Nonspecific ulcerative colitis: the current state of the problem.

Treatment. The problem of treatment of nonspecific ulcerative colitis is far from being resolved.

Radical surgical treatment of nonspecific ulcerative colitis, which consists in total colectomy or resection of the affected part of the colon, is carried out according to very strict indications and is recommended by most surgeons only in the absence of the effect of conservative therapy (I. Yu. Yudin, 1968; Sh. M. Yukhvidova and M . X. Levitan, 1969).

Conservative therapy of nonspecific ulcerative colitis is based on knowledge of the individual links of its pathogenesis and the main symptoms of the disease and should be individualized.

Treatment of an exacerbation is carried out, as a rule, in a hospital and sets itself the task of obtaining an immediate positive effect, i.e. achieving remission during the course of the disease or a significant improvement in the patient's condition. During the period of remission, systematic dispensary observation and maintenance therapy in outpatient settings to prevent exacerbation of the disease.

In the history of conservative treatment of ulcerative colitis, two periods are distinguished: the era before steroid therapy and the era of steroids. Indeed, the inclusion of steroid hormones in the arsenal therapeutic agents expanded the possibilities of conservative treatment of this disease (V. K. Karnaukhov, 1963; S. M. Ryss, 1966; Sh. M. Yukhvidova and M. X. Levitan, 1969; Korelitz et al., 1962). However, the use of steroid hormones did not completely solve the problem of treating ulcerative colitis: firstly, steroids do not give a positive effect in all cases; secondly, the positive effect of this exacerbation does not exclude subsequent exacerbations; thirdly, long-term use of steroid hormones can lead to serious complications. These circumstances, as well as the excessively widespread use of steroid hormones without clear indications for this, caused negativism in relation to the use of steroids in ulcerative colitis.

In the question of steroid therapy for nonspecific ulcerative colitis, one should not take extreme points of view: only steroids or a complete rejection of steroids. Our position on this issue can be formulated as follows: it is desirable to do without the use of steroid hormones, but if necessary, they should be prescribed for long periods, choosing those doses and methods of administration that are most rational in this particular case.

The most rational two-stage conservative treatment of nonspecific ulcerative colitis: Stage I - therapy without the use of steroid hormones, which all patients receive; Stage II - steroid therapy against the background of ongoing stage I therapy.

Stage I therapy, i.e. without steroid hormones, includes a number of activities and drugs:
1. A diet with a predominance of proteins (boiled meat and fish) and a restriction of carbohydrates, fats and fiber. In the acute period, patients receive a mechanically and chemically sparing diet. Unleavened milk is completely excluded, lactic acid products (two-day kefir and cottage cheese) are allowed if they are well tolerated. As the exacerbation subsides, cereals, fruits and vegetables are added to food in boiled, and later - raw. In patients with damage to the left part of the colon and a tendency to constipation, dried fruits (prunes, raisins) are added to the diet. In the remission phase, the diet is further expanded taking into account the individual characteristics of the patient, but the amount of carbohydrates remains limited in order to reduce fermentation processes and to avoid their sensitizing effect.
2. Desensitizing and antihistamines are used daily during the entire period of exacerbation (diphenhydramine or suprastin 2-3 times a day), as well as during remission, but in smaller doses (only at night). Salicylates can also be used as desensitizing agents, but for a shorter period (1-2 weeks) due to the fear of side effects.
3. Vitamins are administered constantly in large doses *: A, E, vitamin C, B vitamins (primarily B12, B6, folic acid), vitamin K. This requirement is due to a decrease in their content in food with a strict diet and a violation of the synthesis by intestinal microflora while increasing demand.
4. Means stimulating reparative processes are used only in acute stage diseases, their use in the remission phase not only does not prevent, but can accelerate the onset of exacerbation. At severe forms diseases, severe bleeding, anemia, blood transfusions are preferred. Transfusion of canned blood is performed in 100-250 ml with an interval of 3-4 days up to 5-8 times. In the absence of these indications, aloe or Filatov's serum is used for blood transfusions for 2-3 weeks. With the defeat of the distal segment of the rectum, a good effect is given by the local use of metacil (methyluracil) in suppositories for 1-2-3 weeks (until complete epithelialization of erosions in the sphincter area).
5. Bacteriostatic agents are used to suppress secondary infection. The best effect (reduction and disappearance of purulent deposits on the surface of the mucous membrane and abscesses of crypts and follicles) gives the use of per os sulfonamides (etazol, ftalazol, sulgin 4.0 g per day), enteroseptol and mexaform (4-8 tablets per day) . It is necessary to take into account the sometimes occurring intolerance to enteroseptol.

Salazopyrin (asulfidine) has a successful combination of antibacterial and desensitizing effects. Inclusion of it in a complex of other measures gives a positive effect in cases of mild and moderate severity. Often there is intolerance to the drug (dyspepsia, leukopenia), which does not allow the use of large doses. With good tolerance, salazopyrin is prescribed 1.0 g 3-6 times a day for 2-3 weeks, upon reaching a clear positive effect, the dose is reduced to 2.0 g per day, and the use of the drug can be continued for several months in outpatient clinics. conditions to prevent recurrence of the disease.

The use of antibiotics in nonspecific ulcerative colitis is contraindicated, as they cause a restructuring of the intestinal microflora, aggravating dysbacteriosis, and give allergic reactions.

Only topical application of furatsilin in the form of drip enemas from 300-500 ml of a 1: 5000 solution is justified. An allergic reaction to furatsilin is also possible, but is extremely rare.

The indication for the use of broad-spectrum antibiotics administered parenterally is only the development of sepsis.
6. Drugs that normalize the intestinal microflora, like colibacterin, are not very effective in the acute phase. The use of colibacterin in the phase of subsiding exacerbation (2-4 doses per day) and in the remission phase allows some patients to prevent exacerbation or mitigate it.
7. Therapeutic enemas can be used in cases where there is no violent inflammation of the rectal mucosa with severe bleeding.

In the presence of abundant purulent discharge, the above-described enemas from a solution of furacilin are used. In the absence of a pronounced secondary infection and lethargy of reparative processes, microclysters from fish oil or rosehip seed oil give a positive effect. The addition of Shostakovsky's balm, according to our observations, does not increase the effectiveness of fish oil enemas.

In 50-60% of cases, the above-described conservative therapy (stage I) has a positive effect, i.e., the exacerbation subsides, and remission occurs.

The indication for stage II therapy, i.e., the inclusion of steroids against the background of stage I therapy, is: 1) absence. a clear positive effect from therapy without steroids for 3-4 weeks; 2) the rapid course of the disease with high fever, profuse bleeding, total damage to the colon, i.e., cases of an acute form of the disease, where expectant management is impossible; 3) individual experience in relation to this patient, based on previous hospitalizations, in which therapy without steroid hormones was ineffective (Fig. 43).

Rice. 43. The ratio of the frequency of various indications for the use of steroid therapy.

Hatching in the grid - no effect from the 1st stage of therapy; vertical - acute course of the disease; horizontal - previous use of steroid hormones; without shading - previous clinical experience in relation to this patient.

The main contraindication to the use of steroids is the prospect of the need for surgical intervention, since healing against the background of steroid therapy surgical wounds slows down sharply. Hypertonic disease, peptic ulcer and diabetes are relative contraindications to steroid therapy. If necessary, this therapy should apply an appropriate "cover" from antihypertensive drugs, vicalin, diet and limited to topical steroids (in the form of an enema).

Doses and routes of administration of steroid hormones depend on the clinical features of the disease. The dose of steroid hormones should be as small as possible, since they are used for a very long time. In cases of moderate severity, a dose of 15 mg should be started, in more severe cases, with 20-25 mg of prednisolone or an adequate amount of another drug. In the absence of a therapeutic effect after 5-7 days, the dose is increased by another 5 mg. In this way, the minimum dose that gives a clear therapeutic effect is gradually determined. Usually 20 mg is enough, but in some cases the effect is obtained only from 35-40 mg. This dose is prescribed to the patient for the period necessary to achieve a state close to remission, in most cases it is 1-3 weeks. Then the dose of steroids is gradually reduced by 5 mg over 5-10 days, amounting to 5-10 mg per day by the time of discharge from the hospital. The total duration of the use of steroid hormones in a hospital in most cases is 1-1.5 months, but in some patients it reaches 3-4 months. Upon discharge from the hospital, the patient continues to take the minimum maintenance dose of steroids (2.5-5.0 mg of prednisolone) for 2-3 months.

When choosing a method of administering steroid hormones, one should first of all take into account the extent of the colon lesion. With a left-sided process, therapeutic enemas give a good effect. The emulsion is administered drip with 100-300 ml of saline. The effective dose of hydrocortisone is in most cases 60 mg (1/2 bottle), but often it has to be increased to 125 mg (1 bottle). When a positive effect is achieved, the dose is reduced. The introduction of steroids in the form of a therapeutic enema is fundamentally the most beneficial, since it creates a sufficient concentration of the drug in the lesion with a small overall effect on the body. The introduction of steroids per clismam is not advisable in cases of total damage to the colon, as well as when it is impossible to hold an enema for a long time.

The most common is the use of tablet preparations of steroid hormones, as it is technically simple and the drug is easily dosed, which is especially important for long-term outpatient steroid use. It should be borne in mind that with this method of administration, the risk of unwanted side effects of steroids increases.

Of the tablet preparations with an equal effect, prednisolone, dexamethasone, triamcinolone can be used. In cases of long-term use of steroids, a positive effect of changing the drug is sometimes observed.

Of the methods of parenteral administration, intramuscular (hydrocortisone) and intravenous (prednisolone) are used. Intramuscular administration hydrocortisone in severe cases of total damage is more effective than taking oral tablets, but debilitated patients may develop abscesses at the injection site of the emulsion, so long-term use of this method of administration is undesirable. Intravenous drip administration of prednisolone is advisable in severe cases.

A combination of various methods of administering steroid hormones is rational. So, with insufficient effect from therapeutic enemas, simultaneous parenteral administration or oral administration of tablets can be added. The methods of administration of steroid hormones can be changed during the treatment of the patient: after receiving a clear positive effect from hydrocortisone enemas (with a left-sided process) or parenteral administration (with a total lesion), they switch to giving a tablet preparation, which is then continued on an outpatient basis as anti-relapse therapy.

The above-described complex conservative therapy in the patients we observed in 90% of cases gave a positive effect: removal of exacerbation phenomena with improvement in the patient's condition or the onset of clinical remission. It should be emphasized that obtaining a direct positive effect does not guarantee against the onset of another exacerbation of the disease. On our material, the duration of remission in 2/3 of cases does not exceed 1/2-1 year. Continuation of anti-relapse therapy after discharge from the hospital prolongs the remission phase.

Although the success of conservative therapy does not solve the problem of curing ulcerative colitis, it can reduce the need for colectomy.

Question about indications surgical treatment nonspecific ulcerative colitis is decided jointly by the therapist and surgeon. Absolute reading to urgent surgical intervention are complications such as perforation, toxic dilatation syndrome, profuse bleeding. The indication for planned colectomy is a continuous course or a recurrent form with frequent exacerbations that are not amenable to conservative therapy ***.

