is an inflammatory disease of the large intestine that can occur for various reasons. The disease can be caused by poisoning, microflora disturbance, drug abuse, any infectious disease, and so on.

The International Classification of Diseases, Tenth Revision (ICD-10) assigns different numbers depending on which type was diagnosed in the patient. The disease can have both acute and chronic forms. There are several main types of the disease:

1. . There are many reasons for this type of illness. However, all forms of ulcerative colitis have ICD-10 code K51. The ICD code for the ulcerative form may also indicate what type of ulcerative colitis is present in a given patient.
2. Infectious. The cause of this disease is pathogenic microorganisms. The code for this type of disease is designated K52.2. Allergic and nutritional colitis may also be included here.
3. Ischemic. It occurs as a result of impaired blood circulation in the vascular system of the large intestine. Refers to number K52.8.
4. Toxic. Appears due to intoxication of the body and is recorded under the number K52.1.
5. Radiation. This type of disease develops only as a result of radiation sickness and is coded K52.0.

Colitis is an inflammation of the colon mucosa

It has a code according to ICD-10 depending on the reason for its appearance. It can also be said that the ICD-10 code for chronic colitis is determined in the same way. In addition, the disease may be complicated by gastroenteritis and therefore have a different classification code.

Classification of colitis allows us to determine the cause of its occurrence, as well as outline further plans for its therapeutic treatment. The therapeutic course should be developed the attending physician who will select the most effective treatment methods for each specific situation.

Treatment

It should be developed by a gastroenterologist or. First of all, colitis can be treated through dietary adjustments. The disease is characterized by irritation of the colon mucosa, so the main point of the diet is to create more comfortable conditions for the digestive system.

For this purpose, foods high in fiber should be temporarily stopped and replaced with soft boiled or stewed food with a minimum of spices, or better yet, no spices at all.

You need to eat 4-6 times a day, which will allow the gastrointestinal tract not to resort to heavy loads. In addition, you should drink plenty of fluids to avoid dehydration of the intestinal mucosa.

Damage to the intestinal mucosa occurs for a variety of reasons

In addition to diet, methods of classical drug therapy can also be used. Various antibiotic drugs are used ( Tsifran, Enterofuril, Normix), analgesics and antispasmodics ( Papaverine, No-shpa). The issue of normalizing stool and intestinal microflora is also addressed.

Conclusion

When the first signs of colitis appear, you should consult a doctor as soon as possible. If you do not start treating the disease on time, it can develop into a disease, after which it will become much more difficult to cure.

For the purpose of prevention, it is necessary to monitor the quality of your diet, exclude fatty, fried, too sour and spicy foods from your diet, and also periodically visit a proctologist and gastroenterologist. Chronic colitis is best treated through long-term therapy in a sanatorium-resort setting.

This term translated from Latin means inflammation of the colon. The inflammatory process occurs in the intestinal mucosa. The cause of the disease may be:

1. Infectious bacteria;
2. Poor nutrition and use of low-quality products;
3. Long-term use of antibiotics;
4. Abuse of laxatives;
5. Abdominal surgery;
6. Working with toxic substances (arsenic, mercury).

Both women and men over forty years of age are susceptible to colitis. All over the world, forty percent of people suffer from chronic colitis (ICD-10 code is K50-52, different codes according to the classification of the disease). Based on their effect on the body, they are divided into two classifications:

• Acute is a non-protracted disease of the gastrointestinal tract of the body.
• Chronic colitis is a natural continuation, lasts for years and requires long-term treatment.

With any type of disease, and even when the inflammatory process begins, the body gives signs, the main thing is to recognize them.

Signs of chronic colon disease:

• Complete absence of stool for a week;
• Heaviness in the abdomen after and before meals, an external sign of an enlarged abdomen;
• Severe, frequent pain in the abdominal area, a pronounced symptom of the disease;
• Changes in stool, presence of blood and discharge;
• Frequent and false urge to go to the toilet “for the most part”, resulting in the release of mucus;
• Stool immediately after eating, early in the morning after waking up or before bedtime;
• Diarrhea with complications in the form of complete dehydration of the body;
• Bad breath, consequences of food stagnation in the stomach and intestines of a person;
• Constant rumbling in the stomach;
• Weakness and severe fatigue of the body, the immune system is weakened;
• Frequent belching with odor;
• Rapid weight loss;
• Pain in muscles and joints;
• Dolichosigma (constant constipation).

