Clinical guidelines ulcerative colitis. Etiology of nonspecific ulcerative colitis: causes. Indications for expert advice

Nonspecific ulcerative colitis is a disease of the intestine, localized in the mucous membrane and characterized by the occurrence inflammatory process. The mucous membranes of the large intestine are affected, and the thin section is not affected by the process at all. As a rule, a disturbed diet, stress, stomach diseases lead to disruption of the intestines. Ulcerative colitis can be one of the consequences of an untreated inflammatory disease. With untimely therapy, the disease becomes chronic.

According to statistics, women are more likely to be affected by this disease than men. As for the age category, people from 16 to 45 years old are mostly affected. The disease is rarely detected after 55 years. Studies show that 70 out of 100,000 people have different shape ulcerative colitis. As for the regional prevalence of the disease, Europeans get sick 2 times less often than Americans. Based on the ethnicity of citizens, among the population with African roots, this type intestinal disease occurs 2 times less often than among the "white", and 3 times less often than among the Jewish peoples.

Medical classification of nonspecific ulcerative colitis

Medical classification of a disease called ulcerative colitis at the site of localization:

1. Distal.
2. Left side.
3. Subtotal.
4. Total.

By the nature of the flow:

1. Spicy.
2. Chronic.
3. Recurrent ulcer.

According to the severity, it is divided into:

1. Light form (initial stage).
2. Medium shape.
3. Severe form of the disease.

The degree of activity of the inflammatory process is:

1. Minimum.
2. Moderate.
3. Maximum.

According to the phases of the course of the disease, two stages are distinguished:

1. Aggravation.
2. Remission.

Pathogenesis of nonspecific ulcerative colitis: types of colon disease

As a rule, the pathogenesis of the disease of nonspecific ulcerative colitis begins with the first type - distal. Infection occurs through the rectum and gradually spreads up to the splenic flexure. When inflammation reaches this stage, then this is the second type of disease - left-sided. Basically, this stage is observed in 75% of cases. With larger areas of infection, inflammation spreads along the ascending intestine and types 3 and 4 of the disease occur.

The symptoms and treatment of ulcerative colitis depend on the type of disease affecting the large intestine. Since all subspecies of the disease are different, in addition to the main symptoms, additional ones can be observed. Accordingly, the treatment methodology is determined by the attending physician, based on the clinical picture.

Distal colitis- This is a type of disease in which the membrane of the left intestine, sigmoid and rectum is involved in the inflammatory process. This process is massively distributed, accompanied by periodic pain syndromes and stool disorder.

Non-specific left-sided ulcerative colitis of the colon is a type of disease in which inflammation affects the rim of the intestine. As a rule, it is accompanied by pain syndromes on the left side and lack of appetite,.

Subtotal and total colitis are the most dangerous types of the disease, as they threaten with complications, severe pain, continuous diarrhea and large blood loss.

What is characteristic of chronic ulcerative colitis?

Chronic ulcerative colitis is the most painful and prolonged type of disease, characterized by overflow of the large intestine. blood vessels, which burst and form bleeding ulcers and tears.

As for the degrees of severity, such a classification of colitis was introduced in 1955 (authors - Truelove and Witts). It is still used today, as it allows you to separate the methods of treatment at different stages.

The disease of nonspecific ulcerative colitis is characterized by a cyclic course and a temporary manifestation of symptoms. That is, the symptoms can either appear or disappear for a while. The stages of exacerbation are replaced by stages of remission.

Etiology of nonspecific ulcerative colitis: causes

The etiology of ulcerative colitis has not yet been fully determined. But there are several main theories for the occurrence of this kind of inflammation of the intestine.

The first factor influencing the development of intestinal inflammation is genetic predisposition. It is believed that in the presence of close relatives with this disease, the chance of developing the disease increases by 35%. Scientists have come to the conclusion that this kind of disease can cause gene mutations, which will lead to infection of the offspring.

Other scientists and doctors refute the previous theory of the occurrence of the disease called ulcerative colitis and argue that the disease is caused by a microbiological factor, namely infection. But even here their opinion is divided, forming several possible options.

Some researchers believe that inflammation occurs on its own due to the development pathogenic microorganisms. It is believed that it is Actinobacteria avium complex that provokes an infectious disease of the large intestine.

Another part of the doctors is sure that the cause of nonspecific ulcerative colitis is a violation of the immune system, namely autoimmune factors. Normally, the immune system does not produce antibodies to its own antigens. But in case of malfunctions, he may stop “recognizing his own”, which will provoke the release of antibodies that attach to antigen cells and destroy them. When this kind of destructive processes inflammation occurs in the body.

Intestinal and extraintestinal manifestations of nonspecific ulcerative colitis

General manifestations of the disease nonspecific ulcerative colitis characteristic of 65% of cases:

1. Diarrhea.
2. Stool with blood, pus and mucous discharge.
3. Various kinds of pain in the lower abdomen.
4. Bloating and increased gas formation.
5. Temperature 38 degrees (manifested sometimes).
6. General malaise.
7. Lack of appetite.
8. Weight loss.

Such symptoms in ulcerative colitis, however, may be mild. Diarrhea is observed in 96% of cases of the disease, very rarely this symptom can be replaced by the opposite symptom -. Various kinds of impurities in the feces appear due to the presence of ulcers in the intestines that bleed. Pain in nature can be acute, mild in the form of colic or spasms of the smooth muscles of the intestine. Fever is observed only in severe forms of the disease. General weakness and weight loss are triggered by lack of appetite, which in turn is caused by dehydration.

Distinguish special features in non-specific ulcerative colitis different degrees gravity. initial stage characterized by a liquid consistency of the stool up to 5 times a day and a small amount of blood with mucus in the discharge. But at the same time, the general condition is normal.

Symptoms of the appearance of nonspecific ulcerative colitis of the intestine for moderate severity are characterized by bloody discharge with mucus, liquid stool up to 8 times a day, slight fever up to 37.5 degrees and anemia. General state while being satisfactory.

In the third form of severity, diarrhea is observed more than 8 times a day, abundant excretion of impurities of blood, mucus and pus, a temperature of 38 degrees and above, a decrease in hemoglobin, and tachycardia. The general condition is severe, there is pain in the abdomen, general fatigue possibly dizziness.

In addition to intestinal factors, with this kind of disease, various extraintestinal manifestations of the disease of ulcerative colitis occur. This may be the formation of nodules under the skin, which are palpable, or skin necrosis in some places. Also among the skin manifestations, dermatitis with various types rashes. Concerning oral cavity and pharynx, it is likely the development of aft, glossitis or. Rare, but possible manifestation eye diseases type of iridocyclitis, and the like.

Tests for the diagnosis of non-specific ulcerative colitis

When the first symptoms appear, you should consult a doctor. This type of disease is treated by a gastroenterologist. Diagnosis for non-specific ulcerative colitis is divided into the following steps:

• Inspection.
• Palpation of the abdomen.
• Immunological analysis.
• Fecal analysis.
• Endoscopic examination of the large intestine.
• X-ray study.
• Conclusion of the diagnosis.

A medical examination begins with an assessment of the condition of the eye shell. In the presence of inflammatory processes, the gastroenterologist can simultaneously write out a referral for treatment by an ophthalmologist. visual inspection the lower abdomen can give an indication of the presence of bloating.

This is followed by the process of probing the abdomen, in which painful sensations may appear. Also, the doctor can tell if the large intestine is enlarged.

A complete blood count is performed to determine the level of hemoglobin and to detect anemia, which is one of the symptoms of the disease.

Biochemical analysis can reveal a lack of C-protein, which indicates the presence of an inflammatory process. It will also help to find out if there is a lack of calcium, magnesium and albumin.

Immunological analysis may show an overestimated amount of antibodies, which will be a sign of an abnormal functioning of the immune system. Analysis of feces with bloody-purulent impurities will reveal the presence of pathogenic microflora.

The fundamental tests for diagnosing ulcerative colitis are endoscopy and x-rays. For endoscopic analysis, the patient is prepared in advance by cleaning the intestines with the help of several enema sessions. The device for research is called an endoscope and is a tube with a camera and a lamp at the end. The image is displayed on the screen, which allows you to see the problem from the inside. With the help of the procedure, the diagnosis is made 80% more accurate.

X-ray, in turn, helps to see the presence of perforation, fistulas, etc., which radically changes the treatment process.

Differential diagnosis of ulcerative colitis: differences from Crohn's disease (with table)

Differential diagnosis of nonspecific ulcerative colitis helps to establish the truth of the diagnosis. Since some intestinal infections and Crohn's disease are very similar in their presentation of symptoms, it is important to check the reliability of the diagnostic conclusion.

For nonspecific ulcerative colitis of the intestine and Crohn's disease, differences are characteristic even in possible complications. For colitis - bowel cancer, and for Crohn's disease - the formation of lymphomas. If in the first case, only parts of the large intestine are diffusely affected, then in the second case, inflammation spreads to the entire digestive tract.

