Non-specific ulcerative colitis (NUC)

Nonspecific ulcerative colitis is inflammation that affects the large intestine, which occurs in a chronic form.

The etiology of the disease has not been fully elucidated, but it has been precisely established that with its progression mucosal ulceration occurs. The disease is characterized by periods of exacerbation and remission (attenuation). NUC therapy is directly dependent on how severe the symptoms of inflammation are.

In severe cases, the only method of getting rid of the disease is surgery.

What it is?

Nonspecific ulcerative colitis, or UC, is a chronic pathological process affecting the mucous membrane of the large intestine. It develops due to genetic disorders, combined with the impact of certain factors. The disease is accompanied by aggravation and abating of alarming symptoms.

UC is diagnosed in 35–100 patients per 100 thousand of the population, which is almost 0.1% of the incidence.

Causes of development

The etiology of NUC remains not fully understood, but in medicine there are several factors that can lead to the development of the disease. Experts emphasize, first of all, that people with a family history of such violations are most susceptible to this type of colitis. It has also been established that NUC is transmitted along a genetic line; consequently, it is a hereditary disease.

Other causes of the disease include:

  1. Infectious lesions of the mucous membrane of the large intestine (usually bacterial).
  2. The lack of adequate or timely treatment of any inflammatory lesions of the digestive tract.
  3. Autoimmune processes that force the immune system to work against the body, attacking and destroying its healthy cells.
  4. Stressful situations and unhealthy diet with a predominance of junk food.

Often, NUC starts from the rectum, gradually spreading over the entire area of ​​the mucous membrane of the large intestine. The phases of exacerbation and remission periodically replace each other, so the main task of the therapy is to prolong the second (remission) stage of the pathology for the longest period.

Pathological anatomy

The acute stage of NUC is accompanied by exudative edema and congestion of the intestinal mucosa with thickening and smoothing of its folds. With the progression of the pathological process and its transition to the chronic form, the destruction of the mucous becomes more pronounced. Its ulceration is observed, which penetrates to the submucosal, less often - the muscular layer. In chronic NUC, pseudo-polyps are formed, which look like papillary processes of the intestinal mucosa.

In severe lesions, shortening of the intestine, narrowing of its lumen, the absence of a gaustre is noted. At the same time, the muscular membrane is involved in the pathological process extremely rarely.

NUC does not form strictures. Inflammation can affect any parts of the intestine, but the rectum is always involved in a pathological process that has a diffuse continuous nature. In different segments of the large intestine, inflammation can occur with varying intensity. Pathological changes are gradually moving into the normal mucosa, with no clear boundaries.

During the histological examination of the mucous membranes inflamed during the exacerbation of NUC, the presence of hemorrhages, ulceration and dilation of the capillaries are recorded. In parallel, the formation of crypt abscesses and the formation of lymphocytic, plasma, neutrophilic and eosinophilic infiltrates of the lamina propria (lamina propria) are detected. Along with this decreases the number of goblet cells.

In the intestinal submucosal layer, the changes are not very intense. But if ulcerative lesions have penetrated into the submucosa, then the severity of the process increases significantly.

Forms of the disease

Depending on the location of the source of inflammation and the characteristics of the manifestation, the disease is divided into several types. According to the mechanism of development pathology is divided into:

  • continuous;
  • acute;
  • recurrent.

In the first case, the symptoms of the disease are present almost constantly, in the third - appear periodically. In the acute course of NUC, a sudden outbreak of the disease occurs with all the accompanying clinical signs.

Depending on the localization of the inflammatory process NUC is divided into 5 types:

  1. Left sided. In this situation, the colon is affected. The development of pathology begins with diarrhea, with blood impurities visible in the feces. The pain is located in the left side of the abdomen, the patient loses his appetite, against the background of which dystrophy is rapidly developing.
  2. Total. This form of UC is considered the most dangerous, since the disease can lead to serious and extremely serious consequences - dehydration, collapse, hemorrhagic shock, etc. This type of disease is characterized by severe pain, persistent diarrhea, accompanied by massive blood loss.
  3. Pancolitis is a disease that affects the entire area of ​​the rectum.
  4. Distal colitis. In this case, the left intestine is involved in the pathological process. In other words, inflammation affects the sigmoid and rectum at the same time. This is the most common form of colitis. This type of disease is accompanied by pain, the source of which is located, as a rule, in the left iliac, tenesmus, the presence of mucus or blood impurities in the stool, flatulence, and less often - constipation.
  5. Proctitis - inflammation of the rectal mucosa.