Causes of the disease:

• Bad habits;
• Infection;
• Long-term use of antibiotics, laxatives;
• Food and drug allergies;
• Metabolic disorders of the body;
• Inactive lifestyle.

Diagnosis of the disease

If symptoms are present, it is necessary to diagnose the disease. It is performed by a therapist or gastroenterologist. All data and symptoms must be presented. Enterites are divided into several types.

Etiological classification (by causes) of colitis:

1. Infectious (consequences of intestinal infection);
2. Nutritional (poor nutrition);
3. Allergenic (if you are allergic to food);
4. Intoxication (result of poisoning);
5. Radiation (receiving radiation);
6. Ulcerative (consequences of an ulcer of the mucous membrane).

When diagnosing a disease, a doctor must confidently make a diagnosis. There are diseases with symptoms similar to chronic colitis:

• Bowel cancer;
• Any disease of the digestive organs;
• Appendix;
• Enteritis.

For a reliable analysis, a comprehensive study is carried out. The medical history needs to be analyzed. Using the following methods, the area and damage to the intestine are identified, the severity is determined, and treatment is prescribed.

1. A general and biochemical blood test is carried out to analyze the condition of the body organs;
2. Scatological examination of stool is necessary to study the level of amino acids, ammonia and fiber;
3. Examination of an x-ray of the colon;
4. Colonoscopy is a method for identifying the source of infection and atrophic changes in the intestine;
5. Irrigoscopy - using this method, changes in relief in the intestinal mucosa are detected;
6. Ultrasound of internal organs and study of their structure (distal colitis).

Treatment methods for chronic colitis

When the pathogenesis of the disease is identified, immediate therapy is required. Timely initiation of therapy will prevent complications and improve a person’s general condition.

The procedure depends on the degree of the disease. At the initial stage, a special diet is prescribed, and exacerbation of the disease leads to the use of medications.

In case of exacerbation of the disease and in case of urgent hospitalization, the patient is prescribed medications and a strict diet. Treatment is prescribed to each patient individually depending on the type, stage of the disease and area of ​​infection in the body. If treated incorrectly, the situation can develop into serious complications.

Drug treatment

Clinical treatment means pill therapy or surgery for complications.

Medicines for treatment:

1. Sulfonamides (antibacterial and antiallergic drugs);
2. Eubiotics (effective drugs with a high content of hydroxyquinoline, reduce abdominal pain, normalize stool);
3. Probiotics (microorganisms necessary to restore the intestinal environment);
4. Antispasmodics (to reduce pain);
5. Laxatives (to combat constipation and diarrhea);
6. Antibiotics;
7. Sedatives ();
8. Enzyme tablets;
9. Vitamins (an effective form for healing the tissues of the intestinal mucosa);
10. Multienzyme tablets (for dysbacteriosis).

A diet is necessary and without proper nutrition the effectiveness of medications is zero, it is impossible to cure the disease.

The diet is compiled individually. General rules :

1. Eat at least four times a day in small portions;
2. Add fiber to your diet in the form of cereals, vegetables, fruits and bread;
3. Eat meat and fish without fat and boiled;
4. Eat boiled eggs for breakfast in the morning (non-infectious colitis);
5. Give preference to first courses made from vegetable broths;
6. Diversify your diet with seafood;
7. Exclude carbonated drinks, alcoholic drinks, dairy products, hot spices.

Folk remedies for treatment

Chronic colitis can be treated at home and with folk remedies after remission.

Folk remedies against colitis:

1. Sage tincture. Pour a tablespoon of dried leaves into two glasses of hot water, let it brew for thirty minutes, strain and take the decoction three times a day, half a glass before meals. Duration: two weeks.
2. Plantain juice. Extract the juice from finely chopped fresh leaves. Add an equal amount of honey and keep in a water bath for twenty minutes. Store the juice in the refrigerator with the lid tightly closed. Take one teaspoon twice a day for ten days.
3. Apple juice. Add one hundred grams of honey per liter of freshly squeezed juice. Take in the morning on an empty stomach for two months. Use only if colitis is non-ulcerative.
4. Walnuts. Take 2 pieces as a snack once a day after lunch.