The differences between Crohn's disease and ulcerative colitis can be summarized in a table:

Basic Treatments and Nutrition for Ulcerative Colitis

The main methods of treatment in case of non-specific ulcerative colitis are divided into:

1. Conservative treatment.
2. Medical.
3. Surgical intervention.
4. supportive therapy.

What kind of methodology to apply is determined by the attending physician. And in order to avoid complications, careful adherence to the instructions is necessary.

Conservative treatment in the case of non-specific ulcerative colitis is based on the observance of a special diet. In the acute phase, the patient is limited in food, and only takes filtered water as a drink. When the aggravation subsides, you can switch to a low-fat protein diet. These are eggs, cottage cheese, boiled chicken fillet, lean steamed fish, etc.

With nonspecific ulcerative colitis, it is not advisable to eat vegetables and fruits in the diet, because. coarse fiber will harm the inflamed intestinal mucosa. It is allowed to take viscous cereals, purees, decoctions and compotes. AT severe cases diseases of patients are hospitalized and transferred to an artificial type of nutrition. As vitamins, the patient is prescribed mineral supplements and vitamin complexes.

The main recommendation for non-specific ulcerative colitis is the intake of soft and easily digestible food (liquid, semi-liquid and pureed foods are well suited). It is advisable to monitor the temperature of the food consumed. Too cold or too hot food irritates the intestines, causing complications. The most comfortable temperature is 30-40 degrees. The frequency of meals is set by the doctor, but it is advisable to make a diet with fractional and frequent meals. Spicy, sour, fried and rough foods are prohibited.

Medications for non-specific ulcerative colitis

With moderate severity of symptoms of nonspecific ulcerative colitis of the intestine, treatment is prescribed with medications. The goals of this therapy are:

1. Elimination of the acute phase of the disease.
2. Maintenance of a stable condition and remission.
3. Prevention and prevention of complications of the disease.

Sulfasalazine and glucocorticoids are anti-inflammatory drugs used to achieve remission. "Sulfasalazine" perfectly fights the inflammatory process, stopping its spread and blocking subsequent exacerbations. "Salofalk" is a kind of analogue of the previous drug with mesalazine, which is part of the composition, which gradually dissolves in each section of the intestine due to three types of shell. The dosage and duration of administration is prescribed by the attending physician, depending on the severity of the lesion of the intestinal system.

For the treatment of ulcerative colitis of the intestine, preparations based on 5-aminosalicylic acid are widely used both as an independent treatment component and as an additional one. It depends on the severity of the disease. Such drugs not only relieve inflammation, but also are preventive measure preventing the formation of cancerous tumors.

The second main component of drug treatment of nonspecific ulcerative colitis are glucocorticoid preparations. These include Prednisolone and Hydrocortisone. Used in the form of enemas or parenterally. But these drugs have a number side effects(obesity, diabetes, stomach ulcers and the like), so more and more are being replaced by new steroids.

For the treatment of emerging non-specific ulcerative colitis in adults with steroid drugs Budesonide, Fluticasone are used. These drugs are highly effective and have minimal side effects.

Metronidazole is widely used as an anti-infective and antibacterial agent. But its long-term use causes a number of side effects, so its administration is prescribed in the form of a suspension and for no longer than 3 days.

As antidiarrheal drugs, the doctor carefully prescribes "Loperamide" or "Imodium", but the reaction of the body is carefully observed, because. such substances can disrupt intestinal tone. And as an anesthetic, Ibuprofen or Paracetamol can be used.

According to clinical guidelines, antibiotics "Clindamycin", "Cefobide", "Ampicillin" can be prescribed for nonspecific ulcerative colitis. From the side of the immune system, Cyclosporine is used, which modulates the release of antibodies in the body. According to statistics, this drug contributed to the onset of sustainable remission in 70% of patients with acute colitis.

How to treat ulcerative colitis: surgery for exacerbation

With an exacerbation of nonspecific ulcerative colitis, the attending physician may prescribe the necessary surgical intervention. An operation is needed if:

1. Inefficiency of diet and conservative therapy.
2. development of complications.
3. Bleeding discoveries.
4. Colon perforations.
5. Malignant neoplasm, etc.

The operation is to remove the affected area intestinal tract or free end connection ileum with anal canal. These surgical options are most effective as a treatment for this disease.

As adjuvant therapy in ulcerative colitis, a broad-spectrum antibiotic is prescribed to eliminate the threat in the form of abscesses, edema and other inflammatory processes. These can be "Metronidazole", "Ciprofloxacin" and "Trimethoprim-sulfamethoxazole". Probiotic preparations may be recommended, but their effect is weakly expressed in such diseases.

Possible Complications of Nonspecific Ulcerative Colitis

At untimely treatment diseases, complications of nonspecific ulcerative colitis can occur:

1. Dilatation of the intestine.
2. Bowel perforation.
3. Obstructive lesions of the intestine.
4. Bleeding.
5. Fistula.
6. Malabsorption.
7. thromboembolic complications.
8. Dysplasia.
9. Cancer diseases.
   

   In order to avoid possible complications, it is necessary to undergo a regular examination by a specialist and, at the first manifestations of a violation of the intestines, seek help from a gastroenterologist. Running the disease can lead to bleeding.

Prevention of nonspecific ulcerative colitis

How exactly it is worth treating ulcerative colitis, you learned above, but in no case should you self-medicate in order to avoid causing irreparable harm to the body. The best option would be to prevent infection through simple measures to prevent diseases of the gastrointestinal tract. To do this, take care of nutrition first. It should be regular, fractional and in small portions. Eat healthy, natural foods. Don't forget about the variety of nutrients. As a preventive measure, eat steamed foods, mashed potatoes, smoothies, puddings, sticky cereals, and other foods prepared without fat.

Regularly donate blood and feces for analysis, this will help to see health problems and start treatment at an early stage. And, of course, you need to get rid of addictions like smoking and alcohol - they weaken the immune system and contribute to the development of many diseases. Stress for the body is another negative factor, try to control yourself and not succumb to feelings. Try to avoid taking oral contraceptives, they can cause the formation of microclots. Long-term use antibiotics also affect intestinal health, so after a cycle of treatment with such drugs, take care of the "settlement" of the microflora with beneficial microorganisms.

The article has been read 1,150 times.

Size: px

Start impression from page:

transcript

1 Nonspecific ulcerative colitis in children: clinical experience and modern approaches to diagnosis and treatment. Department of Propaedeutics of Children's Diseases of EE "BSMU" Department of Pediatric Gastroenterology of the 4th City Children's Clinical Hospital of Minsk Nazarenko O.N., Yurchik K.V., Pinevich O.P., Tvardovsky V.I. Kukharonak N.S., Belokhvostik A.S. Summary. This article analyzes the latest recommendations for the diagnosis and treatment of pediatric patients with ulcerative colitis, proposed by European association pediatric gastroenterologists, hepatologists and nutritionists (ESPGHAN). These recommendations establish the need for a thorough history taking and examination of patients, identify indications for endoscopic examination(colonoscopy and FGDS) and the volume of laboratory tests for diagnosis and subsequent control of the disease. A nonspecific ulcerative colitis activity index (PUCAI) is proposed, which is necessary to assess the activity of the inflammatory process and the degree of response to ongoing therapy. The effectiveness and expediency of the proposed approaches are confirmed by the results of our own research. Keywords: nonspecific ulcerative colitis, children, recommendations for diagnosis and treatment. Ulcerative colitis in children: clinical experience and current approaches to diagnosis and treatment Belarusian State Medical University, Minsk 4th City Children's Clinical Hospital, Minsk Nazarenko O.N., Yurchyk K.V., Pinevich O.P., Tvardovsky V.I., Kuharonak N.S., Belohvostik A.S. summary. This article analyzes the recent recommendations of ESPGHAN for management of patients with ulcerative colitis. The necessity of a thorough study of the patient's history and examination of patients was established; indication for endoscopy (colonoscopy and fibrogastroduodenoscopy) and the amount of required laboratory tests for diagnosis and follow-up of the disease were determined. Pediatric

