Chronic enteritis – the inflammatory and dystrophic pathology of a small intestine leading to disorder of its digestive, transport and barrier functions. In symptomatology allocate local (frustration of a chair, a meteorizm, belly-aches) and the general (increased fatigue, irritability, headaches and dizzinesses, problems with skin, nails and hair, endokrinopatiya) signs, frustration of all types of exchange. The program of diagnostics includes a calla, to a koprogramm, ultrasonography of OBP, a radiological and endoscopic research with a biopsy. Treatment is conservative, consists in purpose of a diet, antibacterial, replacement and symptomatic therapy.
Chronic enteritis is the polietiologichny pathology which is developing as a result of dystrophy and an atrophy of all layers of a tonkokishechny wall, the shown disorder of all its functions (transport and absorption of nutrients, barrier, immunological, endocrine function). After studying of the morphological transformations happening in intestines at chronic enteritis it became clear that this disease has not so much the inflammatory nature how many dystrophic (connected with frustration of food and blood supply of a tonkokishechny wall). Depending on defeat level (initial departments of a small intestine or final) the disease can carry lines of an eyunit (defeat of a lean gut) or an ileitis (pathology of a podvzdoshny gut).
In spite of the fact that the exact figures indicating incidence of chronic enteritis are unknown, this pathology is widespread in population. So, in the specialized offices of gastroenterology which are engaged in studying of pathogenesis, clinic and treatment of diseases of a small intestine, patients with this pathology make not less than 90%.
Reasons of chronic enteritis
The most frequent responsible for chronic enteritis are the infectious diseases proceeding with damage of a GIT. The greatest importance belongs to salmonellosis, a shigellez, staphylococcal infections, an iyersenioz, lyamblioz; to infection with a kampilobakter, pseudo-monads, proteas, enteroviruses. The role of protozoan and helminthic invasions is not excluded (ascarids, cryptodisputes, wide lentets, etc.)
Also alimentary factors are urgent: mechanical traumatizing mucous thin department of intestines too dry and dense food, surplus in a diet of spices and hot spices, food poor in carbohydrates and proteins, abuse of alcohol. However separately alimentary factors do not provoke development of pathology. Conditionally it is possible to carry to this group of the reasons also food allergy, action on intestines of toxins and salts of heavy metals, ionizing radiation; long reception of certain medicines (steroids, NPVS, cytostatics, antibiotics). Also refer various anomalies of development to etiologichesky factors. Experts assign an important part to insufficiency of the ileotsekalny valve and development a reflux - the caused chronic enteritis owing to the return hit of contents of a large intestine in thin.
Leads to formation of a chronic inflammation also insufficiency of the sfinkterny device of a big duodenal nipple. At this pathology the continuous expiration of bile and pancreatic juice in a GIT gleam is noted. Digestive juice exerts the excess stimulating impact on a vermicular movement and motility of a small intestine, leading to violation of blood supply and food, and further – intestines dystrophies. Anomalies of a structure of a small intestine, megacolon, the undergone GIT operations, solderings and ischemia of abdominal organs can cause also chronic enteritis.
The main links of pathogenesis are an inflammation of its regeneration, mucous with the subsequent violation; the violation of local immunity in a small intestine promoting penetration of microorganisms into thickness of its wall, production of antibodies to intestinal flora, food, own fabrics. The important part is also assigned to the development of an intestinal dysbiosis leading to strengthening of release of bacterial toxins, violation of digestion and absorption of nutrients (especially fats), to chronic diarrhea and dehydration. There is a disorder of function of the gastrointestinalny endocrine device of a small intestine that leads to progressing of changes and aggravation of violations of reparative processes; violation of both band, and pristenochny digestion; development of fermentopatiya; change of motility of intestines on hypo - or to hyper motor type.
Classification of chronic enteritis
All chronic enterita are classified on:
- to etiologichesky factor (the toxic, bacterial, parasitic, radiation, medicinal, alimentary, postoperative, arisen against the background of anomalies development or other pathology of a GIT – secondary);
- localizations (eyunit, an ileitis, total chronic enteritis);
- to morphological changes (moderate, partial or total atrophy);
- to current (lung, average weight, heavy);
- to disease phase (to remission, aggravations);
- to the leading clinical syndrome (violation of digestion or absorption, enteropatiya, total insufficiency of a small intestine);
- to existence of the accompanying colitis and extra intestinal manifestations.
Symptoms of chronic enteritis
Symptoms of this pathology divide on local and the general. Carry to local an oblozhennost of language, frustration of a chair, a meteorizm, belly-aches; to the general - violation of all types of exchange, endocrine insufficiency, defeat of other bodies.
