Chronic enterokolit – an inflammatory disease of intestines which can develop after the postponed infectious enteropatologiya, somatic diseases, effect of toxins and other factors. The main symptoms – belly-ache, change of a chair, weight reduction and other signs of the broken absorption of nutrients. For the purpose of diagnostics endoscopy with a biopsy, radiological inspection, a bacteriological research a calla is carried out. Treatment consists in correction of violations of motility of intestines and microflora, purpose of antibacterial medicines and a dietotherapy. The forecast is favorable.
Chronic enterokolit – the polietiologichesky disease which is characterized by inflammatory and dystrophic changes of a mucous membrane of a small and large intestine with violation of its digestive, barrier and transport functions. The exact statistics of prevalence of this pathology is absent as quite often patients do not ask for the specialized help. However it is established that among all patients hospitalized in offices of gastroenterology, inflammatory changes of intestines are registered in 85-90% of cases. Still unambiguously the issue of allocation of this disease in a separate nosology is not resolved. If after carrying out bacteriological, radiological, endoscopic methods of diagnostics the concrete type of damage of intestines (for example, ulcer enterokolit) is not differentiated, the diagnosis of a chronic enterokolit is established. Very often at a research of a mucous membrane of intestines there are no macroscopic changes, and at a biopsy lymphocytic infiltration comes to light. In such cases the term "lymphocytic enterokolit" is applied.
Reasons of a chronic enterokolit
Earlier postponed intestinal infections, helminthoses, protozoan invasions, dysbacteriosis, violations of physiology of a mucous membrane of intestines are the main reasons for development of a chronic enterokolit at other diseases of digestive tract, and also allergic diseases, action of ionizing radiation, various toxins, thermal and mechanical factors, abuse of alcohol. At long influence of some damaging factors (generally toxins, including at alcoholic intoxication) development of initially chronic enterokolit without sharp phase is possible. The chronic inflammation of intestines which is formed after sharp is usually connected with the wrong, untimely treatment or its absence, defective food in the period of a convalescence.
At this pathology violation of balance between physiology of immune system and normal intestinal microflora therefore changes macro - and a microstructure of a mucous membrane, processes of regeneration and metabolism in it is observed. Major importance in pathogenesis has change of a microbiocenosis of intestines, barrier, sekretorny and motor functions. Activity of membrane enzymes, the transport channels providing water inflow, ions, products of the proteolysis, fats and carbohydrates is broken. Dysbacteriosis leads to fermentative and putrefactive processes as a result of which a large amount of acids, gas, and also endogenous toxins which also injure a mucous membrane and the nervous terminations is formed. Slime hyper secretion develops. Set of these processes leads to maintenance of a chronic inflammation of intestines and formation of an atrophy of his mucous membrane. At the same time the pathogenesis and disease severity depend more not on the reason, and on a damage rate of enterotsit.
Symptoms of a chronic enterokolit
The main clinical manifestations of a chronic enterokolit are a pain syndrome, violation of a chair and extra intestinal symptoms. Pain can have various localization: in a navel, on each side a stomach, in the lower departments; usually arises in several hours after meal, decreases after defecation and an otkhozhdeniye of gases. When involving in inflammatory process of the lymph nodes located on the intestines course, pain becomes a constant, amplifies after the thermal procedures and physical activities.
Violations of a chair can be various: diarrhea, locks, unstable chair. Directly after meal not plentiful diarrhea, kalovy masses usually watery, mucous is possible. The feeling of incomplete depletion of intestines, false desires to defecation can disturb. Diarrhea arises after the use of too greasy food, a large amount of milk and products rich with cellulose. Ponosa alternate with locks, at the same time kalovy masses becomes fragmented. Patients are disturbed by an abdominal distension, rumbling, nausea, an eructation and a loss of appetite.
Extra intestinal manifestations of a chronic enterokolit are caused by violation of absorption of nutrients. A characteristic symptom – weight reduction which expressiveness characterizes extent of violation of absorption. At the first degree patients lose 5-10 kg of body weight, working capacity decreases. The second degree is characterized by loss more than 10 kilograms, trophic violations, symptoms of hypovitaminosis, a lack of potassium and calcium. At the third degree against the background of loss more than 10 kilograms of body weight are observed the expressed violations of water and electrolytic balance, gipoproteinemichesky hypostases and heavy violations of motility of intestines with prevalence of a gipokineziya. Dryness of skin and mucous is noted, the hair loss, irritability, a sleep disorder, are possible spasms of small muscles.
