Chronic watered code according to ICB 10. Ulcerative colitis

01.02.2021

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.

Treatment goals
- Elimination of the disease (surgical resection for ulcerative colitis).
- Relief of exacerbations of the disease.
- Maintaining remission of the disease.
- Prevention of the development of complications.

Indications for hospitalization
- Availability of indications for surgical treatment.
- The presence of dehydration.
- Uncontrollable pain.
- Uncontrolled diarrhea.

Treatment methods
- - Drug therapy for exacerbation of ulcerative colitis
    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:
    - mesalazine (Pentasa, Salofalk) 3-4 g / day orally, reducing the dose when remission is achieved, by approximately 1 g / week or
    - sulfasalazine (Sulfasalazine-EH) 6-8 g per day, reducing the dose when remission is achieved,
    - prednisolone (Prednisolone) inside 20-30-60 mg / day or methylprednisolone in an appropriate dose, reducing the dose depending on the clinical picture by 5-10 mg / week.
    - Dosage forms of these drugs have been developed for topical use in the form of suppositories, suspensions, which are indicated for mild forms and limited lesions of the rectum.
    Medication for severe exacerbation of ulcerative colitis:
    - prednisolone (Prednisolone) intravenously or orally 100 mg / day, reducing the dose depending on the clinical picture by 5-10 mg / week. After improving the patient's condition, you can gradually switch to aminosalicylates.
    - In case of ineffectiveness / intolerance to corticosteroids: azathioprine (Azathioprine) by mouth 2.5 mg / kg / day (or 6-mercaptopurine) or cyclosporine IV 4 mg / kg / day for 1-2 weeks, then by mouth 5 mg / kg for 6 months.
    - In case of partial obstruction or toxic megacolon, parenteral nutrition is prescribed.
    - For fever, clinical symptoms of sepsis, antibiotic therapy is indicated: ciprofloxacin (Ciprolet, Ciprofloxacin, Cifran) 500 mg IV every 8 hours or imipenem (Tienam) 500 mg IV every 8 hours.
    Drug treatment for the chronic active course of ulcerative colitis:
    - prednisolone (Prednisolone) intravenously or orally 60 mg / day, adjusting the dose depending on the activity of the disease +/-
    - azathioprine (Azathioprine) IV 2-2.5 mg / kg / day or
    - mercaptopurine IV 1 mg / kg / day.
    - In severe forms of ulcerative colitis, in addition to basic theapia, transfusion therapy is used to reduce toxemia, normalize microcirculation (rheopolyglucin), and correct electrolyte disturbances. In order to eliminate toxins and circulating immune complexes, plasmapheresis and hemosorption are used.
    - In recent years, experience has been accumulating in the use of biological therapy - monoclonal antibodies to tumor necrosis factor alpha (infliximabremicade). The positive effect is achieved in 75-80% of cases, occurs quickly and lasts at least 12 weeks after a single injection.
  - Supportive drug therapy
    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.

Evaluation of the effectiveness of treatment
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.

Further observation of patients (dispensary observation)
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).

An intestinal disease such as ulcerative colitis, according to the international classification of diseases (ICD 10), has 51 codes. It combines 8 varieties of this serious ailment. All of them were united by the following factors:

These diseases begin from the rectum, and then spreads in the proximal direction;
In 25% of cases, there is a total defeat of the colon;
In the most severe cases, defective lesions extend to the serous, submucosal and muscular membranes located in the intestinal wall;
They are characterized by both bleeding ulcers in the colon and inflammatory pseudopolyposis.

Collected under Code 51 according to ICD 10, varieties of nonspecific colitis often cause electrolyte imbalance, hypoproteinemia and anemia. Less often, they can lead to such dire consequences as colon cancer or perforation of the intestinal wall.

