Ulcerative colitis - Causes, symptoms and treatment. MF.

Ulcerative colitis is a chronic disease that affects only the mucous membrane of the colon, accompanied by inflammation, edema and ulcerative defects. Most often people are sick at the age of 20 - 40 years and after 55 years.

The figure shows the anatomy of the colon - with ulcerative colitis it is affected all over.

Causes of ulcerative colitis

There is no universally recognized theory of ulcerative colitis. A number of hypotheses are proposed, among them:

• ulcerative colitis is an infectious disease, but the causative agent is not yet known;
• Ulcerative colitis is an autoimmune disease when the own immune system produces antibodies against the epithelial cells of the colon mucosa;
• Ulcerative colitis is a hereditary disease, the development of which triggers a number of unfavorable environmental factors.

The following triggers for the development of the disease are known:

• a diet poor in dietary fiber and rich in carbohydrates;
• dysbiosis;
• stress and trauma;
• a sedentary lifestyle.

An interesting fact is the observation that people who undergo appendectomy are less likely to suffer from ulcerative colitis.

Symptoms of ulcerative colitis

Ulcerative colitis occurs with periods of exacerbation and remission. The severity of exacerbations can range from mild to moderate to severe.

With an exacerbation of mild to moderate severity of the disease, general symptoms show malaise, weakness, and a fever of 38 ° C.Of the local signs of the disease, frequent stools are allocated up to 5 times a day with an admixture of blood and cramping pains in the abdomen.

In case of severe disease, the temperature may rise above 38 ° C, tachycardia( pulse more than 90 beats / minute), pale skin due to anemia( anemia), dizziness, weakness. Of the local signs: stool frequency more than 6 times / day with a lot of blood, blood clots are possible, strong cramping pains in the abdomen before the act of defecation. Similar manifestations can occur with infectious enterocolitis( acute dysentery, salmonellosis), Crohn's disease, ischemic colitis, pseudomembranous colitis, celiac disease( intolerance of foods from wheat and barley), diverticular disease, blood in the stool may be present due to hemorrhoidal bleeding. It should be noted that Crohn's disease is very similar to ulcerative colitis, the main difference is that with Crohn's disease affects the entire thickness of the wall of the bowel, and not just the mucous membrane.

In any case, in the presence of abdominal pain that persists for 6 hours, the allocation of blood from the rectum should contact a surgeon to exclude acute surgical pathology. It is not recommended to use painkillers because they can distort the clinical picture of the disease and prevent the correct diagnosis. You can take spasmolytic drugs - no-spa or buscopan( 2 tablets once).With the development of diarrhea without signs of bleeding, it is possible to use antidiarrhoeal drugs such as loperamide, imodium at an initial dose of 4 mg, then 2 mg after each act of defecation, maximum 16 mg per day, do not take more than 24 hours,to the doctor.

Survey for suspected ulcerative colitis

From laboratory tests, , it is necessary to submit a general blood test to assess the extent of blood loss and severity of anemia, blood for coagulation and bleeding, and a standard set of studies taken during admission to hospital.

Key is the fibro colonoscopy . The key instrumental method of investigation, allowing to make an accurate diagnosis and assess the degree of intestinal mucosa damage, is .This is an endoscopic examination consisting of a visual assessment of the mucosa by a flexible device inserted into the lumen of the gut through the anus.

In the picture, a typical endoscopic picture of ulcerative colitis is inflammation, mucosal edema, ulcerous defects and fibrin stratification.

However, at the time of exacerbation it is difficult to perform a colonoscopy in full volume due to inflammatory changes in the intestine and the danger of perforation.

Irrigoscopy is a safer method of research, although less informative. It consists in performing an enema with barium suspension and subsequent X-ray examination. Barium suspension, enveloping the inside of the intestinal wall, allows you to get a picture of the casts of the mucous membrane on the roentgenogram and judge the extent and severity of ulcerative defects. Also, a possible alternative to barium suspension can be ordinary air, being introduced into the lumen of the intestine, it performs the function of contrast.

Obstetric radiography of the abdominal cavity without the use of contrast agents is necessary for the diagnosis of complications of ulcerative colitis( perforation of the colon).

