Chronic enteritis

Chronic enteritis is a chronic disease of the small intestine, characterized by a disruption of its functions, primarily digestion and absorption, resulting in intestinal disorders and changes in all types of metabolism. The term "chronic enteritis" is mainly used for damage to the small intestine (decision of the Presidium of the "Association of Gastroenterology Societies" - the former All-Union Scientific Society of Gastroenterologists).

Chronic enteritis is not an inflammatory disease in the classical sense of the term. Along with the inflammatory elements, pronounced dystrophic changes develop in the small intestine, mucosal regeneration is disrupted, and its atrophy develops, which leads to the development of maligestion and malabsorption syndromes. The endocrine, immunological, and motor functions of the small intestine are also affected. With predominant damage to the proximal part of the small intestine, it is customary to speak of jejunitis, and with predominant damage to the distal part of the ileum, it is called ileitis.

The causes of chronic enteritis can be varied and include the following:

1. Inflammatory gastrointestinal diseases: This includes diseases such as Crohn's disease and ulcerative colitis, which are characterized by chronic inflammation of the gastrointestinal tract walls.
2. Infections: Certain infections, such as chronic bacterial, viral, or parasitic infections, can cause chronic GI inflammation.
3. Autoimmune conditions: Some autoimmune diseases, such as celiac disease and red wolf disease, can lead to chronic enteritis.
4. Food intolerance: Some people may have chronic enteritis due to intolerance to certain foods, such as lactose (lactase deficiency) or gluten (celiac disease).
5. Toxic or chemical exposures: In some cases, exposure to toxins or chemicals can cause chronic inflammation or damage to the gastrointestinal lining.

Symptoms of chronic enteritis may include abdominal pain, diarrhea, weight loss, fatigue, and other digestive or general symptoms. Treatment for chronic enteritis depends on the cause and symptoms. It may include medications to control inflammation, dietary recommendations, surgery, or other measures to manage the condition and relieve symptoms. Consultation with a gastroenterologist is usually necessary to diagnose and manage chronic enteritis.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Causes chronic enteritis

This process can have various causes and factors that can contribute to its development. Some of the main causes and risk factors for chronic enteritis include:

1. Inflammatory bowel disease:

   • Crohn's disease: This is a chronic inflammatory gastrointestinal disease that can affect any part of the gastrointestinal tract and cause chronic enteritis.
   • Ulcerative Colitis: This is another chronic inflammatory gastrointestinal disease that affects the colon and can cause chronic enteritis.

2. Infections:

   • Chronic or recurrent gastrointestinal infections can cause chronic enteritis.

3. Food intolerance:

   • Lactase deficiency: A lack of the enzyme lactase, needed to digest lactose (the sugar in milk), can cause chronic enteritis after consuming dairy products.
   • Gluten intolerance (celiac disease): This autoimmune disease occurs due to intolerance to gluten, which can cause inflammation and damage to the lining of the small intestine.

4. Autoimmune diseases:

   • Autoimmune diseases such as systemic lupus erythematosus or autoimmune hepatitis can cause chronic enteritis as a result of immune attacks on the body's own gastrointestinal tissues.

5. Genetic disorders:

   • Some genetic disorders, such as Neimann-Pick syndrome and others, can lead to chronic enteritis.

6. Other factors:

   • Other factors such as long-term exposure to toxins or chemicals, poor diet, and uncontrolled medication use can also be causes of chronic enteritis.

Causes of chronic enteritis

[ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]

Pathogenesis

The pathogenesis of chronic enteritis is varied and depends on its specific cause, but in general it includes the following main mechanisms:

1. Inflammation: Many forms of chronic enteritis involve inflammation of the gastrointestinal mucosa. Inflammation may be caused by immune disorders, infection, autoimmune processes, or other factors. As a result of inflammation, ulcers, erosions, and other damage occur in the mucosa.
2. Changes in the immune system: In some cases, chronic enteritis is associated with a disruption in the normal functioning of the immune system. This can lead to autoimmune processes, in which immune cells attack the body's own mucosal tissues.
3. Microbiota imbalance: The composition and balance of microorganisms in the intestinal microbiota may be disrupted, which may contribute to the development of chronic enteritis. This microbiota imbalance may alter the functionality of the intestine and increase inflammatory processes.
4. Genetic factors: In some people, family history may play a role in the development of chronic enteritis. For example, Crohn's disease and celiac disease have a genetic component.
5. Diet and nutrition: Introducing foods containing allergens or highly irritating to the mucous membrane into the diet can also contribute to the development of enteritis.
6. Toxins and infectious agents: Some types of chronic enteritis may develop after exposure to toxins, infections, or harmful chemicals.

