CHRONIC ENTEROCOLITIS

Chronic enterocolitis - polietiologicheskoe inflammatory-dystrophic diseases, which affected

both small and large bowel.

Etiology

The disease occurs most often after past DCI (salmonel, tuberculosis, dysentery, esherihioza,
typhoid, viral diarrhea), gelmin-tozov, diseases caused by protozoa, errors in the feeding regime
(long irregular, inadequate or excess food), food allergic reactions. The development of the
disease contribute to the innate and acquired enzimopatii, immune defects, diseases of the
stomach, liver, biliary tract and pancreas, abnormalities of intestinal bacteria overgrowth,
vitamin deficiency, neurogenic, hormonal disorders, radiation exposure, the irrational use of
medicines, particularly antibiotics, and t . e.

Pathogenesis

The pathogenesis is poorly understood. It is believed, for example, that infectious agents can
cause a violation of the integrity of the tissue cells of the digestive tract, contributing to their
destruction or metaplasia. Because of this form Ar genetically alien organism and cause
autoimmune reactions. The accumulation of clones of cytotoxic lymphocytes and production of
AT, directed against the Ag structures autologous tissue of the digestive tract. Attached
importance deficit secretory IgA, preventing the invasion of bacteria and allergens. Changing the
normal intestinal microflora contributes to a chronic enterocolitis, again increasing the
permeability of the intestinal mucosa to microbial allergens. On the other hand, dysbacteriosis
always accompanies this disease. Chronic enterocolitis may be secondary in diseases of other
organs of digestion.

Clinical picture

Chronic enterocolitis characteristic undulating course: exacerbation of disease followed by

remission. In the period of exacerbation leading clinical symptoms are abdominal pain and
violation of the chair. The nature and intensity of pain can be different. Children often
complain of pain in the navel, lower abdomen with right-handed or left-side localization. The
pains occur at any time of day, but more in the second half of the day, sometimes 2 hours after
meals, intensify before defecation, when running, jumping, riding in the transport, etc. Stupid
dragging pain are more likely to defeat the small intestine, intense - the colon. Equivalents pain -
diarrhea after eating or, especially in young children, food refusal, selectivity of taste.

Another major symptom of chronic enterocolitis - a chair in frustration as alternating diarrhea

(with a primary lesion of the small intestine) and constipation (with lesions of the colon). Most
of the urge for defecation (5-7 times a day) with small portions of feces of different consistencies
(liquid mixed with undigested food, with mucus, gray, shiny, frothy, foul-smelling - if the
predominance of putrefactive processes). Not infrequently there is "sheep" or ribbon-like
feces. Discharge of solid stool can cause cracking of the anus. In this case, the surface of stool a
small number of red blood.

By the constant symptoms of chronic enterocolitis in children also include bloating and feeling
of bursting open the abdomen, rumbling in the intestines and blood transfusions, increased
discharge of gases, etc.Sometimes the clinical picture of disease is dominated by psycho-
vegetative syndrome: develop weakness, fatigue, poor sleep, irritability, headache. Complaints of
bowel dysfunction fade into the background.With long-term course of the disease the delay in
the growth of body weight, less growth, anemia, signs of hypovitaminosis, impairment of
metabolism (protein, mineral).

Diagnosis and differential diagnosis

Chronic enterocolitis is diagnosed on the basis of anamnestic data, clinical presentation (long-
existing bowel dysfunction is accompanied by the development of dystrophy), results of
laboratory examination (anemia, hypo-and dysproteinemia, hypoalbuminemia, decreased serum
cholesterol, total lipids, (3-lipoprotein, calcium, potassium, sodium in the blood serum, the
detection in stool mucus, white blood cells, the degree of ATOR, creators, amilorei), the results
of instrumental methods of investigation (proctosigmoidoscope, kolonofibroskopii, radiological
and morphological studies).

Chronic enterocolitis should be differentiated from a protracted dysentery (see Chapter 27, Acute
intestinal infection), congenital enzimopa a bearing [cystic fibrosis, celiac disease,
disaccharidase deficiency syndrome, exudative enteropathy (see "Congenital enzimopatii and
exudative enteropathy)], etc. .

Treatment

Treatment of chronic enteritis and chronic enterocolitis aimed at the restoration of disturbed
bowel function and prevent exacerbations of the disease. The basis of its therapeutic actions of
health food (designate table number 4 to Pevsner). Also designate a multivitamin (eg Centrum,
VITRUM), enzymes (pancreatin), pre-and probiotics [bifidobacteria bifidum + activated
charcoal-tion (probifor) lineks, acidophilic lactobacilli + kefir fungi (atsipol) enterol, hilak forte]
chelators [diosmektit (smek-ta)], prokinetiki [trimebutin (debridat), loperamide, mebeverin
(dyuspatalin) and others]. By strict indications prescribed antimicrobials: Intetriks, nitrofurans,
nalidixic acid, metronidazole, and others applied herbal medicine, symptomatic agents,
physiotherapy, exercise therapy. Spa treatment is shown not earlier than 3-6 months after
exacerbation.

Forecast

Timely and adequate treatment at all stages of rehabilitation of a favorable prognosis.