Chronic colitis

Description:

Chronic colitis is a widespread disease of thick department of intestines of which chronic inflammatory defeat of mucous, submucosal and muscular covers of a large intestine is characteristic, at a severe disease with a degeneration of own nerve fibrils, and also dysfunction of intestines. Disturbance of functions includes a motor and intracellular transport piece. Chronic colitis is quite often combined with an inflammation in thin department of intestines or a stomach.

There are following types of chronic colitis:
1. Infectious (often after the postponed episode of dysentery or a salmonellosis)
2. Pseudomembranous chronic colitis develops after reception of antibiotics
3. Ischemic – at blood circulation disturbance
4. Beam
5. Medicinal
6. Eosinophilic
7. Lymphocytic
8. Collagenic, etc.
Pathological process at chronic colitis can be localized on one side of intestines, for example right-hand colitis, a proctosigmoiditis, and can have widespread character. In the latter case colitis is called total.

Chronic colitis was allocated in a separate nosological form V.P. Obraztsov (1895), however in the USA and some other countries is still not recognized as an independent disease. Now these positions are actively reconsidered.

Reasons of Chronic colitis:

Chronic colitis is a polyetiological disease. The course of a disease requires quite often a combination of several factors. As the contributing factor for developing of chronic colitis serves disturbance of a diet, unbalanced food, the wrong diet, an alcohol abuse, hypo - and avitaminosis.
A. The most widespread etiological factor is the postponed earlier infectious diseases of intestinal group – for example, dysentery (shigellosis), a salmonellosis, иерсиниоз, etc.  Allocate with a special form of chronic colitis so-called post-dysenteric colitis, however this diagnosis is considered lawful only within 3 years after the postponed dysentery episode.
To B. Kroma of bacteria, inflammatory process can be caused by protozoa or fungi. Special value is given to lyambliya and balantidiya.  
B. At diagnosed for the patient an intestinal dysbiosis can show activity also saprophytic flora inhabiting intestines is normal.
G. The role in development of chronic colitis intoxications – both exogenous (poisoning), and endogenous – is defined at a liver or renal failure.
D. Injury of a mucous membrane by radiation exposure. Beam (radiation) colitis can arise after therapy of malignant new growths.
E. Medicinal colitis develops after reception of some drugs. Most often chronic colitis arises against the background of reception of NPVS, salicylates, antibiotics.
Zh. Allergy. The allergic component is present at the mechanism of development of chronic colitis.
H. Disturbances of fermental exchange. It is greatest clinical value has insufficiency of lactose which promotes hydrolysis disturbance, and it in turn leads to irritation of a mucous membrane.
I. Disturbance of blood circulation in a large intestine leads to development of ischemic colitis.
K. Existence of intercurrent diseases promotes development of chronic colitis – cholecystitis, pancreatitis, a peptic ulcer of a stomach and a 12-tiperstny gut, etc.

Symptoms of Chronic colitis:

The stupid, aching pains in different departments of a stomach are characteristic of chronic colitis. Happens that pain has skhvatkoobrazny character, sometimes the pain poured without accurate localization. Strengthening of a pain syndrome after food, an exercise stress, cleansing enemas, and an utikhaniye after a passage of flatus, bowel emptyings, uses of a warm hot-water bottle, spasmolysants characterizes. Alternation of locks and diarrhea, rumbling,  a meteorism  (abdominal distention), feeling of incomplete bowel emptying, desires to defecation – tenesmus is observed.  The meteorism is arisen because of the accompanying dysbacteriosis and disturbance of digestion. Frequency of bowel emptyings reaches 5-6 times a day, in Calais impurity of slime or blood in the form of streaks can be found. At the expense of an inflammation in the field of a direct and sigmoid gut pain can irradiate in an anus. The course of this disease chronic with periodic aggravations. At a palpation of a stomach morbidity by the course of a large intestine, alternation of its spazmirovanny and expanded sites, sometimes – "a splash symptom" over the relevant department is determined.
The proctitis and sigmoiditis which develop after the postponed dysentery, against the background of abuse of cleansing enemas most often occur among clinical cases of chronic colitis, purgatives the Disease is shown by a pain syndrome in the left ileal area and in the field of an anus, painful desires to defecation, a meteorism. Locks in combination with tenesmus are quite often observed; the chair is not plentiful, sometimes like "sheep a calla", contains a lot of visible slime, and quite often impurity of blood and pus. At a palpation morbidity of a sigmoid gut, its spastic reduction or rumbling (is noted at a diarrhea). In some cases the additional loop of a sigmoid gut - "dolichosigma" (congenital anomaly of development) which is the reason of chronic colitis comes to light. Survey of proctal area and a manual research of a rectum allow to estimate a condition of its sphincter, to reveal quite often found accompanying pathology developing against the background of a chronic proctitis (hemorrhoids, anal fissures, a paraproctitis, a prolapse of the rectum, etc.). The rektoromanoskopiya which allows to estimate a condition of a mucous membrane has great diagnostic value, to reveal existence of ulcer defects.
With the diagnostic purpose conduct a X-ray contrast research of intestines where reveal spastic the narrowed intestines, or an atony, disturbance of a vermicular movement. Because of an inflammation and infiltration of a wall of a gut its relief changes.
The general blood test finds existence of anemia (especially at the ulcer nature of chronic colitis), a leukocytosis, a neutrocytosis, increase in SOE.