Symptoms

In acute form of colitis, the symptoms are intense, while in chronic it is blunted. The first type of pathology is much less common - only 4-10% of cases.

So, the main symptoms of NUC occur:

  1. The appearance of extraneous inclusions in the stool. It may be blood, mucus or even pus. Often the blood covers the feces, and looks like a kind of shell. Usually it has a bright shade, although it can be dark, unlike other diseases (for example, an ulcer), when it becomes black.
  2. Diarrhea, which can sometimes be replaced by constipation. Diarrhea is detected in 95% of patients diagnosed with UC. The frequency of urging to stool is about 4-5 times a day, but sometimes it can reach 15-30 times a day. If the pathological process has struck only the rectum, then the patient has mainly constipation, but this occurs infrequently.
  3. Pain in the lower segment of the abdomen, which are not characterized by intense severity. The pain may be intermittent, tingling, and mild colic due to muscle spasm is also possible. If pain syndrome is exacerbated, it may indicate a deep lesion of the large intestine.
  4. Bloating, which is especially often noted in the lower abdomen.

For the general symptoms of NUC, it is typical:

  • increase in body temperature to febrile values ​​(with severe disease);
  • general weakness and weight loss, as a result of lack of appetite;
  • inflammatory lesion of the iris and ciliary body of the eye;
  • inflammation of the eye vessels;
  • conjunctivitis;
  • arthralgia;
  • myalgia.

The course of the disease depends on the degree of colon damage and the prevalence of the inflammatory process. Pathology can proceed in different ways. In most patients, NUC is characterized by a change in the phase of exacerbation by a period of remission, and vice versa.

The greater the area that affects the inflammation, the longer the exacerbation phase lasts, and the longer it lasts. If the patient has developed complications, the course of non-specific ulcerative colitis is aggravated. But if the treatment was started correctly, and most importantly, in a timely manner, then the pathology can be transferred to the phase of stable remission.

Diagnostics

The only diagnostic scheme for ulcerative colitis does not exist, since the disease may have different manifestations, similar to the symptoms of other diseases. It is important to differentiate NUC from:

  • worm infestations;
  • dysentery;
  • amebiasis;
  • Crohn's disease;
  • tumor processes in the cavity of the small intestine.

In general, the NUC diagnosis is based on:

  1. Anamnesis collection. The doctor asks the patient in detail, assesses complaints, and also studies family history. It is extremely important to give reliable information about whether or not the closest blood relatives have such diseases. Of great diagnostic importance are human-transmitted intestinal infections, food poisoning, allergies, and individual intolerance to certain medicines. You should also be sure to report the presence of bad habits.
  2. Physical examination of the patient. The doctor measures the pulse, body temperature and blood pressure of the patient. It is mandatory to calculate BMI (body mass index) and study intra-abdominal symptoms. During the inspection it is important to find out if there is an expansion of the intestinal sections. Additionally, an examination of the oral cavity, ocular sclera and skin.
  3. Examination of the anus with palpation or rectoromanoscopy.
  4. Review radiography of the digestive tract.
  5. Total colonoscopy with parallel ileoscopy.
  6. Biopsies of large intestine or other gastrointestinal tract.
  7. Ultrasound of the abdominal organs and / or small pelvis.
  8. Laboratory tests of blood, urine, feces.

As a differential diagnosis, an MRI, CT scan, transabdominal or transrectal ultrasound of the intestine, X-ray with contrast, capsular endoscopic examination, etc. may be needed.

Complications

Any disease can have adverse effects, especially if its treatment has been postponed indefinitely. Ulcerative colitis is no exception. In case of late initiation of therapy, its absence or rapid progression, the disease can provoke:

  1. Toxic megacolon. This disease is accompanied by a significant expansion of the lumen of the colon. This complication of nonspecific ulcerative colitis occurs in 5% of patients, and often becomes the cause of death.
  2. Perforation of ulcers of the colon. The incidence of this disease ranges from 3 to 4%. In 70 - 100% of cases, this complication leads to the death of the patient.
  3. The formation of strictures of the colon or rectum. This pathological process is accompanied by a narrowing of the intestinal lumen at a certain site. This leads to a delay in fecal masses, and may also cause intestinal obstruction.
  4. Intestinal bleeding. They are observed in 6% of patients with NLK.
  5. Acute toxic dilatation of the colon. This complication is rare.
  6. The formation of anal fissures, fistulas, the development of paraproctitis. Similar effects of NUC are detected in 30% of patients.
  7. The development of colon cancer. If a patient has suffered from UC for more than 10 years, then there is a high likelihood of his developing colon cancer. Moreover, with each subsequent year, this risk increases by 2%.