Folk remedies should be used after consulting a doctor.

Prevention

To prolong the remission phase, in order to prevent colitis, the following conditions should be met:

• Follow a diet, eat food in moderation;
• Drink two liters of clean water every day;
• Observe basic hygiene rules;
• Often when you want to go to the toilet;
• Get examined and see a doctor if you have pain and intestinal problems;
• Observe safety precautions when working with chemicals;
• Do not use tobacco or alcohol;
• To live an active lifestyle.

Definition. Nonspecific ulcerative colitis (UC) is a chronic autoimmune disease that causes ulcerative-necrotic changes in the colon, as well as multiple systemic lesions.

ICD10: K51 – Ulcerative colitis.

Etiology. The etiological factors of UC may be unknown forms of viral and/or bacterial infection in combination with a genetic predisposition to this disease.

Pathogenesis. In the pathogenesis of the disease, immune hyperreactivity, provoked by etiological factors, is of leading importance. The local pathological process begins with the fixation of immune complexes in the wall of the colon. Then neutrophil infiltration and swelling of the mucous membrane of the rectum and colon occurs. Ulcerations, microabscesses, and sometimes perforation of the intestinal wall appear. Subsequently, fibrosis of the mucous membrane, submucosal layer, strictures, and hyperplastic processes in the mucosa are formed, often with the formation of pseudopolyps and a malignant tumor. Systemic lesions occur: joints (polyarthritis), skin (erythema nodosum, pyoderamia gangrenosum, etc.), eyes (panphthalmitis), biliary system and liver (sclerosing cholangitis, fatty hepatosis), thyroid gland (autoimmune thyroiditis), blood (autoimmune hemolytic anemia ). Long-term course of UC leads to the formation of secondary amyloidosis of internal organs: intestines, kidneys, liver, etc.

Clinical picture. The disease occurs in acute, chronic and recurrent forms.

The acute (fulminant) form is rare. It is extremely difficult. Affects the entire large intestine. Often leads to death.

The chronic form is characterized by a gradual onset, persistent, continuously progressive course, and pronounced systemic manifestations of the disease.

The recurrent form is more common than others. It has a relatively favorable course with periods of exacerbation, followed by long-term remissions, and sometimes spontaneous recovery.

In typical cases, the disease begins with damage to the rectum, which causes the appearance of scarlet blood in normally formed stool. For several years this may be the only manifestation of UC. As the pathological process progresses, patients begin to feel general weakness, lack of appetite, discomfort or pain in the abdomen, and “unreasonable” fever. Intestinal dysfunction is vague - some patients have a tendency to constipation, and some have loose stools. However, soon the leading symptom of the disease becomes frequent stools with blood, mucus, and pus. Severe rectal tenesmus and intense cramping pain in the abdomen begin to disturb, somewhat decreasing after defecation. In some patients, these disorders are accompanied by fever, and they begin to progressively lose body weight.

An objective examination of patients with UC usually reveals bloating and pain on palpation of the colon. Rectal examination reveals perianal irritation, fissures, fistulas, and abscesses in the intestinal wall. The discharge from the colon may contain blood, pus, and mucus with a minimal volume of feces itself.

In UC, especially in the acute course of the disease, the formation of toxic megacolon (colitis gravis) is possible, which is one of the most common causes of death in UC. This extremely serious condition is characterized by:

Reducing the frequency of bowel movements.

Intensification of abdominal pain.

Sudden fever up to 39-40 0 C.

Severe toxicosis with signs of encephalopathy - lethargy, disorientation, confusion.

Weakening or complete disappearance of intestinal peristalsis sounds.

A sharp decrease in the tone of the anterior abdominal wall, through which the distended colon can be easily felt.

A plain X-ray of the abdomen shows distended areas of the colon.

