Chronic colitis: symptoms of exacerbation of the disease, diagnosis and treatment methods. Coding of chronic colitis in ICD 10 ulcerative colitis

Chronic colitis occurs in gastroenterological practice somewhat more often than other inflammatory lesions of the large intestine. Chronic colitis occurs in waves, alternating with remission and acute periods.

Quite often the disease is accompanied by inflammatory pathologies in other gastrointestinal structures. According to statistics, about half of patients with digestive problems suffer from chronic colitis.

Among female patients, the pathology occurs at the age of 20-65, but the age of men suffering from this disease is somewhat older and is 40-65 years.

Definition and disease code according to ICD-10

Chronic colitis is an inflammatory lesion of the intestinal mucosa, which is accompanied by dyspeptic symptoms such as flatulence and diarrhea, constipation and rumbling, pronounced pain and bloating.

Causes

There are many factors that provoke the development of chronic forms of colitis, but the main ones, according to experts, are:

Chronic colitis worsens against the background of stress and excessive anxiety, weakened immunity, nutritional deficiency, consumption of low-calorie foods and even small doses of alcohol.

Varieties

There are several types of pathology:

In accordance with the etiology of inflammation of the colonic mucosa, chronic colitis can also be radiation and ischemic, allergic or toxic, infectious and combined. And depending on the nature of the spread of the pathological process, colitis can be total, when all parts of the colon are affected.

This is typical for ulcerative colitis. Pathology can also be segmental in nature, when the lesion covers only a certain intestinal section.

Spastic appearance

Spastic chronic colitis is a functional disorder and is manifested by intestinal disorders and painful sensations in the abdomen.

Spastic colitis of the chronic form provokes a tendency in patients to diarrhea, while its atonic forms, on the contrary, provoke a tendency to constipation.

Spastic colitis develops mainly on a nervous basis, when the patient is worried about stress and nervous experiences, hormonal imbalances or psychophysical fatigue for a long time. Pathology is also a consequence of poor nutrition, when the patient abuses alcohol, spicy or fatty foods.

This pathological form more often affects women, which experts explain by the typicality of hormonal disorders for this category of patients, because women experience hormonal changes during pregnancy, menstruation, childbirth, etc.

Chronic constipation, intestinal infections, especially prolonged ones, as well as an allergic response to certain foods can also provoke such colitis.

Nonspecific ulcerative

Nonspecific ulcerative colitis is called diffuse inflammatory ulcerative lesions of the intestinal mucosa, which are accompanied by severe systemic and local complications and often cause massive gastrointestinal bleeding.

1. This form of colitis is characterized by cramp-like painful sensations in the abdomen, bloody diarrhea, intestinal bleeding, etc.
2. A characteristic sign of the pathology is a tendency to mucous ulcerations.
3. The pathology is characterized by a cyclical course, in which acute periods are replaced by remission states.

The exact etiology of this form of colitis is unknown, although experts do not rule out that genetic and immune factors play a significant role in the development of the pathological process.

The cause may be bacteria and viral agents that activate the immune system, or autoimmune failures accompanied by sensitization of immune structures against their own cells.

Non-ulcerative

Chronic non-ulcerative colitis is an inflammatory lesion of the large intestine, which is characterized by the presence of dystrophic and atrophic changes in the mucous tissues, leading to dysfunction of the large intestine.

Non-ulcerative colitis of the chronic type develops against the background of previous intestinal pathologies such as dysentery, toxic infections or salmonellosis, yersiniosis, typhoid fever, etc.

The pathology manifests itself as pain in the abdomen - in its lower and lateral parts, which can be aching, dull, spastic or paroxysmal or bursting in nature.

Atrophic

Atrophic chronic colitis is characterized by thinning of the mucous membranes of the colon, accompanied by disturbances in the secretory glandular functions.

In clinical practice, there is no diagnosis of atrophic colitis. This term is used by doctors to describe the nature of the changes that have occurred in the mucous tissues, but it cannot reflect the causes and severity of the pathological process.

With the development of these pathologies, thinning of the mucous tissues affected by inflammation occurs, and in some areas it is completely replaced by granulomatous tissue, which leads to atrophy.

Signs in adults and children

The chronic form of intestinal inflammation involves periodic alternation of remission and aggravated periods, therefore it is natural that patients turn to specialists when an exacerbation of chronic colitis occurs. During periods of remission, these symptoms manifest themselves weakly or erased, or are completely absent.

Signs of chronic colitis include:

• Stool disorders manifested by periodically alternating constipation/diarrhea;
• Unpleasant-smelling belching;
• Pain syndrome in the lateral parts of the peritoneum, and the pain can be of a varied nature - from spasms to aching soreness;
• Constant rumbling in the intestines;
• Abdominal enlargement;
• Increased gas formation;
• Even after defecation, the patient has the feeling that he has not completely emptied his bowels;
• False urges to defecate often occur, although the intestines are emptied only once every few days;
• There is constant malaise and nausea, weakness;
• An unpleasant odor appears in the oral cavity;
• Pale skin and sleep disturbances;
• Brittle nail plates and hair loss;
• Taste changes, etc.

Symptoms of exacerbation

In general, during an exacerbation, each of the above symptoms can clearly manifest in patients. But gastroenterologists identify a number of signs of exacerbation of colitis, when they appear, you need to urgently contact a specialist.

These include unbearable pain in the abdomen, which is spastic in nature, and at night turns into a dull and aching pain.

Most often, this pain is located on the left side of the iliac region. When palpating the intestine in some areas, the pain may intensify.

Also, a sign of exacerbation of colitis can be considered constant bloating, which occurs against the background of an imbalance of microflora.

During an exacerbation, the consistency of the stool also changes and can be expressed in prolonged diarrhea or constipation, and whitish mucous impurities or bloody inclusions may be found in the stool. If such symptoms appear, you should quickly consult a specialist for treatment.

Diagnostics

To identify chronic colitis, the patient undergoes instrumental and laboratory diagnostics. The results of a blood test for colitis show the presence of leukocytosis, neutrophilia and an increase in erythrocyte sedimentation rate. Patients are also given a coprogram, which shows the chemical composition of feces and their microscopic data.

Colonoscopy helps to detect an inflammatory focus, identify the presence of erosive and ulcerative processes, atrophic changes, vascular damage, etc. Irrigoscopic diagnosis allows you to diagnose the presence of peristaltic disorders, relief changes in the mucous membranes, intestinal atony, etc.

Complications

Chronic forms of colonic inflammation can lead to the development of quite serious complications:

• Perforation of the wall of the large intestine followed by peritonitis, which is usually characteristic of nonspecific ulcerative colitis;
• Bleeding in the intestinal structures, which provokes the development of serious anemia;
• Intestinal obstruction, which forms against the background of strictures, adhesions and scars.

Treatment of chronic colitis

Chronic forms of colitis in the acute phase must be treated in a hospital setting under the guidance of an experienced proctologist, and infectious chronic inflammation of the intestine is treated in infectology departments.

The main goal of treatment is to eliminate the provoking etiological factor of the disease and restore intestinal activity.

Diet

During acute periods, patients with colitis are recommended to receive treatment table No. 4a, which involves eating steamed fish and meat dishes, low-fat broths, white bread, boiled eggs and green tea, rosehip infusion or cocoa. One serving should be only 250-300 g.

Gradually, when the inflammatory processes are stopped, the patient is transferred to treatment table No. 4b.

This diet allows patients to eat cereals and soups, pasta and vegetable dishes, milk porridges and butter. When a stable remission state is established, patients with chronic colitis are prescribed an even more expanded diet No. 4b.

Folk remedies

If colitis is complicated by proctosigmoiditis, it is recommended to perform microenemas with chamomile decoctions, which have an anti-inflammatory effect. A similar effect is provided by decoctions of cumin and St. John's wort, sage, etc.

Increased gas formation is easily eliminated with folk remedies based on mint, motherwort and nettle.

To restore broken stools, alder cones, blueberries or bird cherry are often used.

Drugs

If colitis is of infectious origin, patients are prescribed antibiotic therapy and sulfonamides. Since these drugs often provoke dysbacteriosis, they are prescribed for a short course after the causative agent of the infection has been identified.

Prevention of chronic colitis comes down to timely treatment of acute forms of colon inflammation and their prevention. Following the rules of hygiene and the principles of a healthy diet will also relieve intestinal problems.

Chronic colitis can be controlled and kept in remission if the patient strictly follows all medical instructions and takes a set of prescribed medications.

Video program about the features of chronic intestinal colitis:

Codes of forms of colitis according to ICD 10

Colitis 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.

Classification of the disease

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. Ulcerative. 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.

Spastic colitis has an ICD-10 code depending on the cause of its occurrence. 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

A gastroenterologist or coloproctologist should develop treatment. 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.

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 resolved.

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 become chronic, 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.

Spastic intestinal colitis - causes, symptoms, treatment and nutrition

Spastic colitis (often called irritable bowel syndrome by doctors) is a functional intestinal disorder accompanied by pain and other discomfort in the abdominal cavity, the intensity of which decreases after defecation. Each person's disease progresses individually. Some may have constant diarrhea, while others may experience constipation. Normal stools are medium and should not contain blood.

In the article we will look at the main causes and symptoms of spastic colitis, talk about the main methods of diagnosis and treatment, and also give recommendations on maintaining proper nutrition to restore the body.

Spastic intestinal colitis

Spastic colitis is a disorder of the intestines, which is manifested by abdominal pain, constipation and diarrhea (alternately), this disease is a form of inflammation of the large intestine. Impaired motor function of the intestine, impaired motility of the colon leads to involuntary painful contractions of the intestine - spasms. Spasms can occur in different parts.

The main cause of the disease is considered to be poor nutrition - frequent consumption of spicy, heavy foods, and alcohol.

Women are more susceptible to the disease, in whom it is diagnosed 2–4 times more often than in men. The average age of patients with spastic colitis is 20–40 years.

• ICD 10 code: The existing international classification classifies spastic intestinal colitis as class K58, subtypes K58.0 and K58.9 (colitis accompanied by and without diarrhea, respectively).

In approximately 3 out of 10 patients, colitis develops after dysentery, salmonellosis and other acute infections.

Causes and forms of the disease

Spastic colitis can occur in acute or chronic form. The disease is caused by a functional disorder of the gastrointestinal tract, the main factors provoking the disease are stress, frequent overload of the body (both physical and nervous), and poor nutrition.

The most common causes of spastic colitis are the following factors:

• poor nutrition for a long time;
• abuse of laxatives;
• surgical intervention in the gastrointestinal tract;
• long-term treatment with antibiotics;
• development of pathogenic organisms in the intestines.

The functioning of the intestines is regulated by the nervous system, therefore the main causes of the development of spastic colitis are associated with disturbances in it. These include:

• Chronic stress, living with constant fear,
• Overload at work,
• Lack of normal sleep and proper rest.

The cause of intestinal colitis can be diseases of the gastrointestinal tract:

Each of the pathologies has an irritating effect on the walls of the intestines, which cannot cope with their functions and supply food that is not sufficiently digested.

Approximately 20–60% of patients with spastic colitis experience anxiety, panic attacks, hysteria, depression, sexual dysfunction, and irritable bladder syndrome.

Symptoms

All symptoms that accompany chronic spastic colitis can be divided into the following groups:

• intestinal;
• complaints about other parts of the gastrointestinal tract;
• complaints not related to gastroenterology.

The diagnosis of spastic intestinal colitis is more likely if there are complaints from all three groups.

Most IBS symptoms worsen after eating. Typically, an exacerbation of the disease can last 2-4 days, after which the condition improves.

Among the most common symptoms:

• Abnormal bowel movements (constipation, diarrhea, or alternation of both).
• Feeling of heaviness and incomplete bowel movement.
• Flatulence.
• Nausea, appetite disturbances
• Pain in the intestines that goes away after a bowel movement.
• Severe tension in the abdominal muscles.

With spastic colitis, the main symptoms are painful cramps in the abdomen, usually in the morning after eating. Constipation is often replaced by diarrhea, prolonged diarrhea with the passage of pasty stools.

Due to the fact that the initial symptoms of the disease indicate food poisoning, the majority of people do not seek medical help in a timely manner. The disease can lead to anemia and significant weight loss. Ultimately, this negatively affects human life.

Diagnostics

If symptoms indicating KS appear, consultation with a gastroenterologist is necessary. Additional research methods, in particular colonoscopy, play an important role in diagnosis. Treatment necessarily includes a diet, so consulting a nutritionist will also be useful.

