Why do I treat my ulcerative colitis (UC) myself? Treatment of nonspecific ulcerative colitis. Candles with sea buckthorn oil

Treatment program for nonspecific ulcerative colitis

1. Medical nutrition.
2. Basic therapy (treatment with drugs containing 5-amino-salicylic acid, glucocorticoids, cytostatics).
3. The use of astringents, adsorbents and antidiarrheals.
4. Correction of metabolic disorders and anemia.
5. Detoxification therapy.
6. Antibacterial therapy and treatment of intestinal dysbiosis.
7. Local therapy of proctosigmoiditis.
8. Normalization functional state central nervous system.

Patients with UC mild degree can be treated on an outpatient basis, with medium degree The severity of the disease requires hospitalization; in severe cases, emergency hospitalization and intensive treatment are indicated. For correct differentiated treatment, it is necessary to determine the severity of UC.

Light form has the following characteristic features:

• the frequency of bowel movements does not exceed 4 times a day with no big amount blood in stool;
• increased fatigue;
• there is no fever or tachycardia;
• when examining the abdomen, only slight pain is detected along the colon;
• extraintestinal symptoms of the disease are manifested by symmetrical synovitis large joints, erythema nodosum and other skin manifestations;
• slight anemia (Hb>111 g/l), slight increase in ESR(up to 26 mm/h);
• the process is localized mainly in the rectum and sigmoid colon (swelling, hyperemia of the mucous membrane, superficial, often numerous erosions, transient ulcerations, uneven thickening of the mucous membrane).

Form moderate severity characterized by the following manifestations:

• in the acute phase, stools 4-8 times a day with blood;
• there is an increase in body temperature, lack of appetite, weight loss, weakness, intestinal colic, signs of dehydration, pallor, tachycardia, decreased blood pressure;
• when examining the abdomen, there is pain and rumbling in the area of ​​the colon, but there is no distension of the colon;
• often there is anemia (Hb 105-111 g/l), leukocytosis, increased ESR (26-30 mm/h);
• systemic manifestations: jaundice, deformation of large joints, various skin manifestations, eye lesions;
• at endoscopic examination The colon reveals severe hyperemia, swelling of the mucous membrane, multiple erosions, ulcers covered with mucus, pus, and fibrin.

Severe form has the following clinical manifestations:

• stool more than 8 times a day with blood, mucus, often with admixtures of pus;
• body temperature above 38 °C;
• tachycardia (at least 90 beats per minute);
• abdominal pain, lack of appetite; bloating;
• reduction in body weight by more than 10%;
• severe anemia (Hb< 105 г/л), увеличение СОЭ (>30 mm/hour), hypoalbuminemia;
• endoscopic examination reveals sharp hyperemia, swelling of the mucous membrane, multiple erosions, ulcers covered with pus and fibrin; with a long course, the intestinal folding may disappear.

1. Medical nutrition

At easy The form of the disease does not require significant dietary restrictions. However, it is not recommended to consume very sharp, irritating gastrointestinal tract products, and also limit the consumption of milk for diarrhea.

In case of severe exacerbation of the disease, diet No. 4 is prescribed (see “Treatment chronic enteritis"") with modifications (A.R. Zlatkina, 1994):

• increase the protein content to an average of 110-120 g (65% of animal origin) due to the development of protein deficiency in patients; Lean meat, fish (in the form of steam cutlets, quenelles, meatballs, boiled meat, boiled fish), soft-boiled eggs and in the form of steam omelettes, as well as low-fat, lactose-free, anti-anemic protein enpits; dairy products are not recommended during an exacerbation period;
• limit the amount of fat to 55-60 g and add 5-10 g of butter to dishes;
• carbohydrate content - 250 g with maximum fiber limitation.

As the patient’s condition improves, they are gradually transferred to diet No. 4b, 4c (see “Treatment of chronic enteritis”) with an increase in protein content to 110-130 g per day.

