Ulcerative, allergic, acute, chronic ... what is colitis in a child and how to treat it? Nonspecific ulcerative colitis in children - features and treatment

The diagnosis of "non-specific ulcerative colitis" given to a child usually confuses parents. It turns out that it is not so easy to understand what kind of illness attacked a precious child, and the doctor’s explanations, full of medical terms, mostly turn into mush in the head.

Let's decipher the cunning abbreviation "NJK" according to the words in order to clarify:

non-specific - means that the cause of the disease or the specific pathogen is unknown;
ulcerative - indicates the state of the intestinal mucosa during illness;
colitis is the medical term for inflammation of the colon.

That is, under the diagnosis of NUC, ulcerative inflammation of the colon mucosa of unknown origin is hidden. Nonspecific ulcerative colitis in children occurs infrequently, and the disease is more typical for boys. The typical age of onset of symptoms is adolescence. Less commonly, children from 3 to 10 years old get sick with colitis.

There are several theories of the origin of the disease, and none of them is exhaustive.

To date, the disease is considered polyetiological, that is, arising from a number of reasons (infections, malnutrition, allergies, enzyme deficiency, stress), as a result of which the immune system begins to work against the host. The reason for the immediate development of colitis can be any infection carried by the child: influenza, tonsillitis, dysentery.

Symptoms of nonspecific ulcerative colitis in children

With vivid symptoms, children's gastroenterologists have no doubts. In cases where the disease is mild or non-ulcerative, the diagnosis is not so simple. To make a diagnosis, specific laboratory and instrumental studies are carried out. At home, trying to recognize NUC and attempting to treat it is not worth it. The best help for a child is to see a doctor.

There is a triad of symptoms typical for ulcerative colitis.

In this case, the clinical manifestations of each of the symptoms may vary depending on the severity of the course:

Diarrhea. The frequency of urge to stool is from 4 to 20 times.
Blood in the stool. From small streaks in mild cases to a thin, fetid bloody mass with pus and mucus in severe cases.
Stomach ache. Occur before a bowel movement or during a meal. Localized in the lower abdomen (often on the left) or around the navel, by nature - cramping.
Additional symptoms are loss of appetite and body weight, general weakness, fever up to 38°C and anemia.

ATTENTION! There may be complications

Nonspecific colitis in a child can be complicated. The most common systemic complications are:

pain in the joints;
rashes on the skin and mucous membranes;
hepatitis;
eye inflammation.

Local, that is, localized in the intestine, complications in children rarely occur:

haemorrhoids;
intestinal bleeding;
fistulas and abscesses of the rectum.

Treatment of nonspecific ulcerative colitis in children

Therapy is aimed at obtaining a stable remission.

Treatment of non-specific ulcerative colitis in children consists of anti-inflammatory (Sulfasalazine) and immunomodulatory (Azathioprine) therapy. The drugs are taken both in the form of tablets, and, for example, in case of damage to the lower intestines, in the form of suppositories. In particularly difficult cases, treatment with glucocorticoids (Prednisolone) is allowed, the duration and dose of which are prescribed individually in accordance with the age of the child and the severity of the disease.

Nutrition for nonspecific ulcerative colitis in children

A diet for nonspecific ulcerative colitis in children is prescribed from the very beginning of treatment and for a long time.

The bulk of the diet consists of high-calorie and easily digestible foods rich in protein: lean meats, cream, fish, rice porridge, white bread or crackers.

Pickled foods, citrus fruits, whole milk are excluded from the diet.

Pasta, sweet flour products are limited as containing carbohydrates to prevent gas formation.

Polyetiological disease of the colon, accompanied by its inflammatory-dystrophic changes. Colitis in children occurs with abdominal pain, nausea, changes in the frequency and nature of the stool, and malaise. Diagnosis of colitis in children includes coprological and bacteriological examination of feces, irrigography, rectosigmoscopy and colonoscopy, endoscopic biopsy of the intestinal mucosa. Treatment of colitis in children largely depends on its pathogenetic form and includes diet therapy, antibacterial and symptomatic therapy, herbal medicine, restoration of normal intestinal microflora.

General information

Colitis in children is an inflammation of the large intestine, characterized by pain and functional disorders of the large intestine. At least 10% of all cases of chronic colitis begin in childhood, so colon diseases, their diagnosis and treatment are one of the most difficult problems in pediatric gastroenterology. Due to the anatomical and physiological features of the digestive system of young children, the inflammatory process, as a rule, proceeds with the simultaneous involvement of the small and large intestines (enterocolitis). In school-age children, an isolated lesion of various parts of the intestine is usually found - enteritis and colitis.