All types of ulcerative colitis available in the ICD are subdivided according to the following factors:

With the flow. It is chronic with periodic relapses or having a continuous course, as well as acute, sometimes even fulminant;
According to the prevalence of inflammation in the intestine in the varieties of ulcerative colitis collected in ICD 10, they can be total or left-sided. Also presented here are proctitis and proctosigmoiditis;
The intestinal pathologies collected under this code also have a general subdivision according to the degree of severity. In the most severe cases, they are accompanied by frequent and severe diarrhea, which occurs more than 6 times per day, and macroscopic blood inclusions are visible in the masses released from the intestines. At the same time, the general condition of the patient can be called rather bad: weakness, severe anemia, tachycardia and fever;
According to the stages of the disease, the varieties of nonspecific ulcerative colitis, combined into one group according to the ICD, are divided into active (the disease proceeds in an acute form) and passive, which is a state of remission, at any time capable of giving a relapse of the disease;
They also have a subdivision for the presence of extraintestinal manifestations. In the classification of diseases according to the ICD, ulcerative colitis can be with or without them;
It is noted in this intestinal pathology and the presence or absence of complications.

All types of intestinal pathology, combined into one group of the international classification of diseases, require immediate referral to a specialist and the initiation of adequate treatment. With delays, the situation may be fraught with surgical intervention with the complete removal of the intestine.

How to relieve stomach cramps and the reasons for their appearance

The main causes of stomach and intestinal cramps in children are:

pyloric stenosis;
lactase deficiency;
dysbiosis.

If colic in the stomach in adults is accompanied by diarrhea, these are signs of the following diseases:

1. irritable bowel syndrome;

2. intestinal infection;

3. pancreatitis, pancreatic colic (pain is given to the back, collarbone and scapula, most often felt on the left, possibly fever and nausea).

Pain in the lower abdomen, especially on the right, accompanies an attack of appendicitis. But at first, painful jerks can be felt in the epigastric zone. Cramps in the stomach are also symptoms of intestinal and biliary colic.

Signs of other violations:

acute gastritis;
ulcerative colitis;
stomach ulcer;
oncological diseases.

Spasms are also common due to a nervous breakdown. For impressionable people, there is enough stress to start an attack. It can pass quickly, but sometimes it lasts up to several hours. Stomach cramps mainly occur during hunger, and the person usually looks at food with dislike or indifference.

When to see a doctor?

With frequent spasmodic pain in the stomach, you should consult a specialist - a gastroenterologist or neurologist. You need to be especially concerned if the attacks are accompanied by diarrhea, fever, general weakness, dizziness, vomiting, increased heart rate, and yellowing of the skin or whites of the eyes. Women should immediately call an ambulance for vaginal bleeding. This applies to everyone if the seizures began shortly after the injury or cause unbearable pain.

Postpone the visit to the doctor and special treatment is allowed only when the pain in the stomach quickly subsides. In stressful situations, it is not necessary to immediately run for an examination, it is better to try to calm down; breathing practices help to fight colic: you need to breathe quickly, but at the same time the breaths should not be deep. With the urge to vomit, it is not recommended to eat for 6 hours. You can eat soft mashed foods, unleavened crackers, and spicy, dairy, fatty and sour foods should be excluded.

Medicines and folk remedies

If you are unsure of what to do for cramps, do not self-medicate. You can alleviate your condition by taking painkillers: No-shpy, Spazmalgon or Almagel.

Spasms are treated with folk remedies. It is quite simple to make such tinctures.

1. Tea made from mint helps a lot. It is necessary to insist 2-3 teaspoons of dry mint leaves in two hundred milliliters of boiling water for half an hour. Use the infusion as a brew, diluting in equal parts with warm water.

2. Take a tablespoon of chamomile flowers and the same amount of yarrow on a glass of infusion, pour boiling water over them and wait half an hour. Warm herbal tea should be sipped during painful conditions.

3. With severe stomach pains, fresh motherwort juice helps. One teaspoon of juice is mixed with fifty milliliters of warm water and immediately drunk.

4. Spasms of the stomach and intestines also disappear when taking celandine tincture. The green grass is poured with vodka in equal proportions, then it is tightly corked and allowed to brew for 9 days. Drink 1 teaspoon of the product.