At severe During an exacerbation of UC, the most gentle ballast-free, slag-free diet is used. It does not consist of products (in the usual sense of the word), but of vital, easily digestible substances (amino acids, glucose, minerals,
multivitamins, peptides, small amounts vegetable fat). These substances are almost completely absorbed into upper sections small intestine.
In case of loss of more than 15% of body weight, it is prescribed parenteral nutrition by catheterization of the subclavian vein, through which the essential amino acids, protein preparations, fat emulsions (intralipid, lipofundin, vitallipid), solutions of glucose, electrolytes.

2. Basic therapy

Facilities basic therapy influence the main pathogenetic mechanisms: synthesis of inflammatory mediators and immune disorders, including autoimmune reactions.

2.1. Treatment with drugs containing S-ACK

Sulfasolosin (salazosulfapyridine, salazopyridine) is a compound of sulfapyridine and 5-aminosalicylic acid (5-ASA). Under the influence of intestinal flora, sulfasalazine breaks down into sulfapyridine and 5-ASA, which is an effective component of the drug, and sulfapyridine is only its carrier. 5-ASA inhibits the synthesis of leukotrienes, prostaglandins and inflammatory mediators in the colon, resulting in a pronounced anti-inflammatory effect. P. Ya. Grigoriev and E. P. Yakovenko (1993) indicate that sulfasalazine may also exhibit antibacterial effect in the intestine, inhibiting the growth of anaerobic flora, especially clostridia and bacteroides, mainly due to unabsorbed sulfapyridine.

Sulfasalazine should be taken in small portions between meals. The drug can be taken orally or administered into the rectum in the form of a therapeutic enema or suppository. The daily dose of sulfasalazine depends on the severity of the disease, the severity of inflammation, and the extent of the pathological process in the intestine.

For mild forms of the disease and for moderate forms, sulfasalazine is prescribed 3-4 g per day, with severe forms- 8-12 g per day. On the first day it is recommended to take 1 tablet (0.5 g) 4 times a day, on the second day - 2 tablets (1 g) 4 times a day and on subsequent days if the drug is well tolerated - 3-4 tablets 4 times a day , bringing the dose in severe forms to 8-12 g per day.

After the onset of remission, treatment should be continued at the same dose for another 3-4 weeks, and then gradually reduce the dose every 3-5 weeks to a maintenance dose (1-2 g per day), which should be taken for at least a year and discontinued if remission persists (P. Y. Grigoriev, 1993).

Treatment sulfasalazine in 10-30% of cases it is accompanied by the development of side effects:

• gastrointestinal manifestations (anorexia, nausea, vomiting, epigastric pain);
• general symptoms ( headache, fever, weakness, arthralgia);
• hematological disorders (agranulocytosis, pancytopenia, anemia, methemoglobinemia, hemorrhagic syndrome);
• granulomatous hepatitis;
• oligospermia and male infertility.

During development side effects the drug is discontinued until they disappear completely, then you can re-prescribe the drug at half the dose and try to increase it to the optimal one.

Sulfasalazine inhibits absorption in small intestine folic acid, so patients receiving sulfasalazine should also take folic acid 0.002 g 3 times a day.

For left-sided distal localization of UC (proctitis, proctosigmoiditis), sulfasalazine can be used in the form of microenemas and suppositories.
For enema administration, sulfasalazine is used as a suspension of 4-6 g in 50 ml isotonic solution sodium chloride or boiled water daily for 1-1.5 months.

Sulfasalazine suppositories are injected into the rectum 2 times a day. One suppository contains 1 g of sulfasalazine and 1.6 g of cocoa butter.

Salofalk (tidocol, mesacol, mesalazine) - a drug containing only 5-aminosalicylic acid and devoid of sulfapyridine. It is believed that the side effects of sulfasalazine are primarily due to the presence of sulfapyridine in its composition. Salofalk does not contain sulfapyridine, so it causes much less side effects and is better tolerated than sulfasalazine. Salofalk is prescribed for intolerance to sulfasalazine.

A. R. Zlatkina (1994) recommends lungs forms of UC, prescribe salofalk 1.5 g (6 tablets of 0.25 g) daily. At medium-heavy forms, the dose is doubled. At acute In attacks of proctosigmoiditis, enemas with salofalk containing 4 g of the drug in 60 g of suspension, which are done once after stool for 8-10 weeks, are more effective.

