Nyak disease of the intestine. Ulcerative colitis of the intestine - symptoms, treatment, causes. By the nature of the course of the disease

NUC- a chronic relapsing disease of the colon characterized by a severe diffuse ulcerative inflammatory lesion of the mucous membrane of a nonspecific nature.

Etiological factors:

• Genetic factor (HLA system: genetic HLA markers of UC detected)
• microbial factor
• Violation of the permeability of the intestinal barrier.
• environmental factors
• Impaired immune response

Clinic.

According to the length of the process, there are:

distal colitis (in the form of proctitis or proctosigmoiditis);

left-sided colitis (colon damage to the right bend);

total colitis (damage to the entire colon with involvement in the pathological process in some cases of the terminal segment of the ileum);

According to the severity of clinical manifestations, a mild course of the disease, moderate and severe are distinguished.

By the nature of the course of the disease:

lightning-fast form;

acute form (first attack);

chronic relapsing form (with recurring exacerbations, not more than 1 time in 6-8 months);

continuous form (prolonged exacerbation for more than 6 months, subject to adequate treatment).

Diagnosis of ulcerative colitis

is formulated taking into account the nature of the course (recurrence) of the disease, the prevalence of the process (distal, left-sided, total colitis), the severity of the disease (mild, moderate, severe), the phase of the disease (exacerbation, remission), indicating local and systemic complications. For example: ulcerative colitis, total lesion, chronic relapsing course, moderate severity.

For the clinical picture of ulcerative colitis

typical local symptoms (intestinal bleeding, diarrhea, constipation, abdominal pain, tenesmus) and general manifestations of toxemia (fever, weight loss, nausea, vomiting, weakness, etc.). The intensity of symptoms in ulcerative colitis correlates with the extent of the pathological process in the intestine and the severity of inflammatory changes.

Severe total damage to the colon is characterized by profuse diarrhea with an admixture of a significant amount of blood in the feces, sometimes blood clots, cramping abdominal pain before defecation, anemia, symptoms of intoxication (fever, weight loss, severe general weakness). In this variant of ulcerative colitis, life-threatening complications such as toxic megacolon, colonic perforation, and massive intestinal bleeding can develop. A particularly unfavorable course is observed in patients with a fulminant form of ulcerative colitis.

With an exacerbation of moderate severity, rapid stools up to 5-6 times a day with a constant admixture of blood, cramping abdominal pain, subfebrile body temperature, and rapid fatigue are noted. A number of patients have extraintestinal symptoms - arthritis, erythema nodosum, uveitis, etc. Moderate attacks of ulcerative colitis in most cases successfully respond to conservative therapy with modern anti-inflammatory drugs, primarily corticosteroids.

Severe and moderate exacerbations of ulcerative colitis are characteristic of total and, in some cases, left-sided lesions of the colon. Light attacks of the disease with a total lesion are manifested by a slight increase in stool and a slight admixture of blood in the feces.

Diagnostics.

The diagnosis of ulcerative colitis is established on the basis of an assessment of the clinical picture of the disease, sigmoidoscopy data, endoscopic and radiological studies.

According to the endoscopic picture, four degrees of inflammation activity in the intestine are distinguished: minimal, moderate, pronounced and pronounced.

I degree (minimum) is characterized by mucosal edema, hyperemia, lack of vascular pattern, mild contact bleeding, small punctate hemorrhages.

II degree (moderate) is determined by edema, hyperemia, granularity, contact bleeding, the presence of erosion, confluent hemorrhages, fibrinous deposits on the walls.

III degree (expressed) is characterized by the appearance of multiple confluent erosions and ulcers against the background of the changes in the mucous membrane described above. In the lumen of the intestine pus and blood.

IV degree (sharply pronounced), in addition to the listed changes, is determined by the formation of pseudopolyps and bleeding granulations.

In the stage of remission, the mucous membrane is thickened, the vascular pattern is restored, but not completely and somewhat rebuilt. The granularity of the mucous membrane, thickened folds may persist.

Often, with high activity, the surface of the intestinal mucosa is completely covered with fibrinous-purulent plaque, after removal of which a granular diffusely bleeding surface with multiple ulcers of various depths and shapes without signs of epithelialization is found. Ulcerative colitis is characterized by round and stellate ulcers, imprint ulcers, usually not penetrating deeper than the lamina propria, rarely into the submucosal layer. In the presence of multiple micro-ulcers or erosions, the mucous membrane looks like a moth-eaten one.

For ulcerative colitis in the active stage of the process, when examined with a barium enema, the following radiological signs are characteristic: the absence of haustra, smoothness of the contours, ulceration, edema, serration, double contour, pseudopolyposis, restructuring of the longitudinal type of mucosal folds, the presence of free mucus. With long-term ulcerative colitis, thickening of the mucosa and submucosa may develop due to edema. As a result, the distance between the posterior wall of the rectum and the anterior surface of the sacrum increases.

After emptying the colon from barium, the absence of haustra is revealed, mainly longitudinal and rough transverse folds, ulcers and inflammatory polyps.

X-ray examination is of great importance not only for the diagnosis of the disease itself, but also for its severe complications, in particular, acute toxic dilatation of the colon. For this, an abdominal x-ray is performed. With I degree of dilatation, the increase in the diameter of the intestine at its widest point is 8-10 cm, with II - 10 - 14 cm and with III - over 14 cm.

Treatment of patients with ulcerative colitis (NUC) should be carried out in a specialized hospital.