Symptoms chronic enteritis

Symptoms of chronic enteritis can vary depending on the specific type and location of inflammation, as well as its severity. Below are common symptoms that may accompany chronic enteritis:

1. Abdominal pain: Patients with chronic enteritis often complain of abdominal pain, which may be colicky or more constant in nature.
2. Diarrhea: One of the most characteristic symptoms is diarrhea, which may be loose, frequent, and contain blood or mucus.
3. Constipation: Some patients may have alternating periods of diarrhea and constipation.
4. Bloating: Due to impaired digestion and absorption, patients with chronic enteritis may develop bloating and gas.
5. Loss of appetite: Many patients experience loss of appetite and may lose weight.
6. Fatigue and weakness: Chronic enteritis can cause general fatigue, weakness, and malaise.
7. Rectal Pain: When there is inflammation in the lower colon, patients may experience pain in the rectal area.
8. Mucus and blood: In some cases, traces of mucus and blood may be observed in the stool.
9. Malnutrition and nutrient deficiencies: Chronic enteritis can lead to impaired nutrient absorption, which can lead to vitamin, mineral and protein deficiencies.

Symptoms of chronic enteritis can vary depending on its cause, location, and severity.

Symptoms of chronic enteritis

Chronic nonspecific enteritis (CNE) in children

It can be caused by various factors and have various symptoms. This condition can be caused by infections, allergies, autoimmune processes or other reasons. It is important to conduct diagnosis and treatment under the guidance of a pediatrician or gastroenterologist. Here are some common aspects of chronic non-specific enteritis in children:

1. Symptoms: Symptoms of CNE can vary depending on the specific cause and location of the inflammation, but they may include:

   • Stomach ache.
   • Diarrhea.
   • Vomit.
   • Lack of appetite.
   • Weight loss.
   • Underdevelopment or delay in growth and development.

2. Diagnostics: To establish a diagnosis of CNE in children, the following studies can be carried out:

   • Stool tests to detect infections or inflammatory markers.
   • Gastroenteroscopy and colonoscopy with biopsy to assess the condition of the intestinal mucosa and identify pathological changes.
   • Laboratory blood tests, including a complete blood count and biochemical tests.

3. Treatment: Treatment for CNE in children depends on the specific cause and severity of the condition. Possible treatments include:

   • Diet therapy: Dietary changes may be necessary to reduce symptoms and prevent flare-ups. In some cases, temporary use of specialized diets may be necessary.
   • Medication: Your doctor may prescribe anti-inflammatory drugs, antibiotics, or other medications depending on your diagnosis.
   • Supportive care: Antisecretory drugs and rehydration to prevent dehydration may be used to treat symptoms such as diarrhea and vomiting.

4. Following Doctor's Advice: Parents should strictly follow the doctor's advice regarding treatment and diet for their child, and also have their child examined regularly and follow a monitoring plan.

To accurately determine the cause and treatment of CNE in a child, it is important to consult a qualified physician. Each case may be individual, and a pediatrician or gastroenterologist can help develop the best treatment plan for your child.

Forms

Chronic enteritis can be classified based on various criteria such as the cause, location of the lesion, nature of changes in the mucous membrane and other factors. Some common classifications are:

1. Due to:

   • Inflammatory enteropathies: These conditions are caused by chronic inflammation of the gastrointestinal tract and include Crohn's disease and ulcerative colitis.
   • Infectious enteropathies: Caused by infection of the gastrointestinal tract, such as chronic bacterial, viral or parasitic infection.
   • Food intolerances: Associated with intolerance to certain foods, such as lactose (lactase deficiency) or gluten (celiac disease).
   • Genetic disorders: Caused by genetic mutations such as Neimann-Pick syndrome, etc.
   • Autoimmune enteropathies: Occur due to autoimmune attacks on the body's own gastrointestinal tissues.

