Specific ulcerative colitis of the intestine symptoms. Nonspecific ulcerative colitis

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The disease UC (nonspecific ulcerative colitis) is chronic and immune in nature. The exact reasons for its development have not yet been established by science. The risk group for the development of pathology includes all people, regardless of gender and age. However, in the interval from 20 to 40 years and from 60 to 70, more patients are diagnosed with Ulcerative Colitis. The disease occurs in 50-80 people out of 100, the female population predominates. From 3 to 15 new cases are registered per year.

Ulcerative colitis is a chronic inflammatory disease affecting the large intestine.

In this article you will learn:

The concept of pathology and its causes

Nonspecific ulcerative colitis (K51.9 in ICD-10) is a chronic inflammatory process in the large intestine, caused by the aggressive influence of cells of the rectum and colon on each other and accompanied by ulcerative lesions of the intestinal mucosa.

The pathology has no established etiology, which makes diagnosis and, accordingly, treatment difficult.

However, with a competent approach and correct therapy, UC is curable. You can achieve stable remission and significantly improve your quality of life. In 4% of cases, remission lasts 15 years.

The vast majority of patients are women

Possible causes of UC include immune disorders and genetic predisposition. Any viruses and bacteria, infections or congenital pathologies can cause immune imbalance. If we follow the gene theory, then specific genes can provoke UC (they have so far been tentatively identified and not definitively confirmed).

Additionally, among the possible negative factors, the researchers identified smoking and non-compliance with nutritional rules, taking non-steroidal drugs, removal of appendicitis at an early age, and nervous strain.

The likelihood of a combination of external and internal factors has been noted (for example, the scheme “stress - activation of bacteria against the background of a decrease in the regulatory forces of the body”).

Medicine cannot explain the exact causes of the disease

Forms of pathology

Atypical ulcerative colitis has several medical classifications. The forms of the disease and their description are presented in the table.

Differentiating feature	Type	Description
Localization	Distal	Rectum
	Left-handed	Damage to the remaining parts of the colon up to the splenic flexure
	Subtotal	To the hepatic flexure
	Total	Ascending colon
Degree of development (according to Truelove and Witts)	Elementary	Up to 4 bowel movements per day inclusive, there is almost no blood, the heart rate and temperature are normal, hemoglobin is more than 110, the erythrocyte sedimentation rate is no more than 30, a slight increase in the number of white blood cells, the patient’s weight does not change, the lack of nutrients is not reflected.
	Average	Up to 6 bowel movements per day inclusive, blood in the stool is noticeable, heart beats - no more than 90, temperature - 37-38 degrees, hemoglobin - up to 100, erythrocyte sedimentation rate - up to 35, a noticeable increase in the number of white blood cells, the patient’s weight decreases, noticeable lack of nutrients.
	Heavy	More than 6 bowel movements per day, pronounced blood, heart beats more than 90, temperature - 38-39 degrees, hemoglobin - less than 90, erythrocyte sedimentation rate - more than 35, leukocytosis with a shift in the formula, the patient’s weight is noticeably reduced, lack of nutrients is very noticeable .
Character of the current	Chronic	Stages of exacerbations (up to 2 times per year) and stable remissions.
	Spicy	Extremely severe course with complications.
	Continuous	Diagnosed exacerbations more often than 2 times a year, impossibility of achieving remission.

The total type is more susceptible to a severe course. The left-sided type is the most common (80 out of 100). The continuous type occurs in 10 cases out of 100.

Necrotizing ulcerative colitis is a separate type of pathology diagnosed in newborns (usually premature infants) who have been exposed to oxygen and nerve starvation in the womb. But it can also occur as a complication in severe colitis in adults. Characterized by cell death (the last advanced stage).

Smoking is considered one of the provoking factors for the development of the disease.

Signs of pathology

Symptoms of UC in adults include:

• bloody diarrhea with mucus and/or pus;
• discharge of blood from the anus outside of bowel movements;
• abdominal pain similar to contractions, intensifying after eating food;
• false urge to go to the toilet;
• swelling of the legs;
• despite frequent bowel movements, a feeling of incomplete emptying;
• bloating.

Signs of ulcerative colitis intensify as the pathology develops. Tachycardia and fever are added. Over time, noticeable weight loss occurs and signs of nutritional deficiencies are observed.

Symptoms in advanced stages are often supplemented by extraintestinal signs, which complicates the diagnosis and treatment of ulcerative colitis in adults.

Detection methods

Diagnosis of UC includes medical history, palpation and examination, and instrumental techniques:

Symptoms of ulcerative colitis of the intestine in women can be confused with gynecological pathologies, which requires additional consultation with a specialist. Treatment is carried out with hormonal drugs, which also requires consultation with a gynecologist.

If the inflammatory process worsens, it is important to consult a doctor promptly

Possible consequences

Disability from ulcerative colitis and death are the worst complications. You can maintain your ability to work at a mild stage of the disease. Disability group 3 allows for some work.