* Dosage of vitamins: vitamin A - 100,000 IU, or 30-40 mg per day, orally or rectally; vitamin E - 100 mg intramuscularly, ascorbic acid - 500 - 1000 mg parenterally; folic acid - 10-20 mg; vitamin B12 - 200 u daily or 400 u every other day intramuscularly; vitamin B6 - 50-100 mg parenterally; thiamine - 50 mg parenterally; riboflavin 0.1-0.2 inside x 3 or 0.012-0.015 parenterally; vitamin K orally at 0.015 X 3 pro die for a week or intramuscularly in a 0.3% solution in doses of 60-90 mg pro die for 3-5 days. Ascorbic acid, thiamine, vitamin B6, riboflavin, pantothenic acid is recommended to be administered intravenously in 500 ml of 5% glucose solution by drip or jet method.
** According to the action, 5 mg of prednisolone are adequate: 4 mg of triamcinolone, 0.75 mg of dexamethasone, 20 mg of hydrocortisone, 25 mg of cortisone.
*** Domestic monographs by A. A. Vasiliev (1967), I. Yu. Yudin (1968), Sh. M. Yukhvidova and M. X. Levitan (1969) are devoted to the issues of surgical treatment of nonspecific ulcerative colitis.

Nonspecific ulcerative colitis - serious problem gastroenterology, as its etiology remains unknown and no specific treatment is currently available.

T.D. Zvyagintseva, Doctor of Medical Sciences, Professor, S.V. Gridnev; Kharkiv Medical Academy of Postgraduate Education

The relevance of the problem of nonspecific ulcerative colitis (NUC) today is not in doubt, given the variety of mechanisms for the development of the disease, as well as the lack of effectiveness of the means of drug correction used, which often leads to the development of serious complications and permanent disability of the patient. Along with this, in terms of prevalence and social significance, UC occupies one of the leading places among diseases of the digestive system, has a relapsing course and an unfavorable medical and social prognosis.

Nonspecific ulcerative colitis is a chronic inflammatory disease with ulcerative-destructive changes in the mucous membrane of the rectum and colon, characterized by a progressive course and complications (narrowing of the intestinal lumen, perforation, bleeding, sepsis, etc.)

Etiology and pathogenesis

To date, there is no consensus on the causes and mechanisms of development of NUC. There are various theories of the occurrence of NUC: viral, genetic, as well as the influence of various allergic reactions, as a result of which antibodies to the elements of the colon mucosa appear; a defect in the protection of the mucous membrane - a violation of its integrity due to the destruction of mucus by bacterial sulfatases; smoking (non-smokers or those who have stopped smoking get sick 4 times less often than smokers); connection with the removal of the tonsils, appendix (appendectomy before the age of 20 is considered a protective factor for UC).

Clinic

The symptomatology of the disease depends on the prevalence of the lesion, but always correlates with its severity. The leading symptom of UC is common liquid stool with an admixture of blood and mucus, bleeding is the most constant sign of NUC.

Massive bleeding in UC is rare, since large vessels are usually not damaged, but prolonged blood loss quickly leads to the development of anemia.

Diarrhea is noted, more often in the evening and at night, although it is not an obligatory symptom of NUC. Tenesmus may be disturbing - urgent painful urges to defecation in the form of "spitting" of blood and mucus, a feeling of incomplete emptying of the intestine.

The pain syndrome is not typical for UC, some patients note unclear discomfort in the lower abdomen, others have cramping pains localized in the left iliac region before defecation. In most patients, asthenic syndrome is expressed in the form of weakness, malaise, increased fatigue, decreased performance; poor appetite is noted, body weight decreases.

An objective examination often shows pallor of the skin and mucous membranes, an increase in pulse rate, and an increase in body temperature. The abdomen is swollen, pain on palpation indicates a pronounced inflammatory process in the colon. If the inflammatory process is limited to the mucous membrane of the colon, then the abdomen may be painless. On examination anus often reveal swelling and maceration of the perianal zone.

In severe UC, water-electrolyte disorders develop with dehydration, severe weakness, impaired muscle tone.

Certain criteria are used to assess the severity of NUC (Table 1).

Intestinal complications of UC

There are intestinal and extraintestinal complications of UC (Table 2). Local complications of NUC include anal fissure, paraproctitis; the appearance of extensive perianal manifestations should alert the physician regarding Crohn's disease.

Terrible complications are massive bleeding, toxic dilatation and perforation of the colon, which occur as a manifestation of hormonal resistance (ineffectiveness of therapy with high doses of corticosteroids) or under the influence of subjective iatrogenic factors: late diagnosis, inadequacy of conservative therapy, invasive studies of the colon in severe exacerbation colitis and others. The incidence of intestinal bleeding is 1.5-4%, toxic dilatation and perforation - 5-6%.

It should be noted that perforation on the background of massive corticosteroid therapy may occur with an erased clinical picture. The only symptoms sometimes are malaise, tachycardia, weakening bowel sounds. Abdominal and horizontal x-rays usually show free gas in the abdomen.

Acute dilatation of the colon is established when a patient with a severe attack of UC has an expansion of the transverse colon of more than 5-6 cm in diameter with loss of haustration. This complication can be provoked by hypokalemia, it is characterized by continuous diarrhea, massive bleeding, septicemia. The patient's abdomen is usually swollen, the loops of the colon have a doughy consistency due to a sharp decrease in tone, palpation is accompanied by splashing noise.

In some patients, pseudopolyposis is formed as a result of a severe attack. Inflammatory polyps are the result of overgrowth granulation tissue, which is subsequently covered by epithelium. They vary in shape and size, but are usually less than 1.5 cm long. Inflammatory polyps can be pedunculated, non-pedunculated, or "bridged" and are not considered precancerous and may regress.

Frequent exacerbations of NUC lead to a narrowing of the intestinal lumen, while the formation of fistulas, inflammation of the pelvic tissue, and thromboembolism are possible.

Patients with UC in childhood have a high risk of malignant transformation. It has been established that the incidence of colon cancer in patients with UC is 7-10 times higher than in the general population. At chronic course NUC cancer develops at the beginning of the second decade of the disease in approximately 3% of patients, among those ill for more than 20 years - in 17.8%, more than 30 years - in 30%.

Extraintestinal complications of UC

NUC is often accompanied by extraintestinal complications from the liver, skin, eyes, joints, spine, nephritis, amyloidosis, phlebitis, pericarditis, stomatitis, glossitis may develop.

Erythema nodosum is manifested by multiple painful and inflamed nodules on the anterior surface of the legs that occur in the midst of an exacerbation. Changes appear on the trunk or limbs as sterile pustules that open to reveal confluent ulcers. Necrosis progresses, captures fatty tissue and muscles. Pyoderma gangrenosum responds poorly to therapy.

Arthritis is characterized by an asymmetric distribution, large joints(knee, shoulder, ankle, elbow, wrist). They become hot to the touch, swollen. There are no erosions of intra-articular surfaces, inflammatory changes are resolved in the state of remission of the patient.

An extraintestinal complication from the liver is sclerosing cholangitis, it is detected in 4-5% of patients with UC, almost all patients with sclerosing cholangitis (70-90%) are diagnosed with UC. Chronic inflammation in the intrahepatic and extrahepatic bile ducts leads to cholestasis and cirrhosis of the liver. In 33-50% of patients with UC, fatty hepatosis of the liver is detected, in 1-5% - chronic autoimmune hepatitis, due to metabolic changes in 30% of patients with UC - gallbladder calculosis.

Diagnostics

The diagnosis of NUC is established on the basis of the clinical picture, clinical and biochemical blood tests, fecal examinations, sigmoidoscopy or colonoscopy, histological assessment of biopsy specimens, irrigoscopy.

In a clinical blood test, hypochromic or microcytic anemia, leukocytosis, elevated ESR, shift leukocyte formula left; in biochemical analysis - an increase in the level of α 2 - and γ-globulins (in the acute onset of the disease), a decrease in the content of albumin in the blood as a result of its increased exudation into the intestinal lumen. With the progression of the disease, the concentration of potassium, calcium, sodium, chlorine, magnesium, cholesterol, albumin decreases, signs of metabolic acidosis may appear, and a slight transient increase in the level of transaminases is observed.

AT last years there have been reports of another marker of autoimmune inflammation - β 2 -microglobulin, which is produced by lymphocytes, is associated with the major histocompatibility complex and has immunoregulatory properties. It has been established that the concentration of β 2 -microglobulins in NUC increases in accordance with the degree of activity of the inflammatory process in the colon.

duck fecal analysis detects (or excludes) intestinal infections (Salmonella, Shigella, Campylobacter, Clostridium difficile, Yersinia). In immunocompromised patients, one should make sure that there is no cytomegalovirus, herpes viruses, Mycobacterium avium-intracellulare. Keep in mind the infection caused by E. coli(strain O157), especially in the acute onset of the disease, severe pain and blood loss.

Endoscopic examination is carried out for all patients, sigmoidoscopy is considered the most diagnostically valuable study in UC.

With sigmoidoscopy, the condition of the mucous membrane of the rectum and sigmoid colon is assessed. In the initial period of the disease, hyperemia, edema and granularity of the intestinal mucosa, vulnerability, a tendency to bleeding, and single erosions are noted. With a moderate course, the mucous membrane becomes velvety, the vascular pattern disappears, contact and spontaneously bleeding ulcers appear. Severe UC is characterized by large ulcers covered with purulent exudate, which can cause massive spontaneous bleeding. In the future, cicatricial changes in the intestinal wall appear (ulcerative-destructive colitis). Inflammatory polyps, narrowing of the rectal ampulla, and developing strictures reflect severity and chronicity pathological process.

During colonoscopy, the extent of the lesion and the degree of inflammatory changes in various segments of the colon are assessed. Colonoscopy is not a mandatory diagnostic procedure for UC. It can be useful for elucidating the extent of the pathological process, as well as for the differential diagnosis of pseudopolyps and colon cancer.

Biopsy is one of important components confirmation of the diagnosis. With its help, infiltration of the mucous membrane with leukocytes, the formation of crypt abscesses, and a decrease in the number of goblet cells are determined.

Irrigoscopy is inferior in informativeness endoscopic methods studies in the diagnosis of minimal changes. Most early sign UC, detected with double contrasting, is a fine granularity of the mucosa, the line of which becomes uneven. As the severity of the process increases, the mucosa thickens, acquires a wavy appearance, and the surfaces of the ulceration are well traced. Deep ulcers give the impression that the mucosa is literally "pierced with nails." Reveal polypoid formations (pseudopolyps). In patients with a long history, haustration disappears, the intestine narrows and shortens, eventually acquiring the shape of a hose - a symptom of the "water pipe".

To diagnose the disease, the terminal department must be examined ileum, which is often unchanged, however, in patients with a total lesion of the colon, ulceration of the mucous membrane or expansion of the lumen of this section of the small intestine is often detected, in contrast to the narrowing characteristic of Crohn's disease. During the period of remission of UC, partial or complete reversibility of radiological signs of the disease can be observed.

Benign narrowing of the colon develops in 5-10% of patients with UC, they are associated with hypertrophy of the muscularis mucosa.

The presence of a malignant stricture is indicated by fuzzy boundaries of the pathological process, irregular contours, the presence of a dense tapering ring, etc.

AT recent times for the diagnosis of UC, radionuclide methods are used (immunoscintigraphy with technetium-labeled monoclonal antigranulocytic antibodies). One of the modern diagnostic methods is capsule endoscopy.

