-evacuation disorders.

In the treatment of patients with chronic bowel disease wide use received sulfanilamide preparations - ftalazol, ftazin, etazol, salazopyridazine, salozinal, salofalk (see "Non-specific ulcerative colitis") - due to their properties to be adsorbed in the intestine and a pronounced anti-inflammatory effect. However, when assigning them, one should keep in mind the possible side effect(in 3-4% of patients), due to toxic effect on tissues, especially when using drugs of the salazosulfapyridine group. This determines the need for careful monitoring during treatment, taking into account the pharmacokinetics of drugs.

An important place in complex therapy in chronic colitis takes effect on intestinal dysbacteriosis. For this purpose, during the period of exacerbation of the disease, drugs of the oxyquinoline series, nalidixic acid, nitrofurans are used (see "Chronic enteritis"). They have a pronounced antimicrobial activity against pathogenic microorganisms, but, unlike antibiotics, they do not suppress the saprophytic flora, increase the body's resistance, suppress production and reduce the action of toxins. It should be borne in mind that prolonged or repeated use of these drugs may cause the development of allergic reactions. For the correction of intestinal dysbiosis, the use of biological preparations: colibacterin, bifidumbacterin, bificol. According to the indications, these drugs should be alternated with bacteriophages - proteus, staphylococcal.

Given the role of the allergic factor in the pathogenesis of chronic colitis, desensitizing therapy is prescribed.

Inflammatory changes in the mucous membrane of the large intestine, as well as the associated decrease in the processes of digestion and absorption lead to the development of polyhypovitaminosis, and therefore the inclusion in the complex is shown. medical measures vitamin therapy (group B, C, folic and nicotinic acid).

Stimulants of reparative regeneration with non-specific anti-inflammatory action - methyluracil and indomethacin - have been widely used in the treatment. The results of experimental and clinical observations have shown them high efficiency in the complex of therapeutic measures for chronic inflammatory diseases intestines. Conducting a course of treatment for 6-8 weeks leads to the elimination or significant reduction clinical manifestations disease, reducing the severity of the inflammatory process in the intestinal mucosa, the onset of a sufficiently long (1-3 years) remission. Methyluracil is prescribed 0.25-0.5 g 3 times a day during or after meals; indomethacin - starting with a dose of 25 mg 2-3 times a day after meals for older children, with a gradual increase in dose (under the control of tolerance) up to 100 mg per day in 3-4 doses; the drug can also be administered in the form of rectal suppositories, 50 mg 2 times a day. However, the use of indomethacin in pediatric practice is limited by its possible side effect(vomiting, diarrhea, increased effects of intoxication), so it should be used carefully.

Local therapy for chronic colitis includes the use of enemas and suppositories that have an anti-inflammatory effect on the colonic mucosa within the anorectal region. Microclysters from chamomile, collargol are used, and with atrophic and subatrophic changes - oil ( fish fat, vegetable oil). The use of suppositories helps to reduce intestinal spasm, pain in the anus, emptying the intestines. Suppositories are inserted into the anus, usually at night or in the morning before a stool. Are used finished preparations antihemorrhoidal suppositories - anuzol, neoanuzol, betiol, etc.

Along with drug treatment in the complex of therapy, physiotherapeutic procedures are used that have an anti-inflammatory effect, which contribute to the elimination of impaired intestinal motility. Thermal procedures - applications on the abdomen of paraffin, ozocerite - improve blood supply to the intestines, reduce inflammation. With the help of a special rectal tip, diathermy is applied, which normalizes intestinal peristalsis and contributes to the elimination of pain. Depending on the type of motor disorders, electrophoresis of a mud solution is used, as well as drugs: with a tendency to constipation with a predominance of the spastic component, anticholinergics are used, and with intestinal hypotension, calcium preparations are used.

Herbal medicine for chronic bowel diseases is differentiated in accordance with the nature of violations of its activity (constipation, diarrhea) and the nature of motility (hyper-, hypomotor - see "Irritable Bowel Syndrome"). Phytotherapy for colitis is more appropriate to use in the period of attenuation of the inflammatory process, using herbal preparations:

Buckthorn bark - 30 g, elderberry flowers - 20 g, fennel fruits - 10 g, anise fruits - 10 g. One tablespoon of the collection is poured with a glass of boiling water, heated for 15 minutes in a water bath; the infusion is cooled for 45 minutes at room temperature and filtered. Take 1/2-1 cup in the morning on an empty stomach and in the evening before bedtime 30 minutes before meals.

Joster fruits - 20 g, licorice root - 10 g, cumin fruits - 10 g. The method of preparation and use is the same.

Senna leaves - 20 g, dandelion root - 20 g, valerian rhizome - 10 g, nettle leaves - 10 g. The method of preparation and use is the same.

All three collections are used when colitis is combined with constipation.