Inflammation tends to spread and affect other organs (eyes, mouth, bones and joints, skin). For the intestines, the progression of the disease is dangerous due to oncology. There is a risk of fistulas and abscesses.

The most common complications are narrowing, obstruction, persistent bleeding, perforation and dilatation of the intestine. The latter is dangerous due to rupture. Any of these complications require immediate hospitalization.

The first thing to do in the event of an exacerbation of UC is to go to the hospital for qualified help, the purpose of which is to relieve the attack.

Traditional treatment

Treatment of ulcerative colitis with drugs involves taking corticosteroids (Prednisolone, Budesonide), 5-ASA (Mesalazine, Colazal), antidepressants (Methotrexate) and cytostatic drugs (Infliximab). In severe cases with severe fever and strong signs of inflammation, antibiotics (Metronidazole) are used.

Therapeutic baths are one of the methods of treating ulcerative colitis

To eliminate symptoms, medications that relieve pain and stop diarrhea (Loperamide) are prescribed. If necessary, rehydration is carried out, the body is saturated with iron.

5-ASA is usually prescribed as an anti-inflammatory agent. The use of corticosteroids is indicated only during periods of severe exacerbation of the second and third degrees of severity of the disease and for only a few months.

The goal of treatment at present is to eliminate symptoms, reduce inflammation, and prevent relapses. However, new treatments for ulcerative colitis are being developed regularly. Research is being conducted on the effectiveness of innovative topical drugs based on bioprocesses and gene structures. In Israel, Remicade, an anti-TNF drug (tumor necrosis factor), is actively used in practice.

If a combination of medications, diet and physiotherapy is ineffective, surgical treatment is indicated: resection with anastomosis or segmental resection.

During an exacerbation of the disease, the patient is only allowed to drink water

Traditional therapy

Non-traditional methods of treatment include suppositories and a solution of mumiyo, infusions of herbs and plants (chamomile, mint, blueberries, nettle, St. John's wort, celandine), propolis, honey, sea buckthorn.

Treatment of UC with folk remedies will eliminate symptoms, calm the central nervous system, have an anti-inflammatory, wound-healing, analgesic effect, normalize intestinal function, and restore water-salt balance. Strong green tea and infusion of chamomile and St. John's wort will help in the treatment of UC during exacerbation.

Physiotherapy

For nonspecific ulcerative colitis, it is based on current treatment (diadynamic and interference therapy, SMT). In addition, physiotherapy such as vibration therapy, mineral waters, warm baths, mud, and compresses will help treat ulcerative colitis of the intestine.

You will learn more about nonspecific ulcerative colitis from the video:

Prevention of pathology

At the time of acute relapse of chronic ulcerative colitis, you should completely refuse food. You can drink water. Sometimes intravenous nutrition is prescribed. During the remission phase, it is recommended to adhere to table No. 4. Do not irritate or injure the intestinal mucosa. Protein should predominate among the nutrients.

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.

Treatment of nonspecific ulcerative colitis depends on the localization of the pathological process in the intestine, its extent, the severity of the attacks, and the presence of local and systemic complications.

The main goals of conservative therapy:

• pain relief,
• prevention of relapse of the disease,
• preventing the progression of the pathological process.

Ulcerative colitis of the distal intestine: proctitis and proctosigmoiditis are treated on an outpatient basis, as they have a milder course. Patients with total and left-sided lesions of the colon are treated in a hospital setting, since their clinical manifestations are more pronounced and there are greater organic changes.

Nutrition of the sick

The diet for ulcerative colitis of the intestine should be high-calorie, containing foods rich in vitamins and proteins. You should limit your consumption of animal fats and completely eliminate coarse plant fiber from your diet.
The diet should include low-fat varieties of fish; for meat, it is preferable to eat beef, chicken, turkey, rabbit, steamed or boiled; pureed porridge, dried bread, potatoes, and walnuts are useful.
It is worth excluding raw vegetables and fruits from your diet, as they can lead to the development of diarrhea. You should also be careful when consuming dairy products.

Attention! Nutrition for ulcerative colitis of the intestine should be fractional: eating small portions up to six times a day. Excessively cold or hot food can negatively affect the further course of the disease.

In case of exacerbation of ulcerative colitis, it is recommended that patients undergo complete fasting for the first two days, and then gradually switch to gentle food, consisting of steamed vegetables, fruits, rice, oatmeal, cheese, and boiled meat. Bread is added to the diet little by little, as well as raw vegetables without peeling. Pain can be provoked by the intake of coarse plant fiber, whole milk, fatty and spicy foods, and alcohol.

The diet for ulcerative colitis should spare the intestines, help increase its regenerative abilities, eliminate fermentation and putrefactive processes, and also regulate metabolism.

