Chronic enteritis: treatment

When the disease worsens, inpatient treatment is recommended, bed rest.

Treatment of chronic enteritis should be comprehensive, including agents that affect the etiological and pathogenetic factors, as well as local and general manifestations of the disease. According to the research, a positive result of complex treatment, including a diet, enzyme and weak choleretic preparations, antibacterial, enveloping, astringent, absorbent, neutralizing organic acids, along with preparations normalizing the passage of contents through the intestines and reducing inflammatory processes in it, % of patients with chronic enteritis. The patients stopped diarrhea, abdominal pain, swelling, rumbling, which in 52% of cases was combined with a decrease in the degree of colonization of the upper parts of the small intestine by microorganisms.

Therapeutic nourishment for chronic enteritis. An indispensable component of complex therapy is a mechanically, chemically and thermally sparing diet. Therapeutic nutrition has a positive effect on the main links in the pathogenesis of diarrhea: it reduces not only the increased osmotic pressure in the intestinal cavity, but also the intestinal secretion, resulting in the normalization of the passage of the contents through the intestine.

First, with an acute exacerbation, diets № 4 and 4а are prescribed, which help to eliminate inflammation, fermenting processes in the intestine, normalization of intestinal peristalsis. After 3-5 days the patient is transferred to a full-fledged diet (No. 4b), rich in protein (up to 135 g), containing a normal amount of fats and carbohydrates (100-115 and 400-500 g respectively). Exclude products containing coarse vegetative fiber (raw vegetables and fruits, rye bread, prunes, nuts, raisins), as well as dough, snacks, canned foods, smoked products, spices, savory and salty foods, ice cream, whole milk, carbonated drinks, ; pork, beef, mutton fat, beans, beer, kvass, spirits. Limit the consumption of table salt to 7-9 g per day, potatoes. In the diet introduced an increased amount of vitamins, trace elements, calcium, iron, phosphorus, lipotropic substances. The energy value of the diet is 3000-3500 kcal.

The food ration of patients with chronic enteritis should include foods and dishes that help to eliminate the inflammatory process and fill the deficiency of the body's essential substances. When the disease worsens, soups are recommended on mucous broths of cereals and weak meat broth; rubbed or well-boiled porridge in water with the addition of a small amount of butter from rice, semolina, buckwheat, oatmeal, pearl barley; boiled and wiped vegetables, except white cabbage, turnips, beans; homogenized vegetables and meat (baby food); low-fat and non-fatty varieties of meat, fish in the form of kneads, meatballs, steam cutlets, meatballs, soufflé, pâté, soft-boiled eggs, steam omelettes, mild and lean cheese, fresh home-made curds, fresh yogurt (with tolerability), fresh sour cream for adding to dishes, yesterday's white bread, fruit jellies, mousses, kissels, compotes, baked non-acidic apples, juices containing tannic substances (from blueberries, bird cherry, black currant, pomegranate, cornel, quince, pear), pastille, marmalade, marshmallow, from soft non-loosening berries and f uktov in small quantities. It is recommended fractional meals (5-6 times a day).

Diet № 4b is prescribed for 4-6 weeks before the complete normalization of the stool. Because it is physiological, it can be observed for a long time. During the period of remission, an "untreated" variant of the specified diet No. 4c is shown (the amount of protein is increased to 140-150 g), somewhat expanding it: allow some vegetables and fruits to 100-200 g per day: lettuce, dill, parsley, mature tomatoes peel, soft pears (duchesses), sweet apples, oranges and tangerines, blueberries, blueberries, raspberries, strawberries, strawberries.

Food is given in boiled, baked or steam form.

Medical therapy of chronic enteritis is carried out taking into account the etiology and pathogenesis of the disease, the nature and severity of intestinal manifestations and changes in the general condition of the patient, concomitant diseases.

