- How is inflammatory bowel disease( IBD) classified?
- Why does inflammation of the intestinal wall occur?
- What histological changes are formed?
- Symptoms of small intestine inflammation
- Other enteritis
- Symptoms of intestinal lesion
- How is inflammation treated?
- Related Videos
In the group of inflammatory bowel diseases, you can include a huge number of diseases of a different nature, which are accompanied by mucosal disorders from the duodenum to the rectum. We will use the international version of the terminology approved by ICD-10.
According to this document, only non-infectious diseases are considered inflammatory. Despite common causes and clinical signs, a survey scheme, each disease has its own peculiarities, which contributed to its isolation into a separate nosology. Treatment of inflammation of the intestine requires consideration of the nature and stage of the process, the consequences and complications.
How is inflammatory bowel disease( IBD) classified?
Localization of inflammation is distinguished:
- duodenitis - the process develops in the duodenum;
- enteritis - the name indicates a common lesion of the entire small intestine, often associated with gastritis, therefore called gastroenteritis;
- colitis - inflammation is located only in the large intestine.
The inflammatory process in the intestine can alternate with areas of healthy tissue, preferentially localize in the sigmoid colon( sigmoid), lean( jejunite), ileum( ileitis).Depending on the duration of the disease distinguish:
- acute - with a duration not longer than a month;
- chronic - people get sick for years, as a result of treatment, remissions occur, then the condition worsens again.
Classification of ICD-10 all pathology of the inflammatory bowel includes in the heading K50-K52.It begins with Crohn's disease( granulomatous enteritis, terminal ileitis) and ulcerative colitis, followed by the decoding of K52 code:
- gastroenteritis and colitis of radiation etiology;
- toxic( occurs due to poisoning with lead, arsenic, zinc, mercury, phosphorous compounds, alcohol);
- medication( cause non-hormonal anti-inflammatory drugs, antibiotics, cytotoxic drugs);
- allergic( represents a variant of an allergic reaction from the intestinal mucosa with increased sensitivity);
- alimentary( caused by rough food or hunger);
- collagen and lymphocytic colitis( accompanying systemic collagenoses);
- is eosinophilic;
- Other unspecified forms, but not related to infection.
Why does inflammation of the intestinal wall occur?
As we can see from the classification, the disease has many damaging factors, but it is not yet possible to establish the specific cause of inflammation of the intestine, for example, with Crohn's disease and ulcerative colitis. In such cases, one speaks of a polyethiologic disease.
After the "belly holiday" you have to treat
for a long time. The violation of the quality of nutrition, non-compliance, hunger diets and overeating is the most common factor of bowel pathology. Passion for fatty, fried dishes, spicy seasonings, alcohol causes a functional breakdown of digestion followed by inflammation of the intestinal mucosa.
Smoking is characterized by the toxic effect of nicotine, the length of the "experience" of the smoker is important in the development of Crohn's disease. Toxic effect - medicinal preparations with long-term admission and hypersensibility of a person.
Autoimmune damage - possible with different types of enterocolitis. Expressed in the perverted protective reaction of the body to its own cells: the intestinal epithelium is perceived as a foreign body, which leads to the destruction of cells.
Heredity - the incidence in one family among blood relatives is almost 20-fold, genetic mutations that can be transmitted from one generation to another are revealed. Disturbed blood circulation - the most indicative in old age with severe atherosclerosis in the channel of mesenteric arterial branches. The maximum vulnerable area for reducing blood flow is the angle of the transverse and descending colon. Ischemic colitis is localized here.
Changing the structure of microflora( dysbacteriosis) - may occur with prolonged use of antibiotics, cytostatics, radiation therapy or as a consequence of an infectious disease. Instead of bifido- and lactobacilli, strepto- and staphylococci, clostridia, and enterobacteria predominate.
Frequent stresses, disturbances - unstable state of nervous regulation affects all metabolic processes, intestinal innervation
What histological changes are formed?
A modern look at the processes of inflammation in the intestine is a clear division into acute and chronic changes. If acute edema and shortening of villi are detected in the acute enterocolitis, flattening, smoothing of the borders between the cells, then in the case of chronic lesions, the main ones are dystrophic and degenerative changes that go into atrophy.
In this case, inflammatory changes are developed moderately. Atrophy of the mucosa is expressed in the thinning, disappearance of the villi. The gut is called "bald".Specific changes and localization are observed in Crohn's disease and ulcerative colitis.
The name "terminal ileitis" was obtained in connection with the most frequent localization of inflammation in the terminal ileum with the transition to the onset of the large intestine( ascending colon, ileocolitis).Modified areas have clear boundaries, alternating with healthy mucosa.
The intestinal wall thickens, which narrows the lumen. In the affected area, many ulcers of the longitudinal and transverse direction, cracks, crevices on the background of pronounced granulomas( hillocks) are formed. Therefore, by the form of the inner surface, the intestine resembles a "cobblestone pavement".The term entrenched in anatomists.