To make an accurate diagnosis, the following is carried out:

• palpation of the abdominal cavity, during which the doctor determines the degree of swelling of the intestines and the most painful areas;
• stool analysis;
• blood analysis;
• X-ray of the intestines, X-ray with contrast enema;
• anorectal manometry - to determine muscle tone and the strength of spasms.

Using endoscopic methods (colon-fibroscopy, sigmoidoscopy), symptoms of spastic colitis, signs of inflammation, atrophy and dystrophy of the colon are identified. The intestinal walls are swollen, hyperemic, and have a coating of mucus.

To exclude Crohn's disease, ulcerative colitis, celiac disease, and intestinal toxic infections, laboratory tests of blood and stool are performed, including:

• complete blood count, erythrocyte sedimentation rate, C-reactive protein;
• blood test for celiac disease;
• stool analysis for worm eggs and coprogram.

Treatment of spastic intestinal colitis

Spastic colitis requires an individual approach when determining treatment tactics. The combined, complex effect relieves nervous tension, accelerates the restoration of motor function of the colon, and improves digestion.

Patient treatment consists of three components:

• diet,
• medicines (folk remedies),
• psychotherapy.

Much in treatment depends on the doctor’s attitude: the therapist or gastroenterologist must formulate the patient’s appropriate views on the treatment strategy, explain to him the essence of the disease, and tell him about possible side effects on therapy.

Drugs

Drug treatment is prescribed depending on the results of the examination. General medications - antispasmodics, anti-inflammatory drugs, agents to reduce gas formation, vitamin complexes, sorbents.

1. To reduce pain, antispasmodics (No-spa, Decitel) are prescribed; in the hospital, the doctor prescribes cholinergics or adrenergic blockers, but such drugs have severe side effects, so they should be taken only under the supervision of a specialist.
2. If you suffer from constipation, enzymatic preparations are prescribed: festal, digestal.
3. If diarrhea is Creon, apply it when the abdomen is bloated. You need to regularly take activated carbon and enterosgel.
4. In case of increased gas formation, enterosorbents are prescribed (polysorb, enterosgel, activated carbon), acedin-pepsin is prescribed to reduce high acidity, and enzyme preparations are also prescribed to improve digestive function.

Diet and nutrition for spastic colitis

Diet for spastic colitis is very important because it helps restore the functioning of the digestive system. For diarrhea, therapeutic diet No. 4 is recommended, and for constipation No. 2.

For diarrhea, the daily menu should include: jelly, fresh fish and meat, porridge, pureed soups and fruit and vegetable purees.

Basic principles of nutrition

The choice of diet for spastic intestinal colitis is based on the following principles:

1. Food should be natural, not irritating the gastrointestinal mucosa with natural ingredients, such as hot seasonings, and artificial colors and preservatives.
2. Food should be easily digestible and at the same time sufficiently high in calories. It should be steamed, boiled or stewed. It is undesirable to consume fried and smoked foods.
3. The predominance of products of plant and animal origin in the diet is determined by the type of intestinal disorder.

Just following a diet can help completely eliminate spastic pain without taking special medications.

Traditional methods

Before treating spastic colitis with traditional medicine, be sure to consult a gastroenterologist.

1. Pour boiling water (1 glass) over anise (1 teaspoon), let it brew, drink a little throughout the day;
2. A simple and accessible remedy for constipation is potato juice, which is taken one hundred milliliters three times a day.
3. Yarrow. Take the juice from the entire flowering plant. Helps relax the intestinal muscles, relieves cramps and spasms.
4. Celery juice has an effective effect - it helps normalize digestive processes, helps get rid of constipation, and removes excess gases. The root vegetable must be peeled and chopped, squeezed out the juice and taken before meals in the amount of three small spoons. After taking the product, at least half an hour should pass before eating.
5. Coltsfoot is a good remedy for treating colitis. Take a third of a teaspoon of powder prepared from its leaves three times a day half an hour before meals, washed down with honey water or hot milk.

Prevention

1. Reduce stress levels, normalize sleep patterns. To relieve anxiety attacks, you can use breathing exercises and mild sedatives.
2. Physical activity that stimulates motor skills - simple gymnastics in the morning or throughout the day.
3. Avoid alcohol, tobacco, coffee and strong tea.
4. Massages will help improve intestinal motility, and at the same time reduce anxiety and relax. But they must be carried out by a specialist.

Especially preventive measures should be taken by those who suffer from gastrointestinal disorders. At the first symptoms of spastic colitis, you should seek medical help rather than try to treat the disease yourself.

Chronic inactive intestinal colitis

Many of us have experienced unpleasant symptoms such as abdominal pain and diarrhea, often accompanied by vomiting. This usually indicates food poisoning and associated intestinal upset. This situation usually occurs during the ripening period of vegetables and fruits. Therefore, it is not true that most people are in no hurry to visit a doctor, but drink a solution of potassium permanganate and eat activated carbon.

But such an attitude towards these signs is not only unreasonable, but can often turn out to be very dangerous. The fact is that acute colitis also has exactly these manifestations, which, without timely diagnosis and adequate treatment, very quickly passes into the chronic stage and begins to accompany the patient throughout life with constant changes in active and inactive forms of pathology.

Chronic Colitis is a disease that can develop in both adults and children. But, despite the fact that it has been diagnosed in patients for quite some time, the causes of its occurrence are still unknown. Experts are not inclined to say that the acute form of this intestinal disorder will necessarily become chronic. To do this, certain provoking factors must be present, among which the following are usually distinguished:

• Poor nutrition and frequent consumption of hot seasonings and spices that irritate the mucous membrane of the gastrointestinal tract;
• The predominance of stressful situations in life and low mobility;
• Adverse habits such as alcohol abuse and excessive smoking.

All of them are capable of triggering the transition of colitis from the acute to the chronic stage.

Causes of chronic colitis

Although the etiology of chronic colitis has not yet been fully elucidated, and it can be quite difficult to establish one cause that usually provokes the occurrence of this dangerous disease, experts have identified a group of factors, the combination of which most likely contributes to the development of the pathology:

1. The most common etiological factor in the development of chronic colitis is the patient’s infectious diseases belonging to the intestinal group (yersiniosis, salmonellosis, dysentery, etc.);
2. The role of damage to the intestinal mucosa and radiation exposure has been determined. In this case, hr. colitis occurs after treatment of malignant neoplasms;
3. Also, the chronic form of this intestinal pathology can be caused by fungi or bacteria. The biggest role in this is given to balantidia and lamblia.

Any of these reasons can cause the development of colitis. There is also no difference between patients by gender, only in women the chronic form of this pathology usually occurs at a younger age.

Chronic enteritis and colitis

In the case when the disease develops in the small intestine, enteritis is diagnosed. It can have both acute and chronic forms, and its causes are also not fully understood. With it, just like with colitis, the basic functions of the digestive organ are disrupted, such as the absorption of nutrients through their breakdown.

Also, with enteritis, significant changes occur in the structure of the intestinal mucosa, and this contributes to the disruption of the barrier function of its wall and the synthesis of the produced digestive juice. All these signs also correspond to colitis, which occurs in a chronic form.

Signs of chronic colitis in children

In younger patients, the cause of development is hron. Colitis is most often a hereditary factor. The risk of this intestinal pathology occurring in a chronic form increases significantly in those children whose immediate relatives suffer from inflammatory diseases of the digestive organs. For the most part, in addition to genetics, there are several other factors that provoke the active form of this disease in a child:

• Low quality products and unfavorable environment;
• Helminthiasis, dysbacteriosis and other infections;
• Weakened immune system.

Favorable environment for the emergence and development of chronic. Colitis in children can also be caused by stress or abdominal trauma. In addition, the development of this form of the disease in young patients is caused by viral infections such as influenza, ARVI, and measles. By gender, before adolescence, boys are most often susceptible to this disease, and after that, the palm of this pathology passes to girls.

Signs of chronic colitis in children are most often aching pain of a recurrent nature, which is localized in the left half of the abdominal cavity, and is often replaced by paroxysmal contractions. In the evening, or after drinking milk, bloating and flatulence occur. The stool becomes frequent and loose, often containing blood or mucus. Appetite is significantly reduced, and this leads to weight loss.

The peculiarity of the course of inactive chronic colitis in children is also expressed in the fact that the younger the child is, the higher the risk of developing atypical forms of the disease. This causes difficulties in diagnosing the disease. In children, parents should be concerned about very frequent loose stools, which in case of chronic colitis can reach up to 30 times a day, and older children experience tenesmus and false urges to have a bowel movement.

Feces usually contain not only streaks of blood, but also lumps of pus, as well as a large amount of mucus. In the chronic form of the pathology in children, the abdomen may become sunken and may be significantly swollen. If a child has such alarming signs, in most cases indicating the possibility of chronic colitis, and there are also suspected causes for the development of the disease, you should urgently contact a specialist to undergo the necessary diagnostic tests.

Forecast of development hron. colitis

Only in the case of timely and adequate treatment of active chronic colitis that develops in young patients can it result in a complete clinical and laboratory recovery and not progress to the chronic stage. In the event that this does happen, and the disease has become protracted and inactive, compliance with the regimen recommended by the specialist is required in order to be able to prolong the stages of remission of chronic disease for longer periods. colitis

Frequent exacerbations of this inflammatory pathology disrupt not only the child’s psychosocial adaptation, but also his physical development. Therefore, constant prevention of the chronic form of the disease in young patients is required, which does not allow the disease to pass into an active form and involves both full treatment of acute infections of the digestive organ, dysbacteriosis or helminthic infestations, and adherence to an age-appropriate diet prescribed by a specialist both for the prevention of the disease and to support ongoing therapeutic activities.

Dispensary observation for developing hron. colitis is carried out by specialists such as a pediatric gastroenterologist and pediatrician. Any preventive vaccinations can only be done when the chronic form of this disease is in a period of stable remission.

What is the danger of developing chronic colitis during pregnancy?

Such a question as the transition of inactive chronic colitis to an active form during pregnancy worries many patients. The whole point here is that in women the peak development of this disease occurs during the reproductive period of the body.

How can we make sure that the expectant mother, for whom pregnancy can already be a difficult ordeal, is not bothered by the unpleasant sensations of chronic pain? colitis? And what are the reasons for the transition of this inflammatory pathology, which occurs in a chronic manner, into an active form during pregnancy?

To prevent such a situation from arising, all patients diagnosed with chr. colitis, before thinking about having a child, you should consult a specialist and wait for a period of remission in the chronic course of the disease. And then, during the entire period of pregnancy, you must strictly adhere to all the recommendations of your doctor. Only in this case will a woman with chronic colitis be able to safely carry and give birth to a healthy child.

ICD 10 code for chronic colitis

Chron. Colitis, like any other disease, has its own code in the International Classification of Diseases (ICD 10), which makes it possible to classify all such pathologies into one group by type. In this case, they are divided depending on the severity of the disease.

In addition, the classification code of chronic intestinal pathology according to ICD 10, regardless of the causes of the disease, subdivides all its types according to responses to the medical manipulations that were performed, the presence of possible complications, as well as the accompanying symptoms.

What types of classification are distinguished in ICD 10? Their main difference is the type of course of the disease, as well as the form in which it is found. Also, the division of this disease in ICD 10 provides for its etiology and location in the digestive organs.

But no matter how it is classified, and what reasons provoke its development, at the very first suspicious signs you should contact your doctor to undergo timely diagnosis and prescribe adequate treatment in order to avoid possible negative consequences.

Nonspecific ulcerative colitis(UC) is a chronic inflammatory disease of the colon of unknown etiology, characterized by ulcerative-necrotic changes in its mucous membrane.

Code according to the international classification of diseases ICD-10:

The disease always begins in the rectum and spreads proximally. Total damage to the colon occurs in 25% of cases. In severe cases, the damage can spread to the submucosa, muscular and serous membranes of the intestinal wall. Characterized by the formation of ulcers in the colon and rectum, bleeding, abscessation of the crypts of the mucous membrane and inflammatory pseudopolyposis. The disease often causes anemia, hypoproteinemia and electrolyte imbalance, and, less frequently, can lead to perforation or colon cancer.

Frequency- 2-7: 100,000. Two peaks of incidence - 15-30 years (larger peak) and 50-65 years (smaller). The predominant gender is female.

Classification. According to the clinical course.. acute form.. Chronic recurrent.. Chronic continuous. According to the degree of severity... Mild severity... Stool 4 times a day or less, mushy... A small amount of blood in the stool... Fever, tachycardia, anemia are uncharacteristic; body weight does not change, ESR is not changed.. Severe course... Stool 20-40 r/day, liquid... Stool in most cases contains an admixture of blood... Body temperature 38 ° C and above... Pulse 90 V minute or more... Decrease in body weight by 20% or more... Severe anemia... ESR more than 30 mm/h.. Moderate severity includes indicators that are between the parameters of mild and severe degrees.