2 Ulcerative Colitis Activity Index (PUCAI) was suggested to evaluate the activity of the inflammatory process and the response to treatment. The results of our studies confirmed the effectiveness and feasibility of the proposed approaches Key words: ulcerative colitis, children, guidelines for the diagnosis and treatment. Chronic inflammatory diseases bowel disease (CIID) include ulcerative colitis (UC), Crohn's disease (CD), and undifferentiated colitis. These disorders have certain pathological and clinical characteristics, but their pathogenesis has not yet been fully established. . Ulcerative colitis is a chronic relapsing inflammation of the colon. varying degrees severity, with the proximal spread of the process from the rectum. Depending on the length of the process, there are: distal colitis, in which the rectum (proctitis) or the rectum and sigmoid (proctosigmoiditis) are involved in the pathological process; left-sided colitis with damage to the colon to the splenic flexure; total colitis, including widespread colitis (up to the hepatic flexure) and pancolitis (up to the ileocecal region). There is no single criterion for an accurate diagnosis of NUC. As a rule, UC is established in patients with bloody diarrhea, tenesmus, abdominal pain, and, if the process worsens, weight loss, weakness, and nausea. In the structure of CVD, as a rule, Crohn's disease predominates. Thus, in the UK, CD among patients with CIBD is 60%, UC 28%, undifferentiated colitis 12%. Cases of UC with onset in childhood occur in 15% to 20% of patients of all ages and account for 1 to 5 new diagnoses per population per year in most parts of North America and Europe. The onset of the disease in childhood is recorded in 60% - 80% of all cases. Information about the structure of UC in children, depending on the length of the process, is rather contradictory. So, according to Beattie R.M. et al. , in children in 54% of cases there is proctitis and proctosigmoiditis, in 28% - left-sided colitis, and only in 18% - total colitis. Recent publications, on the contrary, indicate a high incidence of more common forms of the disease (in particular, total colitis) in children compared with adults. Since the extent of the disease is associated with its severity, it is not surprising that the onset of the disease in childhood leads to its more severe course, leading in 30-40% of cases to colectomy within 10 years (compared to 20% of such cases in adults). Between 25% and 30% of children require intensive treatment before standard adult therapy is applicable, which is 2 times more common than in adult practice. In addition, children have age-related characteristics such as growth, sexual development,

3 nutrition, features of bone mineralization, as well as teenage problems, both psychosocial and developmental issues. Thus, nonspecific ulcerative colitis with onset in childhood, due to its more severe course, requires, in comparison with ulcerative colitis in adults, a more stringent approach to diagnosis (in particular, colonoscopy rather than rectoscopy) and treatment. To determine remission, the degree of UC activity, and also as a criterion for response to ongoing treatment, it is recommended to use the pediatric ulcerative colitis activity index - PUCAI (Table 1) . This index is determined by collecting clinical data on disease activity and does not include endoscopy or laboratory values, i.e. easy to apply in everyday practice. Table 1. Pediatric Ulcerative Colitis Activity Index (PUCAI) Score 1. Abdominal pain No pain 0 Pain can be ignored 5 Pain cannot be ignored Rectal No 0 Bleeding Small amount, less than 50% of bowel movements 10 Small amount in most bowel movements Consistency and shape of stool A large number of(more than 50% of stool volume) 30 Formed 0 Partially formed 5 Completely unformed Frequency of stools per day > Night stools No 0 Yes Patient's degree of activity PUCAI sum (0 85) Unrestricted activity 0 Intermittently limited activity 5 Severely limited activity 10 PUCAI<10 указывает на ремиссию, лѐгкую активность болезни, среднюю и более 65 баллов тяжѐлую. Клинически достоверный ответ на назначенное лечение устанавливают при снижении PUCAI на 20 баллов.

4 The severity and aggressive course of NUC in children, the difficulties of its diagnosis and treatment determine the relevance of developing optimal schemes for both diagnosis and management of this disease. In September 2012, the European Association of Pediatric Gastroenterologists, Hepatologists and Nutritionists (ESPGHAN) published guidelines for the management of UC in children. They are based on data from systematic reviews of the literature (267 sources), the results of the work of the International working group specialists in children's CVD (27 participants), formed by ESPGHAN, as well as the conclusions of meetings with ECCO. The main attention in these documents is given to the issues of diagnosis and treatment of UC in children and adolescents. The recommendations apply only to outpatients and not to children hospitalized with acute severe colitis (recommendations for this population have been published in the respective pediatric ESPGHAN and ECCO guidelines for the management of acute and severe colitis). In accordance with this document, the diagnosis of pediatric UC should be based on a combination of several parameters: anamnesis, a thorough examination of the patient, the results of ileocolonoscopy with multiple biopsy and histological examination of biopsy specimens, which is performed jointly by gastroenterologists and pediatricians. In all cases, upper endoscopy is recommended to rule out Crohn's disease. Initial laboratory tests should include complete blood count, liver enzymes, albumin, ESR, serum iron, ferritin, and CRH. Stool cultures are needed to rule out infectious diarrhea, as well as testing for Clostridium difficile toxins. Additional stool examinations may be necessary for patients with a history of recent travel. In children under 2 years of age, additional immunological and allergy tests may be performed to rule out colitis due to primary immunodeficiency or allergic conditions. Endoscopic examination is recommended in the following cases: for diagnosis, before a significant change in therapy, and when clinical signs are atypical. Treatment of NUC is not an easy task. The main approaches to the treatment of this disease are presented in Figure 1. In accordance with the recommendations of ESPGHAN, UC therapy should include remission therapy (5-ACA, corticosteroids, anti-TNF therapy, and possibly probiotics) and remission maintenance therapy (5 -ACA, thioprines, anti-TNF and selected probiotics). Assessment of the activity of the inflammatory process and the degree of response to ongoing therapy should be carried out using the PUCAI index. A satisfactory response to treatment is established when this index falls by 20 or more points.

5 Exacerbation or onset of the disease Mild activity (PUCAI 10-35) Induction of remission Moderate activity (PUCAI 40-60) Systemic manifestations Severe activity (PUCAI 65-85) No systemic manifestations Oral 5-ASA at a dose of mg/kg/ days Perhaps the use of 5-ASA in the form of Prednisolone 1 mg / kg daily 1 r / d (max up to 40 mg) + 5-ASA No satisfactory. response 7-14 days Satisfy. response 7-14 days No Sat. response 7-14 days Add enemas and/or probiotics Corticosteroids for 10 weeks IV steroids No response Satisfactory response to treatment In some cases, infliximab or tacrolimus may be given instead of adding IV steroids Satisfactory. response Maintenance of remission 5-ASA is indicated for all patients. Probiotics may be added. Rectal therapy may be used in proctitis /d or mercaptopurine 1.5 mg/kg 1 q/d) Step back If disease activity persists or if there are frequent exacerbations on the background of adequate thioprine therapy, infliximab is indicated (or adalimumab if infliximab is ineffective) In case of ineffective therapy with biological agents (including dose increase) and exclusion of other diagnoses, colectomy is indicated. Figure 1 Principles of therapy for patients with UC Own research. AT last years in the department of gastroenterology of the 4th city children's clinical hospital in Minsk, cases of hospitalization in the hospital of children with chronic inflammatory bowel diseases (CIID), and especially ulcerative colitis, have significantly increased. Thus, until 2008 inclusive, 2 3 patients with ulcerative colitis were treated in the department per year; and Crohn's disease was

6th place only once in a few years. In 2009, 6 new cases of CVD were registered (hospitalizations, including repeated ones, there were 16), in 2010 another 6 new cases (25 hospitalizations of patients with a primary and previously established diagnosis), in 2011 another 6 (28 hospitalizations), and until April 2012 4 (16 hospitalizations respectively). The increase in the incidence of CIBD and the difficulties observed in bringing patients into long-term remission (high frequency of relapses) forced us to conduct a detailed analysis of all cases of the disease. The aim of this study was to optimize the diagnosis and treatment of non-specific ulcerative colitis based on the study of the features of its clinical manifestations and course at the present stage. Material and methods. We carried out a detailed analysis of the case histories (taking into account repeated cases of hospitalization) of all children who were hospitalized in the gastroenterology department of the 4th City Children's Clinical Hospital in years (17 cases of nonspecific ulcerative colitis). When developing case histories, we assessed the anamnesis, the main pathological symptoms and syndromes, as well as laboratory data (general blood count, urine, coprograms, biochemical blood test) and instrumental (ultrasound of the abdominal organs, large intestine, recto- and colonoscopy data with obligatory analysis of the morphology of biopsy specimens, FGDS, irrigoscopy, ECG data and ultrasound of the heart) research methods both during the period of exacerbation and remission of UC. Results. The average age of the children was 9.89 years with a slight predominance of boys (64.7%), the age of diagnosis was 8.32 years, which turned out to be slightly lower than according to the literature. An assessment of the incidence of UC depending on age is shown in Figure 2, which shows that most often this diagnosis was made in preschool children (58.82%) and adolescents,6 17.7 11.7 11, up to 1 year 5 ,8 5.8 5.8 5.8 5, UC Figure 2. The incidence of UC in children depending on age according to the EEO 4DKB in Minsk.