Typical symptom of this pathology is frequent (to 20 times a day) the chair. Desires on defecation arise right after food, the number of kalovy masses is increased in volume. During defecation the shiver in extremities, tachycardia, arterial hypotonia, weakness can be noted. Kalovy masses liquid, contains undigested lumps of food and fiber. If fat exchange is considerably broken, it is noted – kalovy masses zamazkoobrazny, clay-gray color, brilliant. At primary prevalence of processes of fermentation of kcal foamy, its reaction sour. Putrefactive processes cause a fetid smell a calla, its alkaline reaction.
Meteorizm is shown by the abdominal distension and pains passing after defecation and an otkhozhdeniye of gases. Arises more often in the second half of day when intestinal digestion takes place especially actively. Belly-aches at chronic enteritis can be caused by an intestines spasm, a meteorizm, mezadenity (an inflammation of an intestinal bryzheyka), ganglionity (an inflammation vegetative ), the mixed reasons.
The general displays of chronic enteritis are usually noted only at a medium-weight and heavy current, they are caused by violation of digestion and absorption of nutrients in a small intestine. Refer to them weakness, irritability, a constant indisposition, headaches, deterioration in a condition of skin, hair and nails, changes from language ("varnished", with prints of teeth on each side).
At chronic enteritis register violation of exchange of fats, carbohydrates, protein, vitamins, minerals. Violations of proteinaceous exchange are expressed by the progressing weight loss, an atrophy of skeletal muscles, a gipoproteinemiya, hypostases. The changed fatty exchange is shown by thinning of a hypodermic of fat, steatorey, decrease in amount of triglycerides and cholesterol in blood. Failures in exchange of carbohydrates meet much less often and are followed by development of fermentative processes in intestines, hypoglycemic conditions, intolerance of milk. Violations of mineral exchange (most of all – a gipokaltsiyemiya), electrolytic (decrease in level of sodium, potassium, magnesium, phosphorus and other minerals) and water-salt exchange also are characteristic of chronic enteritis. Also absorption of separate vitamins is oppressed (With, B12, B1, B2, PP, A, K, E).
Endocrine violations are inherent not less than thirds of patients with this pathology, mainly with a heavy current. They are shown by polyendocrine insufficiency. At the long course of chronic enteritis the chronic gastritis, hepatitis, pancreatitis worsening a condition of the patient and the forecast of a disease develops.
Prevalence of local symptoms is typical for the easy course of chronic enteritis, loss of weight usually does not exceed 5 kg. The course of average weight is registered at loss of weight to 10 kg, emergence of the general symptoms of a disease. The heavy current is characterized by prevalence of the general symptomatology in a clinical picture of a disease, the progressing iskhudaniye.
Diagnosis of chronic enteritis
The diagnosis of chronic enteritis is established on the basis of a complex of laboratory and tool methods of inspection. In blood tests there are symptoms of anemia, decrease in level of protein, electrolytes, minerals, hormones. Koprogramma reveals a maldigestiya and malabsorption; bacteriological analyses a calla – growth of pathological microflora; the analysis a calla on dysbacteriosis positive. Analyses on helminthoses, definition of antibodies to iyersiniya are surely carried out.
Assessment of morphological changes of a small intestine is possible when carrying out EGDS, intestinalny endoscopy. During this research the biopsy of a mucous membrane of a gut with the subsequent histologic research is surely carried out. The characteristic of motility of a small intestine is made by means of a contrast radiological research. Ultrasonography, the survey X-ray analysis of abdominal organs, a X-ray analysis of a stomach are carried out according to indications for differential diagnostics and detection of associated diseases of a GIT.
It is necessary to differentiate chronic enteritis with not ulcer chronic colitis, tuberculosis and amiloidozy intestines, a disease Krone, fermental enteropatiya, vneshnesekretorny pancreatic insufficiency.
Treatment of chronic enteritis
Treatment of chronic enteritis is performed by the gastroenterologist. This pathology is characterized by a long and heavy current with the frequent periods of an aggravation therefore all patients demand purpose of the medical mode and a special diet. Food has to be chemically, thermally and mechanically sparing, to contain all necessary nutrients, vitamins and minerals.
From medicamentous medicines means for an eradikation of the infectious agent, normalization of intestinal microflora (eubiotika) are appointed; the knitting, enveloping and absorbing medicines; if necessary – gastric juice and pancreatic enzymes; means for normalization of motility of intestines, against diarrhea. Symptomatic treatment includes correction of violations of exchange, vitamin therapy, replacement hormonal therapy, immunomodulators. At chronic enteritis treatment by herbs and mineral waters, sanatorium actions, physical therapy is shown.
Forecast and prevention of chronic enteritis
The forecast of chronic enteritis at correctly organized medical process favorable, the heavy course of a disease usually demands an additional examination for detection of the heavy accompanying pathology.
Prevention of chronic enteritis consists in the prevention and timely treatment of intestinal infections and sharp enteritis which can terminate in transition to a chronic form; observance of a healthy lifestyle and food; exception of etiologichesky factors of this disease; sanitary education of the population.