For treatment distal forms of UC, suppositories are also used: 2 suppositories (500 mg) 3 times a day (morning, afternoon, evening), daily.

Salazopyridazine, salazodimethoxine - 5-ASA-containing drugs are domestically produced, they are less toxic and better tolerated. The mechanism of action is the same as sulfasalazine. The activity of these drugs is higher than that of sulfasalazine. Salazopyridazine and salazodimethoxin are available in tablets of 0.5 g. Treatment with these drugs is carried out mainly with light medium severity of forms of chronic ulcerative colitis.

P. Ya. Grigoriev and E. P. Yakovenko (1993) in active stage diseases, these drugs are prescribed in a daily dose of 2 g (0.5 g 4 times a day) for 3-4 weeks. In case of therapeutic effect daily doses are reduced to 1-1.5 g (0.5 g 2-3 times a day) and treatment is continued for another 2-3 weeks. In severe forms of the disease, an increase in daily dose up to 4 years

2.2. Treatment with glucocorticoid drugs

Glucocorticoid drugs accumulate in the area of ​​inflammation in the colon with UC and block the release of arachidonic acid, prevent the formation of inflammatory mediators (prostaglandins and leukotrienes), reduce capillary permeability, i.e. have a powerful anti-inflammatory effect. In addition, glucocorticoids have an immunosuppressive effect. Indications for prescribing glucocorticoids for UC are as follows (A. R. Zlatkina, 1994):

• left-sided and total forms of ulcerative colitis with severe course, with III degree activity of inflammatory changes in the intestine (according to endoscopic examination);
• acute severe and moderate forms of the disease in the presence of extraintestinal complications;
• lack of effect from other treatment methods for chronic forms of ulcerative colitis.

Glucocorticoids can be used orally, intravenously, and rectally.

Internal glucocorticoids are prescribed for a common process ( prednisolone - 40-60 mg per day, and according to A. R. Zlatkina, - 1-2 mg/kg, but not more than 120 mg per day), and in severe cases, if there is no significant improvement within 4-5 days from taking salicylic sulfonamides, P. Ya. Grigoriev recommends administering hydrocortisone intravenously hemisuccinate (initial dose 200-300 mg, then 100 mg every 8 hours). After 5-7 days, the administration of hydrocortisone is stopped and treatment is continued with oral prednisolone at a dose of 40-60 mg per day, depending on the patient’s condition. After the onset of clinical remission, the dose of prednisolone is gradually reduced (no more than 5 mg per week). The full course of glucocorticoid therapy lasts from 10 to 20 weeks, depending on the form of ulcerative colitis. When the patient's condition improves, it is advisable to include sulfasalazine or salofalk and take until prednisolone is completely discontinued.

In patients with UC limited to the rectum and sigmoid colon, glucocorticoids can be prescribed in suppositories or enemas. Hydrocortisone is prescribed by rectal drip at 125 mg, and prednisolone at 30-60 mg in 120-150 ml of isotonic sodium chloride solution 1-2 times a day. Prednisolone suppositories are also used, 1 suppository 2 times a day (1 suppository contains 5 mg of prednisolone).

You should remember about the possibility of developing side effects of glucocorticoid therapy: systemic osteoporosis, steroid-induced diabetes mellitus, arterial hypertension, Cushingoid syndrome, development of stomach ulcers or duodenum. The development of steroid gastric ulcers and bleeding from them require discontinuation of glucocorticoids, the rest side effects corrected by symptomatic therapy.

2.3. Treatment with cytostatics (non-hormonal immunosuppressants)

The question of the advisability of treating patients with UC with cytostatics has not been completely resolved.

P. Ya. Grigoriev (1993) believes that the cytostatic 6-mercaptopurine is not indicated for exacerbations of UC; it is preferable to use it in cases where the patient is in remission and it is desirable to reduce the dose of glucocorticoids or stop treatment with them.