The clinical picture of ulcerative colitis

Ulcerative colitis is a chronic inflammatory pathology of the large intestine, characterized by the development of ulcers and hemorrhages in the mucous membrane.
The disease affects people between the ages of twenty and forty. More often women suffer from ulcerative colitis.

Causes of the disease

The etiological factor of the disease has not yet been established.

There are a number of hypotheses about the occurrence of ulcerative colitis of the intestine:

ulcerative colitis - an infectious pathology of unknown etiology,
ulcerative colitis is an autoimmune disease based on the production of its own antibodies by the immune system against epithelial cells of the large intestine,
ulcerative colitis has a hereditary predisposition.

The provoking factors of the disease are:

high-carbohydrate, low-fiber diet
intestinal dysbiosis,
mental trauma, stress, emotional stress,
sedentary lifestyle.

Pathomorphology

The pathological anatomy of ulcerative colitis is represented by diffuse superficial lesions of the walls of the large intestine. Usually the pathological process is localized in the rectum and sigmoid colon. The total defeat of the entire intestine is very rare.

The morphological signs of ulcerative colitis are small ulcers on the mucous membrane of the large intestine. Moreover, it is full-blooded, the unaffected epithelium is hypertrophied and protrudes significantly above the surface of the mucous membrane. Ulcers, as a rule, are not deep, the intestinal walls are hardened.

Perhaps the addition of infection and the development of secondary purulent inflammation. All this leads to hypersensitivity of the mucous membrane, which begins to bleed even with minor exposure.

Classification

Classification depending on the location of the pathology

Regional colitis is a local lesion of the large intestine with a small area of inflammation that can grow and then become more severe.
Total colitis is manifested by inflammation that covers the entire epithelium of the large intestine and affects deep tissues.
Left-sided ulcerative colitis.
Ulcerative proctitis is a regional inflammation of the end section of the colon.

Classification depending on the course of the disease

Acute colitis is characterized by sudden onset of obvious attacks under the influence of environmental factors,
Chronic colitis is a sluggish hereditary disease
Recurrent colitis is a type of chronic form of the disease, which turns into acute under the influence of provoking factors, and after their disappearance returns back to chronic.

The latter two types are relatively difficult to treat, since the affected area is large enough.

Ulcerative colitis symptoms

According to the severity of the manifestation of clinical symptoms, the disease is divided into degrees: mild, moderate and severe.

Mild and moderate severity are characterized by the presence in the patient of general symptoms of ulcerative colitis of the intestine: malaise, weakness, an increase in body temperature to 38 ° C, and local signs: increased stool frequency up to five times per knocking, the appearance of blood in the feces and cramping abdominal pain.

The severe course of the disease is manifested by:

fever over 38 ° C,
tachycardia,
pulse more than 90 beats per minute,
pallor of the skin due to developed anemia,
dizziness
weakness
weight loss
frequent stools more than six times a day,
the presence of a large amount of blood in the feces, sometimes blood is secreted in clots,
intense cramping abdominal pain preceding the act of defecation.

Ulcerative colitis may present with constipation and pain in the left iliac region. At the same time, the body temperature rises slightly, and patients do not give special attention to these signs. But soon there is rectal bleeding with an admixture of pus. The amount of blood secreted ranges from a few drops to twenty milliliters.

Clinical symptoms of ulcerative colitis are divided into intestinal and extraintestinal.

Intestinal symptoms of ulcerative colitis: diarrhea or constipation, blood and mucus in the stool, cutting or aching pain in the left abdomen, anorexia and weight loss, fever, water-electrolyte imbalance with kidney damage.

Extraintestinal symptoms: conjunctivitis with further deterioration of vision, stomatitis, gingivitis, arthritis, skin diseases, thrombophlebitis, thromboembolism.

If the pain in the abdomen does not stop for six hours and there is a discharge of blood from the rectum, then urgent medical attention, hospitalization of the patient and a thorough examination are necessary in order to exclude acute surgical pathology.

