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Ulcerative colitis (UC) is a chronic disease of the large intestine characterized by hemorrhagic-purulent inflammation, mainly of the mucous membrane and submucosa, of the intestine with the development of local and systemic complications.
ICD-10 CODE
K51. Ulcerative colitis.
K51.0. Ulcerative (chronic) enterocolitis.
K51.1. Ulcerative (chronic) ileocolitis.
K51.2. Ulcerative (chronic) proctitis.
K51.3. Ulcerative (chronic) rectosigmoiditis.
K51.4. Colon pseudopolyposis.
K51.5. Mucous proctocolitis.
K51.8. Other ulcerative colitis.
K51.9. Ulcerative colitis, unspecified.
An important role in the pathogenesis of UC is attributed to the violation of the barrier function of the intestinal mucosa and its ability to restore. It is believed that a variety of food and bacterial agents can penetrate through defects in the mucous membrane into the deeper tissues of the intestine, which then trigger a cascade of inflammatory and immune responses.
In the acute stage of UC, exudative edema and plethora of the mucous membrane with thickening and smoothing of the folds are noted. With the development of an acute process or its transition to a chronic stage, destruction of the mucous membrane increases, ulceration occurs, penetrating to the submucosal or, less often, to the muscle layer.
Chronic UC is characterized by pseudopolyps (inflammatory polyps). These are islets of the mucous membrane, preserved during its destruction, or a conglomerate formed as a result of excessive regeneration of the glandular epithelium.
The intensity of UC symptoms correlates with the length of the pathological process in the intestine and the severity of inflammatory changes. Light attacks of the UC with total defeat are manifested by a slight increase in stool frequency and a small admixture of blood in the feces.
At exacerbation of moderate severity noted increased stool up to 5-6 times a day with a constant admixture of blood, cramping abdominal pain, low-grade fever, rapid fatigue. A number of patients develop extraintestinal symptoms (arthritis, erythema nodosum, uveitis, etc.). Moderate attacks of UC in most cases are successfully amenable to conservative treatment with modern anti-inflammatory drugs, primarily glucocorticoids.
For heavy total defeat the colon is characterized by profuse diarrhea with an admixture of a significant amount of blood in the feces, sometimes the release of blood in clots; cramping abdominal pain before the act of defecation; anemia; symptoms of intoxication (fever, weight loss, severe general weakness). A particularly unfavorable course is observed in patients with fulminant form of UC. The development of life-threatening complications is possible - toxic megacolon, colon perforation and massive intestinal bleeding.
Toxic colon dilatation - one of the most dangerous complications of UC, which develops as a result of a severe ulcerative-necrotic process in the colon, arises as a result of the cessation of peristaltic contractions of the colon wall and, as a result, the accumulation of intestinal contents in the lumen. In this case, the expansion of the colon or segment quickly reaches a critical value (up to 11-15 cm).
A terrible symptom of the development of dilatation is a sudden decrease in stool against the background of diarrhea, bloating, as well as pain and an increase in symptoms of intoxication. A simple and valuable diagnostic technique is a dynamic X-ray examination of the abdominal organs, in which an increase in pneumatosis and the degree of expansion of the colon is noted.
Colon perforation usually occurs against the background of increasing toxic dilatation or local necrotic changes in the intestinal wall in severe transmural lesions. It is important to bear in mind that against the background of intensive hormonal treatment, the administration of antibiotics, antispasmodics and analgesics, patients do not have the classic picture of "acute abdomen" characteristic of hollow organ perforation, so it can be very difficult to make a timely diagnosis. Once again, X-ray examination helps when the appearance of free gas in the abdominal cavity is noted. It should be remembered that the success of the operation directly depends on the timeliness of the diagnosis and the duration of the development of peritonitis.
Colon perforation is the most common cause of death in fulminant UC, especially in acute toxic dilation. Due to the extensive ulcerative-necrotic process, the colon wall becomes thinner, loses its barrier functions and becomes permeable to a variety of toxic products in the intestinal lumen. In addition to stretching the intestinal wall, microcirculation disorders and proliferation of bacterial flora, especially Escherichia coli with pathogenic properties, play a decisive role in the occurrence of perforation. In the chronic stage of the disease, this complication is rare and proceeds mainly in the form of a pericolytic abscess. Perforation treatment is only surgical.
Cancer on the background of Yak ... In the population of patients with ulcerative colitis, colon cancer occurs significantly more often, especially when UC disease is more than 10 years old. The unfavorable features of such cancer are malignant poorly differentiated forms, multiple and rapid metastasis, the extent of the lesion of the colon by the tumor. With UC, the so-called total form of colon cancer is possible, when intramural tumor growth during histological examination is found in all departments, while the intestine may not be visually changed. The main method of secondary prevention of cancer in UC is the annual clinical examination of patients, especially with total forms and duration of the disease more than 10 years, multiple biopsy of the mucous membrane, even in the absence of visual changes.
The risk of developing colon cancer in UC increases dramatically with a disease duration of more than 10 years, especially if colitis occurs before the age of 18 years. The risk is even higher with the onset of the disease in childhood (up to 10 years).
Systemic complications UC is also called extraintestinal manifestations. Patients may have lesions of the liver, oral mucosa, skin, joints. The exact genesis of extraintestinal manifestations is not fully understood. Their formation involves foreign, including toxic, agents entering the body from the intestinal lumen, and immune mechanisms. Erythema nodosum arises not only as a reaction to the intake of sulfasalazine (associated with sulfapyridine), it is observed in 2-4% of patients and without regard to taking the drug. Gangrenous pyoderma- a rather rare complication (1-2% of patients). Episclerite occurs in 5-8% of patients with exacerbation of UC; acute arthropathy - in 10-15%. Arthropathy manifested by asymmetric damage to large joints. Ankylosing spondylitis detected in 1-2% of patients. Liver damage occurs in 33.3% of patients with UC, manifesting itself in the majority of either transient increase in transaminase levels in the blood, or hepatomegaly... A characteristic serious hepatobiliary lesion is primary sclerosing cholangitis, which is a chronic stenosing inflammation of the intra- and extrahepatic bile ducts. It occurs in approximately 3% of UC patients.
X-ray examination consists in carrying out irrigoscopy and survey fluoroscopy of the abdominal cavity. For the active stage of the UC process when performing a barium enema, the following radiological signs are characteristic: absence of haustra, smooth contours, ulceration, edema, serration, double contour, pseudopolyposis, rearrangement along the longitudinal type of folds of the mucous membrane, the presence of free mucus. With prolonged UC, swelling may cause mucosal and submucosal thickening. As a result, the distance between the posterior wall of the rectum and the anterior surface of the sacrum increases. After emptying the colon from barium suspension, the absence of haustra is revealed, mainly longitudinal and rough transverse folds, ulcers and inflammatory polyps.
Plain X-ray of the abdominal cavity is of great importance in the diagnosis of severe complications of UC, in particular, acute toxic dilatation of the colon. With I degree of dilatation, the increase in the diameter of the intestine at its widest point is 8-10 cm, with II - 10-14 cm and with III - over 14 cm.
Salmonellosis often simulates the picture of UC, as it proceeds with diarrhea and fever, but bloody diarrhea appears only in the second week of illness. Of other forms of colitis of infectious genesis, requiring differentiation from UC, it should be noted gonorrheal proctitis, pseudomembranous enterocolitis and viral diseases.
The most difficult differential diagnosis is between Yak, Crohn's disease and ischemic colitis.
G.I. Vorobiev
Chronic colitis is considered one of the most common pathologies of the distal intestine. To carry out statistical studies and record the incidence of chronic colitis according to the ICD, it has the K52 code.
Gastroenterologists and proctologists often use the code of this disease when preparing various medical documents. Chronic colitis is characterized by an inflammatory lesion of the colon, which in some cases is ulcerative in nature and is accompanied by destruction of the mucous membrane. To make the correct diagnosis, it is necessary to know the classification and the main etiological factors that cause this pathological condition.
In the international classification of diseases of the 10th revision, nosological units are sorted depending on clinical manifestations, pathogenesis and etiology. The colitis code in ICD 10 is K52, however, depending on the form of the disease, the code varies from K52.0 to K52.9. Ulcerative colitis and Crohn's disease are distinguished as separate diseases, since they are of an autoimmune nature. The main reasons provoking the development of inflammatory lesions of the large intestine are:
Chronic inflammation of the colon, depending on the factor that causes it, can be infectious or non-infectious. Also, the disease is often combined with gastroenteritis and other pathologies of the digestive system.
