Chronic nonspecific enterocolitis

Chronic nonspecific enterocolitis - inflammatory-dystrophic lesion of the mucous membrane of the small and large intestine. The frequency of chronic nonspecific enterocolitis among all diseases of the digestive system in children is about 27%. Lesions of the small and large intestine in children are often combined. However, with the primary lesion of the small intestine, the term "chronic enteritis" is used, and with the primary lesion of the large intestine, the term "chronic colitis".

Causes of chronic nonspecific enterocolitis. Chronic nonspecific enterocolitis is a polyethological disease in which the leading role is played by exogenous factors:

• prolonged intestinal infections, especially those borne in the first year of life, or malosymptomatic forms of acute intestinal infections with inadequate therapy;
• prolonged parasitic intestinal infestations, especially giardiasis;
• food allergy;
• prolonged uncontrolled use of certain drugs (salicylates, indomethacin, corticosteroids, immunosuppressants, antibiotics);
• exposure to toxic substances (arsenic, lead, phosphorus), ionizing radiation;
• immunodeficiency states.

In the pathogenesis of chronic nonspecific enterocolitis have the meaning:

• violations of the general and local links of immunological defense with the development of inflammatory-dystrophic changes in the intestinal mucosa;
• intestinal dysbacteriosis, in which there is a change in the qualitative and quantitative composition of the microflora with a disturbance of its habitats;
• damage to the main functions of the intestine with the development of symptoms of impaired digestion and absorption.

Classification. Chronic nonspecific enterocolitis is distinguished:

1. by origin:
   • primary,
   • secondary (against the background of other diseases of the digestive system);
2. by severity:
   • light form,
   • medium gravity,
   • severe form;
3. by period:
   • exacerbations,
   • subresission,
   • remission;
4. by tag:
   • monotonous,
   • relapsing,
   • continuously recurrent;
   • latent;
5. by the nature of morphological changes:
   • inflammatory,
   • atrophic (I, II, III century).

Symptoms of chronic nonspecific enterocolitis include enteral, due to digestive and absorption disorders, and colitis syndromes, which are accompanied by pain and dyspeptic symptoms.

The pains are localized more often in the navel and middle abdomen or around the abdomen:

• can be intense paroxysmal (such as intestinal colic) or monotonous raspiruyuschimi (with flatulence);
• usually provoked by errors in the diet (abundant food containing a large amount of fiber, fat, milk, sweets).

Differential diagnostic criteria of chronic enteritis and colitis, dyskinesia. Colon

Symptoms	Chronic enteritis	Chronic colitis	Dyskinesia of the large intestine
Pain	Bracing Or aching In the middle departments Belly	Grasping or knitting in the lower lateral parts, associated with defecation	Cramping in the lower lateral parts, associated with defecation
Stool disorders	Diarrhea	Alternation of constipation and diarrhea	Constipation
Flatulence	Expressed	Moderately expressed	Not typical
Symptom Obraztsova	+	-	-
Palpation of the large intestine	Painless	Soreness and rumbling along the bowel, palpable spasms and dilated areas	Soreness along the bowel, spasmodic and dilated areas
Mucus in the stool	_	+ +	+
Intestinal absorption	Disrupted	Not violated	Not violated
Recto-Humanoscopy	Sometimes catarrhal or subatrophic proctosigmoiditis	Proctitis, proctosigmoiditis (catarrhal, follicular, subatrophic)	Without pathology
Irrigography	Without pathology	Expanding folds, increased gaustration	Disorders of tonus and bowel movement
Histologically (inflammatory-dystrophic changes)	Mucosa of the small intestine	The mucosa of the large intestine	Without pathology

In chronic enteritis, the stomach is slightly inflated, slightly painful in the mesogastric region. Pathognomonic for chronic enteritis is Obraztsov's symptom.

In chronic colitis, pain depends on the localization and prevalence of the process. For chronic colitis, imperative (empty) desires and tenesmus (painful urge) are characteristic. Characteristic decrease in pain after defecation, the escape of gases, but often worried about the feeling of incomplete emptying of the intestine.