An extremely severe complication of UC is perforation of the wall of the affected colon with the release of its contents into the abdominal cavity. Symptoms of this lesion include:

An attack of intense abdominal pain.

The appearance of local or widespread muscle tension in the anterior abdominal wall.

Sudden increase in heart rate.

Leukocytosis with toxic granularity of neutrophils.

Detection of free gas under the diaphragm on a plain radiograph of the abdomen.

UC is characterized by systemic manifestations. These include changes associated with impaired intestinal function and general metabolism: a decrease in muscle mass, growth retardation in children, various symptoms of vitamin deficiency, polyglandular endocrine insufficiency, general asthenia with a violation of the psycho-emotional sphere (emotional lability, irritability, tearfulness).

Systemic changes caused by autoimmune hyperreactivity include:

Polyarthritis predominantly affecting large joints, ankylosing spondylarthritis.

Skin lesions: erythema nodosum, various rashes, in severe cases, ulcerative dermatitis, pyoderma gangrenosum.

Eye damage: iritis, iridocyclitis, uveitis, episcleritis, keratitis.

Inflammation of the oral mucosa: aphthous or ulcerative stomatitis, gingivitis, glossitis.

Autoimmune thyroiditis.

Autoimmune hemolytic anemia, thrombocytopenic purpura.

Amyloidosis with predominant kidney damage, the formation of nephrotic syndrome.

Damage to the biliary system and liver and in the form of sclerosing cholangitis of small intrahepatic ducts, fatty hepatosis.

Diagnostics.

Complete blood count: hypochromic anemia, leukocytosis with a shift to the left, increased ESR. In severe cases with autoimmune hemolytic anemia, reticulocytosis and thrombocytopenia are detected.

Biochemical blood test: hypoalbuminemia, hypergammaglobulinemia, increased activity of alkaline phosphatase and gamma-glutamyl transpeptidase in the event of sclerosing cholangitis, various electrolyte disorders.

Coprogram: mucus and blood clots are macroscopically visible in the stool. Microscopically: red blood cells, leukocytes, clusters of intestinal epithelial cells, fatty acid crystals. A strongly positive Triboule test for soluble protein (exudate) in the stool.

Immunological analysis: increased content of immune complexes and immunoglobulins circulating in the blood, positive Coombs test for autoimmune hemolytic anemia.

Colonoscopy: disappearance of normal folding of the mucous membrane, inflammatory exudate from mucus, pus, blood. The mucosa is hyperemic, with multiple hemorrhages, dilated small vessels. In severe cases, multiple ulcers and pseudopolyps (epithelium-covered granulation tissue) are visible against the background of hyperemic, sometimes granulating mucosa.

Irrigoscopy with barium enema: narrowing and shortening of the intestine (the “water pipe” phenomenon), smoothness of the contours of the mucous membrane, disappearance of haustration, ulcerative niches, filling defects in places where pseudopolyps are formed.

Differential diagnosis. Carry out primarily with bacterial and amoebic dysentery.

In order to differentiate UC from bacterial dysentery, stool samples are cultured on differential nutrient media. Examination of feces using fluorescent microscopy and the carbon agglomeration reaction allows one to obtain a rapid conclusion about the presence of dysentery.

To differentiate UC from amoebic dysentery, such characteristic symptoms of amoebiasis as blood in the stool in the form of “raspberry jelly”, glassy mucus in the form of “frog caviar”, microscopic visualization of tissue and histolytic forms of amoeba in fresh feces are taken into account.

For differential diagnosis of tumor lesions from other diseases with a similar clinical picture, the results of histological examination of biopsy specimens of the colon mucosa are used. Systemic manifestations of the disease characteristic of UC are taken into account.

Survey plan.

General blood analysis.

Analysis of urine.

Coprogram.

Biochemical blood test: total protein and fractions, alkaline phosphatase, gamma-glutamyl transpeptidase activity.

Immunological study: content of circulating immune complexes, immunoglobulins, Coombs test.

Sigmoidoscopy, colonoscopy.

Irrigoscopy.

Ultrasound of the abdominal organs, kidneys.