Differential Diagnosis

In the course of the differential diagnosis, first of all, Crohn's disease (Table 3), bacterial, ischemic, pseudomembranous colitis, and colon tumors should be excluded.

Of great importance is the differential diagnosis with endophytically growing tumors of the colon (cancer, lymphoma), diffuse familial polyposis, in the recognition of which colonoscopy with multiple biopsy is of decisive importance.

Features pseudomembranous colitis, which has a very similar clinical, endoscopic and histological picture with UC, is associated with antibiotic therapy and recovery after discontinuation of antibiotics and the appointment of vancomycin.

Ischemic colitis, which develops as a result of atherosclerotic lesions of the inferior mesenteric artery, has a picture similar to UC, however, its development in the elderly, pain in the left side of the abdomen, constipation, the presence of vascular noise over abdominal part aorta, the absence of symptoms of intoxication characteristic of an inflammatory disease, diarrhea.

Treatment

Treatment of UC includes: complex therapy of exacerbations, supporting anti-relapse therapy during remissions, timely surgical treatment in the absence of the effect of therapeutic treatment and in the event of life-threatening complications, treatment of postoperative patients.

The complexity of the therapeutic treatment of NUC is due, on the one hand, to the possible resistance of the patient's body to treatment, on the other hand, to the side effects of drugs and their intolerance by patients. In addition, the need to constantly purchase expensive drugs imposes a serious financial burden on patients, so they often do not take the necessary drugs to maintain remission due to their unaffordability.

A patient with UC is, first of all, recommended physical and mental rest. Medical nutrition provides diet No. 4 (with high content protein - 130-150 g / day), restriction of fats in the diet (55-60 g / day), carbohydrates (250-400 g / day) with maximum limit fiber, exclusion of dairy products.

In severe cases of the disease, slag-free foods (nutritional mixtures) containing short- and medium-chain fats, easily digestible proteins that quickly dissolve in water are added to the diet.

In the medical treatment of NUC, drugs are used that affect:

the course of the inflammatory process;
immunological reactivity of the organism;
correction of metabolic disorders;
normalization of absorption processes in the intestine;
restoration of intestinal eubiosis.

The basis of adequate medical treatment is right choice drug (correspondence of the drug to the stage of activity of the inflammatory process), selection of the most effective dose and duration of treatment, allowing to evaluate the effectiveness of therapy.

Currently, the following main groups of drugs are used: sulfasalazine and 5-ASA preparations, corticosteroids, immunosuppressants.

Sulfasalazine is prescribed 1-2 tablets (0.5-1 g) 4-6 times / day every 6 hours (maximum dose - 6-8 g / day), then - 3-4 tablets / day; the maintenance dose is 1.5-2 g / day for 2-4 months. With left-sided localization of UC, sulfasalazine is used in microclysters (1.5-3 g) in the evening.

The advantage of 5-ASA preparations (salofalk, mesalazine, pentasa) over sulfasalazine is that they do not contain sulfapyridine, which causes side effects.

Salofalk (the active substance is mesalazine) is coated with an enteric coating of Eudragit, due to which the drug dissolves in the terminal ileum and is active in the large intestine. It is used 1 tablet (0.5 g) 4 times / day with a gradual decrease in dose to 2 tablets per day; the maximum dose of salofalk is 3 g / day; course of treatment - 5-6 weeks. Salofalk is used in microclysters (4 g), suspensions (2 and 4 g), suppositories (0.25-0.5 g) - 1-3 times / day, in granules (0.5-1 g) - 1-3 times/day

Pentasa is 5-ASA encapsulated in an ethylcellulose shell that dissolves in the colon. Apply 2 tablets (1 g) 4 times a day every 6 hours, in the future - 3 tablets per day, as well as in suppositories (1 g) - 1-2 times a day.

With insufficient effect of 5-ASA drugs, as well as in the treatment of severe forms of UC, along with 5-ASA drugs, local corticosteroids are used: budesonide, beclomethasone dipropionate, fluticasone dipropionate, thixocortol, and systemic (prednisolone, methylprednisolone, hydrocortisone, dexamethasone, polcortolone).

Budesonide is a topical corticosteroid that is minimally absorbed from gastrointestinal tract, has a local effect on the mucous membrane, a high concentration of the drug is created in the intestinal lumen. Budesonide is rapidly metabolized through the liver. It has a higher bioavailability compared to prednisolone, has a high affinity for glucocorticoid receptors. Systemic absorption of the drug is negligible. Apply 1 capsule (3 mg) 2-3 times a day.

Hydrocortisone is administered intravenously up to 200 mg/day, prednisolone - intravenously 1 mg/kg for 5-7 days, then the patient is transferred to oral prednisolone 1 mg/kg with a gradual decrease in dose and its withdrawal within 3-4 days. months.

To stop inflammation in the rectum, suppositories with prednisolone 5 and 10 mg 1-2 times a day are prescribed. Enemas with hydrocortisone 50-100 mg or prednisolone 20-30 mg per 70-100 ml of water are administered once at night so that the enema reaches the sigmoid and descending colons.

In 35% of patients with UC, a steroid-resistant or steroid-dependent course is observed. According to foreign authors, only 49% of patients treated with steroid hormones for the first time have a prolonged response, 22% develop steroid dependence, and 29% need colectomy due to resistance to treatment.

Immunosuppressive drugs used to treat UC include: azathioprine - 2.5-4 mg / kg per day for 2-4 months; cyclosporine - in / in 4 mg / kg or in tablets 10 mg / kg; methotrexate - tablets 0.005 g, 10-25 mg per day. With prolonged use of immunosuppressants, severe side effects (leukopenia, pancreatitis) are possible, and the risk of malignant diseases increases.

Some authors (W.Y. Chey et al., 2001) recommend the use of the recombinant drug infliximab, which is a chimeric monoclonal IgG antibody to tumor necrosis factor α (TNF-α), for UC. Data from multicenter studies on the efficacy and safety of infliximab in UC showed a significantly higher rate of clinical, endoscopic response and remission in patients treated with the drug, compared with the placebo group. Infliximab has also been shown to be effective in Crohn's disease. Infliximab is currently being registered for use in UC.

In severe cases (anorexia, vomiting, fistulas, intestinal obstruction, toxic megacolon), parenteral nutrition is indicated (intravenous drip of amino acids and protein preparations - aminosol-600, -800, human albumin 5-10%, amino blood, blood-substituting solutions). Enter: 70 g of protein per day, glucose - up to 2 liters with insulin, in total - up to 3 liters of liquid.

To normalize the processes of lipid peroxidation and antioxidant protection use of antioxidants.

In the treatment of UC, hemosorption, lymphocytopheresis and lymphoplasmosorption, plasmapheresis are successfully used, which contribute to the removal of toxic products, circulating immune complexes, and correction of immunity. Enteral sorption with polyphepan is used, the course is up to 2 weeks at a dose of 1 g/kg of body weight per day.

Antibacterial therapy is the so-called desperation therapy. Antibiotics are prescribed in case of secondary infection (with the appearance of high fever during therapy with sulfasalazine or prednisone), the presence of purulent complications. Especially antibiotic therapy is indicated for suspected toxic megacolon. Assign ampicillin, pentrexil 0.5-1 g / in or / m every 4-6 hours for 7-10 days; metronidazole 1-1.5 g per day - 7-10 days (metragil 100 mg / day, i.v.); ciprofloxacin - in / in 1 g / day, or 0.75 g 2 times / day per os; amoxiclav - 0.5 g 2 times / day per os; kefzol 0.5-1 g 2-3 times/day IM; klaforan 0.5-1 g 2-3 times / day, i / m; doxycycline 0.2 g per os 1 time / day, subsequently - 0.1 g / day; gentamicin - 0.5-0.8 mg / kg body weight 3 times a day; clarithromycin - per os 0.5 g 2 times a day for 5-14 days; ceftriaxone - in / m 0.5-1 g 2 times a day.

To correct the immunological reactivity of the body, the following are used: thymalin - 0.01% solution i / m, taktivin - 0.01% solution 0.5-1.0 s / c, splenin - i / m or s / c 2-4 ml in day for 10-14 days.

For spastic pains, drugs with an antispasmodic effect are used: dicetel, meteospasmil, spasmomen, duspatalin.

With diarrhea, imodium is prescribed (in drops - 25 drops 1-2 times a day or in capsules of 2 mg 2-3 times a day). Imodium increases intra-intestinal pressure, therefore, due to the danger of toxic dilatation of the intestine, it should be used not in the acute period of the disease, but on final stage treatment.

Preparations with enveloping and antisecretory action: smecta or almagel - 1 package 1-3 times a day, bismuth nitrate 0.5 g 3 times a day before meals.

Antianemic drugs are used (actiferrin - tablets, syrup, drops - 50 drops 3 times a day, tardiferon - 1 tablet 1-2 times a day, sorbifer - 1 tablet 1-2 times a day for 1-3 months, globiron - 1 tablet per day, ferrum lek intramuscularly 2 ml per day), folic acid orally 5 mg per day for 30 days and vitamin B 12 - 200 mcg intramuscularly every other day.

Polyenzymatic preparations: mezim forte 3500, 10,000, pancreatin - 2 tablets 3 times a day, creon - 1-2 capsules 2-3 times a day, pangrol 20,000 - 1-3 tablets 1-3 times a day.

Preparations for the restoration of intestinal microflora: extra bifilakt - 1-2 capsules 2-3 times a day for 3-4 weeks; bifiform - 1-2 capsules 2 times a day for 2-4 weeks; bifidumbacterin - 5 doses 3 times a day, 3-4 weeks; bifikol - 5-10 doses 2-3 times a day, 4-6 weeks; lactobacterin - 5-10 doses 2-3 times a day, 4-6 weeks; colibacterin - 4-8 doses 2-3 times a day, 3-8 weeks; hilak forte - 40-60 drops 3 times a day, 4 weeks; baktisubtil - 1-2 capsules 2 times a day, 2-3 weeks; biosporin - 3-6 doses 2 times a day, 2-3 weeks; lineks - 2 capsules 3 times a day, 2-4 weeks, enterol - 1-2 capsules 2 times a day, 2 weeks.

Sorbents: enterodez - 5 g dissolved in 100 ml of water, 10-14 days; enterosgel - 15-30 g 3 times a day in 30 ml of water, 10-14 days.

Assign microclysters of eikonol, fish oil, oils containing tocopherol (roses, sea buckthorn, wild rose, hypozol, aekol), which have a softening effect.

In a mild form of UC with distal intestinal damage, microclysters with quercetin are used, which have anti-inflammatory, regenerative effects, improve microcirculation.

Surgery

Absolute indications for surgical treatment are intestinal perforation, septic condition associated with acute toxic dilatation of the colon, profuse bleeding.

A relative indication (resection of the colon within healthy tissues) is a progressive relapsing course of UC with repeated massive bleeding, despite complex drug therapy.

Produce colectomy with ileostomy, radical surgery gives a good result. However, if the rectal mucosa remains in situ, the risk of malignancy remains and problems associated with extraintestinal complications remain. Therefore, in patients with severe extraintestinal manifestations, such as advanced liver disease or severe pyoderma gangrenosum, only coloproctectomy leads to their subsidence. Prophylactic colectomy is recommended for patients with UC who have significant dysplasia on multiple biopsies.