7 Unlike adults, in children's practice, local damage to the mucous membrane of the large intestine in NUC (isolated proctitis or left-sided colitis) is much less common. The data of our study were no exception (Figure 3): proctosigmoiditis occurred in only one patient (5.88%), left-sided colitis was observed in 23.53% of cases, total colitis in 70.58% of cases. It should be noted that the average age of children with these variants of UC was 10.0, 15.25 and 8.06 years, respectively, which confirms a higher risk of total damage to the colon mucosa in young children and requires a total colonoscopy with examination to the ileocecal angle. . 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 70.58% 23.53% 5.88% Total Left Proctosigmoiditis % Figure 3. The frequency of occurrence of various types of UC according to the prevalence of UC according to the EEO 4DKB. When assessing the severity of the course of UC, it was found that total colitis with a severe course was observed in 35.29% of cases, total or left-sided, moderate course in 58.82%, and proctosigmoiditis, mild course in 5.88% of cases. Analysis of concomitant diseases in patients with UC showed a relatively high incidence of lesions of the upper digestive tract: functional dyspepsia occurred in 23.52%, chronic gastroduodenitis in 23.52%, GERD in 29.41% of patients, which confirms the need for upper endoscopy in them (not only in terms of differential diagnosis with Crohn's disease) and can distort the clinical picture of the disease (postprandial pain atypical for NUC). Colon polyps were detected in 2 patients with a disease duration of 7 and 8 years, intestinal giardiasis was observed in 2 patients, amoebiasis in one case. Delayed physical development was observed in 17.65% of patients, underweight and anemia in 23.53% of cases. An increase in the incidence of CIBD increases the likelihood of encountering this pathology at the outpatient stage, therefore, during the study, we paid much attention to the analysis of the clinical manifestations of the disease (Figure 4). The figure shows that the most characteristic symptoms for UC are abdominal pain (pain before, during and

8 after a bowel movement, with localization in the left iliac region or lower abdomen), increased stools (which may be mushy) with the presence of blood and mucus in the stool, decreased appetite and pallor of the skin. Paleness 23.53% 11.76% 11.76% 17.65% 35.29% 17.65% Headaches Weakness Nausea Loss of appetite Weight loss 11.76% 41.17% 41.17% 52.94% 82 ,36% 94.11% More than 10 times a day Stools are liquid, 5 10 times a day 00% 80.00% 100.00% Pain syndrome, total Figure 4. The main clinical manifestations of CIBD in children according to the GEO 4 DCS. Changes in the general blood test (Table 3) that were characteristic of exacerbation of UC were moderate leukocytosis, a significant decrease in hemoglobin levels (anemia occurred in 53.33±12.88% of patients), a pronounced stab shift in the leukocyte formula (which occurred in 73.33± 11.42% of cases), accelerated ESR and increased platelet levels. It should be noted that changes in the latter indicator persisted for some time even after the onset of remission of the disease. Evaluation of deviations in the biochemical analysis of blood showed that during the exacerbation of UC most often there was an increase in the level of C-reactive protein (in 46.81% of patients) and an increase in the level of alpha-2 globulins, which was observed in almost all patients. A third of patients had a decrease in serum iron levels.

9 Table 3. Complete blood count during exacerbation and remission of nonspecific ulcerative colitis. UC score, exacerbation, n=15 UC, remission, n=15 Р< Эритроциты 4,83±0,12 4,71±0,08 - Гемоглобин 113,87±4,24 130, 33±2,31 0,01 Лейкоциты 10,46±1,88 8,46±0,99 - Эозинофилы 1,9±0,37 3,21±0,89 - Палочкоядерные 13,2±1,86 7,06±1,86 0,05 Сегментоядерные 46,4±4,14 47,53±3,57 - Лимфоциты 38,23±2,38 46,06±3,57 - Моноциты 7,38±0,81 5,53±0,45 - Тромбоциты 401,86±25,39 374,54±12,81 - СОЭ 14,14±2,53 7,0±0,59 0,05 Основным исследованием, на котором основывался диагноз НЯК, была колоноскопия с множественной биопсией из various departments colon, performed in all patients. In 3 patients, colonoscopy was delayed due to the severity of hemocolitis at the onset of the disease (in these cases, rectoscopy and irrigoscopy were performed to determine the extent of the process). The results of the analysis of the endoscopic picture in NUC in our patients are shown in Figure 5, which shows the proximal spread of the process characteristic of this disease and the most typical endoscopic changes - swelling, hyperemia, blurring of the vascular pattern and contact bleeding of the mucosa, as well as the presence of its damage. Blind Descending Transverse Ascending Polypoid formations Intramucosal hemorrhages Mucosal ulcerations Erosion Contact bleeding Sigmoid Rectum 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% Blurred vascular pattern Hyperemia Edema Pattern 5. Endoscopic changes in the colon mucosa in patients with UC.

10 Typical morphological changes in UC are mucosal and submucosal inflammation, cryptitis, and crypt abscess formation; violation of the architectonics of the mucosa, lymphoid aggregates in the lamina propria and the presence of Paneth cells in the left sections of the colon. Analysis of histological changes in NUC showed that it is far from always possible to base the diagnosis only on a morphological conclusion: in only 5 cases (29.4%), the conclusion of morphologists was: "the morphological picture of NUC". In 5 (29.4%) patients, the conclusion was formulated: "This morphological picture can be observed in infectious colitis and in the debut of UC"; in 5 (29.4%) cases - "The morphological picture can be observed in NUC and CD"; c - 1 (5.9%) "Pathomorphism of UC during treatment", and 1 (5.9%) - "There is a possibility of the onset of Crohn's disease." Obviously, the diagnosis of CVD should be based on a combination of data from clinical, laboratory, instrumental and morphological manifestations of the disease. In our clinic, in addition to mandatory instrumental examinations, all children underwent colon ultrasound. This turned out to be useful for determining the degree of involvement in the pathological process of the colon (with severe UC), when it was impossible to conduct other studies at the moment, and even to identify incipient toxic dilatation of the colon in one case. The analysis of previous diseases showed that in two cases the children had appendectomy, repeated pneumonia in three, salmonellosis in two and rotavirus infection in two cases. Interestingly, when clarifying the family history in patients with UC, there were 2 cases of UC in parents. Despite the rather distinct clinical manifestations, the diagnosis of CIBD is very difficult and requires the exclusion of infectious and surgical causes of symptoms. In our study, in one case of UC in a 5-year-old child, the symptoms of the disease appeared almost immediately after long-term antibiotic therapy with cephalosporins for pneumonia, which required the need for differential diagnosis with colitis caused by Cl.difficile. We were not able to determine the presence of toxins A and B to Cl.difficile, endoscopic examination of pseudomembranes typical of antibiotic-associated colitis was not described, there were signs of UC, which were confirmed morphologically. In the course of treatment, we received a distinct positive dynamics when metronidazole was included in the treatment complex and a complete absence of relapses during 2 years of observation, due to which we managed to stop the basic therapy with 5-aminosalicylic acid preparations. We believe that antibiotic-associated colitis occurred in this case. In addition, when examining patients with suspected CIBD, the gastrointestinal form was detected in 2 cases.

11 food allergies, 2 polyps of the colon, 1 solitary ulcer of the rectum, and in 2 patients of the first year of life, intestinal dysbacteriosis associated with hemolyzing Escherichia coli. We made an attempt to analyze the effectiveness of various therapy options prescribed to our patients with an assessment of the frequency of relapses of the disease. As mentioned above, severe total colitis was observed in 6 patients (35.29% of cases), total or left-sided, moderate course in 10 (58.82%), and proctosigmoiditis, mild course in 1 patient (5.88% ). All patients received 5-aminosalicylic acid preparations as basic therapy (in 14 cases, mesacol, in 3 cases, sulfasalazine) as monotherapy for moderate (5 patients) and mild course. It turned out that in cases where doses of mesacol mg/kg were prescribed, relapses of the disease were observed much less frequently. In 5 patients with a moderate course of the disease, prednisolone at a dose of 1 mg/kg was used to induce remission, followed by a gradual decrease, and in 2 cases it was possible to cancel the drug after 3-4 months. When assessing the tolerability of 5-aminosalicylic acid preparations in our practice, there was 1 case of short-term hematuria at a high dose of mesacol (stopped after its reduction) and one case of intolerance to sulfasalazine (increased diarrhea). In severe cases of the disease (6 patients), prednisone administration (initially intravenously, then orally) proved to be effective only in 2 cases; the effect of the treatment was obtained. We had 1 case of severe ulcerative colitis with subsequent transformation into Crohn's disease and a fatal outcome, despite the consistent administration of corticosteroids, azathioprine, cyclosporine and infliximab, however, due to a change in diagnosis, this case was not included in our statistical development. Conclusions. Thus, the plan for examining patients with UC should include consideration of symptoms, determination of indications for endoscopic examination, colonoscopy and EGD, appointment of a general blood and urine test, coprological examination, biochemical examination (liver tests, CRP, albumin, proteinogram, serum iron), Ultrasound of the large intestine and abdominal organs (assessment of the condition of the liver, gallbladder, pancreas). In terms of differential diagnosis, when establishing a diagnosis and periodically during follow-up, it is necessary to exclude intestinal infections caused by pathogens such as Salmonella, Shigella, Campylobacter, enterohemorrhagic E. coli, Yersinia, Ameba and Cl. Difficile. It should be noted that the schemes proposed in the ESPGHAN recommendations