In patients, complaints of pain in the abdomen and stool disorders prevail.
Depending on the form of the pathological process, blood and mucus in different proportions can be found in the feces.
Often, patients suffer from constipation or vice versa - diarrhea. In ICD 10, chronic colitis belongs to the section of diseases of the digestive tract, therefore, a gastroenterologist or proctologist should deal with the diagnosis of pathology. Early diagnosis can significantly increase the chances of a successful cure, provided that the patient adheres to a special diet and follows the doctor's recommendations. In case of untimely referral to a specialist, serious complications may occur in the form of bleeding, intoxication or the development of a malignant tumor.
Chronic colitis occurs in gastroenterological practice a little more often than other inflammatory lesions of the large intestine. Chronic colitis proceeds in waves, alternating with remission and acute periods.
Quite often, the disease is accompanied by inflammatory pathologies in other gastrointestinal tract structures. According to statistics, about half of patients with digestive problems suffer from chronic colitis.
Among patients, 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 old.
Chronic colitis is an inflammatory lesion of the intestinal mucous tissues, which is accompanied by dyspeptic symptoms such as flatulence and diarrhea, constipation and rumbling, pronounced soreness and bloating.
There are a lot of factors provoking the development of chronic forms of colitis, but the main ones, according to experts, are:
Chronic colitis is exacerbated against the background of stressful conditions and excessive excitement, weakened immunity, nutritional deficiencies, the use of low-calorie foods and even small doses of alcohol.
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 is total, when all colonic divisions are affected.
This is typical of ulcerative nonspecific colitis. Also, pathology is of a segmental nature, when the lesion covers only a certain intestinal section.
Spastic chronic colitis is a functional disorder and is manifested by intestinal disorders and painful sensations in the abdomen.
Chronic spastic colitis provokes a tendency of 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 disturbed for a long time by stress and nervous experiences, hormonal disruptions or psychophysical fatigue. Also, pathology is a consequence of malnutrition, when the patient abuses alcohol, spicy or fatty foods.
Such a pathological form often affects women, which experts explain by the typicality of hormonal disorders for this category of patients, because women experience hormonal changes against the background of pregnancy, menstruation, childbirth, etc.
Chronic constipation, intestinal infections, especially lingering ones, and an allergic response to certain foods can also provoke such colitis.
Nonspecific ulcerative colitis is called diffuse inflammatory ulcerative lesions of the mucous membranes of the intestinal membranes, which are accompanied by the occurrence of severe systemic and local complications and often cause massive gastrointestinal bleeding.
The exact etiology of this form of colitis is unknown, although experts do not exclude that genetic and immune factors play an important role in the development of the pathological process.
The reason may be bacteria and viral agents that activate the immune forces, or autoimmune disruptions, accompanied by sensitization of immune structures against their own cells.
Chronic non-ulcerative colitis is an inflammatory lesion of the large intestine, which is characterized by the presence of degenerative and atrophic changes in the mucous tissues, leading to dysfunction of the large intestine.
Chronic non-ulcer colitis develops against the background of past intestinal pathologies such as dysentery, toxic infections or salmonellosis, yersiniosis, typhoid fever, etc.
The pathology is manifested by soreness in the abdomen - in the lower and lateral parts of it, which can be aching, dull, spastic or paroxysmal or bursting.
Atrophic chronic colitis is characterized by thinning of the mucous membranes of the colonic region, accompanied by impaired secretory glandular functions.
In clinical practice, there is no diagnosis of atrophic colitis. This term is used by physicians 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.
The chronic form of intestinal inflammation involves a periodic alternation of remission and exacerbated periods, therefore it is natural that patients turn to specialists when an exacerbation of chronic colitis occurs. During periods of remission, this symptomatology is weak or erased, or completely absent.
Signs of chronic colitis include:
In general, with an exacerbation, patients may clearly manifest each of the above symptoms. But gastroenterologists identify a number of signs of exacerbation of colitis, with the appearance of which an urgent need to consult a specialist.
These include unbearable soreness in the abdomen, which has a spastic character, and at night transforms into a dull and aching pain.
Most often, this pain is located on the left side of the ileum. On palpation of the intestines in some of its parts, the pain may increase.
Also, a sign of exacerbation of colitis can be considered constant bloating, which occurs against the background of an imbalance in microflora.
The consistency of the stool during an exacerbation also changes and can be expressed in prolonged diarrhea or constipation, and whitish mucous impurities or bloody blotches can be found on the feces. When such symptoms appear, it is necessary to consult a specialist for treatment as soon as possible.
To identify chronic colitis, the patient undergoes instrumental and laboratory diagnostics. The results of a blood test in colitis show the presence of leukocytosis, neutrophilia and an increase in the erythrocyte sedimentation rate. A coprogram is also carried out to patients, which shows the chemical composition of feces and their microscopic data.
Colonoscopy helps to detect an inflammatory focus, to reveal the presence of erosive and ulcerative processes, atrophic changes, vascular lesions, etc. Irrigoscopic diagnostics allows diagnosing the presence of peristaltic disorders, relief changes in the mucous membranes, intestinal atony, etc.
Chronic forms of colonic inflammation can lead to the development of rather serious complications:
Chronic forms of colitis in the acute phase must be treated in stationary conditions under the guidance of an experienced proctologist, and infectious chronic intestinal inflammation is treated in the departments of infectious diseases.
The main goal of treatment is to eliminate the provoking etiological factor of the disease and restore intestinal activity.
During acute periods, patients with colitis are recommended treatment table No. 4a, suggesting the use of steamed fish and meat dishes, low-fat broths, white bread, boiled eggs and green tea, rosehip broth or cocoa. One serving should only be 250-300 g.
Gradually, when the inflammatory processes are arrested, the patient is transferred to the treatment table No. 4b.
This diet allows patients to eat cereals and soups, pasta and vegetable dishes, milk porridge and butter. When a stable remission state is established, patients with chronic colitis are prescribed an even more extended diet No. 4c.
If colitis is complicated by proctosigmoiditis, it is recommended to carry out microclysters with chamomile broths, which have an anti-inflammatory effect. A similar effect is provided by decoctions of caraway seeds and St. John's wort, sage, etc.
Increased gas formation is easily eliminated with folk remedies based on mint, motherwort and nettle.
To restore disturbed stools, alder cones, blueberries or bird cherry are often used.
With an infectious origin of colitis, patients are prescribed antibiotic therapy and the administration of sulfonamides. Since these drugs often provoke dysbiosis, they are prescribed in a short course after determining the causative agent of the infection.
Prevention of chronic colitis is reduced to the timely treatment of acute forms of colonic inflammation and their prevention. Compliance with 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 drugs.
Video program about the features of chronic intestinal colitis:
Colitis is an inflammatory disease of the colon that can occur for a variety of reasons. The disease can be caused by poisoning, microflora disorders, drug abuse, any infectious disease, and so on.
The International Classification of Diseases of the Tenth Revision (ICD-10) assigns different numbers depending on what type of patient was diagnosed with. The disease can be both acute and chronic. There are several main types of the disease:
Spastic colitis has an ICD-10 code, depending on the cause of its occurrence. You can also say that the ICD-10 code for chronic colitis is determined in the same way. In addition, the disease can be complicated by gastroenteritis and therefore have a different classification code.
The classification of colitis allows you to determine the cause of its occurrence, as well as outline further plans for its therapeutic cure. Develop a therapeutic course should the attending physician who will select the most effective treatment options for each specific situation.
The treatment should be developed by a gastroenterologist or coloproctologist. Colitis is primarily treatable through dietary adjustment... 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.
To this end, foods with a high fiber content should be temporarily stopped and replaced with soft boiled or stewed foods with a minimum of spices, or better yet, their complete absence.
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, the 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 normalization of stool and intestinal microflora is also being resolved.
When the first signs of colitis appear, you should consult a doctor as soon as possible. If you do not start treatment of the disease on time, then it can turn into a chronic form, after which it will become much more difficult to cure it.
For prevention purposes, you need to monitor the quality of your nutrition, exclude fatty, fried, too sour and spicy foods from the diet, and periodically visit a proctologist and gastroenterologist. Chronic colitis is best treated with long-term therapy in a spa setting.