Thus, ulcerative colitis is a serious disease with a complex, in many cases, difficult to explain mechanism of development that occurs in people of both young and middle age. Further deep and comprehensive study of this largely mysterious and mysterious disease is required.

The bibliography is under revision.

I have UC for about 5 years. Whereas, like everyone else, I went to special therapy for a couple of weeks. He did prednisolone enemas there, drank sulfasalazine and iron tablets. It all helped, but exactly until the time I left the hospital. I tried to drink an infusion of bergenia rhizome (there are only benefits from it and not a single side effect). It seems to help too. The main thing is to make a strong infusion immediately pour the whole package of the root with boiling water for 1.5 liters. One good day I tried liquid cottage cheese and the blood went again. Here, even badana stopped helping. Last year, in the fall, I had to go to the hospital, because the body was already on the verge, I lost 15 kg. Neither sulfasalazine nor prednisolone tablets helped. When I lay down, I, as usual, underwent all the procedures described above. The stool stabilized, the blood disappeared. But three months later I ate a little liquid cottage cheese and it all started quickly and immediately (blood, diarrhea). All of the above had a temporary effect, side effects (except for bergenia rhizome). I began to look for another way to get rid of the symptoms of exacerbation. I climbed a lot on the Internet, read about everything that they gave me in the hospital from medicines and remembered that they also gave me bifidumbacterin. I read in the indications for use that it helps with intestinal ulcers, but the problem is that I have a completely different disease - NUC. I started looking for an analogue of this pacifier and found it. It's Lactobaccretin! In his testimony, it is written NJAK !!! And what is not unimportant for me is that there are no side effects, except for individual intolerance. I bought it, started taking it as written in the instructions an hour before meals (sometimes, of course, it was not possible to withstand an hour before meals). So I took it for about a month. The blood disappeared, the stool became normal, hard. I slowly stopped taking it and have not taken it for half a month. The day before yesterday, on Victory Day, I sat with a friend and ate a pound of bought venison kebab, drinking vodka and orange juice. Every day I eat like everyone else, the only thing I exclude is all dairy products (milk, cottage cheese, sour cream, cheese, etc.), I try to reduce spicy and pickled dishes. As for the rest, I don't limit myself to anything. I eat everything adding "Sloboda" mayonnaise (it does not contain preservatives) to get better. Porridge with mayonnaise, soup with mayonnaise. I also drink tea after every meal, eating it with five Golden Step sweets, and they contain chocolate, nuts and a lot of other things that seem to be impossible. No lower abdominal pain, no blood, no diarrhea. Returned 10 kg from the lost 15. Conclusion: Of course, everyone has their own characteristics of the body and maybe it only helped me, but I'm sure that you should not take either sulfasalazine or prednisolone or anything else like salofalk for big money during an exacerbation. Prednisolone can only be taken in emergency cases by injecting the solution directly into the colon. I advise you to do this only if there is no Lactobacterin at hand and there is no opportunity to lie down in special therapy for free. But its effect is temporary. The best, most reliable and most importantly harmless and long-lasting effect is given only by Lactobacterin. I myself suffered for about six months, which I just did not try. But best result only from Lactobacterin. Side effects Lactobacterin was not detected, an allergic reaction is possible. It costs Lactobacterin within 200 rubles, in a package of 10 glass cones with dry medicine. Hope my thread helps you. And all the creators of unnecessary expensive sulfasalazine and salofalk burn in hell! Zero point, and a billion side effects. Do not listen to any freaks who want to make money on you and who advise you to buy supposedly a medicine that will cure you for a couple of thousand bucks, or even more. I wish you all recovery from this muck forever. P.S. I myself did not understand at first according to the instructions of Lactobacterin. It's not clear, I agree. But then I realized that 1 capsule just contains 5 doses. That is 10 capsules of 5 doses each. I pour about 15 ml of water, shake and drink. And after an hour (at least half an hour) you can eat. As soon as they wanted to eat, they opened the capsule, poured the entire contents of the capsule with water, drank and eat in an hour. How much you eat per day, so many capsules you take. After a month, you can begin to reduce and take the capsule just before the largest serving. For example, I eat most of the time at lunchtime. I only took it at lunch for the second month. And on the third he stopped altogether. Just in case, I bought a package, but this is just in case I get completely insolent and eat that the thread is sharp, milky or pickled. =)

Yu. Yudin, 1968; Sh. M. Yukhvidova and M. X. Levitan, 1969).

Conservative therapy of nonspecific ulcerative colitis is based on knowledge of the individual links of its pathogenesis and the main symptoms of the disease and should be individualized.

Treatment of an exacerbation is carried out, as a rule, in a hospital and sets itself the task of obtaining an immediate positive effect, i.e. achieving remission during the course of the disease or a significant improvement in the patient's condition. During the period of remission, systematic dispensary observation and maintenance therapy on an outpatient basis are necessary in order to prevent an exacerbation of the disease.

In the history of conservative treatment of ulcerative colitis, two periods are distinguished: the era before steroid therapy and the era of steroids. Indeed, the inclusion of steroid hormones in the arsenal of therapeutic agents has expanded the possibilities of conservative treatment of this disease (V. K. Karnaukhov, 1963; S. M. Ryss, 1966; Sh. M. Yukhvidova and M. X. Levitan, 1969; Korelitz et al. , 1962). However, the use of steroid hormones did not completely solve the problem of treating ulcerative colitis: firstly, steroids do not give a positive effect in all cases; secondly, the positive effect of this exacerbation does not exclude subsequent exacerbations; thirdly, long-term use of steroid hormones can lead to serious complications. These circumstances, as well as the excessively widespread use of steroid hormones without clear indications for this, caused negativism in relation to the use of steroids in ulcerative colitis.

Stage I therapy, i.e. without steroid hormones, includes a number of activities and drugs:

1. A diet with a predominance of proteins (boiled meat and fish) and a restriction of carbohydrates, fats and fiber. In the acute period, patients receive a mechanically and chemically sparing diet. Unleavened milk is completely excluded, lactic acid products (two-day kefir and cottage cheese) are allowed if they are well tolerated. As the exacerbation subsides, cereals, fruits and vegetables are added to food in boiled, and later - raw. In patients with damage to the left part of the colon and a tendency to constipation, dried fruits (prunes, raisins) are added to the diet. In the remission phase, the diet is further expanded taking into account the individual characteristics of the patient, but the amount of carbohydrates remains limited in order to reduce fermentation processes and to avoid their sensitizing effect.

2. Desensitizing and antihistamines are used daily during the entire period of exacerbation (diphenhydramine or suprastin 2-3 times a day), as well as during remission, but in smaller doses (only at night). Salicylates can also be used as desensitizing agents, but for a shorter period (1-2 weeks) due to the fear of side effects.

3. Vitamins are administered constantly in large doses *: A, E, ascorbic acid, B vitamins (primarily B12, B6, folic acid), vitamin K. This requirement is due to a decrease in their content in food with a strict diet and impaired synthesis by microflora intestines with a simultaneous increase in demand.

4. Means that stimulate reparative processes are used only in the acute stage of the disease, their use in the remission phase not only does not prevent, but can accelerate the onset of exacerbation. In severe forms of the disease, severe bleeding, anemia, blood transfusions are preferable. Transfusion of canned blood is performed in 100-250 ml with an interval of 3-4 days up to 5-8 times. In the absence of these indications, aloe or Filatov's serum is used for blood transfusions for 2-3 weeks. With the defeat of the distal segment of the rectum, a good effect is given by the local use of metacil (methyluracil) in suppositories for 1-2-3 weeks (until complete epithelialization of erosions in the sphincter area).

5. Bacteriostatic agents are used to suppress secondary infection. The best effect (reduction and disappearance of purulent deposits on the surface of the mucous membrane and abscesses of crypts and follicles) gives the use of per os sulfonamides (etazol, ftalazol, sulgin 4.0 g per day), enteroseptol and mexaform (4-8 tablets per day) . It is necessary to take into account the sometimes occurring intolerance to enteroseptol.

The use of antibiotics in nonspecific ulcerative colitis is contraindicated, as they cause a restructuring of the intestinal microflora, aggravating dysbacteriosis, and give allergic reactions.

Only topical application of furatsilin in the form of drip enemas from 300-500 ml of a 1: 5000 solution is justified. An allergic reaction to furatsilin is also possible, but is extremely rare.

The indication for the use of broad-spectrum antibiotics administered parenterally is only the development of sepsis.

6. Drugs that normalize the intestinal microflora, like colibacterin, are not very effective in the acute phase. The use of colibacterin in the phase of subsiding exacerbation (2-4 doses per day) and in the remission phase allows some patients to prevent exacerbation or mitigate it.

7. Therapeutic enemas can be used in cases where there is no violent inflammation of the rectal mucosa with severe bleeding.

In 50-60% of cases, the above-described conservative therapy (stage I) has a positive effect, i.e., the exacerbation subsides, and remission occurs.

Rice. 43. The ratio of the frequency of various indications for the use of steroid therapy.

The main contraindication to the use of steroids is the prospect of the need for surgical intervention, since the healing of surgical wounds drastically slows down against the background of steroid therapy. Hypertension, peptic ulcer and diabetes are relative contraindications to steroid therapy. If necessary, this therapy should be applied with an appropriate "cover" of antihypertensives, vicalin, diet, and limited to topical steroids (in the form of an enema).

When choosing a method of administering steroid hormones, one should first of all take into account the extent of the colon lesion. With a left-sided process, therapeutic enemas give a good effect. Hydrocortisone emulsion is administered drip with 100-300 ml of saline. The effective dose of hydrocortisone is in most cases 60 mg (1/2 bottle), but often it has to be increased to 125 mg (1 bottle). When a positive effect is achieved, the dose is reduced. The introduction of steroids in the form of a therapeutic enema is fundamentally the most beneficial, since it creates a sufficient concentration of the drug in the lesion with a small overall effect on the body. The introduction of steroids per clismam is not advisable in cases of total damage to the colon, as well as when it is impossible to hold an enema for a long time.

Of the methods of parenteral administration, intramuscular (hydrocortisone) and intravenous (prednisolone) are used. Intramuscular administration of hydrocortisone in severe cases of total damage is more effective than taking oral tablets, but debilitated patients may develop abscesses at the injection site of the emulsion, so long-term use of this method of administration is undesirable. Intravenous drip administration of prednisolone is advisable in severe cases.

Although the success of conservative therapy does not solve the problem of curing ulcerative colitis, it can reduce the need for colectomy.

The issue of indications for surgical treatment of nonspecific ulcerative colitis is decided jointly by the therapist and the surgeon. Absolute indications for urgent surgical intervention are such complications as perforation, toxic dilatation syndrome, profuse bleeding. The indication for planned colectomy is a continuous course or a recurrent form with frequent exacerbations that are not amenable to conservative therapy ***.

** According to the action, 5 mg of prednisolone are adequate: 4 mg of triamcinolone, 0.75 mg of dexamethasone, 20 mg of hydrocortisone, 25 mg of cortisone.

*** Domestic monographs by A. A. Vasiliev (1967), I. Yu. Yudin (1968), Sh. M. Yukhvidova and M. X. Levitan (1969) are devoted to the issues of surgical treatment of nonspecific ulcerative colitis.

How to cure ulcerative colitis of the intestine?

