Intestinal atrophy

Intestinal atrophy is a secondary pathological condition that occurs against the background of inflammatory reactions in intestinal tissues - in particular, with a prolonged course of colitis or enteritis. The disease is characterized by periodic acute pain attacks, defecation disorders, loss of body weight, general weakness and discomfort. In the absence of timely medical care, dangerous complications can develop, such as perforation, intestinal obstruction, bleeding, malignization, etc. Doctors strongly recommend that if intestinal atrophy is suspected, it is mandatory to contact the appropriate specialist and undergo comprehensive therapy. [1]

Epidemiology

Intestinal atrophy is a fairly common pathology found in both adults and children. The disease combines elements of the inflammatory process, mucosal tissue dystrophy, hypotrophy/atrophy of smooth muscle and functional disorder of the intestine. This pathological condition may account (according to different data) for about 10% of all chronic diseases of the digestive organs, with a prevalence of at least 5-12 cases per 1 thousand population.

Endoscopic, serologic, genetic, and morphologic diagnostic capabilities have greatly expanded over the past few decades. Scientists have conducted numerous studies examining disorders of the digestive tract. Thanks to numerous scientific works, there are ideas about this pathology, which is not always symptomatically manifested and confirmed by laboratory, which makes statistics extremely difficult.

Intestinal atrophy has been actively researched for many years, as well as other chronic problems affecting the large and small intestine. Nevertheless, quite a few issues are still not fully understood. From the perspective of modern medicine, intestinal atrophy is considered as a clinical and morphological phenomenon characterized by dyspepsia and pain syndrome with morphologically evident manifestations of tissue dystrophy/atrophy, shoaling of intestinal glands, and formation of lymphoplasmacytic infiltration of varying intensity. There are certain tissue changes characteristic of intestinal atrophy, but this term is relatively rarely used in clinical practice. Much more often you can hear the diagnosis of chronic enterocolitis, irritable bowel syndrome, Crohn's disease, nonspecific ulcerative colitis.

In the ICD-10 list, the pathology can be categorized as K52.9 - Non-infectious gastroenteritis and colitis unspecified.

Very rarely, congenital atrophy of small intestinal microvilli, or microvillus inclusion syndrome, is a rare genetic disorder inherited in an autosomal recessive manner. The disorder is caused by congenital atrophy of apical microvilli with intracellular accumulation of apical enzymes in the epithelial structures of the small intestine.

The frequency of morbidity can vary greatly, depending on both the diagnostic measures used and the patient's willingness to receive medical care. Unfortunately, in many cases adult patients do not seek medical attention, or do not seek it in a timely manner, but only at the stage of complications.

A special variant of intestinal atrophy - celiac disease - is found in one out of a hundred people in the world, although many people do not seek medical attention, and the percentage of people with the disease can be much higher. On average, such a diagnosis is established about 5-10 years after the first signs of the disorder appear.

Causes of the intestinal atrophy

Intestinal atrophy is a multifactorial pathology. There are more than ten known causes that can lead to atrophy of mucosal tissues and, as a consequence, to the development of functional failure of the intestine. Atrophic disorders can be a consequence of pathology or age infolution. Genetically determined hypotrophy or atrophy of the mucosal tissue of the digestive system is not uncommon.

Among the most common causes of intestinal atrophy are considered to be:

• chronic inflammatory processes (colitis, enteritis, enterocolitis);
• changes in local and functional conditions (this includes poor nutrition, sedentary lifestyle, etc.);
• intoxication, poisoning;
• hormonal disturbances in the body.

In addition, psycho-emotional stress, a long history of smoking and alcohol abuse, long-term or frequent use of medications (in particular, antibiotics, non-steroidal anti-inflammatory drugs and corticosteroid hormones) affect the condition of the intestine. Probable provoking factors include genetic predisposition, occupational hazards, concomitant somatic pathologies.