The course of the disease in children and the elderly has its own characteristics.

Ulcerative colitis develops in children of all ages, but most often in adolescents. The disease manifests itself in symptoms that are very meager and insignificant. The symptoms of ulcerative colitis in children are growth retardation and paroxysmal diarrhea. At the same time, the periods of remission last quite long - several years.

In older people, the disease develops sluggishly, which is associated with an age-related decrease in the body's immune function. Complications develop much less frequently in the elderly than in children and young people.

It is necessary to differentiate ulcerative colitis with dysentery, salmonellosis, Crohn's disease, pseudomembranous colitis, celiac disease, diverticulum, hemorrhoidal bleeding. Of the entire list of diseases, Crohn's disease is considered the most similar in clinical manifestations to ulcerative colitis. The main difference is that Crohn's disease is characterized by damage to the entire thickness of the intestinal wall, and ulcerative colitis - only the mucous membrane.

Diagnostics

The diagnosis of ulcerative colitis always begins with an analysis of the patient's complaints and anamnestic data. Then, the patient is examined, in which signs of anemia are detected, and palpation of the abdomen determines pain on the left or throughout the abdomen.

Additional research methods are laboratory, endoscopic and radiological.

Laboratory research methods:

general blood analysis,
blood for clotting,
standard studies taken when a patient is admitted to a hospital.

The main instrumental research method is fibrocolonoscopy. It is carried out as follows: a flexible probe is inserted into the rectum through the anus, which has a microcamera at the end, with which it is possible to view and assess the state of the mucous membrane of the large intestine. Any endoscopic examination is prohibited in full during the period of exacerbation of the disease, as this can worsen the patient's condition and even lead to perforation of the intestinal wall. Colonoscopy is a universal diagnostic method that allows you to understand what ulcerative colitis is.

Irrigoscopy is a safer and less informative research method, which consists in introducing a barium suspension into the rectum using an enema, followed by an X-ray examination. With the help of barium on the roentgenogram, it is possible to obtain an impression of the intestinal mucosa and from it to judge the presence and severity of ulcerative defects.

X-ray diagnostics allows you to determine the localization of the pathological process, its prevalence, the presence of complications and monitoring the development of the disease.

Microbiological examination of nonspecific colitis is carried out in order to exclude the viral etiology of the disease. For this, bacteriological inoculation of the test material is carried out and a conclusion is made on the basis of the results obtained. Ulcerative colitis is characterized by the release of pathogenic microorganisms from feces, an increase in the number of staphylococci, proteus, a decrease in lactobacilli, as well as the release of specific microflora, which is uncharacteristic for the intestines of a healthy person.

It is possible to identify complications of ulcerative colitis - colon perforation - using plain radiography of the abdominal organs without the use of contrast media.

Complications of ulcerative colitis

Complications of ulcerative colitis occur when the treatment of pathology is not started in a timely manner or is not effective.

Life-threatening bleeding.
Toxic dilatation of the colon, resulting from the arrest of peristaltic contractions and the presence of pronounced inflammatory changes in the intestinal mucosa.
Colon perforation, which is a violation of the integrity of the intestinal wall with the outflow of intestinal contents into the free abdominal cavity.

This leads to the development of other complications - peritonitis and sepsis.
Colon polyps and cancer.
Stenosis and development of intestinal obstruction.
Hemorrhoids and anal fissures.
Extraintestinal complications: arthropathy, hepatitis, cholecystitis, pyoderma, mental disorders.

But perhaps it is more correct to treat not the effect, but the cause?

Treatment goals: maintenance of remission and prevention of complications (disappearance of pathological impurities in feces, normalization of stool, relief of abdominal pain, regression of systemic manifestations, decrease in ESR, increase in hemoglobin content, etc.).

Non-drug treatment: diet number 4.