Symptoms (signs)

Clinical picture

The onset of the disease can be acute or gradual.

The main symptom is repeated watery stools mixed with blood, pus and mucus, combined with tenesmus and false urge to defecate. During the period of remission, diarrhea may completely stop, but the stool is usually pasty, 3-4 times a day, with a slight inclusion of mucus and blood.

Cramping pain in the abdomen. Most often this is the area of ​​the sigmoid, colon and rectum, less often - the area of ​​the navel and cecum. Typically, the pain intensifies before defecation and decreases after bowel movement. The localization of pain depends on the level of the lesion. Typically, the pain intensifies before defecation and decreases after bowel movement.

Possible damage to other organs and systems. Skin and mucous membranes: dermatitis, aphthous stomatitis (5-10%), gingivitis and glossitis, erythema nodosum (1-3%) and erythema multiforme, pyoderma gangrenosum (1-4%), lower ulcers limbs.. Arthralgia and arthritis (in 15-20% of cases), incl. and spondylitis (3-6%) .. Ophthalmological complications (4-10%): episcleritis, uveitis, iridocyclitis, conjunctivitis, cataracts, retrobulbar optic neuritis, corneal ulcers .. Liver: fatty hepatosis (7-25%), cirrhosis (1-5%), amyloidosis, primary sclerosing cholangitis (1-4%), chronic active hepatitis.

Diagnostics

Laboratory research. Peripheral blood analysis.. Anemia (post-hemorrhagic - as a result of blood loss; bone marrow reaction to latent inflammation; malabsorption of iron, folic acid, vitamin B 12).. Leukocytosis of varying severity.. Increased ESR.. Hypoprothrombinemia.. Hypoalbuminemia due to malabsorption amino acids.. Increased content of a 1 - and a 2 - globulins.. Hypocholesterolemia. Electrolyte disturbances.. Hypokalemia as a result of decreased absorption of both direct ions and vitamin D.. Hypomagnesemia.

Special studies. Sigmoidoscopy during an exacerbation is performed without preliminary bowel preparation. Colonoscopy is prescribed after acute symptoms have subsided, because in severe cases of the disease, perforation of the ulcer or toxic dilatation is possible.. Mild UC - granularity of the mucous membrane.. Moderate UC - the mucous membrane bleeds on contact, there are ulcerative lesions and mucous exudate.. Severe UC - spontaneous bleeding from the intestinal mucosa , extensive ulcerative lesions and the formation of pseudopolyps (epithelial-covered granulation tissue). Irrigography.. Reduced severity or absence of haustration.. Uniform narrowing of the intestinal lumen, its shortening and rigidity of the walls (the appearance of a “water pipe”).. Longitudinal orientation of the folds of the mucous membrane with a change in their structure according to the type of small and large retina.. Jaggedness and blurred contours intestinal tube due to the presence of ulcers and pseudopolyps (during the acute phase).. The procedure is contraindicated in the development of toxic megacolon. Plain radiography of the abdominal organs is especially important in cases of severe ulcerative colitis, when colonoscopy and irrigography are contraindicated.. Shortening of the colon.. Lack of haustration.. Irregularity of the mucous membrane.. Dilatation of the colon (toxic megacolon).. Free gas under the dome of the diaphragm during perforation.

Differential diagnosis. Acute dysentery. Crohn's disease. Intestinal tuberculosis. Diffuse familial polyposis of the colon. Ischemic colitis.

Treatment

TREATMENT

Diet. Various diet options No. 4. You should avoid eating raw fruits and vegetables for the purpose of mechanically sparing the inflamed mucous membrane of the colon. In some patients, a dairy-free diet can reduce the severity of clinical manifestations, but if it is ineffective, it should be abandoned.

Lead tactics

For sudden exacerbations, bowel emptying with intravenous fluids for a short period of time is indicated. Total parenteral nutrition allows for long-term rest for the intestines.

Salicylosulfonamide drugs are effective for all degrees of severity of the disease, causing remission and reducing the frequency of exacerbations. Sulfasalazine 0.5-1 g 4 times a day until clinical manifestations subside, then 1.5-2 g/day for a long time (up to 2 years) for the prevention of relapses, or... Salazodimethoxin 0.5 g 4 times / day for 3-4 weeks, then 0.5 g 2-3 times / day for 2-3 weeks. Mesalazine - 400-800 mg 3 times a day orally for 8-12 weeks; to prevent relapses - 400-500 mg 3 times a day if necessary for several years. The drug should be taken after meals with plenty of water. For left-sided UC, the drug can be used rectally (suppositories, enema). Indicated in cases of insufficient effectiveness and poor tolerability of sulfasalazine.

GK - for acute forms of the disease, severe relapses and moderate forms, resistant to other drugs. For distal and left-sided colitis - hydrocortisone 100-250 mg 1-2 times a day rectally by drip or in microenemas. If effective, the drug should be administered daily for 1 week, then every other day for 1-2 weeks, then gradually, over 1-3 weeks, the drug is discontinued. Prednisolone orally 1 mg/kg/day, in extremely severe cases - 1.5 mg/kg/day In case of an acute attack, it is possible to prescribe 240-360 mg/day intravenously, followed by switching to oral administration. 3-4 weeks after achieving clinical improvement, the dose of prednisolone is gradually reduced to 40-30 mg, then sulfasalazine can be added, and then the reduction is continued until complete withdrawal.

As an adjuvant in combination with sulfasalazine or GC - cromoglycic acid in an initial dose of 200 mg 4 times a day 15 minutes before meals.

For mild or moderate manifestations without signs of toxic megacolon, consolidating drugs (for example, loperamide 2 mg) or anticholinergic drugs are cautiously prescribed. However, the use of drugs that actively inhibit peristalsis can lead to the development of toxic dilatation of the colon.

Immunosuppressants, for example mercaptopurine, azathioprine, methotrexate (25 mg IM 2 times a week), hydroxychloroquine.

If there is a risk of developing anemia, take iron supplements orally or parenterally; in case of massive bleeding - blood transfusion.

For toxic megacolon.. Immediate withdrawal of consolidating and anticholinergic drugs.. Intensive infusion therapy (0.9% sodium chloride solution, potassium chloride, albumin).. Corticotropin 120 units/day or hydrocortisone 300 mg/day intravenously. Antibiotics (for example, ampicillin 2 g or cefazolin 1 g IV every 4-6 hours).

Contraindications. Sulfasalazine is contraindicated in cases of hypersensitivity, liver or kidney failure, blood diseases, porphyria, glucose-6-phosphate dehydrogenase deficiency, and breastfeeding. Mesalazine is contraindicated in case of hypersensitivity to salicylates, blood diseases, liver failure, gastric and duodenal ulcers, children under 2 years of age, and breastfeeding.

Surgery. Indications... Development of complications... Toxic megacolon with ineffectiveness of intensive drug therapy for 24-72 hours... Perforation... Excessive bleeding with unsuccessful conservative therapy (rare)... Carcinoma... Suspicion of carcinoma in intestinal strictures .. Lack of effect from conservative therapy, rapid progression of the disease.. Growth retardation in adolescents, not corrected by conservative treatment.. Dysplasia of the mucous membrane.. Disease duration of more than 10 years (increased risk of cancer). The following groups of surgical interventions are distinguished: Palliative (disconnection operations) - the application of a double-barreled ileo- or colostomy. Radical - segmental or subtotal resection of the colon, colectomy, coloproctectomy. end.

Complications. Acute toxic dilatation (toxic megacolon) of the colon (up to 6 cm in diameter) develops in 3-5% of cases. It is probably caused by severe inflammation with damage to the muscular lining of the colon over a large area and disruption of the nervous regulation of intestinal functions. A certain role belongs to the inadequate prescription of anticholinergics and fixative drugs. The condition is usually severe, with high fever, abdominal pain, significant leukocytosis, exhaustion, and death is possible. Treatment is intensive drug therapy for 48-72 hours. Failure to respond to treatment is an indication for immediate total colonectomy. Mortality is about 20% with a higher rate in patients over 60 years of age. Massive bleeding. The main symptom of UC is bleeding from the rectum (up to 200-300 ml/day). Massive bleeding is considered to be blood loss of at least 300-500 ml/day. Perforation of colon ulcers in UC occurs in approximately 3% of cases and often leads to death. Strictures in UC - 5-20% of cases. Colon cancer. Patients with subtotal or total colon disease and a disease duration of more than 10 years have an increased risk of colon cancer (after 10 years, the risk of carcinoma is 10% and can increase to 20% after 20 years and to 40% after 25-30 years). Colon cancer that occurs against the background of ulcerative colitis is usually multifocal and aggressive. prophylactic total colonectomy.

Synonyms. Colitis is ulcerative - hemorrhagic nonspecific. Idiopathic ulcerative colitis. Ulcerative trophic colitis. Ulcerative proctocolitis. Rectocolitis is ulcerative and hemorrhagic. Rectocolitis hemorrhagic purulent.

Reduction. UC - nonspecific ulcerative colitis.

ICD-10. K51 Ulcerative colitis

Nonspecific ulcerative colitis (UC) or ulcerative colitis is a chronic disease of the colon, which, together with Crohn's disease, is classified as “inflammatory bowel disease” (IBD). The word “colitis” means inflammation of the large intestine, “ulcerative” - emphasizes its distinctive feature, the formation of ulcers.

Compared to Crohn's disease, UC is diagnosed 3 times more often. According to statistics from American experts, per 100,000 people. on average there are 10-12 with this diagnosis. Women get sick somewhat more often than men. Most cases are diagnosed at the age of 15-25 years (20-25% of patients under 20) or 55-65 years. It is very rare in children under 10.

Causes and risk factors for developing ulcerative colitis

The causes of UC are unknown. Most researchers are inclined to think that this is an autoimmune problem. Risk factors identified:

• genetic. Ulcerative colitis often affects people who have blood relatives with the same diagnosis. To be precise, this pattern is observed in 1 out of 4 cases. Also, UC is particularly common among certain ethnic groups (for example, Jews), which also suggests the heritable nature of the disease;
• environmental factors. Most cases are registered among residents of the northern regions of Eastern Europe and America. The prevalence of ulcerative colitis is influenced by air pollution and diet. It has also been noted that in countries with a high level of hygiene, UC is more common;
• taking non-steroidal anti-inflammatory drugs.

Classification of ulcerative colitis (ICD codes)

According to the International Classification of Diseases, 10th revision, UC has code K51.

Depending on the location of inflammation, several subclasses are distinguished:

K51.0 - small and large intestine (enterocolitis)

K51.1 - ileum (ileocolitis)

K51.2 - rectum (proctitis)

K51.3 - rectus and sigmoid (rectosigmoiditis)

K51.4 - colon

This group of diseases also includes mucosal proctocolitis (K 51.5) - left-sided colitis affecting the rectum and sigmoid colon, and the descending part of the colon to the splenic angle.

Symptoms and signs of ulcerative colitis

Depends on the location, area of ​​inflammation and severity of inflammation.

Main signs of UC:

• recurring diarrhea (diarrhea), often with blood, mucus or pus;
• stomach ache;
• frequent urge to have bowel movements.

Many patients complain of weakness, loss of appetite and weight.

UC is characterized by alternating exacerbations and periods with moderate symptoms or even asymptomatic ones. If it worsens, the following may be added:

• joint pain (arthritis);
• ulcers of the oral mucosa;
• soreness, redness and swelling of skin areas;
• eye inflammation.

In severe cases, the temperature rises, breathing becomes rapid and shallow, the heartbeat becomes fast or irregular, and blood in the stool becomes more noticeable.

In most patients, it is difficult to identify specific factors that provoke exacerbation. However, it is known that these can be infectious diseases and stress.

Diagnosis of UC

It is impossible to make a diagnosis based solely on symptoms. Only by excluding other probable and more common causes of the painful condition can the doctor confirm the presence of this particular disease. Usually carried out:

Only surgical intervention can get rid of the problem forever. And even surgery does not guarantee a complete recovery.

The main goal of drug therapy is to mitigate the symptoms, transform the disease into an asymptomatic form and try to ensure that such remission lasts as long as possible.

The following groups of drugs are prescribed:

• anti-inflammatory drugs. As a rule, they form the basis of treatment. At the first stage - aminosalicylates in the form of tablets or rectal suppositories. In severe cases or if there is no effect, corticosteroids are added to the treatment regimen. They have a more pronounced anti-inflammatory effect, but also serious side effects. The purpose of taking them is to restrain the development of exacerbation for as long as possible. They are often prescribed to maintain remission.
• immunosuppressants (cyclosporines, infliximab, azathioprine) - drugs that suppress immune reactions. They are prescribed to relieve symptoms and put people into remission.
• antibiotics – to control infection;
• antidiarrheal drugs;
• painkillers (paracetamol). Patients with UC are contraindicated from taking ulcerogenic drugs: ibuprofen, diclofenac, naproxen and products containing them;
• Iron supplements – for the treatment of anemia.