Treatment for ulcerative colitis

The main goal of treatment for ulcerative colitis is the rapid achievement of persistent remission of the disease. The treatment is based on anti-inflammatory drugs: aminosalicillata( sulfasalazine, mesalazine), glucocorticoid hormones( metipred, dexamethasone, prednisolone) and cytotoxic drugs( methotrexate, azathioprine, mercaptopurine).The latter is prescribed only in severe forms of the disease, as they depress the immune system, promoting the development of immunodeficiency.

Hemostatic agents( dicinone, aminocaproic acid, tranexam) are prescribed for symptomatic treatment, in case of heavy bleeding, red blood cells and freshly frozen blood plasma may need to be transfused.

For the normalization of intestinal peristalsis, antispasmodics( no-shpa, papaverine) and antidiarrhoeals( loperamide) are used.

Antibiotic therapy is prescribed for complications.

With severe exhaustion, parenteral nutrition is prescribed( intravenous administration of nutritional mixtures - amino acid solutions, fat emulsions and carbohydrates).

If these conservative measures are ineffective and bleeding from the rectum continues for more than 100 ml / day, surgical treatment is indicated. The only effective method of surgical treatment is the implementation of colectomy with abdominal-anal rectal resection, that is, the removal of the entire colon. This crippling operation is performed strictly according to the indications of a limited contingent of patients.

Features of nutrition and the prevention of recurrences with ulcerative colitis

Given that the long-term inflammatory process in the body leads to weight loss and exhaustion, nutrition with ulcerative colitis should be high-grade, high-calorie, contain foods rich in vitamins and proteins. Take food in small portions, 6 times a day. It is necessary to exclude from the diet sauces, spices, fatty and fried foods, coarse vegetable fiber in the form of raw vegetables and fruits, as they contribute to the development of diarrhea. For the same reason, it is necessary to be cautious about the use of milk and dairy products. You can eat fish, low-fat meat( beef, turkey, chicken, rabbit) in baked and boiled form, soups with low fat-free meat and fish broth, porridge, eggs( up to 2 pieces a day soft-boiled or as a steam omelet),potatoes, rice, jelly, blueberry jelly, ripe pears and other berries and fruits, curd soufflé, dried bread. From drinks you can drink tea, black coffee, cocoa on the water, broth of wild rose, bird cherry and blueberries.

After relieving ulcerative colitis, anti-inflammatory drugs are taken within six months. Further control colonoscopy is performed. In the absence of inflammatory changes from the mucosa of the colon, the course of treatment is terminated, if the endoscopic picture of the disease persists, the course of treatment is extended for another 6 months until the next study.

To the planned fibrocolonoscopy it is necessary to prepare. The simplest way to do this is with Fortrans. On the eve of the study, you must follow the diet indicated above, you can drink tea right before the test. On the day of the study, after dilution of the drug in the calculation of 1 packet per 1 liter of water( the number of sachets depends on your weight), drink in divided portions for 4 hours. The chair stops 3 hours after the last dose. After this, you can perform a colonoscopy.

Complications of ulcerative colitis

In the absence of timely treatment, complications may develop:

• life-threatening bleeding;
• toxic dilatation of the large intestine - excessive expansion of the diameter of the large intestine due to the cessation of peristaltic contractions due to pronounced inflammation of the mucous membrane. At the same time stagnation of intestinal contents occurs, which is absorbed into the blood and exerts a toxic effect on the body as a whole. Eliminate this condition by colonoscopy with the removal of the contents of the gut. In the absence of timely assistance, the following complication occurs;
• Perforation of the colon - this is a violation of the integrity of the intestinal wall, accompanied by the discharge of intestinal contents into the free abdominal cavity with the development of peritonitis( inflammation of the peritoneum) and sepsis( blood infection);
• Colon cancer can occur with prolonged ulcerative colitis, so people who have reached 50 years of age should undergo a planned colonoscopy;
• Extraintestinal complications - ulcerative colitis can cause the development of arthropathies( swelling and pain in large joints), liver, biliary tract, skin( pustular eruption - pyoderma).

Prevention of ulcerative colitis

To date, measures for the prevention of ulcerative colitis have not been developed. Warn the development of complications can only be timely diagnosis and treatment of the disease.

As noted by the great scientist Hippocrates: "A person should know how to help oneself in illness, meaning that health is the highest wealth of a person."Take care of your health. It is better to overestimate the severity of your symptoms than it is too late to seek medical help.

Surgeon-physician Tevs DS