Nonspecific ulcerative colitis
Content:
- What is ulcerative colitis?
- Ulcerative colitis symptoms
- Causes of ulcerative colitis
- Forms of ulcerative colitis
- Diagnostics of the ulcerative colitis
- The consequences of ulcerative colitis
- Treatment of ulcerative colitis of the intestine
- Diet and nutrition for ulcerative colitis
What is ulcerative colitis?
Ulcerative colitis is a disease of the gastrointestinal tract, namely the large intestine, characterized by an inflammatory process of its mucous membrane.
As a result of this inflammation, ulcers and areas of necrosis are formed in areas of the intestine. The disease is chronic and tends to recur.
Most often, pathology affects the young population, people aged 15 to 30 years. Less often, the first attacks of the disease develop after 50 years. Statistics indicate that out of 100 thousand of the population, an average of 70 people fall ill. In addition, women are diagnosed more often than men.
The pathological process does not involve the small intestine and affects only certain parts of the large intestine, and not its entire surface. The disease manifests itself either in the rectum or in the sigmoid colon, that is, at the end of the large intestine. Then there is a further spread of the inflammatory process.
Can ulcerative colitis be cured?
Whether there is an opportunity to cure ulcerative colitis, every person who has been diagnosed with such a diagnosis thinks about. Those diseases that belong to the category of chronic ones cannot be completely cured. Ulcerative colitis refers to just such diseases. But this does not mean that it is worth completely abandoning the therapeutic effect.
The disease can and should be controlled by choosing the optimal tactics of exposure together with the attending physician. This must be done, since the pathology is cyclical, that is, periods of remission are replaced by periods of exacerbation. If you ignore the presence of colitis for a long time, this threatens the development of complications, up to and including death. Therapy and diet helps to contain the disease by preventing recurrences. Therefore, with proper treatment, the quality and life expectancy of a person with ulcerative colitis is not impaired. Stable remission can be observed for years.
Ulcerative colitis symptoms
The symptomatology of the disease depends on where exactly the pathological process is located and on its intensity. In addition, it is worth distinguishing between intestinal and extraintestinal manifestations.
Intestinal symptoms include:
- The appearance of diarrhea, in which blood impurities are found. Often, in addition to bloody clots, mucus and pus are present in the stool, which gives them a fetid odor. It happens that blood with mucus and pus appears in the intervals between bowel movements. Stool frequency varies depending on the severity of the disease and can go up to 20 times per day. A person can lose up to 300 ml of blood per day. With a milder course of the disease, a person defecates several times, more often in the morning and at night.
- Pain symptoms also vary in severity. They can be both sharp, causing severe discomfort, and weak, not causing serious suffering to a person. Sometimes it is not possible to get rid of painful sensations even with the help of medicines, which indicates the development of a complication of the disease. The place of pain localization is the left side of the abdomen or the left iliac region. As a rule, an increase in painful sensations occurs before the act of defecation, and after it they subside somewhat. Also, pains can gain strength after eating.
- An increase in body temperature, but, as a rule, is insignificant, up to subfebrile levels.
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General intoxication of the body with accompanying symptoms, including the appearance of weakness, dizziness, the development of depression, decreased mood, the onset of irritability and tearfulness. The patient's appetite falls, in connection with which he begins to lose weight, which in some cases leads to anorexia. Intoxication is typical if the disease is severe.
- Tenesmus or false urge to empty the bowels. In some cases, instead of feces, either mucus or mucopurulent masses is released.
- Expressed flatulence.
- Fecal incontinence.
- Change from diarrhea to constipation. This transition is a sign that severe inflammation has begun to develop in the mucous membrane lining the colon.
- Ulcerative colitis can sometimes develop rapidly. This form of the disease is called fulminant and will be discussed below.
In addition to intestinal symptoms, the patient suffers from extraintestinal lesions:
- The development of erythema nodosum (the formation of subcutaneous nodules detected by palpation), pyoderma gangrenosum (necrosis of the skin area). This is due to the increased circulation in the blood of bacteria and immune complexes produced to fight them. In addition, skin lesions such as focal dermatitis, urticarial and postular rashes are also seen.