Cytostatics have a pronounced immunosuppressant effect, suppress immune mechanisms pathogenesis of UC.

When azathioprine (Imuran) is combined with prednisolone, remission occurs faster. With such complex therapy, it is possible to reduce a large dose of glucocorticoids. Azathioprine is recommended at an average dose of 150 mg per day (2-2.5 mg/kg).

Due to the high risk of side effects during treatment with non-hormonal immunosuppressants (pancytopenia, anemia, leukopenia, the development of pancreatitis, the addition of infectious and inflammatory diseases, etc.), short courses of treatment (3-4 weeks) are recommended, followed by a decrease and withdrawal of cytostatics.

IN last years Data have appeared on the possibility of using the immunosuppressant cyclosporine in the treatment of ulcerative colitis. It has a main effect on the cellular component of immunity, suppressing the synthesis and release of interleukin-2, inhibiting the function of T-helper lymphocytes and the production of autoantibodies. Interleukin-2 plays an important role in the progression of UC. Treatment with cyclosporine is prescribed when all previous treatments have been ineffective (i.e. cyclosporine is a drug “ last row"). Treatment is prescribed with doses of 15 mg/kg per day for 2 weeks, then the dose is reduced to a maintenance dose, individually selected, which can be used for many months (up to a year). The drug does not affect Bone marrow, but may have toxic effect on the kidneys.

Suppositories for colitis are popular dosage form, thanks to the direct effect of medicinal components on inflammatory foci. Suppositories have a minimum of contraindications, are practically not absorbed into the systemic bloodstream, and do not directly affect the functionality of internal organs.

All drugs in the form of suppositories for colitis and intestinal inflammation have anti-inflammatory, antimicrobial and regenerating effects, which significantly facilitates the course of the disease and quickly reduces the intensity of symptomatic manifestations. Correct Application rectal suppositories relieve the patient’s condition within a few days.

Rectal suppositories are easily inserted into the rectal space and begin to act almost immediately after dissolution

Benefits of rectal suppositories

Unlike local and systemic drugs for proctitis and colitis, rectal suppositories are effective against any form of inflammation of various parts of the intestine, thanks to the targeted effect of active medicinal components.

The drugs directly affect the affected area, disinfect and create a protective film on the mucous membranes. The main advantages of rectal suppositories are:

• absence negative influence on gastrointestinal intestinal microflora;
• maintaining the therapeutic effectiveness of the drug components inside the intestine;
• speed of directed influence;
• ease of use in children and adults;
• dosage accuracy.

Suppositories for treating the intestines are easily inserted into the anus without causing any discomfort.

Important! Despite the absence of absolute contraindications, independent use of drugs is unacceptable. Inadequate dosage can contribute to traumatization of mucous membranes, persistent diarrhea and complicate the recovery process.

Popular and effective means

So, which intestinal suppositories should you choose to relieve inflammation and speed up the healing of affected areas of the mucous membranes? The choice of drugs for the treatment of colon colitis is usually determined by the form, severity and stage of the disease, and the symptomatic complex. At inflammatory lesion intestines the most effective are the following medications:

1. Suppositories Relief. The drug copes well with pain, eliminates bleeding in ulcerative colitis of the intestine, paraproctitis. Candles contain oil shark liver, which has a beneficial effect on the intestinal mucosa, promotes rapid regeneration, restoration and healing.
2. Salofalk. The drug is used for severe inflammation of the walls of the intestinal sections, reducing swelling, painful syndrome, bleeding. The components of the product protect the mucous membranes from damage, creating a protective film on the affected area. Candles are used 3 times a day, laying cotton swab into the anus after inserting a suppository.
3. Ultraproct. Hormonal suppositories for intestines against inflammation with the active ingredient - fluocortolone. The drug reduces pain, swelling, eliminates severe itching, relieves problems with bowel movements, especially colitis with constipation. Being hormonal agent, the drug should be taken under the mandatory supervision of the attending physician.
4. Viburkol. Homeopathic medicine for administration in colitis with constipation and defecation disorders. The product perfectly restores intestinal function in case of colitis and hemorrhoids. Viburkol has antipyretic, antispasmodic, analgesic effects. Due to the natural nature of the drug, suppositories can be used by children early age, pregnant and lactating women.
5. . The suppository contains the analgesic Lidocaine, bismuth, titanium dioxide and bufexamac. The analgesic and anti-inflammatory effect for colitis is achieved in any form of the disease. All these components have a drying astringent effect and an anti-inflammatory effect. After using Proctosan suppositories, the first results are felt within 3-5 days regular use. 2 suppositories per day are enough.
6. Diclofenac. A well-known pain reliever that eliminates not only painful syndrome, but also improves the condition of the intestinal mucous membranes. Contains suppository active substance diclofenac and solid fats. Prescribed when acute colitis intestines of any form and for the treatment of ulcerative colitis during an exacerbation. The drug is effective against ulcerative colitis with signs of bleeding.
7. Natalsid. Suppositories for stopping bleeding in all forms of colitis. The drug is effective for colitis with stool disorders. The hemostatic drug is based on brown seaweed, which not only affects the source of bleeding, but also stimulates the regeneration of mucous tissues, reducing the inflammatory focus.
8. Papaverine. Antispasmodic suppositories to eliminate pain in acute colitis against the background of increased muscle contractility. The use of the drug is symptomatic only. Papaverine not only eliminates spasms, but also has a pronounced analgesic effect.

Important! All anti-inflammatory suppositories for inflammation of the rectum should be prescribed only after consultation with a doctor. Considering the diversity of manifestations of colitis, symptomatic manifestations differ in each case.

Other effective remedies

Other things medicines for colitis include inexpensive and effective suppositories for colitis based on natural ingredients, as well as those that have found their use in various areas medicine and cosmetology. Among the wide-profile medicinal suppositories highlight:

1. Ichthyol candles. Contains anti-inflammatory rectal suppositories the natural component is ichthammol, and vitepsol is considered an auxiliary component. Ichthyol suppositories for colitis have a healing and restorative effect on the affected areas of the intestine. Two suppositories per day are enough to eliminate unpleasant symptoms associated with colitis.
2. Methyluracil suppositories. A drug from the sulfonamide group, they are sulfonamide suppositories. Action active ingredients The drug is aimed at suppressing the inflammatory focus and activating metabolic processes in the affected mucous membranes. Methyluracil suppositories for intestinal colitis stimulate the regenerative activity of mucosal cells and accelerate the synthesis of red blood cells. After just a few days, bleeding decreases, swelling and pain decrease.
3. Propolis based suppositories. Natural components in propolis suppositories accelerate the restoration of mucous membranes, soften the intestinal lining, relieve pain and eliminate pathological processes. Despite absolute safety, the use of propolis suppositories for colitis can cause allergic reactions, especially in young children.
4. Sea buckthorn candles. Sea buckthorn oil in the composition of the drug has an excellent disinfecting and anti-inflammatory effect. Sea buckthorn resolves fatty acid, thereby accelerating the restoration of the mucous epithelium. Against the background of the use of suppositories with sea ​​buckthorn oil swelling and itching are eliminated, vascular conductivity in the affected area is improved. The course of use is 14 days, 2 suppositories per day.

About drugs for the treatment of hemorrhoids and intestinal inflammation in E. Malysheva’s program on health:

Long-term diarrhea of ​​unknown origin with the presence of blood and mucus in the stool may be a consequence of this chronic disease colon, such as ulcerative colitis, or UC for short.

The first symptoms of the disease most often begin to appear between the ages of 20 and 30 years, with equal prevalence in women and men. Plays a decisive role in the occurrence of UC hereditary predisposition. This can be evidenced by the statistical fact that the disease recurs in 10% of first-degree relatives.

Despite the fact that any part of the colon can be affected by the disease, UC most often affects sigmoid colon. The most severe course diseases affecting the rectum.

The main cause of nonspecific ulcerative colitis remains to this day modern medicine unknown. Among different versions The reasons for the occurrence of the UC process include the following: unfavorable factors environment and ecology, viruses and various microorganisms. However, none of the listed factors can be a clear cause of the disease.