Sample menu for ulcerative colitis:

• Breakfast - rice or any other porridge with butter, steamed cutlet, tea;
• Second breakfast - about forty grams of boiled meat and berry jelly;
• Lunch - soup with meatballs, meat casserole, dried fruit compote;
• Dinner - mashed potatoes with fish cutlet, tea;
• Snack - baked apples.

Drug treatment

Treatment of ulcerative colitis of the intestine is carried out in three main directions:

• preventing or stopping internal bleeding;
• restoration of water-salt balance in the body;
• cessation of pathogenic effects on the intestinal mucosa.

Individual selection shortens treatment time as much as possible and has minimal toxic effects on the body.

Medications

Medicines used to treat ulcerative colitis are conventionally divided into two large groups. The first includes basic anti-inflammatory drugs - corticosteroids, aminosalicylates and immunosuppressants. The second group includes all other auxiliary medications.

The main group of anti-inflammatory drugs:

1. The use of aminosalicylates allows one to achieve stable remission in eighty percent of cases of ulcerative colitis.
2. Immunosuppressants play an important role in the treatment of the disease, especially in patients with hormonal dependence and resistance. But cytostatics are prescribed only in extremely severe cases, as they suppress the immune system and lead to immunodeficiency.
3. One of the most effective anti-inflammatory drugs are steroid hormones, which, even in extremely severe forms of the disease, are considered more active than aminosalicylates. Corticosteroids can accumulate in the inflamed intestinal mucosa and block the release of arachidonic acid, which prevents the formation of inflammatory mediators - leukotrienes and prostaglandins.

Indications for the use of steroid hormones are as follows:

• acute severe forms of the disease with the presence of extraintestinal complications;
• left-sided and total with a severe course and the presence of inflammatory changes; third degree of activity, detected by endoscopic examination;
• lack of therapeutic effect from other medications.

Treatment regimen for severe attacks of chronic ulcerative colitis

The latter includes:

• antihypertensive drugs;
• diuretics;
• calcium preparations;
• antacids;
• antiplatelet agents under the control of the blood coagulation system;
• To normalize stool, antispasmodics and antidiarrheals are used;
• complications are treated with antibacterial drugs.

Inpatient treatment of ulcerative colitis is completed after achieving stable remission of the disease with the disappearance of all clinical manifestations, which must be confirmed endoscopically.
If conservative treatment is ineffective and bleeding from the rectum continues, surgical treatment is performed, which consists of performing a colectomy with resection of the rectum.

The operation to remove the entire thickness of the intestine is mutilating and is performed strictly for health reasons in a very limited group of patients.

ethnoscience

It is believed that herbal medicine is one of the effective branches of traditional medicine.

Phytotherapy

Infusions of medicinal herbs have a mild restorative effect: they envelop the damaged intestinal mucosa, heal wounds, and stop bleeding. Herbal infusions and decoctions can replenish fluid loss in the body and restore water and electrolyte balance.

The main components of medicinal herbal mixtures are:

1. The leaves and fruits of currants, raspberries and strawberries help the liver fight any acute inflammatory process in the body.
2. Dried blueberries cleanse the intestines of putrefactive microorganisms and help in the fight against cancer cells.
3. Nettle improves blood clotting, relieves inflammation, and cleanses the intestines of decay and putrefaction products.
4. Peppermint fights emotional lability, diarrhea, relieves inflammation and spasms, and has a pronounced antimicrobial effect.
5. Chamomile is a powerful herbal antibiotic that can also relieve spasms.
6. Yarrow stops diarrhea, has bactericidal properties and cleanses the intestines of pathogenic microorganisms.
7. St. John's wort stimulates intestinal motility and has an anti-inflammatory effect.

These herbs are used to treat ulcerative colitis in the form of infusions and decoctions. They are combined into collections or brewed separately.

• Dry raspberry leaves and branches are poured with boiling water and left for half an hour. Take one hundred milliliters four times a day before meals.
• A collection of medicinal herbs is prepared as follows: mix a teaspoon of centaury grass, sage leaves and chamomile flowers. Then pour a glass of boiling water and leave for thirty minutes. Drink one tablespoon every two hours. After three months, the intervals between doses of the infusion are lengthened. This treatment is harmless and can last for a long time.
• Peppermint leaves are poured with boiling water and left for twenty minutes. Take a glass twenty minutes before meals. An equally effective remedy for colitis is an infusion of strawberry leaves, which is prepared in a similar way.
• Fifty grams of fresh pomegranate seeds are boiled over low heat for half an hour, poured with a glass of water. Take two tablespoons twice a day. Pomegranate decoction is a fairly effective remedy for allergic colitis.
• One hundred grams of yarrow herb is poured with a liter of boiling water and left for a day in a closed container. After straining, the infusion is boiled. Then add one tablespoon of alcohol and glycerin and stir well. Take thirty drops half an hour before meals for a month.
• Mix equal quantities of sage, peppermint, chamomile, St. John's wort and cumin. This mixture is placed in a thermos, poured with boiling water and left overnight. Starting from the next day, take the infusion regularly, half a glass three times a day for a month.