Treatment of ulcerative colitis

The treatment regimen for NUC depends on the severity of symptoms and the general well-being of the patient. Treatment involves taking special medications that eliminate diarrhea and normalize digestive processes. In case of severe pathology, they resort to the prescription of more serious drugs, but sometimes surgical intervention may be required.

During the initial diagnosis of the patient's disease, they are hospitalized in a hospital for a full examination and identification of hematological and metabolic disorders. Often in patients with NUC reveal hypovolemia, acidosis, pererenal azotemia. Such disorders arise against the background of the active loss of electrolytes and fluids during diarrhea. For this reason, infusion therapy and blood transfusion are required for patients.

Treatment for NUC is aimed at:

  • prevention of development or elimination of related complications (anemia, infectious and inflammatory lesions of the gastrointestinal tract);
  • feeding the body and ensuring full sexual and general development of the body in children with NUC;
  • weakening and complete elimination of the clinical manifestations of the disease;
  • control of the disease and prevention of its exacerbation.

Drug treatment

Pharmacotherapy for NUC is based on the use of:

  • anti-inflammatory drugs;
  • anticytokines;
  • immunosuppressants;
  • pain medication;
  • antidiarrheal medications.

The relief of the inflammatory process is performed with the help of NSAIDs - Sulfasalazine, Mephalazine - and corticosteroid hormones. But the last group of medicines is prescribed only in case of severe disease.

The healing process is accelerated by physiotherapeutic procedures - SMT, diadynamic therapy and interference therapy.

Diet

In the treatment of NUC, the patient must be prescribed a diet immediately after his hospitalization. It allows the use of only boiled and baked products. You can only eat 5 times a day, dinner - no later than 19.00.

The menu includes foods enriched with proteins, vitamins and minerals. Daily calorie intake is at least 2500 - 3000.

Special emphasis should be placed on the use of:

  • berries;
  • fruits;
  • low-fat fish species;
  • boiled eggs;
  • tomato juice;
  • cheese;
  • the liver;
  • Chicken;
  • beef

In parallel with this, it is necessary to completely abandon alcohol, mushrooms, dairy products, carbonated beverages, legumes, coffee, chips and spices.

Surgery

Surgical intervention is carried out in case of failure of conservative treatment or the development of complications - bowel perforation, massive bleeding, etc. The operation may be:

  • reconstructive;
  • palliative;
  • radical (when a subtotal resection of the affected intestine is performed, a coloptectomy or retention ileostomy is performed).

Most often, in this situation, resection of the large intestine is performed, followed by the creation of an ileorectal anastomosis. The latter is a connection of the ileum with the anal canal. In exceptional cases, segmental resection is performed - an operation to remove a small portion of the inflamed intestinal tissues.

Forecasts

Projections for patients with NUC are established based on the severity of the pathology, the severity of symptoms, the presence of complications and the timeliness of initiation of therapy. If the treatment was delayed, it is fraught with serious consequences:

  • massive intestinal bleeding;
  • perforation of the colon with the subsequent development of peritonitis;
  • the formation of fistulas, ulcers;
  • severe dehydration of the body;
  • sepsis;
  • hepatic dystrophy;
  • urolithiasis (caused by a violation of the absorption of fluid in the intestine);
  • colon cancer.

The appearance of such complications not only aggravates the course of the underlying disease, but also significantly worsens the general condition of the patient, reduces his quality of life. In 5–10% of cases death occurs, and 40–50% of patients get a disability.

A mild or moderate course of the disease, not complicated by the previously listed pathological conditions, usually has a favorable prognosis.Especially if the therapy was started in time, the patient is on a diet, and also strictly follows all the recommendations given by the attending physician. The probability of recurrence in this case is significantly reduced, their frequency reaches 1 time in several years. They flow much easier, and quickly stoped with the help of drugs.

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