Treatment of patients with UC should be individual, taking into account the nature of the disease, the prevalence of the process, and

as well as the severity of the exacerbation.

At the heart of pharmacotherapy, it is necessary to adhere to generally accepted world standards:

• the fastest possible elimination of acute attacks of the disease.
• prevention and elimination of complications.
• elimination of relapses and their prevention.
• surgical treatment in the absence of a therapeutic effect in the development of life-threatening complications.

Basic principles of pharmacotherapy:

• diet food.
• preparations of 5-aminosalicylic acid.
• glucocorticoids (as indicated).
• antibacterial therapy (taking into account the sensitivity of the microflora).
• enteral and parenteral nutrition.
• correction of metabolic and dysbiotic disorders.
• application of sorbents
• reserve drugs - immunocorrective (immunosuppressive) drugs, with the ineffectiveness of the above drugs (salicylates, steroids).

Basic therapy for nonspecific ulcerative colitis includes preparations of 5-aminosalicylic acid,

glucocorticoids, as well as the appointment of antibacterial drugs based on the results of microbiological

research of intestinal contents.

With the help of this therapy, remission is achieved in 70-80% of cases with mild to moderate UC, as well as reduce the indications for surgical treatment.

Surgical treatment in the form of coloproctectomy allows the patient to be cured of NUC.

In severe cases, a coloproctectomy or subtotal colectomy is performed, leaving the rectal stump. The operation is completed with an ileostomy or the formation of a reservoir from the small intestine and an ileoanal anastomosis, which is considered the standard of surgical treatment.

In the presence of cancer in the colon in patients with ulcerative colitis (NUC), a colectomy combined with BAR of the rectum is performed, and in case of rectal cancer, a colectomy combined with abdominoperineal extirpation of the rectum. The operation is completed with the imposition of a permanent single-barrel ileostomy according to Brook.

The disease nonspecific ulcerative colitis (NUC), characterized by chronic inflammation of the intestinal mucosa, occurs as a result of a combination of genetic factors with external causes that exacerbate symptoms and serve as a sign of the disease. The disease has a tendency to exacerbate and increases the risk of cancer of the rectum or colon. Timely diagnosis and measures taken can improve the quality of life and prevent dangerous consequences.

What is ulcerative colitis

NUC is accompanied by destruction of cells and tissues of the intestine against the background of a deficiency of immunoglobulins, which provokes the penetration of pathogenic microorganisms into tissues with subsequent inflammation. The disease occurs in the proportion of 100 cases for every 100 thousand of the population. The definition carries a collective semantic load, the disease is divided into forms depending on localization, which, according to the international classification of ICD-10, have the code K51.

Symptoms

The symptoms of UC in adults have a wide range of manifestations, which leads to the absence of serious concern for the patient and the expectation that "it will pass by itself." In the opposite case (fulminant colitis), the patient goes straight to the hospital. You need to contact a specialist if you notice the following symptoms:

1. Blood with excreted feces is the surest sign. These may be faint marks on toilet paper or blood clots.
2. Fragments of mucus and purulent discharge in the feces.
3. Diarrhea, in which the number of diarrhea reaches 20 per day.
4. With the defeat of the sigmoid department, constipation is characteristic.
5. Tenesmus (false urge to defecate). Often caused by accumulations of pus and mucus that come out instead of stool (rectal spit).
6. Flatulence.
7. Pain in the left side of the abdomen (left-sided colitis).
8. Against the background of intoxication, fever develops and the temperature rises.

Extraintestinal manifestations of UC

Non-intestinal lesions caused by UC are diverse. Some are caused by the ileocolitis form (Crohn's disease) - lesions in the oral cavity, others - by the chronic form of enterocolitis. In total, extraintestinal manifestations occur in no more than 20% of patients. Typical ones include:

• erythema nodosum (inflammation of the vessels of the skin and subcutaneous fat);
• pyoderma gangrenosum (skin necrosis);
• symptoms of aphthous stomatitis in the oral cavity in the form of erosions;
• various eye lesions: conjunctivitis, keratitis, uveitis, episcleritis, retrobulbar neuritis, choroiditis;
• joint damage in the form of arthritis, increased fragility (osteoporosis) and softening of the bones (osteomalacia);
• necrosis of a separate segment of bone tissue (aseptic necrosis);
• a third of patients experience lung damage;
• violation of the endocrine system leads to total damage to the liver, pancreas and biliary tract

Signs of ulcerative colitis of the intestine

In the course of the development of the disease, the damage to the mucous membranes increases, which leads to the formation of ulcers, sometimes penetrating to the layer of muscle tissue. In the chronic course of peptic ulcer, conglomerates of cells (inflammatory polyps) appear, which are formed in the process of restoring the affected intestinal epithelium. In a severe form of the disease, the large intestine thickens, and its lumen narrows, haustras (protrusions of the wall) disappear. In the acute phase, capillaries expand in the mucosal epithelium and hemorrhages occur, leading to ischemic necrosis.

Causes

The exact etiology of the disease has not yet been established. There is a correlation between the psycho-emotional state that provokes the disease. To date, experts are seriously discussing three conceptually feasible options:

1. Genetic predisposition, including autoimmune disorders. There are a number of studies that fix the same gene mutations in a large number of patients. However, not all people with such pathologies are susceptible to the disease.
2. Infectious pathology.
3. Adverse environmental factors: strong contraceptives, strict diets.