- Lesion of the oropharynx, which occurs in 10% of patients. This is expressed in the spread of aft, which pass after it is possible to achieve remission. Also, glossitis and gingivitis, ulcerative stomatitis can begin to develop in the oral cavity.
- Eye diseases are observed even less often, no more than 8% of patients. Patients may suffer from iridocyclitis, uevitis, choroiditis, conjunctivitis, keratitis, retbulbar neuritis, and panophthalmitis.
- Joint lesions, which are expressed in arthritis, spondylitis, sacroiliitis. Moreover, often such lesions of the articular tissue are precursors of ulcerative colitis.
- More often than other systems, the lungs are exposed to pathological processes.
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As a result of failures in the work of the endocrine gland, there are failures in the work of the liver, bile ducts, and pancreas.
- Very rarely, patients complain of myositis, osteomalacia, osteoporosis, vasculitis, glomerulonephritis.
- Cases of the development of autoimmune thyroiditis and hemolytic anemia have been described.
The first signs of ulcerative colitis
In order not to confuse the onset of the disease with other similar pathologies of the intestinal tract, you need to have an idea of what the first signs of colitis may be.
There are several options for the development of the disease:
- Firstly, diarrhea may develop at first, and after a few days, blood and mucous masses are found in the stool.
- Secondly, rectal bleeding can open immediately after the manifestation of the inflammatory process. In this case, the chair will not be liquid, but decorated, or of a mushy consistency.
- Thirdly, the patient may suffer from diarrhea, intoxication and rectal bleeding at the same time.
Most often, the disease begins to develop gradually, with diarrhea, which is caused by the development of extensive inflammation in the intestinal mucosa. Against the background of this process, it becomes unable to reabsorb sodium and water. Blood, in turn, appears due to the fact that ulcers form on the membrane, forming a loose connective tissue permeated with a vascular network. Symptoms tend to decrease and then gain momentum again.
In addition to diarrhea, the first signs of the onset of the disease may be pain that occurs mainly on the left side and a slight increase in body temperature. A person may experience pain in the joints, since in some cases, damage to their tissues precedes the development of the disease.
So, the four early signs to look out for, and which enable a person to independently suspect ulcerative colitis, are: bloody diarrhea, joint pain, abdominal discomfort, and fever.
Causes of ulcerative colitis
The question of the etiology of the disease is still open and scientists are still looking for the reasons that cause its development.
However, there are reliably known risk factors that have a provoking effect on the development of a pathological process in the large intestine:
- Genetic predisposition. The risk of a close blood relative suffering from the disease is greatly increased when similar cases of ulcerative colitis are present in the family.
- The infectious nature of the disease. The intestine is the part of the body where a huge number of bacteria are concentrated. Some of them at some point in time can lead to the development of inflammation.
- Autoimmune mechanisms in the body. This idea was prompted by scientists that ulcerative colitis is associated with seasonal exacerbations, it responds well to treatment with hormonal drugs. Studies have confirmed that the harder the process in the intestine, the more aggravated the changes in the immune status.
- Violation of the diet, errors in the menu.
- Stress and other traumatic factors.
Scientists come to the conclusion that this disease depends on many factors, each of which has a certain influence on the formation of ulcerative colitis. However, the leading role, most likely, belongs to intestinal antigens. In support of this theory, one can cite a large study conducted by American scientists, the results of which were published in the Los Angeles Times. Scientists have been able to experimentally establish a connection between fungi found in the intestine and ulcerative colitis.
Thus, at present, in the theory of the pathogenesis of the disease, the leading role is assigned to two factors: immune and genetically determined.
Forms of ulcerative colitis
It is customary to distinguish several forms of the disease, which depend on the place and degree of localization of the inflammatory process in the colon, as well as on the nature and intensity of the disease.
So, depending on the localization of inflammation, they are distinguished:
- Left-sided colitis. This form differs in that the colon is affected. Symptoms begin with diarrhea with blood impurities. The pains are localized on the left side, the appetite disappears, which leads to dystrophy.