We can distinguish the most frequent causes of atrophic changes in the tissues of different parts of the intestine:

• Hereditary predisposition. If the closest relatives were found to have signs of intestinal atrophy, then the risks of getting this pathology sharply increase.
• Improper eating habits. Prolonged fasting as well as frequent overeating leads to improper functioning of the digestive system.
• Consumption of low-quality and unhealthy food. Some "unhealthy" foods irritate the intestines, contributing to the development of a chronic inflammatory process.
• Neglect of the diet prescribed by a doctor as part of the therapy of any pathology of the gastrointestinal tract.
• Prolonged or severe stress, depression, neurosis.
• Prolonged antibiotic therapy, imbalance of microflora in the intestine, dysbacteriosis.
• Intoxication, including alcoholic intoxication. Any intoxication (poisoning) negatively affects the mucous tissues of the digestive organs.
• Hypodynamia. Lack of necessary physical activity weakens the muscle system. The smooth muscles of the intestines are also affected.
• Frequent use of laxative medications.
• Independent and chaotic use of medicines that affect the work and condition of the digestive tract. This can also include incorrectly calculated doses, ignoring side effects.

Risk factors

When assessing the possible causes of intestinal atrophy, it should be taken into account that in most cases it is not about one, but about a whole complex of factors. In this case, the leading cause many experts call alimentary disorders - that is, improper nutritional character and regimen. This fact is confirmed by the fact that the processes of atrophy are always secondary and arise against the background of other pathologies. It is no secret that at present, according to the most optimistic calculations, no more than 30% of people adhere to a rational diet. The bulk of the population everywhere violate the food regime - disorderly eating, often eat food "dry" and "on the run", overeating, as well as irrationally approach the choice of diet, eating a lot of sweet, fatty and spicy, abusing fast food, sodas and other harmful products. And in most cases, the wrong mode and nature of nutrition are present in combination with each other.

An important role in the development of intestinal atrophy play an important role in worm infestations and intestinal infectious lesions - in particular, salmonellosis, disinfection, giardiasis, etc., in the development of intestinal atrophy. The involvement of the quality of microbial flora is evidenced by diagnosed dysbacteriosis, which is found in the vast majority of patients with intestinal atrophy.

These factors are the leading ones in terms of the causes of atrophic processes. Most often we are talking about these main links of pathology:

• alimentary link, which leads to disorders of intestinal motility with further development of inflammatory reaction;
• infectious-parasitic link, affecting directly the intestinal tissues with the subsequent formation of dysbiosis, inflammation and further motor disorders.

Improper diet, frequency and amount of food consumed, infections and dysbacteriosis, which are often combined with each other, abdominal trauma and hereditary predisposition - this is the main list of the most likely causes of the start of atrophic processes.

Some role is also played by the so-called psychogenic factors that favor the onset and further course of the inflammatory reaction. When collecting anamnesis and interviewing reveals signs of vegetovascular dystonia, a tendency to depression and hypochondria. Specialists have enough reasons to believe the involvement of aggravated heredity. As for the involvement of psychogenic factors, patients with intestinal atrophy are often found to have increased anxiety and insecurity, emotional lability and impressionability. Against the background of mood swings and neurosis, intestinal motility disorders and inflammatory reactions are aggravated.

To the group of factors favorable to the appearance of atrophy, we can add hypodynamia, avoidance of physical activity, eating mainly refined foods, as well as many bad habits - primarily such as smoking and alcohol abuse.

As for such an atrophic process as celiac disease, several factors are involved in its development, including genes and dietary habits. It is an autoimmune disease in which the tissues of the small intestine are damaged due to the consumption of gluten. When people with certain genetic risks eat foods with gluten, an immune response develops in the form of a response to gluten proteins (gliadins and glutenins) that attack small intestinal structures. During these attacks, the villi that facilitate nutrient absorption are damaged. The damaged villi become shorter and flatter, significantly impairing the absorption of nutrients.

People with celiac disease have allele variants such as HLA-DQ2 or HLA-DQ8. However, inheriting these alleles does not always lead to the development of celiac disease and intestinal atrophy. In addition, other factors must be present, such as the consumption of gluten-containing foods (wheat, barley, rye, etc.). [2]

Pathogenesis

The pathogenetic mechanism of intestinal atrophy is often interrelated with disorders of intestinal biocenosis. Pathological proinflammatory role is played by microbial amino acids - metabolic products scatol and indole. Due to increased activity of opportunistic flora increases the level of histamine, which leads to general sensitization, weakening of humoral and cellular protection. Since such flora perfectly adapts to environmental conditions, it gradually suppresses healthy intestinal flora. Against the background of bifidobacteria deficiency, the processes of digestion, absorption and assimilation of nutritional components are disturbed.

