Differential diagnosis and treatment of inflammatory bowel diseases. Chronic bowel disease

What is VZK? How can children and adults with IBD be helped? Answers to these important questions for our readers today will be given by one of the leading Russian specialists in the field of IBD, an expert of the Moscow Department of Health on pediatric gastroenterology, a member of the Russian group for the study of IBD, the organizer of the annual conferences "Kanshi Readings" dedicated to IBD in children, a leading pediatric gastroenterologist in GMS Clinic, Doctor of Medical Sciences Elmira Ibragimovna Aliyeva.

Elmira Ibragimovna, good afternoon! Tell us about the VZK. What applies to this pathology and what is this diagnosis?

Inflammatory bowel disease (IBD) is a group of chronic, inflammatory, progressive diseases of the gastrointestinal tract. These include Crohn's disease and ulcerative colitis. Crohn's disease can affect any part of the gastrointestinal tract from the mouth to the anus.

Ulcerative colitis affects the mucous membrane of the colon, which, due to the inflammatory process, bleeding ulcers appear.

How easy is it to distinguish IBD from such a common disease of civilization as irritable bowel syndrome (IBS) and various intestinal dysbioses?

IBS can be similar in symptoms to IBD, especially in older children. But there are warning signs, sometimes referred to as "red flags," that make you think of IBD. These symptoms include:

  • unmotivated weight loss;
  • onset of symptoms at night;
  • persistent, intense abdominal pain;
  • the presence of fever;
  • the presence of blood in the stool;
  • changes in analyzes (inflammatory syndrome, anemia, etc.).

Therefore, it is the conduct of invasive diagnostic studies (gastroscopy and colonoscopy) in children that is an important step in the diagnosis of IBD. What symptoms (intestinal and extraintestinal) suggest IBD? Intestinal symptoms of IBD include:

  • stomach ache;
  • diarrhea;
  • the presence of blood, mucus, pus in the stool.

For extraintestinal:

  • joint damage;
  • aphthous stomatitis;
  • stunting, etc.

In ulcerative colitis, given that the colonic mucosa is affected, intestinal symptoms are usually present. In Crohn's disease, the picture depends on which area is affected, and the diagnosis can be complicated.

- What research should be done to be absolutely sure of the presence of IBD?

The examination should always be comprehensive in order to identify the prevalence of the process, extraintestinal manifestations and complications. In ulcerative colitis, in addition to general laboratory tests and ultrasound, colonoscopy with ladder biopsy is very important.

In Crohn's disease, in addition to endoscopic studies (colonoscopy and esaphagogastroscopy), additional x-ray studies, including CT (computed tomography) or MRI (magnetic resonance imaging), are required to clarify the prevalence of the inflammatory process.

What are the causes of IBD? Why does IBD more often affect not children of the first years of life, but mainly adolescents? And why in last years VZK began to steadily "get younger"?

The cause of these diseases is not clear. No theory that explains the development of these diseases has been successful. But one thing is clear: IBD is an abnormal immune response of the body to some kind of trigger (infection, stress, etc.). Very often it is not possible to isolate this moment of the disease, as it appears gradually and develops gradually. Of great importance is the genetic predisposition to diseases (IBD in parents). Therefore, if we keep in mind the most weighty theory - immunogenetic, then it becomes clear why diseases are more common in adolescents.

In young children, the immune status is only being formed, and the internal failures of the body, the external environment have not yet had time to leave their "imprints". But recently, more and more diseases are diagnosed in children under 5 years old, and I want to note that it is distinguished by a persistent, severe course. It should also be borne in mind that in children at an early age, the diagnosis of IBD, especially Crohn's disease, may go undiagnosed for a long time. In recent years, the diagnosis of IBD has improved, which directly affected the incidence of the disease.

As you know, IBD can be treated, but a complete cure is usually impossible. What features in the diet, behavior, lifestyle of the child will allow him to encounter exacerbations of IBD as rarely as possible?

With ulcerative colitis, a cure is possible only after the complete removal of the colon (but there are moments here too), and it is impossible to cure the patient from Crohn's disease. Our task is a long-term remission, which allows the child to lead a normal life. Restriction in diet is required during an exacerbation of the disease, including limited physical activity. If the patient has received a good effect from the therapy, then he continues to take drugs (maintenance therapy) in order to avoid exacerbations of the disease. An interesting fact is that there are a lot of gifted children among IBD patients.