To treat chronic enteritis with increased infection of the upper gastrointestinal tract, with concomitant focal infections (tonsillitis, cystitis, pyelitis, etc.), antibacterial drugs are prescribed (for example, tetracycline 250 mg 4 times a day for 5-8 days, levomycetin 0.5 g 4 times a day, erythromycin 200,000 units 3 times a day for 5-7 days, etc.). When anaerobic flora is effective, lincomycin hydrochloride, clindamycin and metronidazole - 7-10-day courses, in severe cases - repeated weekly courses every 6 weeks. Also recommend sulfanilamide preparations (phthalazole, sulgin, biseptol, etazol) and the means of nitrofuran series (furazolidone, furazolin 0.1 g 4 times a day for 5-10 days). Favorable effect is provided by preparations of the oxyquinoline series, which possess antibacterial and antiprotozoal activity, in particular, inte- trix, enterosep- thol. It has been proved that oxyquinoline derivatives should not be prescribed for diseases of the optic nerve, peripheral nervous system, liver, kidneys, iodine intolerance. Treatment with these drugs should be carried out in short courses and only under the supervision of a doctor. In recent years, because of fear of side effects, they have rarely been used; more often use intetriks, because the methylated derivatives entering into its structure reduce its toxicity.

For the treatment of chronic enteritis associated with giardiasis, metronidazole is recommended - 0.25 g 3 times a day for 2-3 weeks or 2.0 g per day for 3 days.

When infection of the upper parts of the gastrointestinal tract with microorganisms resistant to sulfonamides and antibiotics, or a proteome, as well as a combination of chronic enteritis with inflammatory diseases of the genitourinary system, designate neviramone (0.5-1.0 g 4 times daily for 7- 14 days). Detection of pathogenic fungi (especially in candidiasis) requires the appointment of nystatin or levorin for 500,000 units 3-4 times a day for 10-14 days. If campylobacteria are isolated during sowing, erythromycin, gentamicin, and also tetracycline, inte- trix, or furazolidone are shown.

When a combination of chronic enteritis with chronic cholecystitis against hypo- and achlorhydria, a good effect can be obtained from nicodine, which has bactericidal, bacteriostatic and choleretic effects. The drug is recommended to take 1.0 g 4 times daily after meals, given the amidicotinic acid contained in the preparation, for 10-14 days. If necessary, spend 2-3 courses with a 10-day break.

After the application of antibacterial drugs, bacterial - bifidumbacterin and bifikol are prescribed for 5 doses 2 times a day, colibacterin and lactobacterin 3 times a day 3 times a day. Thanks to this consistent administration of these drugs, it is possible to achieve a more stable clinical effect. This is facilitated by the gradual elimination of bacterial preparations. In this case, the phenomena of dysbacteriosis disappear, the intestinal microflora is normalized.

To influence one of the most important intestinal manifestations of the disease, diarrhea is prescribed antidiarrheal agents, the arsenal of which continues to be replenished. An effective antidiarrheal agent is loperamide (imodium), administered 1 drop per 2 kg of body weight 3 times a day or 1 capsule 2-3 times a day. The drug is well tolerated with prolonged admission; it suppresses propulsive peristalsis, intensifies impulsive contractions, increases the tone of intestinal sphincters, slows down passage, inhibits the secretion of water and electrolytes, stimulates fluid absorption. The pronounced antidiarrheal effect has reisec (1-2 tablets or 30-40 drops 3 times a day).

The astringent and absorbing agents (bismuth nitrate, dermatol, tanalbine, chalk, white clay, smectite), including plant origin (alder cones, oak cortex, pomegranate cortex, rhizome of a blood-groove, serpentine, lapchatka, tansy flowers, St. John's Wort have not lost their value. , sorrel, plantain, sporish, sage, root of althaea, comfrey, black currant, bird cherry, blueberry) in the form of broths and infusions. An inhibitory and antispastic property is possessed by agents that inhibit the motor function of the intestine: tincture of opium, codeine, atropine, metacin, belladonna extract, platyphylline, papaverine, no-shpa in usual therapeutic doses.