The use of drugs from different groups is the most effective, which is confirmed by the analysis of the effectiveness of various options for managing patients in our observation (when we selected therapy, especially for severe variants of the disease, after unsuccessful attempts to use outdated treatment protocols). Literature. 1. E. G. Tsimbalova, A. S. Potapov, and P. L. Shcherbakov, Russ. // Physician C Arend LJ, Springate JE. // Pediatric Nephrology Vol. 19. P Beattie RM et al. / /Journal of Pediatric Gastroenterology and Nutrition Vol. 22. P Bousvaros A., Leichtner A., ​​Bupree T. Treatment of ulcerative colitis in children and adolescentes: 5. Harris MS, Lichtenstein GR. // Alimentary Pharmacology and Therapeutics Vol. 33. P Hyams J. S. // Pediatrics in Review Vol. 26(9). P IBD Working Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). // Journal of Pediatric Gastroenterology and Nutrition Vol. 41. P Kim S.C., Ferry G.D. // Gastroenterology Vol P Kohli R, Melin-Aldana H, Sentongo TA. // Journal of Pediatric Gastroenterology and Nutrition Vol. 41. P Lichtenstein GR, Kamm MA. // Alimentary Pharmacology and Therapeutics Vol. 28. P Loftus EV Jr, Kane SV, Bjorkman D. // Alimentary Pharmacology and Therapeutics Vol. 19. P Mark D.R., Langton C., et al. // Pediatrics Vol. 119(6). P Sandhu B.K., Fell J.M.E., et al. // Journal of Pediatric Gastroenterology and Nutrition Vol. 50(1). P Selhub J, Dhar GJ, Rosenberg IH. // Journal of Clinical Investigations Vol. 61.P Sentongo TA, Piccoli DA. // Journal of Pediatric Gastroenterology and Nutrition Vol. 27. P Turner, D., Levine, A., Escher, J.C., et al. Journal of Pediatric Gastroenterology and Nutrition Vol. 55(3). P

13 17. Turner, D, Otley, AR, Mack, D, et al. // Gastroenterology Vol.33. P Turner D, Travis SP, Griffiths AM, et al. // American Journal of Gastroenterology Vol P Authors: Ph.D. Assistant of the Department of Propaedeutics of Children's Diseases of the Belarusian State Medical University, (Shishkin St., tel.; working tel.; Yurchik K.V. Department of Propaedeutics of Children's Diseases of BSMU Tvardovsky VI 4th ​​year student of the pediatric faculty of BSMU Kukharonak NS 4th year student of the pediatric faculty of BSMU Belokhvostik AS

D. S. Kovshar, A. V. Vasilevskaya CHARACTERISTICS OF CLINICAL MANIFESTATIONS OF THE DISEASE AND FEATURES OF THE TROPHOLOGICAL STATUS IN CHILDREN WITH NON-SPECIFIC ULCERANT COLITIS. Conference Proceedings 368 Scientific

Conclusion on the clinical efficacy of the immunomodulatory drug "Derinat" in the treatment of left-sided nonspecific ulcerative colitis. General characteristics of the drug. Derinat (sodium deoxyribonucleate)

Www.printo.it/pediatric-rheumatology/en/intro Familial Mediterranean Fever Version 2016 2. DIAGNOSIS AND TREATMENT 2.1 How is this condition diagnosed? Typically used for diagnosis

UDC 616.345 Zaitseva V.I student Popova E.V. student Plekhanov E.O student Merzlyakov S.V., student Supervisor: Styazhkina S.N. professor, d.m.s. CLINICAL CASE OF A PATIENT WITH NON-SPECIFIC ULCER

Section 9: Medical Sciences ZHANGELOVA SHOLPAN BOLATOVNA Candidate of Medical Sciences, Associate Professor, Professor of the Department of Internal Diseases 2, ALMUKHAMBETOVA RAUZA KADYROVNA Ph.D., Associate Professor, Professor of the Department of Internal Diseases 2, ZHANGELOVA

OOO "AlexAnn" Veracol Collection Contents 1. Toxicological studies in vivo...2 2. The study of the effectiveness of the drug Veracol in gastroenteritis of dogs and cats 3 3. The study of the effectiveness of use

Dysbacteriosis (from other Greek δυσ, a prefix that denies the positive meaning of the word or reinforces the negative one, and “bacteria”) is a qualitative change in the normal species composition of bacteria (microbiota) of the intestine

Colon Cancer Prevention What is Colon Cancer? The large intestine is the part of the digestive system where the by-products of digestion of nutrients from food accumulate. total length

E. A. Trestyan, D.S. Zenkova THE PROBLEM OF PEN AND THE STRUCTURE OF ITS CAUSES ACCORDING TO THE DEPARTMENT OF THE GEB OF THE 4TH DGKB Supervisor Cand. honey. Sciences, Assoc. O. N. Nazarenko Department of propaedeutics of childhood diseases, Belarusian

3.0.013 Department of Surgical Hepatology FPO Clinical case Lesson 9. Antibiotic-associated diarrhea Clinical case Patient M. Age: 66 years. Position: Lecturer at the University of St. Petersburg.

CLINICAL LIVER DISEASE PHARMACOLOGY AND BILE TRACTS clinical pharmacology of liver and biliary tracts REFLUX DISEASE Akhmedov V.A.

Kondyurina E.G., Zelenskaya V.V. EXPERIENCE WITH THE USE OF COMPLIVIT-ACTIVE IN CHILDREN OF PRIMARY SCHOOL AGE Novosibirsk State Medical Academy, Polyclinic Department 2 Children's Clinical Hospital 4 Presentation

Www.printo.it/pediatric-rheumatology/en/intro KAWASAKI DISEASE Version 2016 2. DIAGNOSIS AND TREATMENT 2.1 How is this condition diagnosed? The diagnosis of CD is a clinical diagnosis (i.e. diagnosis

BILARY TRACT DYSKINESIA: DIAGNOSIS ISSUES Fedorova D.D., Turchina M.S. Federal State Budgetary Educational Institution of Higher Education "Oryol State University. I.S. Turgenev” Orel, Russia BILIARY DYSKINESIA: PROBLEMS OF DIAGNOSIS

MV Pavlovets CHARACTERISTICS OF THE COURSE OF GASTROESOPHAGEAL REFLUX DISEASE DEVELOPING ON THE BACKGROUND OF OR DUE TO BRONCHIAL ASTHMA Supervisor Cand. honey. Sciences, Assoc. O. N. Nazarenko Department

MINISTRY OF HEALTH OF UKRAINE VGUZU "Ukrainian Medical Dental Academy" "Approved" at a meeting of the Department of Internal Medicine 1 Head of Department Associate Professor Maslova A.S. Protocol 17

SABAL-PROSTATE Introduction Benign prostatic hypertrophy (BPH) is the most common disease in men over 50 years of age, and its frequency increases with age. Many

Differential diagnostic signs of abdominal pseudotuberculosis and acute appendicitis Symptoms Abdominal pseudotuberculosis Acute appendicitis Epidemiological data More often in spring,

EARLY PREVENTION OF COLORECTAL CANCER Examination of stool for occult blood. New standard Fob Gold new screening standard Fecal occult blood test FOB quantitative immunoassay

FEDERAL STATE BUDGETARY EDUCATIONAL INSTITUTION OF HIGHER EDUCATION "AMUR STATE MEDICAL ACADEMY" OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION Fund of appraisal funds

Perfiliev Yu.I., Letifov G.M., Yakovlev A.A., Starovoitov Yu.Yu., Volkov A.S., Stolyarova I.G. The effectiveness of SCENAR therapy in the complex treatment of socially significant diseases of the digestive system Rostovskiy

Annotations of the academic discipline "B1.B.39.1 Faculty Therapy" of the direction of training specialists 31.05.01 General Medicine Discipline of the curriculum for training specialists in the direction 31.05.01. Medical

Guidelines for the management of inflammatory bowel disease in children (short version) Purpose of the clinical guideline: List of the Working Group on Adaptation of the Clinical Guidelines: Reviewers to provide

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS I APPROVE First Deputy Minister R.A. Chasnoit January 13, 2009 Registration 087-0908 ALGORITHM FOR DIAGNOSTICS OF INFLAMMATORY AND ONCOLOGICAL DISEASES

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS Pinevich 2015 e "t isrational 006-0115 ALGORITHMS FOR DIAGNOSTICS AND SECONDARY MEDICAL PREVENTION

Educational Institution "Belarusian State Medical University" Department of Polyclinic Therapy TOPIC: Diseases of the esophagus (GERD), stomach (functional dyspepsia, chronic gastritis, peptic

Union of Pediatricians of Russia Union of Pediatricians of Russia Science Center children's health First Moscow State Medical University. THEM. Sechenov Russian Research Medical University

Analysis of the statistical reporting form 61 “Information on the population of patients with HIV infection” in the Volga Federal District for 2014 Based on the data of the annual statistical form 61 “Information on the population of patients with HIV infection”

Www.printo.it/pediatric-rheumatology/en/intro Periodic Fever C Aphthous Stomatitis, Pharyngitis, Lymphadenitis (PFAPA) Version 2016 1. WHAT IS PFAPA 1.1 What is it? PFAPA is an abbreviation that

Www.printo.it/pediatric-rheumatology/en/intro JUVENILE SPONDYLOARTHRITIS/ENTHESITIS ASSOCIATED ARTHRITIS (SPA-EAA) Version 2016 2. DIAGNOSIS AND TREATMENT 2.1 How is this condition diagnosed? Doctors

Pirogov Russian National Research Medical University Department of Hospital Pediatrics A case of aberrant pancreas (choristoma) in a child with typical shape celiac disease

State Institution "Institute of Gastroenterology" of the Ministry of Health and social protection population of the Republic of Tajikistan "APPROVED" Director of the State Institution "Institute of Gastroenterology" of the Ministry of Health and Social Protection of the Republic of Tajikistan Azimova

Clinic, diagnosis and treatment of toxocariasis in children. T.A. Piskun, N.I. Yakimovich 1st Department of Children's Diseases, Belarusian State Medical University According to WHO, helminthiases rank 4th in terms of the degree of damage to public health

RUSSCO Working Group Project on Maintenance Therapy: Individualization of maintenance therapy (correction of anemia, neutropenia and administration of osteomodifying agents) PRACTICAL RECOMMENDATIONS FOR TREATMENT

T. E. Polunina Candidate of Medical Sciences, Institute for Advanced Studies of the Federal Directorate of Biomedical and Extreme Problems under the Ministry of Health of the Russian Federation, Moscow, Clinical Gastroenterology Cycle.

