Nonspecific ulcerative colitis in children symptoms. Nonspecific ulcerative colitis in children - symptoms and treatment

In approximately 10% of all cases of ulcerative colitis, the disease begins in childhood. In Western countries, the incidence of ulcerative colitis in children increased in the 1970s and 80s, after which it has remained at the same level. The typical age of onset of symptoms is prepubertal or pubertal. Recently there has been a trend towards more early appearance symptoms - in primary school years.

Causes

The etiology of ulcerative colitis in children still remains unknown, and therefore there are no methods for specific etiological treatment. Conservative treatment is based on systemic or local suppression of the immune response from the colon. This is most often achieved using derivatives acetylsalicylic acid and systemic or local use of corticosteroids.

Treatment

In children it is more aggressive than in adults. They often have a widespread form of the disease, and pancolitis develops more often in childhood than in adults. Therefore, children require more aggressive drug treatment for ulcerative colitis than adults. Corticosteroids should usually be used from the onset of the disease. The use of systemic corticosteroids represents a very important problem, since the side effects of their high doses on the growth and development of the child are not only very serious, but are sometimes an indication for surgical treatment.

Surgery

From 40 to 70% of children with ulcerative colitis undergo surgical treatment. Since the condition of most children can be stabilized with drug treatment, there are now rarely indications for emergency intervention for toxic, persistent bleeding or untreatable fulminant forms of the disease. Typical indications for surgical treatment of ulcerative colitis in children are: lack of effect from actively pursued conservative therapy, dependence on high doses of corticosteroids with significant side effects, delayed growth and development of the child, as well as severe extraintestinal manifestations diseases. should not be considered as a method of primary or early treatment ulcerative colitis in children. A significant proportion of patients manage to cope with the symptoms of the disease and achieve long-term remission on minimal doses of drugs or even after discontinuation of drug treatment. In addition, the functional outcomes of reconstructive proctocolectomy are not comparable to normal bowel function. After repeated exacerbations of the disease, patients get used to the fact that they will have bowel movements several times a day. Before surgery, proctocolectomy should be excluded by any means, since reconstructive proctocolectomy is not indicated for Crohn's disease.

The “gold standard” for surgical treatment of ulcerative colitis in children is proctocolectomy and permanent ileostomy. Limited resection of the colon and colectomy with ileorectal anastomosis are a thing of the past, as they are associated with a high rate of complications and relapses of the disease. Proctocolectomy and permanent ileostomy give excellent results and help cope with the symptoms of ulcerative colitis in children, but are not very well accepted by children and adolescents, since they are associated with significant restrictions in social life, and the presence of an ileostomy changes appearance child. Reconstructive proctocolectomy with ileoanal anastomosis has become universally accepted as the standard procedure for pediatric ulcerative colitis. Many pediatric surgeons advocate the creation of an ileal pouch. Some children still perform a direct ileoanal anastomosis without a reservoir.

Reconstructive proctocolectomy is a major operation accompanied by a high incidence of postoperative complications. Septic complications are the most common complications because most patients with treatment-resistant ulcerative colitis are immunocompromised due to high-dose corticosteroid use. Many children are significantly underweight as a result prolonged diarrhea and eating disorders. To avoid septic complications, it is absolutely necessary to reduce the dose of systemic corticosteroids to the lowest possible level or switch to local application budesonide, which has a less pronounced systemic immunosuppressive effect. If possible, it is also necessary to cope with malnutrition by prescribing an appropriate diet. For this purpose, sometimes, although rarely, it is necessary to carry out parenteral nutrition.

If the child has, as in most cases with ulcerative colitis, chronic diarrhea, the intestines can be emptied simply by colonic lavage. If there is no diarrhea, it is advisable to rinse the entire intestine with a polyethylene glycol solution.

Progress of the operation

Upon induction of anesthesia, prophylactic administration (cefotaxime and metronidazole) is started. The operation is performed under general anesthesia. Nitric oxide should be avoided as it causes bloating. It is advisable to insert a catheter into the epidural space for postoperative pain relief. Additional pain relief can be provided with opioids administered through patient-controlled analgesia (PAC). IN bladder A catheter is inserted and left in place until the epidural and opioids are stopped.

The patient is placed on the operating table in the lithotomy position with a Trendelenburg tilt of 10-15°. The abdomen is treated from the lower chest to the perineum. A midline incision is made from the middle between the xiphoid process and the umbilicus to the suprapubic region, which provides free access to all parts of the colon. There is usually no need to use automatic retractors. They can cause ischemia of the wound edges and contribute to increased pain in the wound area in the postoperative period. A complete examination of the intestines is performed to rule out Crohn's disease.

It is very important that before commencing a colectomy, the surgeon assesses the distance to which the terminal ileum should be brought down to the perineum. If the intestinal rotation is complete, its position is normal, and the terminal ileum reaches the pubis, then it can be hoped that the ileoanal anastomosis will be performed without tension. After mobilization of the ileocecal zone, the ileum is transected with a stapler close to the ileocecal angle.

Mobilize ascending colon, crossing the parietal peritoneum, and the hepatic angle. The splenic angle is mobilized. Big seal may be preserved if it is not very damaged during its separation from the transverse colon. It is better to isolate the omentum using a bipolar cautery or scissors, crossing it as close to the intestinal wall as possible. The parietal peritoneum, which secures the descending and sigmoid colon, is dissected. The vessels of the mesentery of the colon are ligated or cauterized directly at the intestinal wall. Usually, only the main arteries of the colon need to be ligated - the right, middle and left. The colon is crossed with a stapler at the junction of the sigmoid colon and the rectum. The entire colon is removed.