Surgical treatment for ulcerative colitis

The main disadvantage of the operation is its traumatic nature. In most patients, a portion of the large intestine is removed, sometimes including the anus. To remove feces, an ileostomy is formed: a small hole is made in the abdominal wall, to which the edge of the small intestine is attached. The feces are collected in a small bag (colostomy bag) that is attached to the ileostomy.

This solution may be permanent or temporary. In the second case, a reservoir is formed in parallel from the small intestine, which is attached to the anus. While this artificial “bag” heals, bowel movements occur through a temporary ileostomy. During the next operation it will be stitched up. It becomes possible to remove feces naturally. But the frequency of bowel movements is much higher than normal (up to 8-9 times a day).

Diet for ulcerative colitis

Nutrition is important to prevent exacerbations. If the condition worsens, the diet must be followed. General recommendations:

• limit consumption of dairy products;
• choose foods low in fat;
• reduce the content of coarse fiber in the diet (fresh fruits, vegetables, whole grain cereals). It is better to steam, stew or bake vegetables and fruits;
• avoiding alcohol, spicy foods, and caffeinated drinks.

Also, each patient has “personal” products that aggravate the disease. To identify them, it is useful to keep a food diary.

It is important to eat little and often, drink enough water, and take multivitamins.

Complications of the disease

• intestinal bleeding;
• intestinal perforation;
• severe dehydration;
• osteoporosis;
• dermatitis;
• arthritis;
• conjunctivitis;
• mouth ulceration;
• colon cancer;
• increased risk of blood clots;
• toxic megacolon;
• liver damage (rare).

Correct lifestyle for ulcerative colitis

Stress can trigger an exacerbation, and it is important to be able to cope with it. There is no universal advice. One person is helped by sports, another by meditation, breathing practices, the third restores mental balance by doing his hobby or communicating with loved ones.

Forecast

Current medications control symptoms well in most patients. With proper treatment, serious complications are quite rare. Approximately 5% of patients are subsequently diagnosed with colon cancer. The longer and more severe the UC, the higher the likelihood of oncological problems. The risk of developing a tumor is lower if the rectum and lower part of the small intestine are affected.

Prevention

Prevention measures have not been developed to date. After all, it is still unclear what exactly causes ulcerative colitis. Patients are recommended to undergo regular colonoscopy to detect cancer changes early and begin treatment for cancer in the early stages.

• spicy with blood
• acute hemorrhagic
• acute watery
• dysenteric
• epidemic

Infectious or septic:

• colitis hemorrhagic NOS

enteritis hemorrhagic NOS

Infectious diarrhea NOS

Gastroenteritis and colitis of unspecified origin

Neonatal diarrhea NOS

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International statistical classification of diseases and related health problems.

Other gastroenteritis and colitis of infectious and unspecified origin (A09)

Excluded:

• caused by bacteria, protozoa, viruses and other specified infectious agents (A00-A08)
• non-infectious diarrhea (K52.9)
  • neonatal (P78.3)

• spicy with blood
• acute hemorrhagic
• acute watery
• dysenteric
• epidemic

Infectious or septic:

• colitis hemorrhagic NOS

enteritis hemorrhagic NOS

Infectious diarrhea NOS

Neonatal diarrhea NOS

The release of a new revision of the ICD is planned by WHO in 2017-2018.

K50-K52 Non-infectious enteritis and colitis

Excluding: irritable bowel syndrome (K58), megacolon (K59.3)

Excluding: ulcerative colitis (K51)

• • duodenum
  • ileum
  • jejunum
• segmental and terminal ileitis

Excluding: in combination with Crohn's disease of the colon (K50.8)

• granulomatous and regional colitis
• Crohn's disease (regional enteritis):
  • colon
  • colon
  • rectum

Excluding: in combination with Crohn's disease of the small intestine (K50.8)

• Crohn's disease of the small and large intestine

• hypersensitive food enteritis and colitis

• eosinophilic gastritis or gastroenteritis

• colitis, diarrhea, enteritis, gastroenteritis: infectious (A09), unspecified in countries where conditions suggest an infectious origin of these conditions (A09)
• functional diarrhea (K59.1)
• neonatal diarrhea (non-infectious) (P78.3)
• psychogenic diarrhea (F45.3)

Other non-infectious gastroenteritis and colitis (K52)

Drug-induced gastroenteritis and colitis

If it is necessary to identify a drug, if of medicinal origin, or a toxic substance, use an additional external cause code (class XX).

Hypersensitive food enteritis and colitis

Excludes: colitis of undetermined origin (A09.9)

Eosinophilic gastritis or gastroenteritis

Microscopic colitis (collagenous colitis or lymphocytic colitis)

Excluded:

• colitis, diarrhea, enteritis, gastroenteritis:
  • infectious (A09.0)
  • unspecified origin (A09.9)
• functional diarrhea (K59.1)
• neonatal diarrhea (non-infectious) (P78.3)
• psychogenic diarrhea (F45.3)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Diarrhea that lasts more than a month is considered chronic.

Etiology and pathogenesis[edit]

The causes of acute diarrhea are numerous (see Table 10.3).

Clinical manifestations[edit]

Vomiting and diarrhea usually appear suddenly. There may be no fever, but reduced fluid intake or significant fluid loss can lead to dehydration, especially in children under 3 years of age. In most cases, no treatment is required.

Non-infectious gastroenteritis and unspecified colitis: Diagnosis[edit]

When collecting anamnesis, race and age are ascertained; the presence of blood or mucus in the stool, weight loss, delayed physical development, fever, recurrent infections; information about travel, use of medications (especially antibiotics); previous operations on the gastrointestinal tract. Family history is also collected. During a physical examination, the degree of development of the muscular system is assessed, exhaustion, symptoms of dehydration, swelling, the shape of the abdomen (bloated abdomen), mass formations in the abdominal cavity, rectal prolapse, and emotional reactions (especially irritability) are noted. A thorough neurological and cardiological examination is carried out. Laboratory tests include complete blood count, urinalysis, serum protein levels (albumin, transferrin), stool analysis, sweat test, and malabsorption tests.

1) History. Find out the duration of the disease, the consistency of stool, the frequency of bowel movements and urination, the amount of food consumed and its type; is there weight loss, tears when crying, mucus and blood in the stool, associated symptoms (fever, rash, vomiting, abdominal pain). In addition, they note whether there have been contacts with animals, travel; whether the child attends a day care facility; what sources of drinking water does the family use; What are the illnesses of family members at the time of the examination?

2) During physical examination, heart rate, blood pressure and their orthostatic changes are determined; assess skin turgor, condition of mucous membranes, fontanelles, presence of tears when crying, activity, emotional reactions (irritability).

3) The number of laboratory tests in non-severe cases is minimal. Wright's staining of stool preparations helps to detect neutrophils, and determination of the specific gravity of urine helps to detect the early stage of dehydration. If neutrophils are detected in the stool, the likelihood of identifying an infection during culture increases dramatically.

Differential diagnosis[edit]

Non-infectious gastroenteritis and unspecified colitis: Treatment[edit]

1) For mild to moderate dehydration, the best treatment method is to drink solutions containing water and electrolytes (see Table 10.4). When vomiting, liquid is given often and little by little (5-15 ml).

2) Boiled skim milk has high osmolarity and can cause hypernatremia. In general, liquids with high osmolarity (Coca-Cola, Ginger Ale, apple juice, chicken broth) are not used for rehydration.

3) Upon completion of rehydration therapy (usually after 8-12 hours), easily digestible foods (rice, rice flour, bananas, corn flakes, crackers, toasted bread) are prescribed. In case of secondary deficiency of disaccharidases, liquids containing lactose or sucrose are diluted with water in a 1:1 ratio.

4) The effectiveness of kaolin and preparations containing belladonna has not been proven. Diphenoxylate, paregoric and loperamide are not recommended for children despite the inhibition of excess intestinal motility; fluid loss into the intestinal lumen continues, but it can no longer be assessed. In addition, these drugs delay the elimination of toxins.

5) Antiemetics (promethazine, dimenhydrinate) are not recommended, as they cause side effects. For persistent vomiting, more detailed examination and treatment is indicated.

6) Careful monitoring (including daily weighing) is especially important for children in the first months of life, in whom dehydration develops very quickly.

Prevention[edit]

Other [edit]

Chronic diarrhea in children

Chronic diarrhea lasts more than 2 weeks. The reasons for it - see table. 10.5.

A. Irritable bowel syndrome is the most common cause of chronic diarrhea in children.

1) Etiology is unknown. It is possible that stress plays a role in the development of the disease.

2) Examination and diagnosis. The disease most often occurs between the ages of 1 and 5 years. History of watery, loose stools after dietary changes. Physical examination and urine analysis are normal, development is not impaired, stool culture results are negative. The diagnosis is made by excluding other causes of chronic diarrhea.

3) Treatment. The main goal is to eliminate diarrhea and normalize growth and development.

a) Parents are assured that the child’s illness is not dangerous.

b) Adjust the diet.

c) If diet therapy is unsuccessful, hospitalization is indicated. The cessation of diarrhea during a hospital stay often reassures the family that the child is not suffering from a serious illness and prompts a search for psychological causes of the diarrhea.

d) Antidiarrheals are not used.

e) To exclude developmental anomalies, X-ray studies with contrast agents are performed.

Synonyms: chewing gum diarrhea, dietary food diarrhea.

Osmotic diarrhea is a form of diarrhea. Osmotic diarrhea is caused by water retention in the intestine as a result of the intake of water-soluble substances that are not absorbed in the intestine. For example, excessive consumption of hexitol, sorbitol and mannitol (used as sugar substitutes in candy, chewing gum and diet products) can lead to their slow absorption in the gastrointestinal tract and increased small intestinal motility, leading to the development of osmotic diarrhea.

Osmotic diarrhea can also occur with antacid therapy, disaccharidase deficiency, magnesium sulfate and lactulose, glucose-galactose and fructose malabsorption.

ICD code: K52.9

Non-infectious gastroenteritis and colitis, unspecified

Non-infectious gastroenteritis and colitis, unspecified

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Non-infectious gastroenteritis and colitis, unspecified (K52.9)

Version: MedElement Disease Directory

general information

Short description

Gastroenteritis is inflammation of the mucous membranes of the stomach and small intestine.

Colitis is an inflammatory or inflammatory-dystrophic lesion of the colon.

Diarrhea and gastroenteritis of suspected infectious origin - A09

Note 2. List of terms describing colitis in relation to this subheading:

Secondary colitis - colitis observed with damage to other organs (for example, gastritis, cholecystitis).

Hemorrhagic colitis - colitis accompanied by bleeding from an eroded or ulcerated wall of the colon.

Constipative colitis is colitis that develops as a result of frequent constipation.

Catarrhal colitis is colitis characterized by hyperemia and swelling of the mucous membrane with the formation of abundant, mainly mucous, exudate.

Cystic colitis - colitis accompanied by blockage of the intestinal crypts, which leads to the accumulation of mucus in them and cystic expansion.

Left-sided colitis - colitis in which the parts of the colon located on the left (descending colon, sigmoid colon) are predominantly affected.

Drug-induced colitis is colitis that develops as a complication of drug therapy (with allergies, intoxication, dysbacteriosis).

Necrotizing colitis - colitis accompanied by necrosis of the colon mucosa.

Acute colitis - colitis characterized by a sudden onset, diarrhea, enteralgia and, as a rule, a short course.

Superficial colitis - colitis with localization of the pathological process in the superficial layer of the mucous membrane of the colon.

Polypous colitis is colitis accompanied by the formation of one or more polyps on the mucous membrane of the colon.

Post-resection colitis - colitis that develops as a result of extensive resection of the intestine or stomach.

Right-sided colitis - colitis in which the parts of the large intestine located on the right (cecum and ascending colon) are predominantly affected.

Segmental colitis - colitis with isolated damage to one or more parts of the colon (for example, typhlitis, transversitis, proctosigmoiditis).

Fibrinous colitis is a colitis in which fibrin is deposited in the form of films on the mucous membrane.

Follicular-ulcerative colitis - colitis accompanied by suppuration or ulceration of the lymphatic follicles of the intestinal wall.

Follicular colitis - colitis accompanied by multiple enlargement of the lymphatic follicles of the intestinal wall.