Classification

For a systematic classification of UC, it is best to refer to the International Classification of Diseases system. In accordance with this system, the disease is divided into forms:

1. Chronic ulcerative enterocolitis (lesion of the mucous membrane of the small and large intestines) - K51.0.
2. Chronic ulcerative form of ileocolitis, also known as Crohn's disease (lesion of the ileum and colon) - K51.1.
3. Chronic ulcerative form of proctitis (damage to the mucous membrane of the rectum) - K51.2.
4. Chronic ulcerative form of sigmoiditis (damage to the sigmoid colon) - K51.3
5. Pseudopolyposis (restructuring of the mucous tissues of the intestine, their dysplasia) - K51.4.
6. Mucosal type proctocolitis (lesion of the rectum, sigmoid and descending transverse colon, including the splenic angle) - K51.5.

Diagnostics

A gastroenterologist can determine distal nonspecific colitis when examining a patient and detecting a number of specific signs. In addition to visual examination, laboratory blood tests are carried out. The patient has a decrease in the number of red blood cells, hemoglobin (signs of anemia), an increased number of leukocytes, C-reactive protein (which is an indicator of inflammation).

An immunological study of blood in patients shows an increase in the level of cytoplasmic antineutrophil antibodies. Of the instrumental methods, the following methods are used:

• endoscopy (rectosigmoidoscopy, colonoscopy) - reveal the presence of ulcers, polyps, intestinal bleeding, atrophy of the colon mucosa;
• radiography - a contrasting barium mixture is used, the patient is found to have an expansion of the intestinal lumen, the formation of ulcers.

Treatment of ulcerative colitis

Treatment of UC consists of a comprehensive symptomatic approach. The objectives of therapy include the elimination of immune inflammation with medications, the maintenance of remission with the help of folk recipes and the patient's diet, and the prevention of local complications. If the methods of classical drug therapy do not help to cure the patient or the effect of them is weak, a surgical operation is performed.

Conservative therapy

Treatment of nonspecific ulcerative colitis begins with medication. Popular groups of drugs are:

1. Antibiotics - are used after surgery, with fevers and sepsis, toxic dilatation of the colon. Of the available drugs, Trichopolum, Metronidazole are isolated at a dose of 10-20 mg / kg per day.
2. Immunosuppressants or cytostatics - are prescribed when corticosteroids are ineffective or continuous treatment. Azathioprine, Methotrexate, Cyclosporine are prescribed. The dose is set by the doctor (from 25 to 100 mg / day), the course of treatment is at least three months.
3. Immunomodulators - Timalin and Taktivin correct the immunological imbalance, eliminate the process of inflammation, help to cure the disease in a complex way.
4. Angioprotectors - Parmidin, Trental.
5. Enterosorbents - Polyphepan, Karbolen, Enterosgel, Vaulin.
6. Intestinal antiseptics - Intestopan, Furazolidone.
7. Antidiarrheal drugs - Almalox, Reasek, Imodium.
8. Enzymes - Mezim, Creon, Pancreatin.
9. Biological products (pre-and probiotics) - Lactobacterin, Bifikol.

Anti-inflammatory drugs

The first in the list of drugs for the treatment of colitis are non-steroidal anti-inflammatory drugs and glucocorticoids. They are assigned on an individual basis and are divided into the following groups:

1. Aminosalicylic acid preparations are salicylates that inhibit the synthesis of inflammatory mediators. These include Sulfasalazine, Mesalazine, Pentasa.
2. Azo compounds - Olsalazin, Balsalazid, Salofalk, Mesacol. Available in the form of tablets, microclysters and rectal suppositories.
3. Hormone therapy with glucocorticoids - used in the absence of the effect of salicylates, they are distinguished by a rapid effect. Means are administered rectally or systemically. Popular drugs are Prednisolone and Methylprednisolone at a dose of 1-2 mg / kg of body weight for a course of 10-20 weeks.

Diet

Of great importance is the diet in ulcerative colitis of the colon. During periods of exacerbation, the patient is recommended fasting, only water is allowed. With a long remission, you need to adhere to the following nutritional rules:

• reduce the amount of fat, increase the percentage of protein, include lean fish, meat, cottage cheese, eggs in the diet;
• give up coarse fiber, bananas, milk, chocolate, coffee, citrus fruits, strawberries, red apples, muffins, spicy foods;
• from carbohydrates, cereals, honey, kissels, jelly, compotes, decoctions are allowed;
• with a high severity of lesions, the patient is transferred to parenteral and enteral nutrition;
• pomegranate juice is used as an astringent.

Treatment with folk remedies

Chronic colitis is accompanied by diarrhea and constipation, traditional medicine recipes will help cure them:

1. Mix chamomile and yarrow in a 5:1 ratio, add an equal amount of nettle, St. John's wort and wild rose. Brew a tablespoon of the collection with a glass of water or put in a water bath. Drink a glass before meals to stop diarrhea and bleeding and prevent putrefaction.
2. To restore intestinal motility, mix equal amounts of herbs: chamomile, goutweed, nettle, mint, valerian root, blueberries. Pour three tablespoons in a thermos with three cups of boiling water overnight. Drink a glass before meals.
3. For the treatment of edema, rapid cell recovery and wound healing, it is recommended to do microclysters with sea buckthorn oil. Type in a pear 50 ml of oil, enter into the rectum in the supine position for the night. Empty your bowels in the morning, drink 1-2 tablespoons of oil on an empty stomach.