Treatment. A diet with an increased content of animal protein and a slight restriction of fats is prescribed. In case of loss of more than 15% of body weight, parenteral nutrition is prescribed through a subclavian catheter. Lipofundin, Intralipid, Vitalipid, glucose and electrolyte solutions are administered dropwise.

5-aminosalicylic acid preparations are used as a basic anti-inflammatory treatment for ulcerative colitis:

Sulfasalazine tablets (0.5) in a dose of 1.5 to 12 g per day, depending on the severity of the disease.

Salofalk (tidokol, mesalazine) in tablets (0.25) is given in a daily dose of up to 1.5 g for mild forms, and up to 3 g for moderate forms of UC.

Salazopyridazine and salazodimethoxin tablets (0.5) are usually prescribed 1 tablet 4 times a day. In severe cases of the disease, the dose can be increased to 4 g per day.

Glucocorticoids are recommended for all patients with severe UC, for moderate forms in the presence of systemic lesions, and in the absence of effect from other treatment methods. Prednisolone is given orally in a daily dose of 40-60 mg for 3-5 months, followed by gradual withdrawal.

Cytostatics are used when it is necessary to reduce the dose of administered glucocorticoids or stop treatment with them:

Azathioprine 1 tablet (0.05) 3 times a day for 3-4 weeks.

Cyclosporine starting at a dose of 15 mg per day for 2 weeks, then the dose is reduced to an individually selected minimum level that ensures remission of UC.

If there is a threat of developing toxic megacolon or sepsis, antibacterial drugs are prescribed. Cephalosporins, metronidazole, and biseptol are used. After a course of antibiotic therapy, they try to restore normal intestinal microflora by prescribing oral bactisubtil, bifidumbacterin, bificol for at least 2-3 months.

To combat intoxication and electrolyte disorders, intravenous drip infusions of glucose, Ringer, and saline solutions are prescribed.

In many cases, hemosorption and plasmapheresis provide a high therapeutic effect, allowing to reduce the content of circulating immune complexes in the blood.

If conservative treatment is ineffective, resection of the affected colon is performed.

Forecast. Mortality over 20 years of chronic disease reaches 40%. In mild forms of UC, the prognosis is much more favorable.

Publication date: 26-11-2019

What is chronic colitis and what is the disease code according to ICD-10?

Chronic colitis (ICD-10 indicates different codes depending on the specifics of the disease) is a disease with prolonged inflammatory processes in the large intestine. Symptoms of this disease appear in only half of the patients who come for a consultation with a gastroenterologist. According to statistics, in women this disease develops after about 20 years, and in men - after 40. There are practically no patients in childhood.

Classification of the disease

The classification of colitis has been developed not only depending on the type of disease, but also according to the ICD-10 code. It all depends on the severity of the disease and its characteristics. Each type has a different clinical picture and causes different responses to therapeutic intervention.

First of all, the disease can be acute or chronic. In the acute form, the symptoms are quite vivid. In this case, inflammatory processes can occur not only in the area of ​​the large intestine, but also affect the stomach and small intestine. As a result, the patient develops a complex of signs of gastroenterocolitis. In the chronic form of the disease, the symptoms subside, but the disease periodically worsens.

Based on etiology, the disease is divided into the following types:

1. Ulcerative. This is a disease that does not have an exact etiology. It can develop due to a hereditary factor, infection or autoimmune processes. All forms of ulcerative colitis, according to the ICD-10 classification, have code K51. This includes proctocolitis of the mucosal type, pseudopolyposis of the colon, rectosigmoiditis, proctitis, ileocolitis, enterocolitis, unspecified disease and other forms with the manifestation of ulcers. Enterocolitis of ulcerative type in chronic form has code K51.0. For ileocolitis in chronic ulcerative form, numbering K51.1 has been established. Chronic proctitis with ulcers is distinguished by the number K51.2. Recrosigmoiditis in chronic form with identified ulcers is designated as K51.3. For pseudopolyposis, the numbering is set to K51.4. If mucosal type proctocolitis is detected, then it is K51.5. Other ulcerative type colitis is designated by code K51.8. If this is an unspecified form, then the number K51.9 is indicated.
2. Infectious. This type of colitis is caused by pathogenic microflora, which can be specific, conditionally pathogenic, or standard. The international organization has established the number K52.2 for this form of the disease. In addition, colitis and gastroenteritis of alimentary and allergic types are indicated under this number.
3. Ischemic. In this case, the disease develops due to occlusion of a branch of the abdominal aorta. It is what ensures blood circulation in the large intestine. According to the classification, this disease has the number K52.8. The same line includes specified non-infectious forms of colitis and gastroenteritis, except for toxic and radiation ones. As for unspecified forms of colitis and gastroenteritis of a non-infectious nature, the code K52.9 is established, according to ICD-10.
4. Toxic. This form of the disease is caused by poisoning with poisons, drugs or other drugs. According to ICD-10, group K52.1 is established. But this includes not only colitis in this form, but also gastroenteritis.
5. Radiation. This form of colitis appears with radiation disease in a chronic form. According to ICD-10, the number is set to K52.0. This also includes radiation gastroenteritis.