Folk remedies

• One hundred grams of dried watermelon rinds are poured into two glasses of boiling water and taken one hundred milliliters six times a day.
• Eight grams of propolis should be eaten daily to reduce the symptoms of colitis. It must be chewed for a long time on an empty stomach.
• Squeeze the juice from onions and take one teaspoon three times a day. This folk remedy is very effective in the treatment of ulcerative colitis.
• The whey obtained by squeezing feta cheese is recommended to be taken twice a day.
• Walnut kernels are eaten regularly for three months. Positive results will become noticeable within a month from the start of treatment.
• How to cure ulcerative colitis using microenemas? For this, starch microenemas are shown, prepared by diluting five grams of starch in one hundred milliliters of cool water.
• Microenemas made from honey and chamomile, which are pre-brewed with boiling water, are considered effective. One enema requires fifty milliliters of solution. The duration of treatment is eight procedures.
• Viburnum berries are poured with boiling water and viburnum tea is drunk immediately before eating.

is a diffuse ulcerative-inflammatory lesion of the mucous membrane of the large intestine, accompanied by the development of severe local and systemic complications. The clinical picture of the disease is characterized by cramping abdominal pain, diarrhea mixed with blood, intestinal bleeding, and extraintestinal manifestations. Ulcerative colitis is diagnosed based on the results of colonoscopy, irrigoscopy, CT, and endoscopic biopsy. Treatment can be conservative (diet, physical therapy, medications) or surgical (resection of the affected area of ​​the colon).

General information

Nonspecific ulcerative colitis (UC) is a type of chronic inflammatory disease of the large intestine of unknown etiology. Characterized by a tendency to ulcerate the mucous membrane. The pathology occurs cyclically, with exacerbations followed by remissions. The most characteristic clinical signs are diarrhea streaked with blood and spasmodic abdominal pain. Long-term nonspecific ulcerative colitis increases the risk of malignant tumors in the large intestine.

The incidence is about 50-80 cases per 100 thousand population. At the same time, 3-15 new cases of the disease are detected annually for every 100 thousand inhabitants. Women are more prone to developing this pathology than men; in them, UC occurs 30% more often. Nonspecific ulcerative colitis is characterized by primary detection in two age groups: young people (15-25 years old) and older people (55-65 years old). But besides this, the disease can occur at any other age. Unlike Crohn's disease, ulcerative colitis affects only the mucous membrane of the large colon and rectum.

Causes

Currently, the etiology of ulcerative colitis is unknown. According to researchers in the field of modern proctology, immune and genetically determined factors may play a role in the pathogenesis of this disease. One theory for the occurrence of ulcerative colitis suggests that the cause may be viruses or bacteria that activate the immune system, or autoimmune disorders (sensitization of the immune system against one's own cells).

In addition, it has been noted that ulcerative colitis is more common in people whose close relatives suffer from this disease. Currently, genes have also been identified that may likely be responsible for hereditary predisposition to ulcerative colitis.

Classification

Nonspecific ulcerative colitis is distinguished by the localization and extent of the process. Left-sided colitis is characterized by damage to the descending colon and sigmoid colon, proctitis is manifested by inflammation in the rectum, and with total colitis the entire large intestine is affected.

Symptoms of UC

As a rule, the course of nonspecific ulcerative colitis is wavy, periods of remission are replaced by exacerbations. At the time of exacerbation, ulcerative colitis manifests itself with various symptoms depending on the localization of the inflammatory process in the intestine and the intensity of the pathological process. If the rectum is predominantly affected (ulcerative proctitis), bleeding from the anus, painful tenesmus, and pain in the lower abdomen may occur. Sometimes bleeding is the only clinical manifestation of proctitis.

In left-sided ulcerative colitis, when the descending colon is affected, diarrhea usually occurs, and the stool contains blood. Abdominal pain can be quite pronounced, cramping, mainly on the left side and (with sigmoiditis) in the left iliac region. Decreased appetite, prolonged diarrhea and indigestion often lead to weight loss.

Total colitis is manifested by intense abdominal pain, constant profuse diarrhea, and severe bleeding. Total ulcerative colitis is a life-threatening condition, as it threatens the development of dehydration, collapse due to a significant drop in blood pressure, hemorrhagic and orthostatic shock.

Particularly dangerous is the fulminant form of ulcerative colitis, which is fraught with the development of severe complications, including rupture of the colon wall. One of the common complications in this course of the disease is toxic enlargement of the large intestine (megacolon). It is assumed that the occurrence of this condition is associated with the blockade of intestinal smooth muscle receptors by excess nitric oxide, which causes a total relaxation of the muscle layer of the large intestine.