Surgery

If conservative treatment fails, surgery is indicated. Types of operations are colectomy (removal of the colon or part of it), proctocolectomy (removal of the rectum and colon), proctocolectomy with ileostomy (without preserving the anus). The reasons for the operation are.

Nonspecific ulcerative colitis (NUC) is a fairly rare disease in which there is inflammation and destruction of the tissues of the large intestine. True, recently reports have begun to appear that cases of NUC have become more frequent.

The name of the disease is deciphered as follows:

• The term "non-specific" means that the disease occurs on its own, without any specific external cause (at least to date, the causes of UC are unknown).
• The term "ulcerative" refers to the condition of the intestine in this disease. During the period of exacerbation in patients with UC, the intestinal mucosa is covered with multiple bleeding ulcers.
• The term "colitis" means "inflammation of the large intestine".

In most patients with ulcerative colitis, the disease involves the rectum, just above the anus, and gradually spreads higher, involving the sigmoid colon and, in some cases, the entire large intestine.

Causes of nonspecific ulcerative colitis

As mentioned above, at the moment the exact causes of the development of NUC are not known.

Most patients with ulcerative colitis have antibodies in their blood.against intestinal tissues. This means that the main mechanism for the development of the disease may be the destruction of intestinal tissues under the influence of the patient's own immune system.

Some researchers believe that the cause of UC may be an increase in the sensitivity of the body's immune system to bacteria living in the intestines. As you know, the large intestine of all people is inhabited by a huge number of bacteria, which in most healthy people normally coexist with the immune system.It is also assumed that a certain role in the development of ulcerative colitis is played by hereditary predisposition to the development of this disease.

Studies have shown that among people whose blood relatives have had UC, this disease occurs about 5-20 times more often than in people whose relatives have never had this disease.

According to some reports, the use of milk and dairy products can cause an exacerbation of the disease.

Symptoms and signs of nonspecific ulcerative colitis.

Nonspecific ulcerative colitis develops over many years in the form of alternating episodes of exacerbation and remission (remission of the disease). During the period of exacerbation, new foci of inflammation form in the intestines and the symptoms of the disease become apparent. Usually, the severity of the symptoms of the disease corresponds to the strength of the inflammation of the intestine. During the period of remission, inflammation subsides and the symptoms of the disease almost completely disappear.

The main symptoms and signs of NUC are:

• Prolonged but slight fever (above 37.5 C)
• Attacks of pain in the abdomen (especially often in the left lower abdomen), which are accompanied by the need to go to the toilet
• Prolonged or intermittent diarrhea with blood
• Weight loss, constant fatigue
• Severe pain in the anus

• Bloody discharge from the rectum, blood in the stool, traces of blood on toilet paper or linen
• Great difficulty passing even soft stools (constipation).

Signs of a possible spread of the disease can be:

• Inflammation and pain in large joints (femoral joint, lower back);
• Frequent episodes of aphthous stomatitis;
• The appearance of a rash, purulent inflammation or dense, scaly lesions on the skin;
• Pain in the eyes, blurred vision.

Nonspecific ulcerative colitis in children.

NUC can develop in a child of any age, but it is especially common in adolescents.

Treatment of nonspecific ulcerative colitis in children is carried out according to the same principles as in adults.

Tests and examinations to detect non-specific ulcerative colitis.

Diagnosis of non-specific ulcerative colitis can be quite complex and involve a large number of tests and examinations. This is due to the fact that the symptoms that are observed in NUC can be observed in many other diseases, therefore, before making a diagnosis of NUC, doctors must exclude other possible diseases.

The complex of analyzes and examinations in the diagnosis of NUC may include:

• General and biochemical blood test
• General urine analysis
• Assay to detect p-ANCA type antibodies and ASCA type antibodies. This analysis is necessary in order to distinguish Crohn's disease from ulcerative colitis (NUC). The detection of p-ANCA antibodies and the absence of ASCA antibodies is a sign of UC, in the opposite situation (the absence of p-ANCA antibodies and the presence of ASCA antibodies), the diagnosis of Crohn's disease is more likely.

To determine the condition of the intestine and identify the exact location of the foci of inflammation, the following examinations may be needed:

X-ray examination of the stomach and intestines- This is a series of x-rays of the abdomen, which are done after the patient is given to drink a certain amount of a contrast agent (barium), similar to dissolved chalk. Barium does not transmit x-rays well and, as it travels down the intestines, it provides clear images of the inside of the stomach and intestines.

Irrigoscopy- This is a procedure during which doctors take a series of x-rays of the abdominal organs after a contrast mass (barium) is injected into the rectum of the person being examined, using an enema.

Colonoscopy- this is one of the most accurate methods for diagnosing ulcerative colitis. Colonoscopy allows not only to accurately determine the location of inflammatory foci, their number and the degree of damage to the structure of internal organs, but also to obtain tissue samples (biopsy) in order to distinguish UC from other diseases with similar symptoms (for example, intestinal cancer).

In some cases, to clarify the state of the internal organs of the person being examined, an ultrasound scan may be necessary. or computed tomography of the abdomen.

What drugs can be used in the treatment of ulcerative colitis?
5-aminosalicylic acid preparations (salicylates)

5-aminosalicylic acid preparations (Sulfasalazine, Mesalazine) have a pronounced anti-inflammatory effect and are currently considered first-line drugs (that is, they are used in the first place) in the treatment of mild and moderate cases of UC.

As with other drugs, the effectiveness of 5-aminosalicylic acid preparations depends on their dosage.

