Chronic nonspecific enterocolitis

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

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

• protracted intestinal infections, especially those suffered in the first year of life, or low-symptom forms of acute intestinal infections with inadequate therapy;
• long-term parasitic invasions of the intestine, especially giardiasis;
• food allergy;
• long-term uncontrolled use of certain medications (salicylates, indomethacin, corticosteroids, immunosuppressants, antibiotics);
• exposure to toxic substances (arsenic, lead, phosphorus), ionizing radiation;
• immunodeficiency states.

In the pathogenesis of chronic nonspecific enterocolitis the following are important:

• violations of the general and local links of the immune 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 disruption of its usual habitat;
• 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 organs);
2. by severity:
   • mild form,
   • moderate severity,
   • severe form;
3. by period:
   • exacerbations,
   • subremission,
   • remission;
4. by tag:
   • monotonous,
   • recurrent,
   • continuously recurring;
   • latent;
5. by the nature of morphological changes:
   • inflammatory,
   • atrophic (I, II, III degree).

Symptoms of chronic nonspecific enterocolitis include enteral syndrome, caused by digestion and absorption disorders, and colitic syndrome, which are accompanied by pain and dyspeptic symptoms.

The pain is most often localized in the navel area and the middle parts of the abdomen or throughout the entire abdomen:

• can be intense, paroxysmal (like intestinal colic) or monotonous, distending (with flatulence);
• are usually provoked by dietary errors (rich foods containing a large amount of fiber, fats; milk; sweets).

Differential diagnostic criteria of chronic enteritis and colitis, dyskinesia of the colon

Signs	Chronic enteritis	Chronic colitis	Dyskinesia of the colon
Pain	Cramping Or whining In the middle sections Belly	Cramping or aching in the lower lateral regions, associated with defecation	Cramping in the lower lateral sections, associated with defecation
Bowel disorders	Diarrhea	Alternating constipation and diarrhea	Constipation
Flatulence	Expressed	Moderately expressed	Not typical
Obraztsov's symptom	+	-	-
Palpation of the colon	Painless	Pain and rumbling along the intestine, spasmodic and dilated areas are palpated	Pain along the intestine, spasmodic and dilated areas
Mucus in stool	_	+ +	+
Intestinal absorption	Violated	Not violated	Not violated
Rectosigmoidoscopy	Sometimes catarrhal or subatrophic proctosigmoiditis	Proctitis, proctosigmoiditis (catarrhal, follicular, subatrophic)	No pathology
Irrigography	No pathology	Widening of folds, increased haustration	Disturbances of tone and bowel movement
Histologically (inflammatory-dystrophic changes)	Mucous membrane of the small intestine	Mucous membrane of the colon	No pathology

In chronic enteritis, the abdomen is slightly swollen and slightly painful in the mesogastric region. Obraztsov's symptom is pathognomonic for chronic enteritis.

In chronic colitis, pain depends on the localization and prevalence of the process. Chronic colitis is characterized by imperative (empty) urges and tenesmus (painful urges). A decrease in pain after defecation and gas discharge is typical, but a feeling of incomplete bowel emptying is often disturbing.

Dyspeptic disorders in chronic nonspecific enterocolitis are characterized by flatulence and diarrhea. In chronic enterocolitis, the stool is abundant, mushy, often with greenery and undigested residues, and foul-smelling. The urge to defecate occurs during or 15-20 minutes after eating and is accompanied by strong rumbling, pouring, and abdominal pain. The frequency of stool is up to 5-6 times a day. In the coprogram in chronic enterocolitis, steatorrhea (fatty acids and fatty acid soaps) predominates, often iodophilic flora.

An exacerbation of chronic colitis is characterized by an increase in stool frequency up to 3-5 times a day, in small portions, but alternating constipation and diarrhea is possible. The feces are usually brown with mucus. Sometimes (with an erosive process) there may be blood in the feces.

Constipation is usually observed during remission of chronic colitis. When palpating the abdomen, rumbling and pain along the colon are determined, and spasmodic areas are often palpated. In the coprogram - mucus, leukocytes, erythrocytes.

General enteral syndrome is manifested by trophic disorders, metabolic disorders, polyhypovitaminosis. Weight deficit depends on the severity of chronic nonspecific enterocolitis. Severe forms of chronic nonspecific enterocolitis are characterized by anemia, which can be caused by impaired iron absorption (hypochromic), less often by protein deficiency and vitamins B12, folic acid, B6, blood loss.

Diagnosis of chronic nonspecific enterocolitis is based on clinical and anamnestic data, on the results of coprological, 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, dysbacteriosis. The most difficult differential diagnosis is with celiac disease. If there is blood in the stool, nonspecific ulcerative colitis, Crohn's disease, acute dysentery, campylobacteriosis, amebiasis and balantidiasis, intestinal tuberculosis, polyposis, anorectal fissures are excluded.

Treatment of chronic nonspecific enterocolitis. An important aspect of the treatment of chronic nonspecific enterocolitis is diet. In the diet (table No. 4) coarse fiber, refractory fats, fried, spicy, milk are limited. Food is taken warm in small portions 5-6 times a day.

Drug therapy includes:

Correction of intestinal dysbacteriosis:

1. suppression of growth of opportunistic flora:
   • oxyquinoline drugs (intetriks, enterosediv, chlorquinaldol);
2. "planting" normal flora (bifiform, lactobacterin, linex, travis, nutrolin-B, primadophilus, etc.).

Improving the digestion process in the intestines (digestal, festal, enzistal, mezim, kombitsim, elcim, oraz, creon, pancitrate).

Improving metabolic processes in the mucous membrane (complex preparations of multivitamins with microelements - complivit, oligovit, centrum, supradin, unicap, etc.).

Normalization of intestinal motor function. Prescribed:

• astringents - tansal, tannalbin, kaolin, smecta, cholestyramine, polyphepan, as well as decoctions of oak bark, alder cones, pomegranate peels, dried blueberries and bird cherry fruits;
• drugs that reduce flatulence - adsorbents (smecta, polyphepan), meteospasmil, espumisan, dill (fennel), caraway, medicinal dawn;
• drugs that act on enkephalin receptors: alverine and for children over 2 years old - imodium (loperamide), dicetel.

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

In addition, for chronic colitis, local treatment is used (medicinal microclysters with a decoction of anti-inflammatory herbs: chamomile, calendula, St. John's wort; with sea buckthorn oil, rosehip oil).

During the period of subsidence of acute symptoms, exercise therapy and water procedures are indicated: circular shower, underwater massage, swimming pool. In case of diarrhea, mineral waters of low mineralization (Essentuki No. 4, Slavyanovskaya, Smirnovskaya) are prescribed in warm form, in case of constipation - highly mineralized cooled mineral waters (Essentuki No. 17, Batalinskaya).

Sanatorium and resort treatment is carried out during the period of remission.

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

• during the first year, an examination with an assessment of the coprogram and stool analysis for dysbacteriosis is carried out every 3 months;
• subsequently - once every 6 months. Anti-relapse treatment includes courses of eubiotics, mineral waters, vitamins, and herbal medicine.

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