Diagnostics of a chronic enterokolit
Consultation of the gastroenterologist allows to reveal some characteristic symptoms of this pathology, anamnestichesky data (communication with the postponed intestinal infections or action of other etiologichesky factors). At survey of the patient pallor and dryness of skin, mucous membranes is defined; language dry, is laid over by a white raid. At a palpation of a stomach morbidity in various otela, alternation of spazmirovanny and atonichny sites, rumbling can be noted. Laboratory researches do not reveal essential changes, in blood test is possible insignificant , at heavy violation of absorption the gipoproteinemiya is defined.
Consultation of the endoscopist is necessary for assessment of extent of change of a mucous membrane of intestines. During an ezofagogastroduodenoskopiya the initial department of a small intestine is visualized, when carrying out a kolonoskopiya – final department thin and all large intestine. Usually mucous membrane at a macroscopic research is not changed, symptoms of dystrophy of an epithelium, fibers, hyperaemia, hypostasis and bleeding are possible.
The endoscopic biopsy with a histologic research of material is surely carried out. A characteristic sign of a chronic enterokolit is change of enterotsit of fibers and a blanket of a mucous membrane. Visually cages do not differ from normal, subject to involute changes of enterotsit, but their quantity is significantly more, than normal, such cages can occupy all surface of fibers, and not just their disteel departments. Diffusion infiltration of deep layers of a mucous membrane lymphocytes is also typical.
At suspicion on chronic enterokolit the bacteriological research a calla for the purpose of definition of changes of microflora is conducted. Opportunistic microorganisms (a klebsiyella, proteas), and also qualitative (laktozonegativny, gemoliziruyushchy enteropatogenny strains appear) and quantitative (the maintenance of bifidobacteria, lactobacilli decreases) changes of a normal microbiocenosis come to light. The quantity of the accompanying flora increases: bakteroid, yeast.
The clinical picture of a chronic enterokolit can be not specific very therefore differential diagnostics with such diseases is surely carried out as ulcer enterokolit, a disease Krone, malignant new growths, ; at the same time the leading role is assigned to radiological and endoscopic inspection. Also somatic diseases at which exhaustion as a secondary syndrome is possible are excluded: hormonal and active tumors, pathology of endocrine system, functional damages of the central nervous system with violation of motility of intestines and other diseases of digestive tract.
Treatment of a chronic enterokolit
Treatment of a chronic enterokolit is carried out in several directions: dietotherapy, correction of violations of motility of intestines, normalization of microflora and antibacterial therapy. The diet means an exception of whole milk, crude fruit and vegetables, restriction of the simple carbohydrates, seasonings and products causing the increased gas generation.
In case of identification of pathogenic microorganisms the corresponding antibacterial medicines are appointed: sulfanylamides, nitrofurans, antifungal and other means. Also specific bacteriophages are applied: staphylococcal, proteyny, sinegnoyny etc. A probiotics (medicines with the maintenance of bifidobacteria and lactobacilli) and eubiotik is appointed. For the purpose of normalization of processes of digestion and absorption fermental medicines (Pancreatinum) are used. Apply essentsialny phospholipids to stabilization of membranes of enterotsit.
At the expressed diarrhea for decrease in secretion of water and electrolytes, and also delay of propulsive ability of intestines loperamide is appointed. In the period of an aggravation the knitting, enveloping means, enterosorbents can be applied. At the expressed gipoproteinemiya pour mixes of amino acids or plasma. If necessary correction of water and electrolytic violations (intravenous administration of medicines of potassium, calcium) is carried out.
Forecast and prevention
The forecast at a chronic enterokolit favorable, at competent systematic treatment is reached good effect. For this reason any clinical case of the heavy current which is badly giving in to therapy has to be studied regarding existence of heavier pathology.
Primary prevention consists in the prevention of intestinal infections, observance of rules of personal hygiene, isolation of infectious patients, timely adequate treatment of diseases which can become the reason of an enterokolit. For the purpose of the prevention of a recurrence all patients have to is long to keep to a diet and to strictly implement all recommendations of the doctor.