With a severe course of the disease with a loss of more than 15% of body weight during the period of this exacerbation, parenteral nutrition is indicated. This requires adequate hydration and correction of electrolyte disturbances (usually hypokalemia).

In the treatment of NUC and CD, the effectiveness of 5-aminosalicylic acid (5-ASA), glucocorticoids and cytostatics has been proven. Basic therapy consists in the appointment of 5-ASA drugs (preferably in combination with folic acid).

The main indications for the appointment of corticosteroids in UC are: left-sided and total lesions with a severe course, III degree of activity, acute severe and moderate forms with extraintestinal manifestations / complications.

Indications for the appointment of corticosteroids in CD are: severe anemia, weight loss over 20% of the original, extraintestinal manifestations / complications, relapse after surgery.

In patients with intolerance or ineffectiveness of 5-ASA and corticosteroids, cytostatics (azathioprine) are indicated, which are also prescribed to patients in whom remission has been achieved with their use.

With a mild course use mesalazine at a dose of 2-4 g / day, mainly in tablet form or sulfasalazine (2-8 g / day). Preference is given to mesalazine, which is less toxic and has fewer side effects. With isolated proctitis, it is possible to prescribe mesalazine in the form of rectal suppositories and enemas (4-8 g / day).
For a more lasting effect, a combination of 5-ASA preparations with corticosteroids prescribed in the form of rectal enemas (hydrocortisone at a dose of 125 mg, prednisolone 20 mg twice a day until the cessation of bloody discharge) is possible. After achieving remission, patients should receive maintenance therapy with mesalazine or sulfasalazine (2 g / day) for at least 2 years.

For moderate forms 5-ASA preparations in the above doses are combined with corticosteroids (hydrocortisone or prednisolone). Hydrocortisone is administered rectally at a dose of 100-200 mg twice a day. Prednisolone is also prescribed in the form of enemas, 20 mg twice a day, or 40 mg orally per day (until the effect is achieved, usually within the first week), 30 mg (next week), 20 mg (one month), followed by a dose reduction by 5 mg / day. In the presence of perianal complications, the complex of therapeutic measures includes metronidazole at a dose of 1.0-1.5 g / day. Additional drugs (antibiotics, prebiotics, enzymes, etc.) are prescribed according to indications.

With severe forms 5-ASA preparations in the above doses are combined with large doses of corticosteroids. Hydrocortisone is prescribed 100 mg intravenously 6 times a day or prednisolone 30 mg intravenously 4 times a day for 5-7 days. Intravenous administration of corticosteroids is combined with rectal administration (hydrocortisone 100 mg in enemas 2 times a day). In the future, they switch to oral administration of corticosteroids. According to the indications indicated above, azathioprine is administered intravenously at a dose of 150 mg / day. In the future, azathioprine is prescribed at a dose of 50 mg / day as maintenance therapy.

Patients should be examined daily, and those in serious condition - 2 times a day. Particular attention should be paid to changes in body temperature, pulse rate, abdominal size and abdominal wall tension.

Emergency indications for surgical treatment NUC(colectomy) are: toxic dilation, perforation, massive bleeding, lack of improvement in severe course against the background of adequate therapy (including intravenous steroids) for 5 days. Planned indications include: severe course of NUC in the absence of effect from conservative therapy with disease progression, frequent relapses that significantly worsen the quality of life, high-grade dysplasia or malignancy.

The main indications for surgical treatment of CD are: severe forms in the absence of the effect of conservative therapy, intestinal obstruction due to strictures, fistulas, abscesses, perforation.