The use of various natural balneological factors in the treatment of chronic colitis is very appropriate and is widely used in pediatric practice. Balneotherapy is prescribed in the remission phase or not earlier than 2-3 months after the exacerbation of the disease. The intake of mineral water contributes to the normalization of the motor-evacuation function of the intestine, improves the processes of digestion and absorption, increases the secretory function of the glands of the intestinal mucosa. Are used mineral water low or medium mineralization, rich in sodium sulfate and magnesium salts, affecting the neuromuscular apparatus of the intestine. In chronic colitis, accompanied by diarrhea, mineral waters are prescribed in a reduced amount, 1-2 times a day, always hot. Reception of warm mineral water is indicated for chronic colitis, accompanied by spastic constipation. With a decrease in the motor function of the intestine, mineral water should be drunk cold, since in this case it helps to stimulate intestinal motility.

Apart from medicinal drink various mineral waters, rectal procedures in the form of bowel lavage, intestinal shower are widely used for intestinal diseases. Intestinal lavage helps to remove fecal matter, mucus, toxins. Mineral water, acting on the mucous membrane and receptors of the distal intestine, reduces the inflammatory process, has a normalizing effect on the intestinal microflora and motor-evacuation function. Contraindications for rectal procedures are increased vulnerability of the rectal mucosa, the presence of anal fissures, and the erosive nature of the mucosal lesion.

In the period of subsiding of the inflammatory process, exercise therapy is indicated. In chronic colitis with constipation and a predominance of spasms, special attention is paid to the choice of starting positions (standing on all fours, lying on your back with legs bent at the knees). At low tone intestines are assigned exercises for the abdominal muscles in various starting positions.

Clinical examination of children with chronic colitis provides for their registration in form No. 30, systematic active monitoring, anti-relapse treatment, and the creation of conditions conducive to complete recovery. After discharge from the hospital, treatment with vitamins (groups B, C, folic acid) should be continued for 3-4 weeks. When chronic colitis is combined with enteritis, enzymes (pancreatin, panzinorm, trienzyme, festal, creon) are prescribed for 1-2 months, with persistent dysbacteriosis - biological preparations for 1/2-2 months. Phytotherapy for 2 weeks monthly for six months (with a change in the fees of medicinal plants). Mineral water, taking into account bowel function for a month. In autumn and spring, anti-relapse courses of treatment lasting 1-1.5 months are recommended. Vitamins (groups B, C, nicotinic acid), eubiotics, biological products, herbal medicine are prescribed, and at the end - mineral waters. The duration of dispensary observation is at least 3 years from the onset or last exacerbation of the disease.

Sanatorium treatment should be carried out in local sanatoriums and balneological resorts in Ukraine (Berezovsky mineral waters, Morshyn, Mirgorod, Truskavets, etc.) in the period of remission in the absence of severe bowel dysfunction.

In the rhythm of today's life, it is often impossible to keep track of the quality and regularity of your own nutrition. From this, the main problems arise in the stomach area, complaints of pain become more frequent. Chronic intestinal colitis is a disease associated with the appearance of inflammatory processes in the layers of the large intestine. It is always accompanied by a violation of the functions of motility and secretion. This problem is most susceptible to people who have previously encountered disorders in the field of digestion.

Exacerbation of chronic colitis can occur for a variety of reasons. The main and most common are:

The causes of intestinal colitis can be very diverse from infectious agents to ischemic factors. Based on this, chronic colitis can be classified as follows:

infectious;
alimentary;
toxic;
ischemic;
allergic;
ray;
combined.

Video “Causes and symptoms”

The video tells about the causes and symptoms of the disease.

Signs and symptoms

Signs of intestinal colitis can appear only in the most advanced stage, when the pathology is already clearly expressed. In the early stages, the disease does not have a bright and pronounced character. There are such health problems that, as a rule, no one pays much attention to:

These signs are very fleeting and are perceived as one-time deviations, while the cause remains.

Chronic colitis never appears quickly and suddenly. It makes itself felt after any inflammation or injury. More than half of the cases are associated with incorrect treatment of intestinal infections. An interesting fact is that in 12% of cases the disease is able to recede on its own without any medical care. This happens when the patient simply does not apply for qualified help and does not feel problems to maintain normal rhythm life.

In remission, colitis has the following symptoms:

With visual and careful observation, one can note the presence of a whitish coating on the tongue, swelling in the stomach area, when examined with a stethophonendoscope, wave-like contractions of the walls are observed, and painful sensations appear during palpation examination.

Diagnostics

In order to compare the diagnosis of chronic intestinal colitis with symptoms and prescribe treatment, a number of relevant studies are carried out, which are prescribed by the doctor.

To begin with, blood is taken for a general analysis. The main thing that people pay attention to is an increased rate of ESR, leukocytes and neutrophils.

They also do a stool coprogram, here important indicator is the presence of fiber, protein, fats, starch, ammonia and organic acids.

A colonoscopy is performed, that is, the large intestine and its surface are examined using an endoscope. Where can you find the lesion, the severity of the vascular pattern.

In order to trace relief changes, irrigoscopy is done - X-ray method colon examination with contrast agent which is injected into the large intestine.

Against the background of all studies, the attending physician must exclude a number of diseases that have similar symptoms:

Crohn's disease;
oncology of the colon;
dysentery in the chronic stage;
appendicitis in a chronic condition;
amoebiasis;
enteritis;
pathology of the digestive system and liver.