QUESTIONS FOR INTRODUCTION TESTS UNDER THE PROGRAM OF TRAINING SCIENTIFIC AND PEDAGOGICAL PERSONNEL IN POSTGRADUATE STUDIES IN THE DIRECTION OF TRAINING 31.06.01 CLINICAL MEDICINE 1. The concepts of "health" and disease. Quality

AA Starchenko, AD Plaksa Cholelithiasis: Fundamentals of Conservative and Surgical Treatment in Children and Adults Supervisor: Cand. honey. Sciences, Assoc. O. N. Nazarenko Department of propaedeutics

REVIEW of the official opponent of the doctor of medical sciences, professor Abdulkhakov Rustam Abbasovich for the dissertation work of Stepina Ekaterina Alexandrovna “Clinical and laboratory indicators of endothelial function

Ministry of Health of the Russian Federation State Budgetary Educational Institution of Higher Professional Education Izhevsk State Medical Academy PROGRAM SUMMARY

Www.printo.it/pediatric-rheumatology/en/intro PAPA-Syndrome Version 2016 1. WHAT IS PAPA 1.1 What is it? The acronym PAPA stands for pyogenic arthritis, pyoderma gangrenosum, and acne. This is genetically determined

Functional disorders of the gastrointestinal tract in children Abstract Abstract: Biliary dyskinesia. any chronic pathology gastrointestinal tract (especially inflammatory), rational therapy functional

Responsible executors: -Demikhov Valery Grigorievich, Doctor of Medical Sciences, Professor, Director Dmitry Rogachev" of the Ministry of Health of Russia - Morshchakova Valentina Fedorovna MD, Deputy

Clinical study of the therapeutic efficacy of the drug in the treatment of superficial pyoderma in dogs. Clinical testing of the drug took place in August-November 213 on the basis of a veterinary clinic

State budgetary educational institution of higher professional education "Smolensk State Medical University" of the Ministry of Health of the Russian Federation Pediatric

Expression of CD68, FasL and COX-2 in the colon mucosa in IBD in the formation of therapy programs and prognosis of malignant growth A.V. Santimov Department of Hospital Pediatrics 2015 State of the problem

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS Minister Pinevich 2012 226-1212 ALGORITHM OF DISPENSARY SUPERVISION FOR VIRAL HEPATITIS instructions for use INSTITUTIONS-DEVELOPERS: Institution

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS I APPROVE First Deputy Minister R.A. Chasnoyt May 6, 2010 Registration 136-1109 DIAGNOSTICS AND CHEMIOPROPHYLAXIS OF LATENT TB

Onco check-up Onco check-up Onco check-up is a program aimed at identifying the early stages and latent forms of certain types of cancer for people who have not previously been diagnosed oncological diseases

Ministry of Health of the Russian Federation Form 6 Saratov State Medical University "APPROVED" Head. Department of Children's Infectious Diseases, prof. Mikhailova E.V. 200 METHODOLOGICAL DEVELOPMENT

4, 2010 Information Ministry of Health and social development Russian Federation Order No. 415n dated June 2, 2010 On approval of the Procedure for rendering medical care population with diseases of the gastroenterological

Www.printo.it/pediatric-rheumatology/en/intro SCHENLEIN-HENOCH PURPLE Version 2016 1. WHAT IS SCHENLEIN-GENOCH PURPLE 1.1 What is it? Henoch-Schönlein purpura (HSP) is a disease in which

Reactive arthritis (Reiter's syndrome) Reactive arthritis (Reiter's syndrome) section: Children's infectious diseases, date: 11/19/2015,

THE PROBLEM OF GLUTEN ENTEROPATHY (CELIAC) IN DAGESTAN E.M. Esedov, F.D. Akhmedov department hospital therapy 3 DHMA The essence of the concept Celiac disease (gluten-sensitive enteropathy) is a chronic disease

SELECTED SECTIONS OF DIAGNOSIS AND TREATMENT... 609 DIAGNOSIS AND CONSERVATIVE THERAPY OF ULCERATIVE COLITIS Gorgun Yu. V., Portianko AS, Marakhovsky Yu. Kh. Ulcerative (UC) belongs to the group of chronic inflammatory

Thematic plan for Practical classes in outpatient therapy for 6th year students of the PF for 11-12 semesters 2016-2017 academic year N2 Scope of p/p Theme and its content in hours 1. The main sections of the practical

Federal State Budgetary Educational Institution higher education"Smolensk State Medical University" of the Ministry of Health of the Russian Federation (FGBOU VO SSMU

M. A. Deryusheva, A. E. Shimanskaya CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF MEASLES IN MINSK IN 2014 Academic Supervisors: Art. teacher O. A. Gorbich, Ph.D. honey. sciences, assistant. N. V. Solovey Department of Epidemiology,

Ulcerative colitis: diagnosis and conservative therapy Gorgun Yu.V., Port Yanko A.S. Belarusian Medical Academy of Postgraduate Education, Belarusian State Medical University of Ulcerative

Although the prevalence of ulcerative colitis is not high, there is a regular increase in cases. Over the past 4 decades, the number of people with this disease as a percentage of healthy people has increased by more than 6 times.

Let's define terms. Ulcerative colitis is chronic illness large intestine with immune inflammation of the mucosa. Only the large intestine is affected, while the rectum is limited to inflammation of the mucous membrane.

Exacerbation or recurrence of the disease - the occurrence of symptoms in remission.

In non-specific ulcerative colitis, clinical recommendations boil down to the fact that in order to treat the disease, surgical intervention, drug treatment, psychological support for the patient, and diet are used.

The severity of relapse determines the choice of a specific method of therapy. The following factors also influence:

the length of the affected area of ​​the intestine; duration of history; existing extraintestinal manifestations; the risk of complications; the effectiveness of previous therapy.

To assess the severity of recurrence, various parameters are used, including the Mayo index.

The Mayo index is equal to stool frequency + the presence of rectal bleeding+ data of endoscopic examination + general opinion of the doctor. All these parameters are indicated in numerical form - each digital code indicates a certain degree of severity.

Ulcerative colitis in children: types, symptoms and treatment

Babies get sick with ulcerative colitis quite rarely (15 people out of 100), but in recent years such cases have become more frequent. At the same time, in half of them the disease has a chronic form and is treated for a sufficiently long period of time.

Ulcerative colitis in children of different ages is called special form diseases of the colon mucosa. With it, purulent and erosive blood inflammations of unknown origin appear in the indicated organ and interfere with the normal functioning of the gastrointestinal tract. As a result, particles of such formations can come out with the feces of a child. With them, complications may occur local character or covering the entire body.

Varieties of ulcerative colitis in children

There are several varieties of this disease:

Non-specific. Spastic. Crohn's disease. Colon irritation. Undifferentiated.

The first type of the disease does not have a clear location and can manifest itself throughout the mucous membrane of the colon. It should be noted that in children under 2 years of age, ulcerative colitis is more common among boys, and at an older age it is more common among girls. At the same time, it is very dangerous for both the former and the latter, and the course of the disease is usually moderate or severe.

The spastic appearance is manifested by the presence of dry stool in small quantities with spotting, gas and spasmodic pain in the abdomen. It can be cured by eating right. Considered the most mild form diseases.

The third variety can be localized in several places. In this case, wounds-cracks appear, the walls of the large intestine become thicker, pain is felt in the abdomen on the right. After a tissue study, the disease is identified by the resulting granulomas.

For ulcerative colitis with irritation of the large intestine in a child, frequent discharge feces (up to 6 times a day), accompanied by painful sensations. At the same time, food does not have time to be completely digested. First there is a bowel movement in a large volume, and then - little by little. At the first signs of this type of illness, you should seek help from a specialist in order to avoid serious consequences and prevent it from becoming chronic.

The last type of the disease combines those colitis that are difficult to attribute to any other group according to the results of the tests (1 out of 10 cases). Its symptoms are similar to various of those described above, so it should be treated with sparing drugs, individually selecting them.