Spastic colitis (often referred to by doctors as irritable bowel syndrome) is a functional bowel disorder with pain and other discomfort in the abdomen, the intensity of which decreases after a bowel movement. Each person has an individual course of the disease. Someone may have persistent diarrhea, while others are concerned about constipation. The stool is normal and should be free of blood.
In the article, we will consider the main causes and symptoms of spastic colitis, talk about the main methods of diagnosis and treatment, and also give recommendations on how to follow proper nutrition to restore the body.
Spastic colitis is a malfunction of the intestines, which is manifested by abdominal pain, constipation and diarrhea (alternately), this disease is a form of inflammation of the large intestine. Violation of the motor function of the intestine, impaired motility of the colon leads to involuntary painful contractions of the intestine - spasms. Spasms can occur in different areas.
The main cause of the disease is considered to be unhealthy diet - the frequent use of spicy, heavy food, 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.
About 3 out of 10 patients develop colitis after dysentery, salmonellosis, and other acute infections.
Spastic colitis can be acute or chronic. 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), unhealthy diet.
The most common causes of spastic colitis are:
The work of the intestine is regulated by the nervous system, therefore, it is with violations in it that the main causes of the development of spastic colitis are associated. These include:
Colitis can be caused by 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 feeds insufficiently digested food.
Approximately 20-60% of patients with spastic colitis have anxiety, panic attacks, hysteria, depression, sexual disorders, irritable bladder syndrome.
All symptoms that accompany chronic spastic colitis can be divided into the following groups:
The diagnosis of spastic colitis of the intestine is more likely in the presence of complaints of all three groups.
Most IBS symptoms get worse after eating. Usually, the exacerbation of the disease can last 2-4 days, after which the condition improves.
Among the most common symptoms are:
With spastic colitis, the main symptoms are painful abdominal cramps, usually in the morning after eating. Constipation is often replaced by diarrhea, prolonged diarrhea with the discharge of mushy stools.
Due to the fact that the initial symptoms of the disease indicate food poisoning, the overwhelming majority of people do not seek medical help in a timely manner. The disease can lead to anemia, significant weight loss. Ultimately, this negatively affects human life.
If symptoms appear suggesting KS, consultation with a gastroenterologist is necessary. Additional research methods, in particular, colonoscopy, play an important role in diagnostics. Treatment necessarily includes diet, so a dietitian consultation will also be helpful.
For an accurate diagnosis, it is carried out:
With the help of endoscopic methods (colon-fibroscopy, sigmoidoscopy), symptoms of spastic colitis, signs of inflammation, atrophy and dystrophy of the colon are revealed. The walls of the intestine are edematous, hyperemic, and have a coating of mucus.
To exclude Crohn's disease, ulcerative colitis, celiac disease, intestinal toxicoinfections, a laboratory study of blood and feces is carried out, including:
Spastic colitis requires an individual approach when determining treatment tactics. The combined, complex effect relieves nervous tension, accelerates the restoration of the motor function of the large intestine, and improves digestion.
Patient care consists of three components:
Much in the treatment depends on the attitude of the doctor: the therapist or gastroenterologist must form the patient's appropriate views on the treatment strategy, explain to him the essence of the disease, talk about possible side effects on therapy.
Drug treatment is prescribed depending on the results of the examination. General drugs - antispasmodics, anti-inflammatory, gas reducing agents, vitamin complexes, sorbents.
Diet for spastic colitis is very important as it helps to restore the functioning of the digestive system. For diarrhea, a therapeutic diet No. 4 is recommended, and for constipation No. 2.
With diarrhea, the daily menu should include: jelly, steamed fish and meat, cereals, mashed soups and fruit and vegetable purees.
The choice of a diet for spastic colitis of the intestine is based on the following principles:
Diet alone can contribute to the complete elimination of spastic pain without taking special medications.
Before treating spastic colitis with traditional medicine, be sure to consult a gastroenterologist.
Especially preventive measures should be followed by those who suffer from gastrointestinal disorders. At the first symptoms of spastic colitis, you should seek medical help, and not try to treat the disease yourself.
Many of us have experienced unpleasant symptoms such as abdominal pain and diarrhea, often accompanied by vomiting. This usually indicates food poisoning and an associated bowel disorder. This situation usually occurs during the ripening period of vegetables and fruits. Therefore, it is incorrect, most people are in no hurry to visit a doctor, but drink a solution of potassium permanganate and seize with 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 such manifestations, which, without timely diagnosis, as well as adequate treatment, very quickly turns into a chronic stage and begins to accompany the patient through life with constant changes of 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 a long time, the reasons for its occurrence are still unknown. Experts are not inclined to argue that the acute form of this bowel disorder will necessarily become chronic. For this, certain provoking factors must be available, among which the following are usually distinguished:
All of them are capable of provoking the transition of colitis from an acute stage to a chronic one.
Although the etiology of chronic colitis has not yet been fully elucidated, and it is quite difficult to establish one cause that usually provokes the onset of this dangerous disease, specialists have identified a group of factors, the combination of which most likely contributes to the development of pathology:
Any of these causes can cause colitis to develop. There is also no gender difference between patients, only in women the chronic form of this pathology usually occurs at a younger age.
In the case when the disease develops in the area of 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 chronic colitis.
In young patients, the cause of the development of hron. colitis is most often a hereditary factor. The risk of this pathology of the intestine, proceeding in a chronic form, is significantly increased in those children whose closest relatives suffer from inflammatory diseases of the digestive organs. For the most part, in addition to the genetic one, there are several more factors that provoke the active form of this disease in a child:
A 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 such viral infections as influenza, SARS, measles. By gender, until the transitional age, boys are most often susceptible to this disease, and after it the palm of this pathology goes to girls.
Signs of chronic colitis in children are most often aching pains of a recurrent nature, which are localized in the left half of the abdominal cavity, and are often replaced by paroxysmal contractions. In the evening, or after drinking milk, there is bloating and flatulence. The stool becomes frequent and thin, often with inclusions of blood or mucus. Appetite is significantly reduced, and this leads to loss of body weight.
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 in him. This becomes the reason for the difficulties arising in the diagnosis of the disease. In babies, the anxiety of parents should be caused by a very frequent loose stool, which, with chr. colitis can reach up to 30 times a day, and older children have tenesmus, false urge to empty the bowels.
Stool usually contains not only blood streaks, but also lumps of pus, as well as a large amount of mucus. In the chronic form of pathology in children, the stomach can sink, and it can be significantly swollen. In the event that a child has such alarming signs, in most cases indicating the possibility of chron colitis, and there are also presumptive reasons for the development of the disease, you should urgently contact a specialist to undergo the necessary diagnostic tests.
Only in the case of timely adequate treatment of active chronic colitis developing in young patients, can it result in complete clinical and laboratory recovery and not go into the chronic stage. In the event that this did happen, and the disease took on a protracted, inactive nature, it is required to adhere to the regimen recommended by a specialist in order to be able to prolong the stages of remission of chr. colitis.
Frequent exacerbations of this inflammatory pathology disrupt the child not only 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 transition of the disease to an active form and presupposes both a full treatment of acute infections of the digestive organ, dysbiosis or helminthic invasions, 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 at the developing hron. colitis is done by specialists such as a pediatric gastroenterologist and pediatrician. It is possible to do any preventive vaccinations only when the chronic form of this disease is in a period of stable remission.
The question of how the transition of inactive chronic colitis to an active form during pregnancy worries many patients. The thing here is that in women, the peak of the development of this disease occurs during the period of the reproductive system of the body.
How to make sure that the expectant mother, for whom pregnancy can be an ordeal anyway, is not bothered by chronic discomfort. colitis? And what are the reasons for the transition of this chronic inflammatory pathology to an active form during pregnancy?
In order to prevent such a situation from arising, all patients diagnosed with Chr. colitis, before thinking about having a baby, you should consult with a specialist and wait for a period of remission in the chronic course of the disease. And then, during the entire period of pregnancy, it is necessary to strictly adhere to all the recommendations of the attending physician. Only in this case a woman with chronic colitis will be able to bear and give birth to a healthy child without any problems.