There is another classification of this disease depending on the location of the lesions. First, there is pancolitis, in which all parts of the colon are affected. Secondly, there is typhlitis - inflammatory processes develop on the mucous membrane of the sigmoid intestine. Thirdly, there is such a form as sigmoiditis, when inflammatory processes spread to the mucous membranes of the sigmoid intestine. The last form is proctitis. In this case, inflammation develops only on the rectal mucosa. There are often situations when one patient develops several forms of the disease simultaneously, that is, not only in the colon, but in adjacent areas.

Causes of the disease

Nonspecific ulcerative colitis and its other types in chronic form can be caused by various factors. For example, this may apply to medications. This disease is usually caused by antibiotics, laxatives and sulfonamides. Due to prolonged use, they are absorbed into the intestinal walls, disrupt the microflora and cause inflammation.

Dietary disorders can also contribute to this, for example: fasting, dieting, overeating, fried and fatty foods, smoked foods, alcoholic drinks. Colitis can be caused by occupational poisoning. This applies to people who work with arsenic, mercury and metal compounds.

In old age, UC (nonspecific ulcerative colitis) and other forms of chronic disease are often caused by intestinal atony. In addition, it is necessary to take into account the toxic substances that are released during the development of renal and liver failure, as well as gout. Sometimes this illness is caused by an allergic reaction to medications and foods. It is imperative to take into account malformations of the intestine and its individual structures.

Often the disease develops after an injury to the abdominal cavity, which leads to disruption of blood flow in this area and damage to the intestinal walls. This can happen not only after an injury, but also during surgery. Blood flow in the intestines can also be disrupted due to thrombosis of blood vessels and the development of atherosclerosis in this area.

There are a number of conditions under which chronic colitis worsens:

• stress and any anxiety;
• lack of fruits and vegetables in the diet;
• low-calorie diet;
• drinking alcohol;
• weak immunity after suffering an infectious disease.

All these factors can provoke an exacerbation.

Symptoms of the chronic form

Usually the symptoms of this disease are secondary. They appear against the background of other diseases that affect the organs of the digestive system: hepatitis, cholecystitis, pancreatitis, gastritis, etc.

During an exacerbation of chronic colitis, the patient constantly feels pain that is dull in nature. Unpleasant sensations intensify during eating, shaking or after stress. The stool changes - diarrhea and constipation may alternate. Often there is rumbling and bloating in the abdomen. Sometimes tenesmus appears - this is a false urge to defecate. When defecating, mucus may come out of the rectum along with stool.

A person feels an unpleasant bitterness in the mouth, especially in the morning. During the day he quickly gets tired, feels weak and unwell. Belching often appears. The patient is feeling sick. Sleep is also disturbed.

All these symptoms are associated with the fact that the large intestine does not perform its functions and does not absorb useful substances - microelements, vitamins, proteins. As a result, this affects metabolic processes in the body. During remission, symptoms are mild and disappear quickly.

Complications appear in ulcerative and fibrous forms of the disease, when the pathology disrupts the muscle layer of the organ.