Ulcerative colitis is a chronic disease in which the colon becomes inflamed and ulcerated. The disease can affect people of any age, but, as medical practice shows, ulcerative colitis of the intestine most often occurs in 15-30 years. This disease is characterized by its own symptoms and methods of treatment.

manifestation of ulcerative colitis

A feature of ulcerative colitis is that different parts of the colon can be affected. In this case, the small intestine always remains untouched.

Usually the disease begins to develop from the lower part of the large intestine - sigmoid colon, or straight. Sometimes, in some patients, a significant part of the large intestine is already affected at the onset of the disease.

Each person suffering from ulcerative colitis of the large intestine manifests the disease differently. The same symptoms in different patients may have different intensity.

The clinical picture in ulcerative colitis of the intestine has three main features:

The onset of the course of the disease may be acute or gradual. Symptoms depend on the nature of the inflammation and its localization in the intestine. Some patients may for a long time ulcerative colitis develops, and the disease manifests itself only with an admixture of blood in the stool.

Others are hospitalized with severe bloody diarrhea, fecal incontinence, very high fever, severe abdominal pain and general weakness.

For extraintestinal manifestations of the disease, symptoms such as:

arthritis;
spondylitis;
iritis, conjunctivitis, blepharitis;
stomatitis;
skin diseases.

At moderate inflammation the pathological process affects only the intestinal mucosa.

In severe forms, inflammation extends to the deeper layers of the intestinal wall.

In the course of the study, specialists manage to notice that the mucous membrane has become edematous, hyperemic, ulcerated.

symptoms of ulcerative colitis

The most specific symptoms of the disease are:

the presence of blood in the feces - occurs in more than 90% of patients, while the amount of impurities may be different;
mucus and pus in the stool;
abdominal pain;
loss of appetite;
diarrhea - occur in 65% of patients;
constipation - occurs in 20% of patients.

With a long course of the disease, patients show signs of intoxication of the body. It is manifested by palpitations, vomiting, dehydration and loss of appetite.

Many patients for the entire period of the course of the disease may have only one attack.

It can be very strong and severe, accompanied by prolonged diarrhea mixed with blood. Joins the diarrhea fever body and sharp pain in a stomach.

Usually, an attack occurs gradually: the urge to defecate becomes more frequent, there are slight spastic pains in the lower abdomen. The occurrence of these signs of ulcerative colitis of the intestine is observed in 2/3 of all patients.

Diagnosis of ulcerative colitis of the intestine

Ulcerative colitis requires differential diagnosis with such diseases:

of paramount importance for differential diagnosis assigned microbiological research feces. In modern gastroenterology, instrumental and laboratory techniques are used to diagnose the disease.

For this, the following studies are carried out:

fibroileocolonoscopy;
histological analysis;
irrigoscopy;
hemogram;
coprogram;
molecular genetic research.

What kind of research to conduct, can only be determined by a specialist.

ulcerative colitis treatment

After confirming the diagnosis, determining the severity and localization of inflammation, the gastroenterologist prescribes the treatment of the disease. It must be carried out under the supervision and control of specialists, self-treatment of such a disease is inappropriate.

The disease is considered serious, it can progress dramatically, causing many unpleasant and even life-threatening symptoms for the patient. Ulcerative colitis is difficult to treat because some patients have resistance to certain drugs before starting therapy, and it can develop over time. This feature of the body can cause the development of many complications.

For mild and moderate forms nonspecific colitis bowel treatment can be done on an outpatient basis. Patients with severe forms of this disease are necessarily in a hospital, where they are constantly monitored by specialists.

A sparing diet becomes mandatory, which must be observed not only during treatment, but it is advisable to adhere to it for the rest of your life.

Drug therapy for ulcerative colitis

Regardless of the stage of the disease, symptomatic treatment ulcerative colitis. Patients are prescribed drugs of the following groups:

products containing 5-acetylsalicylic acid - Salofalk, Sulfasalazine, Pentase;
corticosteroids in the form of tablets and droppers - Hydrocortisone, Prednisolone, Methylprednisolone;
immunosuppressants - Cyclosporine, Azathioprine, Methotrexate.

Treatment of intestinal diseases gives good results when using suppositories, foam, rectal droppers and enemas aimed at eliminating the inflammatory process of the colon. They are able to relieve pain, reduce swelling and inflammation of the mucous membrane.

diet for ulcerative colitis

Dietary nutrition for any diseases of the gastrointestinal tract is an important part of therapy.

In ulcerative colitis, the diet should be based on the following principles:

Elimination of coarse fiber from the diet;
Food must be steamed or boiled;
It is desirable to rub the products on a grater;
Exclusion of chemical irritants of the intestinal mucosa - spicy, salty, canned, pickled foods;
The use of high-protein foods - lean meat, turkey, low-fat river fish, egg white, soy products.

Adhering to a diet for ulcerative colitis can reduce the intensity of symptoms and speed up the healing process.

If you experience unpleasant symptoms that indicate the occurrence of disorders in the activity of the intestines, you should consult a specialist. Only experienced doctors after the diagnosis will tell you how to cure ulcerative colitis of the intestine.

Features of nonspecific ulcerative colitis

Nonspecific ulcerative colitis (UC) is a chronic inflammatory disease of the large intestine. According to the WHO, about 0.4% of the world's population suffers from it. The peculiarity of nonspecific ulcerative colitis is its severe course, poor responsiveness to therapy and unknown reason occurrence.

Reasons for development

Scientists have not yet been able to determine the specific causes of the onset of the development of this incurable disease.

But still, they identify a number of factors that increase the risk of its occurrence:

hereditary factors - in 10% of patients, there is someone from close relatives with this disease;
prone to food allergies;
smoking - UC is twice as likely to occur in heavy smokers;
lack of breastfeeding by the mother in the first six months of life.

UC is an autoimmune process. The body itself begins to produce antibodies, that is, killer cells that usually appear in the blood to fight tumors or infections against its own body.

Clinical picture of NUC

Symptoms depend on the prevalence and severity of the process, as well as the stage of the disease.

If the inflammation is localized only in the rectum (more than 54% of all cases of UC), the symptoms are mild. With a total form, when the entire large intestine is affected, the disease has a severe course.

As a rule, the disease does not begin quickly, but slowly. It is constantly progressing slowly. Only in 5% of all cases, the disease begins acutely, has a fulminant nature, and is characterized by intestinal bleeding, sepsis, and anemia.

Nonspecific ulcerative colitis is manifested by the following symptoms:

an increase in body temperature to subfebrile numbers (up to 38 degrees);
diarrhea with mucus and blood;
urge to defecate;
cramps and pain in the abdomen.

Complications of UC from the intestines

The main complications of the disease are intestinal. Their general characteristics are presented in the table:

A sharp increase in body temperature;
Cutting in abdomen;
Severe pain on palpation of the abdomen.

On the x-ray It can be seen that the diameter of the intestine exceeds 6 cm.

Extraintestinal complications

More than 40% of patients have extraintestinal complications of the disease:

Purulent lesions of the skin and mucous membranes. Develop during an exacerbation. Manifested by purulent stomatitis and pyoderma.
Eye diseases: episcleritis, keratitis, iridocyclitis, retrobulbar neuritis.
joint inflammation: arthritis, ankylosing spondylitis.
Acute diseases of the hepatobiliary system: hepatitis, sclerosing choloangitis, cholangiocarcinoma.
kidney disease: glomerulonephritis, chronic renal failure.
Systemic connective tissue diseases: myositis, vasculitis.
General: anemia, decreased body, lack of albumin in the blood.

Examinations and criteria for making an accurate diagnosis

When collecting an anamnesis, the doctor should first find out the presence of nonspecific ulcerative colitis in relatives.

Examination and palpation of the patient does not make it possible to put accurate diagnosis. On palpation, there will be pain in the lower abdomen. It can be visually seen that the abdomen is slightly enlarged.

To confirm the diagnosis, the following instrumental and laboratory examinations are carried out:

Endoscopic examination of the large intestine with biopsy

If UC is suspected, a colonoscopy is mandatory. It is contraindicated in toxic dilatation. When performing a colonoscopy, the doctor takes a piece of intestinal tissue (biopsy) for morphological study. The laboratory determines the presence of inflammation, the cellular composition of the biopsy. The main signs of NUC during colonoscopy are presented in the table:

Diffuse redness of the intestinal mucosa;
The vascular pattern is not visible on the mucosa;
There are small erosions and small ulcerative areas;
The inflammatory process covers only the rectum.

The presence of hemorrhages under the mucous membrane (petechiae);
Grainy pattern of the mucous membrane;
There are many ulcers on the mucous membrane, the bottom of which is covered with pus and fibrin films.

Inflammation progresses rapidly, it has a necrotizing character.
Multiple purulent exudate.
Pseudopolyps appear on the intestinal mucosa.
The entire large intestine is affected.
Intestinal microabscesses.

Radiography

Increasing the diameter of the intestine;
No fecal shadows;
There are not affected tissue areas;
"Grainy" mucosa.

Pseudopolyps;
Increased intestinal width.

Treatment

Treatment of nonspecific ulcerative colitis includes the following items:

diet is the basis of all treatment;
drug therapy;
surgery.

Since UC is an autoimmune disease, its therapy must be constant and continuous.

The goal of therapy is to prolong the period of remission and avoid new episodes of exacerbation and the spread of inflammation to new areas of the large intestine. It is not yet possible to talk about a complete recovery, since the disease is incurable.

Basic nutritional rules for NUC

Nutrition is as important a component of therapy as medicines.

In severe cases, with exacerbation, food intake is prohibited. You can't even drink water. All the necessary nutrients and liquid are supplied to the body through a dropper. Even drinking water will stimulate the work digestive system and exacerbate the situation.

With light and medium flow, you must constantly adhere to strict rules nutrition.

Lean meat and fish. It can also be used to cook low-fat soups.
Kashi, except for wheat and barley. You can eat pasta.
White bread, biscuit cookies.
Vegetables: potatoes, carrots, tomatoes, zucchini.
Mushrooms.
Boiled eggs. You can also eat a steamed omelet.
Berries, apples. You can eat them raw, cook compotes from them.
Dairy products - no more than 100 grams per day.
Greens: dill and parsley;
Tea and coffee.

All varieties of cabbage, peppers, sorrel, beets, onions.
carbonated water;
Alcohol, including beer.
All products are fried and smoked.

The diet should be compiled, taking into account the need for a large intake of protein foods:

Breakfast: 100 grams of cottage cheese, buckwheat porridge, a cup of black coffee.

Snack: oven baked apple, compote.

Lunch: fish soup with potatoes and carrots, boiled fish and pasta.

Snack: Tea, sandwich with a piece of boiled chicken breast and dill.

Dinner: mashed potatoes and carrots, steamed chicken meatballs.