Causes of colitis in children

Acute colitis in children, as a rule, develops against the background of an intestinal infection (salmonellosis, shigellosis, escherichiosis, yersiniosis, food poisoning, rotavirus infection, etc.) and in most cases is combined with acute gastritis, acute enteritis or gastroenteritis. Sometimes the cause of acute colitis in children is individual intolerance to certain food components, gross violations of the diet, and radiation exposure.

Psychogenic factors, vegetative-vascular dystonia in children, aggravated heredity, congenital features of intestinal development (dolichosigma, megacolon), sedentary lifestyle, bad habits in adolescence contribute to the implementation of inflammation of the intestinal mucosa. Secondary colitis in children occurs with endocrine diseases (hypothyroidism, myxedema), diseases of the central nervous system (myasthenia gravis, cerebral palsy).

Classification

Inflammatory changes in the colon may be widespread or limited to one or more segments. In accordance with this, an isolated inflammation of the caecum (typhlitis) is isolated; inflammation of the blind and ascending colon (typhlocolitis); inflammation of the transverse colon (transversitis); inflammation of the transition of the transverse colon to the descending colon (angulitis); inflammation of the sigmoid colon (sigmoiditis); inflammation of the rectum and sigmoid colon (proctosigmoiditis); inflammation of the rectum (proctitis); generalized inflammation (pancolitis).

Based on the endoscopic picture and morphological features, catarrhal, atrophic and erosive-ulcerative colitis in children are distinguished. By the nature of the clinical course of colitis in children are divided into acute and chronic; according to the type of flow - into monotonous, recurrent, progressive, latent; according to the severity of the course - light, moderate, severe.

Depending on the condition of the motility of the colon and the predominant functional disorders of the intestine, colitis is distinguished in children with a predominance of constipation or diarrhea, alternating constipation and diarrhea. In the clinical course of colitis in a child, a phase of exacerbation, clinical remission, clinical endoscopic (histological) remission is distinguished.

The main clinical forms of colitis occurring in children are acute colitis, chronic colitis, ulcerative colitis, and spastic colitis.

Symptoms of colitis in children

Acute infectious colitis occurs against the background of severe toxicosis and exicosis: fever, anorexia, weakness, vomiting. As a result of intestinal spasm, the child is worried about pain in the iliac region, tenesmus. The chair becomes more frequent from 4-5 to 15 times a day; stools are watery, frothy, character; greenish color, an admixture of mucus and streaks of blood. During a bowel movement, rectal prolapse may occur. When examining a child with acute infectious colitis, signs of dehydration are noted: decreased tissue turgor, dry mucous membranes, sharpening of facial features, oliguria.

Chronic colitis in children has an undulating course with alternating exacerbations and remissions. The main clinical manifestations of colitis in children are pain and impaired stool. Pain is localized in the navel, right or left iliac region; have a whining character; occur after eating, worse during movement or before defecation.

Stool disorder in chronic colitis in children can be expressed by diarrhea, constipation, or their alternation. Sometimes there is an increase in the urge to defecate (up to 5-7 times a day) with the release of feces of a different nature and consistency (liquid, with mucus or undigested food, "sheep" or ribbon-like feces, etc.). Constipation in children, followed by hard stools, can lead to anal fissures and a small amount of red blood in the stool.

Children with chronic colitis complain of bloating and distension of the abdomen, rumbling in the intestines, increased gas discharge. Sometimes in the clinic of colitis in children, psychovegetative disorders dominate: weakness, fatigue, irritability, sleep disturbance, headache. The long course of colitis in children can lead to a delay in weight gain and growth, anemia, hypovitaminosis.

Chronic colitis in children requires differentiation from celiac disease, cystic fibrosis, intestinal dyskinesia, chronic appendicitis, enteritis, diverticulitis, Crohn's disease.

Diagnostics

The diagnosis is based on the data of the anamnesis, clinical picture, physical, laboratory, instrumental (X-ray, endoscopic) examination.

In the study of blood in children suffering from colitis, anemia, hypoalbuminemia, and a decrease in the level of electrolytes in the blood serum are detected. A coprological examination reveals the presence of leukocytes, mucus, steatorrhea, amylorrhea, and creatorrhea in the feces. Bacteriological examination of feces makes it possible to exclude the infectious nature of acute and chronic colitis in children. An analysis of feces for dysbacteriosis, as a rule, demonstrates a change in the microbial landscape of the intestine due to an increase in opportunistic agents - staphylococci, proteus, candida.

An endoscopic examination of the intestine (colonoscopy, rectoscopy) in children often reveals a picture of catarrhal colitis: the mucous membrane of the colon is hyperemic, edematous; lymphoid follicles are enlarged; a large amount of mucus, petechial hemorrhages, vulnerability of the mucosa upon contact are found. Endoscopic biopsy of the intestinal mucosa and morphological examination of the biopsy contribute to the differential diagnosis of various forms of colitis in children.