Factors that provoke ulcerative colitis in a child

Scientists are still studying the etiology of this disease, but cannot come to a consensus. To date, it is believed that the factors provoking ulcerative colitis are:

Decreased immunity. Improper nutrition. Availability various infections in the body (dysentery bacillus, salmonella, SARS, chickenpox, etc.). Taking certain medications for inflammation. Psychic trauma. Transmission of the disease by genes (the risk of getting sick increases fivefold).

Each of the above reasons possible factor, which can provoke the development of the disease.

The main symptoms of ulcerative colitis in children

Depending on what symptoms are manifested by ulcerative colitis of the intestine in children, treatment is prescribed a certain kind diseases. In a child, the disease usually progresses rapidly, therefore, in order to avoid surgical intervention, it is necessary to see the first signs of the disease without wasting time to contact a specialist. That is why it is very important to know how this disease manifests itself in a particular case in order to be able to diagnose it as soon as possible and begin to treat it, preventing it from flowing into a chronic form and the occurrence of various complications.

The main symptoms of ulcerative colitis of the colon in children are:

Diarrhea (stools up to 6-10 times a day) or constipation. Blood discharge from the anus and in the stool. The feces do not have clear shapes, come out with mucus or purulent secretions. Constant general fatigue of the child. Sudden weight loss. Significant decrease in appetite. Colic in the stomach. Pain in the abdomen or around the navel. Dysbacteriosis.

During the frequent urge to defecate, only liquid with mucus and blood comes out. Due to frequent bowel movements, irritation, itching, cracks appear in the anus. As a result of a decrease in the number of bifidobacteria in the intestine, the work of other internal organs.

One of the symptoms of ulcerative colitis of the intestine in children of different ages is pale skin of the face with bruises under the eyes. She loses healthy look, acquiring a grayish-greenish tone. Rashes appear, sometimes dermatitis, in severe forms of the disease, abscesses may occur. When listening to the heart, arrhythmia is palpable.

When an ultrasound of the internal organs is prescribed, with this disease, an increase in the liver or spleen may be observed. The gallbladder and ducts are affected.

Symptoms of nonspecific ulcerative colitis in young children can be expressed, in addition to these manifestations, also:

Stomatitis. Urticaria. high temperature body (about 38°C). conjunctivitis. Iris redness eye shell. Aches and pains in the joints.

Due to the disease, children may experience a delay in sexual and physical development.

As soon as any of the above symptoms of ulcerative colitis in children have been noticed, it is necessary to immediately consult a doctor for the appointment of treatment. In no case should you self-medicate, because, firstly, an accurate diagnosis is necessary, and secondly, some types of ulcerative colitis in children can develop at lightning speed and even lead to death.

Diagnosis of ulcerative colitis in a child

Diagnosis of ulcerative colitis by a specialist occurs through communication with the patient's parents, identifying complaints. This is followed by the assignment:

General blood test. Studies of feces. Abdominal ultrasound. Sounding. biopsies. Colonoscopy. Sigmoidoscopy. Sigmoscopy. Irrigography (X-ray of the colon).

AT clinical analysis blood, decreased hemoglobin, increased total leukocytes and stab cells, the erythrocyte sedimentation rate in the patient's blood increases. In feces, an increase in the number of leukocytes and erythrocytes, mucus, undigested food is detected.

Treatment and prevention of ulcerative colitis in children

Treatment of ulcerative colitis of the intestine in children is prescribed by a doctor after identifying the reasons why the disease could occur. The disease can be treated in two ways:

In the first case, the baby is prescribed drug therapy with 5-aminosalicylic acid to reduce the inflammatory process in the mucosa (for example, Sulfasalazine), immunosuppressants (Azathioprine). They are available both in tablets and in the form of suppositories. If their impact is not enough, clinical recommendations for ulcerative colitis in children will be glucocorticoid agents ("Prednisolone"), designed to lower local immunity, due to which the body's antibodies will stop responding to the rectal mucosa. If there are contraindications to hormonal drugs, children can rarely be prescribed drugs from the group of cytostatics ("Azathioprine"). The dosage and period of use of these drugs is determined by the doctor on an individual basis and depends both on the age of the child and on the complexity of the form of the disease.

Surgery for nonspecific ulcerative colitis in children as a treatment is possible if the disease worsens too quickly and the drugs do not have the desired effect. In this case, the part of the intestine in which inflammation has occurred is removed, which enables the child to resume normal eating, and sometimes becomes a vital necessity.

Adhere to the necessary dietary medical nutrition. Provide your child with a drink in the form of non-carbonated mineral water and herbal medicinal infusions and decoctions.

In addition to diet (food should be as high in calories as possible), it is important to minimize physical exercise for a child, do not supercool the young body. It is also necessary to protect as much as possible from possible infectious diseases, mental stress and overwork. The doctor may also prescribe vitamins, iron-containing preparations, Smekta, and dietary supplements in addition to therapy.

Prevention of ulcerative colitis in a child is to comply with proper nutrition, complete cure from a variety of infectious diseases, exclusion of contact with carriers of infections. Hardening and charging will also help eliminate the disease. Get exercise and stay healthy!

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2010 (Order No. 239)

Ulcerative colitis, unspecified (K51.9)

general information

Short description

(NUC) is a chronic inflammatory disease of the colon, characterized by ulcerative-necrotic changes in the mucous membrane, which is localized mainly in its distal parts. Changes initially occur in the rectum, then spread sequentially in the proximal direction and in about 10% of cases capture the entire colon.

Crohn's disease- non-specific primary chronic, granulomatous inflammatory disease involving all layers of the intestinal wall in the process, characterized by intermittent (segmental) lesions of various parts of the gastrointestinal tract. The consequence of transmural inflammation is the formation of fistulas and abscesses.

Protocol"Nonspecific ulcerative colitis. Crohn's disease. Ulcerative colitis"

ICD-10 codes: K 50; K 51

K50.0 Crohn's disease of the small intestine

K50.1 Crohn's disease of colon

K50.8 Other varieties of Crohn's disease

K51.0 Ulcerative (chronic) enterocolitis

K51.2 Ulcerative (chronic) proctitis

K51.3 Ulcerative (chronic) rectosigmoiditis

Classification

Classification(depending on the location of the lesion)

Nonspecific ulcerative colitis:

1. By localization: distal colitis (proctitis, proctosigmoiditis), left-sided colitis (damage to the splenic flexure), subtotal colitis, total colitis, total colitis with retrograde ileitis.

2. By form: acute (1 attack), fulminant (fulminant course - fever, hemorrhages, left-sided or total colitis with complications: toxic megacolon, perforations); chronic relapsing; chronic continuous. Chronic form - clinical symptoms over 6 months

3. By phase: exacerbations, remissions.

4. Downstream (severity):

4.1 Lung: stool up to 4 times a day with a slight admixture of blood, fever and tachycardia are absent, moderate anemia, ESR is not higher than 30 mm/h, complications and extraintestinal manifestations are not typical.

4.2 Medium: stools 4 to 8 times a day with clots or bright red blood, subfebrile temperature, tachycardia over 90 bpm, anemia 1-2 tbsp., ESR within 30 mm/h, weight loss up to 10%, complications are not typical, there may be extraintestinal manifestations.

4.3 Severe: stool more than 8 times a day with blood loss over 100 ml, febrile temperature, anemia of 2-3 degrees, ESR over 30 mm/h, severe tachycardia, weight loss over 10%, complications and extraintestinal manifestations are typical.

Diagnostics

Diagnostic criteria BC and NJC

Complaints and anamnesis
Crohn's disease - diarrhea, pain in the right iliac region, perianal complications, fever, extraintestinal manifestations (Ankylosing spondylitis, arthritis, skin lesions), internal fistulas, weight loss.

Nonspecific ulcerative colitis - bleeding from the rectum, frequent bowel movements, constant urge to defecate, stools mainly at night, abdominal pain mainly in the left iliac region, tenesmus.

Physical examination: deficiency of body weight, symptoms of intoxication, polyhypovitaminosis; pain on palpation of the abdomen mainly in the right and left iliac regions.

Laboratory research: accelerated ESR, leukocytosis, thrombocytosis, anemia, hypoproteinemia, hypoalbuminemia, CRP, an increase in alpha-2 globulins, reticulocytosis.

Instrumental Research: colonoscopy, sigmoidoscopy - the presence of transverse ulcers, aphthae, limited areas of hyperemia, edema in the form of " geographical map”, fistulas with localization in any part of the gastrointestinal tract.

Contrast radiography with barium - rigidity of the intestinal wall and its fringed outlines, strictures, abscesses, tumor-like conglomerates, fistulous passages, uneven narrowing of the intestinal lumen up to the "lace" symptom.
With NUC: granulation (granularity) of the mucosa, erosion and ulcers, jagged contours, wrinkling.

Histology (by agreement with parents) - edema and infiltration of lymphoid and plasma cells of the submucosal layer, hyperplasia of lymphoid follicles and Peyer's patches, granulomas. With the progression of the disease, suppuration, ulceration of the lymphoid follicles, the spread of infiltration to all layers of the intestinal wall, hyaline degeneration of granulomas.