According to current clinical studies, the optimal dosage of these drugs can be from 2.4 to 4.8 g / day.

Although treatment with higher doses is usually more effective and results in faster resolution of symptoms, doctors often decide to start treatment with lower doses (which may also be effective) and increase the dosage if necessary.

Immunosuppressants

We have already said above that the development of an inflammatory reaction in the intestines of people with UC is largely determined by the aggressive effect of immune system cells on normal intestinal tissues.

In this regard, for the treatment of severe cases of ulcerative colitis, doctors may recommend drugs that have the ability to suppress the activity of immune system cells and their ability to destroy intestinal tissue. In medicine, drugs with such properties are called immunosuppressants.

In the treatment of UC, immunosuppressants containing thiopurine derivatives (Azathioprine, 6-mercaptopurine) and Methotrexate are used.

Some recent research suggests that these drugs can be very effective in maintaining remission achieved with other drugs (eg, corticosteroids or cyclosporine).

Corticosteroid anti-inflammatory drugs

Drugs from the group of corticosteroid hormones (derivatives of Dexamethasone, Prednisolone, etc.) have a pronounced anti-inflammatory and immunosuppressive effect.

Typically, they are used to treat severe forms of ulcerative colitis or to quickly resolve symptoms and achieve remission in milder forms of the disease, followed by switching to other drugs that maintain remission (for example, immunosuppressants).

Usually, treatment is started with a high dose of the drug, which is gradually reduced (for example, by 5 mg every week) until a minimum dose is reached that maintains a good therapeutic effect.

How can I determine which medications and at what dosage should I take?

The effectiveness of the treatment of nonspecific ulcerative colitis largely depends on how correctly the drugs were selected and how correctly the regimen for taking them was drawn up.

In order to choose drugs and draw up a regimen for taking them, doctors determine how aggressively the disease develops, what the condition of the sick person is at the time of treatment, how pronounced the symptoms of the disease are, and how important it is for the sick person to quickly reduce their intensity.

According to the nature of development, doctors divide nonspecific ulcerative colitis into 3 categories:

1. mild illness
2. moderate illness course
3. severe illness

In the case of people with severe disease, treatment with 5-aminosalicylic acid preparations may not be effective, so treatment with corticosteroid hormones or drugs that suppress the activity of the immune system may be the best solution for them.

On the other hand, in people with mild to moderate disease, treatment with 5-aminosalicylic acid preparations can be quite effective and eliminates the need for the use of corticosteroids or immunosuppressants, which are associated with a high risk of side effects.

In cases where it is very important for the patient to quickly eliminate the symptoms of the disease, doctors can treat with corticosteroid hormones (even in mild and moderate cases), and then switch to 5-aminosalicylic acid drugs to maintain remission.

Despite the fact that ulcerative colitis belongs to the category of serious diseases, properly organized treatment often allows very good control of its development and symptoms and improves the quality of life of sick people to almost normal levels.

Surgical treatment of nonspecific ulcerative colitis.

In a number of cases, the treatment of non-specific ulcerative colitis involves surgery (removal of part or all of the large intestine).

Surgery for NUC may be necessary in the following cases:

• The disease is not treatable with drugs
• If a person has been diagnosed with cancer
• If the disease provoked severe bleeding or intestinal perforation
• If a sick child has a noticeable developmental delay.

Surgery can lead to complete recovery from ulcerative colitis.

Doctor's observation

Due to the fact that patients suffering from ulcerative colitis have a significantly increased risk of developing bowel cancer, it is recommended that all patients with this disease undergo periodic colonoscopy, which helps to detect cancer in a timely manner and start its treatment on time (in the early stages, bowel cancer responds well to treatment).
The first colonoscopy should be done no later than 8 years after the onset of UC. Further colonoscopy should be repeated approximately every 1-5 years, depending on the situation.

Diet for the treatment of ulcerative colitis

Unlike Crohn's disease, in which diet is an important part of the treatment, in patients with UC, diet does not have any significant effect on disease progression. The main recommendations for catering in the case of UC include:

• The diet should include mainly easily digestible foods (meat, fish, eggs, rice, white bread, potatoes, flour products)
• It is recommended to limit the consumption of whole milk and dairy products. This is necessary to relieve the symptoms of lactase deficiency (diarrhea, bloating), which develop in many patients with ulcerative colitis. Due to the fact that milk and dairy products are an important source of calcium, limiting their intake should be compensated by taking calcium supplements.

Nonspecific ulcerative colitis (UC) is a chronic inflammatory disease of the large intestine. According to the WHO, about 0.4% of the world's population suffers from it. A feature of nonspecific ulcerative colitis is its severe course, poor compliance with therapy and an unknown cause.

Reasons for development

Scientists have not yet been able to determine the specific causes of the onset of the development of this incurable disease.

But still, they identify a number of factors that increase the risk of its occurrence:

• hereditary factors - in 10% of patients, there is someone from close relatives with this disease;
• prone to food allergies;
• smoking - UC is twice as likely to occur in heavy smokers;
• lack of breastfeeding by the mother in the first six months of life.

UC is an autoimmune process. The body itself begins to produce antibodies, that is, killer cells that usually appear in the blood to fight tumors or infections against its own body.

Symptoms depend on the prevalence and severity of the process, as well as the stage of the disease.

If the inflammation is localized only in the rectum (more than 54% of all cases of UC), the symptoms are mild. With a total form, when the entire large intestine is affected, the disease has a severe course.