A significant role in the pathogenetic mechanism of intestinal atrophy development is played by neuro-regulatory disorders of the organ, which are based on the weakness of inhibitory effects of the cerebral cortex on the lower sections with a strong drop in the reactivity of the sympathetic part of the autonomic nervous system, as well as an increase in the level of bioactive substances - histamine and serotonin.

A significant contribution to the development of atrophic processes is a failure of immunologic reactivity. Increase in the level of immunoglobulins is accompanied by the appearance of intestinal autoantibodies in the blood, indicating the involvement of sensitization to tissue antigens. With changes in the biological and immunological properties of the microorganism, symbiotic relations between the organism and intestinal microflora are disturbed, which creates favorable conditions for immunological disorders. [3]

The blood circulation undergoes strong changes. Vascular permeability changes, manifestations of disseminated intravascular coagulation syndrome occur.

Intestinal atrophy can develop due to intoxication and toxic metabolic processes, endocrine pathologies, diseases of the central nervous system. The problem naturally occurs when motility disorders or toxic effects on intestinal tissues.

Gliadin plays a leading role in the pathogenesis of celiac disease. Its fractions are toxic for people with celiac disease. At the same time, alpha-gliadin with 33-mer peptide plays the role of an activator of immune reaction, which is due to its resistance to the effects of digestive proteinases.

In celiac disease, the consumption of foods containing gluten is an important, but not the only factor in the development of the pathology. Antigens of the major histocompatibility complex are also important. In general, intestinal atrophy in celiac disease has a multifactorial origin. Along with genetic predisposition and toxic gluten influence, internal environmental factors play an additional role in the development of the disorder. [4]

Symptoms of the intestinal atrophy

Diverse pathogenetic mechanisms of the development of intestinal atrophy determine the diversity and nonspecificity of the symptomatology of the pathology. The disorder does not have such symptoms, by which it would be possible to clearly determine the presence of atrophy. Moreover, often (especially in the early stages of development), the clinical picture is extremely scanty. The course of the disease is prolonged, it can proceed with periodic alternation of relapses and remissions, with a gradual worsening of the problem.

In periods of exacerbation, patients feel worse, signs of intoxication appear or intensify: fatigue, appetite worsens, slightly increased temperature, bothers pain in the head. At the same time, abdominal pain appears - aching, with a tendency to intensify before or during the act of defecation.

Many patients associate the onset or worsening of pain syndrome with the consumption of food: more often it happens about 1.5 hours after a meal. If pain occurs immediately after eating, it is due to increased gas and abdominal bloating. Discharge of gas or the act of defecation leads to relief of pain or its disappearance. In general, the pain syndrome can be described as aching, often caused by eating.

In addition to painful sensations, the defecation rhythm is disturbed, the character of feces changes. Patients more often report constipation than diarrhea. Stools may be absent for 1-3 days, which sometimes makes it necessary to give an enema or take laxatives. Mucus or blood may be found in the stools. The nature of feces: the so-called "sheep", or compacted fecaloma. Sometimes there is stool instability, change of constipation with diarrhea.

Many patients present signs of autonomic dysfunction and neurological disorders: insomnia or drowsiness, irritability, general fatigue, headache, pulse instability.

During external examination, symptoms of chronic intoxication are noticed. There is plaque on the tongue. The abdominal area is bloated, sometimes painful on palpation. In hyperkinesia, signs of spastic colitis dominate, and in hypokinesia - atonic or hypotonic colitis.

In general, the course of intestinal atrophy is prolonged, wavy. Other existing diseases of the digestive tract have a pronounced influence on the symptomatology, which should be paid attention to during the diagnosis.

If atrophic changes spread to the intestines and stomach, then such symptoms as deterioration of appetite, unpleasant belching and nausea are noticed. Many patients report a feeling of heaviness and fullness in the abdominal region, excessive salivation, heartburn, and an unpleasant aftertaste in the oral cavity.

Gradually, the clinical picture expands, supplemented by rumbling in the abdomen, intolerance to dairy products, stool instability. Some patients lose body weight, anemia develops, hypovitaminosis, resulting in severe weakness and fatigue, difficulty breathing even with a little physical activity.

Problems with digestion of food affect the condition of the skin. The skin becomes dry, flaking and dandruff appears. At the same time, immunity deteriorates and vision weakens.