- Total colitis. This form of the disease is considered the most life-threatening, as it threatens the development of complications, in particular, dehydration, a drop in blood pressure, hemorrhagic shock. Symptoms of such colitis are manifested in the form of pain of high intensity, persistent profuse diarrhea, massive blood loss.
- Pancolitis, characterized by inflammation of the rectum along its entire length.
- Distal colitis. This form of colitis is characterized by the inclusion in the pathological process of the membrane of the left intestine, that is, the sigmoid and rectum at the same time. It is distal colitis that is widespread. Symptoms are severe pain, mainly localized in the left iliac region, tenesmus, mucus and blood streaks in the stool, flatulence, and sometimes constipation.
- Proctitis, in which only the rectum is affected.
Depending on the characteristics of the course of the disease, there are:
- Chronic continuous colitis.
- Fulminant or acute colitis.
- Chronic recurrent colitis.
Chronic ulcerative colitis
Chronic ulcerative colitis is characterized by the fact that the intestinal lining is hyperemic, the vascular pattern undergoes a change, and erosion and atrophic formations are found along its line.
The main symptom of chronic ulcerative colitis is a long-term disorder of the stool, which increases up to 15 times a day during an exacerbation. Also, diarrhea is replaced by constipation.
In addition, abdominal pain, which has an aching monotonous character, is a constant companion of chronic colitis. During periods of remission, patients complain of increased gas production, rumbling in the abdomen. However, weight loss is not observed, appetite, as a rule, is not disturbed.
Often such people have neurological disorders, in particular, fatigue, irritability, hyperhidrosis. The abdomen is swollen, at a doctor's appointment, during palpation, there is a moderate pain in individual segments of the colon.
Exacerbation of ulcerative colitis
An exacerbation of the disease is characterized by the violent manifestation of all symptoms. The stool becomes more frequent, it contains impurities of blood and mucus. Electrolyte disturbances increase rapidly, if untreated, dehydration develops.
An acute ulcerative process in the colon is dangerous to ignore, as it threatens with complications. Among them, the development of arrhythmias (due to a lack of magnesium and potassium), edema (due to a drop in oncotic blood pressure against the background of a decrease in proteins in the blood), hypotension, dizziness, decreased vision, intoxication of the body.
In addition, fulminant or fulminant colitis is especially dangerous, which can even lead to rupture of the colon and internal bleeding.
Diagnostics of the ulcerative colitis
If a person suspects that he is developing ulcerative colitis, then it is necessary to seek medical help. Either a therapist or a gastroenterologist can diagnose the disease.
For an accurate diagnosis, laboratory tests will be required, including:
- General blood analysis. According to its results, anemia and an increase in the number of leukocytes are diagnosed.
- Biochemical blood test, where C will be increased - a reactive protein, indicating the presence of an inflammatory process. The number of gamma globulins will increase, the quantitative content of magnesium, calcium and albumin will decrease.
- Immunological blood test, which will detect the growth of antibodies (cytoplasmic antineutrophilic).
- Stool analysis, which will contain blood, mucus and pus.
Endoscopy, which includes colonoscopy and rectosigmoscopy, will indicate the presence of:
- Purulent, mucous and bloody discharge in the intestinal lumen;
- Puffiness;
- Hyperemia;
- Pseudopolyps;
- Bleeding.
When endoscopy is performed during remission of the disease, atrophy of the mucous membrane lining the intestines is observed.
We must not forget about X-ray examination. In this disease, a barium mixture is used to create contrast. According to the results of an X-ray, the patient has polyps, ulceration, a decrease in the length of the intestine, if any.
Scientists are developing a new type of examination - capsule endoscopy, which in some cases can replace colonoscopy. This procedure is painless and does not cause discomfort, however, visualization is worse than with a direct examination of the intestine.
The consequences of ulcerative colitis
The consequences of late diagnosed ulcerative colitis can be quite serious:
- If the entire colon is affected, there is a risk of developing colorectal cancer in the next few years.
- In addition, there is a risk of colon perforation, which can be fatal.
- The disease often becomes the reason that cracks form in the intestines, intestinal bleeding develops.
