Nonspecific ulcerative colitis: symptoms, causes and treatment features

Recurrent chronic pathology of the gastrointestinal tract (GIT), which is characterized by the formation of necrotic sites and ulcers, as well as inflammation of the large intestine, was called ulcerative colitis. Symptoms of it are manifested by general weakness, blood diarrhea, pain in the abdomen, etc. Unfortunately, to date, there are no innovative methods of therapy that would allow a radical change in the known approaches to treating the disease.

Etiology of the disease

The exact cause of ulcerative colitis has not been identified. The following theories deserve attention:

• This is an autoimmune pathology. As a result of the influence of some provocative factors, with a genetic predisposition in the individual’s body, a process is activated against its own antigens.
• Environmental impact. The main reason is the cause of an infectious nature.
• Symptoms of ulcerative colitis are caused by an imbalance in the immune system in the digestive tract. Adverse factors provoke an inadequate inflammatory response, which is formed due to acquired or genetic malfunctions in the mechanisms of immune regulation.

Based on the foregoing, several risk factors are distinguished:

• autoimmune;
• emotional;
• infections
• heredity;
• chemical, biological, physical and other causes of inflammation.

Diagnostics

To confirm the pathology, the following types of examinations are carried out:

• Finger.
• Using a colonoscope, examine the intestinal mucosa and take biomaterial for histology.
• Complete blood count showing a low red blood cell count and high white blood cell count.
• In the study of feces, the presence of white and red blood cells is detected and bacterial culture is performed. In addition, this analysis eliminates other pathologies.
• MRI or CT can be used to examine the intestines in detail.
• X-ray using a contrast agent. This method is done with pronounced symptoms in order to exclude intestinal perforation.
• Ultrasound of the abdominal cavity.
• Consultations of an endocrinologist, rheumatologist, gynecologist, dermatologist if necessary.

Classification

The length distinguish colitis:

• total - the colon is completely affected;
• distal - proctitis is observed;
• left-sided - the part (to the right bend) of the colon is affected.

According to the severity of signs of ulcerative colitis:

• heavy
• average;
• lung.

By the nature of the course of the disease, the following forms are distinguished:

• lightning fast;
• spicy;
• recurrent chronic - exacerbations occur every six months;
• continuous - prolonged exacerbation.

Symptoms

Clinic of nonspecific ulcerative colitis is characterized by local and general symptoms. The first are manifested:

• diarrhea
• constipation
• intestinal bleeding;
• pain in the abdomen;
• involuntary urge to act defecation.

Of the common symptoms, there are:

• nausea
• vomiting
• weight loss;
• elevated temperature;
• general weakness.

The severity of symptoms of ulcerative colitis in adults depends on the severity of inflammation and bowel damage. With a moderate degree, the following symptoms are noted in the patient:

• a slight increase in temperature;
• fatigue
• pain in the abdomen of cramping nature;
• from five to six times a day, the urge to act defecation;
• stool with streaks of blood disseminated;
• there are manifestations of arthritis, erythema nodosum and some other signs that are not related to the underlying disease.

With a severe degree of ulcerative colitis of the intestine, symptoms appear as the following picture:

• diarrhea with a large number of blood spots or clots in the feces;
• before defecation, pain of a cramping nature occurs;
• anemia due to significant blood loss;
• fever;
• weight loss.

Perhaps the development of life-threatening complications - severe bleeding as a result of perforation of the colon. In patients with fulminant form of the disease, an unfavorable course is noted. For the treatment of moderate forms of ulcerative colitis, hormonal drugs are used that have an anti-inflammatory effect.

Complications

All the complications that occur with this pathology are divided into systemic and local. The latter are manifested:

• Acute toxic dilatation of the colon, which is considered one of the serious consequences of the disease. A prerequisite for the occurrence is toxicosis caused by a ulcerative necrotic process. During the next severe attack, the completely affected intestine or its section expands. In the first stages of acute toxic dilatation, intensive treatment is indicated. Surgical intervention is recommended if conservative therapy is ineffective.
• Perforation of the intestine. Such a complication is considered to be a common cause of death in fulminant form of the disease, as well as with the addition of acute toxic dilatation. The walls of the intestines become thinner and lose their protective functions under the influence of a massive ulcerative necrotic process. The pathogenic microflora is activated and promotes the formation of perforation. In the chronic stage of ulcerative colitis, this complication is quite rare. Conservative treatment is not used, surgical intervention is indicated.
• Large intestinal bleeding. This type of consequence is quite rare. With the right treatment with hemostatic and anti-inflammatory drugs, you can cope without surgery. In case of prolonged intestinal hemorrhage, doctors recommend surgery.
• Colon neoplasms. According to medical statistics, the risk of cancer increases with a disease duration of more than ten years, and especially when diagnosing a disease in childhood.

Main therapy

Anti-inflammatory drugs are the basic therapy for the treatment of ulcerative colitis in adults, the symptoms of which have been described above. The most common medicines are Sulfasalazine, Hydrocortisone, Prednisolone, Budesonide, Fluticasone. The last two drugs give a small number of side effects and, to a lesser extent than other hormonal drugs, inhibit the hypothalamic-pituitary-adrenal system. Long-term use of corticosteroids leads to the development of side effects, which are manifested:

• diabetes mellitus;
• Obesity
• osteoporosis;
• hypertension
• the formation of erosion and ulcers in the stomach and intestines.