In 10-20% of cases, patients with ulcerative colitis have extraintestinal manifestations: dermatological pathologies (pyoderma gangrenosum, erythema nodosum), stomatitis, inflammatory eye diseases (iritis, iridocyclitis, uveitis, scleritis and episcleritis), joint diseases (arthritis, sacroiliitis, spondylitis ), lesions of the biliary system (sclerosing cholangitis), osteomalacia (softening of bones) and osteoporosis, vasculitis (inflammation of blood vessels), myositis and glomerulonephritis.

Complications

A fairly common and serious complication of ulcerative colitis is toxic megacolon - expansion of the colon as a result of paralysis of the muscles of the intestinal wall in the affected area. With toxic megacolon, intense pain and bloating in the abdomen, increased body temperature, and weakness are noted.

In addition, ulcerative colitis can be complicated by massive intestinal bleeding, intestinal rupture, narrowing of the colon lumen, dehydration as a result of large fluid loss with diarrhea and colon cancer.

Diagnostics

The main diagnostic method for detecting ulcerative colitis is colonoscopy, which allows a detailed examination of the lumen of the large intestine and its internal walls. Irrigoscopy and X-ray examination with barium can detect ulcerative defects of the walls, changes in the size of the intestine (megacolon), impaired peristalsis, and narrowing of the lumen. An effective method for imaging the intestine is computed tomography.

In addition, a coprogram, a test for occult blood, and bacteriological culture are performed. A blood test for ulcerative colitis shows a picture of nonspecific inflammation. Biochemical indicators can signal the presence of concomitant pathologies, digestive disorders, functional disorders in the functioning of organs and systems. During a colonoscopy, a biopsy of the altered area of ​​the colon wall is usually performed for histological examination.

Treatment of UC

Since the causes of nonspecific ulcerative colitis are not fully understood, the goals of therapy for this disease are to reduce the intensity of the inflammatory process, subside clinical symptoms and prevent exacerbations and complications. With timely correct treatment and strict adherence to the recommendations of the proctologist, it is possible to achieve stable remission and improve the patient’s quality of life.

Ulcerative colitis is treated with therapeutic and surgical methods, depending on the course of the disease and the patient’s condition. One of the important elements of symptomatic treatment of nonspecific ulcerative colitis is dietary nutrition.

In severe cases of the disease at the height of clinical manifestations, the proctologist may recommend a complete refusal to eat, limiting yourself to drinking water. Most often, during an exacerbation, patients lose their appetite and tolerate the ban quite easily. If necessary, parenteral nutrition is prescribed. Sometimes patients are transferred to parenteral nutrition in order to more quickly alleviate the condition of severe colitis. Eating is resumed immediately after appetite is restored.

Diet recommendations for ulcerative colitis are aimed at stopping diarrhea and reducing irritation of the intestinal mucosa by food components. Products containing dietary fiber, fiber, spicy and sour foods, alcoholic beverages, and roughage are removed from the diet. In addition, patients suffering from chronic intestinal inflammation are recommended to increase the protein content in their diet (at the rate of 1.5-2 grams per kilogram of body per day).

Drug therapy for ulcerative colitis includes anti-inflammatory drugs, immunosuppressants (azathioprine, methotrexate, cyclosporine, mercaptopurine) and anticytokines (infliximab). In addition, symptomatic medications are prescribed: antidiarrheals, painkillers, iron supplements for signs of anemia.

Non-steroidal anti-inflammatory drugs - 5-aminosalicylic acid derivatives (sulfasalazine, mesalazine) and corticosteroid hormonal drugs are used as anti-inflammatory drugs for this pathology. Corticosteroid drugs are used during periods of severe exacerbation in cases of severe and moderate severity (or if 5-aminosalicylates are ineffective) and are not prescribed for more than a few months.

Corticosteroid hormones are prescribed to children with extreme caution. Anti-inflammatory hormone therapy can cause a number of severe side effects: arterial hypertension, glucoseemia, osteoporosis, etc. Physiotherapeutic methods of treatment for ulcerative colitis can include diadynamic therapy, SMT, interference therapy, etc.

Indications for surgical treatment are the ineffectiveness of diet and conservative therapy, the development of complications (massive bleeding, perforation of the colon, if a malignant neoplasm is suspected, etc.). Resection of the large intestine followed by the creation of an ileorectal anastomosis (connection of the free end of the ileum to the anal canal) is the most common surgical technique for treating ulcerative colitis. In some cases, a section of the affected intestine limited within healthy tissues is removed (segmental resection).

Prognosis and prevention

There is currently no prevention of ulcerative colitis, since the causes of this disease are not completely clear. Preventative measures for the occurrence of relapses of exacerbation are compliance with the doctor’s lifestyle instructions (nutrition recommendations similar to those for Crohn’s disease, reducing the number of stressful situations and physical overexertion, psychotherapy) and regular medical supervision. Sanatorium-resort treatment has a good effect in terms of stabilizing the condition.