Chron. colitis, like any other diseases, has its own code in the international classification of diseases (ICD 10), which allows all such pathologies to be distinguished into one group by type. They are subdivided in this case, 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 onset of the disease, subdivides all its types according to the response to those therapeutic manipulations that were carried out, the presence of possible complications, as well as the accompanying symptoms.
What types of classification stand out in ICD 10? Their main difference is the type of course of the disease, as well as the form in which it is. Also, the subdivision 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 did not provoke its development, at the very first suspicious signs, you should contact your doctor for timely diagnosis and prescription of adequate treatment in order to avoid possible negative consequences.
ICD-10 was introduced into health care practice throughout the Russian Federation in 1999 by order of the Ministry of Health of Russia dated 05/27/97. No. 170
A new revision (ICD-11) is planned by WHO in 2017 2018.
As amended and supplemented by WHO
Processing and translation of changes © mkb-10.com
Chronic colitis (ICD-10 indicates different codes depending on the specificity of the disease) is a disease with prolonged inflammatory processes in the large intestine. Symptoms of such an ailment appear only in half of the patients who come for a consultation with a gastroenterologist. According to statistics, in women, this ailment develops after about 20 years, and in men after 40. There are practically no patients in childhood.
The classification of colitis has been developed not only depending on the type of disease, but also according to the ICD-10 code. It all depends on the severity of the disease and its characteristics. Each type has a different clinical picture and causes different responses to treatment.
First of all, the disease can be acute or chronic. In the acute form, the symptoms are quite bright. In this case, inflammatory processes can occur not only in the area of the large intestine, but also affect the stomach and small intestine. As a result, the patient develops a complex of signs of gastroenterocolitis. In the chronic form of the disease, the symptoms fade away, but the disease periodically worsens.
On the etiological basis, the ailment is divided into the following types:
There is another classification of this disease, depending on the localization of the lesions. First, pancolitis is isolated, in which all parts of the colon are affected. Secondly, there is typhlitis - inflammatory processes develop on the mucous membrane of the sigmoid-intestinal region. Thirdly, there is such a form as sigmoiditis, when inflammatory processes spread to the mucous membranes of the sigmoid-intestinal region. The last form is proctitis. In this case, inflammation develops only on the rectal mucosa. There are often situations when one patient develops simultaneously several forms of the disease, that is, not only in the large intestine, but in adjacent zones.
Ulcerative colitis and other chronic types of ulcerative colitis can be caused by various factors. For example, this can be related to drugs. Usually such an ailment is caused by antibiotics, laxatives and sulfonamides. Due to long-term use, they are absorbed into the intestinal walls, disrupt the microflora and cause inflammation.
Eating disorders can also contribute to this, for example: fasting, dieting, overeating, fried and fatty foods, smoked meats, alcoholic beverages. Colitis can be caused by occupational poisoning. This applies to people who work with arsenic, mercury and metal compounds.
In old age, NUC (ulcerative colitis) and other forms of chronic disease are often caused by intestinal atony. In addition, you need to take into account the toxic substances that are released during the development of renal and liver failure, as well as gout. Sometimes such an ailment is triggered by an allergic reaction to drugs and food. It is imperative to take into account the malformations of the intestine and its individual structures.
Often, the ailment develops after an injury to the abdominal cavity, which entailed disturbances in blood flow in this area and damage to the intestinal walls. This can happen not only after an injury, but also during surgery. Blood flow in the intestine can be disrupted due to thrombosis of blood vessels and the development of atherosclerosis in this area.
There are a number of conditions under which chronic colitis worsens:
All these factors can provoke an exacerbation.
Usually the symptoms of this disease are secondary. They manifest themselves against the background of other diseases that affect the organs of the digestive system: hepatitis, cholecystitis, pancreatitis, gastritis, etc.
During an exacerbation of chronic colitis, the patient constantly feels pains that are dull in nature. The unpleasant sensations are aggravated by eating, shaking, or after stress. Stool changes - diarrhea and constipation may alternate. There is often rumbling and bloating in the abdomen. Sometimes tenesmus appears - this is a false urge to defecate. During bowel movements, mucus may come out of the rectum along with feces.
A person has an unpleasant bitterness in the mouth, especially in the morning. During the day, he quickly gets tired, feels weak, unwell. Belching often occurs. The patient is sick. Sleep is also disturbed.
All these symptoms are associated with the fact that the large intestine does not perform its functions and does not absorb useful substances - trace elements, vitamins, proteins. As a result, it affects the metabolic processes in the body. During remission, symptoms are mild and quickly resolve.
Complications appear with ulcerative and fibrous forms of the disease, when pathology violates the muscular layer of the organ.
For example, an ulcer may perforate when the stool passes into the peritoneum. This leads to peritonitis. Gangrene may develop. This happens with vascular thrombosis. If the blood vessels are destroyed, severe intestinal bleeding begins. In addition, an infection can enter the intestine and spread to other organs, which can cause sepsis, pyelonephritis, an abscess of the liver and the area around it.
The code for chronic colitis is different depending on the type of disease, which is indicated in the ICD-10. This usually applies to the class K51 and K52 with further clarifications depending on the shape and type.
Chronic colitis is considered one of the most common pathologies of the distal intestine. To carry out statistical studies and record the incidence of chronic colitis according to the ICD, it has the K52 code.
Gastroenterologists and proctologists often use the code of this disease when preparing various medical documents. Chronic colitis is characterized by an inflammatory lesion of the colon, which in some cases is ulcerative in nature and is accompanied by destruction of the mucous membrane. To make the correct diagnosis, it is necessary to know the classification and the main etiological factors that cause this pathological condition.
In the international classification of diseases of the 10th revision, nosological units are sorted depending on clinical manifestations, pathogenesis and etiology. The colitis code in ICD 10 is K52, however, depending on the form of the disease, the code varies from K52.0 to K52.9. Ulcerative colitis and Crohn's disease are distinguished as separate diseases, since they are of an autoimmune nature. The main reasons provoking the development of inflammatory lesions of the large intestine are:
Chronic inflammation of the colon, depending on the factor that causes it, can be infectious or non-infectious. Also, the disease is often combined with gastroenteritis and other pathologies of the digestive system.
In patients, complaints of pain in the abdomen and stool disorders prevail.
Depending on the form of the pathological process, blood and mucus in different proportions can be found in the feces.
Often, patients suffer from constipation or vice versa - diarrhea. In ICD 10, chronic colitis belongs to the section of diseases of the digestive tract, therefore, a gastroenterologist or proctologist should deal with the diagnosis of pathology. Early diagnosis can significantly increase the chances of a successful cure, provided that the patient adheres to a special diet and follows the doctor's recommendations. In case of untimely referral to a specialist, serious complications may occur in the form of bleeding, intoxication or the development of a malignant tumor.
Chronic colitis occurs in gastroenterological practice a little more often than other inflammatory lesions of the large intestine. Chronic colitis proceeds in waves, alternating with remission and acute periods.
Quite often, the disease is accompanied by inflammatory pathologies in other gastrointestinal tract structures. According to statistics, about half of patients with digestive problems suffer from chronic colitis.
Among patients, pathology occurs in summer, but the age of men suffering from this disease is somewhat older and is years.
Chronic colitis is an inflammatory lesion of the intestinal mucous tissues, which is accompanied by dyspeptic symptoms such as flatulence and diarrhea, constipation and rumbling, pronounced soreness and bloating.
There are a lot of factors provoking the development of chronic forms of colitis, but the main ones, according to experts, are:
Chronic colitis is exacerbated against the background of stressful conditions and excessive excitement, weakened immunity, nutritional deficiencies, the use of low-calorie foods and even small doses of alcohol.
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 is total, when all colonic divisions are affected.
This is typical of ulcerative nonspecific colitis. Also, pathology is of a segmental nature, when the lesion covers only a certain intestinal section.
Spastic chronic colitis is a functional disorder and is manifested by intestinal disorders and painful sensations in the abdomen.
Chronic spastic colitis provokes a tendency of 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 disturbed for a long time by stress and nervous experiences, hormonal disruptions or psychophysical fatigue. Also, pathology is a consequence of malnutrition, when the patient abuses alcohol, spicy or fatty foods.
Such a pathological form often affects women, which experts explain by the typicality of hormonal disorders for this category of patients, because women experience hormonal changes against the background of pregnancy, menstruation, childbirth, etc.