In order to clarify the degree and severity of inflammation in colitis in children, irrigography is performed. To study the functional state of the colon, a barium passage x-ray is performed.

Treatment of colitis in children

Treatment of colitis in children is aimed at eliminating the pathogen, restoring bowel function, preventing relapse or exacerbation. In all cases of colitis in children, a mechanically and chemically sparing diet is prescribed: weak broths, mucous decoctions, steam dishes, omelettes, cereals, kissels. Therapy of acute infectious colitis in children is carried out according to the rules for the treatment of intestinal infections (antibiotic therapy, oral rehydration, taking bacteriophages, enterosorbents, etc.).

In chronic colitis in children, in addition to therapeutic nutrition, the intake of enzyme preparations (pancreatin), prebiotics and probiotics, enterosorbents, prokinetics (loperamide, trimebutine) is indicated. Antibacterial drugs are prescribed according to strict indications. As part of the treatment of colitis, children are recommended to use mineral water without gas, infusions and decoctions of medicinal herbs. If necessary, the complex of therapeutic measures includes IRT by a pediatric gastroenterologist. Preventive vaccinations are allowed during the period of persistent remission of chronic colitis in children.

Newborn babies are often victims of various diseases. In the infancy period, although the child has already been born, his internal organs are still being formed, strengthened and prepared for a new environment.

A very important element in the formation of a full-fledged body is nutrition. Babies under one year of age usually eat breast milk or formula. But at the same time, their body is preparing and slowly trying new food. It is against this background that problems with the digestive system of the baby are very often observed. Colitis is one of the most dangerous diseases. This is an inflammatory pathology that is observed in the large intestine. Infants have features of the passage of this disease: they may be affected by the departments and the small intestine. In addition, it is very difficult for babies up to a year.

What causes colitis in newborns?

Colitis is an intestinal disease that has a dystrophic-inflammatory character. This is a very complex disease, and for young children it is also very dangerous. Often, due to untimely or improper treatment, colitis becomes chronic and torments with its unpleasant manifestations for a long time.

15% of newborns under one year old are diagnosed with this disease. Boys are at risk, this is due to the special hormonal structure. In total, four types of colitis are distinguished; in infants, allergic colitis is manifested in most cases.

There are many reasons for colitis, but specifically in babies up to a year old, it occurs as a result of such factors:

At such a delicate age, colitis develops very quickly and the affected area of the intestine becomes very large. The acute form of the disease is very dangerous for the child's body, so diagnosis and treatment must be carried out urgently.

Parents should carefully monitor the condition of the baby, and if the first symptoms are detected, immediately consult a doctor.

Characteristic signs of colitis in children under one year old:

Digestive disorders: frequent regurgitation, constipation, which alternate with diarrhea;
As a result of the inflammatory process, the body temperature rises;
In the feces, you can see mucus, blood, pus;
Vomit;
Dryness and pallor of the skin and mucous membranes, as a result of dehydration of the child's body.

It is also possible to determine by the state of the child that something is happening. Colitis usually causes pain and discomfort in the intestines. Since the baby cannot report such problems, he often cries, becomes moody, refuses to eat, sleeps poorly.

Such symptoms should be a signal for urgent medical attention.

Diagnosis and treatment of colitis

For infants, colitis can cause the development of other diseases, such as peritonitis. If you do not see a doctor in time, the symptoms become more acute, and it is more difficult to determine the exact diagnosis.

Since colitis is a very dangerous disease, especially for children under one year old, treatment should take place exclusively in a stationary mode. For quick and effective rescue, complex therapy is prescribed, which includes the following measures:

course of antibiotics. The drug and dose depends on the age of the child and the stage of the disease. In addition, the antibiotic is selected after determining the exact pathogen.
special diet. If the baby is completely on, then the mother should give up aggressive foods and foods that can cause allergies. The mixture, with artificial nutrition, should also be chosen hypoallergenic and easily digestible. After six months, the baby can be given liquid low-fat soups, grated cereals, chicken broths. But it is required to exclude fresh vegetables and fruits for a while.
Against the background of colitis may develop. Therefore, for the purpose of prevention, probiotics and sorbents are prescribed. For this age category, Laktiale and Smekta are considered the safest.
Non-steroidal anti-inflammatory and analgesic drugs. Often used in the form of droppers. This method is considered more effective and safer.

Treatment requires calmness and patience. During this period, you should not give the baby to try new foods, so as not to cause an exacerbation. Also, do not panic if the child refuses food, then his damaged intestines are not yet ready.

For prevention purposes, doctors recommend eliminating all allergenic foods from the diet. Also, try small portions of each new food. Particular attention should be paid to the hygiene of the baby and his behavior. For example, if your child shoves everything in his mouth, then you need to ensure the cleanliness of all his toys and things that surround him. Do not let your child play with keys, money, telephone and other things that are often found in public places.