First signs

The leading symptom of all types of intestinal atrophy is blunt or attack-like pain in the abdominal region. The exact localization of pain depends on which intestinal segment is affected. Thus, pain may be noted in the navel area, in the right iliac region, left subcostal area, or "spill over" throughout the abdominal zone.

There is often temporary relief after gas or a successful act of defecation. After some time, the pain returns or worsens. Taking antispasmodics or applying a heat source can also help relieve the pain.

The appearance of pain with physical activity or pushing may indicate deeper intestinal atrophy.

Other first signs often include:

• defecation disorders, constipation alternating with diarrhea, "sheep" feces;
• sounds of "rumbling" in the abdomen, bloating, with a tendency to intensify after meals;
• abnormal impurities in the feces (more often - mucus or blood, streaked);
• a feeling of pressure, heaviness in the intestinal area;
• painful tenesmus (false urges to defecate);
• appetite worsening and associated gauntness;
• Subfebrile fever, headache, severe fatigue;
• belching air;
• nausea and vomiting (rare).

The clinical picture of such a pathological condition as celiac disease has similar signs:

• gauntness;
• alternating between constipation and diarrhea;
• dull, pulling abdominal pain;
• joint pain;
• vesicular rashes on the skin and mucous membranes;
• constant and severe fatigue.

The symptoms of intestinal atrophy may coincide with those of chronic gastroenteritis. The course of the disease - intermittent, with alternating periods of exacerbations and remissions. Such changes are usually provoked by nutritional disorders, or external stressors. Unfortunately, when the first signs are detected, an extremely small percentage of patients seek medical help. Most patients ignore the problem or self-medicate, which over time leads to the aggravation of pathology and the development of complications.

Stomach and intestinal atrophy

The development of atrophic processes in the stomach is usually provoked by various aggressive factors - in particular, the bacterium Helicobacter pylori, hydrochloric acid, duodenogastric reflux, pepsin, as well as insufficient protection of the mucosa (for example, with a deficit of epithelial regeneration, improper blood supply of the organ, etc.).

Atrophy begins approximately 2-3 years after the start of the inflammatory process. For example, atrophic signs are found in 43% of patients with chronic gastroenterocolitis already 10 years after the manifestation of pathology. Specialists often talk about atrophy as the final stage of inflammatory disease.

Two main mechanisms are known for the development of mucosal tissue atrophy:

• damage due to direct exposure (particularly bacterial);
• an autoimmune reaction.

Helicobacter pylori infection is massively widespread. It causes damage and structural changes in cells, negatively affects the protective function of the mucosa, favors and supports the constant course of the inflammatory process in the tissue, which entails atrophy. [5]

In turn, the autoimmune process is caused by hereditary failures of immunoreactivity of the body. During the "antigen-antibody" reaction, there is premature die-off and improper maturation of new cellular structures. This entails a gradual weakening of gastric acidity, changes in the mucosal structure, a decrease in the production of hydrochloric acid. In the digestive system, the absorption of vitamins and iron is impaired, and anemia occurs.

Helicobacter-associated gastritis can provoke the development of autoimmune aggression against gastric epithelial tissue with further development of atrophic and metaplastic processes. Patients with detected Helicobacter pylori are more often found to have glandular atrophy, especially pronounced at high titers of autoantibodies.

In its development, atrophy of the stomach and intestines passes through several stages:

• superficial inflammatory process develops, hydrochloric acid production suffers insignificantly, there are no signs of pathology;
• there are foci of atrophy;
• Diffuse changes with pronounced disorders of secretory function appear (mucosal tissue is thinning, foci of small intestinal metaplasia are formed).

Atrophy of the stomach and intestines is considered one of the basic risk factors for malignant tumor development. The main symptoms of the problem: change in appetite, nausea, unpleasant belching. Most patients have a feeling of heaviness and fullness in the stomach, salivation, heartburn, unpleasant taste in the oral cavity is noted. Gradually added and other symptoms such as flatulence, unstable stool (constipation is replaced by diarrhea). With frequent diarrhea is possible gauntness, manifestations of mineral and vitamin deficiency, anemia. As a result of impaired evacuation of food may be bothered by abdominal pain (dull, pressing, with increased intensity after eating). If untreated, atrophic processes can cause the development of hypovitaminosis and anemia, achlorhydria, ulcerative lesions and cancer.