2. By location of the lesion:

   • Small intestine: Enteritis can affect the small intestine, which is called small intestinal enteritis.
   • Colon: If the lesion is concentrated in the colon, it may be called enterocolitis.
   • Generalized enteritis: When both the small and large intestines are affected.

3. By the nature of changes in the mucous membrane:

   • Eosinophilic enteritis: Characterized by the accumulation of eosinophils in the mucous membrane.
   • Ulcerative enteritis: Accompanied by the formation of ulcers and damage to the mucous membrane.
   • Infiltrative enteritis: Characterized by inflammatory infiltrates in the tissues of the mucous membrane.

Classifying chronic enteritis can be difficult because of the variety of its forms and causes.

Types of chronic enteritis

Chronic nonspecific enteritis and chronic ulcerative enteritis are two different types of chronic inflammatory bowel disease that have different characteristics and treatments:

1. Chronic nonspecific enteritis:

   • This term is commonly used to describe a chronic inflammatory bowel condition that has no specific identifiable cause or is not related to classic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.
   • Symptoms may include abdominal pain, diarrhea, indigestion, and giddiness.
   • Diagnosis of chronic nonspecific enteritis can be difficult and involves extensive testing, including gastroscopy, colonoscopy, biopsies, and laboratory tests.

2. Chronic ulcerative enteritis (Crohn's disease):

   • Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the digestive system, from the mouth to the anus, but most commonly affects the lower end of the small intestine (ileum) and the beginning of the large intestine.
   • Symptoms of Crohn's disease can include abdominal pain, diarrhea, vomiting, weight loss, ulcers, and other problems.
   • The diagnosis of Crohn's disease can be confirmed by gastroscopy, colonoscopy, biopsies and other laboratory tests. Crohn's disease is usually characterized by specific changes in the intestinal mucosa.

Treatment for chronic nonspecific enteritis and Crohn's disease may involve a variety of methods, including medications to reduce inflammation, symptom control, surgery for complications, and dietary changes.

Diagnostics chronic enteritis

Diagnosis of chronic enteritis requires a comprehensive approach and may include the following methods and stages:

1. Medical history and physical examination: The doctor will conduct a detailed interview with the patient to determine the nature and duration of symptoms. A physical examination may reveal signs such as abdominal pain, bloating, or other changes.

2. Laboratory tests:

   • Clinical blood test: Allows to identify signs of inflammation and anemia.
   • Stool test: Can help determine if there is blood, bacteria, parasites, or other abnormalities in your stool.
   • Immunological tests: For example, tests for gluten antibodies to detect celiac disease.
   • Biochemical tests: May include lactase levels, liver enzymes, and other markers.

3. Instrumental studies:

   • Gastroenteroscopy: This is a procedure in which a doctor performs an endoscopic examination of the gastrointestinal tract using a gastroenteroscope. During this procedure, a biopsy of the lining may be taken for laboratory testing.
   • Colonoscopy: Similar to gastroenteroscopy, but examines the large intestine.
   • Barium enema: This x-ray technique can be used to examine the structure of the intestine.
   • Abdominal ultrasound: Can help detect changes in the structure of abdominal organs.

4. Genetic tests: To diagnose genetic disorders such as celiac disease or other rare inherited conditions.

5. Other special tests:

   • Food Restriction Trial: If intolerance to certain foods is suspected, a food elimination trial may be performed.
   • Tests for infections: If symptoms are related to infections, appropriate tests may be ordered.

Diagnosis of chronic enteritis

[ 11 ], [ 12 ], [ 13 ]

Treatment chronic enteritis

Treatment of chronic enteritis depends on its cause and nature. Enteritis can be caused by various factors, such as infections, inflammatory bowel diseases, allergies or other medical conditions. Therefore, for effective treatment, it is necessary to first establish a diagnosis and determine the underlying cause of the disease. Here are the general principles of treating chronic enteritis:

1. Establishing an accurate diagnosis: It is important to first perform a comprehensive medical examination and diagnostic workup, including laboratory tests, educational methods, endoscopy, biopsy and other procedures to determine the cause and nature of the enteritis.
2. Treating the underlying cause: Treatment will be directed at the underlying disease or condition that is causing the enteritis. For example, inflammatory bowel diseases such as Crohn's disease or ulcerative colitis will use specific medications such as antibiotics, immunomodulators, or drugs that reduce inflammation.
3. Symptom control: Various medications may be used to relieve the symptoms of chronic enteritis. For example, antidiarrheal medications, antibiotics, antispasmodics, and pain relievers may be prescribed depending on the symptoms.
4. Diet and nutritional support: Depending on the type of enteritis and symptoms, a specific diet is recommended. For example, in celiac disease, gluten should be completely eliminated from the diet. In some cases, specialized medical food products may be required.
5. Prevention of complications: It is important to have regular check-ups with your doctor and follow recommendations for preventing complications such as anemia, vitamin and mineral deficiencies, inflammatory changes, and others.
6. Supportive care: Some patients with chronic enteritis may receive supportive care, such as medications that help restore the mucous membrane and normalize bowel function.

Treatment of chronic enteritis should be carried out under the supervision of a doctor, who will develop an individual treatment plan depending on the diagnosis and severity of the disease. Self-medication is not recommended, as improper treatment can worsen the condition.

Treatment of chronic enteritis

Medicines for chronic enteritis

Treatment for chronic enteritis depends on its cause and characteristics. Here are some of the medications that can be used to treat various forms of chronic enteritis:

1. Anti-inflammatory drugs:

   • Mesalamine: Used to treat inflammatory bowel diseases such as ulcerative colitis.
   • Sulfasalazine: Used for ulcerative colitis and some other inflammatory bowel diseases.

2. Glucocorticosteroids:

   • Prednisolone, betamethasone, and others: Used to reduce inflammation and relieve symptoms during exacerbations of chronic enteritis.

3. Immunomodulators:

   • Azathioprine, Methotrexate, and others: Used to suppress the immune response and reduce inflammation in inflammatory bowel disease.

4. Biological drugs:

   • Infliximab, Adalimumab, Golimumab, and others: These drugs may be used for more serious forms of inflammatory bowel disease, such as Crohn's disease and ulcerative colitis.

5. Antibiotics:

   • Metronidazole, Ciprofloxacin and others: Can be used for infectious forms of chronic enteritis.

6. Anti-eosinophilic drugs:

   • Glucocorticosteroids and leukotriene antagonists (eg, montelukast): Used for eosinophilic enteropathy.

7. Drugs for symptomatic treatment:

   • Antispasmodics (eg, mevacam, drotaverine): Used to relieve abdominal pain and spasms.
   • Anti-stool medications (eg, loperamide): Used to reduce the frequency and severity of diarrhea.
   • Preparations for maintaining normal intestinal microflora, such as probiotics.

8. Dietary changes: Diet can play an important role in the treatment of chronic enteritis, and your doctor may recommend a special diet depending on the diagnosis.

Diet and nutrition for chronic enteritis

Diet and nutrition play an important role in managing symptoms and maintaining health in chronic enteritis. The approach to nutrition may vary depending on the type and cause of enteritis, so it is recommended to consult with a doctor or dietitian to develop the best diet plan. Here are some general dietary recommendations for chronic enteritis:

1. Eliminating or limiting trigger foods:

   • If you have celiac disease or gluten intolerance, completely eliminate gluten-containing foods (wheat, barley, rye) from your diet.
   • If you have lactose intolerance, avoid milk and dairy products containing lactose. Instead, you can use lactose-free or low-lactose alternatives.
   • For other types of food intolerances and allergies, eliminate foods that cause the reaction.

2. Soft diet:

   • If symptoms worsen, you may need to switch to a soft diet that excludes fatty, spicy and raw foods.
   • Try more mushy cereals, processed vegetables and fruits, potatoes, and soft proteins (such as skinless chicken).
   • Avoid alcohol and soda drinks.
3. Increase Water Intake: Dehydration can be one of the symptoms of chronic enteritis, so it is important to increase water intake to prevent dehydration.
4. Small, frequent meals: Instead of eating three large meals, try eating smaller meals more frequently throughout the day. This can help reduce the strain on your GI tract.
5. High-fiber diet: In some forms of chronic enteritis, such as Crohn's disease, high-fiber foods can worsen symptoms. In this case, avoid raw vegetables, seeds, and coarse fiber foods.
6. Monitor your micronutrient intake: You may need to increase your intake of certain micronutrients, such as iron, vitamin B12, and folate, if you are deficient due to poor absorption.
7. Probiotics: Some people with chronic enteritis find relief by taking probiotics, which can help restore the balance of microflora in the gastrointestinal tract.
8. Maintaining optimal weight and nutritional status: Regular monitoring by a doctor and a nutritionist will help maintain optimal nutritional status and weight.