With a mild course without complications, the prognosis is favorable. About 80% of patients taking 5-acetylsalicylates as maintenance therapy do not report relapses or complications of the disease throughout the year. Patients usually experience relapses once every five years; in 4% there are no exacerbations for 15 years. Surgical treatment is resorted to in 20% of cases. The probability of developing a malignant tumor in patients with ulcerative colitis ranges from 3-10% of cases.

Ulcerative colitis is a chronic inflammatory process in the mucous membrane of the colon, accompanied by the appearance of non-healing ulcers, areas of necrosis and bleeding. This pathology differs from simple inflammation. With it, ulcerative defects form on the colon mucosa. Prolonged course of the disease increases the likelihood of developing cancer.

Therefore, at the slightest suspicion of this disease, you should consult a doctor who will recommend the correct treatment of ulcerative colitis with the help of medications and folk remedies.

What is ulcerative colitis?

Ulcerative colitis is a chronic inflammatory disease of the colon mucosa, resulting from an interaction between genetic and environmental factors, characterized by exacerbations. UC affects the rectum, gradually spreading continuously or immediately affecting the rest of the colon. This disease is also called nonspecific ulcerative colitis (UC).

Usually occurs in adults aged 20 to 35 years or after 60. In children, this disease occurs extremely rarely and accounts for only 10-15% of cases of all identified pathologies. At the same time, girls are at greatest risk of developing the disease among adolescents, and in the preschool and primary school period, on the contrary, boys are.

Ulcerative colitis is classified:

• according to the clinical course - typical and fulmicant; chronic form (recurrent and continuous);
• localization - distal (proctitis, proctosigmoiditis); left-sided (to the middle of the transverse colon); subtotal; total (pancolitis); total with reflux ileitis (against the background of total ileitis, a section of the ileum is involved in the process);
• severity of clinical manifestations.

The pathological anatomy (morphological substrate of the disease) of ulcerative colitis is represented by diffuse superficial damage to the walls of the large intestine. In the vast majority of cases the disease is localized in the terminal (final) parts of the large intestine: sigmoid and rectum. Involvement of the entire large intestine is much less common. Involvement of the final portion of the small intestine is very rare.

Causes

Unfortunately, the exact etiology of this disease is unknown - scientists were able to find out that the autoimmune process, genetic inheritance and certain infectious agents play a role in the formation of the disease.

Residents of cities in developed countries are more susceptible to ulcerative colitis. As a rule, the disease develops either in young people or in those over 60, although in fact a person of any age can get this disease.

It has been suggested that it may be provoked by:

• some unspecified infection (but ulcerative colitis is not contagious);
• unbalanced diet (fast food, diet lacking fiber, etc.);
• genetic mutations;
• medications (non-hormonal anti-inflammatory drugs, contraceptives, etc.);
• stress;
• changes in intestinal microflora.

Under the influence of these factors, symptoms of ulcerative colitis develop as a result of autoimmune processes in the body.

Symptoms of ulcerative colitis of the intestine

Ulcerative colitis has an acute phase and a remission phase. The disease begins gradually at first, but quickly gains momentum when the symptoms become more pronounced.

Symptoms of ulcerative colitis from the digestive system:

• cramping pain in the abdomen localized predominantly on the left, which is difficult to relieve with medications;
• diarrhea or loose stools mixed with mucus, blood or pus, worse at night or in the morning;
• constipation that replaces diarrhea, which is caused by intestinal spasm;
• bloating();
• frequent false urge to defecate (tenesmus), which occurs due to retention of feces above the area with inflammation;
• spontaneous release of mucus, pus and blood (not during defecation) as a result of imperative (irresistible) urges.

In 10% of cases, in addition to the mentioned intestinal and general symptoms, extraintestinal manifestations occur:

• joint lesions;
• various rashes on the skin and mucous membranes (for example, in the mouth);
• eye disorders;
• damage to the liver and bile ducts;
• thrombus formation, etc.

They may precede intestinal disorders. The severity of extraintestinal manifestations sometimes depends on the activity of the inflammatory lesion of the intestine, and in some cases is completely unrelated to it.

With mild ulcerative colitis, patients complain of cramping pain or discomfort in the abdomen, weakness. Semi-liquid stools are possible 2-4 times a day with a small admixture of blood and mucus.

If ulcerative colitis is more severe, then loose stools occur up to 8 times a day with a significant admixture of mucus, blood and pus. With this form of the disease the following are noted:

• pain in the abdomen, often in the area of ​​the left half (flank).
• there is weakness,
• slight fever
• weight loss.
• may be tachycardia,
• pain in the liver.

Symptoms during an exacerbation

During the period of exacerbation, symptoms of intoxication appear:

• fever,
• weakness,
• malaise.