Chronic colitis - colitis characterized by a gradual onset and long course with alternating remissions and exacerbations.

Erosive colitis - colitis characterized by the formation of erosions in the mucous membrane of the colon.

Ulcerative colitis is colitis characterized by the formation of ulcers in the mucous membrane of the colon.

Classification

According to clinical and morphological characteristics:

According to the prevalence of the process:

Pancolitis - the process is localized in all parts of the colon;

Segmental colitis - the process is localized in certain parts of the colon;

Typhlitis - right-sided colitis, characterized by damage to the proximal parts of the colon;

Sigmoiditis, proctosigmoiditis - left-sided colitis, characterized by damage to the distal parts of the colon;

Colitis in combination with enteritis and gastritis;

Ileitis (terminal) - damage to the ileum (on the border with the small intestine);

Transversitis - damage to the transverse colon;

Primary colitis (isolated lesion);

Secondary colitis (complication of other diseases).

Etiology and pathogenesis

1. Infectious colitis:

2. Toxic colitis:

3. Toxic-allergic colitis: nutritional.

Forms of acute colitis:

1. Catarrhal acute colitis - hyperemic and edematous intestinal mucosa is noted, on the surface of which accumulations of exudate (serous, mucous or purulent in nature) are visible. The inflammatory infiltrate penetrates the thickness of the mucous membrane and the submucosal layer, in which hemorrhages are visible. Dystrophy and necrobiosis Necrobiosis is a more or less long-term process of irreversible disruption of tissue functioning, preceding their death (necrosis)

epithelium are combined with desquamation Desquamation is scaly peeling (flaking) of the epithelium or other tissues from the surface of an organ, occurring either normally or as a result of various pathological processes

surface epithelium and hypersecretion of glands.

2. Fibrinous acute colitis. Depending on the depth of necrosis of the mucous membrane and the penetration of fibrinous exudate, croupous and diphtheritic fibrinous colitis are distinguished.

3. Purulent acute colitis - phlegmonous inflammation is noted (phlegmonous colitis, colon phlegmon).

4. Hemorrhagic acute colitis - multiple hemorrhages form in the intestinal wall, and areas of hemorrhagic impregnation appear.

5. Necrotizing acute colitis - necrosis of the mucous membrane and often the submucosal layer is observed.

6. Gangrenous acute colitis.

7. Ulcerative acute colitis - as a rule, is the final stage of diphtheritic or necrotic changes in the intestinal wall, but in some cases, ulcers in the colon can occur at the very beginning of the disease.

It is a primary or secondary chronic inflammation of the colon.

Chronic colitis is caused by the same factors as acute (infectious, toxic and toxic-allergic factors). In the development of chronic colitis, the duration of action of these factors in conditions of increased local (intestinal) reactivity is important.

In the majority of cases, the occurrence of the disease is associated with intestinal dysbiosis, which develops as a result of acute intestinal infections and is aggravated by long-term use of certain medications (antibiotics).

Chronic colitis can be secondary - as a consequence of diseases of other organs of the digestive system: chronic gastritis with secretory insufficiency, chronic pancreatitis with exocrine pancreatic insufficiency, chronic calculous cholecystitis, peptic ulcer, hepatitis, cirrhosis of the liver, congenital or acquired deficiency of intestinal enzymes.

Chronic colitis of an allergic nature has been described.

Immune disorders play a role in the development of chronic colitis.

In some cases, the nature of chronic colitis is unknown (Crohn's disease and ulcerative colitis).

A biopsy for chronic colitis reveals changes similar to those for chronic enteritis. The difference is the fact that with colitis, inflammatory phenomena are more clearly expressed, which are combined with dysregenerative changes and lead to atrophy and sclerosis of the mucous membrane.

The lamina propria of the mucous membrane, in which hemorrhages occur, is infiltrated with lymphocytes, plasma cells, and eosinophils; the cellular infiltrate often penetrates into its muscle layer. Cellular infiltration can be moderate focal or pronounced diffuse with the formation of individual abscesses in the crypts and foci of ulceration.

Epidemiology

Sign of prevalence: Common

Sex ratio(m/f): 1

In childhood - due to alimentary gastroenterocolitis;

In young and old age - due to nonspecific ulcerative colitis and Crohn's disease;

At all ages - due to toxic and radiation colitis and microscopic colitis.

Risk factors and groups

Infectious enterocolitis Enterocolitis is an inflammation of the mucous membrane of the small and large intestine.

Presence of autoimmune diseases;

Long-term or repeated drug therapy (antibacterial therapy, PPIs PPIs (PPIs) - proton pump inhibitors. A drug that reduces the secretion of gastric hydrochloric acid by blocking the proton pump in the parietal cells of the gastric glands.

NSAIDs Nonsteroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drugs/agents, NSAIDs, NSAIDs, NSAIDs, NSAIDs) are a group of drugs that have analgesic, antipyretic and anti-inflammatory effects that reduce pain, fever and inflammation.

Clinical picture

Clinical diagnostic criteria

Symptoms, course

Acute colitis. Clinical picture:

1. Acute onset.

2. Frequent bowel movements. The stools are light, liquid or mushy, mixed with mucus or, often, blood and pus; may lose fecal character.

3. Cramping pain in the abdomen.

4. When the distal parts of the colon are affected, tenesmus is observed. Tenesmus is a false painful urge to defecate, for example with proctitis, dysentery.

5. The stomach is swollen. The large intestine is spasmodic, painful on palpation (especially the distal parts).

6. Possible disorders of the cardiovascular system (tachycardia Tachycardia - increased heart rate (more than 100 per minute)

Hypotension Hypotension is low hydrostatic pressure in blood vessels, hollow organs or body cavities.

Diarrhea is characteristic (especially with left-sided colitis), the urge to defecate is sometimes imperative. During an exacerbation, it is possible to increase the frequency of stools up to once a day. During one act of defecation, a small amount of liquid or mushy feces containing a lot of mucus is released.

In some patients, the urge to defecate appears when eating (gastroleocecal or gastrointestinal reflex).

Constipation is also possible (more often with right-sided colitis). The stool may be unstable: diarrhea is replaced by constipation and vice versa (this type of stool disorders must be distinguished from “false” diarrhea in patients with functional constipation or coprostasis. Coprostasis is stagnation of feces in the colon

When feces become liquefied as a result of irritation of the mucous membrane of the colon).

A typical symptom of chronic colitis is the symptom of insufficient bowel movement, when after defecation the patient has a feeling of incomplete emptying.

An exacerbation of the process is characterized by a false urge to defecate, which is accompanied by the passage of gases and individual lumps of feces, covered with strands or flakes of mucus (possibly streaked with blood), or periodic discharge of mucus in the form of films.

2. Abdominal pain is a constant symptom of chronic (especially right-sided) colitis. The pain is localized mainly in the lower abdomen (more rarely throughout the abdomen: with left-sided colitis - in the left iliac region, with right-sided colitis - in the right abdomen.

The pain is usually aching and monotonous, less often it has a paroxysmal character.

In some cases, patients may complain of a feeling of fullness that increases in the evening.

There may be increased pain after eating (especially after eating certain vegetables and milk). Gastrocecal syndrome may also be present - an urge that appears immediately after eating.

The pain becomes less intense after the passage of gas, defecation, as well as when exposed to heat, taking antispasmodics, anticholinergics. The opposite situation is observed with the addition of mesadenitis. Mesadenitis is inflammation of the lymph nodes of the intestinal mesentery.

The pain intensifies after defecation, enemas, and sudden movements.

Damage to the rectum is accompanied by tenesmus and pain in this area after defecation.

Flatulence due to impaired digestion of food in the small intestine and dysbacteriosis;

Increased release of gases;

Rumbling and feeling of transfusion in the abdomen.

Neurotic disorders and signs of dysfunction of the autonomic nervous system (fatigue, irritability, pulse lability, axillary hyperhidrosis);

Weight loss (due to a decrease in food intake as a result of dieting or fear of increased symptoms);

Hypovitaminosis (in about 50% of cases) and anemia of nutritional origin or due to uncontrolled use of antibacterial drugs.

The abdomen is moderately distended;

On palpation: tenderness of the entire colon or its individual segments, the intestinal wall is thickened; reduced intestinal mobility is detected when the serous membrane is involved in the process and the formation of adhesions;

On ausultation: increased peristalsis.

Diagnostics

Acute colitis (gastroenterocolitis, enterocolitis)

The diagnosis is made based on the history and clinical picture.

In order to exclude the infectious nature of the disease, a thorough bacteriological examination of stool, serological tests, PCR, as well as endoscopy and x-ray examination are used.

Chronic colitis (gastroenterocolitis, enterocolitis)

The diagnosis is established on the basis of anamnesis, clinical picture, as well as the results of instrumental and laboratory studies.

1. X-ray methods:

1.1. Determination of the localization and extent of the lesion (pancolitis Pancolitis - inflammation of the colon throughout its entire length

Right- or left-sided colitis, transversitis Transversitis is a form of segmental colitis (inflammation of the mucous membrane of the colon with isolated damage to one or more sections), characterized by localization of the process in the transverse colon

1.2. Identification of the nature of pathological changes (erosive, with symptoms of perivisceritis. Perivisceritis is inflammation of the tissue surrounding the internal organ.

), their severity, the presence of stenoses and fistulas.

With colitis, the folds swell (cushion-shaped) or may disappear completely. The folds have a random direction (sometimes transverse); The appearance of small mobile filling defects due to accumulations of mucus is typical.

colon, which is manifested by intense segmental contractions of the colon (up to a sharp spasm). The intestine takes on the appearance of a cord with jagged contours in the area of ​​spastic contractions.

Functional disorders of the colon are manifested by changes in the speed of passage of the contrast mass through it.

With hypermotor dyskinesia Dyskinesia is the general name for disorders of coordinated motor acts (including internal organs), consisting of impaired temporal and spatial coordination of movements and inadequate intensity of their individual components.

rapid (after 8-12 hours) emptying of the colon is observed. In some cases, increased motility is observed only in some segments of the colon, while in other parts of the colon the contrast mass may linger for 48 hours or more.

With hypomotor dyskinesia Dyskinesia is the general name for disorders of coordinated motor acts (including internal organs), consisting in a violation of the temporal and spatial coordination of movements and inadequate intensity of their individual components.

the passage of contents through the colon is slowed down.

2. Endoscopic examination (FGDS FGDS - fibrogastroduodenoscopy (instrumental examination of the esophagus, stomach and duodenum using a fiber-optic endoscope)

Colonoscopy Colonoscopy is a method of examining the inner surface of the colon, based on its examination using a colonoscope.

Sigmoidoscopy Sigmoidoscopy is a method of examining the rectum and sigmoid colon by examining the surface of their mucous membrane using a sigmoidoscope inserted into the intestinal lumen.

Depending on the location of the process, colonoscopy and sigmoidoscopy more often reveal hyperemia, swelling, bleeding, and ulcers; more rarely - erosive changes, accumulations of mucus or thinning and pallor of the mucous membrane.

3. Examination of biopsy samples from different parts of the intestine is the most important diagnostic criterion.

Recently, there has been an overdiagnosis of chronic colitis (enterocolitis), doctors make this diagnosis only on the basis of patient complaints of abdominal pain, stool instability, bloating and other symptoms, while the diagnosis of chronic colitis requires morphological confirmation (by analogy with chronic gastritis ).

Laboratory diagnostics

Laboratory tests indicating exacerbation of chronic colitis:

Increased ESR (usually);

Increase in CRP level;

Decreased albumin levels;

Slight decrease in plasma electrolyte concentrations.

With left-sided colitis: increased content of mucus, leukocytes, intestinal epithelial cells, and sometimes erythrocytes in the stool;

With right-sided colitis: increased amount of iodophilic flora, digestible fiber, intracellular starch (caecal scatological syndrome);

Increased calprotectin levels;

Hidden blood (not red blood cells, not visible streaks of blood) in the stool appears with gastroenterocolitis with bleeding in the upper intestines (stomach).

1. Detection of diagnostically significant values ​​of pANCA in serum pANCA - antineutrophil perinuclear IgG antibodies - autoantibodies to components of the cytoplasm of neutrophils

and ASCA ASCA - antibodies to Saccharomycetes of the IgG and IgA classes

In the absence of vasculitis, unspecified colitis is transferred to the subheadings “Ulcerative colitis” and “Crohn’s disease”, respectively.

2. Tests for the infectious nature of gastroenterocolitis must be carried out without fail. Positive serological, bacteriological, PCR tests transfer gastroenterocolitis to the heading “Intestinal infections” (A00-A09).

Differential diagnosis

Complications

Perforation Perforation is the occurrence of a through defect in the wall of a hollow organ.

