Chronic non-ulcer colitis: diagnosis

Laboratory and instrumental data

• General analysis of blood, urine and biochemical blood test without significant changes.
• Coprologic analysis. Stool analysis provides for microscopy, a chemical study (determination of the daily amount of feces of ammonia, organic acids, protein [by the Tribula reaction], fat, fiber, starch), bacteriological study.

Based on the results of coprological research, the following coprological syndromes can be distinguished:

• increased motility of the colon. The amount of feces increased, faeces or mild consistency, light brown or yellow, a weakly acidic or neutral reaction, a lot of intracellular starch, digested fiber, iodophilic flora;
• slowing the motility of the colon. The amount of feces is reduced, the consistency is solid ("sheep feces"), the smell is putrefactive, the reaction is alkaline, the remnants of undigested food in normal quantity;
• increased motility of the large and small intestine. The amount of feces is increased, the consistency is liquid, the color is greenish, the reaction is alkaline, many undigested muscle fibers, neutral starch, extra- and intracellular starch, cellulose, iodophilic flora;
• a syndrome of fermentation dyspepsia. The amount of feces is increased, the stools are of a mushy consistence, frothy, yellow, acidic odor, the reaction is sharply acidic, a lot of starch, digested fiber, iodophilic flora, the amount of organic acids is increased (20-40 mmol / l), a small amount of soaps and fatty acids;
• syndrome of putrefactive dyspepsia. The amount of feces is increased, the stool is of a liquid or mushy consistence, dark brown in color, the smell is putrefactive, the reaction is sharply alkaline, the amount of protein and ammonia is sharply increased (ammonia amount 10-14 mmol / l), a considerable amount of digested fiber;
• Coprologic signs of exacerbation of colitis. Tribule sample (for soluble protein) is positive, the amount of white blood cells in the feces is increased, many cells of the ejaculated epithelium;
• ileocecal syndrome. The feces are not decorated, the smell is sharply acidic or rancid, the color is golden yellow, a lot of undigested fiber, in a small amount - altered muscle fibers and split fat, a small amount of leukocytes, mucus;
• koledistalny syndrome. The feces are not formed, much mucus, it lies superficially, many leukocytes and epithelial cells.

The study of bacterial flora reveals a dysbacteriosis decrease in the number of bifidobacteria, lactobacilli, an increase in the number of hemolytic and lactosonegative escherichia, pathogenic staphylococcus, protea, hemolytic streptococcus .

• Endoscopic examination of the large intestine (sigmoidoscopy, colonoscopy) reveals inflammatory changes in the mucous membrane, erosion, strengthening or depletion of the vascular pattern, atrophy - with a prolonged course of the inflammatory process.

With the help of a colonoscopy, the diagnosis of segmental colitis in the corresponding part of the large intestine is also verified.

The diagnosis of chronic colitis is also confirmed by histological examination of biopsy specimens. This method is especially important in the differential diagnosis of chronic colitis and colon cancer.

• X-ray examination of the large intestine (irrigoscopy) - in case of chronic colitis asymmetric gaustration, hypo- or hypermotor dyskinesia, smoothness of the mucosal relief, uneven filling of the colon with barium are detected.

Depending on the severity of clinical and laboratory data, there are three degrees of severity of chronic colitis.

The mild form of chronic colitis has the following characteristic features:

• in the clinical picture, indistinctly expressed "intestinal" symptoms predominate (minor pains in the abdomen of the spilled character or in the lower parts, bloating, a feeling of incomplete bowel movement, unstable stools, discomfort in the rectum);
• expressed neuropsychiatric symptoms (it sometimes comes to the fore);
• the general condition of patients does not suffer much;
• palpation pain of the large intestine;
• Coprological examination does not reveal any significant changes;
• when endoscopy is determined by the picture of catarrhal inflammation against the background of the mucosal edema, sometimes there are hemorrhages and slight vulnerability of the mucous membrane.

Chronic colitis of moderate severity is characterized by a more persistent and recurrent course. For this form of chronic colitis are characteristic:

• sharply expressed intestinal complaints (almost constant pain throughout the abdomen, heaviness in the lower half of the abdomen, swelling, rumbling, transfusion, feeling of bursting, loose stools, often alternating constipation and diarrhea);
• marked asthenoneurotic syndrome;
• weight loss during exacerbation of the disease;
• swelling, soreness in palpation of all parts of the colon, rumbling and splashing in the region of the cecum;
• typical coprologic syndromes (in the stool poorly digested muscle fibers, soaps, fat, fatty acids, mucus, leukocytes, a positive Tribulus reaction to protein are found);
• marked inflammatory changes in the mucous membrane of the large intestine, revealed by endoscopic examination.