The further course of the process extends to the entire thickness of the intestine, leads to the formation of fistulas inside the peritoneum and into the adjacent organs, abscesses
Scars form from the connective tissue. They deform the diameter of the intestine and cause obstruction. Obviously, regional lymph nodes are affected. With ulcerative colitis, the process starts with the rectum, then spreads to the sigmoid( proctitis, proctosigmoiditis), transversal and then goes on to total colitis.
In the mucous layer, an infiltrate is formed. An obligatory sign are microabscesses between the villi( crypt).Narrow long ulcers are arranged along the muscle bands in rows. Their bottom is clean or covered with a touch of fibrin.
All changes rarely go deep into the submucosal and muscular layer. Healing occurs when the proliferation of granulomatous tissue. There are false polyps, it is possible to transform the epithelium into malignant cells.
Symptoms of small intestine inflammation
The main clinical syndromes of enteritis:
- painful - usually patients experience blunt pains or spastic in the near-umbilical area, right in the ileum, throughout the abdomen;
- indigestion - includes flatulence, a feeling of rumbling and transfusion in the abdomen;
- Insufficiency of digestion and absorption - causes a general symptomatology indicating hypovitaminosis, anemia, loss of protein and carbohydrates.
Local symptoms include diarrhea, rumbling in the abdomen, pain, flatulence. Diarrhea is from four to 20 times a day. Sudden strong urge to defecate after a meal with copious, watery bowel movements, with general weakness, trembling of hands, palpitations, lowering of blood pressure.
Characteristic increase in the number of feces, its liquid or mushy consistency, yellow color, the inclusion of pieces of undigested food with muscle fibers. With steatorrhea( high fat content), stool color changes to gray with a shiny coating.
If putrefactive processes occur in the intestines, a fetid smell appears. With increased fermentation, the stool masses have a foamy appearance with gas bubbles. The appearance of blood and mucus is not typical. Diarrhea is caused by:
- by hypersecretion of the intestine with secretion into the intestine;
- with increased osmotic pressure;
- accelerated the passage of content;
- inadequate absorption of bile acids.
Bloating( flatulence) - manifests itself at the height of digestion after lunch, consumption of milk and sweet dishes. The abdomen is enlarged in size, becomes a tight belt or belt, the patient is difficult to breathe. There are moderate pains throughout the abdomen. They decrease after defecation and the escape of gases. There are possible attacks of arrhythmia, pain in the heart.
Meteorism is one of the symptoms of the pathology of
Pain syndrome causes:
- spastic paroxysmal contractions of the small intestine;
- bloating of the intestine by gases;
- nonspecific mezadenitis( involvement in inflammation of the mesentery) - differ in constancy, not associated with food, do not decrease after defecation, it is impossible to remove drugs with spasmolytics, located along the mesentery of the small intestine( right iliac zone - navel - hypochondria on the left);
- ganglionitis - the inflammation of the ganglia of the vegetative nervous system is attached to the pathological process, they do not decrease after defecation, they are stitching, they are permanent.
General signs of the inflamed small intestine are manifested in cases of the course of the disease in moderate and severe form. They are caused by a violation of absorption and digestive process. Patients appear:
- malaise, weakness;
- memory degrades;
- frequent headaches and dizziness;
- decreased appetite.
With damage to the ileum, it is possible to develop a functional dumping syndrome: after intake of carbohydrate food, the substances are quickly absorbed, this irritates the insular apparatus and causes the production of the insulin hormone.
The patient from the increase in insulin senses trembling, sweating, palpitations
External signs are:
- dry, flaky, skin with a greyish shade, reduced elasticity;
- pigmentation on the neck, face;
- hair loss;
- brittle nails;
- in the tongue on the sides of the teeth are visible, the color is crimson, with cracks, atrophy of the papillae.
Symptoms are caused by a violation of all types of metabolism. In Crohn's disease, the small intestine is most often affected, although 20% of patients have changes in the rectum. Symptoms associated with a particular site, it is common to subdivide into 4 types:
- inflammatory - there are pains in the iliac region to the right, resemble acute appendicitis, painful palpation here( terminal ileitis);
- obstructive - the main symptom is partial intestinal obstruction caused by narrowing of the lumen of the gut; the patient has severe spastic pains, bloating, vomiting, constipation;
- diffuse ejnoneileitis - pains and local soreness are found in the ileum region to the right and near the navel, marked exhaustion, signs of partial obstruction;
- abdominal fistulas, abscesses - are formed in the late stage of the disease, accompanied by fever, intense persistent abdominal pain, exhaustion.
Common symptoms for Crohn's disease include:
- polyarthritis( aching ankle, knee, joints of the fingers);
- temperature increase;
- on the skin of erythema nodosum, pustular rash, dermatitis;
- eye damage due to inflammation of all membranes;
- changes in the liver( hepatitis, fatty degeneration, cirrhosis, cholestasis);
- inflammation of all mucous membranes( mouth stomatitis, tongue - glossitis), pronounced soreness;
- nephrotic syndrome due to amyloidosis of the kidneys;
- autoimmune thyroiditis;
- hemolytic anemia.