Complications and consequences

In the absence of treatment and neglect of medical advice, the risks of developing the formidable complications of intestinal atrophy are significantly increased:

• colon cancer; [6]
• perforation of the affected intestinal wall;
• complete or partial intestinal obstruction;
• cachexia;
• massive bleeding;
• septic complications.

Intestinal atrophy can become so complicated that the patient requires emergency surgery.

Particularly serious complications include:

• Toxic megacolon - excessive expansion of the large intestinal lumen, causing marked deterioration of the patient's well-being, febrile fever, constipation, flatulence, other appearances of intoxication.
• Massive intestinal bleeding - occurs when large vessels supplying blood to the intestinal wall are exposed. The volume of blood loss can be up to 500 ml per day.
• Perforation of the large intestinal wall - formed against the background of excessive stretching and atrophic thinning of the wall of the hollow organ. As a result, intraintestinal contents enter the abdominal cavity, peritonitis develops.
• Colorectal cancer - is capable of developing with a prolonged existing atrophic process. Atrophy of the large intestine and rectum is particularly common for malignization.

Malignant transformation is diagnosed:

• with a ten-year course of atrophy - in 2% of cases;
• with a 20-year course in 8% of cases;
• if intestinal atrophy has been present for more than 30 years - in 18% of cases.

Diagnostics of the intestinal atrophy

In order to get the most complete picture of the existing disease and subsequently choose the right treatment tactics, the doctor prescribes a comprehensive diagnosis, including both laboratory and instrumental studies.

Blood tests are taken first. This is necessary to identify the inflammatory or allergic process, to determine the possible anemia (as a result of blood loss), to assess the quality of metabolic processes (protein, water-electrolyte) and the likelihood of involvement of the liver or other internal organs. Also laboratory diagnostics is carried out in order to assess the effectiveness of the prescribed treatment and monitor the dynamics.

In addition to general and biochemical blood tests, the doctor may prescribe a study of the indicators of perinuclear cytoplasmic antineutrophil antibodies (pANCA), saccharomyces antibodies (ASCA) and so on.

Stool analysis includes coprogram, Gregersen reaction (determines the presence of hidden blood). At the same time, possible impurities of mucus, pus, blood in feces are detected.

In the presence of an infectious process and the need to select antibacterial drugs prescribe bacteriological culture and PCR.

Endoscopy is one of the main instrumental procedures for intestinal atrophy. The method can be used both on an outpatient and inpatient basis. At the first stage of endoscopic examination, the doctor explains to the patient how to properly prepare for the procedure. In almost all cases, preparation requires cleansing the intestinal cavity with the help of special laxatives, cleansing enema or both in combination. On the day of the planned endoscopic examination is forbidden to eat (breakfast), it is allowed to drink water. In general, the technique involves the introduction of an endoscopic tube through the anus, equipped with an illuminating device and a video camera. Thus, the specialist can visually examine the condition of the mucosal tissue and determine the characteristic signs of intestinal atrophy. If necessary, a biopsy - a particle of intestinal tissue - is taken at the same time, and then sent for histologic examination.

Endoscopic instrumental diagnosis can be represented by such procedures:

• Rectoromanoscopy using a rigid rectoromanoscope in the area of the rectum and sigmoid colon;
• Fibroileocolonoscopy using a flexible endoscope in the colon and ileum;
• Fibrosigmoidoscopy using a flexible endoscope in the rectum and sigmoid colon;
• Fibrocolonoscopy using a flexible endoscope in the colon.

The duration of these procedures can vary from 20-30 minutes to an hour and a half (e.g., if superficial anesthesia is used).

Radiography is ordered only when endoscopy cannot be performed for some reason.

Another common method, irrigoscopy, involves the enema administration of a barium suspension - a radiographic contrast agent - to the patient, after which X-rays of the intestine are taken. Further, after emptying, air is introduced into the intestinal cavity and again take pictures. As a result, the specialist gets a picture of narrowing and dilatation of the intestine, areas of inflammation or superficial changes in the mucosa.

Review radiography is ordered to rule out the development of complications - such as perforation or toxic enlargement of the intestine.

Ultrasound in intestinal atrophy is practically not used due to low informativeness. [7]

Differential diagnosis

Before proceeding to a full-fledged diagnosis, the doctor must exclude the presence in the patient of many diseases that run with a similar clinical and endoscopic picture. Among such pathologies:

• infectious enterocolitis (parasitic, bacterial, viral etiology);
• Crohn's disease;
• Ischemic form of enterocolitis (caused by a deficiency of blood supply to the intestinal wall);
• diverticulitis;
• enterocolitis caused by taking certain medications;
• radiation enterocolitis;
• a malignant tumor of the colon;
• rectal solitary ulcer;
• endometriosis in women, etc.