Acute colitis, as well as exacerbation of chronic colitis, must be treated in a hospital, in the department of proctology. Colitis of an infectious nature is treated in specialized infectious departments.
Adherence to a therapeutic diet is very important in the treatment of chronic colitis. At the same time, all foods that can mechanically or chemically irritate the intestinal mucosa are excluded from the diet. Frequent meals are recommended, preferably pureed. Since dairy products can cause fermentation and gas formation, it is advisable to refuse them during the treatment. From bakery products, dried unsweetened wheat bread is allowed. It is advisable to use steamed meat and fish of low-fat varieties. When severe clinical symptoms subside, the diet is gradually expanded. To combat constipation, it is recommended to include boiled vegetables, fruit purees (jelly), bran bread and other fiber-rich foods in the diet. Vegetable oil and a sufficient amount of liquid consumed per day, preferably purified water, contribute to the improvement of the passage of intestinal masses.
During an exacerbation, it is forbidden to eat raw fruits and vegetables. It is necessary to refuse chilled foods, lactic acid foods and foods with a high acid content. To regulate the secretion of fluid in the intestine, the use of trusted salt is limited.
In the case of the infectious nature of colitis and to suppress the pathogenic bacterial flora that has developed as a result of dysbiosis, antibiotics are prescribed in short courses (digital drugs, enterofuril, rifaximin). For the selection of adequate antibiotic therapy, it is necessary to consult a gastroenterologist. The analysis of feces for eggs of worms is indicative, and if they are detected, it is necessary to prescribe anthelmintic drugs.
To relieve pain, antispasmodics (drotaverine, papaverine) are prescribed. In chronic colitis, the appointment of sulfosalase and other anti-inflammatory drugs, as well as glucocorticoids, is indicated.
In the treatment of proctosigmoiditis, local therapy is useful: microclysters with decoctions of herbs with an anti-inflammatory effect - chamomile, calendula, with tannin or protargol. With proctitis, rectal suppositories with belladonna, anesthesin to relieve severe pain, astringents (dermatol, zinc oxide, xeroform) are prescribed.
With diarrhea, astringent and enveloping agents are prescribed internally (tanalbin, bismuth nitrate, white clay, a decoction of oak bark, other decoctions and infusions of fees containing tanning components). For constipation, colon hydrotherapy (bowel cleansing) is indicated.
Severe spasms with colitis may be an indication for the appointment of anticholinergics.
In addition to the above funds, for colitis, enterosorbents can be prescribed (to combat flatulence), enzyme preparations (in case of indigestion as a result of enzyme deficiencies), eubiotics (to correct dysbiosis).
A good effect in the treatment of chronic colitis is given by regular spa treatment, balneotherapy.

Which is an inflammation of the mucous membrane and has characteristic signs. This form of the disease involves the alternation of the phase of exacerbation and remission, when there are no symptoms. Quite often, it is accompanied by other inflammatory processes in the digestive tract.

There are many reasons that can lead to this pathology. Treatment will largely depend on this. Therapy is usually complex, and one of its components is a special diet. Also, medications of various groups are prescribed, aimed at eliminating both the cause and the symptoms.

1. What is it

Chronic colitis of the intestine is an inflammatory process that affects the mucous membrane and submucosa of this organ. The disorder is equally common in women and men, but in the latter it manifests itself at a later age.

The chronic form of colitis involves an exacerbation phase and a remission phase when there are no signs. Symptoms in this form are less pronounced than in acute colitis. Pathology is diagnosed simply, treated comprehensively.

Risk factors

The risk factors for colitis are as follows:

reduced immunity;
improper nutrition;
frequent stress;
alcohol abuse;
a history of autoimmune diseases;
abnormal structure of blood vessels in the intestine.

2. Code according to ICD-10

In ICD 10, colitis is K52, but depending on the form, it varies from K52.0 to K52.9. Crohn's disease and ulcerative colitis stand out as separate diseases because they are autoimmune in nature.

3. Reasons

In about 30% of patients, intestinal inflammation is a consequence of intestinal infections (dysentery, salmonellosis). Less commonly, the reason is long-term treatment with antibiotics, which disrupt the normal balance of the intestinal microflora.

The causes can also be related to alcohol abuse and unhealthy diet, which contribute to inflammation. In some cases, chronic colitis is a complication of other gastrointestinal diseases, such as chronic, pancreatitis, as well as a consequence of abnormalities in the development or functional insufficiency of the intestine.