Chronic constipation, intestinal infections, especially lingering ones, and an allergic response to certain foods can also provoke such colitis.
Nonspecific ulcerative colitis is called diffuse inflammatory ulcerative lesions of the mucous membranes of the intestinal membranes, which are accompanied by the occurrence of severe systemic and local complications and often cause massive gastrointestinal bleeding.
The exact etiology of this form of colitis is unknown, although experts do not exclude that genetic and immune factors play an important role in the development of the pathological process.
The reason may be bacteria and viral agents that activate the immune forces, or autoimmune disruptions, accompanied by sensitization of immune structures against their own cells.
Chronic non-ulcerative colitis is an inflammatory lesion of the large intestine, which is characterized by the presence of degenerative and atrophic changes in the mucous tissues, leading to dysfunction of the large intestine.
Chronic non-ulcer colitis develops against the background of past intestinal pathologies such as dysentery, toxic infections or salmonellosis, yersiniosis, typhoid fever, etc.
The pathology is manifested by soreness in the abdomen - in the lower and lateral parts of it, which can be aching, dull, spastic or paroxysmal or bursting.
Atrophic chronic colitis is characterized by thinning of the mucous membranes of the colonic region, accompanied by impaired secretory glandular functions.
In clinical practice, there is no diagnosis of atrophic colitis. This term is used by physicians 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.
The chronic form of intestinal inflammation involves a periodic alternation of remission and exacerbated periods, therefore it is natural that patients turn to specialists when an exacerbation of chronic colitis occurs. During periods of remission, this symptomatology is weak or erased, or completely absent.
Signs of chronic colitis include:
In general, with an exacerbation, patients may clearly manifest each of the above symptoms. But gastroenterologists identify a number of signs of exacerbation of colitis, with the appearance of which an urgent need to consult a specialist.
These include unbearable soreness in the abdomen, which has a spastic character, and at night transforms into a dull and aching pain.
Most often, this pain is located on the left side of the ileum. On palpation of the intestines in some of its parts, the pain may increase.
Also, a sign of exacerbation of colitis can be considered constant bloating, which occurs against the background of an imbalance in microflora.
The consistency of the stool during an exacerbation also changes and can be expressed in prolonged diarrhea or constipation, and whitish mucous impurities or bloody blotches can be found on the feces. When such symptoms appear, it is necessary to consult a specialist for treatment as soon as possible.
To identify chronic colitis, the patient undergoes instrumental and laboratory diagnostics. The results of a blood test in colitis show the presence of leukocytosis, neutrophilia and an increase in the erythrocyte sedimentation rate. A coprogram is also carried out to patients, which shows the chemical composition of feces and their microscopic data.
Colonoscopy helps to detect an inflammatory focus, to reveal the presence of erosive and ulcerative processes, atrophic changes, vascular lesions, etc. Irrigoscopic diagnostics allows diagnosing the presence of peristaltic disorders, relief changes in the mucous membranes, intestinal atony, etc.
Chronic forms of colonic inflammation can lead to the development of rather serious complications:
Chronic forms of colitis in the acute phase must be treated in stationary conditions under the guidance of an experienced proctologist, and infectious chronic intestinal inflammation is treated in the departments of infectious diseases.
The main goal of treatment is to eliminate the provoking etiological factor of the disease and restore intestinal activity.
During acute periods, patients with colitis are recommended treatment table No. 4a, suggesting the use of steamed fish and meat dishes, low-fat broths, white bread, boiled eggs and green tea, rosehip broth or cocoa. One serving should only be g.
Gradually, when the inflammatory processes are arrested, the patient is transferred to the treatment table No. 4b.
This diet allows patients to eat cereals and soups, pasta and vegetable dishes, milk porridge and butter. When a stable remission state is established, patients with chronic colitis are prescribed an even more extended diet No. 4c.
Increased gas formation is easily eliminated with folk remedies based on mint, motherwort and nettle.
To restore disturbed stools, alder cones, blueberries or bird cherry are often used.
With an infectious origin of colitis, patients are prescribed antibiotic therapy and the administration of sulfonamides. Since these drugs often provoke dysbiosis, they are prescribed in a short course after determining the causative agent of the infection.
Prevention of chronic colitis is reduced to the timely treatment of acute forms of colonic inflammation and their prevention. Compliance with 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 drugs.
Video program about the features of chronic intestinal colitis:
According to international agreements, spastic colitis is a functional bowel disorder accompanied by pain and other discomfort in the abdominal cavity, the intensity of which decreases after the act of defecation. Pain syndrome is associated with stool disorders (frequency, appearance, consistency) and lasts more than six months.
Irritable bowel syndrome (another name for spastic colitis) has a significant impact on the quality of life of patients. The diagnosis is made in the event that the complex of the indicated violations is traced at least three times a month during the last quarter.
The existing international classification classifies spastic colitis of the intestine as class K58, subspecies K58.0 and K58.9 (respectively, colitis, accompanied by diarrhea, and without it).
By the nature of the stool disorder
There are four types of this disease, differentiated among themselves by changes in the stool.
Unfortunately, not all patients are able to reasonably assess changes in their stool. Some of them, by diarrhea, mean frequent emptying, accompanied by formed feces; others refer to constipation as uncomfortable sensations in the anus and rectum during bowel movements.
A complex of various reasons leads to the development of spastic colitis, including stress, taking antibiotics, infections. There is a theory about the supposed mechanism of IBS formation: the disease occurs due to an increase in the activity of certain parts of the gastrointestinal tract.
Food passes through the digestive tract due to the phenomenon of peristalsis. If the peristalsis becomes too strong or abnormal, severe pain syndrome develops. This explains the transient nature of the clinic: the strength of the waves of peristalsis changes every minute.
The following factors can influence such activity:
All symptoms that accompany chronic spastic colitis can be divided into the following groups:
The diagnosis of spastic colitis of the intestine is more likely in the presence of complaints of all three groups.
We list the features of the symptomatology:
In a standing position, the appearance of pain in the hypochondrium on the left is noted. Its intensity decreases when the patient moves to a horizontal position with a slightly raised pelvis. Typically, a decrease in the intensity of pain after eating, emptying, gas discharge, the use of antispasmodics, during menstruation. Pain usually does not bother at night.
This clinic cannot be considered pathognomonic for IBS, since all symptoms can occur in other diseases of the gastrointestinal tract. However, chronic spastic colitis is often accompanied by complaints of dyspeptic disorders: heartburn, nausea, bloating and non-gastroenterological symptoms.
The latter includes headaches, the appearance of pain in the lumbar region, muscles, joints, a feeling of internal trembling. There are frequent urination, more frequent urination at night, a feeling of a full bladder after emptying. In such patients, it is worth emphasizing separately the tendency to emotional disturbances: excessive hypochondria, depression, anxiety; sleep problems.
Attention should be paid to the discrepancy between the volume of complaints and the sufficiently satisfactory state of health and the duration of the disease.
Attention! If "alarming symptoms" appear in the form of a sharp weight loss, nocturnal or persistent pain, the progression of the disease, you should undergo a complete examination in relation to oncology. Suspicion of another pathology should also appear if one of the patient's relatives had colon cancer, NUC, celiac disease or Crohn's disease.
Spastic colitis of the intestine should be differentiated from:
Suspicion of chronic spastic colitis entails a comprehensive examination, consisting of the following measures:
Patient care consists of three components:
Much in the treatment depends on the attitude of the doctor: the therapist or gastroenterologist must form the patient's appropriate views on the treatment strategy, explain to him the essence of the disease, talk about possible side effects on therapy.
Diet and nutrition
The dietary food for each patient with spastic colitis is selected individually and depends on the variant of the pathology. However, there are general recommendations:
The drugs prescribed by the gastroenterologist for spastic colitis can be divided into the following groups:
Loperamide - affects the consistency of feces, reduces the intensity and number of tenesmus. It does not affect the pain syndrome.
Smecta - a daily three-time intake of the drug, according to the test results, helped to improve the quality of life of patients with IBS, reduced the severity of symptoms such as bloating, flatulence, abdominal pain.
Rifaximin effectively eliminates diarrheal syndrome, eliminates bloating. Since spastic colitis is a chronic disease, long-term use of rifaximin should be carried out as directed by a physician.
