Chronic enterocolitis - Causes, Symptoms, Diagnosis and Treatment
Chronic enterocolitis - Inflammatory bowel disease that may develop after infectious enteropatologii, somatic diseases, the action of toxins and other factors. The main symptoms - abdominal pain, change in stool, weight loss and other symptoms of malabsorption of nutrients. For the purpose of diagnostics performed endoscopy with biopsy, X-ray examination, bacteriological examination of feces. Treatment consists of correction of intestinal motility and microflora, the appointment of antibacterial drugs and dietetics. Weather favorable.
Chronic enterocolitis
enterocolitis - polietiologic disease characterized by inflammatory and degenerative changes in the mucous membrane of the small and large intestines in violation of its digestive, barrier and transport functions. Accurate statistics of this disease prevalence is not, as is often the patients do not seek specialized help. However found that among all patients admitted to the Division of Gastroenterology, inflammatory bowel changes recorded in 85-90% of cases. Until now, certainly not resolved the question of the allocation of the disease in a separate nosology. If after conducting bacteriological, radiological, endoscopic methods of diagnosis does not differentiate a particular type of intestinal lesions (eg, ulcerative enterocolitis), a diagnosis of chronic enterocolitis. Very often when the intestinal mucosa study no macroscopic changes, and biopsy revealed lymphocytic infiltration. The term "lymphocytic enterocolitis" is used in such cases.
helminth infections, protozoan infestations, goiter, disturbances Physiology of the intestinal mucosa in other diseases of the gastrointestinal tract, as well as allergic diseases, effects of ionizing radiation, various toxins, thermal and mechanical factors, alcohol abuse. Prolonged exposure to some damaging factors (mainly toxins, including during alcohol intoxication) may develop chronic enterocolitis without primary acute phase. Chronic inflammatory bowel disease, emerging after an acute, usually associated with improper, untimely treatment or lack of it, malnutrition during convalescence.
In this disease there is an imbalance between the immune system physiology and normal intestinal microflora, thereby changing the macro- and microstructure of mucosal regeneration and metabolic processes in it. The main importance in the pathogenesis of a change in bowel microbiocenosis, barrier, secretory and motor functions. Disrupted activity of membrane enzymes, transport channels providing flow of water, ions, proteins, cleavage products, fats and carbohydrates. Dysbacteriosis results in fermentative and putrefactive processes, which resulted in a large amount of acid gas, and endogenous toxins that also damage mucous membranes and nerves. Develops mucus hypersecretion. The combination of these processes leads to the maintenance of chronic inflammatory bowel disease and the formation of its mucosa atrophy. In this disease the pathogenesis and severity vary to a greater degree on the cause, and the degree of damage to the enterocytes.
diarrhea, constipation, unstable chair. Immediately after a meal can not abundant diarrhea, stool is usually watery mucous. It may disturb the feeling of incomplete evacuation, false urge to defecate. Diarrhea occurs after eating too much fatty food, large quantities of milk and foods rich in fiber. Diarrhea alternating with constipation, and the stool becomes fragmented. Patients worried about bloating, rumbling, nausea, belching and loss of appetite.
Extraintestinal manifestations of chronic enterocolitis caused by malabsorption of nutrients. The characteristic symptom - reduction in weight, the severity of which characterizes the degree of malabsorption. In the first degree, patients lose 5-10 kg of body weight, reduced working capacity. The second stage is characterized by the loss of more than 10 kilograms, trophic disorders, signs of vitamin deficiencies, lack of potassium and calcium. In the third degree on the background of the loss of more than 10 kg of body weight observed expressed disturbances of water and electrolyte balance, gipoproteinemicheskie swelling and severe disorders of intestinal motility with a predominance of hypokinesia. There dryness of the skin and mucous membranes, hair loss, irritability, sleep disturbance, possible convulsions small muscles.
Gastroenterologist reveals some of the characteristics of this disease, medical history (connection with the transfer of intestinal infections or the effect of other etiological factors). On examination, the patient is determined by the pallor and dryness of the skin, mucous membranes; tongue dry, coated with white bloom. On palpation of the abdomen may experience pain in different hotels, the alternation of spastic and atonic areas rumbling. Laboratory tests did not reveal significant changes in blood test is possible slight leukocytosis, hypoproteinemia determined in severe malabsorption.
To assess the extent of the intestinal mucosa changes necessary to consult a doctor-endoscopist. During esophagogastroduodenoscopy visualized initial small intestine, during a colonoscopy - the final part of the small intestine and the entire large. Usually the mucosa on gross examination is not changed, there may be signs of degeneration of the epithelium of the villi, redness, swelling and bleeding.
Always held endoscopic biopsy with histological examination material. A characteristic feature of chronic enterocolitis is a change in the enterocytes of the villi and the surface of the mucous membrane layer. Visually cells are different from normal subject involutional changes of the enterocytes, but their number is significantly higher than normal, such cells can occupy the entire surface of the villi, and not only their distal portions. Also typical of the diffuse infiltration of the deep layers of mucosal lymphocytes.
If you suspect a chronic enterocolitis conducted bacteriological examination of feces to determine the microflora changes. Are identified opportunistic microorganisms (Klebsiella, Proteus) and quality (there lactosonegative, hemolyzing enteropathogenic strains) and quantitative (reduced content of bifidobacteria, lactobacilli) changes normal microbiocenosis. The number of accompanying flora: Bacteroides, yeast.
The clinical picture of chronic enterocolitis can be very nonspecific, so be sure to carry out differential diagnosis of diseases such as ulcerative enterocolitis, Crohn's disease, cancer, diverticulosis; thus leading role for X-ray and endoscopic examination. Excluded are also somatic diseases, in which the possible depletion of the secondary syndrome: hormonally active tumor, pathology of the endocrine system, functional lesions of the central nervous system with intestinal dysmotility and other diseases of the gastrointestinal tract.
intravenous preparations potassium, calcium).
Prediction and prevention
The prognosis of chronic enterocolitis favorable with proper systemic treatment achieved good effect. That is why any clinical case of heavy flow to poorly therapy should be studied for the presence of more severe disease.
Primary prevention is the prevention of intestinal infections, personal hygiene, isolation of infectious patients, timely adequate treatment of diseases that can cause enterocolitis. In order to prevent relapse, all patients should be long-term diet and strictly comply with all recommendations of the physician.