Medical therapy

Mesalazine- used as basic treatment nonspecific ulcerative colitis. Its dose ranges from 2 to 4 grams per day. The dose depends on the severity of the clinic, the severity of the disease and the presence of an exacerbation. This drug is an antimicrobial and anti-inflammatory agent. It significantly reduces the frequency of exacerbation episodes.
Systemic corticosteroids- are used during an exacerbation. Dose - 1 mg per kilogram of the patient's weight per day. Then gradually the dose of steroids is reduced by 10 mg every two weeks, and when remission occurs, they are gradually completely canceled. For basic therapy, corticosteroids can be prescribed, in the absence of the effect of Mesalazine treatment.
Topical corticosteroids- applied in the form rectal suppositories. The name of the drug is Budesonide. It is used during an exacerbation, starting with a dose of 9-18 mg per day, and then it is slowly reduced. Local forms of corticosteroids are more effective than systemic ones in UC.
Immunosuppressants- is prescribed, with the ineffectiveness of corticosteroids, or with the need for their long-term use. Immunosuppressants suppress immune system thereby reducing the body's production of antibodies against its own cells. Immunosuppressants include the following drugs:
- Azathioprine;
- Cyclosporine;
- Mercaptopurine.
Antibiotics- are prescribed when a purulent infection is attached, and with sepsis. In NUC, the following antibacterial drugs are used:
- Ciprofloxacin;
- Tienam (imipenem);
- Metronidazole.

Surgery

Surgical treatment of the disease is indicated in the development of intestinal complications, or in the absence of a result from drug treatment.

The main indications for surgery are presented in the table:

Nonspecific ulcerative colitis

Non-specific ulcerative colitis (UC) is a chronic inflammation of the colon mucosa that occurs as a result of the interaction of genetic factors and factors external environment and is characterized by exacerbations. For every inhabitant, one person is found, i.e. in 0.1% of the population. By gender, women are affected more often than men. In the English-language literature, the term "ulcerative colitis" is currently used.

Causes of nonspecific ulcerative colitis

1. Genetic predisposition. A family history of colitis or Crohn's disease increases a patient's risk of developing ulcerative colitis. Genes are being studied that are associated with the development of the disease, but the role of only genetic factors has not yet been proven, and the presence of mutations in certain genes does not always cause the development of ulcerative colitis;

2. The risk of developing the disease increases the use of non-steroidal anti-inflammatory drugs for a long time, while short courses of their use are most likely safe;

3. Viruses, bacteria? The role of these factors is unclear to the end and to date there is no evidence. Stress, food allergies (dairy and other products) can provoke the first attack or exacerbation of the disease, but do not play the role of an independent factor in the development of ulcerative colitis. One of the factors in the pathogenesis of the disease are autoimmunization and immunological disorders.

Symptoms of nonspecific ulcerative colitis

diarrhea or mushy stool with an admixture of mucus, pus, blood;
"false", "mandatory" or obligatory urge to defecate;
pain more often in the left side of the abdomen;
feverish conditions, depending on the severity, the temperature rises from 37 to 39 degrees;
appetite decreases;
with a long and severe course of the disease, weight loss is observed;
general weakness;
joint pain;
water and electrolyte disturbances of varying degrees.

There are constitutional features in people with ulcerative colitis: the activity of the pituitary gland is reduced; adrenal glands and altered responses of growth hormone and hormones thyroid gland. Stimulation of the vagus nerve is stressed, resulting in the release of acetylcholine. This causes a violation of the process of contraction of the colon, and can also cause oxygen starvation epithelium and submucosal layer, and as a result - a decrease in the amount of mucus. The resistance of the colon mucosa and the nutritional supply of the obligate microbial flora are reduced. As a result, oxygen starvation of the cells of the gastric mucosa develops, leading to necrosis, with the appearance in the blood of autoantigens to the epithelium of the colon. This causes the spread of the process with all the accompanying manifestations.

For ulcerative colitis, abdominal pain is not characteristic. This usually happens if the visceral peritoneum is involved in the inflammatory process. Complicated by the fact that if the patient develops toxic expansion of the colon, this indicates the onset of perforation of the intestine. This process is due to continuous diarrhea, initial infection of the blood, massive bleeding. At the same time, the stomach is swollen. Palpation of a loop of the large intestine shows a sharp decline tone, palpation is accompanied by splashing noise.

Classification

Varieties of ulcerative colitis and their diagnosis:

1. Nonspecific ulcerative colitis, a sharp exacerbation, average degree gravity. The rectum and sigmoid colon are affected, erosive-hemorrhagic form, period of symptom reduction.

2. Nonspecific ulcerative colitis, an acute form, a rapidly progressive process with complete damage to the colon, bloating of the intestine and a violation of its motor-evacuation function, starting blood poisoning.

3. Nonspecific ulcerative colitis, predominantly inflammation of the lower part of the rectum, erosive-hemorrhagic form with a latent course, a period of remission.

Diagnosis

The definition of non-specific ulcerative colitis is not difficult in most cases.

When diagnosed through sigmoidoscopy, swelling and vulnerability of the rectum are visible. Due to the bleeding of the intestinal wall in the lumen of the intestine, blood and mucus are observed in a significant amount. Sigmoidoscopy is used to set correct diagnosis. Another diagnostic method - colonofibroscopy is performed after a decrease in acute symptoms to clarify the extent of the pathological process. To determine the disappearance of motion food bolus in the direction of the rectum, an x-ray examination (irrigoscopy) is used. The presence of polypoid formations, thickening and unevenness of the intestinal wall, shortening of the intestine itself, narrowing of the lumen with suprastenotic expansion are also determined. By using x-ray examination evaluate the pathology of the process and the severity of the disease. In patients with mild nonspecific ulcerative colitis, the above symptoms may not appear. In cases of long-term observations and information about a patient with a progressive course of radiographic symptoms, there is something in common with a tumor of the colon (the presence of filling defects in pseudopolyposis, narrowing of the lumen). In this case, endoscopic and histological examination is prescribed.

Even in mild cases, laboratory blood tests can reveal increase in ESR and leukocytosis. With the deterioration and progression of the disease, anemia may occur, a shift of the leukocyte formula to the left appears.

In cases of severe course of this disease, the concentration of potassium and calcium in the blood decreases. As a result of developing water and electrolyte disorders with dehydration, impaired muscle tone.

In the acute onset of nonspecific ulcerative colitis, distinct symptoms of intoxication are distinguished - tachycardia, fever, weakness, leukocytosis is observed with a significant shift in the leukocyte count, immunoglobulins in the blood serum. Septicemia is one of the most common symptoms of intoxication that develops with a decrease in the barrier function of the pathologically altered colon.

Treatment of nonspecific ulcerative colitis

With an exacerbation of patients with nonspecific ulcerative colitis, they are hospitalized. The affected part of the intestine is most often removed. In general, treatment is aimed at increasing immunity, fighting infection, and eliminating hormonal disorders.

The increase in protective forces is achieved by blood transfusion, a diet high in protein and vitamins (groups B, E, A, ascorbic acid).

If preliminary complex therapy is ineffective, steroid hormones are prescribed.

To get rid of a secondary infection, anti-infective therapy is prescribed: sulfonamides (sulgin), antibiotics (sigmamycinED 4 times a day), enemas with furacilin (1: 5000).

To promote the epithelialization of the intestinal mucosa, preparations with a high content of vitamins A and E are prescribed (rosehip seed oil, fish oil - locally, in the form of enemas).

Perforations, bleeding, bowel cancer, lack of effectiveness of conservative treatment are indications for surgical intervention.

The polyetiology of the disease makes it difficult to carry out preventive measures.

Since ulcerative colitis is a cyclically occurring chronic disease with alternating periods of remissions and exacerbations of unequal duration, in general, prevention comes down to lengthening the periods of remission and preventing relapses and consists in dispensary observation, hormonal treatment, good nutrition and vitamin therapy.

Diet for non-specific ulcerative colitis

A strict diet is prescribed for nonspecific ulcerative colitis for 1 month after an exacerbation of the disease. A month later, the diet softens, and with full recovery is canceled.

Nutrition for nonspecific ulcerative colitis, as with any type of colitis, is fractional, at least 5 times a day. Dishes should be steamed or boiled, served crushed.

Low-fat varieties of fish, meat, poultry, boiled or stewed. Soup broths are also low-fat and weak.
Any porridge, except for millet and pearl barley.
Vegetarian first courses, incl. mushroom seasoned with any cereals and chopped vegetables.
Pasta.
Non-acidic sour cream (as a seasoning for a dish), fresh cottage cheese, mild cheese, milk (exclusively in dishes), dairy products, unsalted butter.
Eggs in the form of an omelette or soft-boiled.
From vegetables: fried early zucchini and pumpkin, boiled cabbage with oil (cauliflower, white cabbage), potatoes in the form of a casserole or mashed potatoes, cucumbers and tomatoes can be.
Snacks: soaked herring, doctor's sausage, jellied fish or meat, liver pate (beef, poultry), lean ham.
Any fruits and berries, except for plums, melons and apricots. Fresh compotes, mousses, jellies.
Drinks: rosehip broth, tea, coffee on the water with milk or cream.
From spices (limited): peppercorns, bay leaf, onion (boiled), cinnamon.
Stale wheat bread, lean cookies and crackers, limited: pies with meat, rice, jam.

Marinades and smoked meats.
Vinegar, ground pepper, horseradish, mustard.
Radish, radish, swede, sorrel, spinach, raw onion, garlic.

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Hydrocortisone suspension for ulcerative colitis

Instructions for use "Hydrocortisone"

"Hydrocortisone" is used topically or systemically. Outwardly, an ointment is used to heal damaged uninfected skin surfaces. eye ointment and eye drops"Hydrocortisone" reviews are effective in the treatment of allergic conjunctivitis, blepharitis, keratitis and some other diseases. A suspension of hydrocortisone acetate is used intraarticularly for rheumatoid arthritis, carpal tunnel syndrome, subacute and acute bursitis, etc. Hydrocortisone acetate injections are given subcutaneously for lupus erythematosus, toxidermia, lichen planus, etc.

Tablets are used for systemic treatment. suspension, powder for injection. "Hydrocortisone" is prescribed for endocrine disorders, congenital adrenal hyperplasia, adrenal insufficiency, skin diseases, respiratory diseases, allergic reactions, multiple sclerosis. emergency conditions. In emergency conditions, "Hydrocortisone" is used intravenously. Adults are prescribed from 100 to 450-500 ml of the drug or more, depending on the severity of the condition. The highest dose is up to 1,500 mg / day. Intramuscularly "Hydrocortisone" is used in adults in the amount of 125-200 mg per day, in children - 15-30 mg per day.

A suspension of Hydrocortisone is administered intra-articularly and periarticularly: for adults, 3-50 mg, for children from three months to one year - up to 25 mg, from one to six years - 25-50 mg each, for children from six to fourteen years old - 50- 75 mg. Eye hydrocortisone ointment is injected into the conjunctival sac 1-3 times a day. Ointment "Hydrocortisone" should be applied in a thin layer on the skin up to four times a day, no more than three weeks.

Contraindications, side effects of "Hydrocortisone"

"Hydrocortisone" for external and local use is contraindicated in case of hypersensitivity, in a short period after vaccination, with dermatitis near the mouth, with viral, fungal and bacterial diseases of the eyes and skin, with acne vulgaris, rosacea. With caution, the drug is used in the first trimester of pregnancy. during lactation, systemic lesion in tuberculosis. with diabetes. "Hydrocortisone" for external and topical use is contraindicated in children under two years of age.

In systemic treatment, "Hydrocortisone" is prescribed with caution in patients with severe arterial hypertension, with fungal diseases, in postoperative period, with peptic ulcer, diverticulitis. during lactation and pregnancy, with nephritis, renal failure, myasthenia gravis. detailed information about contraindications and side effects of "Hydrocortisone" is given in the annotation to the drug. The drug can be bought at any pharmacy without a doctor's prescription at an affordable price.