These diseases may show symptomatology similar to that of intestinal atrophy. However, the treatment of these pathologies is fundamentally different. That is why at the appearance of the first signs of the disorder, the patient should consult a doctor and do not try to diagnose and treat the disease on their own.

It is often difficult to differentiate between intestinal atrophy and Crohn's disease. If there are doubts, the doctor prescribes additional diagnostics:

• immunologic;
• radiologic;
• endoscopic.

Making the correct diagnosis is extremely important, even though many of the diseases presented have similar mechanisms of development. Even in these situations, the treatment is always different. In rare cases, a diagnosis of unclassified (undifferentiated) enterocolitis is made: when for some reason a precise diagnosis cannot be established.

Diagnosis of celiac disease is a separate problem. Unlike diseases associated with food allergies (including gluten allergies), celiac disease cannot be directly linked to the consumption of gluten-containing foods. The involvement of gluten in the damage of intestinal tissue can be detected only in the course of morphological analysis of mucosal biopsy. Atrophy of the villi of the small intestine is characteristic not only of celiac disease, but also of acute intestinal infections or immunoglobulin deficiency.

As for diverticulitis, it is an atrophy of the intestinal muscles with its expansion in low-lying areas. It is a chronic pathology in which the walls of the large intestine form sac-like bulges through the layer of musculature. The diagnosis of diverticulitis is not established until the doctor completely excludes the presence of cancer. It is important to remember that patients are often diagnosed with both diverticula and colorectal cancer at the same time. Sometimes cancer and diverticulosis exist together in the same segment of the colon.

Treatment of the intestinal atrophy

Immediately after diagnosis, a patient with intestinal atrophy is prescribed a special diet, which is important to strictly observe. Specialists make an individualized food plan, which describes all recommendations on the composition and rules of cooking, dietary regimen.

Medications are used depending on the indications and diagnostic results. If an infectious process is detected, antibiotic therapy may be prescribed. To reduce pain syndrome, antispasmodics are used. In most cases, it is appropriate to use drugs that can restore normal intestinal microflora. If indicated, laxatives or astringents may be required.

During periods of inflammatory exacerbation exclude seasonings, fried and fatty foods, refractory fats, smoked meats and sausages, sauces, preservatives and marinades. Mushrooms and nuts, fresh pastries and pancakes, coffee and cocoa (including chocolate), sodas and ice cream, fast food and snacks, raw fruits and vegetables, milk and dried fruits are prohibited.

Recommended foods include dairy-free porridge based on rice, oatmeal, buckwheat, semolina. Allowed eggs, cereal and vegetable soups (without passivation), white lean meat and steamed sea fish, dried light bread, galettes, rusks, vegetable mashed potatoes (including potato), baked fruit without skin (apples or pears), non-concentrated compotes and sours, non-acidic natural jelly. Food is steamed, boiled, pureed or pureed, baked, served warm.

In periods of remission, food can not be grinded or puréed. Introduce into the diet natural juices with a dilution of water 50/50, non-acidic berries, jam, marmalade, marshmallows, fresh cucumber.

Dairy products are introduced in stable remission. Preference is given to non-acidic cottage cheese of medium fat content (can be in the form of casseroles or steamed cheese cakes), natural yogurt and kefir. Hard non-sharp cheese can be consumed only if the normal function of defecation.

If a patient is diagnosed with celiac disease, the main therapeutic method is a strict lifelong adherence to a gluten-free diet. The diet is completely free of wheat, rye, barley, oats in all their manifestations. So, under the ban fall bread, pasta, oatmeal, wheat or semolina. The positive effect of changing the diet becomes noticeable during the first few weeks.

The choice of types of conservative and surgical treatment is determined depending on the severity and extent of the atrophic process, the effectiveness of previously conducted therapy, the degree of risk of complications. [8]

Indications for surgical intervention include:

• absence of the necessary effect from conservative treatment or impossibility of its continuation;
• the development of intestinal complications;
• process malignancy, or its increased risks.