Alternative medicine also has several methods in its arsenal. First of all, various decoctions based on honey and propolis are used to treat colitis. But these foods can cause severe allergies. Therefore, doctors do not recommend resorting to such methods in the treatment of children under one year old. In such cases, you need to be careful in choosing the method of therapy, because we are talking about the health of the child.

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 a special form of disease 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. Together with them, complications of a local nature or covering the entire body are possible.

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 feces in small quantities with bloody secretions, gases and spasmodic pain in the abdomen. It can be cured by eating right. It is considered the mildest form of the disease.

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 fecal excretions (up to 6 times a day), accompanied by painful sensations, are characteristic. 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 sign 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.
Wrong nutrition.
The presence of various infections in the body (dysenteric bacillus, salmonella, etc.).
Taking certain medications for inflammation.
Psychic trauma.
Transmission of the disease by genes (the risk of getting sick increases fivefold).

Each of these reasons is a possible factor that 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, the treatment of a certain type of disease is prescribed. 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.
Feces do not have clear forms, 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.

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 may change.

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. It loses its healthy appearance, acquiring a grayish-greenish tone. Rashes appear, in some places, 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:

Urticaria.
High body temperature (about 38 ° C).
Redness of the iris.
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:

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

In a clinical blood test, there is a reduced hemoglobin, an increase in the total number of leukocytes and stab cells, and an increase in the erythrocyte sedimentation rate in the patient's blood. 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:

Medically.
Operatively.

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.
Give the child a drink in the form of non-carbonated mineral water and herbal medicinal infusions and decoctions.

In addition to the diet (food should be as high-calorie as possible), it is important to minimize physical activity for the child, not to overcool 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, Smecta, and dietary supplements in addition to therapy.

Prevention of ulcerative colitis in a child consists in maintaining proper nutrition, complete recovery from a variety of infectious diseases, and avoiding contact with carriers of infections. Hardening and charging will also help eliminate the disease. Get exercise and stay healthy!

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It appears relatively rarely and accounts for less than 15% of the total age-specific incidence rate.

Both boys and girls can get sick with colitis equally. But, nevertheless, at an early age, boys get sick more often, and in adolescence, girls.

The reasons.

Reasons leading to ulcerative colitis in children, have not yet been fully elucidated. It is believed that ulcerative colitis develops as a result of the vital activity of pathogenic microorganisms (staphylococci, salmonella) or allergies to certain foods (eggs, citrus fruits, milk). In recent years, more and more doctors are leaning towards the autoimmune theory, which is based on the attack of the immune system and the production of antibodies to the proteins of the intestinal mucosa.

Symptoms of overt colitis in children

In most cases ulcerative colitis It is determined by three main symptoms: abdominal pain, diarrhea, the presence of blood and mucus in the stool.

Cramping pains in the lower abdomen or in the navel occur after eating or immediately before the act of defecation. Depending on the severity of the colitis, the frequency of stools can be up to 20 times a day. With a mild course of colitis, single streaks of blood are observed in the stool, and with a severe one, bloody loose stools with a fetid odor are observed. There is an increase in temperature up to 38 ° C, the child refuses to eat, becomes lethargic and indifferent to everything.

Complications. As a rule, local complications in the form of profuse bleeding, rupture of the intestine at the site of the formed ulcer, or degeneration of the ulcer into cancer, are not observed in children. But, there is a high risk of infection spreading and damage to other organs:

eye - episcleritis,

skin - erysipelas,

liver - hepatitis,

pancreas - pancreatitis,

from the circulatory system - anemia, etc.

Treatment of childhood ulcerative colitis

Successful treatment is based on drug therapy and a strict diet, and alternative treatment serves as their complement.

Medical treatment includes the appointment of anti-inflammatory drugs "Sulfasalazine" and immunosuppressants "Azathioprine". These drugs are available not only in the form of tablets, but also in the form of suppositories for lesions of the lower sections of the large intestine. In severe cases, glucocorticoids "Prednisolone" are prescribed. The dose and duration of taking medications is selected strictly individually, depending on the age of the child and the severity of the disease.

Diet for ulcerative colitis in children is prescribed from the very beginning of treatment and should be followed for a long time. Milk, citrus and pickled foods are excluded from the child's diet. The main emphasis is on protein-rich, easily digestible and high-calorie foods: lean meats, cream, fish, rice porridge, white bread or crackers. To prevent gas formation, carbohydrates are limited (pasta, sweet flour products).

During the period of remission, you can use proven folk remedies.

Potato juice will help normalize the intestinal microflora. It is necessary to rub the potatoes on a fine grater and squeeze out half a glass of juice. Give your child a drink 30 minutes before meals. Ordinary black tea can be replaced with wild strawberry leaf tea. Pour half a tablespoon of leaves with a glass of boiling water.