When diagnosing the disease and prescribing treatment for chronic intestinal colitis, comprehensive research. This helps to establish the stage and form of the disease, as well as the changes that have occurred in the body under the influence of the disease.

Treatment

Colitis is treated by a special doctor - a gastroenterologist. The diagnosis is confirmed by an endoscopist. If the diagnosis is confirmed, then in case of exacerbation, the patient is hospitalized. Treatment is carried out in a hospital under the supervision of doctors.

The main requirements in the treatment of the disease include methods of dealing with the "provocateurs" of inflammation. The basic purposes are:

revision and normalization of the regime;
strict diet;
drugs that kill the infection;
drugs that restore the intestinal microflora, as well as immunostimulating agents;
antihistamines;
vitamin and mineral complexes.

During remission, bed rest is completely unnecessary, on the contrary, it is necessary to live a full and active life. The main thing is to avoid stress on the abdominal muscles. You can do non-strength exercises. Sports such as swimming, walking, Pilates are perfect.

Sleep should be restored and normalized, this is well influenced by walks before bedtime, teas with mint and lemon balm, a special bandage can be used and tight underwear should be avoided.

In order to defeat chronic colitis and the treatment prescribed by the doctor gave a result, it is necessary to forget about the use of alcoholic beverages and tobacco products.

Diet

The key to recovery and the "foundation" of treatment is strict special diet. She is prescribed by a gastroenterologist or nutritionist. It is necessary to eat small portions, but often. As a rule, meals should be 6 meals a day. Eating passes through an equal period of time, with the exception of a night's sleep.

Meals and food should be balanced. The ratio of carbohydrates, proteins and fats should be 4:1:1, respectively. If a relapse occurs, then carbohydrates are reduced.

Best for stress relief digestive system, eat homogeneous dishes, frayed. It is good that soups are present in the diet, but flour products should be excluded. It is not advisable to consume grapes, coffee, tea, chocolate, cocoa, spicy dishes, fresh cabbage, offal and fatty fish.

It is better to give up freshly squeezed juices, eat fruits and vegetables. You can add some chicken and lamb.

Preference is given to the steam method of processing products, to refuse frying. And after sleep, it is recommended to drink a glass of warm water on an empty stomach.

Treatment with drugs and medicines

The treatment of colitis is based on two main stages:

elimination pain symptoms with an acute form;
prevention of recurrence in the future.

During exacerbation and sharp deterioration the patient's condition, treatment is carried out in the hospital in the department of gastroenterology.

Medicines are used for severe forms. In cases of allergic and enzymatic forms, appropriate medications are prescribed for a long period.

Antibacterial and antimicrobial therapy includes: Furazolidone, Loperamide, Enterofuril, Tetracycline, etc.

Of the antispasmodics prescribed: No-shpa, Drotaverine hydrochloride, Papaverine hydrochloride, Duspatalin. If the pain is very strong, then intramuscularly should be injected with Platifillin.

If there is a pathology of the gallbladder together with colitis, then it is necessary to prescribe choleretic drugs: Hofitol, Holosas, Allochol, rosehip syrup.

To restore damaged tissues and enhance cellular regeneration, it is necessary to take nicotinic acid and B vitamins.

To facilitate the processes of digestion and improve the absorption of food, enzymes are taken: Creon, Mezim, Pancreatin.

To cleanse the body and remove harmful toxic substances, adsorbing agents may be prescribed. medications. The most popular: Smecta, activated carbon.

In case of violation of the stool, namely with constipation, laxatives of plant origin - Sennade, saline - Bisacodyl are used.

The most important thing is not to prescribe a course of treatment on your own, and in case of any deterioration in the condition, contact your doctor for advice and a change in the medication program.

ethnoscience

Do not neglect folk remedies in the fight against the disease. In the "grandmother's well" there are always a few simple, but very effective recipes. Here are a few of them:

Help to cope with an unpleasant illness herbal preparations, tinctures and decoctions:

20 ml tincture of hawthorn, peony, mint, calendula, motherwort; Combine 30 ml of valerian, 5 ml of belladonna and take this mixture from 1 to 8 drops at a time. Do the procedure 3-4 times a day 10 minutes before meals.
For constipation, which may accompany the disease, use a special collection of herbs. It includes: dill seeds, oregano, buckthorn bark and immortelle inflorescences.

Having considered how chronic colitis manifests itself, its symptoms and treatment different ways should study the consequences associated with the disease and preventive measures.

Consequences and preventive measures

In case of exacerbation and severity of symptoms, it is necessary to call a doctor and “move” to a hospital for further treatment. If you ignore the "signals" of the body for help, then the following may develop: serious complications and diseases:

inflammation of the kidneys - nephritis;
intoxication in the body;
violation water balance, dehydration;
violation between blood flow to the heart and its outflow;
decrease in the content of chlorine minerals in blood plasma;

Treatment is complex, taking into account all the current and accompanying symptoms of the disease. In the absence of a clear pronounced signs serious measures must be taken to recover the patient, otherwise such consequences may arise.