Bleeding is acute and chronic;

Toxic dilatation Dilatation is a persistent diffuse expansion of the lumen of a hollow organ.

Protein-energy malnutrition with weight loss;

Abscesses An abscess is a cavity filled with pus and delimited from surrounding tissues and organs by a pyogenic membrane

Adhesions and cicatricial strictures Stricture is a sharp narrowing of the lumen of a tubular organ due to pathological changes in its walls

with the development of obstruction;

Treatment

Forecast

The prognosis for chronic colitis is generally favorable. However, a long-term process with persistent constipation is a risk factor for the development of colon cancer.

Hospitalization

Prevention

Prevention depends on the etiology of colitis. In most cases it is not developed.

A serious illness of unknown etiology. It is believed to be an autoimmune problem. So far, the only way to completely get rid of it is through surgery.

What is ulcerative colitis?

Nonspecific ulcerative colitis (UC) or ulcerative colitis is a chronic disease of the colon, which, together with Crohn's disease, is classified as “inflammatory bowel disease” (IBD). The word “colitis” means inflammation of the large intestine, “ulcerative” - emphasizes its distinctive feature, the formation of ulcers.

Compared to Crohn's disease, UC is diagnosed 3 times more often. According to statistics from American experts, per 100,000 people. on average there are 10-12 with this diagnosis. Women get sick somewhat more often than men. Most cases are diagnosed at the age of 15-25 years (20-25% of patients under 20) or 55-65 years. It is very rare in children under 10.

Causes and risk factors for developing ulcerative colitis

The causes of UC are unknown. Most researchers are inclined to think that this is an autoimmune problem. Risk factors identified:

• genetic. Ulcerative colitis often affects people who have blood relatives with the same diagnosis. To be precise, this pattern is observed in 1 out of 4 cases. Also, UC is particularly common among certain ethnic groups (for example, Jews), which also suggests the heritable nature of the disease;
• environmental factors. Most cases are registered among residents of the northern regions of Eastern Europe and America. The prevalence of ulcerative colitis is influenced by air pollution and diet. It has also been noted that in countries with a high level of hygiene, UC is more common;
• taking non-steroidal anti-inflammatory drugs.

Classification of ulcerative colitis (ICD codes)

According to the International Classification of Diseases, 10th revision, UC has code K51.

Depending on the location of inflammation, several subclasses are distinguished:

K51.0 - small and large intestine (enterocolitis)

K51.1 - ileum (ileocolitis)

K51.2 - rectum (proctitis)

K51.3 - rectus and sigmoid (rectosigmoiditis)

K51.4 - colon

This group of diseases also includes mucosal proctocolitis (K 51.5) - left-sided colitis affecting the rectum and sigmoid colon, and the descending part of the colon to the splenic angle.

Symptoms and signs of ulcerative colitis

Depends on the location, area of ​​inflammation and severity of inflammation.

Main signs of UC:

• recurring diarrhea (diarrhea), often with blood, mucus or pus;
• stomach ache;
• frequent urge to have bowel movements.

Many patients complain of weakness, loss of appetite and weight.

UC is characterized by alternating exacerbations and periods with moderate symptoms or even asymptomatic ones. If it worsens, the following may be added:

• joint pain (arthritis);
• ulcers of the oral mucosa;
• soreness, redness and swelling of skin areas;
• eye inflammation.

In severe cases, the temperature rises, breathing becomes rapid and shallow, the heartbeat becomes fast or irregular, and blood in the stool becomes more noticeable.

In most patients, it is difficult to identify specific factors that provoke exacerbation. However, it is known that these can be infectious diseases and stress.

Diagnosis of UC

It is impossible to make a diagnosis based solely on symptoms. Only by excluding other probable and more common causes of the painful condition can the doctor confirm the presence of this particular disease. Usually carried out:

Only surgical intervention can get rid of the problem forever. And even surgery does not guarantee a complete recovery.

The main goal of drug therapy is to mitigate the symptoms, transform the disease into an asymptomatic form and try to ensure that such remission lasts as long as possible.

The following groups of drugs are prescribed:

• anti-inflammatory drugs. As a rule, they form the basis of treatment. At the first stage - aminosalicylates in the form of tablets or rectal suppositories. In severe cases or if there is no effect, corticosteroids are added to the treatment regimen. They have a more pronounced anti-inflammatory effect, but also serious side effects. The purpose of taking them is to restrain the development of exacerbation for as long as possible. They are often prescribed to maintain remission.
• immunosuppressants (cyclosporines, infliximab, azathioprine) - drugs that suppress immune reactions. They are prescribed to relieve symptoms and put people into remission.
• antibiotics – to control infection;
• antidiarrheal drugs;
• painkillers (paracetamol). Patients with UC are contraindicated from taking ulcerogenic drugs: ibuprofen, diclofenac, naproxen and products containing them;
• Iron supplements – for the treatment of anemia.

Surgical treatment for ulcerative colitis

The main disadvantage of the operation is its traumatic nature. In most patients, a portion of the large intestine is removed, sometimes including the anus. To remove feces, an ileostomy is formed: a small hole is made in the abdominal wall, to which the edge of the small intestine is attached. The feces are collected in a small bag (colostomy bag) that is attached to the ileostomy.

This solution may be permanent or temporary. In the second case, a reservoir is formed in parallel from the small intestine, which is attached to the anus. While this artificial “bag” heals, bowel movements occur through a temporary ileostomy. During the next operation it will be stitched up. It becomes possible to remove feces naturally. But the frequency of bowel movements is much higher than normal (up to 8-9 times a day).

Diet for ulcerative colitis

Nutrition is important to prevent exacerbations. If the condition worsens, the diet must be followed. General recommendations:

• limit consumption of dairy products;
• choose foods low in fat;
• reduce the content of coarse fiber in the diet (fresh fruits, vegetables, whole grain cereals). It is better to steam, stew or bake vegetables and fruits;
• avoiding alcohol, spicy foods, and caffeinated drinks.

Also, each patient has “personal” products that aggravate the disease. To identify them, it is useful to keep a food diary.

It is important to eat little and often, drink enough water, and take multivitamins.

Complications of the disease

• intestinal bleeding;
• intestinal perforation;
• severe dehydration;
• osteoporosis;
• dermatitis;
• arthritis;
• conjunctivitis;
• mouth ulceration;
• colon cancer;
• increased risk of blood clots;
• toxic megacolon;
• liver damage (rare).

Correct lifestyle for ulcerative colitis

Stress can trigger an exacerbation, and it is important to be able to cope with it. There is no universal advice. One person is helped by sports, another by meditation, breathing practices, the third restores mental balance by doing his hobby or communicating with loved ones.

Forecast

Current medications control symptoms well in most patients. With proper treatment, serious complications are quite rare. Approximately 5% of patients are subsequently diagnosed with colon cancer. The longer and more severe the UC, the higher the likelihood of oncological problems. The risk of developing a tumor is lower if the rectum and lower part of the small intestine are affected.

Prevention

Prevention measures have not been developed to date. After all, it is still unclear what exactly causes ulcerative colitis. Patients are recommended to undergo regular colonoscopy to detect cancer changes early and begin treatment for cancer in the early stages.

How dangerous is ulcerative colitis and how is it treated?

Chronic and acute ulcerative colitis (UC) are one of the most serious diseases of the gastrointestinal tract. There are no ways to get rid of this disease forever, and treatment (transferring the disease into remission) is quite complex and lengthy.

Ulcerative colitis does not have a clearly established cause, but scientists suggest that the trigger for the disease is an error in the functioning of the immune system. Moreover, the onset of the disease is often preceded by certain factors (alcohol consumption, poisoning, other gastrointestinal diseases), which only complicates the determination of the exact cause of the disease.

In this article we will talk in detail about how to treat such a disease using medication and home treatment. We will also look at patient reviews and opinions about certain types of therapy.

What is ulcerative colitis?

Ulcerative colitis is a fairly serious and potentially life-threatening disease, characterized by a chronic course and difficulty in treating. This disease has a wave course, when periods of exacerbation of the disease are replaced by short remission.

Chronic ulcerative colitis occurs due to genetic failures due to the influence of unfavorable factors. Although the disease can be treated, it is not possible to completely eliminate it.

Therefore, treatment comes down to introducing the disease into a stage of long-term remission. But this is not achieved in every patient. The prognosis is especially severe in cases where nonspecific ulcerative colitis is diagnosed in children. The development of the disease before adulthood is characterized by increased resistance to therapy and a statistically greater chance of developing complications.

The disease affects the mucous membrane of the colon and rectum, causing the development of erosions and ulcers on its surface. In moderate and severe cases of the disease, the patient is issued a certificate of disability, since this pathology significantly reduces the patient’s ability to work.

Statistics: how common is UC?

According to modern estimates, approximately every 35-100 people per 100,000 nonspecific ulcerative colitis is detected to varying degrees of severity. It turns out that approximately 0.01% of the world's population suffers from this pathology.

It has been noted that most often the onset of the disease occurs at a young working age (20-30 years), while in older people the development of ulcerative colitis is relatively rare.

Unfortunately, there is no data on the number of patients in the Russian Federation. In the USA, records are being kept, and at the moment the number of patients with ulcerative colitis in this country is 2 million people.

Acute and chronic ulcerative colitis: differences and features

This disease in all cases has a chronic course. After the acute period, it becomes chronic, from time to time moving from the remission stage to the relapse stage. In ICD-10 (the so-called international classification of diseases of the 10th Congress) the disease is divided into the following subtypes:

• chronic enterocolitis with damage to the colon (ICD-10 code: K51.0);
• chronic ileocolitis (ICD-10 code: K51.1);
• chronic proctitis with damage to the rectum (ICD-10 code: K51.2);
• chronic rectosigmoiditis (ICD-10 code: K51.3);
• mucosal proctocolitis (ICD-10 code: K51.5);
• atypical forms of ulcerative colitis (ICD-10 code: K51.8);
• unspecified forms of ulcerative colitis (ICD-10 code: K51.9).

What is obvious is that the subspecies are separated from each other by localization and severity of the process. Each individual subtype has its own basic treatment regimen; there is no universal treatment for all types of ulcerative colitis.

But what are the differences between the acute process and the chronic process in this disease? The fact is that the disease only begins acutely, but it is not limited to this. It enters a chronic stage, which from time to time passes from the remission stage to the relapse stage.

With the acute onset of the disease, all its symptoms reach a peak intensity (manifestation). After a while, the symptoms fade away, and the patient mistakenly believes that he is getting better and the disease is receding. In fact, it goes into remission, and statistically Over the next year, the probability of its recurrence is 70-80%.

Nonspecific ulcerative colitis (video)

Causes of ulcerative colitis

The exact causes of this disease are unknown to science. However, almost all doctors in the world tend to believe that there is three main causes UC. Namely:

1. Genetic factor.
2. Bacterial and viral invasion.
3. Aggressive influence of the external environment.

Genetic predisposition is currently the main suspected cause of UC. It has been statistically observed that the risk of developing ulcerative colitis is higher in those people who have a family history. The presence of ulcerative colitis or Crohn's disease in relatives increases the risk of developing the disease in a potential patient by approximately 35-40%.

Moreover, there is evidence that defects in certain genes also play a significant role in the development of the disease. This is a congenital feature that occurs even in cases where the closest relatives did not have the defective gene.

Bacterial and viral invasion in itself is not considered to be the cause of the development of UC. But in medicine there is a version that it is bacterial and viral infection that triggers the development of the disease in those patients who have a genetic predisposition to it.

The same applies to the aggressive influence of environmental factors (smoking, some diets, injuries, and so on). These factors themselves cannot be the cause, but in some patients they became precursors to the development of ulcerative colitis.

Symptoms of Ulcerative Colitis

Symptoms of UC are nonspecific and resemble the symptoms of many other diseases of the gastrointestinal tract. Because of this, the time from the onset of the disease (when the first symptoms appear) to the moment of diagnosis is significantly lengthened.

In general, ulcerative colitis in the vast majority of patients has the following symptoms:

1. Frequent diarrhea, the stool takes on a mushy form, and there are often admixtures of pus and greenish mucus.
2. False urge to defecate, imperative urges.
3. Pain of varying intensity (a purely individual symptom) in the abdominal area (in the vast majority of cases in its left half).
4. Fever with a temperature between 37 and 39 degrees Celsius. It has been noticed that the more severe the disease, the higher the temperature.
5. Significant decrease in appetite and change in taste preferences.
6. Weight loss (only chronic long-term ulcerative colitis manifests itself this way).
7. Water-electrolyte pathological changes from mild to severe.
8. General weakness, lethargy and concentration problems.
9. Pain of varying intensity in the joints.