What is the prognosis for patients with IBD? Is surgical treatment always necessary and what determines the success of the treatment of such patients?

The prognosis depends on the course of the disease, on the response to drug therapy (often there are resistant forms), on the frequency of exacerbations, and on the complications of IBD. The need for surgical treatment is more common in Crohn's disease. The emergence of new drugs (genetic engineering or biological therapy) has significantly changed the course of IBD and reduced the frequency of surgical treatment. Success, of course, depends on the time of diagnosis of the disease. Late diagnosis is associated with serious complications, and, naturally, increases the frequency of surgical interventions.

Chronic inflammatory bowel disease is considered to be any long-term enteritis - both infectious and immunoallergic etiology, which leads to a chronic inflammatory process in the intestine.

In addition to celiac disease, these diseases include ulcerative rectocolitis, Crohn's disease, and other rarer diseases: colitis in Behcet's disease, necrotizing enterocolitis in young children. All these diseases are characterized by:
- unknown etiology (except celiac disease);
- inflammatory nature of lesions;
- chronic course and possible relapses;
- association with other non-intestinal diseases;
- good response to corticosteroid therapy;
- the possibility of surgical resolution (treatment).

  • Epidemiology

In the occurrence of these diseases big role play both geographical (more common in Northern Europe) and genetic factors.

Crohn's disease is more common in Western countries and among urban populations.

  • Etiology and pathogenesis

The etiology is unknown, we can only assume the influence of infectious diseases and nutrition. The pathogenesis is associated with a violation of the immune response from the intestinal mucosa, the nature of which is not well understood, it is only known that T- and B-lymphocytes are activated, the production of cytokines and complement increases.

  • pathological anatomy

Histopathological observations reveal two main and many intermediate types of disorders in chronic inflammatory bowel disease.

Crohn's disease. It is characterized by clearly demarcated transmural segmental lesions, separated by an externally unchanged mucosa. The lesion extends to the mesenteric lymph nodes. Any part of the gastrointestinal tract can be affected, but the intestinal ileum is more commonly affected. Typical formation of stenoses, abscesses and fistulas. Characterized by mucosal edema, ulceration, atrophy and thickening of the intestinal wall, lymph node hyperplasia.

There is a granulomatous lesion. In 60-70% of cases, the granuloma is found on the surgical material and only in 30-40% of the biopsy. The granuloma consists of epithelioid and giant cells. Despite the tendency to necrosis, caseous necrosis is not noted. Easily formed ulcers and fistulas.

Ulcerative rectocolitis. This is a disease of the colon. It starts at the rectal level and spreads upward. The process is superficial, affecting the submucosal, mucosal, and rarely deeper layers. The acute stage is characterized by mucosal hyperemia, edema, easily bleeding erosions and ulcers. In the intervals between ulcerative lesions, the mucosa is hypertrophied, pseudopolyps are often formed. The described lesions may be combined with perianal fissures. Histologically, the formation of crypts and abscesses is characteristic, in which lymphocytes, eosinophils, neutrophils, and plasma cells accumulate. Granulomatous tissue is absent.

Variants of the two main types of chronic inflammatory bowel disease described above:
1. Ulcerative enterocolitis. Some authors consider it a congenital form of Crohn's disease. Lesions affect the entire digestive tract, but are predominantly localized in the final part of the ileum and in the initial part of the colon.
2. Behçet's syndrome, in which retinitis, blindness, painful ulcerative and necrotic lesions of the oral mucosa and genitals join intestinal lesions.
3. Necrotizing enterocolitis in infants often leads to lethal outcome. Clinical manifestations of the disease occur in the first week of life: diarrhea mixed with blood, signs of peritonitis and shock. Multiple ulcerative lesions with perforation are characteristic.

  • Clinic

Classically, chronic bowel disease is characterized by both gastrointestinal (diarrhea, abdominal pain, blood in the stool) and general (fever, weight loss, growth retardation) symptoms.

Crohn's disease: against the background of anorexia, typical for this disease, general symptoms predominate. Pain in the abdomen resembles attacks of appendicitis. Blood in the stool is rarely found. On examination, pain is noted in the right iliac region, and a mass is sometimes palpated there.