Clinical guidelines

Chronic enteritis is a chronic inflammatory disease of the intestinal mucosa. Treatment and clinical recommendations for patients with chronic enteritis may vary depending on the cause and severity of the disease. Here are general clinical recommendations for the management of chronic enteritis:

1. Diagnostics and assessment:

   • The first step is to accurately diagnose the cause of chronic enteritis. This may require various laboratory and instrumental studies, such as blood tests, stool tests, endoscopy with biopsy, and others.

2. Treatment of the underlying disease:

   • Treatment of chronic enteritis directly depends on its cause. For example, if the underlying cause is Crohn's disease or ulcerative colitis, then treatment will be aimed at alleviating symptoms and reducing inflammation in accordance with the doctor's recommendations.

3. Pharmacotherapy:

   • Your doctor may prescribe medications such as anti-inflammatory drugs, immunosuppressants, antibiotics, and others depending on the cause of your chronic enteritis and the severity of your symptoms.
   • Patients should strictly follow the doctor's instructions regarding dosage and duration of treatment.

4. Diet and nutrition:

   • Depending on the cause and symptoms, dietary adjustments may be necessary. For example, with Crohn's disease or celiac disease, it may be necessary to eliminate certain foods, such as gluten or certain types of food, to reduce intestinal irritation.
   • It is recommended to consume easily digestible foods and adhere to a meal schedule.

5. Monitoring and inspection:

   • Patients with chronic enteritis should undergo regular medical examinations and monitor their bowel function.
   • The doctor will evaluate the effectiveness of the treatment and make adjustments as necessary.

6. Symptom management:

   • Patients may be prescribed medications to reduce symptoms, such as antispasmodics, antiemetics, and others.
   • Factors that may aggravate symptoms, such as stress and poor diet, should be avoided.

7. Lifestyle and psychological support:

   • It is important to maintain a healthy lifestyle, including physical activity levels and stress management.
   • Patients with chronic enteritis may require psychological support, as the disease can affect quality of life.

8. Research into causes and prevention: In some cases, especially autoimmune forms of enteritis, it is important to research the causes of the disease and take measures to prevent it.

Patients with chronic enteritis are advised to work closely with their physician to develop an individualized treatment and support plan and to strictly follow medical recommendations for disease management.

Prevention

Prevention of chronic enteritis depends on its cause and the main risk factors. Here are some general recommendations and preventive measures:

1. Compliance with hygiene rules:

   • Wash your hands regularly with soap before eating and after using the toilet, especially in public places.
   • Make sure food is prepared and stored clean to prevent gastrointestinal infections.

2. Prevention of infections:

   • Avoid contact with people with gastrointestinal infections if possible.
   • Prepare and handle food properly to prevent the spread of foodborne infections.

3. Proper nutrition:

   • If you have food intolerances or allergies, avoid foods that cause reactions.
   • Maintain a balanced diet and make sure your diet contains enough important micronutrients and vitamins.

4. Maintaining a healthy lifestyle:

   • Maintain an active lifestyle with regular physical activity.
   • Avoid excessive consumption of alcohol and nicotine.

5. Compliance with treatment and doctor's recommendations:

   • If you have already been diagnosed with chronic enteritis, follow your doctor's recommendations for treatment and diet.
   • Periodically undergo examination and consultation with a doctor to monitor the condition and promptly adjust treatment.

6. Taking precautions when traveling:

   • When traveling to countries with poor sanitary conditions, be sure to follow food safety regulations and drink only bottled or boiled water.

7. Stress Prevention:

   • Stress can worsen symptoms of chronic enteritis. Practice relaxation and stress management techniques.

8. Prevention of complications:

   • For Crohn's disease and ulcerative colitis, follow your doctor's recommendations to prevent complications and flare-ups.