Treatment of Chronic colitis:

Patients with chronic colitis strict observance of a diet is shown, in the period of an aggravation appoint No. 4a which includes steam meat and fish dishes,  stale white loaf, steam omelets, the fat-free weak beef-infusion and fish broths, the wiped porridges on water, soft-boiled eggs, kissels, broths and bilberry jelly, a bird cherry, a pear, a quince, a dogrose, tea, coffee and cocoa on water.
In process of subsiding of an aggravation appoint a diet No. 4b, add a dry biscuit, cookies, razvarenny grain, vermicelli and vegetables soups, boiled vegetables, porridge casserole with milk addition to a diet, not strong cheese, fresh sour cream, baked apples, jam, butter.
During remission pass to a diet 4v which includes less mechanically sparing food pereraboka: all dishes give in not wiped look, add low-fat ham, the soaked herring, crude vegetables and fruit, juice. Also fennel, parsley greens, jellied fish, language and black caviar are resolved.
If in a clinical picture the chair delay prevails, then the products containing the increased amount of food fibers (vegetables, fruit, grain products, especially wheat bran) are shown. Bran needs to be filled in with boiled water for 20 — 30 min., then to merge water and to add them to porridges, soup, kissel or to use in pure form, washing down with water. A dose of bran from 1 to 9 tablespoons in day. After elimination of locks it is necessary to continue reception them in the quantities providing an independent chair of 1 times in 1 — 2 day. It is better to use bread with the increased content of bran.
The knitting, adsorbing drugs are shown at dominance of a diarrheal syndrome, appoint white clay of 1 g; calcium carbonate of 0,5 g, Dermatolum of 0,3 g in the form of the talker before food 3 times a day).
In the absence of effect that is usually connected with the accompanying dysbacteriosis, appoint antibacterial drugs to 7 — 10 days (Enteroseptolum, Intestopanum on 1 tablet 3 times a day, Nevigramonum of 0,5 g 4 times a day, nitroxoline on 0,05 g 4 times a day or Biseptolum-480 on 2 tablets 2 times a day).
At the strengthened gas generation appoint absorbent carbon on 0,25 — 0,5 g 3 — 4 times a day, infusion of a leaf of a peppermint, camomile flowers.
With atonic options of disturbance of motor function of intestines it is reasonable to patient to appoint a raglan (cerucal) on 0,01 g 3 times a day, at spastic forms of disturbance of motility — anticholinergic and spasmolytic drugs (Nospanum on 0,04 g 4 times a day, a papaverine a hydrochloride on 0,04 g 3 — 4 times a day, Platyphyllinum hydrotartrate on 0,005 g 3 times a day, Methacinum on 0,002 g 2 times a day).

At water diarrhea of various origin as symptomatic means it is possible to apply имодиум 0,002 g 2 times a day.
For the purpose of increase in reactivity of an organism appoint under skin aloe extract (on 1 ml/days, 10 — 15 injections), Peloidinum (inside on 40 — 50 ml 2 times a day for 1 — 2 h to food).  
The importance in complex therapy of chronic colitis is played by physical therapy. Carrying out an electrophoresis with analgetics, calcium chloride and zinc sulfate is recommended. Diadynamic currents, amplipulsetherapy are shown to patients with hypomotor options of colitis.
At a proctosigmoiditis appoint the microclysters having antiinflammatory properties (camomile, tannin, protargolovy), at a proctitis — candles ("Anesthesol", "Neoanusolum", etc.).
After an extract from a hospital recommend reception of probiotics -  a bifikola or a kolibakterina on 5 doses 3 times a day within 1 month, broths and infusions of medicinal plants. For example, at colitis with dominance of a lock use the following collecting: a) camomile, buckthorn bark, parsley;
b) calendula, marjoram, leaf of Senna.
At dominance of a diarrhea:
a) alder compound fruits, mint, dogrose;
b) sage, St. John's Wort, nettle, bird cherry;
c) flax seed, bilberry, cinquefoil, fennel.
Components of each collecting should be mixed in equal quantities, 2 tablespoons of mix to fill in 250 ml of boiled water, to insist 20 min. (it is desirable in a thermos). To filter and accept in the morning on an empty stomach and for the night before going to bed. Each of collecting is accepted within a month, consistently. It is possible to repeat courses 2 times a year.
Working ability of patients at moderately severe and severe forms of the chronic colitis which is especially followed by a diarrhea is limited. The types of works connected with impossibility to observe a diet, frequent business trips are not shown them. Sanatorium treatment is shown in specialized balneological sanatoria (Borjomi, Dzhermuk, Druskininkai, Yessentuki, Zheleznovodsk, Pyatigorsk, Truskavets).
An important role in therapy is played by psychotherapeutic methods of treatment, the group and individual psychotherapy is recommended.