Sulfasalazine was first used to treat ulcerative colitis in the forties of the last century. The drug not only removes the inflammatory process, but also has a preventive effect. In the individual’s body, “Sulfasalazine” breaks down into sulfapyridine and 5-aminosalicylic acid, which blocks inflammatory mediators and modulates immune responses. Thanks to the use of this agent, epithelial intestinal functions are restored, and the damaging effect on intestinal tissue is reduced. In addition to Sulfasalazine, doctors actively prescribe a drug with the active substance mesalazine, which has different trade names and types of coatings that ensure its release in different parts of the digestive system. The most effective, according to doctors, is Salofalk. In the period of active inflammation, a large dose is prescribed, then it is reduced to a supporting one. The duration of admission is set individually. The use of the above medicines is the main therapy that can be used to eliminate the symptoms of ulcerative colitis and treat mild and moderate forms of the disease in adults.

Alternative medicine

As an additional method, you can use decoctions of medicinal plant materials, which have a hemostatic and anti-inflammatory effect:

• lichen;
• burnet;
• licorice;
• gray alder;
• nettle.

In some cases, the use of alternative methods prolongs remission. In addition, it is possible to take fish oil inside and use it for enemas.

Other medications for relieving symptoms and treating ulcerative colitis

For these purposes, antibacterial agents are used that are able to modulate the body's immune response and inhibit the anaerobic intestinal flora. These requirements are met by Metronidazole. However, prolonged ingestion of the drug increases the risk of developing adverse reactions. The safest is the use of the drug in the form of a suspension administered rectally. When complications in the form of toxic dilatation of the intestine occur, it is recommended to take the following medications: Ampicillin, Clindamycin, Cefobid. Of immunosuppressants, Cyclosporin is used to treat the disease. It has been proven that intravenous administration of a high dose of this drug causes remission in almost 80% of individuals with a severe course of the disease. Most of the side effects of the drug are slightly expressed and minimized with a decrease in dosage. However, when applied, it is possible to develop a herpetic lesion of the esophagus, convulsions, lung abscess, etc. Supportive treatment with this drug is not carried out.

Of monoclonal antibodies to TNF-α, the drug Infliximab is prescribed.

Diet therapy

Treatment of ulcerative colitis of the intestines, the symptoms of which we have already examined, is carried out against the background of dietary nutrition, which has a number of features:

• the food consumed by the patient should be gentle and not contain coarse fiber;
• excludes all dairy products, fresh fruits and vegetables, any canned food, pickles and pickles;
• a balanced amount of carbohydrates, fats, proteins, vitamins and minerals should be present in the diet;
• give preference to fractional nutrition - take small portions of food every two to three hours;
• the temperature of the products should be between 30 - 35 degrees;
• all food should be steamed;
• before use, food is ground;
• when in hospital conditions, a fourth table diet is prescribed.

In case of malabsorption of microelements and an imbalance of vitamins in the patient's body, vitamin-mineral complexes are recommended. Parenteral nutrition is indicated for the treatment of severe forms of the disease.

Features of the treatment of ulcerative colitis in adults

Depending on the form of the disease, there are different treatment regimens:

1. For mild cases, “Prednisolone” is prescribed for a month, and then, gradually reducing the dosage, it is canceled. Microclysters with hormonal drugs spend a short weekly course. "Sulfasalazine" or "Mesalazine" is taken orally for a long period.
2. In moderate cases, treatment is the same as in the previous form, but drugs are used in higher dosages. In addition, a strict diet is shown, implying the rejection of dairy and high-protein foods, and fiber restriction.
3. In severe cases, infusion-transfusion therapy is used using drugs for parenteral nutrition, albumin, plasma, erythrocyte mass, saline and glucose.

A big problem in the treatment of ulcerative colitis is resistance (resistance) and dependence on hormones. In such patients, there is a low effectiveness of conservative therapy. In all forms, antibacterial agents and concomitant treatment are indicated. Among the main directions in the treatment of the disease, the following are distinguished:

• restoration of immune balance;
• stress resistance increase;
• normalization of neuroendocrine regulation;
• restoration of intestinal microflora.

Surgery

This type of treatment is recommended by the doctor in the absence of the effect of drug therapy, in emergency conditions and fulminant forms of pathology.

Indications for surgery for ulcerative colitis are divided into absolute and relative. The latter include a continuously recurring, chronic course of the disease for many years. Absolute is:

• intestinal bleeding;
• severe toxic dilatation of the intestine;
• suspected perforation;
• colon cancer and other conditions.

Features of treatment in children

Symptoms of ulcerative colitis of the intestine are also manifested in the younger generation. The disease in children is characterized by a progressive course and severe complications leading to disability. Despite the general approaches, there are some differences in the treatment of pathology in adults and children. They are associated with the developmental features of the baby, insufficient experience in the clinical use of medicines in this category of patients. Comprehensive treatment includes:

• diet food;
• basic therapy with sulfonamides, salicylates and hormones;
• antibacterial drugs;
• immunosuppressants;
• immunomodulators;
• symptomatic remedies.

One of the conditions for successful treatment of children is physical and psychological peace. Outdoor games should be limited. Hiking in the fresh air is welcome. Bed rest is indicated for exhaustion, metabolic disturbances, weakness, and temperature.

Surgical treatment is performed according to the following indications:

• colon perforation;
• heavy bleeding;
• bowel carcinoma;
• growth retardation of the child on the background of the used therapy, which has no effect;
• prolonged colitis.

Conclusion

Symptoms of intestinal ulcerative colitis are mainly manifested in adults aged 20 to 40 years, and the female population is diagnosed with this disease more often than the stronger sex. Diarrhea and frequent urges to defecate significantly reduce the individual’s quality of life and may be the reason for disability due to disability. In most cases, the disease is accompanied by dysbiosis. The treatment is individual, comprehensive, aimed at preventing complications and achieving remission.