Ultrasound - thickening of the wall, decrease in echogenicity, anechoic thickening of the intestinal wall, narrowing of the lumen, weakening of peristalsis, segmental disappearance of haustra, abscesses.

Indications for expert advice:

Dentist;

Physiotherapist;

Surgeon (by indications).

List of main diagnostic measures:

1. Complete blood count (6 parameters).

2. Examination of feces for occult blood.

3. Coprogram.

4. Esophagogastroduodenoscopy.

5. Sigmoidoscopy.

6. Colonoscopy.

7. Contrast radiography with barium.

8. Histological examination biopsy.

9. Determination of total protein.

10. Determination of protein fractions.

11. Coagulogram.

12. Dentist.

14. Physiotherapist.

15. Surgeon (according to indications).

Additional diagnostic studies:

1. Determination of bilirubin.

2. Determination of cholesterol.

3. Determination of glucose.

4. Definition of ALT, AST.

5. Determination of C-reactive protein.

6. X-ray of the stomach.

7. Ultrasound of the abdominal organs.

8. Determination of iron.

9. Colonoscopy.

Differential Diagnosis

Medical tourism

Get treatment in Korea, Israel, Germany, USA

Medical tourism

Get advice on medical tourism

Treatment

Treatment tactics

Purpose of treatment:

Ensuring remission;

Prevention of complications.

Non-drug treatment

Medical treatment

In the treatment of UC and CD, the effectiveness of 5-aminosalicylic acid, glucocorticoids and cytostatics has been proven.

Basic therapy consists in prescribing 5-aminosalicylic acid preparations. Use mesalazine at a dose of 2-4 g / day. predominantly in tablet form or sulfasalazine (2-8 g / day, always in combination with folic acid 5 mg/day). Mesalazine is preferred as it is less toxic and has fewer side effects.

In the presence of perianal lesions, the complex of therapeutic measures includes metronidazole at a dose of 1-1.5 g / day.
Additional drugs (antibiotics, prebiotics, enzymes, etc.) are prescribed according to indications.
Once remission is achieved, patients should receive maintenance therapy with mesalazine or sulfasalazine 2 g/day for at least 2 years.

In case of intolerance to 5-aminosalicylic acid preparations, prednisolone (10-30 mg every other day) is used. Azathioprine is prescribed as maintenance therapy to patients in whom remission has been achieved with its use (50 mg / day).

Preventive actions:

Prevention of bleeding;

fistula prevention;

Prevention of the formation of strictures;

Prevention of purulent-infectious complications;

Prevention of the development of deficient conditions (anemia, polyhypovitaminosis).

Further management: patients with UC and CD are subject to dispensary observation with a mandatory annual visit to the doctor and sigmoidoscopy with targeted biopsy of the rectal mucosa in order to identify the degree of inflammation and dysplasia. Colonofibroscopy with multiple targeted biopsy is performed for total colitis that has existed for more than 10 years. Blood tests and liver function tests are done annually. In remission, patients with UC and CD are prescribed salofalk 0.5 x 2 r for life. in the day or sulfasalazine 1 g x 2 p. in d.

List of essential medicines:

1. Mesalazine 250 mg, 500 mg, tab.

2. Sulfasalazine 500 mg, tab.

3. Prednisolone 0.05, tab.

4. Metronidazole 250 mg, tab.

List of additional medicines:

1. Azathioprine 50 mg tab.

2. Thiamine bromide 5%, 1.0

3. Pyridoxine hydrochloride 5%, 1.0

4. Aevit, caps.

5. Aktiferrin, syrup, drops, tablets

6. Methyluracil, 0.25 tab., suppositories 0.5

7. Duphalac, syrup

8. Dicynon, solution 12.5%, 2.0 ml, tab. 0.250

9. Epsilon-aminocaproic acid, solution 5%, 100 ml

Treatment effectiveness indicators: disappearance of pathological impurities in the feces, relief of abdominal pain, normalization of stool, regression of systemic manifestations.

Hospitalization

Indications for hospitalization (planned):

1. First established diagnosis of UC and CD.

2. Exacerbation of the disease (moderate and severe course, laboratory signs process activity, presence of systemic manifestations).

3. The presence of complications and the risk of developing the activity of the process.

The required amount of research before planned hospitalization:

Complete blood count (6 indicators);

Total protein and fractions, CRP;

Coagulogram;

Sigmoidoscopy, irrigoscopy or colonoscopy;

Fibrogastroduodenoscopy.

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 239 of 04/07/2010)
   1. 1. Guido Adler. Crohn's disease and ulcerative colitis. M., "Geotar - honey", 2001. 2. Management of ulcerative colitis. Society of Surgery of the alimentay tract. 2001. 3. American College of Radiology. Imaging recommendations for patients with Crohn's disease. 2001.4. Clinical guidelines for practicing doctors. M, 2002. 5. Practical gastroenterology for a pediatrician, M.Yu. Denisov, M., 2004 6. Diseases of older children, a guide for physicians, R.R. Shilyaev et al., M, 2002 7. Practical gastroenterology for a pediatrician, V.N. Preobrazhensky, Almaty, 1999

Information

List of developers:

1. Head of the Department of Gastroenterology, RCCH "Aksay", F.T. Kipshakbaeva.

2. Assistant of the Department of Children's Diseases KazNMU named after. S.D. Asfendiyarova, Ph.D., S.V. Choi.

Download: Google Play Store | AppStore

Attached files

Attention!

• By self-medicating, you can cause irreparable harm to your health.
• The information posted on the MedElement website cannot and should not replace an in-person medical consultation. Be sure to contact medical institutions if you have any diseases or symptoms that bother you.
• Choice medicines and their dosage, should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
• The MedElement website is an information and reference resource only. The information posted on this site should not be used to arbitrarily change the doctor's prescriptions.
• The editors of MedElement are not responsible for any damage to health or material damage resulting from the use of this site.

These recommendations were developed by the expert commission of the Russian Gastroenterological Association, Association of Coloproctologists of Russia LLC and the Society for the Study of Inflammatory Bowel Diseases at the Association of Coloproctologists of Russia, consisting of:

ABBREVIATIONS 4

1. INTRODUCTION 4

2. DEFINITION AND CLASSIFICATION OF ULCERATIVE COLITIS 5

3. DIAGNOSTICS OF ULCERATIVE COLITIS 7

4. CONSERVATIVE TREATMENT OF ULCERATIVE COLITIS 10

5. SURGICAL TREATMENT OF ULCERATIVE COLITIS 13

6. FORECAST 18

ABBREVIATIONS

C-rP - C-reactive protein

5-ASA - 5-aminosalicylic acid

6-MP - 6-mercaptopurine

AB - antibiotics

AZA - azathioprine

CD - Crohn's disease

IBD - inflammatory bowel disease

GCS - glucocorticosteroids

CI - confidence interval

IARA - ileoanal reservoir anastomosis

IFM - infliximab

NSAIDs - non-steroidal anti-inflammatory drugs

PSC - primary sclerosing cholangitis

RCT - randomized controlled trial

RRR - irritable reservoir syndrome

LE - level of evidence

UC - ulcerative colitis

1. 1. Introduction

Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), has been and remains one of the most serious problems in modern gastroenterology. Despite the fact that in terms of the incidence of IBD, they are significantly inferior to other gastroenterological diseases, but in terms of the severity of the course, the frequency of complications and mortality, they occupy one of the leading places in the structure of diseases of the gastrointestinal tract all over the world. The constant interest in IBD is primarily due to the fact that, despite a long history of study, their etiology remains unknown, and the pathogenesis has not been sufficiently elucidated 1 2 .

Ulcerative colitis (UC) is a chronic disease that only affects the large intestine and never spreads to the small intestine. The exception is the condition designated by the term "retrograde ileitis", however, this inflammation is temporary and is not a true manifestation of UC.

The prevalence of UC ranges from 21 to 268 cases per 100,000 population. The annual increase in incidence is 5-20 cases per 100,000 population, and this figure continues to increase (approximately 6 times over the past 40 years) 3 .

social significance UC determines the predominance of the disease among people of young working age - the peak incidence of UC falls on 20-30 years, as well as a deterioration in the quality of life due to the chronic process, and therefore frequent inpatient treatment 4 .

These recommendations for the diagnosis and treatment of patients with UC are a guide for practitioners who manage and treat such patients. Recommendations are subject to regular review in accordance with new data scientific research in this region. These recommendations are based on literature data and the European Evidence-Based Consensus for the diagnosis and treatment of ulcerative colitis, which is the leading guideline for the treatment of UC in the countries of the European Union.

These recommendations include the following sections: definition and classification of ulcerative colitis, diagnosis, conservative and surgical treatment. For certain provisions of the recommendations, the levels of evidence are given according to the generally accepted classification of the Oxford Center evidence-based medicine(Table 1).

Table 1. Evidence levels and grades of recommendation based on Oxford Center for Evidence-Based Medicine guidelines 5