As a rule, the disease does not begin quickly, but slowly. It is constantly progressing slowly. Only in 5% of all cases, the disease begins acutely, has a fulminant nature, and is characterized by intestinal bleeding, sepsis, and anemia.

Nonspecific ulcerative colitis is manifested by the following symptoms:

• an increase in body temperature to subfebrile numbers (up to 38 degrees);
• diarrhea with mucus and blood;
• urge to defecate;
• cramps and pain in the abdomen.

Complications of UC from the intestines

The main complications of the disease are intestinal. Their general characteristics are presented in the table:

More than 40% of patients have extraintestinal complications of the disease:

1. Purulent lesions of the skin and mucous membranes. Develop during an exacerbation. Manifested by purulent stomatitis and pyoderma.
2. Eye diseases: episcleritis, keratitis, iridocyclitis, retrobulbar neuritis.
3. joint inflammation: arthritis, ankylosing spondylitis.
4. Acute diseases of the hepatobiliary system: hepatitis, sclerosing choloangitis, cholangiocarcinoma.
5. kidney disease: glomerulonephritis, chronic renal failure.
6. Systemic connective tissue diseases: myositis, vasculitis.
7. Are common: anemia, decreased body, lack of albumin in the blood.

When collecting an anamnesis, the doctor should first find out the presence of nonspecific ulcerative colitis in relatives.

Examination and palpation of the patient does not make it possible to make an accurate diagnosis. On palpation, there will be pain in the lower abdomen. It can be visually seen that the abdomen is slightly enlarged.

To confirm the diagnosis, the following instrumental and laboratory examinations are carried out:

Endoscopic examination of the large intestine with biopsy

If UC is suspected, a colonoscopy is mandatory. It is contraindicated in toxic dilatation. When performing a colonoscopy, the doctor takes a piece of intestinal tissue (biopsy) for morphological examination. The laboratory determines the presence of inflammation, the cellular composition of the biopsy. The main signs of NUC during colonoscopy are presented in the table:

Radiography

Signs of NUC:

Treatment of nonspecific ulcerative colitis includes the following items:

1. diet is the basis of all treatment;
2. drug therapy;
3. surgery.

Since UC is an autoimmune disease, its therapy must be constant and continuous.

The goal of therapy is to prolong the period of remission and avoid new episodes of exacerbation and the spread of inflammation to new areas of the large intestine. It is not yet possible to talk about a complete recovery, since the disease is incurable.

Nutrition is as important a component of therapy as medicines.

In severe cases, with exacerbation, food intake is prohibited. You can't even drink water. All the necessary nutrients and liquid are supplied to the body through a dropper. Even drinking water will stimulate the digestive system and aggravate the situation.

With mild to moderate course, you must constantly adhere to strict nutritional rules.

Allowed products:

• Lean meat and fish. It can also be used to cook low-fat soups.
• Kashi, except for wheat and barley. You can eat pasta.
• White bread, biscuit cookies.
• Vegetables: potatoes, carrots, tomatoes, zucchini.
• Mushrooms.
• Boiled eggs. You can also eat a steamed omelet.
• Berries, apples. You can eat them raw, cook compotes from them.
• Dairy products - no more than 100 grams per day.
• Greens: dill and parsley;
• Tea and coffee.

Prohibited Products:

• All varieties of cabbage, peppers, sorrel, beets, onions.
• carbonated water;
• Alcohol, including beer.
• All products are fried and smoked.

The diet should be compiled, taking into account the need for a large intake of protein foods:

Breakfast: 100 grams of cottage cheese, buckwheat porridge, a cup of black coffee.

Afternoon snack: oven-baked apple, compote.

Dinner: fish soup with potatoes and carrots, boiled fish and pasta.

Snack: Tea, sandwich with a piece of boiled chicken breast and dill.

Dinner: mashed potatoes and carrots, steamed chicken meatballs.

1. Mesalazine- used as a basic treatment for nonspecific ulcerative colitis. Its dose ranges from 2 to 4 grams per day. The dose depends on the severity of the clinic, the severity of the disease and the presence of an exacerbation. This drug is an antimicrobial and anti-inflammatory agent. It significantly reduces the frequency of exacerbation episodes.
2. Systemic corticosteroids- are used during an exacerbation. Dose - 1 mg per kilogram of the patient's weight per day. Then gradually the dose of steroids is reduced by 10 mg every two weeks, and when remission occurs, they are gradually completely canceled. For basic therapy, corticosteroids can be prescribed, in the absence of the effect of Mesalazine treatment.
3. Topical corticosteroids- are used in the form of rectal suppositories. The name of the drug is Budesonide. It is used during an exacerbation, starting with a dose of 9-18 mg per day, and then it is slowly reduced. Local forms of corticosteroids are more effective than systemic ones in UC.
4. Immunosuppressants- is prescribed, with the ineffectiveness of corticosteroids, or with the need for their long-term use. Immunosuppressants suppress the immune system, thereby reducing the body's production of antibodies against its own cells. Immunosuppressants include the following drugs:
   • Azathioprine;
   • Cyclosporine;
   • Mercaptopurine.
5. Antibiotics- are prescribed when a purulent infection is attached, and with sepsis. In NUC, the following antibacterial drugs are used:
   • Ciprofloxacin;
   • Tienam (imipenem);
   • Metronidazole.

Surgery

Surgical treatment of the disease is indicated in the development of intestinal complications, or in the absence of a result from drug treatment.