Laxatives affecting osmosis: lactulose, macrogol 4000 - retain water in the intestinal lumen, promote emptying without discomfort;
Substances that increase the volume of feces and work according to the reflex principle (plantain seeds), liquefy the masses, making their consistency softer. They do not irritate the intestinal mucosa, do not cause addiction syndrome. Dietary fibers such as bran are simply ineffective in this case.
The duration of therapy with the indicated means does not exceed two weeks.
On the territory of the Russian Federation, a drug is produced that has been developed specifically for patients with spastic colitis and meets the above requirements and composition.
Proven effective treatments for spastic colitis include hypnosis, counseling with a psychotherapist with active psychological support, and behavioral cognitive therapy. Double randomized studies have disproved the use of techniques such as acupuncture and relaxation for this disease.
Not all patients are adherent to the treatment of their disease. Many people do not like the idea that they will have to take too much (in their opinion) drugs. They find it outrageous harmful.
Some patients prefer to resort to traditional medicine recipes.
Official medicine does not have an unequivocal opinion about the course of spastic colitis. In the course of numerous trials, it was determined: despite the active therapy, the clinical picture of the disease in most of the patients remains, but does not increase. The chance of eliminating symptoms within a year and a half is about 40%. The circumstances that negatively affect the prognosis and course of the disease include:
CHRONIC INVOLVED COLITIS
Chronic non-ulcerative colitis - chronic inflammation
colon disease characterized by the development of
inflammatory-dystrophic, and with long-term existence
Atrophic changes in the mucous membrane, as well as disorders
the function of the large intestine.
In the pathological process can be involved as the whole thickness
flock of intestines (total colitis), and mainly various
its departments (right-sided colitis, left-sided colitis, procto-
sigmoiditis, transverse). Often, chronic colitis is combined with
The question of the allocation of chronic non-ulcer colitis in self-
a standing nosological form has not been resolved, unequivocally
there is no wearing to this problem. In the USA and Western Europe, this
the disease is not recognized. Thorough examination of patients with
using endoscopy, bacteriological and morphological
methods allows to distinguish the following etiological forms
we colitis: ischemic, infectious, pseudomembranous
(after antibiotic treatment), medicinal, radiation,
collagen, lymphocytic, eosinophilic, with diverticulum -
disease, systemic diseases, transplantation
ny cytostatic (neuropenic).
About 70% of all colitis occurs in a nonspecific ulcer
venous colitis and Crohn's disease of the large intestine (granuloma-
In the international classification of diseases, 10 revisions
(ICD-10) grades K50-52 include non-infectious enteritis and
K-50 - Crohn's disease of the small and large intestine.
K-51 - Ulcerative colitis.
K-52 - Other non-infectious gastroenteritis and colitis.
52.0. - Radiation colitis and gastroenteritis.
52.1. - Toxic colitis.
52.2. - Allergic gastroenteritis and colitis.
52.8. - Other forms.
52.9. - Unclassified gastroenteritis and colitis.
In the USSR, there was a point of view according to which chronic
non-ulcer colitis stands out as an independent noso-
logical unit. Many well-known gastronomic
Roenterologists (A.M. Nogaller, 1998, etc.).
P. Ya.Grigorieva (1998): if the type of colitis after a bacterial
fecal examination of feces, colonoscopy with biopsy and
X-ray examination of the large intestine etiologically
cannot be verified, then it should be attributed to chronic
zentery, salmonellosis, foodborne diseases, abdominal
typhoid, yersiniosis, etc. Particularly important is the
renal dysentery and yersiniosis, which can cause
mother is chronic. Many gastroenterologists suggest
to allocate post-dysenteric colitis. According to
A.I. Nogaller (1989) diagnosis of post-dysenteric colitis
can only be eligible for the first three years after
after suffering acute dysentery. In the future, in the absence of
in the development of bacterial carriers in the basis of the development of chronic
colitis are various other etiological and pathogenetic
ical factors, in particular, dysbiosis, sensitization to
auto microflora, etc.
be caused by protozoa (amoebae, lamblia, balanti-
diy, Trichomonas), helminths.
3. Conditionally- pathogenic and saprophytic Flora causes development
chronic colitis, as a rule, with prolonged
intestinal dysbiosis.
4. Alimentary factor- irregular food intake, mono-
miscellaneous, mainly carbohydrate or protein food,
depleted in vitamins and plant fiber; frequent
the use of hard-to-digest and spicy foods,
However, it is likely that the nutritional factor is rather
predisposing to the development of chronic colitis than you
5. Intoxication exogenous(poisoning with salts of mercury, arsenic,
phosphorus, etc.) and endogenous(renal and hepatic insufficiency
accuracy). Under these conditions, the release of toxic
substances of the mucous membrane of the large intestine, which is able to
promotes the development of inflammatory and dystrophic changes in it
6. Radiation impact - X-ray irradiation, radiation
therapy, long-term work with ionizing cure
lack of proper measures and radiation protection.
The most important are the so-called "ray" quantities.
you arising from radiation therapy of malignant neoplasms
formations of the pelvic organs and abdominal cavity.
7. Reception certain medicinal funds. The development of chronic
of `` drug-induced '' colitis is possible with prolonged
you, antibiotics, salicylates and other non-steroidal
Chronic nonulcer colitis 227
anti-inflammatory drugs, digitalis drugs
8. Food and medicinal allergy. A common cause of chro-
colitis due to the high prevalence of
food and drug allergies. Allergic component
is also present in the pathogenesis of many forms of chronic
9. Congenital fermentopathy. The greatest value due to its
it has a prevalence of disaccharidase deficiency
(primarily lactase deficiency). In this case, there is a constant
severe irritation of the mucous membrane of the large intestine
products of incomplete hydrolysis of food.
10. Ischemia walls thick intestines with atherosclerosis mesenteric
arteries, circulatory failure (see Ch.
≪Ischemic disease intestines). Ischemic colitis
they disappear mainly in the elderly.
11. Diseases others organs systems digestion. Chronic
colitis often develops in patients suffering from
chronic gastritis (especially atrophic), chronic
sky pancreatitis with exocrine insufficiency,
chronic cholecystitis, post-gastro-resection diseases
diseases, gastric ulcer and 12 duodenal ulcer -
so-called "secondary" colitis. In the development of ≪secondary≫
colitis impairment of digestive function
bowel movements, the development of dysbiosis.
The main pathogenetic factors of chronic colitis
Those are as follows:
1. Immediate damage mucous shell thick
intestines under the influence of etiological factors. It belongs
primarily to the influence of infection, medicinal substances,
toxic and allergic factors.
2. Violation function immune systems, in particular, reducing
protective functions of the gastrointestinal immune system.
The lymphoid tissue of the gastrointestinal tract performs
function of the first line of specific protection against microorganisms
nizms; most of the body's Ig-producing cells
(B-lymphocytes and plasmocytes) are located in the 1.propria of the intestine.
ka (Brandtzaeg, 1995). The presence of local immunity, opti-
minimal synthesis by the intestinal wall of immunoglobulin A, lyso
zima is a reliable protection against infection and
the development of an infectious and inflammatory process in
intestines. With chronic enteritis and colitis, it decreases
production of immunoglobulins by the intestinal wall (formerly
total IgA), lysozyme, which contributes to the development of chronic
3. Development sensitization organism patients to auto microflora
intestines and microorganisms located in other foci
infection, plays an important role in the pathogenesis of chronic co-
lita (A.M. Nogaller, 1989). In the mechanism of development of microbial
Allergies matter changes in the properties of the auto microflora,
increased permeability of the intestinal mucosa
for microbial antigens; and food allergies.
4. Autoimmune violations also play a role in
the development of chronic colitis (mainly in severe
its flow). A. M. Nogaller (1989), M. X. Levitan (1981) to-
showed the presence of sensitization to antigens of the mucous membrane
colon and production of antibodies to the modified
epithelium of the intestinal wall.
Nika leads to impaired motor function of the intestine and
promotes the development of trophic disorders of the mucous membrane
colon lining.
6. Dysbacteriosis - the most important pathogenetic factor of chronic
colitis, supporting the inflammatory process in
the mucous membrane of the colon. For details, see chap. ≪Dis-
7. Violation secretions gastrointestinal hormones, biogenic
amines, prostaglandins. Details about the effect of gastrointestinal
nal hormones on the function of the stomach and intestines, see Ch.
functions of the gastrointestinal endocrine system
promotes disorders of intestinal motor function, development
dysbiosis, aggravation of the inflammatory process in the
zycous membrane of the intestine, disorders of the secretory, excretion
function of the large intestine. In particular, with chronic
with colitis, water absorption in the right half decreases
large intestine, absorption and secretion of water and
electrolytes in the left section.