Prevention

Unfortunately, most people think about their own health too late, when the disease is already developing, there are pronounced symptoms. Many, even knowing about the presence of the problem, continue to neglect the advice of the doctor, ignore the recommendations on healthy eating and active lifestyle, considering it a matter of difficulty and ineffective. Meanwhile, the most effective prevention of the development of intestinal atrophy is just simple and effective. It consists of the following recommendations:

• eat regularly, at about the same time;
• consume a sufficient amount of room temperature liquid (calculation of the optimal volume of liquid - from 30 to 40 ml per 1 kg of body weight);
• avoid sweets, foods with preservatives, smoked meats, spicy spices, animal fats;
• include fermented milk products, fiber, vegetable oils in the daily diet.

It is obligatory to give up well-known bad habits. It is proved that alcohol and nicotine contribute to the development of inflammatory processes of the GI tract, oncology, pathologies of the liver and pancreas, which is due to the negative influence of alcohols, toxins, chemical compounds. Important: digestive problems, including intestinal atrophy, can indirectly provoke not only conventional cigarettes, but also hookahs, IQOS and so on.

Another important preventive measure is to take a conscious approach to your own health. Self-medication should not be practiced: if suspicious symptoms appear, it is necessary to visit your family doctor and undergo diagnostics. Unjustified and improper use of medicines can lead to very unfortunate consequences. For example, intestinal atrophy can be provoked by prolonged use of nonsteroidal anti-inflammatory drugs, prolonged antibiotic therapy, illiterate use of corticosteroid drugs. No less dangerous and all sorts of folk procedures with unproven effectiveness: this category includes a variety of so-called "cleansing" of the GI tract, tyubazhi, prolonged fasting, etc. Any of these procedures should be agreed in advance with a doctor and performed only with his permission and under his supervision.

In order to prevent diseases of the stomach and intestines, it is recommended to normalize the psycho-emotional state, avoid overwork, stress, excessive reactions to possible difficult life situations (dismissal, divorce, etc.). In these situations can help sessions of meditation, counseling psychologist, sports training, autotraining. In some cases, special sedatives can be taken at the doctor's insistence.

Prevention also includes the fight against obesity: it consists of proper nutrition and exercise. It is known that excessive body weight provokes the appearance of problems with the pancreas and liver, contributes to a decrease in intestinal motility. To get rid of extra pounds, you need to carefully consider and make a diet, the basis of which should be vegetables and fruits, cereals, lean white meat and seafood. A healthy diet is necessarily complemented by competent and dosed physical activity.

These measures can gradually stabilize metabolism, strengthen immunity, saturate the blood with oxygen, improve psycho-emotional state. As a result - a person will avoid the development of various diseases of the digestive system, including intestinal atrophy, and preserve their own health for a long time.

Forecast

Intestinal atrophy is a serious pathological change in the intestinal structure. If treatment is neglected or untimely therapeutic measures can develop serious complications, internal bleeding, irreversible changes in the digestive system.

To improve the prognosis of the disease, avoid further morphologic changes and development of colon cancer, it is recommended:

• consult your doctor at least twice a year;
• regularly perform routine endoscopy (frequency is determined by the doctor depending on the intensity of morphologic abnormalities in the intestine);
• regularly take blood tests for timely detection of anemia and assessment of the dynamics of treatment;
• Adhere to the diet prescribed by the attending doctor;
• Follow all medications prescribed by your doctor;
• coordinate with doctors to take any medications that can adversely affect the condition of intestinal tissues.

Intestinal atrophy is a disease characterized by thinning of the intestinal mucosa, which is due to the influence of negative factors. Initially, the inflammatory process gradually progresses, the mucosa is destroyed down to the ligamentous-muscular mechanism of the affected part of the gastrointestinal tract. Due to the prolonged pathological process, the lumen of the hollow organ narrows, its function is gradually lost.

Intestinal atrophy is accompanied by a number of nonspecific symptoms that significantly worsen the quality of life of the patient. And some complications can pose a threat not only to health, but also to the life of the patient. Unfortunately, there are often difficulties with the timely establishment of the correct diagnosis, since the symptomatology of intestinal atrophy is similar to other diseases of this organ. Nevertheless, if the diagnosis is made in time and correctly, and the prescribed treatment is correct, then the prognosis can be considered conditionally favorable. It is impossible to completely cure the disease, but it is often possible to stop its further development.