Nonspecific ulcer colitis – the diffusion ulcer and inflammatory damage of a mucous membrane of a large intestine which is followed by development of heavy local and system complications. The clinic of nonspecific ulcer colitis is characterized by skhvatkoobrazny belly-aches, diarrhea with blood impurity, intestinal bleeding, extra intestinal manifestations. Ulcer colitis is diagnosed by results of a kolonoskopiya, an irrigoskopiya, KT, an endoscopic biopsy. Treatment of nonspecific ulcer colitis can be conservative (a diet, physical therapy, medicines) and surgical (a resection of an affected area of a thick gut).
Nonspecific ulcer colitis
Nonspecific ulcer colitis – a kind of chronic inflammatory diseases of a large intestine of not clear etiology. It is characterized by tendency to an ulceration of mucous. The disease proceeds cyclically, aggravations are replaced by remissions. The most characteristic clinical signs – diarrhea with blood streaks, belly-ache of spastic character. It is long existing nonspecific ulcer colitis increases risk of developing of malignancies in a large intestine.
Incidence of nonspecific ulcer colitis makes about 50-80 cases on 100 thousand of the population. At the same time 3-15 new cases on each 100 thousand inhabitants annually come to light. Are more inclined to development of this pathology of the woman, than men, their NYaK meets for 30% more often. Primary identification in two age groups is characteristic of nonspecific ulcer colitis: at young people (15-25 years) and senior citizens (55-65 years). But in addition, the disease can arise also at any other age. In difference from a disease the Krone, at ulcer colitis suffers a mucous membrane only thick obodochny and a rectum.
Reasons of development of nonspecific ulcer colitis
Now the etiology of nonspecific ulcer colitis is unknown. According to assumptions of researchers in pathogenesis of this disease the immune and genetically caused factors can play a role. One of theories of developing of nonspecific ulcer colitis assumes that the viruses or bacteria which are making active immune system, or autoimmune violations can serve as the reason (an immunity sensitization against own cages).
Besides, it is noted that nonspecific ulcer colitis meets more often at people whose close relatives have this disease. Now genes which can possibly be responsible for hereditary predisposition to ulcer colitis are also revealed.
Classification of nonspecific ulcer colitis
Ulcer colitis is distinguished on localization and prevalence of process. Left-side colitis is characterized by defeat of the descending obodochny and sigmovidny gut, proktit is shown by an inflammation in a rectum, at total colitis all large intestine is affected.
Symptoms of nonspecific ulcer colitis
As a rule, the course of nonspecific ulcer colitis wavy, the periods of remission are replaced by aggravations. At the time of an aggravation ulcer colitis is shown by various symptomatology depending on localization of inflammatory process in intestines and intensity of pathological process.
At primary damage of a rectum (an ulcer proktit) bleedings from back pass, painful tenezma, pains in a stomach bottom can be noted. Sometimes bleedings are the only clinical manifestation of a proktit.
At left-side ulcer colitis when the descending obodochny gut is struck, usually there is diarrhea, kalovy masses contains blood. Belly-aches can be quite expressed, skhvatkoobrazny, mainly in the left side and (at a sigmoidita) in the left podvzdoshny area. The loss of appetite, long diarrhea and violation of digestion often lead to decrease in body weight.
Total colitis is shown by intensive belly-aches, constant plentiful diarrhea, the expressed bleeding. Total ulcer colitis is a life-threatening state as threatens with development of dehydration, collapses owing to considerable falling of arterial pressure, hemorrhagic and orthostatic shock.
The lightning (fulminantny) form of nonspecific ulcer colitis which is fraught with development of heavy complications up to a rupture of a wall of a thick gut is especially dangerous. One of widespread complications at such course of a disease is toxic increase in a thick gut (megacolon). It is supposed that emergence of this state is connected with blockade of receptors of smooth muscles of intestines excess of nitrogen oxide that causes total relaxation of a muscular layer of a large intestine.
In 10-20% of cases at patients with nonspecific ulcer colitis extra intestinal manifestations are noted: dermatological pathologies (a gangrenous piodermiya, a knotty eritema), stomatitises, inflammatory diseases of eyes (Irit, iridotsiklit, uveit, sklerit and episklerit), diseases of joints (arthritises, sakroileit, spondilit), defeats of bile-excreting system (skleroziruyushchiya holangit), the osteomalyation (a softening of bones) and osteoporosis, vaskulita (an inflammation of vessels), miozita and glomerulonefrit.
Diagnosis of nonspecific ulcer colitis
The main diagnostic method revealing ulcer colitis is the kolonoskopiya allowing to investigate in details a gleam of a large intestine and its internal walls. Irrigoskopiya and a radiological research with barium allows to find ulcer defects of walls, changes of the sizes of intestines (megacolon), violation of a vermicular movement, narrowing of a gleam. An effective method of visualization of intestines is the computer tomography.