Hydrocortisone - instructions for use, reviews, analogues, side effects of the drug and indications for the treatment of allergic and inflammatory diseases in adults and children

The page contains instructions for use hydrocortisone. It is available in various dosage forms of the drug, and also has a number of analogues. This annotation has been verified by experts. Leave your feedback about the use of Hydrocortisone, which will help other visitors to the site. The drug is used for various diseases. The tool has a number of side effects and features of interaction with other substances. Doses of the drug differ for adults and children. There are restrictions on the use of the drug during pregnancy and during breastfeeding. Hydrocortisone treatment can only be prescribed by a qualified doctor. The duration of therapy may vary and depends on the specific disease.

Suspension for injection

Intra- and periarticular.

In one day, you can enter no more than 3 joints. Re-injection is possible subject to a 3-week interval. Injection directly into the joint may adverse effect on hyaline cartilage, so the same joint can be treated no more than 3 times a year.

For tendonitis, the injection should be given into the sheath of the tendon - not directly into the tendon. Not suitable for systemic treatment and for the treatment of the Achilles tendon.

Adults: depending on the size of the joint and the severity of the disease, 5-50 mg intra- and periarticularly. In / m adults, the drug is injected deep into the gluteal muscle at a dose of 125-250 mg per day.

Children: 5-30 mg per day, divided into several doses. A single dose for periarticular administration to children aged 3 months to 1 year: 25 mg, from 1 year to 6 years: 25-50 mg, from 6 to 14 years: 50-75 mg.

For parenteral use. Dosing regimen is individual. Apply intravenously by jet, intravenous drip, rarely - intramuscularly. For emergency therapy, intravenous administration is recommended. The initial dose is 100 mg - 500 mg, then repeated every 2-6 hours, depending on the clinical situation. High doses should be used only until the patient's condition stabilizes, but usually not more than 48-72 hours, because. possible development of hypernatremia. Children - at least 25 mg / kg per day. In the form of a depot form, it is administered intra- or periarticularly at a dose of 5-50 mg once with an interval of 1-3 weeks. Intramuscularly - 125-250 mg per day.

Ointment for external use

Hydrocortisone - indications for the use of a hormonal drug

Hydrocortisone - indications for its use are numerous. Short-term use of this drug is possible with inflammatory and allergic diseases, as well as with immediate-type allergic reactions according to vital indications. In addition, hydrocortisone can be used for some endocrine diseases.

Systemic use of hydrocortisone

For systemic use, this drug is available in the form of tablets for oral administration, suspension for injection and dry matter for solution for injection.

Hydrocortisone / Hydrocortisone

Hydrocortisone is a synthetic glucocorticosteroid drug. It has anti-inflammatory, decongestant, desensitizing, antiallergic, antipruritic effect.

Analogues: Acortin, Hydrocortisone Nycomed, Hydrocortisone-AKOS, Hydrocortisone-POC, Hydrocortisone acetate, Hydrocortisone acetate suspension for injection 2.5%, Hydrocortisone hemisuccinate, Hydrocortisone hemisuccinate lyophilized for injection, Hydrocortisone ointment 1%, Corteid, Cortef, Laticort, Lokoid, Lokoid , Locoid lipocream, Solu Cortef, Solu Cortef, Sopolcort N

Treatment of nonspecific ulcerative colitis

The treatment of nonspecific ulcerative colitis is similar to the treatment of Crohn's disease, therefore, the features of pathogenetic therapy with corticosteroid drugs and sulfonamides are proposed.

Treatment of mild and moderate forms of ulcerative colitis

Sulfasalazine

Mild to moderate forms of ulcerative colitis should be treated with sulfasalazine. If there is no effect, the dose can be increased to 6-8 g per day with the usual therapeutic dose of 3 g / day. In order to avoid recurrence of the disease after the end of taking an increased dose (up to 4 weeks), the dosage of the drug is reduced to maintenance (1.5-0.5 g per day) and the patient receives it for a long time. Side effects of the drug with prolonged use are limited. These include nausea, loss of appetite, headache, leukopenia. In the case of localization of ulcerative colitis on the left, part of sulfasalazine can be used in the form of microclysters. Enemas should be carried out once a day at night.

The drug like salazopyridazine has a similar effect at a dose of 2 g / day. It is prescribed for a duration of 3-4 weeks, then over the next month the dose is gradually reduced to 0.5 g per day.

Treatment with corticosteroids

In the treatment of ulcerative colitis, corticosteroids are the drugs of choice. Apply prednisolone and hydrocortisone or their analogues. Failure to achieve regression acute phase diseases due to sulfasalazine, these drugs are prescribed. They are also used in severe cases of the disease. In this case, the dosage of prednisolone is 40 mg per day for a month. The dosage is determined by the patient's condition, it is halved with a less severe course of the disease, but together with the hydrocortisone microclyster administered simultaneously, 125 IU once a day.

To exclude withdrawal syndrome, it is advisable to prescribe hydrocortisone during a decrease in hormonal therapy.

It is necessary to follow a number of rules while using sulfasalazine and prednisolone: as the dose of prednisolone decreases, it is necessary to increase the dose of sulfasalazine, which, with an optimal ratio hormonal agent should be 1.5-2 g.

When anemia is detected, patients are prescribed iron preparations (Ferrum Lek, Ferroplex, etc.), folic acid 5 mg / day, vitamin B 200 mcg every other day. The course of admission is 30 days.

In the complex of therapy in the treatment of nonspecific ulcerative colitis, drugs used in Crohn's disease and chronic enteritis are also used to eliminate the consequences of the disease, absorption and improve intestinal motility.

Treatment of severe forms of ulcerative colitis

In the case of a severe course of the disease, patients with ineffective treatment need a delayed surgical intervention. As well as patients with repeated heavy bleeding.

Urgent surgical intervention is necessary for intestinal perforation, profuse bleeding, as well as in a septic condition caused by acute toxic dilatation of the colon.

In the case of a progressive recurrent course of ulcerative colitis, a relative indication for surgical intervention (partial excision of the colon within healthy tissues) is necessary, despite the prescribed drug therapy.

There is a need for observation by a gastroenterologist of patients with nonspecific ulcerative colitis. In mild forms of the disease, the ability to work should be limited (contraindicated physical work and work associated with increased neuropsychic stress). With a more severe course of the disease, patients are unable to work.

Disease prevention

All patients, in order to prevent relapses, should consult a gastroenterologist once a quarter to correct drug therapy. With prolonged nonspecific ulcerative colitis, patients are at risk oncological diseases intestines. As a result, during the period of remission of symptoms, they need to monitor the condition of the colon every year through endoscopic and x-ray studies.

Treatment of nonspecific ulcerative colitis - groups of drugs: action and method of application, limitations

Non-specific ulcerative colitis (abbreviated as UC) is a chronic, relapsing inflammatory disorder of the colon, the etiology of which is still being elucidated.

Strategies for the treatment of the disease are primarily aimed at combating inflammation during an exacerbation, as well as maintaining the patient's body during remission.

Development of new biological methods therapy for a debilitating disease continues, scientists are developing drugs for the treatment of ulcerative colitis, which are capable of maximally short term relieve patients of the symptoms of UC.

Medical therapy

Despite the efforts of scientists and the clinical research, there is no a large number of drugs that can cope with the course of nonspecific ulcerative colitis of the intestine.

Drugs that treat UC are prescribed to overcome relapses, control inflammation, and reduce the risk of developing cancer.

The purpose of the drugs depends on the course of the disease. UC can be mild, moderate, or severe. The dosage of medications also varies depending on the severity.

In fact, the success of the treatment of the disease depends on the number medicinal product. Therefore, many different formulations have been developed to determine the effect of the drug on the disease.

Patients with ulcerative colitis have to take a large number of pills to achieve the target effectiveness of drug use. After a decrease in the manifestations, the course of therapy is adjusted, this is also important, because the drugs used in NUC negatively affect other body systems.

Ongoing medical research is being carried out to develop new more effective drugs, they are aimed at improving the available medicines to obtain optimal therapeutic results with maximum safety and minimum side effects for patients suffering from ulcerative colitis in the intestine.

Aminosalicylates or 5-ASA medications

The use of this group of drugs makes it possible to achieve stable remission in 80% of cases of UC.

Aminosalicylates are the most common line of treatment for patients with mild to moderate ulcerative colitis.

5-ASA drugs are considered effective as a treatment for sharp look disease, and for maintenance during remission.

The first drug belonging to this class is Sulfasalazine, which was previously developed for the treatment of rheumatoid arthritis. The drug is metabolized in the colon by bacteriogenic azo reductase to sulfapyridine and 5-aminosalicylic acid (5-ASA), which is the actual biologically active and effective agent. Sulfasalazine can be considered the first drug that has been successfully used for many years to induce remission in patients with mild to moderate colitis. To obtain the proper medicinal effect, you should drink 2-4 pills per day. It is also possible to treat an inflammatory disease with Sulfasalazine suppositories. Candles are injected into the rectum 2 r / day.
Asakol. The drug is contraindicated to take with gastric ulcer, liver or kidney failure, in the last trimester of pregnancy. Asakol in acute course inflammatory disease take 400-800 mg 3 rubles / day, the duration of use is 2-3 months. For the prevention of the disease, it is recommended to take tablets of 400-500 mg 3 times a day.

In addition to oral preparations of 5-ASA, suppositories can also be used (more on this below). Treatment of ulcerative colitis with rectal agents allows you to quickly get rid of the disease.

Corticosteroids

Glucocorticosteroids are intended for patients who have experienced a relapse of the disease.

Medicines of this group are also prescribed to victims who do not respond to 5-ASA or with moderate and severe currents ulcerative colitis of a nonspecific nature.

Their use is limited to remission induction as corticosteroids play no role in maintenance therapy.

The drugs are used topically, orally or parenterally. The method of application depends on the severity of the disease.

Nonspecific ulcerative colitis

Treatment. The problem of treatment of nonspecific ulcerative colitis is far from being resolved.

Conservative therapy of nonspecific ulcerative colitis is based on knowledge of the individual links of its pathogenesis and the main symptoms of the disease and should be individualized.

Treatment of an exacerbation is carried out, as a rule, in a hospital and sets itself the task of obtaining an immediate positive effect, i.e. achieving remission during the course of the disease or a significant improvement in the patient's condition. During the period of remission, systematic dispensary observation and maintenance therapy on an outpatient basis are necessary in order to prevent an exacerbation of the disease.

In the history of conservative treatment of ulcerative colitis, two periods are distinguished: the era before steroid therapy and the era of steroids. Indeed, the inclusion of steroid hormones in the arsenal of therapeutic agents has expanded the possibilities of conservative treatment of this disease (V. K. Karnaukhov, 1963; S. M. Ryss, 1966; Sh. M. Yukhvidova and M. X. Levitan, 1969; Korelitz et al. , 1962). However, the use of steroid hormones did not completely solve the problem of treating ulcerative colitis: firstly, steroids do not give a positive effect in all cases; secondly, the positive effect of this exacerbation does not exclude subsequent exacerbations; thirdly, long-term use of steroid hormones can lead to serious complications. These circumstances, as well as the excessively widespread use of steroid hormones without clear indications for this, caused negativism in relation to the use of steroids in ulcerative colitis.