A distinctive sign of ulcerative colitis from simple catarrhal disease is weight loss. Patients often look exhausted. Their appetite is reduced. With intestinal colitis, ulcerative defects are formed. They may bleed as stool passes.

Symptoms may become weaker and then worsen again. If continuous treatment is carried out, a remission phase begins and the symptoms subside. How often relapses occur is determined by the treatment, and not by how damaged the intestines are.

Consequences and possible complications

In the absence of drug therapy and non-compliance with the diet, complications may develop. In this case, the symptoms of ulcerative colitis become more pronounced. Possible consequences of inflammation of the large intestine:

• massive bleeding;
• toxic dilatation of the intestine (formation of megacolon);
• perforation;
• malignancy of ulcers;
• joint inflammation;
• damage to internal organs (gallbladder, liver, skin).

Diagnostics

The diagnosis and treatment of ulcerative colitis is carried out by a therapeutic specialist or gastroenterologist. Suspicion of the disease is caused by a complex of corresponding symptoms:

• diarrhea mixed with blood, mucus and pus
• abdominal pain;
• arthritis, eye disorders due to general intoxication of the body.

Laboratory diagnostic methods:

• clinical blood test (increased quantity and ESR, decreased level of hemoglobin and red blood cells);
• biochemical blood test (increased levels of C-reactive protein and immunoglobulins);
• biopsy - histological examination of tissue samples;
• stool analysis for fecal calprotectin is a special marker for diagnosing intestinal diseases, which in ulcerative colitis can increase to 100 - 150;
• coprogram (presence of occult blood, leukocytes and erythrocytes).

If the results of the tests confirm presence of the disease, the doctor prescribes an instrumental examination. An endoscopy is performed to detect possible swelling in the mucous membrane, the presence of pseudopolyps, pus, mucus, blood in the intestines and determine the extent of organ damage.

Endoscopic examinations (colonoscopy, rectosigmoidoscopy) make it possible to identify a complex of symptoms characteristic of the pathology in the patient:

• the presence of mucus, blood, pus in the intestinal lumen;
• contact bleeding;
• pseudopolyps;
• granulosa, hyperemia and swelling of the mucous membrane;
• in the remission phase, atrophy of the intestinal mucosa is noted.

X-ray examination is also an effective method for diagnosing ulcerative colitis. A barium mixture is used as a contrast agent in this procedure. An X-ray of a patient with ulcerative colitis clearly visualizes expansion in the lumen of the large intestine, shortening of the intestine, and the presence of ulcers and polyps.

Treatment of ulcerative colitis

Treatment will be symptomatic, it should eliminate the inflammation process and maintain remission, as well as prevent complications. If medications are not effective, surgery may be indicated.

The objectives of treating a patient with UC are:

• achieving and maintaining remission (clinical, endoscopic, histological),
• minimizing indications for surgical treatment,
• reducing the incidence of complications and side effects of drug therapy,
• reduction in hospitalization time and treatment costs,
• improving the patient's quality of life.

The results of treatment largely depend not only on the efforts and qualifications of the doctor, but also on the willpower of the patient, who clearly follows medical recommendations. The modern medications available in the doctor’s arsenal allow many patients to return to normal life.

Medications

To make these goals a reality, experts prescribe the following treatment methods for patients with intestinal ulcerative colitis:

• taking non-steroidal anti-inflammatory drugs, for example, Salofalk, Dipentum, Sulfasalazine;
• use of corticosteroids (Metyprednisolone, Prednisolone);
• antibacterial therapy through the use of drugs such as Tienama, Cifran, Ciprofloxacin, Ceftriaxone;
• taking immunomodulators (Azathioprine, Cyclosporine, Infliximab, Methotrexate);
• consumption of calcium and vitamins A, C, K.

In case of purulent complications or infection, systemic antibacterial drugs are used. Medicines alone cannot cure a person. In the remission phase, in the absence of pain and bleeding, physiotherapeutic procedures are prescribed. Most often carried out:

• Exposure to alternating current.
• Diadynamic therapy.
• Interference therapy.

Patients with mild and moderate variants of ulcerative colitis can be treated on an outpatient basis. Severe patients must be examined and treated in a hospital, since both diagnostic and therapeutic interventions can have serious and even life-threatening complications.

With proper implementation of the doctor’s recommendations, daily adherence to dietary instructions, as well as supportive therapy, it is possible to significantly increase the time of remission and improve the patient’s quality of life, but, unfortunately, complete recovery cannot be achieved when treating this disease.

Operation

Surgical treatment of ulcerative colitis is indicated for patients who do not respond to conservative methods. The indications for surgery are:

• perforation (perforation of the intestinal wall);
• signs of intestinal obstruction;
• abscess;
• presence of toxic megacolon;
• profuse bleeding;
• fistulas;
• bowel cancer.