Besides, make a koprogramma, the hidden blood test, bacteriological crops. Blood test at ulcer colitis shows a picture of a nonspecific inflammation. Biochemical indicators can signal about existence of the accompanying pathologies, disorders of digestion, functional violations in work of bodies and systems. During a kolonoskopiya usually make a biopsy of the changed site of a wall of a thick gut for a histologic research.
Treatment of nonspecific ulcer colitis
As the reasons causing nonspecific ulcer colitis up to the end are not found out, problems of therapy of this disease is a decrease in intensity of inflammatory process, subsiding of clinical symptomatology and prevention of aggravations and complications. At timely correct treatment and strict following to recommendations of the doctor, it is possible to achieve permanent remission and improvement of quality of life of the patient.
Treatment of ulcer colitis is made by therapeutic and surgical methods depending on the course of a disease and a condition of the patient. One of important elements of symptomatic therapy of nonspecific ulcer colitis is dietary food.
At the heavy course of a disease in the middle of clinical manifestations the proctologist can recommend full refusal of meal, having limited to the water use. Most often patients at an aggravation lose appetite and transfer the ban quite easily. Parenteral food is in case of need appointed. Sometimes patients are transferred to parenteral food for the purpose of more bystry simplification of a state at hard proceeding colitis. Meal is renewed right after appetite is restored.
Recommendations about a diet at ulcer colitis are submitted on the termination of diarrhea and decrease irritation by components of food of a mucous membrane of intestines. From a diet the products containing food fibers, cellulose, hot, sour dishes, alcoholic beverages, rough food are removed. Besides, increase in contents in a protein diet is recommended to the patients suffering from chronic inflammations of intestines (at the rate of 1,5-2 grams on kilogram of a body a day).
Medicamentous therapy of nonspecific ulcer colitis includes resolvents, immunodepressants (, a methotrexate, , ) and antitsitokina (). In addition, symptomatic means are appointed: antidiarrheal, anesthetics, iron medicines at the symptoms of anemia taking place.
As anti-inflammatory medicines at this pathology apply nonsteroid resolvents – derivatives of 5-aminosalicylic acid (, ) and kortikosteroidny hormonal medicines. Kortikosteroidny medicines apply in the period of the expressed aggravation in case of a heavy and medium-weight current (or at inefficiency of 5 aminosalycylates) and do not appoint more than to several months.
To children kortikosteroidny hormones are appointed with extra care. Anti-inflammatory hormonal therapy can cause a number of heavy side effects: arterial hypertension, glyukozemiya, osteoporosis, etc. From physiotherapeutic methods of treatment at ulcer colitis the diadinamoterapiya, SMT, an interferentsterapiya, etc. can be applied.
Indications to surgical treatment is inefficiency of a diet and conservative therapy, development of complications (massive bleeding, perforation of a thick gut, at suspicion on emergence of a malignant new growth etc.). The resection of a large intestine with the subsequent creation of an ileorektalny anastomoz (connection of the free end of a podvzdoshny gut with the anal channel) is the most widespread surgical technique of treatment of nonspecific ulcer colitis. In certain cases the site of the affected intestines (a segmentary resection) limited within healthy fabrics is exposed to removal.
Complications of nonspecific ulcer colitis
Quite widespread and serious complication of nonspecific ulcer colitis is the toxic megacolon - expansion of a thick gut as a result of intestines wall muscles paralysis on an affected area. At toxic megacolon note intensive pains and swelling in a stomach, temperature increase of a body, weakness.
Besides, nonspecific ulcer colitis can be complicated by massive intestinal bleeding, a rupture of intestines, narrowing of a gleam of a thick gut, dehydration as a result of big loss of liquid with diarrhea and cancer of a large intestine.
Prevention and forecast of nonspecific ulcer colitis
There is no specific prevention of NYaK at the moment as the reasons causing this disease up to the end are not clear. Preventive measures of emergence of a recurrence of an aggravation is observance of doctor's instructions on a way of life (to the recommendation about food similar to that at a disease Krone, decrease in quantity of stressful situations and a physical overstrain, psychotherapy) and regular dispensary observation. The quite good effect in respect of stabilization of a state gives sanatorium treatment.
At not heavy current without complication the forecast favorable. About 80% of the patients accepting 5-atsetilsalitsilata in quality the supporting therapies do not celebrate a recurrence and complications of a disease for a year. Patients with nonspecific ulcer colitis have recurrence of 1 times in five years, in 4% of an aggravation is absent within 15 years. Resort to surgical treatment in 20% of cases. The probability of development of a malignant tumor in sick NYaK fluctuates within 3-10% of cases.