The main indications for surgery are presented in the table:

Operations that are carried out with NUC:

• Palliative surgery, ileostomy- its purpose is to temporarily "turn off" part of the colon. A stoma is placed on the anterior abdominal wall, through which feces will pass. Sometimes - the stoma is removed forever.
• Radical operation- removal of the entire large intestine. Instead, an anastomosis from the small intestine is used.

Nonspecific ulcerative colitis is not a curable disease. But thanks to a constant diet and properly selected basic therapy, it is possible to stop its spread and avoid frequent episodes of exacerbation. With the ineffectiveness of such treatment, patients undergo surgical interventions. Both the diet and all medications should be prescribed exclusively by a doctor. In the absence of exacerbation, the doctor should routinely examine the patient once a month. Close contact between the doctor and the patient, and a trusting relationship between them, is very important.

Treatment of nonspecific ulcerative colitis is long, often delayed for several years, and requires the joint efforts of the doctor and the patient. To eliminate the disease, both traditional methods, which are based on medication, and folk methods are used. In severe cases, surgery is performed. Nonspecific ulcerative colitis most often affects people from 20 to 40 years old, it is less common in children (about 10% of cases).

Causes and mechanisms of the development of the disease

The causes of nonspecific ulcerative colitis are not yet fully understood.

According to the assumptions of the researchers, it can be provoked by the following factors:

• spread of infection in the large intestine;
• malnutrition, the predominance of fatty, high-calorie foods low in fiber;
• hereditary predisposition, gene mutations;
• long-term use of certain drugs, such as non-steroidal anti-inflammatory drugs;
• frequent stressful situations, intense experiences;
• disorders of the intestinal microflora.

As a result of these factors, immune agents begin to attack not pathogenic bacteria and viruses, but the mucous membrane of the large intestine. It becomes inflamed and ulcers form.

Nonspecific ulcerative colitis and Crohn's disease have similar mechanisms of development. The differences are in the depth and breadth of the lesions. In the first case, the disease covers only the large intestine, ulcers and inflammation spread in the mucous membrane and submucosal layer.

In Crohn's disease, the entire digestive tract is involved in the pathological process: from the oral cavity to the anus. In this case, all layers of the digestive tract are captured.

Classification

Nonspecific ulcerative colitis is classified according to the localization of the pathological process:

• proctitis and proctosigmoiditis - the disease covers the rectum and sigmoid colon;
• left-sided colitis - the rectum and left half of the colon are affected up to the splenic flexure;
• total colitis - all parts of the large intestine are inflamed;
• regional colitis - inflammation of the large intestine and regional nodes of the lymphatic system.

In terms of severity, nonspecific ulcerative colitis can be mild, when stools become more frequent, moderate - diarrhea up to 8 times a day, slight fever, severe - diarrhea, temperature above 38 ° C and worsening of the general condition.

Another classification option for non-specific ulcerative colitis is based on the nature of its course. The disease can be acute, chronic and recurrent.

Symptoms

Symptoms of non-specific ulcerative colitis manifest themselves in different ways. Some people, already having the disease, feel well for several years, only occasionally note blood in the stool.

This sign is either ignored, or attempts are being made to eliminate it by folk methods. In others, the onset is acute, with severe diarrhea, high fever, severe pain, and general weakness. In such cases, the patient is urgently hospitalized.

Symptoms of non-specific ulcerative colitis include:

• feces with blood, the amount of which ranges from barely noticeable streaks to profuse flow;
• feces with mucus and pus;
• diarrhea;
• constipation, indicating damage to the rectum and sigmoid colon;
• false urge to defecate, in which not feces come out, but blood, pus and mucus - “rectal spit”;
• nighttime urge to defecate;
• fecal incontinence;
• increased gas formation, flatulence;
• pain in the abdomen, more often in the left half of it and moderately severe;
• signs of intoxication - fever, fever, vomiting, tachycardia, weight loss, dehydration, loss of appetite, general weakness;
• extraintestinal manifestations of nonspecific ulcerative colitis - joint damage, rash on the skin and mucous membranes, visual disturbances, increased thrombus formation, impaired liver function, etc.

The last group of symptoms occurs in about 1 out of 10 patients. Sometimes they occur before the main intestinal ones.

Diagnostics

Diagnosis of nonspecific ulcerative colitis consists of laboratory and instrumental methods. First, the doctor conducts a patient survey and a digital examination, after which a list of necessary procedures is determined.

Treatment of non-specific ulcerative colitis during exacerbation is carried out in a hospital: the administration of drugs with the help of droppers and injections is required, sometimes nutrition through a tube. In the chronic form of the disease, all procedures can be carried out at home, combining traditional methods with folk ones.

Traditional Methods

Non-surgical treatment of nonspecific ulcerative colitis is carried out using the following groups of drugs:

• containing 5-acetylsalicylic acid in the form of tablets, capsules, as well as rectal suppositories, foams and enemas (Sulfasalazine, Mesacol, Salofalk, Tidokol, Pentasa, etc.);
• corticosteroids in the form of tablets, rectal and intravenous infusions (Prednisolone, Hydrocortisone, etc.);
• immunosuppressants (Azathioprine, 6-mercaptopurine, Methotrexate, Infliximab, etc.).

Depending on the clinical picture, additional drugs may be prescribed to stop bleeding, eliminate dehydration and restore water and electrolyte balance, and heal the intestinal mucosa. Symptomatic therapy is also carried out as needed: antispasmodic, antipyretic, antidiarrheal or laxatives are prescribed.