The above factors, including various chemical additives in food, harmful industrial emissions, as well as electromagnetic and microwave radiation, radioactive irradiation, lead to an imbalance of beneficial and pathogenic bacteria in the microflora of the entire intestine, and in particular the colon. Beneficial bacteria The intestines produce various volatile fatty acids during their life processes. If for some reason their production is disrupted, then the final product contains inferior polysaccharides, which form mucus in the intestines. Further violation microbial composition, intestinal dysbiosis, causes death (necrosis) of the cells that form its mucous tissue. As the disease progresses, the affected areas become larger and the intestinal protective barrier may be damaged in places. This. in turn, can lead to the “leakage” of microbes into the body’s bloodstream with the subsequent development of inflammation colon- toxic expansion of the intestinal lumen, its perforations and bleeding.

In these cases, during fibrocolonoscopy - examination of the colon using medical diagnostic equipment, inside its mucous membrane shows numerous ulcerative defects against the background of general inflammation of the mucous tissue. At the same time, in some patients with ulcerative colitis, the lumen of the colon “swells” to 15 - 20 centimeters in diameter, and the so-called balloon-like expansion of the lumen develops.

Clinical forms of nonspecific ulcerative colitis:

1. Acute;
2. Chronic.

According to the severity of the process in patients with UC, they are divided into:

1. Severe form of colitis;
2. Lightning form colitis

The acute form of colitis develops only in 20% of cases, mainly develops chronic form diseases. Light form accompanied by cramping abdominal pain. The stool is mushy in nature with a frequency of 3 to 4 times a day. In this case, patients may have satisfactory general physical state and well-being.

The severe form is accompanied by more intense pain in the abdomen, diarrhea with blood, mucus or pus up to 10 times a day. Patients begin to lose weight. Complications in the form of sepsis begin to appear. In some cases, a severe form may occur as early as initial stage diseases, leading to a decrease blood pressure, dehydration, aching joints, enlarged spleen and liver, skin manifestations. With this form of the disease, mortality (mortality) reaches 40 - 100%.

The development of the UC process can lead to complications such as extensive purulent infection(sepsis), inflammation of the joints, damage to the kidneys, liver, heart, eyes and skin areas.

Treatment

Treatment of nonspecific ulcerative colitis is carried out with the appointment special diet, medications. In severe cases, elimination surgery may be indicated local complications. Treatment of severe forms of the disease is carried out only in a hospital setting.

The diet for nonspecific ulcerative colitis consists of prescribing treatment tables No. 4a, No. 4b, No. 4c, including high protein content, low fiber content, plant fibers and fats. At the same time, fruits, vegetables, root vegetables and dairy products are completely excluded from consumption. Recommended for consumption in the diet are pureed porridges (with the exception of millet), low-fat varieties meat and fish, meat and fish broths, juices in a 1:1 ratio with water.

At chronic diarrhea, accompanied by disturbances of all types of metabolism and loss of fluid in the body, protein amino acid preparations, vitamins, and saline solutions are administered.

The basis drug treatment ulcerative colitis consists of hormonal corticosteroids and drugs based on 5-aminosalicylic acid. They break down in the colon, forming substances that suppress harmful intestinal microflora and eliminate inflammation that affects the intestinal mucosa. These drugs include: sulfasalazine, salazopyridazine, sulfaliridine. American scientists in the 90s found that the most effective means treatment and maintenance of stable remission is azathioprine. They also identified and studied following features development of nonspecific ulcerative colitis:

• The occurrence of annual exacerbations in 40-50% of patients from the 2nd to the 4th year from the onset of the disease;
• Remission of the disease process in the 1st year is 40% of patients, i.e. they have no clinical manifestations of the disease, it develops covertly;
• After 10 years from the onset of the disease, only 30% of patients experience exacerbations;
• In people who smoke, the risk of developing ulcerative colitis is 40% higher than in non-smokers, which confirms the fact that harmful environmental factors influence the occurrence of the disease. However, certain components have been discovered tobacco smoke, reducing the risk of exacerbation. For this reason, if UC develops after a person quits smoking, he may be advised to resume the bad habit.
• Increasing the time of remission of the disease reduces the risk of exacerbation.