Ulcerative rectocolitis: intestinal symptoms predominate - tenesmus, diarrhea mixed with blood. On palpation of the abdomen, pain is noted along the colon.

  • Complications

Stenoses, abscesses and fistulas, fissures, megacolon, perforations with massive bleeding, colon carcinoma, protein-losing enteropathy. Common complications such as inflammation of the iris, choroid, aphthous stomatitis, arthritis, pericholangitis, sclerosing cholangitis are characteristic.

  • Diagnosis

Chronic diarrhea with abdominal pain, bloody stools suggest chronic inflammatory bowel disease.

To confirm the diagnosis, it is necessary to evaluate the data of laboratory analysis: complete blood count; sideremia; transferinemia; immunoglobulins; blood clotting time; blood levels of calcium, phosphorus, zinc, copper; bone age; C-reactive protein, a1-antitrypsin; stool analysis. Contrast radiography with barium has acquired a particularly important role for the diagnosis. Double contrast radiography is widely used, in which it is noted:
- decrease in the lumen of the intestinal wall;
- heterogeneity of the pattern;
- cystic areas.

The presence of these three features in the terminal ileum forms the Bodart triad, typical of Crohn's disease.

The spread of the inflammatory process can be judged by areas filled with leukocytes labeled with radioactive iodine I111. Computed tomography is indispensable for detecting complications (fistulas, abscesses).

The final diagnosis is based on a biopsy.

The differential diagnosis is made with
- allergic colitis;
- nodular lymphoid hyperplasia;
- chronic granulomatous disease;
- appendicitis;
- intestinal polyposis and lymphoma;
- Schonlein-Henoch disease.

  • Forecast

Improved significantly in recent years. Child mortality has practically disappeared (from 15 to 2%).

Ulcerative rectocolitis has a great tendency to relapse. Supervision of children is
- growth control;
- control over indicators of the inflammatory process;
- for therapy.

  • Treatment

Nutritional therapy plays an important role, especially in Crohn's disease, which is characterized by weight loss and stunting.

A new approach to therapy lies in the possibility of achieving remission with a diet without hormone therapy.

Pharmacotherapy is based on the use of corticosteroids, sulfasalazine, salazopyrin, metronidazole. Immunosuppressants are of little use due to their toxicity.

Surgical treatment is possible with severe complications (megacolon, stenosis, abscesses, fistulas) and in cases of growth retardation in pubertal and prepubertal periods.

From clinical practice

Liver damage, although without obvious clinical manifestations, is quite common in chronic bowel diseases. In adults, in 70% of cases, pericholangitis develops with a portal triad. 50% have fatty liver changes. 10% acquire liver disease. Cirrhosis of the liver develops in 5%.

Other more severe and rare complications are chronic active hepatitis, sclerosing cholangitis, and biliary tract carcinoma.

It should be noted that chronic active hepatitis is a common complication in children, while pericholangitis and sclerosing cholangitis are very rare and asymptomatic.

We present a clinical case of ulcerative colitis in a three-year-old girl. The initial phase of the disease was asymptomatic. Subsequently, pronounced hepatomegaly developed.

The girl was hospitalized at the age of three. For 8 months before hospitalization, irritability, loss of appetite, intermittent pain in the abdomen, feces with an admixture of scarlet blood were noted. With the above symptoms, the girl was hospitalized. On examination, significant hepatomegaly was noted (+4 cm from under the costal arch along the right midclavicular line). In the blood test, ESR is 104 mm per hour; total blood protein 9.9 g%; albumin 2.5 g%; a1-globulin 0.3; a2-globulin 1.1; b-globulin 1.0; g-globulin 5.0; IgG 4810 mg%; alkaline phosphatase 1273 IU; Anti-nuclear and anti-smooth muscle antibodies are absent.

During the hospitalization, the girl complained of frequent abdominal pain. In the feces there is an admixture of mucus and scarlet blood. The analysis of fecal mucus revealed a lot of neutrophilic leukocytes. Endoscopically revealed an extensive inflammatory process throughout the colon with mucosal edema. Upon contact with the instrument, the mucosa bled easily.

With multiple biopsies, a histological analysis was performed, which revealed thinning of the glandular ducts with mono- and polynuclear infiltration.