It is possible to treat ulcerative intestinal colitis surgically today in the following ways:

1. through partial or total colectomy - excision of the colon;
2. using proctocolectomy - removal of the colon and rectum leaving the anus;
3. through a proctocolectomy and a temporary or permanent ileostomy, through which natural waste is removed from the body.

It is necessary to pay attention to possible physical and emotional problems after surgical treatment; Care should be taken to ensure that the patient receives all necessary instructions before and after surgery and that full medical and psychological support is provided.

Knowing exactly what ulcerative colitis is and how to treat it, we can say with confidence that the prognosis of the disease is quite favorable. The pathological process is curable thanks to modern methods of therapy. Most patients experience complete remission, and only 10% of cases retain mild clinical symptoms.

Diet and proper nutrition

With this disease, normalization of nutrition is of paramount importance. The diet for ulcerative colitis is aimed at mechanical, thermal and chemical sparing of the colon mucosa.

1. The diet is based on the consumption of chopped, soft food, steamed or boiled.
2. You should forever forget about hot sauces, fatty seasonings, alcohol, and cigarettes.
3. Fruits and vegetables should be consumed only in heat-treated form, because in their raw form they contain a lot of fiber, which negatively affects the functioning of the affected intestines.
4. During an exacerbation, the diet includes liquid and pureed porridge (rice, semolina) in water (milk and broths are excluded). Buckwheat porridge enhances motor skills, so it is not recommended during an exacerbation. It is convenient to use porridge for baby food, but it needs to be diluted by half with water.

Authorized products:	For ulcerative colitis, you need from the diet exclude the following foods and dishes:
boiled chicken turkey boiled veal rabbit dried pears dried blueberries buckwheat (kernel) semolina oat groats white rice white bread crackers butter	flour products: pasta, pastries, cookies, cakes; rich, fatty and milky soups; fatty meats or fish; canned food; dairy products: raw, fried eggs, kefir, sour cream, milk; cereals: pearl barley, millet, barley; any snacks and smoked meats; sweets, chocolate; fruits and berries, dried fruits; jams, preserves; sauces, mayonnaise, tomato; any alcohol; spices.

To find out exactly what foods you are allowed to eat, consult your doctor.

Menu for ulcerative colitis for the day

A diet for ulcerative colitis of the intestine can be implemented through the following menu option.

1. Breakfast: cereal porridge with 1 tsp. melted butter, steam cutlet, rosehip decoction.
2. Lunch: curd mass, berry jelly.
3. Lunch: potato soup with meatballs, rice and minced meat casserole, compote.
4. Afternoon snack: green tea, crackers.
5. Dinner: stewed vegetables, fish cutlet, tea.
6. Before bed: kefir/baked apple.

This menu option is suitable for the period after an exacerbation. Additionally, you can eat 200-250 grams of dried bread, 1 glass of jelly or compote.

A diet for ulcerative colitis of the colon, including the rectum, leads to a number of positive changes:

• promotes the rapid restoration of normal stool, eliminating diarrhea or constipation;
• increases the effectiveness of medications, as it compensates for protein losses, accelerates the healing of the mucous membrane, due to which a number of medications begin to act more actively;
• compensates for the loss of nutrients, restores metabolism and energy reserves.

Folk remedies

In therapeutic therapy, it is also allowed to use folk remedies, but only if the disease is at the initial stage of development and the treatment is agreed upon with the doctor. The most effective ways to treat the disease, according to patients, are fasting, refusing to eat animal foods, and switching to a raw food diet. Herbal remedies include decoctions of yarrow, alder cones, wormwood, sage, and potato juice.

1. 100 g dried watermelon rind pour 2 cups of boiling water, leave and strain. Take 100 g up to 6 times a day. This allows you to relieve inflammation in the intestines in acute and chronic forms of the disease.
2. Perfectly relieves inflammatory processes in the intestines potato juice. It is enough to grate a potato, squeeze the juice out of it and drink it half an hour before meals.
3. Take an equal amount of peppermint leaf, inflorescences of chamomile, rhizomes of cinquefoil erecta. Infuse 1 tablespoon of the mixture for 30 minutes in 1 glass of boiling water, strain. Take 1 glass 2-3 times a day for colitis.
4. Treat symptoms of exacerbation bird cherry helps well. Traditional healers recommend preparing a decoction (one spoonful of flowers per glass of water). Take three times, ¼ cup every day.

Prevention

Prevention of the development of this intestinal pathology consists of proper nutrition and periodic examination. It is important to promptly treat chronic diseases of the digestive tract. The prognosis for ulcerative colitis in the absence of complications is favorable.

Ulcerative colitis is a serious disease that requires immediate and competent treatment. Do not delay visiting your doctor when the first symptoms appear. It is important to remember that in the event of an acute form of the disease, the organ is affected quickly, which can lead to the development of cancer or various complications.