To improve the digestive process, enzyme preparations are recommended: pancreatin (0.5-1.0 g 3-4 times a day), abomin (0.2 g 3 times a day), panzinorm-forte (1-2 tablets 3 once a day), festal (1 tablet 3-4 times a day), digistal (1 tablet 3-4 times a day), pankurmen (1-2 tablets 3 times a day), mezim-forte, trienzyme and etc. Enzyme preparations should be taken before or during meals for 1-2 months (if necessary, repeated courses are shown). If a patient with chronic enteritis with a decreased secretory function of the stomach takes enzymes, there is no need to take dilute hydrochloric acid or gastric juice. The exception is patients with achlorhydria who take these drugs for a long time and note their beneficial effect on the well-being and character of the stool. Normalization of cavitary digestion is also promoted by drugs (lobil) containing bile acids.

When inclined to constipation is shown the gradual introduction into the diet of dietary fiber. To the appointment of laxatives should be approached with great care. Saline laxatives in chronic enteritis are contraindicated.

With pronounced meteorism, vegetative carminative agents are prescribed (chamomile flowers, mint leaves, valerian root, fennel seeds, parsley, cumin, rhizome of aura, herb, oregano, iosop) in the form of infusion or decoction, and also carboline.

With simultaneous involvement of the small and large intestine, especially the lower segment of the latter, microclyster with protargol, Shostakovskiy balsam, fish oil, chamomile broth and antipyrine, decoction of eucalyptus, etc., in combination with suppositories with belladonna extract, novocaine, xerophore, dermatol, chamomile etc.

Thermal procedures for the abdominal region: warming, semi-alcoholic compresses, poultices; applications of paraffin, ozocerite; diathermy, non-erythematous doses of quartz, etc., stop pain in the abdomen, reduce the frequency of stool.

To transduodenal and rectal lavage bowel should be approached carefully and strictly differentiated to avoid increased pain in the abdomen and diarrhea. They can be recommended only to patients with mild course of the disease without signs of irritation of the intestine, in which its atony prevails.

To eliminate the changes in the general condition of patients and the disorder of metabolic processes, substitution therapy is indicated. To fill the deficiency of vitamins parenterally for 4-5 weeks, vitamins B1 and B6 for 50 mg, PP - 10-30 mg, C - 100 mg. It is recommended parenteral introduction of vitamin B12 - 100-200 mkg not only with hyperchromia anemia, but also in combination with fat-soluble vitamins with steatorrhea. It is suggested that B12 and C be administered on the 1st day, B6 and C in the second, B1 and PP in the third, 0.02 grams of riboflavin, 0.003 g of folic acid 3 times a day, vitamin A at 3300 IU 2 times a day.

The courses of parenteral administration of vitamins are carried out 2-3 times a year; between them prescribe multivitamin preparations in a therapeutic dose (1 dragee 3 times a day).

In chronic enteritis, which proceeds with protein deficiency, along with the diet, parenteral administration of plasma, serum (150-200 ml), protein hydrolysates and amino acid mixtures (aminopeptide, aminocrovin, aminazole, polyamine, alvezin, etc.) is recommended along 250 ml for 20 days in combination with anabolic hormones: nerobol 0,005 g 2-3 times a day, methylandrostenediol (0.01 g 2-3 times a day), nebrolil, retabolil (2 ml every 7-10 days for 3-4 weeks), as well as fatty mixtures (interlipid). Simultaneous introduction of anabolic drugs with amino acids increases the effectiveness of therapy in patients with chronic enteritis.