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For example, perforation of an ulcer may occur when stool passes into the peritoneum. This leads to peritonitis. Gangrene may develop. This happens with vascular thrombosis. If the blood vessels are destroyed, severe intestinal bleeding begins. In addition, an infection can enter the intestines and spread to other organs, causing sepsis, pyelonephritis, abscess of the liver and areas near it.

The code for chronic colitis varies depending on the type of disease, which is indicated in ICD-10. This usually applies to classes K51 and K52, with further clarification depending on the shape and type.

Treatment Goals: maintaining remission and preventing complications (disappearance of pathological impurities in stool, normalization of stool, relief of abdominal pain, regression of systemic manifestations, decrease in ESR, increase in hemoglobin content, etc.).

Non-drug treatment: diet number 4.

In severe cases of the disease if there is a loss of more than 15% of body weight during the period of this exacerbation, parenteral nutrition is indicated. In this case, adequate hydration and correction of electrolyte disturbances (usually hypokalemia) are necessary.

In the treatment of UC and CD, the effectiveness of 5-aminosalicylic acid (5-ASA), glucocorticoids and cytostatics has been proven. Basic therapy consists of prescribing 5-ASA drugs (preferably in combination with folic acid).

The main indications for prescribing corticosteroids for UC are: left-sided and total lesions with severe course, III degree of activity, acute severe and moderate forms with extraintestinal manifestations/complications.

Indications for prescribing corticosteroids for CD are: severe anemia, weight loss exceeding 20% ​​of the initial one, extraintestinal manifestations/complications, relapse after surgery.

In patients with intolerance or ineffectiveness of 5-ASA and corticosteroids, cytostatics (azathioprine) are indicated, which are also prescribed to patients in whom remission has been achieved with their use.

For mild flow use mesalazine at a dose of 2-4 g/day, mainly in tablet form, or sulfasalazine (2-8 g/day). Preference is given to mesalazine, which is less toxic and has fewer side effects. For isolated proctitis, it is possible to prescribe mesalazine in the form of rectal suppositories and enemas (4-8 g/day).
For a more lasting effect, it is possible to combine 5-ASA drugs with corticosteroids prescribed in the form of rectal enemas (hydrocortisone at a dose of 125 mg, prednisolone 20 mg twice a day until bleeding stops). Once remission is achieved, patients should receive at least 2 years of maintenance therapy with mesalazine or sulfasalazine (2 g/day).

For moderate forms 5-ASA preparations in the above doses are combined with corticosteroids (hydrocortisone or prednisolone). Hydrocortisone is administered rectally at a dose of 100-200 mg twice a day. Prednisolone is also prescribed in the form of enemas 20 mg twice a day or orally 40 mg per day (until the effect is achieved, usually during the first week), 30 mg (next week), 20 mg (one month), followed by a dose reduction by 5 mg/day. In the presence of perianal complications, the complex of treatment measures includes metronidazole at a dose of 1.0-1.5 g/day. Additional drugs (antibiotics, prebiotics, enzymes, etc.) are prescribed according to indications.

For severe forms 5-ASA preparations in the above doses are combined with large doses of corticosteroids. Hydrocortisone is prescribed 100 mg intravenously 6 times a day or prednisolone 30 mg intravenously 4 times a day for 5-7 days. Intravenous administration of corticosteroids is combined with rectal administration (hydrocortisone 100 mg in enemas 2 times a day). Subsequently, they switch to oral corticosteroids. According to the indications mentioned above, azathioprine is prescribed intravenously at a dose of 150 mg/day. In the future, azathioprine is prescribed as maintenance therapy at a dose of 50 mg/day.

Patients must be examined daily, and those in serious condition - 2 times a day. Particular attention should be paid to changes in body temperature, pulse rate, abdominal size and abdominal wall tension.

Emergency indications for surgical treatment UC(colectomy) are: toxic dilatation, perforation, massive bleeding, lack of improvement in severe cases with adequate therapy (including intravenous steroids) within 5 days. Planned indications include: severe UC in the absence of effect from conservative therapy with disease progression, frequent relapses, significantly worsening quality of life, high-grade dysplasia or malignancy.

Main indications for surgical treatment of CD are: severe forms in the absence of effect from conservative therapy, intestinal obstruction due to strictures, fistulas, abscesses, perforation.