Among biogenic amines, a significant role belongs to
serotonin. It is known that in the phase of exacerbation of chronic co-
lita hyperserotoninemia is observed. The severity of her cor-
relies on the specifics of the clinic. So, hyperserotoninemia
combined with diarrhea, hyposerotoninemia - with constipation. High
cue level of serotonin contributes to the development of dysbiosis,
especially colonization in the intestine of hemolytic intestinal
In chronic colitis, the inflammatory process in the mucous membrane
the membrane of the large intestine is combined with regenerative
dystrophic changes, and with a long course of
pain develops atrophy of the mucous membrane.
Chronic colitis without mucosal atrophy in the period
exacerbation is characterized by the fact that the mucous membrane is completely
bloody, with punctate hemorrhages and erosions. Histological
microscopic examination of the mucous membrane reveals lymphoid
plasmacytic infiltration 1.propria, an increase in the number
Chronic atrophic colitis is characterized by a smoothed
ness of folds, granularity of the mucous membrane, it has
pale gray in color. Microscopic examination
there is a flattening of the villi, a decrease in crypts and the number
goblet cells. Lymphoid-plasmacytic
infiltration of the lamina propria of the mucous membrane.
Perhaps the development in some cases of the so-called number
lagenic colitis, which is characterized by thickening of the subepis
the telial layer due to excess collagen synthesis.
Chronic colitis is characterized by pain localized
mainly in the lower abdomen, in the area of the flanks (in
lateral parts of the abdomen), i.e. in the projection of the large intestine,
less often - around the navel. Pain can be of a varied nature,
are dull, aching, sometimes paroxysmal, spastic
type, bursting. A characteristic feature of pain is
that they decrease after passing gas, defecation, after
applying heat to the abdominal area, as well as after taking spasms
prayer preparations. Increased pain is noted when taken
coarse vegetable fiber (cabbage, apples, cucumbers, etc.)
vegetables and fruits), milk, fatty, fried foods, alcohol,
champagne, carbonated drinks.
With the development of pericolitis and mesenteric adenitis, the pain becomes constant
yannoy, aggravated by shaking driving, jumping, after cleaning
In many patients, increased pain is accompanied by an urge to
defecation, rumbling and transfusion in the abdomen, feeling of bloating
tia, distention of the abdomen.
Chronic colitis is accompanied by abnormal stool
in all patients. The nature of these violations is different and trainable.
caught by a disorder of the motor function of the intestine. Often on-
loose loose or mushy stools with
admixture of mucus. In some patients, the urge to defecate
occur soon after a meal (gastrointestinal or
gastrocecal reflex). In some cases, the syndrome is observed
insufficient bowel movement. This is manifested in the
a small amount of gruel during bowel movements
leg or liquid feces, sometimes with an admixture of decorated pieces
kov, often with mucus, such stool occurs several times a day. At
this, patients complain of a feeling of insufficient emptying
bowel movements after defecation.
With a lesion predominantly of the distal thick
intestines, especially when involved in the pathological process of the back
his passage, there are frequent urge to defecate, tenesmus,
the release of small amounts of feces and gases. False
the urge to defecate, while there is almost no feces, there is
there is only a small amount of gas and mucus.
Profuse diarrhea in chronic colitis is rare and
Chronic colitis can also be accompanied by constipation.
Long retention of feces in the lower sections of the thick
intestine causes irritation of the mucous membrane, increased sec-
rection and secondary liquefaction of feces. Constipation may change for 1-2 days.
frequent bowel movements with the separation of the original solid
feces ("stool stopper"), and then liquid, foamy, fermenting
or fetid putrefactive masses ("constipation diarrhea"). Some
patients with constipation alternate with diarrhea.
Dyspeptic syndrome is often observed, especially in
period of exacerbation of chronic colitis, and is manifested by nausea,
decreased appetite, metallic taste in the mouth.
Asthenoneurotic manifestations can be expressed in sufficient
definitely bright, especially with a long course of the disease. Pain-
some complain of weakness, fatigue, headache,
decreased performance, poor sleep. Some sick
very suspicious, irritable, suffer from carcinophobia.
Data from an objective clinical study of patients
Weight loss is uncommon for chronic colitis.
Weight loss, however, can be observed in some patients who
when they sharply reduce the amount of food taken due to
with an increase in the intestinal manifestations of the disease after eating. WHO-
it is possible to increase body temperature to subfebrile figures with
exacerbation of the disease, as well as with the development of pericolitis, mesa
The tongue in patients with chronic colitis is lined with grayish
white bloom, moist.
Palpation of the abdomen reveals soreness and
either the entire large intestine, or mainly one
his department. Also characteristic is the detection of areas of skin hy-
peresthesia (Zakharyin-Ged zone). These zones are located in the sub-
iliac and lumbar regions (respectively 9-12 lumbar
segments) and are easily detected when the skin is tingled with a needle
or gathering the skin in a fold.
With the development of nonspecific mesenteric soreness
on palpation is quite pronounced, not limited to thick
intestine, but is determined around the navel and in the mesenteric
lymph nodes - medially from the cecum and on the middle
dine line connecting the navel with the point of intersection of the left
midclavicular line and costal arch.
With the development of concomitant ganglionitis (involvement in the
inflammatory process of the solar plexus) there is a sharp
soreness on deep palpation in the epigastric region and
along the white line of the abdomen.
Quite often in chronic colitis, palpation reveals
alternation of spasmodic and widened areas of a thick
intestines, sometimes "splash noise".
With the so-called secondary colitis caused by other
diseases of the digestive system, objective research
patient examination reveals clinical signs of these diseases
(chronic hepatitis, pancreatitis, biliary diseases
Clinical symptoms of segmental colitis
Segmental colitis is characterized by symptoms of pre-
property damage to any of the departments of the thick
shechnik. Distinguish between typhlitis, transverse, sigmoiditis, proctitis.
Typhlitis - predominant lesion of the cecum.
The main symptoms of typhlitis are:
Pain in the right side of the abdomen, especially in the right ileum.
noah area, radiating to the right leg, groin, sometimes the belt
Stool disturbance (more often diarrhea or alternation of diarrhea and constipation)
Spasm or expansion and tenderness on palpation blind
Restriction of the mobility of the cecum with the development of peri-
Soreness inwardly from the cecum and in the umbilical
areas with the development of nonspecific mesenteric adenitis.
Transverse - inflammation of the transverse colon.
Pain, rumbling, and bloating, predominantly in the midsection.
vota, while the pain appears shortly after eating;
Alternating constipation and diarrhea;
Imperative urge to defecate immediately after eating (gastrointestinal
Soreness and dilatation of the transverse colon
(detected by palpation), in some patients it may be
spasm or alternation of spasmodic and
Angulite - isolated lesion of the splenic angle across
river colon ("left hypochondrium syndrome").
It is characterized by:
Severe pain in the left hypochondrium, often radiating to
the left half of the chest (often in the region of the heart),
Reflex pain in the region of the heart;
Feeling of fullness, pressure in the left hypochondrium or in
left upper quadrant of the abdomen;
Tympanitis with percussion of the left upper quadrant of the abdomen;
Tenderness to palpation in the area of the splenic flexure
transverse colon;
Unstable stool (alternating diarrhea and constipation).
Sigmoiditis- inflammation of the sigmoid colon.