If the inflammation is most pronounced in the lower parts of the colon, then local preparations are more effective: suppositories, rectal droppers, enemas and foams.

The use of corticosteroids, immunosuppressants and drugs with 5-acetylsalicylic acid should be strictly controlled by a doctor. Only a specialist can evaluate the appropriateness of their use in a particular clinical case.

These groups of drugs can cause severe side effects, such as bone marrow damage or hepatitis. Sometimes in the medical history of patients with ulcerative colitis resistance to their effects or initial immunity is noted.

If conservative therapy is ineffective, then surgical intervention is necessary.

For nonspecific colitis, surgery can be performed in one of three ways:

• palliative - the end of the intestine is brought to the abdominal wall, a permanent or temporary fistula is formed;
• radical - segments of the intestine are removed, then its integrity is restored;
• reconstructive - the intestine is removed and replaced with a prosthesis.

Can ulcerative colitis be permanently cured? It is difficult to eliminate the disease with conservative methods, but if you have patience and strictly follow all the doctor's prescriptions, you can achieve long-term stable remission.

Folk methods

Treatment of nonspecific ulcerative colitis with folk remedies is used for chronic course, during periods of remission. Herbal infusions and decoctions with a mild effect are widely used, which envelop the affected areas of the mucous membrane, promote healing of ulcers and stop bleeding.

To prepare a drink, you can use the following components:

• a mixture of raspberry, strawberry and currant leaves - supports the liver and restores water and electrolyte balance;
• dried blueberries - cleanse the intestines of rotting substances, prevent the formation of cancer cells;
• nettle leaves - increase blood clotting, eliminate inflammation;
• peppermint leaves - reduce spasms and inflammation, prevent the growth of bacteria, calm the nervous system;
• chamomile flowers - fight microbes, reduce spasms and inflammation;
• yarrow grass - has bactericidal properties, eliminates diarrhea;
• pomegranate peel - stops diarrhea, relieves inflammation, prevents the growth of bacteria;
• Potentilla leaves and stems - heal ulcers, stop diarrhea;
• celandine grass - reduces nervous tension, fights inflammation and the spread of microbes;
• wormwood grass - cleanses the intestines from pathogenic microflora;
• St. John's wort - enhances intestinal motility, eliminates purulent impurities in the feces, reduces inflammation;
• alder cones - have an astringent effect, heal wounds.

Each of these herbs can be used alone or mixed together. Infusions and decoctions must be prepared according to the instructions on the package.

Complications

Nonspecific ulcerative colitis can lead to the development of colorectal cancer. According to statistics, in patients with a 10-year experience, the risk of oncology increases by 2%, with a 20-year-old - by 8%, with a 30-year-old - by 18%. For this reason, regular bowel examinations, including colonoscopy, and cancer-preventive therapy are necessary.

Another complication of non-specific ulcerative colitis is toxic megacolon. In this disease, intestinal loops swell and expand. Lack of treatment leads to a rupture of the wall, inflammation of the peritoneum develops - peritonitis, and then a general infection of the blood - sepsis.

Consequences

The consequences of nonspecific ulcerative colitis are associated with its extraintestinal manifestations. In the large intestine, autoimmune reactions are activated. Sometimes they spread to other organs, causing damage to the eyes, skin, joints, oral mucosa, circulatory system, and liver. Partially, foreign agents (toxins, allergens, etc.) take part in their formation.

With nonspecific ulcerative colitis may develop:

• erythema nodosum;
• gangrenous pyoderma;
• episcleritis;
• arthropathy;
• ankylosing spondylitis;
• hepatomegaly.

Prevention of pathology

It is impossible to prevent the development of nonspecific ulcerative colitis, since the causes of its development are unknown.

But you can take measures that will reduce the frequency of exacerbations and will contribute to long-term remission:

• regularly take medications prescribed by a doctor;
• follow a therapeutic diet;
• undergo preventive examinations, according to the appointed schedule;
• take Acetaminophen, Efferalgan, Paracetamol as painkillers, refuse non-steroidal anti-inflammatory drugs (Ibuprofen, Naproxen, etc.).

You also need to remember that antibiotics exacerbate ulcerative colitis. You can take them only as a last resort, as prescribed by a doctor.

Diet

Nutrition for nonspecific ulcerative colitis of the intestine should be sparing, not irritating to the mucous membrane. The diet is based on the use of foods high in protein and vitamins.

With an exacerbation of the disease, the requirements are especially stringent: fruits, vegetables, any spicy, salty, sour, smoked and fatty foods are prohibited. Foods that cause fermentation are excluded: milk, fresh pastries, legumes. The diet consists of cereal decoctions, pomegranate juice, jelly, viscous boiled cereals.

When the acute period of the disease is over, boiled and stewed vegetables, fruits, twisted meat dishes, and soft fish can be added to the menu. You can also use curd mass, sour-milk drinks, puddings.

Nonspecific ulcerative colitis is a disease in which the mucous membrane of the large intestine (sometimes the submucosal layer) becomes inflamed and covered with ulcers. As a rule, the pathology proceeds in a chronic form with attacks of exacerbations.

The treatment is conservative, long-term, if it is ineffective, an operation is performed. It is impossible to prevent ulcerative colitis, since its causes have not been established, but if you follow the diet and the doctor's recommendations, you can reduce the frequency of relapses.

Useful video about ulcerative colitis