Long-term use of anabolic steroids does not follow, as they have some androgenic properties, and nerobol, in addition, suppresses the production of the small intestine monoglycerol lipase. It was noted that prednisalone stimulates the production of this enzyme and neutralizes the negative effect of nebrol on it, and also reduces the intake of plasma proteins into the intestine. However, steroid hormones for chronic enteritis are shown only in severe cases with a pronounced hypoproteinemia associated with the syndrome of hypercatabolic exudative enteropathy, which is more common in other serious diseases of the small intestine. They are recommended in those cases when there is a clear clinical picture of insufficiency of the adrenal cortex, confirmed by special studies, in particular the determination of 17-ACS in urine and blood. In addition, corticosteroid therapy is suitable for patients with a severe allergic component, not stopping the appointment of antihistamines.

Functional deficiency of the endocrine system is closely related to the protein deficiency in the body and often disappears or decreases as it is eliminated. Only in severe cases, with pronounced endocrine disorders, it is necessary to prescribe special hormonal medications: thyroidin with thyroid function deficiency (0.1 g 2-3 times a day), parathyroid - in case of parathyroid gland failure (0.5-0 , 1 ml intramuscularly), adiurecrin - with pituitary insufficiency (0,03-0,05 g 2-3 times a day to sniff).

For elimination of mineral deficiency and correction of water-electrolyte disturbances in cases of moderate severity (decrease in serum calcium level to 4.0-4.3 meq / L, potassium - up to 3.0-3.5 meq / L with unchanged content sodium and normal parameters of the acid-base state), 20-30 ml of panangine, 2000-3000 mg of calcium gluconate in a 5% solution of glucose or isotonic sodium chloride solution, 250-500 ml, are administered intravenously. Electrolyte solutions are administered 4-5 times a week for 25-30 days.

In case of severe disease (decrease in calcium content below 2.0 meq / L, potassium below 3 meq / L, hyponatremia, hypomagnesemia, acid-base shifts), correction of water-electrolyte disturbances is differentiated. However, such pronounced water-electrolyte disturbances are more often observed in other serious diseases of the small intestine.

With anemia or iron deficiency without anemia, iron preparations are taken orally after a meal - ferroplex, ferrocal 2 tablets 3 times a day or gemostimulin 1 tablet 3 times a day; when expressed iron deficiency anemia they are administered parenterally: ferrum-lek, ectopic by 2 ml intramuscularly every other day - 10-15 injections. Iron preparations should be taken for a long time - even after the normalization of the hemoglobin content. To avoid diarrhea, you can reduce the dose.

In macrocytic anemia, intramuscularly injected vitamin B12 500 μg weekly for 3-4 weeks.

In chronic enteritis caused by immunodeficiency, they give a good therapeutic effect, and also contribute to the normalization of absorption (according to the results of a sample with D-xylose) and the disappearance of steatorrhoea, which eliminate disbacteriosis against the background of blood transfusions and the introduction of y-globulin.

With eosinophilic enteritis prescribe drugs that affect allergic reactions, with radiation - corticosteroids, sulfasalazine, salicylates, broad-spectrum antibiotics, cholestyramine.

Mineral waters with chronic enteritis in the absence of diarrhea should be taken with caution in a warm form, without gas, no more than 1 / 4-1 / 3 glasses per reception. Only weakly mineralized waters can be recommended: Slavyanovskaya, Smirnovskaya, Essentuki No. 4, Izhevsk, Narzan, etc. The time of reception of mineral water depends on the state of acid-releasing function of the stomach: with reduced acidity for 15-20 minutes, at normal - for 40-45 min , with increased - for 1 hour 30 minutes before meals.

The prognosis depends on the frequency of relapse, the severity of changes in the general condition and the degree of involvement in the pathological process of a number of organs and systems. The disease is prolonged, the course is recurrent. With early diagnosis, timely assignment of etiological and pathogenetic treatment, recovery with restoration of the structure of the mucosa of the small intestine is possible. In severe progressive course, accompanied by frequent exacerbations, exhaustion, anemia, endocrine, vitamin, mineral deficiency and dystrophic changes in internal organs, there can be a fatal outcome. However, this, according to several authors, is rare. Some doctors emphasize that chronic enteritis is characterized by benign course and favorable prognosis.

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