- Toxic megacolon is another complication of the disease, which consists in the expansion of the intestine in the area affected by colitis. The process is accompanied by severe pain, high fever and general weakness.
Treatment of ulcerative colitis of the intestine
The treatment of the disease is carried out symptomatically, since there is no possibility of medication to influence the cause of the inflammation. Therefore, the goals that the doctors strive to realize are reduced to relieving inflammation, preventing serious complications and establishing a state of stable remission.
Conservative therapy of the disease consists of:
- In compliance with the diet. When the disease is in the acute phase, the patient is completely restricted in food, and only water is offered as a source of drinking. When the acute phase is over, the patient needs to switch to a protein diet, low in fat. The priority will be eggs, cottage cheese, lean meats and lean fish. Coarse fiber is also not suitable for eating, as it can injure irritated intestinal mucosa. The source of carbohydrates should be sought in a variety of cereals, compotes based on berries, etc. In especially difficult cases, the patient is transferred to artificial nutrition.
- Since refusal from fresh fruits and vegetables threatens with vitamin deficiency, the patient is recommended to take vitamin and mineral complexes.
- Reception of nonsteroidal anti-inflammatory drugs, including mesalazine, sulfasalazine, salofalk.
- Corticosteroid hormonal drugs are prescribed, but with extreme caution. This is due to the fact that they can cause some serious complications, in particular, osteoporosis, hypertension. These are drugs such as prednisolone, methylprednisolone.
- Therapy with antibacterial agents: cyfran, ciprofoxaline, ceftriaxocon.
- Symptomatic medications needed to relieve pain, stop diarrhea, increase blood iron levels, if there is anemia.
- There are physiotherapeutic methods of influencing the disease. Among them, special effectiveness has been shown: SMT (modulated current exposure), diadynamic therapy, interference therapy and others.
When conservative methods do not give the desired effect in the fight against the disease, doctors resort to surgical intervention.
The indications for surgery for ulcerative colitis are:
- perforation (perforation of the bowel wall)
- signs of intestinal obstruction
- abscess
- presence of toxic megacolon
- profuse bleeding
- fistulas
- bowel cancer
The following are used as modern operational techniques:
- Proctocolectomy with the imposition of either a temporary or permanent ileostomy for the removal of human waste products.
- Colectomy (excision of the colon)
- Proctocolectomy (removal of the rectum and colon) while preserving the anus
As for the prognosis, in the case of uncomplicated colitis, it is favorable. The majority of patients (almost 80%) who promptly start treatment do not experience bouts of exacerbation of the disease throughout the year. Relapses occur on average once every five years, but in rare cases (about 4%), this period can last up to 15 years.
Surgical intervention is required relatively infrequently; about 20% of the total number of patients need it. Malignant neoplasms develop in 10% of cases. The absence of clinical manifestations does not mean that the patient is insured against cases of relapse of the disease. The most unfavorable prognosis is considered in the progressive form of the disease.
On the subject: Treatment of colitis with folk remedies
Diet and nutrition for ulcerative colitis
According to the majority of gastroenterologists, it is impossible to create a unified diet that would suit every patient without exception. Each case requires an individual approach. However, there are practical recommendations as to what should be the diet of a sick person.
You must adhere to the following principles:
- A diet for ulcerative colitis is not able to cover all the needs of the human body for vitamins and minerals, since it is gentle and excludes many foods.
- It is important to avoid lactose-containing foods. We are talking about milk and all its derivatives.
- Fats should be avoided.
- Fiber and carbohydrate foods are prohibited.
- The focus of the diet should be on protein foods.
Traditionally, doctors recommend that patients with intestinal inflammation eat diet 4b.
Diet 4b
Melon diet principle:
- It involves avoiding fresh vegetables and fruits that contain coarse, indigestible fiber, which causes bloating and can injure the intestines. In addition, all legumes, fruit juices, corn, nuts, seeds, sorrel, rhubarb, spinach, etc. are banned. The exception is cream, cheese, sour cream, coffee, garlic, onions, and spices.
- However, not all fruits are banned. When the patient's condition stabilizes, he is allowed to eat a banana, pear or apple without a peel, after heat treatment. From vegetables, you can use zucchini, pumpkin, carrots, potatoes after heat treatment and in a grated form.