There are also extraintestinal manifestations of ulcerative colitis. Namely:

• nodular erythema;
• moderate and gangrenous pyoderma (as complications of ulcerative colitis);
• aphthous stomatitis;
• various arthralgias (including ankylosing spondylitis);
• uveitis;
• episcleritis;
• primary sclerosing cholangitis.

Diagnosis of ulcerative colitis

Diagnosis of this disease, given its typical location and course, does not cause difficulties for experienced gastroenterologists and proctologists. But the final diagnosis is never made by just one physical (superficial) examination, and for its accurate formulation the following medical diagnostics are performed:

1. Fibroileocolonoscopy (diagnosis of the intestine along its entire length at 120-152 cm of initial length, and sigmoidoscopy at 60 cm of the distal part closer to the anus).
2. Clinical blood diagnostics.
3. Blood chemistry.
4. Fecal calprotectin analysis.
5. PCR blood test.
6. Bacterial culture of stool.

Drug treatment of ulcerative colitis

Treatment with medications is quite effective in introducing the disease into a stage of long-term remission. But is it possible to completely cure this disease? Unfortunately, at the moment the disease cannot be completely cured. However, research is being intensively carried out in the world's leading scientific laboratories, and in the future, perhaps in 10-15 years, thanks to gene therapy, the disease can be cured forever.

Treatment with folk remedies at home does not have the desired effect, and sometimes aggravates the situation. Treatment with folk remedies at home can be used only after consultation with a doctor, but one cannot count on any effectiveness of such therapy; it only reduces the severity of the symptoms of the disease.

The main drug therapy is aimed at eliminating inflammation, the body's autoimmune reaction and regenerating affected tissues. So the basis of therapy is the use of Sulfasalazine and Mesalazine. These drugs provide anti-inflammatory and regenerative effects. They are prescribed in higher doses during exacerbation of the disease.

Basic therapy also includes hormonal drugs - Prednisolone and Dexamethasone. But for moderate and mild severity of the disease, they are rarely prescribed; they are justified in using either during exacerbation of the disease, or in case of resistance to treatment with sulfasalazine and mesalazine.

Biological agents have also shown their effectiveness, among which Remicade and Humira are preferred. In some cases, doctors resort to prescribing Vedolizumab, although it is still being studied for serious complications from its use.

Diet for ulcerative colitis

Diet is a very important component of the overall treatment of ulcerative colitis. Nutrition for this disease should have a menu in which the constituent elements of food are distributed as follows:

• 200-230 grams of carbohydrates;
• 115-120 grams of proteins;
• 50-55 grams of fat.

The diet has prohibitions on the consumption of certain foods. Not allowed to eat the following dishes:

1. Any baked goods made from butter dough.
2. Fatty and fish soups.
3. Millet cereal.
4. Fried, fatty and smoked meat.
5. Fried, fatty and smoked fish.
6. Onions, garlic, any mushrooms and radishes.
7. Sour fruits and berries.
8. Any pickles, hot and sour spices (including horseradish and mustard).
9. Any alcoholic drinks.

Despite such serious prohibitions, this diet allows you to eat many other delicious dishes. So you can eat the following foods:

• dried wheat bread, any dietary cookies;
• broths based on fish, meat and, accordingly, vegetables;
• boiled porridge, vegetable purees and even noodles (but without adding spices!);
• veal, lean rabbit meat, steamed cutlets, poultry (but only without skin!);
• lean and only boiled fish;
• zucchini puree, pumpkin, carrots;
• any sweet fruits and berries (and in any form!);
• mild cheeses, fruit and berry sauces;
• parsley dill;
• sour cream, kefir and cottage cheese.

Meals for this disease should be exclusively fractional, 6-8 times a day. At the same time, meals should be in small portions; overeating is not only not recommended, but also prohibited due to the excessive load on the gastrointestinal tract.

Ulcerative nonspecific colitis - description, symptoms (signs), diagnosis, treatment.

Short description

Nonspecific ulcerative colitis(UC) is a chronic inflammatory disease of the colon of unknown etiology, characterized by ulcerative-necrotic changes in its mucous membrane.

Code according to the international classification of diseases ICD-10:

• K51 Ulcerative colitis

The disease always begins in the rectum and spreads proximally. Total damage to the colon occurs in 25% of cases. In severe cases, the damage can spread to the submucosa, muscular and serous membranes of the intestinal wall. Characterized by the formation of ulcers in the colon and rectum, bleeding, abscessation of the crypts of the mucous membrane and inflammatory pseudopolyposis. The disease often causes anemia, hypoproteinemia and electrolyte imbalance, and, less frequently, can lead to perforation or colon cancer.

Frequency- 2–7:100,000. Two peaks of incidence - 15–30 years (larger peak) and 50–65 years (smaller). The predominant gender is female.

Classification According to the clinical course, acute form Chronic recurrent Chronic continuous By severity Mild degree of severity Stool 4 times a day or less, mushy Admixture of blood in the stool in a small amount Fever, tachycardia, anemia are uncharacteristic; body weight does not change, ESR is not changed Severe stool 20–40 r/day, liquid feces in most cases contains an admixture of blood Body temperature 38 ° C or higher Pulse 90 per minute or more Reduced body weight by 20% or more Severe anemia ESR more than 30 mm/h Moderate severity includes indicators that are between the parameters of mild and severe degrees.

Symptoms (signs)

Clinical picture

The onset of the disease can be acute or gradual.

The main symptom is repeated watery stools mixed with blood, pus and mucus, combined with tenesmus and false urge to defecate. During the period of remission, diarrhea may completely stop, but the stool is usually pasty, 3-4 times a day, with a slight inclusion of mucus and blood.

Cramping pain in the abdomen. Most often this is the area of ​​the sigmoid, colon and rectum, less often - the area of ​​the navel and cecum. Typically, the pain intensifies before defecation and decreases after bowel movement. The localization of pain depends on the level of the lesion. Typically, the pain intensifies before defecation and decreases after bowel movement.

Possible damage to other organs and systems Skin and mucous membranes: dermatitis, aphthous stomatitis (5–10%), gingivitis and glossitis, erythema nodosum (1–3%) and erythema multiforme, pyoderma gangrenosum (1–4%), ulcers of the lower extremities Arthralgia and arthritis (in 15–20% of cases), incl. and spondylitis (3–6%) Ophthalmological complications (4–10%): episcleritis, uveitis, iridocyclitis, conjunctivitis, cataracts, retrobulbar optic neuritis, corneal ulcers Liver: fatty hepatosis (7–25%), cirrhosis (1–5 %), amyloidosis, primary sclerosing cholangitis (1–4%), chronic active hepatitis.

Diagnostics

Laboratory research Peripheral blood analysis Anemia (posthemorrhagic - as a result of blood loss; bone marrow reaction to latent inflammation; malabsorption of iron, folic acid, vitamin B 12) Leukocytosis of varying severity Increased ESR Hypoprothrombinemia Hypoalbuminemia due to malabsorption of amino acids Increased content of a 1 - and a 2 - globulins Hypocholesterolemia Electrolyte disturbances Hypokalemia as a result of decreased absorption of both direct ions and vitamin D Hypomagnesemia.

Special studies Sigmoidoscopy during an exacerbation is carried out without preliminary bowel preparation. Colonoscopy is prescribed after the acute phenomena have subsided, because in severe cases of the disease, perforation of the ulcer or toxic dilatation is possible Mild UC - granularity of the mucous membrane Moderate UC - the mucous membrane bleeds on contact, there are ulcerative lesions and mucous exudate Severe UC - spontaneous bleeding from the intestinal mucosa, extensive ulcerative lesions and formation pseudopolyps (epithelium-covered granulation tissue) Irrigography Reduced severity or absence of haustration Uniform narrowing of the intestinal lumen, its shortening and rigidity of the walls (the appearance of a “water pipe”) Longitudinal orientation of the folds of the mucous membrane with a change in their structure according to the type of small and large retina Jaggedness and blurred contours of the intestinal tubes due to the presence of ulcers and pseudopolyps (in the acute phase) The procedure is contraindicated in the development of toxic megacolon Plain radiography of the abdominal organs is especially important in cases of severe UC, when colonoscopy and irrigography are contraindicated Shortening of the colon Lack of haustration Roughness of the mucous membrane Dilatation of the colon (toxic megacolon) Free gas under the diaphragm dome during perforation.

Differential diagnosis Acute dysentery Crohn's disease Intestinal tuberculosis Diffuse familial polyposis of the colon Ischemic colitis.

Treatment

TREATMENT

Diet. Various diet options No. 4. You should avoid eating raw fruits and vegetables for the purpose of mechanically sparing the inflamed mucous membrane of the colon. In some patients, a dairy-free diet can reduce the severity of clinical manifestations, but if it is ineffective, it should be abandoned.

Lead tactics

For sudden exacerbations, bowel emptying with intravenous fluids for a short period of time is indicated. Total parenteral nutrition allows for long-term rest for the intestines.

Salicylosulfonamide drugs are effective for all degrees of severity of the disease, causing remission and reducing the frequency of exacerbations Sulfasalazine 0.5–1 g 4 times a day until clinical manifestations subside, then 1.5–2 g/day for a long time (up to 2 years) for prevention relapses, or Salazodimethoxin 0.5 g 4 times / day for 3-4 weeks, then 0.5 g 2-3 times / day for 2-3 weeks Mesalazine - 400-800 mg 3 times / day orally within 8–12 weeks; for the prevention of relapses - 400–500 mg 3 times a day, if necessary, for several years. The drug should be taken after meals with plenty of water. For left-sided UC, the drug can be used rectally (suppositories, enema). Indicated in cases of insufficient effectiveness and poor tolerability of sulfasalazine.

GK - for acute forms of the disease, severe relapses and moderate forms, resistant to other drugs. For distal and left-sided colitis - hydrocortisone 100-250 mg 1-2 times / day rectally by drip or in microenemas. If effective, the drug should be administered daily for 1 week, then every other day for 1–2 weeks, then gradually, over 1–3 weeks, the drug is discontinued Prednisolone orally 1 mg/kg/day, in extremely severe cases - 1.5 mg/day kg/day In case of an acute attack, it is possible to prescribe 240–360 mg/day intravenously, followed by switching to oral administration. 3-4 weeks after achieving clinical improvement, the dose of prednisolone is gradually reduced to 40-30 mg, then sulfasalazine can be added, and then the reduction is continued until complete withdrawal.

As an adjuvant in combination with sulfasalazine or GC - cromoglycic acid in an initial dose of 200 mg 4 times a day 15 minutes before meals.

For mild or moderate manifestations without signs of toxic megacolon, consolidating drugs (for example, loperamide 2 mg) or anticholinergic drugs are cautiously prescribed. However, the use of drugs that actively inhibit peristalsis can lead to the development of toxic dilatation of the colon.

Immunosuppressants, for example mercaptopurine, azathioprine, methotrexate (25 mg IM 2 times a week), hydroxychloroquine.

If there is a risk of developing anemia, take iron supplements orally or parenterally; in case of massive bleeding - blood transfusion.

For toxic megacolon Immediate withdrawal of consolidating and anticholinergic drugs Intensive infusion therapy (0.9% solution of sodium chloride, potassium chloride, albumin) Corticotropin 120 IU/day or hydrocortisone 300 mg/day IV drip Antibiotics (for example, ampicillin 2 g or cefazolin 1 g IV every 4–6 hours).

Contraindications Sulfasalazine is contraindicated in case of hypersensitivity, liver or kidney failure, blood diseases, porphyria, glucose-6-phosphate dehydrogenase deficiency, breastfeeding. Mesalazine is contraindicated in case of hypersensitivity to salicylates, blood diseases, liver failure, gastric and duodenal ulcers, children under 2 years of age, breastfeeding.

Surgery Indications Development of complications Toxic megacolon with ineffectiveness of intensive drug therapy for 24–72 hours Perforation Excessive bleeding with unsuccessful conservative therapy (rare) Carcinoma Suspicion of carcinoma with intestinal strictures Lack of effect from conservative therapy, rapid progression of the disease Growth retardation in adolescents, not corrected by conservative treatment treatment Dysplasia of the mucous membrane The duration of the disease is more than 10 years (increased risk of cancer) The following groups of surgical interventions are distinguished Palliative (disconnection operations) - application of a double-barreled ileo - or colostomy Radical - segmental or subtotal resection of the colon, colectomy, coloproctectomy Restorative - reconstructive - application of the ileum - rectal or iliac-sigmoid anastomosis end to end.