Percutaneous liver biopsy revealed inflammatory and granulomatous changes predominantly in the portobiliary spaces. Moreover, there was an inflammatory process such as pericholangitis and initial cholangitis in the interlobular ducts.

Initial treatment with prednisone followed by salazopyridine (SAZP) resulted in complete remission of intestinal symptoms. Clinical remission with complete regression of hepatomegaly (the liver was palpable at the costal arch) was confirmed histologically. Normalized and laboratory parameters (IgG 997 mg%).

It is known that ulcerative colitis is often accompanied by intolerance to cow's milk protein, so a skin test and a test for the determination of specific IgE were performed. IgE were significantly increased.

The rapid clinical remission was due to two factors: the appointment of salazopyridine (SAZP) and the simultaneous elimination of cow's milk from the diet.

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chronic inflammatory bowel diseases

E. Tsalikova, L. Principessa, F. Scalercio,
V. Guidi, O. Bederti
Department of Pediatrics,
University of Rome "La Sapienza"

Summary
Chronic inflammatory bowel diseases are commonly believed to present in the form of two diseases with aetiologies of unknown origin, Ulcerative Rectocolitis and Chron’s Disease, which are characterized by important inflammatory events affecting the normal structure of the intestinal wall, with a tendency to relapse.

Both diseases share a variety of common characteristics and are thus considered by many as one single clinical entity.

The common features are the following:
- unknown aetiology
- inflammatory aspect of the lesions
chronicity of the course of disease, with possible relapses
- association with extra-intestinal symptoms
- good response to corticosteroid therapy
- recourse to surgery (for a limited number of cases).

The aforenamed two paradigmatic pictures constitute the essentials of a spectrum comprising an indefinite number of intermediate pictures, for example Behcet's Colitis, similar to Ulcerative Colitis but where ulcers can be found in the area of ​​the mouth and the genitals, or Ulcerative Enterocolitis of the infant , thought to be a congenital form of Chron's Disease.

Both pictures display gastrointestinal symptoms such as diarrhoea, tenesmus and bloody stools, usually prevailing in Ulcerative Colitis, and are accompanied by general symptoms such as fever and weight loss, usually found in Chron’s Disease.

One of the recent and most interesting aspects of Chron’s disease is the possibility to induce remission as well as restoration of the patient’s growth by administration of an elementary diet. The administration of a hypercaloric diet has also proved useful in correcting growth speed and in reducing the need of steroids, which also play an important role in inducing disease remission.

In order to further maintain remission, the administration of salazopirina (sulfosalazina) and the corresponding salacylates, as well as of immunosoppressors such as azathioprine and cyclosporins, have proven useful. The administration of metronidazolo is indicated in the case of perineal injuries only. The use of surgery should be limited to complications and, in the presence of failure to thrive, only if the lesions are well delimited.

Scientists at the University of Manchester have analyzed the intestinal mucosa of mice and found changes in bacteria that could lead to inflammatory bowel disease (IBD).

In comparison, in this case, the occurrence of IBD was detected 12 weeks earlier than if stool samples of experimental animals were used instead of mucosal tests.

In this way, appeared new method early diagnosis and further increase in the efficiency of IBD treatment.

Inflammatory bowel diseases such as are chronic conditions, which can cause severe pain in the abdomen, and. IBD affects over 250,000 English people.

The diagnosis is often made only after the patient has developed characteristic symptoms. It has been proven that as soon as the disease begins to manifest, the composition of bacteria in the stool of patients also changes. However, it was not clear whether the bacteria themselves lead to inflammation, or vice versa, a change in the composition of the microbiota is the result of the pathology that has begun.

However, bacteria commonly found in stool samples have a different profile than those found in the lining that protects intestinal tissue. Researchers at the University of Manchester have studied this point.

Stool samples do not fully reproduce the complex picture of the gut microbiota. We took mucus samples from healthy areas and closer to those where certain problems have already begun. As a result, we were able to see microbiota changes twelve weeks before they were detected in stool samples.

Complex and not well understood, but believed to be a symbiosis of an interplay of genetic and environmental factors, as well as lifestyle changes and changes in the immune system's response to gut bacteria.

All this can lead to thinning of the mucous layer and disruption of the bacterial population. Microorganisms gain access to the epithelial cells that cover the intestines, resulting in stimulation of the immune system and activation of the inflammatory process.

