Chronic non-ulcerative colitis

Chronic non-ulcerative colitis is a chronic inflammatory disease of the colon, characterized by the development of inflammatory-dystrophic, and with prolonged existence - atrophic changes in the mucous membrane, as well as dysfunction of the colon.

The entire colon (total colitis) or predominantly its different sections (right-sided colitis, left-sided colitis, proctosigmoiditis, transversitis) may be involved in the pathological process. Chronic colitis is often combined with chronic enteritis.

The issue of isolating chronic non-ulcer colitis as an independent nosological form has not been resolved; there is no unambiguous attitude to this problem. In the USA and Western Europe, this disease is not recognized. A thorough examination of patients using endoscopy, bacteriological and morphological methods allows us to identify the following etiological forms of colitis: ischemic, infectious, pseudomembranous (after antibiotic treatment), drug-induced, radiation, collagenous, lymphocytic, eosinophilic, in diverticular disease, in systemic diseases, transplant cytostatic (neuropenic).

About 70% of all colitis is caused by nonspecific ulcerative colitis and Crohn's disease of the colon (granulomatous colitis).

In the International Classification of Diseases, 10th revision (ICD-10), classes K50-52 include non-infectious enteritis and colitis:

• K-50 - Crohn's disease of the small and large intestine.
• K-51 - Ulcerative colitis.
• K-52 - Other non-infectious gastroenteritis and colitis.
  • 52.0. - Radiation colitis and gastroenteritis.
  • 52.1. - Toxic colitis.
  • 52.2. - Allergic gastroenteritis and colitis.
  • 52.8. - Other forms.
  • 52.9. - Unclassified gastroenteritis and colitis.

In the USSR, there was a point of view according to which chronic non-ulcerative colitis was distinguished as an independent nosological unit. Many well-known gastroenterologists still think so.

The following statement by P. Ya. Grigoriev (1998) should be considered valid: if the type of colitis cannot be etiologically verified after a bacteriological examination of feces, colonoscopy with biopsy, and X-ray examination of the colon, then it should be classified as chronic non-ulcerative colitis.

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Causes of chronic colitis

1. Past acute intestinal diseases - dysentery, salmonellosis, food poisoning, typhoid fever, yersiniosis, etc. Particular importance is attached to past dysentery and yersiniosis, which can become chronic. Many gastroenterologists suggest distinguishing post-dysenteric colitis. According to A. I. Nogaller (1989), the diagnosis of post-dysenteric colitis can be valid only during the first three years after acute dysentery. In the future, in the absence of bacterial carriage, various other etiological and pathogenetic factors underlie the development of chronic colitis, in particular, dysbacteriosis, sensitization to augomicroflora, etc.

Causes of Chronic Colitis

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Pathogenesis of chronic colitis

The main pathogenetic factors of chronic colitis are the following:

1. Direct damage to the mucous membrane of the colon under the influence of etiological factors. This applies primarily to the influence of infection, drugs, toxic and allergic factors.
2. Impaired immune system function, in particular, decreased protective functions of the gastrointestinal immune system. The lymphoid tissue of the gastrointestinal tract serves as the first line of specific defense against microorganisms; most Ig-producing cells of the body (B-lymphocytes and plasma cells) are found in the intestinal L. propria. The presence of local immunity, optimal synthesis of immunoglobulin A and lysozyme by the intestinal wall is a reliable defense against infection and prevents the development of infectious and inflammatory processes in the intestine. In chronic enteritis and colitis, the production of immunoglobulins (primarily IgA) and lysozyme by the intestinal wall decreases, which contributes to the development of chronic colitis.

Pathogenesis of chronic colitis

Symptoms of chronic colitis

Chronic colitis is characterized by pain localized mainly in the lower abdomen, in the area of the flanks (in the lateral parts of the abdomen), i.e. in the projection of the large intestine, less often - around the navel. The pain can be of various nature, there are dull, aching, sometimes paroxysmal, spastic, bursting. A characteristic feature of the pain is that it decreases after the passage of gases, defecation, after applying heat to the abdomen, and also after taking antispasmodic drugs. Increased pain is noted with the intake of coarse plant fiber (cabbage, apples, cucumbers and other vegetables and fruits), milk, fatty, fried foods, alcohol, champagne, carbonated drinks.

Symptoms of chronic colitis

Diagnosis of chronic colitis

• General blood test, urine test and blood biochemistry test showed no significant changes.
• Coprological analysis. Stool analysis includes microscopy, chemical examination (determination of the content of ammonia, organic acids, protein [using the Triboulet reaction], fat, fiber, starch in the daily amount of feces), and bacteriological examination.

Diagnosis of chronic colitis

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Treatment of chronic colitis

During the period of exacerbation of chronic colitis, hospitalization is indicated. Treatment should be aimed at eliminating the etiologic factor, normalizing the functional state of the intestine and the body's reactivity, correcting water-electrolyte imbalance (in case of diarrhea) and the microbial spectrum of the intestine, reducing the inflammatory process in the intestine.

Treatment of chronic colitis