Dyspeptic disorders in chronic nonspecific enterocolitis are characterized by flatulence and diarrhea. With chronic enterocolitis stool abundant, mushy, often with greens and undigested remnants, fetid. Desecration of defecation occurs during or after 15-20 minutes after a meal and is accompanied by a strong rumbling, transfusion and abdominal pain. Stool frequency up to 5-6 times a day. In the coprogram with chronic enterocolitis, steatorea (fatty acids and soaps of fatty acids) prevails, often iodophilic flora.

To exacerbate chronic colitis, the stool becomes more frequent 3-5 times a day, in small portions, but alternating constipation and diarrhea is possible. Cal is usually brown with mucus. Sometimes (with an erosive process) in the stool can be blood.

Constipation is usually observed in the remission of chronic colitis. When palpating the abdomen, rumbling and tenderness are determined along the course of the large intestine, often palpating spasms of its areas. In the coprogram - mucus, leukocytes, erythrocytes.

The general enteral syndrome is manifested by trophic disorders, metabolic disorders, polyhypovitaminosis. Deficiency of weight depends on the severity of chronic nonspecific enterocolitis. For severe forms of chronic nonspecific enterocolitis, anemia is typical , which can be caused by a violation of iron absorption (hypochromic), less often - deficiency of protein and vitamins B12, folic acid, B6, blood loss.

Diagnosis of chronic nonspecific enterocolitis is based on clinical and anamnestic data, on the results of coprologic, bacteriological, functional, endoscopic, histological and radiological studies.

Differential diagnosis of chronic nonspecific enterocolitis is carried out with diseases of the small intestine, accompanied by symptoms of malabsorption, dyskinesia of the colon, dysbiosis. The most complex differential diagnosis with celiac disease. In the presence of blood in the stool eliminated nonspecific ulcerative colitis, Crohn's disease, acute dysentery, campylobacteriosis, amebiasis and balantidiasis, intestinal tuberculosis, polyposis, anorectal fissures.

Treatment of chronic nonspecific enterocolitis. An important aspect of the treatment of chronic nonspecific enterocolitis is diet. In the diet (table number 4) restrict coarse fiber, refractory fats, fried, hot, milk. Food is taken in warm form in small portions 5-6 times a day.

Medication therapy includes:

Correction of intestinal dysbiosis:

1. suppression of growth of conditionally pathogenic flora:
   • oxyquinoline preparations (intetriks, enterosediv, chlorohinaldol);
2. "Planting" of normal flora (bifiform, lactobacterin, linex, travis, nutrolin-B, primadofilus, etc.).

Improve digestion in the intestines (digestal, festal, enzyme, mezim, combi, elzim, Oraza, Creon, pancitrat).

Improvement of metabolic processes in the mucosa (complex preparations of multivitamins with trace elements - complim, oligovit, centrum, supradin, unicap, etc.).

Normalization of motor function of the intestine. Assign:

• astringents - tansal, tanalbine, kaolin, smecta, cholestyramine, polyphepan, as well as decoctions of the bark of oak, alder cones, pomegranate crusts, dry fruits of blueberries and bird cherry;
• drugs that reduce flatulence, - adsorbents (smecta, polyphepan), meteospazmil, espumizan, dill (fennel), caraway seeds, medicinal dawn;
• drugs affecting enkephalin receptors: alverine and children older than 2 years - imodium (loperamide), dicetel.

Correction of general metabolic disorders (iron, calcium, etc.).

In chronic colitis, in addition, apply local treatment (medicinal microclysters with a decoction of anti-inflammatory herbs: chamomile, calendula, St. John's wort, with sea buckthorn oil, dogrose oil).

During the abatement of acute phenomena, exercise therapy, water procedures are shown: circular shower, underwater massage, pool. With diarrhea, mineral waters of low mineralization (Essentuki No. 4, Slavyanovskaya, Smirnovskaya) are prescribed in a warm form, with constipation - highly mineralized chilled mineral waters (Essentuki No. 17, Batalinskaya).

Sanatorium-and-spa treatment is carried out during remission.

Dispensary observation of patients with chronic nonspecific enterocolitis is carried out within 5 years from the moment of the last exacerbation:

• in the first year, an examination with an evaluation of the coprogram, an analysis of feces for dysbiosis is carried out every 3 months;
• in the subsequent - 1 time in 6 months. Anti-relapse treatment includes courses of eubiotics, mineral waters, vitamins, phytotherapy.

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