Some types of lesions of the small intestine are associated with gastritis, so the clinic must display epigastric pains, belching, heartburn, nausea and vomiting.
Occurs in response to the use of toxic and toxic substances, alcohol and surrogates, herbal infusions, medicines. Has no seasonality. Symptoms appear in the first two days: nausea and vomiting, pain in the abdomen on the left, diarrhea with an admixture of blood( if the black stool is a sign of bleeding).
A type of allergic reaction to food allergens such as citrus fruits, strawberries, various exotic fruits, peanut nuts, crab meat. Possible intolerance to milk and cereals, caused by a lack of enzymes.
"islands" of infiltration with eosinophils appear on the intestinal wall, they enter the epithelial layer massively and disrupt its function
. The clinic develops in the first 24 hours. There is nausea, vomiting, pain in the left side of the abdomen, diarrhea, rumbling. Possible simultaneous rash on the skin. If you exclude the arrival of an allergen, the disease passes after 3 days.
Symptoms of digestive disorders and pain appear after overeating of unusual heavy food( fried meat, shish kebabs, spicy sauces), alcohol. A strict diet helps to normalize well-being.
Signs of lesions of the large intestine
The symptoms of inflammation of the large intestine can be most clearly seen in the example of ulcerative colitis. The main manifestations are as follows. Diarrhea with impurities of mucus, pus, blood. Stool frequency up to 20 per day. Sometimes almost pure blood is released at 100-300 ml / day.
Odor smelly. Diarrhea is caused by massive inflammation on the mucosa of the colon, the loss of the ability to suck water and sodium. Bleeding manifests itself as the ulceration and destruction of the vasculature. The pain syndrome has a cramping character.
Strengthen during defecation, then weaken. Intensive pain and signs of peritonitis are uncharacteristic, since inflammation is located only in the mucous and submucosal layer. Severe pain gives a complicated course.
Pain is more often projected into the left iliac, lateral and peripodic region, because they are caused by a lesion of sigmoid, transverse-colon, rectum, pain in palpation is determined here.
Intoxication is expressed in severe disease, manifested by severe weakness, fever,lack of appetite, nausea, weight loss, depressed state, irritability, crying.
Dystrophic syndrome - patients strongly lose weight, because of avitaminosis are pale, the skin is dry, wrinkled, hair is brittle. Systemic manifestations do not differ from Crohn's disease. They reflect the autoimmune mechanism of the lesion and depend on the severity of the patient's condition. The disease proceeds acutely( the most severe lightning-fast form) or chronically.
How is inflammation treated?
For the purpose of optimal treatment, the gastroenterologist must be sure of the diagnosis, so the patient will have to repeatedly take tests. To work on all pathogenetic links, drugs that do not possess toxic properties are needed.
Particular care should be taken with medicinal herbs. They themselves are capable of adding allergic manifestations. The most aggressive is St. John's wort. The patient needs a long diet with the exception of any sharp, fried foods, legumes, cabbage, fresh fruits, fat confectionery, coffee, chocolate.
The question of how to treat inflammation of the intestines requires an individual approach. The most commonly used 5-aminosalicylic acid( 5-ASA, Mesalamin) - causes the blocking of the synthesis of substances that stimulate inflammation. The best form is Sulfasalazine, which allows the release of 5-ASA in the ileum and large intestine.
Negative properties include: nausea, headache, hemolytic anemia due to impaired absorption of folic acid, agranulocytosis. Significantly reduced the adverse effects of Olsalazin, Balsalazin. Asakol, Pentaza - preparations with a protective shell, allowing "to bring" the medicine to the large intestine.
Recommended for use in rectal suppositories
Glucocorticoids - used in acute and severe cases. Assign short courses intravenously. Negative manifestations include: increased blood glucose, increased blood pressure, insomnia, nervous disorders.
More secure Budesonide. The drugs are used in enemas for the night. Immunomodulators are drugs that suppress a hyperactive defense reaction, an autoallergic process.
- Anti-cytokine preparations( infliximab, adalimumab, natalizumab, thalidomide, CDP571, CDP870) are new agents for the treatment of Crohn's disease. Apply cautiously because of its toxicity.
- Antibiotics - a broad spectrum are indicated when there are signs of infection of fistulous passages, peritoneum. The most effective is ciprofloxacin.
On the background of treatment, it is necessary to correct the bacterial flora of the intestine, so the doctor prescribes probiotics and prebiotics for a long course. Yet no healer has cured inflammation of the intestines with folk remedies. Advertising tricks can not be taken seriously. It's a waste of time and money.
The reception of herbal decoctions is not recommended for enterocolitis with an autoimmune component. This does not apply to alimentary diseases. During the recovery period, it is possible to use decoction of mint, cranberry. Inflammatory bowel disease is a serious problem. It can be avoided only with the help of proper nutrition, taking into account ill-being in heredity.