In cases where the process of nonspecific ulcerative colitis affects an area of ​​the rectum no more than 15 - 20 cm from anus the following may be assigned local procedures, such as: therapeutic enemas, rectal suppositories and ointments.

Art. 402 gr. l.f. N.Sh. Sharov.

UIRS: « Treatment of nonspecific ulcerative colitis."

Patients with exacerbation of UC are subject to hospitalization, preferably in a specialized gastroenterological or coloproctological department. Bed rest is indicated in moderate and severe forms of the disease. However, long-term appointment bed rest inappropriate and have an adverse effect on the physical and mental state sick.

Treatment of nonspecific ulcerative colitis includes the following components:

Diet therapy

· Preparations of basic and auxiliary therapy

· Infusion therapy for the purpose of detoxification, correction of protein and water-electrolyte balance, vitamins.

· Sedatives(minor tranquilizers: Elenium, Seduxen)

· Antidiarrheal therapy: anticholinergic drugs /contraindicated in glaucoma/ (tinctures and extracts of belladonna, solutan, platifillin), codeine, astringents of plant origin (decoctions from pomegranate peels, acorn bark, infusions of bird cherry fruits, blueberries, serpentine rhizomes, gray alder cones).

· Surgery- indicated when complications develop and there is no effect from conservative therapy.

Diet therapy. One of the main directions in the treatment of nonspecific ulcerative colitis is the correction of adequate nutrition and diet therapy. At the height of the disease, diet No. 4 or 4b is prescribed. During the period of subsidence of acute phenomena - diarrhea, abdominal pain - the patient is transferred to an unprocessed diet. It should be emphasized that prolonged adherence to a strict diet does not contribute to the restoration of the patient’s metabolism and strength impaired due to the disease. It is necessary to strive to ensure that the dishes are varied and tasty. Recommended lean meats, boiled or steamed, eggs, mashed porridge, fried White bread, cracker. Walnuts should be included in your diet. acute stage diseases, decoctions of rose hips, blueberries, pears and other sweet and ripe berries and fruits, as well as some juices (orange, tomato).

Principles rational nutrition should exclude fried, fatty, salty, spicy foods. Also, chocolate should not be included in the diet of a sick child. legume products, mushrooms, fruits and vegetables that stimulate peristalsis (plums, kiwi, dried apricots, beets). During an exacerbation, the amount of fiber, sweets, and juices is limited. With long-term remission, the diet can be significantly expanded, but milk and dairy products are contraindicated throughout life.

Many patients with ulcerative colitis have intolerance to various foods, especially milk and dairy products, so excluding them from the diet can help improve. In the acute stage of the disease rich food is not sufficiently digested and absorbed, so food should be given in small portions, but often. In case of diarrhea, the intervals between meals should not exceed 2.5 g/hour. It is recommended to have dinner no later than 21:00.

With nonspecific ulcerative colitis, it especially affects protein metabolism, since the absorption of proteins in the intestine is sharply disrupted, their breakdown occurs and losses with liquid feces increase. Metabolic disorders increase especially quickly during an acute, severe attack of the disease. In such cases, food containing an increased amount of protein is prescribed (130 - 150 g per day). During a severe attack of nonspecific ulcerative colitis, the amount of fluid consumed orally is also reduced, focusing on the nature of the bowel movements. If they are very watery and abundant, limit yourself to 5 glasses of liquid per day. Along with the fact that the diet should be high-protein, it should also be low-residue, i.e., not contain coarse fiber.

If acute toxic dilatation of the colon occurs, you should stop eating for 24 hours and prescribe parenteral nutrition.

Drug therapy.