- You need to refuse flour products, only dried bread will do. Soups are prepared in low-fat meat or vegetable broths. The meat in the second courses is twisted or ground. Desserts are mostly jellies and mousses. Useful jelly, compotes and decoctions of dried berries (currants, rose hips, hawthorn). It's important to eat at least five eggs a week. They are cooked soft-boiled, steamed, in the form of omelets.
- The dishes themselves are steamed, boiled or baked, in no case should you fry and bring to a brown crust. When it is possible to achieve a stable remission, the diet can be expanded with prohibited dishes, but only after consulting a doctor.
Ulcerative colitis weekly menu
Recommendations for drawing up a menu for a sick person are necessarily given by a doctor. During the acute phase, a person is not recommended to eat food at all. Therefore, the proposed menu is suitable for the period of remission.
Monday
- As a first breakfast, you can make a steamed omelet and drink weak tea.
- An apple baked in the oven is suitable for lunch.
- For lunch, the patient can be offered chicken breast meat broth with egg flakes. The second consists of carrot puree and low-fat beef steamed cutlets. Jelly is used as a dessert.
- At afternoon tea, you can drink cocoa in the water.
- For dinner, they eat boiled pollock with mashed potatoes, rice pudding (made from white rice), seasoned with pear gravy, and unsweetened tea.
- Before going to bed, you can drink jelly.
Tuesday
- The first breakfast consists of manna and unsweetened tea.
- For a second snack, you can use grated low-fat cottage cheese.
- For lunch, prepare vegetable puree soup (potatoes, carrots, zucchini) and boiled veal meatballs.
- The afternoon snack consists of a broth of quince and a crouton.
- Pike perch cutlets with buckwheat porridge are prepared for dinner. Unsweetened tea is used as a drink.
- The evening ends with blueberry jelly.
Wednesday
- You can start your day with oatmeal in water and a little butter. Unsweetened herbal tea is used as a drink.
- For lunch, you can eat a soft-boiled egg.
- At lunch, the patient eats a portion of rice soup with pike meatballs. For the second, you can cook mashed potatoes and steamed chicken cutlets. Rosehip broth is suitable as a drink.
- The afternoon snack consists of grated cottage cheese with a small amount of sugar.
- For dinner, steamed fish dumplings and buckwheat porridge are prepared.
- The day ends with jelly with crackers.
Thursday
- The morning starts with poached eggs and semolina. The drink is unsweetened cocoa in water.
- The second breakfast consists of pear jelly.
- For lunch, they prepare a decoction of vegetables with meatballs from river fish, veal soufflé and buckwheat pudding. You can wash down the dishes with bird cherry broth.
- As a snack before dinner, you can use a rusk and a decoction of rose hips.
- Rabbit dumplings with boiled rice are prepared for dinner.
- Before going to bed, you can drink a glass of oatmeal jelly.
Friday
- The morning begins with a bunch of rice porridge and blueberry compote.
- As a snack before the main meal, eat a soft-boiled egg.
- For lunch, chicken meatballs with liquid boiled puree and pear compote.
- The afternoon snack consists of cottage cheese and apple pudding.
- For dinner, carrot puree and boiled softened pike perch with black currant jelly.
Saturday
- In the morning, a slimy broth of oatmeal with rosehip jelly is used.
- As a snack before lunch - egg porridge.
- Lunch itself consists of pureed buckwheat soup, steamed cod meatball with vegetable casserole.
- In the afternoon snack, the patient is offered cottage cheese pate with carrots and tea.
- For dinner, potato cutlets with boiled tongue and quince jelly.
- You can eat a baked apple before bed.
Sunday
- The morning starts with curd pate and cocoa on water.
- The second snack consists of apple custard with croutons and rosehip jelly.
- For lunch, you can eat lean jellied fish and semolina soup with carrots.
- For an afternoon snack, the patient is offered currant jelly.
- Chopped veal zrazy steamed with mashed potatoes and unsweetened tea are ideal for dinner.
- You can end the day with oatmeal jelly.
The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist
Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.