Studying bacteria for more early stages diseases can provide a better understanding of how and why is broken. In the future, we will be able to understand which bacteria cause inflammation, and which potentially contribute to the healing of the resulting wounds.

Bacteria in the gut tend to live in a carefully balanced system, and this is incredibly important for proper digestion and health. However, for some reason, the balance can be upset.

The ability to look at the causes of these imbalances early on, as well as understanding the specific bacteria involved, will give us much more insight into the causes of ulcerative colitis and Crohn's disease.

May 16, 2012, 07:00

Then there is inflammatory bowel disease, or IBD. If the doctor puts you like this, then you have to run away from him, the doctor ... Why are stomach diseases getting younger and more difficult to diagnose? Why are previously rare diseases now becoming, alas, not at all rare? Doctor of Medicine, gastroenterologist Oleg Shifrin told Medpulse readers about this.

What isinflammatory bowel disease (IBD)?

The term "inflammatory bowel disease" includes a group of inflammatory diseases probably related to the body's immune response to its own intestinal tract resulting in chronic inflammation. 2% of the world's population is affected by autoimmune diseases, which are characterized by the self-destruction of certain organs. More than 2.2 million people in Europe (5 million worldwide) have IBD. There is a genetic predisposition to IBD, and patients with IBD have a greater propensity to develop a malignant process. Although these diseases can usually be controlled with medications, the causes and cures for IBD are currently unknown.

IBD is a progressive, debilitating disease. It causes physical, mental and socio-economic problems, exacerbated by insufficient knowledge and incomplete understanding of the causes of the disease, the treatment standards for which are still under development.

Types of IBD

There are three main types of IBD. The two most common types are Crohn's disease and ulcerative colitis, followed by undifferentiated colitis, which has characteristics of the first two diseases.

Crohn's disease is a severe chronic inflammatory autoimmune disease of the gastrointestinal tract. Crohn's disease can affect any part of the gastrointestinal tract from the mouth to the anus, although it most commonly affects the final part of the small intestine, the ileum.

Crohn's disease manifests itself during the life of the patient in the form of exacerbations or remissions. Common symptoms of Crohn's disease include abdominal pain, diarrhea, and weight loss. Less common symptoms include poor appetite, fever, night sweats, rectal pain and sometimes rectal bleeding with abdominal pain, diarrhea, weight loss, and fever. In addition to these internal symptoms, others are noted, such as inflammation and pain in the joints, skin lesions, swelling of the eyes or liver, as well as fatigue, anemia, and stunting.

Ulcerative colitis It is a disease that affects the large (colon) intestine. The median age of people diagnosed with ulcerative colitis is 35, although the disease can present at any age. Ulcerative colitis as a relapsing disease. This means that the symptoms of the disease may disappear and reappear. Exacerbation of ulcerative colitis can be sudden and severe. Common complications include bleeding, intestinal perforation, and bloating.

Diagnosis and causes

Although the disease can begin at any age, there has been a recent trend of IBD being diagnosed at a younger age, usually between 20 and 40 years of age. The disease in such patients is characterized by a more aggressive course. IBD is not inherited, but it may occur more often in relatives of patients with IBD.

The doctor begins the diagnosis of IBD in a patient by identifying and evaluating the symptoms of the disease. Diagnosis is usually based on the collection of a complete patient history and a series of studies, including laboratory tests and the use of imaging methods (radiography, barium enema, colonoscopy), and, if necessary, biopsy.

This chronic autoimmune disease is incurable, but modern methods of therapy allow it to be controlled.

Unfortunately, the causes of IBD are still not known. Despite the best efforts of researchers to create an ideal drug to cure this disease, all modern drugs involve supportive therapy. Thus, communication between the patient and the doctor becomes especially important for making an accurate diagnosis and monitoring the treatment process.

Treatment is maintaining remission

The main goal of the treatment of IBD is to achieve and maintain remission - that is, to minimize the risk of relapse, as well as to prevent the development of complications that would require surgical intervention, which would mean for patients the removal of part or all of the intestine.

by the most modern look treatment is biological therapy - these are drugs that selectively block molecules that are key in the development of inflammation in IBD. These drugs make it possible to achieve remission in cases where standard therapy is ineffective, and maintain it for a long period of time, reverse the pathological progress of the disease, reduce the risk of operations and disability, thereby returning the patient to a full life.