Stage I therapy, i.e. without steroid hormones, includes a number of activities and drugs:
1. A diet with a predominance of proteins (boiled meat and fish) and a restriction of carbohydrates, fats and fiber. In the acute period, patients receive a mechanically and chemically sparing diet. Unleavened milk is completely excluded, lactic acid products (two-day kefir and cottage cheese) are allowed if they are well tolerated. As the exacerbation subsides, cereals, fruits and vegetables are added to food in boiled, and later - raw. In patients with damage to the left part of the colon and a tendency to constipation, dried fruits (prunes, raisins) are added to the diet. In the remission phase, the diet is further expanded taking into account the individual characteristics of the patient, but the amount of carbohydrates remains limited in order to reduce fermentation processes and to avoid their sensitizing effect.
2. Desensitizing and antihistamines are used daily during the entire period of exacerbation (diphenhydramine or suprastin 2-3 times a day), as well as during remission, but in smaller doses (only at night). Salicylates can also be used as desensitizing agents, but for a shorter period (1-2 weeks) due to the fear of side effects.
3. Vitamins are administered constantly in large doses *: A, E, ascorbic acid, B vitamins (primarily B12, B6, folic acid), vitamin K. This requirement is due to a decrease in their content in food with a strict diet and impaired synthesis by microflora intestines with a simultaneous increase in demand.
4. Means that stimulate reparative processes are used only in the acute stage of the disease, their use in the remission phase not only does not prevent, but can accelerate the onset of exacerbation. In severe forms of the disease, severe bleeding, anemia, blood transfusions are preferable. Transfusion of canned blood is performed in 100-250 ml with an interval of 3-4 days up to 5-8 times. In the absence of these indications, aloe or Filatov's serum is used for blood transfusions for 2-3 weeks. With the defeat of the distal segment of the rectum, a good effect is given by the local use of metacil (methyluracil) in suppositories for 1-2-3 weeks (until complete epithelialization of erosions in the sphincter area).
5. Bacteriostatic agents are used to suppress secondary infection. The best effect (reduction and disappearance of purulent deposits on the surface of the mucous membrane and abscesses of crypts and follicles) gives the use of per os sulfonamides (etazol, ftalazol, sulgin 4.0 g per day), enteroseptol and mexaform (4-8 tablets per day) . It is necessary to take into account the sometimes occurring intolerance to enteroseptol.

The use of antibiotics in nonspecific ulcerative colitis is contraindicated, as they cause a restructuring of the intestinal microflora, aggravating dysbacteriosis, and give allergic reactions.

Only topical application of furatsilin in the form of drip enemas from 300-500 ml of a 1: 5000 solution is justified. An allergic reaction to furatsilin is also possible, but is extremely rare.

In 50-60% of cases, the above-described conservative therapy (stage I) has a positive effect, i.e., the exacerbation subsides, and remission occurs.

Rice. 43. The ratio of the frequency of various indications for the use of steroid therapy.

When choosing a method of administering steroid hormones, one should first of all take into account the extent of the colon lesion. With a left-sided process, therapeutic enemas give a good effect. Hydrocortisone emulsion is administered drip with 100-300 ml of saline. The effective dose of hydrocortisone is in most cases 60 mg (1/2 bottle), but often it has to be increased to 125 mg (1 bottle). When a positive effect is achieved, the dose is reduced. The introduction of steroids in the form of a therapeutic enema is fundamentally the most beneficial, since it creates a sufficient concentration of the drug in the lesion with a small overall effect on the body. The introduction of steroids per clismam is not advisable in cases of total damage to the colon, as well as when it is impossible to hold an enema for a long time.

Although the success of conservative therapy does not solve the problem of curing ulcerative colitis, it can reduce the need for colectomy.

The use of hydrocortisone ointment for hemorrhoids

Hydrocortisone - brief information on the drug

It happens that people come to the pharmacy in search of hydrocartized ointment or other forms this product. In fact, this pronunciation is erroneous. The main component is called hydrocortisone, and the rest of the names should be formed from this word. Of course, an experienced pharmacist will understand everything and give the right remedy, but it's still better to learn the correct option.

Domestic manufacturers offer a variety of dosage forms of hydrocortisone. These can be ointments for the eyes and external use, cream, suspension, powder for solution, tablets. The basis of any of these products is hydrocortisone acetate, a substance synthesized by the adrenal cortex. Candles under this name are not produced, so you will have to look for combined suppositories with a chemical compound in the composition.

Hormone-based hemorrhoid ointment and other topical products have the following therapeutic properties:

The substance stops the influx of leukocytes to the problem area, which leads to the attenuation of the inflammatory process.
Unbearable itching passes in the anus, which often accompanies the disease.
Local immunity increases, tissues more actively resist pathogenic agents. The risk of infection is reduced, as is the likelihood of developing an allergy to the medications used.
The swelling of the mucosa is eliminated, due to which the symptoms usually worsen. The process of bowel movement ceases to cause severe discomfort and pain. Pinched nodes relax, facilitating the general condition of the patient.
The course application of creams and ointments for hemorrhoids with hydrocortisone promotes the healing of tissues damaged by the disease. Cracks and wounds heal, bleeding stops, and the risk of infection is reduced.

Despite this diversity useful properties, the use of Hydrocortisone alone for hemorrhoids may not be enough. Better resort to integrated approach. Do not forget that it is necessary to actively combat the causes of the development of pathology.

Features of the use of ointment for hemorrhoids

Hydrocortisone ointment for hemorrhoids has a 1% concentration and is applied externally. Possibility of application to mucous membranes lower divisions rectum should be agreed with the doctor. With local use of the remedy, you can count not only on the elimination of nodes, but also the healing of anal fissures, ulcers and wounds on the surface of the skin. To obtain the maximum effect from therapy, it is recommended to additionally use suppositories based on natural ingredients such as calendula.

Before processing problem area you should empty the intestines and hold the toilet of the anus. For this, cool water or chilled herbal decoction. Squeeze a small amount of medicine onto your finger and gently spread a thin layer over the sore spot. Now you need to wait 5-10 minutes until the drug is absorbed, you do not need to wash after that. It remains to wash your hands with soap and you can return to your business.

Combination with other medicines

When using an ointment or suppositories with hydrocortisone, the compatibility of the component with other drugs must be taken into account. For example, drugs against epilepsy and allergies, as well as barbiturates, reduce the therapeutic ability of a hormonal product. Before combining products with anticoagulants, it is necessary to take a blood test. Hydrocortisone is able to enhance the effect of these drugs, which will significantly change the composition of the biological fluid.

By combining a chemical compound of a hormonal nature with Paracetamol, an excessive load on the liver can be provoked. In combination with the antifungal drug Amphotyrecin B, hydrocortisone can cause heart failure. It also cannot be combined with diuretics and cardiac glycosides due to the risk of developing potassium deficiency. And under the influence of anabolic steroids, the substance will cause severe swelling of the tissues.

Indications and contraindications for therapy

Hydrocortisone ointment is recommended for use in external hemorrhoids and anal fissures, regardless of the stage of development of the pathology. It quickly gives relief in the acute course of the process, but sometimes it is also used as prophylactic. Candles with an active ingredient will help to cope with internal nodes and bumps, erosion on the surface of the mucosa. Oral medication or hydrocortisone microenemas may be prescribed for ulcerative colitis (UC). In the first case, tablets are shown, in the second - solutions prepared from powder.

Based on the increased chemical and biological activity of the main component of the drugs, there are many contraindications to their use:

Side effects as a result of the use of Hydrocortisone are very rare, despite the specificity of the active substance. Sometimes patients notice a slight reddening of the treated tissues or itching in the anus, but they quickly pass. The only thing to remember is not to exceed the duration of therapy set by the doctor. Otherwise, there is a risk of tissue atrophy and a decrease in their functionality.

Patients with diabetes mellitus and any other consequences of failure metabolic processes can use hydrocortisone only with the permission of a doctor and under his supervision

Effective analogues of Hydrocortisone

In the treatment of hemorrhoids, you can use not only 1% Hydrocortisone ointment. The modern drug market offers many other effective and affordable means. It can be both soft forms and candles. When choosing a suitable product, it is necessary to pay attention not only to their cost, but also to the presence of contraindications, features pharmacological action and application rules.

Proctosedyl - properties, application rules

As part of multicomponent drug in addition to hydrocortisone acetate, benzocaine, heparin, esculoside, framycetin and butamben are present. Such a set active substances endows him with numerous medicinal properties. Using ointment or suppositories Proctosedil, you can achieve suppression of inflammation, elimination of pain and itching. The product relieves edema, strengthens the walls of blood vessels and fights microbes. It also thins the blood, which helps to dissolve blood clots and prevent their formation.

Products show their effectiveness in the treatment of internal and external knots, anal fissures, infections of the anus, anal itching and thrombosis. hemorrhoids. They are prohibited for use in case of allergies to components, in childhood, during pregnancy and lactation. In the fight against viral and fungal tissue lesions, products will not help, but will only aggravate the situation. With prolonged use of the drug or neglect of dosing rules, osteoporosis, diabetes mellitus, and a decrease in the functionality of the adrenal cortex may develop.

For hemorrhoids or its complications, the ointment is applied directly to the nodes or injected into the rectum using an applicator. Regardless of the form of the product, it should be applied 2 to 4 times a day for 7 days. An increase in the duration of therapy is possible only with the permission of the doctor while maintaining the symptoms. But at the same time, manifestations of positive dynamics should be obvious. Manipulations will have a greater effect if you empty your intestines and wash yourself with cool water before they are carried out.

Posterisan Forte - description and features

The drug contains two active component: hydrocortisone and E. coli in an inactivated form. Their action is mainly aimed at eliminating the inflammatory process. At the same time, swelling disappears, an increase in local immunity starts, cracks and various injuries heal more actively. Against the background of such reactions, the bumps and nodes decrease in size, soreness and itching gradually disappear. Most often this remedy is part of complex therapy hemorrhoids, eczema and anal fissures, skin diseases of local localization.

The use of the product will have to be abandoned for fungal or viral lesions area around the anus, local manifestations of tuberculosis or syphilis. The drug is contraindicated during pregnancy and lactation, although it has been proven that its components do not penetrate into breast milk and unable to pass through the placenta. If therapy is resorted to, then under the strict supervision of a doctor. Side effects from topical use of the product are rare, if you do not neglect the rules for its use and treatment regimen.

Medicinal ointment is distributed over the surface of the problem area in a thin layer or is used to perform applications. At internal lesions the product can be inserted into the rectum by means of an applicator. All manipulations are performed after the obligatory toilet of the problem area. To obtain a stable therapeutic effect, the drug is used up to 3-4 times a day for 2 weeks. The maximum duration of exposure is 3 weeks.

Hydrocortisone in the treatment of ulcerative colitis

For ulcerative colitis rectal application Hydrocortisone is indicated as part of complex therapy. This is possible only under the supervision of a doctor, usually manipulations are carried out in a hospital. In some cases, the effect is combined with internal reception Prednisolone. To obtain the desired effect, the powder form of the product is first diluted with saline. Depending on the volume of the received agent and the condition of the patient, the finished mass is injected rectally or an enema is administered. It is important to understand that attempts to self-treat nonspecific colitis in this way can aggravate the situation.