Severe form of chronic colitis is characterized by the addition of clinical signs of involvement in the pathological process of the small intestine (enteral syndrome), which in fact determines the severity of the disease. The severe form of chronic colitis is characterized by:

• prolonged diarrhea, swelling, sensation of raspiraniya in the abdomen;
• clinical manifestations of malabsorption syndrome (weight loss, trophic disorders - hair loss, dry skin, brittle nails and other symptoms;
• marked swelling of the entire abdomen, or predominantly in the near-bulbous region;
• Coprologic analysis reveals pronounced changes characteristic of lesions of the large and small intestine (liquid stool consistency, yellow or greenish-yellow stool color, many undigested muscle fibers, neutral fat, fatty acids, extracellular starch, digested fiber, depleted epithelium, a large number of leukocytes , a sharply positive reaction Tribulus);
• pronounced inflammatory changes and atrophy of the mucous membrane of the large intestine, 12-finger and jejunum in endoscopic examination, erosions are often detected.

Differential diagnosis

Differential diagnosis of chronic non-ulcerative colitis and intestinal tuberculosis.

The main characteristic symptoms of intestinal tuberculosis are:

• syndrome of tuberculous intoxication (general weakness, malaise, weight loss, low-grade fever, marked sweating, especially at night, decreased appetite);
• permanent pain in the abdomen, most often in the right iliac and peripump region; with the development of tuberculous mesidenitis, pain is localized from the cecum from the cecum, as well as to the left and down from the navel in the course of the mesentery of the small intestine;
• dense painful thickening of the walls of the cecum, determined by palpation of the cecum and terminal segment of the ileum; sometimes in the right ileal region a dense tumor-like formation is determined;
• tenesmus and false urge to defecate when the rectum is affected; In the region of the anus or on the intestinal mucosa ulcers not prone to healing can be identified;
• ulceration of the mucous membrane, scar stenoses, dyskinetic phenomena are revealed during colonoscopy and radiographic examination of the large intestine;
• a characteristic picture of the tuberculous process in the histological examination of biopsy specimens of colon ulcers (epithelioid granulomas with multinucleated giant cells of Pirogov-Langhans and caseosis);
• presence in the stool of hidden blood, soluble protein (positive reaction Tribula);
• sharply positive tuberculin tests;
• pronounced pulmonary signs of tuberculosis;
• hypochromic anemia, leukopenia with relative lymphocytosis, an increase in ESR.

Differential diagnosis of chronic non-ulcerative colitis and colon cancer.

In the initial, early period of colon cancer, there are usually no characteristic symptoms, the cancer most often occurs asymptomatically and is usually detected accidentally during regular check-ups, colonoscopy, sigmoidoscopy, and digital rectal examination. These studies are usually undertaken about any other disease or chronic colitis that the patient has suffered for many years.

In the future, the so-called "general intoxication syndrome" develops, manifested by a growing general weakness, a decrease in appetite, weight loss, weight after eating, vague abdominal pain, rumbling and swelling of the abdomen, unstable stools. These symptoms are very suspicious of colon cancer, especially if there is anemia, an increase in ESR, mucus and blood in the feces, pain during defecation.

Symptomatic of colon cancer depends on the location of the tumor.

Cancer of the right half of the large intestine has the following characteristic manifestations:

• intestinal bleeding (clinically pronounced or latent) and hapochromic anemia;
• pain in the right abdomen of a permanent character;
• palpable, bulky, dense tumor in the region of the cecum or ascending section of the transverse colon;
• absence of symptoms of intestinal obstruction (the contents of the right half of the large intestine are quite liquid and pass well through the narrowed part of the intestine).

Cancer of the left half of the large intestine has the following characteristic symptomatology:

• cramping pains in the abdomen, alternating diarrhea and constipation;
• limited swelling of the left half of the abdomen, visible peristalsis of the intestine;
• picture of partial intestinal obstruction (in connection with pronounced annular narrowing of the lumen of the intestine);
• palpable bulging tumor in the left half of the colon;
• Cancer of the rectum is easily determined by finger research;
• the allocation of blood with feces (in the form of a syphilis or veins), mucus and pus (usually with the disintegration of a tumor in the rectum);
• pain in the anus and obstruction of defecation (with a tumor of the rectum);
• a constantly positive reaction to the latent blood in the feces.

Tumor of the rectum and sigmoid colon is well revealed with sigmoidoscopy, and the transverse colon and the right half of the colon - with the help of a colonoscopy. During the study, a biopsy is made from all suspected cancer sites (at least 3-4 pieces) for histological confirmation of the diagnosis of cancer.

An important method for the diagnosis of colon cancer is irrigoscopy (i.e. X-ray examination of the colon with filling it with enema contrast medium - barium sulfate suspension). Colon cancer is manifested by a filling defect, uneven contours of this defect, often by a ring-shaped narrowing of the lumen of the intestine at the site of the tumor.

[1], [2], [3], [4], [5], [6], [7], [8], [9]