What to pay attention to. Advice from MD Oleg Samuilovich Shifrin, head. Department of Chronic Intestinal and Pancreatic Diseases of the Clinic for Propaedeutics of Internal Diseases, Gastroenterology and them. V.Kh. Vasilenko of the First Moscow State Medical University. THEM. Sechenov:

Diarrhea, persistent loose stools, abdominal pain, blood in stools. With all these feelings, it's time to see a doctor. And don't pull. Otherwise it will be too late. And besides, the treatment and diagnosis of IBD is still poorly suited to the standards and requires time and professionalism.

Savchenko Irina Grigorievna

What is inflammatory bowel disease?

Inflammatory Bowel Disease (IBD)- ulcerative colitis and Crohn's disease - diseases of the gastrointestinal tract in which inflammation of the intestinal mucosa occurs. At ulcerative colitis Only the large intestine is affected Crohn's disease- any part of the digestive tract (from the mouth to the rectum), but most often the small and large intestine.

Bowel injury in ulcerative colitis

Gastrointestinal injury in Crohn's disease

Data on the incidence of inflammatory bowel disease in different countries vary widely. The highest incidence in the Scandinavian countries, the northern states of the USA, Israel. On average, 7 to 15 new cases of ulcerative colitis and 4 to 7 cases of Crohn's disease are diagnosed annually per 100,000 population. These diseases can affect any age, but most often appear in 20-40 years of age. The second age peak of the onset of the disease is after 60 years.

Why do inflammatory bowel diseases occur?

Unfortunately, the causes of the development of inflammatory bowel disease have not yet been fully established. An unknown factor causes a malfunction in the body's immune system, which leads to inflammation of the intestinal mucosa, as a result of which the intestinal wall is also damaged.

It is currently believed that inflammatory bowel disease is realized through the interaction of 3 main factors:

  • genetic predisposition;
  • the nature of nutrition - the predominance of refined foods in the diet, passion for fast food, etc .;
  • violation of the composition of the intestinal microflora (microbiota).

It is important for you to know that ulcerative colitis and Crohn's disease are chronic diseases that have an undulating course, with periods of exacerbation and remission. Constant medical supervision will allow you to control your condition well. This involves regular visits to the doctor - up to twice a year, even if you do not have symptoms of active illness. A visit to the doctor will allow not only to observe the course of the disease, but also to correct the treatment.

How to suspect inflammatory bowel disease?

  • diarrhea (diarrhea) from 2-4 times to 8-10 or more times a day;
  • an admixture of blood and mucus in the stool, blood can be either in the form of streaks in the stool, or in its pure form;
  • false painful urge to stool (tenesmus), with the release of mucus, blood or pus (“rectal spitting”) with little or no stool;
  • pain in the abdomen, often spasmodic, aggravated before a stool and not relieved after a stool;
  • the above symptoms often occur at night or in the early hours of the morning.

General symptoms of IBD include weight loss, loss of appetite, fever, fatigue, slower growth and development compared to peers.

Can other organs and body parts be affected?

Some patients with IBD may develop similar pathologies in other parts of the body - extraintestinal manifestations.

The most frequent of them:

  • arthritis (inflammation of the joints)
  • oral ulcers (stomatitis)
  • skin lesions (erythema - the appearance of small painful red spots on the legs)
  • inflammation of the eyes (less common). You should consult an ophthalmologist in case of redness of the eyes, pain, irritation in order to avoid the development of more serious symptoms.

How to diagnose?

If IBD is suspected, the patient must undergo a series of examinations:

1. Blood tests(to detect inflammation)

2. Fecal analysis in order to detect blood and exclude intestinal infection

3. Endoscopy:

-esophagogastroduodenoscopy A device in the form of a thin, flexible tube (endoscope) is inserted through the mouth to look at the esophagus, stomach, and upper small intestine. This study is necessary for the diagnosis of Crohn's disease, if the inflammatory process occurs in the upper gastrointestinal tract and to identify concomitant diseases.

- colonoscopy- "gold standard" for the diagnosis of IBD. In this test, an endoscope is inserted through the anus into the large intestine and lower small intestine. This procedure looks at the lining of the intestine and takes a biopsy (a small piece of intestinal tissue) using an endoscope. Microscopic analysis of the biopsy allows further correct diagnosis.