It is characterized by the following symptoms:
Pain in the left iliac region or lower abdomen
on the left, aggravated by prolonged walking, shaking driving,
physical activity. Pain often radiates to the left groin
area and perineum;
Feeling of pressure and distention in the left iliac region
Spasmodic contraction and soreness of the sigmoid colon
on palpation, sometimes the expansion of the sigmoid is determined
intestines. In some cases, dense feces create
on palpation, a feeling of density and tuberosity of the sigmoid
bowel, which requires differential diagnosis with
hello. After a cleansing enema, density and tuberosity
Proctosigmoiditis - inflammation in the area of the sigmoid and direct
Typical for proctosigmoiditis:
Pain in the anus during bowel movements;
False urge to defecate with gas, sometimes
mucus and blood (in the presence of erosive sphincteritis, cracks
anus, hemorrhoids);
Feeling of an empty bowel after a bowel movement;
Itching and "wetness" in the anal area;
Ovine-type feces (fragmented) mixed with mucus,
With a digital examination of the rectum, it can determine
spasm of the sphincter (in the period of exacerbation of proctosigmoid
The diagnosis of proctosigmoiditis is easily verified using
Laboratory and instrumental data
1. General analysis of blood, urine and biochemical blood test without
2. Scatological analysis. Stool analysis provides micro-
scopy, chemical research (determination of the content in
daily amount of ammonia, organic acids, protein
[via the Triboulet reaction], fat, fiber, starch),
bacteriological examination. Based on the results
scatological research, the following can be distinguished
scatological syndromes (A. M. Nogaller, K. Yu. Yudtsashev,
A.G. Malygin, 1989):
Strengthening the motility of the colon. The amount of feces will increase
but, the feces are mushy or liquid consistency, light
brown or yellow, the reaction is slightly acidic or
trawl, a lot of intracellular starch, digested
fiber, iodophilic flora;
Deceleration of colon motility. The amount of feces is reduced
chenot, the consistency is solid ("human feces"), the smell is putrid,
alkaline reaction, remnants of undigested food in normal
Strengthening the motility of the large and small intestines. Feces
increased, liquid consistency, greenish color, reaction
alkaline, many undigested muscle fibers,
starch, extracellular and intracellular starch, cellular
chats, iodophilic flora;
Fermentative dyspepsia syndrome. The amount of stool is increased
feces of a mushy consistency, frothy, yellow,
sour smell, the reaction is sharply sour, a lot of starch,
fiber, iodophilic flora, the amount of organ-
chemical acids increased (20-40 mmol / l), a slight
a lot of soaps and fatty acids;
Putrid dyspepsia syndrome. The amount of stool is increased
feces of a liquid or mushy consistency, dark brown
gray color, putrid smell, the reaction is sharply alkaline,
the amount of protein and ammonia is sharply increased (the amount of ammonia
cammole / l), a significant amount of digestible
Scatological signs of exacerbation of colitis. Triboulet test
(for soluble protein) positive, in the feces increased co-
foliage of leukocytes, many cells of desquamated epithelium;
Ileocecal syndrome. The feces are not formalized, the smell is sharply acidic
light or rancid oil, golden yellow color, in a large
a large amount of undigested fiber, in a small amount
quantity - altered muscle fibers and cleaved
fat, a small number of leukocytes, mucus;
Colidistal syndrome. The feces are not formalized, there is a lot of mucus, she
lies superficially, many leukocytes and epithelial cells.
The study of bacterial flora reveals dysbiosis
Reducing the number of bifidobacteria, lactobacilli,
an increase in the number of hemolytic and lactose-negative
Escherichia, pathogenic staphylococcus, proteus, hemolytic
streptococcus (see Ch. ≪Dysbacteriosis intestines).
3. Endoscopic examination of the large intestine (rector-
manoscopy, colonoscopy) reveals inflammatory changes
mucous membrane, erosion, strengthening or depletion of the
vascular pattern, atrophy - with a prolonged course of inflammation
Colonoscopy also verifies the diagnosis
segmental colitis in the corresponding section of the thick
The diagnosis of chronic colitis is also confirmed by
by the power of histological examination of biopsies. This method
especially important in the differential diagnosis of chronic
colitis and colon cancer.
4. X-ray examination of the large intestine (irri-
goscopy) - in chronic colitis, asymmetric
naya gaustration, hypo- or hypermotor dyskinesia, conjunctival
femininity of the relief of the mucous membrane, unevenness of
filling the colon with barium.
Depending on the severity of clinical and laboratory
data distinguish three degree gravity chronic colitis.
Easy the form chronic colitis has the following characteristics
The clinical picture is dominated by mild
`` Intestinal '' symptoms, (minor abdominal pain
of that nature or in the lower sections, bloating, feeling
incomplete bowel movements, unstable stools,
discomfort in the rectum);
Psychoneurotic symptoms are expressed (sometimes it is
steps to the fore);
The general condition of patients is not significantly affected;
There is palpation tenderness of the sections of the thick
A coprological study does not reveal significant
With endoscopy, the picture of catarrhal inflammation is determined
against the background of edema of the mucous membrane, sometimes they reveal
Xia hemorrhages and easy vulnerability of the mucous membrane.
Chronic colitis average degree gravity characterized by
more persistent and recurrent course. For this form
chronic colitis is characterized by:
Severe intestinal complaints (almost constant pain
all over the abdomen, heaviness in the lower abdomen, bloating,
rumbling, transfusion, bloating, loose stools,
often alternating constipation and diarrhea);
Significantly pronounced asthenoneurotic syndrome;
Decrease in body weight during an exacerbation of the disease;
Bloating, tenderness on palpation of all parts of the thick
intestines, rumbling and splashing in the area of the cecum;
Typical scatological syndromes (in the feces are found
poorly digested muscle fibers, soaps, fat, fatty
acids, mucus, leukocytes, positive Triboulet reaction
Significantly pronounced inflammatory changes in mucus
There is no etiotropic therapy for ulcerative colitis.
Symptomatic treatment is carried out, which is aimed at suppressing the inflammatory process.
The choice of the drug (aminosalicylates, corticosteroids, immunosuppressants and antibacterial agents) depends on the activity of the disease, the presence of complications, localization and prevalence of the process.
With resistance to ongoing therapy or the development of complications, they resort to surgical treatment.
With exacerbation of ulcerative colitis, aminosalicylates and corticosteroids are most widely used. Their effectiveness has been proven in numerous placebo-controlled studies.
Drug treatment of exacerbation of the disease of mild to moderate severity:
Medication for severe exacerbation of ulcerative colitis:
Drug treatment for the chronic active course of ulcerative colitis:
Supportive therapy is determined by the choice of drug for the treatment of the acute process. So, to maintain remission after using local and systemic forms of aminosalicylates, they switch to a maintenance dose in the same form of administration. It has been proven that the risk of relapse is reduced with constant administration of a maintenance dose of aminosalacylates, and in distal colitis, local administration of drugs is more effective.
In total colitis, aminosalicylates and sulfasalazine are approximately equally effective, but the use of the latter is limited by side effects.
After corticosteroid therapy, it is possible to use aminosalicylates at a maintenance dose (0.75-2 g / day), as well as switch to cytostatics: azathioprine (Azathioprine) at the rate of 2 mg / kg or mercaptopurine. After cyclosporine, only cytostatics are used.
The disappearance of symptoms, the normalization of the endoscopic picture and laboratory parameters indicate the effectiveness of therapy.
The effectiveness of the use of aminosalicylates is assessed on the 14-21st day of therapy, corticosteroids - on the 7-21st day, azathioprine - after 2-3 months.
The duration and extent of the process should be documented in the patient's medical history and in the outpatient card.
Sigmoidoscopy is usually carried out every time with an exacerbation of ulcerative colitis and is planned annually as a control procedure for all patients under dispensary supervision. A targeted biopsy of the rectal mucosa is recommended for each sigmoidoscopy in order to clarify the diagnosis and identify dysplasia.
Colonofibroscopy with multiple targeted biopsy is indicated for total colitis that has existed for more than 10 years; it is not mandatory for left-sided localization of the process.
The study of blood and liver function tests is carried out annually. Macrocytosis may be associated with the intake of sulfasalazine, but other reasons must also be borne in mind (alcohol intake, vitamin B 12 and folic acid deficiency, hemolysis, myxedema).
A slight increase in the activity of AST or ALT is the basis for the complete exclusion of alcohol at 4-6 weeks and a re-examination of transaminases. If an elevated level of AST or ALT persists after this, it is necessary, if possible, to cancel sulfasalazine and other drugs for 3-4 months.
The study of serum markers of hepatitis B, C viruses, and liver biopsy are indicated if an increase in AST of more than 2 norms persists for 3-4 months.
A constant (more than 3-4 months) or more than 3 norms increase in alkaline phosphatase is the basis for ultrasound to exclude cholestasis, as well as primary sclerosing cholangitis, which is diagnosed using endoscopic retrograde cholangiopancreatography (ERPCG).