4. Forms of chronic colitis

The disease is of several types:

Spastic. It is manifested by severe pain that occurs in various parts of the intestine, therefore, the dislocation of pain changes.
... This disease is characterized by spread. Ulcers and bleeding are also possible.

Depending on the provoked cause, chronic colitis can be allergic, infectious, ischemic, radiation, toxic, combined. In the latter case, several etiological factors are combined.

According to the prevalence of lesions, colitis is:

segmental - when only a specific part of the intestine is involved in the pathological process;
total - the entire colon is affected.

By severity:

mild degree - when it is easy to achieve remission;
moderate severity - medication and diet are needed to ensure a long-term retreat of symptoms;
severe degree - exacerbation prevails over remission, and it is difficult to achieve the latter.

5. Symptoms

Since in a chronic course, the phase of retreat of symptoms and exacerbation alternates, most often patients turn to the doctor exactly when the symptoms are acutely felt. In remission, they are absent at all or are expressed very weakly.

The main symptoms of chronic colitis are as follows:

With ulcerative colitis, the following symptoms are possible:

slight tingling;
loss of appetite;
inflammation of the organs of vision (it is extremely rare);
pain in the joints;
muscle weakness.

With an exacerbation of the symptoms of this form, changes in the intestinal mucosa are possible, such as swelling, bleeding, the appearance of small ulcers and formations similar to polyps.

Chronic colitis of a spastic nature is manifested as follows:

pain cramps, aggravated by hunger or at night;
bloating;
alternation and;
insomnia and, as a result, constant fatigue;
headache of varying intensity;
complete emptying of the intestine is often possible only from the second or third time, and the process of stool removal occurs only once a few days;

To reduce the manifestation of symptoms, a constant diet is needed, but it must be borne in mind that certain foods can provoke.

6. Diagnostics

To diagnose chronic colitis, you will need to consult a therapist and a gastroenterologist. Its measures are as follows:

7. Treatment of chronic colitis

Treatment for chronic colitis differs depending on the phase of the disease. At the stage of remission, it is enough to adhere to a diet, with an exacerbation, drug therapy is needed. Treatment should be individualized, taking into account the type of disorder, the severity of the symptoms and the general condition of the patient.

Drug treatment

Usually, the following groups of medicines are used for chronic colitis:

Non-drug treatments

From non-drug methods for chronic colitis, spa treatment can be indicated. Mineral waters, baths, microclysters, bowel lavage are useful.

Sometimes doctors recommend courses of physiotherapy procedures such as magnetotherapy, acupuncture, mud applications. Surgery may be required in the presence of urgent indications in case of complicated colitis.

Some folk recipes can also be used:

A decoction of sage, St. John's wort, cumin, mint helps to cope with inflammation.
With increased gas production, mint, motherwort, nettle are useful.
To eliminate spasms in the intestines, microclysters with a decoction of calendula or chamomile can be carried out.
When micro enema with sea buckthorn oil is useful for the night.

Additional methods of treatment are carried out in courses. Before using them, it is recommended to consult a doctor.

Diet for chronic colitis

Therapy will not be effective if the patient does not follow a special diet. Diet rules for chronic colitis are as follows:

The diet should be high in fiber. It is found in vegetables, cereals, bread.
Food should be consumed 4-6 times a day.
Lean fish and meat are used boiled. You can also use boiled eggs.
The diet should include a lot of first courses cooked in vegetable broths.
Seafood is healthy.
Fruits and vegetables must be peeled.
Foods that irritate the intestines should be eliminated from the diet. These include dairy and fermented milk products, legumes, spicy and salty foods, nuts, and alcohol.

Food should be high in calories and include a large amount of substances the body needs: vitamins, proteins, and so on.

Diet for colitis is one of the measures included in the complex treatment of the disease

8. Possible complications and consequences

If the disease is left untreated, it can provoke a number of complications. This is mainly about. The consequences can be as follows:

Perforation of the ulcer, which often results in peritonitis. In this case, the symptoms will appear