Treatment of almost all forms of UC (except for those complicated by perforation, toxic dilatation, profuse bleeding) begins with conservative methods. The goal of any therapeutic intervention is to relieve inflammation, achieve remission and maintain it for as long as possible.
For the treatment of nonspecific ulcerative colitis in widespread practice salazal preparations (sulfasalazine, salazopyrin, salazodimethoxin), 5-aminosalicylic acid preparations (mesalazine and its analogues under trade names– salofalk, mesacol, pentasa, etc.) and corticosteroid hormones. These drugs are the basis for the treatment of ulcerative colitis. Adjuvant therapy includes immunosuppressants, leukotriene B4 inhibitors, anesthetics, stabilizers mast cells, immunoglobulins, reparants, cytoprotectors, antibacterial drugs, antioxidants and nicotine.

Basic therapy. As a rule, treatment begins with a prescription sulfasalazine or 5-ASA drugs(except for severe and common forms of UC).

In 1942, the drug sulfasalazine was first used in patients with combined damage to the intestines and large joints, which gave a pronounced positive effect: relief of arthralgia and hemocolitis. Sulfasalazine has been used in the treatment of ulcerative colitis to this day. However, its use was limited by a large number of side effects, such as hemolytic anemia, neutropenia, drug-induced hepatitis, Stevens-Johnson syndrome, pericarditis, interstitial nephritis, pancreatitis. The frequency of side effects according to different authors ranges from 5 to 55%. The composition of sulfasalazine includes mesalazine (5-aminosalicylic acid), which has an anti-inflammatory effect, and sulfapyridine, which ensures the delivery of mesalazine to the colon, the site of localization of the main inflammatory process in ulcerative colitis. Sulfapyridine promotes the development large quantity side effects.

Numerous studies in the development of drugs containing mesalazine made it possible in the late 70s and early 80s to create drugs that do not contain sulfapyridine. This resulted in a significant reduction in side effects, which in turn allowed the use of higher doses of mesalazine and reduced the need for corticosteroids. Mesalazine is active upon local contact with the intestinal mucosa and its therapeutic efficacy is correlated with the concentration in the intestinal lumen. These features of mesalazine made it possible to develop and successfully use local therapy in the form of suppositories, microenemas as in acute period and during maintenance therapy.

5-ASA drugs can be divided into 3 groups. The first group includes Sulfasalazine and Olsalazine, which are released under the influence of intestinal flora and act in the colon. The second group includes Mezakol, Salofalk, Rovaza. The release of these drugs depends on the pH of the environment and their action is localized in the terminal section ileum and in the large intestine. The third group includes the drug Pentasa, which is released slowly and acts throughout the entire intestine:

The mechanism of action of 5-ASA drugs is based on an anti-inflammatory effect, which is realized through inhibition of prostaglandin formation, reduction in the synthesis of cytokines: IL-1, IL-2, IL-6, tumor necrosis factor, inhibition of the lipoxygenase pathway of arachidonic acid metabolism, and reduction in the production of free radicals.

Indications for the use of 5-ASA drugs: primary therapy for mild UC activity, primary therapy in combination with steroids for moderate and severe UC activity, maintenance therapy for UC

In our country, the most commonly used 5-ASA drugs are sulfasalazine, salofalk and pentasa. As noted earlier, sulfasalazine has been used in the treatment of ulcerative colitis for 60 years. The breakdown of sulfasalazine into mesalazine and sulfapyridine depends on the composition of the intestinal flora and occurs only in the colon. When inflammation is localized in the cecum and ascending colon (in wounded children), the effectiveness of sulfasalazine is significantly reduced.

Salofalk - active ingredient this drug is mesalazine. The drug is a tablet coated with a coating that is resistant to gastric juice. Its feature is the absence of a sulfonic component, which reduces the number of side effects. Activation of salofalk occurs when the acidity of the medium changes above 6. The site of action of salofalk is mainly in the terminal ileum and colon.

Pentasa - on Russian market This drug was introduced relatively recently. Active substance is also mesalazine, enclosed in microgranules that are resistant to acidic environment stomach. Pentasa is released slowly, gradually along the intestine, starting from the duodenum. At the same time, changes in the level of intraluminal pH and acceleration of transit during diarrhea do not affect the rate of drug release. Thanks to these features, Pentasa provides high therapeutic concentrations throughout the small and large intestines.