4. Radiation diagnostic methods(ultrasound, X-ray (with a contrast agent) study, computed tomography, etc.) play an auxiliary role in the diagnosis of IBD.

How are inflammatory bowel diseases treated?

IBD is a chronic disease that alternates with periods of exacerbation and remission (when there are no symptoms of the disease).

Treatment goals:

  • in case of exacerbation, achieve remission as soon as possible (eliminate inflammation);
  • maintain remission as long as possible - for this it is necessary to take medications that will prevent the onset of symptoms of the disease;
  • prevent complications of the disease.

Medical treatment VZK includes major(aimed at stopping inflammation in the intestines and preventing its occurrence) and auxiliary(antibiotics, antispasmodics, enzymes, prebiotics, butyric acid - aimed at stopping either symptoms or enhancing the main anti-inflammatory therapy) drugs. The choice of drug and dosage form depends on the localization and prevalence of inflammation in the intestine, as well as the severity of the disease.

What medications are used to treat IBD?

The main drugs for the treatment of IBD:

1. 5-ASA preparations(mesalazine, sulfasalazine). Dosage forms - tablets, granules for oral administration and suppositories, enemas, rectal foam for topical administration into the intestine.

2. Steroid hormones(glucocorticosteroids) - systemic(acting at the level of the whole organism), are administered orally or intravenously and topical - budesonide(acting directly in the affected area of ​​the intestine), are administered orally or topically into the intestine in the form of foam.

3. Immunosuppressants.

4. Biologicals- administered intravenously or subcutaneously.

Things to keep in mind while treating IBD:

1. Taking drugs should be regular and constant, even if the child is in remission and there are no symptoms of the disease.

2. Any changes in therapy should be only with the permission of your doctor. THEREFORE, IT IS IMPOSSIBLE TO: stop taking medications, reduce the dose of medications, replace prescribed medications with other medications.

3. If symptoms appear (recurrence of the disease), do not self-medicate, immediately contact your doctor.

The use of butyric acid in radiation injuries of the intestine

One of the promising methods of drug prevention to maintain remission in patients with UC is the use of butyric acid and inulin - Zakofalk as part of complex therapy (for example, in combination with mesalazine).

A decrease in the level of butyric acid in inflammatory bowel disease (IBD) has been found in many studies, which served as the basis for studying the effectiveness of its use in IBD. One of the reasons for the decrease in butyric acid in patients with IBD is a significant decrease in the number of microbes that synthesize this metabolite. The state of mucosal and fecal microflora associated with mucosal and fecal microflora was studied in patients with Crohn's disease, ulcerative colitis and in healthy people. There is a dramatic decrease in butyric acid-producing bacteria (particularly Faecalibacterium prausnitzii) in both feces and colonic mucosa in patients with IBD compared with healthy individuals.

The use of Zakofalk as a means of enhancing the main therapy for the prevention of exacerbation of ulcerative colitis is justified by a decrease in the concentration of this metabolite in these patients and the main effects of butyric acid on the colon mucosa:

1. Antiatrophic action - restoration of trophism of the mucous membrane of the colon.

2. Anti-inflammatory action. Restoration of the barrier functions of the colon.

3. Regulation of the processes of normal maturation and development of cells of the colon mucosa.

4. Antidiarrheal action - regulation of water and electrolyte balance in the colon.

5. Prebiotic effect - creating a favorable environment for the growth of one's own beneficial microflora.

The effectiveness of Zakofalk is confirmed in in large numbers research. Thus, in a large study conducted at 19 gastrocenters that are part of the IBD study group in Italy, patients with mild to moderate forms of ulcerative colitis (number of patients = 196) who did not achieve a satisfactory response to standard mesalazine therapy within 6 months Zakofalk was added 1 tablet 3 times a day. After 6 months, patients treated with the combination of mesalazine and Zakofalk showed a statistically significant decrease in the frequency of defecation, blood and mucus impurities, as well as a decrease in the clinical activity index - 86% were in the phase of clinical remission (had no symptoms of the disease).

For the prevention of exacerbation (maintenance of remission) of ulcerative colitis, Zakofalk in combination with the main therapy (mesalazine) is used 1 t 3-4 times a day, the minimum course is 3-6 months, maintenance therapy is possible 1 t 2 times a day for a long time.

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