Complications Acute toxic dilatation (toxic megacolon) of the colon (up to 6 cm in diameter) develops in 3–5% of cases. It is probably caused by severe inflammation with damage to the muscular lining of the colon over a large area and disruption of the nervous regulation of intestinal functions. A certain role belongs to the inadequate prescription of anticholinergics and fixative drugs. The condition is usually severe, with high fever, abdominal pain, significant leukocytosis, exhaustion, and death is possible. Treatment is intensive drug therapy for 48–72 hours. Failure to respond to treatment is an indication for immediate total colonectomy. Mortality is about 20% with a higher rate in patients over 60 years of age. Massive bleeding. The main symptom of UC is bleeding from the rectum (up to 200–300 ml/day). Massive bleeding is considered to be blood loss of at least 300-500 ml/day. Perforation of colon ulcers in UC occurs in approximately 3% of cases and often leads to death. Strictures in UC - 5-20% of cases. Colon cancer. Patients with subtotal or total colon disease and disease duration greater than 10 years have an increased risk of colon cancer (at 10 years, the risk of carcinoma is 10% and can increase to 20% after 20 years and to 40% after 25–30 years) Cancer colon, arising against the background of UC, as a rule, multifocal and aggressive. In patients with UC more than 8–10 years old, annual colonoscopic examinations with biopsies every 10–20 cm should be performed. In the presence of high-grade dysplasia, the possibility of prophylactic total colonectomy should be considered.

Synonyms Ulcerative hemorrhagic nonspecific colitis Ulcerative idiopathic colitis Ulcerative trophic colitis Ulcerative proctocolitis Ulcerative hemorrhagic rectocolitis Purulent hemorrhagic rectocolitis.

Reduction. UC - nonspecific ulcerative colitis.

ICD-10 K51 Ulcerative colitis

Is it possible to permanently cure ulcerative colitis?

Nonspecific ulcerative colitis (UC) is a disease of the large intestine that has only a chronic form. It is characterized by a severe recurrent course and erosive and ulcerative lesions of the mucous membrane. UC is inflammatory in nature, but the inflammation never spreads to neighboring organs or the small intestine.

If a person has nonspecific ulcerative colitis, not a single doctor can tell him whether it can be cured forever.

In modern medicine there is no cure for this disease, but experimental treatment is being developed with which it is possible to transfer the chronic process into lifelong remission.

The disease is more common in developed European countries and the USA - on average 10 people per 10,000 population. Countries in which UC is more common:

There is no specific age range for the occurrence of UC. It can affect all age groups, but older people are at minimal risk. According to statistics, the Jewish nation is more susceptible to UC. Also noted hereditary predisposition to the disease: in families where parents suffer from UC, the risk of developing the disease in children increases by more than 15%.

If ulcerative colitis is detected, the life expectancy of patients is shortened by an average of 10 years.

Causes

A reliable cause of UC has not been found. There are several theories about the occurrence of this disease:

• Influence of environmental factors. Under the influence of inhaled chemical vapors (tobacco smoke, exhaust gases), the mucous membrane of the large intestine is destroyed.
• Taking medications. Frequent use of antibiotics causes dysbiosis in the intestine, including the colon, which leads to a decrease in the protective properties of the mucous membrane and the appearance of erosive lesions.
• Microorganisms. There is a theory that UC is an infectious disease and can be caused by bacteria or viruses.
• Theory of oral contraceptives. Explains the occurrence of ulcerative colitis in women who use hormonal means to prevent pregnancy. Estrogens in contraceptives can cause the formation of microthrombi in the vessels of the large intestine.
• Autoimmune origin of the disease. Scientists believe that UC is an autoimmune disease in which the immune system fights against colon cells as if they were foreign.

According to case histories of ulcerative colitis, there is an association with hereditary factors. More than 15% of patients with UC also had cases of this disease in their family.

Classification

Nonspecific ulcerative colitis - ICD code 10 K51. Also, according to ICD 10, UC is classified as follows:

1. K51.0 – Ulcerative enterocolitis;
2. K51.1 - Ulcerative ileocolitis (affects all parts of the large intestine);
3. K51.2 - Ulcerative proctitis (damage to the rectum and colon);
4. K51.3 - Ulcerative rectosigmoiditis (damage to the rectum and sigmoid colon);
5. K51.9 - Ulcerative colitis, unspecified.

In addition to ICD 10, there is a UC classification depending on location:

• Total;
• Left-handed;
• Proctitis;
• Total, which is combined with damage to the distal ileum.

Symptoms

In a person suffering from ulcerative colitis, the symptoms primarily indicate a disruption in the functioning of the rectum. The act of defecation and the nature of bowel movements change:

1. Frequent urge to defecate, the number of visits to the toilet can reach 20 or more times per day;
2. The stool has a mushy consistency;
3. Pathological impurities appear in the stool - blood, mucus, pus;
4. There are false urges to defecate.

In addition to defecation disorders, a change in general condition is noted. Weakness and fatigue appear, in some cases the body temperature rises to 39 0 C. Due to constant urges, a person cannot concentrate on work, attention is lost, and performance decreases. Due to the loss of large amounts of fluid in feces, dehydration occurs. A person’s skin turns pale, sleep is disturbed, and appetite disappears. Sexual function decreases, libido disappears. Body weight is significantly reduced.

The water-electrolyte balance is disrupted, which leads to disruption of the functioning of all organs and systems:

• Electrolyte disturbances lead to changes in heart function. The patient feels palpitations, cardiac activity becomes arrhythmic, and shortness of breath is noted.
• The functioning of the urinary system and kidneys is disrupted. Due to fluid loss, the filtration capacity of the kidneys is reduced, which can lead to kidney failure. There is also a risk of kidney stones.
• Violation of the osteoarticular system. Joint mobility decreases due to a decrease in the amount of electrolytes, and pathological fragility of bones appears.

Diagnostics

Diagnosis of UC begins with clarification of the patient’s complaints. Since the complaints are characteristic, after communicating with the patient it is easy to make a preliminary diagnosis. An objective examination is carried out to determine:

1. Dry skin, decreased elasticity;
2. Pain in the lower abdomen;
3. Minor joint deformities;
4. Impaired heart function and rapid, uneven pulse.

Further, additional research methods are prescribed. A general blood test reveals anemia, leukocytosis, and a shift in the leukocyte count to the left. When analyzing urine - an increase in its density, the presence of salts, cylinders. In advanced forms, protein and sugar appear in the urine. A biochemical blood test reveals C-reactive protein and circulating immune complexes, indicating an autoimmune component of the disease.

Instrumental methods include sigmoidoscopy, during which a section of intestinal tissue is taken for biopsy. There is thickening of the intestinal folds, their smoothness, and swelling of the mucous membrane. A characteristic symptom is the presence of ulcers and erosions that penetrate shallowly into the thickness of the intestine and, in rare cases, reach the muscle layer. Microscopic examination reveals hemorrhages and changes in the structure of capillaries, a decrease in the number of goblet cells.

If appropriate symptoms are present, consultations with related specialists, ECG and X-rays are prescribed.

Conservative treatment

Before starting treatment, be sure to prescribe a diet for nonspecific ulcerative colitis of the intestine. Diet features:

• Food must be liquid or soft, all solid foods must be crushed or grated;
• The temperature of the food should be no less than 15 and no more than 65 degrees;
• You are allowed to drink tea, but not hot;
• Only low-fat broths are allowed, yesterday’s bread;
• Spicy, fried or salty foods are contraindicated.

Nutrition for UC should be balanced and rich in vitamins; food should be taken 5-6 times a day in small portions. If there is significant intestinal damage, the patient is transferred to parenteral nutrition.

In addition to diet, for ulcerative nonspecific colitis, an appropriate regimen is prescribed. Patients are prohibited from physical activity, it is necessary to alternate between work and rest, and get enough sleep.

The main directions in drug treatment are the fight against inflammatory changes and the healing of existing erosions. Drugs that have this effect are derivatives of 5-aminosalicylic acid:

They can be used in the form of tablets or microenemas. The course of treatment is lifelong. In addition to these drugs, glucocorticosteroids (dexamethasone or prednisolone) are prescribed in combination. They are administered intravenously and are used only in case of relapse of the disease.

The drug vedolizumab is also used. It is an antibody. The medicine is new, so it is not widely used. However, studies have been conducted showing that the drug caused long-term remission in most patients.

A side effect of the drug against ulcerative colitis is a slowdown in sperm movement. Therefore, men with ulcerative colitis experience infertility, but it is reversible. If the drugs are discontinued, sexual function is restored.

Traditional methods of treatment

If nonspecific ulcerative colitis is diagnosed, treatment with folk remedies can also lead to remission of the disease, but only in combination with drug treatment. There are methods for internal use or directly introduced into the rectum. For UC, it is recommended to select folk remedies together with your doctor.

Herbs that help in the fight against UC:

• St. John's wort. It is brewed for 1.5 hours in proportion to 2 tablespoons of 0.5 liters of water. You need to drink half a glass 3 times a day before meals.
• Chamomile. Has a softening and healing effect. It is brewed in the same way as St. John's wort and after infusion, honey is added. Take 3-4 times a day.
• Herbal intestinal preparations. Sold in pharmacies. 2 tablespoons are brewed in 0.5 liters of boiling water and infused for 2 hours. You need to drink 4 times a day half an hour before meals.

In addition to herbs, you can take propolis tincture internally. It has a healing and antibacterial effect, and also relieves inflammation. The tincture is sold in pharmacies and added to tea or clean water, 10 drops. It must be taken 3 times a day before meals.

Sea buckthorn oil is used for microenemas, as it has a healing effect. It is recommended to administer before bedtime and then fall asleep. The course of treatment is 30 enemas.

Experimental treatment

In modern medicine, an experimental method has been developed to treat ulcerative colitis. This technique is called stool transplantation. Its essence lies in the transplantation of normal microflora from the donor to the recipient. Since UC is a disease in which the balance of microorganisms in the colon is disrupted, transplantation of normal microflora helps heal changes in the intestinal wall and eliminate symptoms. Since the method is experimental, it is used quite rarely and not in all hospitals. Despite the fact that the method does not require taking additional medications, the diet for UC should be maintained.

Any person who meets the following requirements can become a donor:

1. The donor cannot be a family member or a person who eats with the patient;
2. Must not have gastrointestinal diseases;
3. The presence of an acute infectious process in the body, HIV infection, viral hepatitis is a strict contraindication to donation;
4. Strictly from 18 years of age.

After collecting stool from the donor, it is mixed with water and introduced into the lumen of the large intestine to the maximum depth through a colonoscope.

Thanks to this method, recovery histories are known for patients with ulcerative colitis. Although a stool transplant does not completely cure the disease, lifelong remission is possible, which is compared to recovery. According to research, this method can restore 90% of the microflora of the affected intestine.

If a person has nonspecific ulcerative colitis, treatment with a stool transplant at home is strictly contraindicated.

Nonspecific ulcerative colitis. Crohn's disease

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

general information

Short description

Classification

1 Severity of ulcerative colitis

Classification of Crohn's disease(working)

Risk factors and groups

Diagnostics

Complaints and anamnesis: diarrhea, pain in the right iliac region, weight loss.

Physical examination: diarrhea, pain in the right iliac region, perianal complications, fever, extraintestinal manifestations, internal fistulas, weight loss.

Instrumental studies:

1. Endoscopic: the presence of transverse ulcers, aphthae, limited areas of hyperemia and edema in the form of a “geographical map”, fistulas localized in any part of the gastrointestinal tract.

2. X-ray: rigidity of the intestinal wall and its fringed outlines, strictures, abscesses, tumor-like conglomerates, fistulous tracts, uneven narrowing of the intestinal lumen up to the “lace” symptom.

3. Histological: swelling and infiltration of lymphoid and plasma cells of the submucosal layer, hyperplasia of lymphoid follicles and Peyer's patches, granulomas. As the disease progresses, suppuration, ulceration of lymphoid follicles, spread of infiltration to all layers of the intestinal wall, hyaline degeneration of granulomas occur.

4. Ultrasonic: wall thickening, decreased echogenicity, anechoic thickening of the intestinal wall, narrowing of the lumen, weakened peristalsis, segmental disappearance of haustra, abscesses.

Instrumental studies

1. Endoscopic: in accordance with the classification.

2. X-ray: granulation (graininess) of the mucous membrane, erosions and ulcers, jagged contours, wrinkling.

3. Histological: inflammatory infiltration of lymphatic and plasma cells, dilation of glands, emptying of goblet cells, crypt abscesses, erosions and ulcers with undermined edges.

Consultations with specialists - according to indications.

List of basic diagnostic measures

Treatment

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.

Further management: follow-up after remission is achieved consists of endoscopic examination at least once every 2 years for at least 8 years.

List of essential medications:

* - a drug included in the list of vital medicines