Stay sutures or an angled large clamp placed on the proximal rectal stump facilitate its release. This allows the surgeon to freely tighten and isolate the colon from either side. The mesentery of the rectum in patients with ulcerative colitis is often thickened and swollen, so dissection of the mesentery is traumatic and accompanied by bleeding. It is easiest to carry out this stage to the right of the rectum. Small vessels are crossed with a cautery as close to the intestinal wall as possible. Using hooks with a wide and long “blade” and pulling up the rectal stump facilitates release.

The discharge continues in a caudal direction to the pelvic floor. A digital rectal examination helps ensure the adequacy of abdominal discharge. If the lower border of the isolated intestine is 3-4 cm from the anal verge, then usually transanal removal of the mucous membrane and rectal removal of the intestine are performed without any difficulties.

The next stage of surgery for ulcerative colitis in children is mobilization of the ileum to bring it down into the . The ileocolic artery is ligated and dissected. The mesentery of the ileum is mobilized upward to the level proximal part superior mesenteric artery. This may require mobilization of the mesenteric root and separation from the duodenum and inferior border of the pancreas. The mesenteric arteries leading to the distal two or three vascular arcades of the terminal ileum are ligated and dissected proximally. For an ileoanal anastomosis to be performed without tension, the distal end of the ileum or the tip of the J-pouch must reach anterior to the pelvic ring to the base of the penis in boys or anterior section girls' vaginas.

The length of the figurative reservoir should be 7-10 cm. The terminal section of the ileum is “bent” and the apex of the future reservoir is cut longitudinally with a cautery along the antimesenteric edge. The hole should be small (1.5-2 cm), since it widens significantly when it goes down to the anus. The branches of the stapler are inserted into each sleeve of the reservoir, brought together and stitched. Using a 75 mm machine or two 50 mm staplers is often enough to create a reservoir. The hardware suture line can be reinforced with 4/0 or 5/0 absorbable sutures. The reservoir and terminal ileum are covered with warm wet wipes and left in the abdominal cavity. The abdominal wall wound is also loosely covered with warm, damp wipes.

The perineal stage of the operation for ulcerative colitis in children begins with the application of stretching sutures between the mucocutaneous edge of the anal canal and a special round “colostomy” ring. These sutures keep the anus open and dilated, allowing good access to the anal canal. A solution of adrenaline (1:100,000) is injected under the mucous membrane to “lift” it and reduce bleeding during transanal excision.

Transanal mucosectomy (removal of the mucous membrane) begins along the dentate line. A small rim (5-6 mm) of the anal transitional epithelium must be left, otherwise sensitivity in the anal area is significantly reduced and the anal reflex may be lost. Relapse of ulcerative colitis in the zone of transitional anal epithelium does not occur. The mucous membrane of the anal canal is dissected along the entire circumference and mucosectomy begins. Some surgeons prefer to place multiple stay sutures in the mucosa just above the incision level to facilitate mucosectomy. Small clamps with triangular windowed jaws are used to tighten the edges of the mucosa. Mucosectomy is performed using sharp and blunt scissors. In ulcerative colitis, mucosectomy is much more difficult to perform than in non-inflammatory diseases. it can be quite significant. Preoperative topical cortisone suppositories or aerosols may help reduce intraoperative blood loss and facilitate mucosal drainage. Mucosectomy is continued for 5-8 cm to the level above the pelvic floor.

The cuff, consisting of the muscular lining of the anal canal and the distal part of the rectum, can be divided transanally, entering the pelvic cavity, at the upper border of the mucosectomy. Pulling up the mucous “tube” twists the proximal end of the muscular cuff inside the distal end, where the cuff can be safely crossed without the risk of damaging the urethra and prostate. Another method is to evert the rectum through the anus and cut the muscle cuff outside the anus at the superior edge of the mucosectomy. Bleeding from small vessels of the cuff is stopped by cauterization with electrocautery.

A long soft clamp is inserted through the muscle cuff into the pelvis. The D-shaped reservoir (or the distal ileum in the case of direct reduction surgery) is grasped with a clamp and brought down through the anus. An assistant working from the abdomen ensures that the mesentery of the lowered intestine does not twist during descent. The mesentery of the reductive reservoir (or distal ileum) is a component of the reducible segment, very closely related to it, and requires to be relegated along the shortest route. Therefore, in the pelvic area, the mesentery is located anterior to the intestine, but this does not mean that the relegated segment will be twisted.

Since there is always tension when placing the first sutures, we recommend first placing sutures in the 4 “corners” of the future anastomosis, which is created with one row of separate 4/0 absorbable sutures, capturing the ileum (through all layers) and the anal canal. The tension along the suture line usually disappears when the threads are cut, allowing the suture line to contract and move into the anal canal.

The space between the retracted colon and the “posterior” perineum is sutured with a continuous 4/0 absorbable suture. The pelvic cavity is inspected to perform hemostasis. A round disc of skin is excised at the stoma site. A cross-shaped incision is made in the fascia. The hole in the fascia and muscles should be widened (bluntly) to the size of two fingers. The peritoneum is opened and a loop of the ileum located as close as possible to the ileoanal anastomosis is brought out onto the abdominal wall. The abdominal wall incision is sutured layer by layer and a stoma is formed over some device that acts as a spur. Usually there is no need for a pelvic cavity.

After operation

Postoperative gastric decompression via a nasogastric tube is usually not required. The urinary catheter can be removed as soon as the epidural anesthesia wears off. The prophylactic course of antibiotics is continued for 72 hours after surgery. If the child was on high doses of corticosteroids before surgery, then after surgery corticosteroids are administered parenterally until oral administration is possible. Corticosteroids may be discontinued when ACTH stimulation confirms normal function own adrenal cortex.

It is advisable to provide enteral nutrition, the full amount of which can usually be achieved within the first 5 days after surgery. The discharge from the stoma is sometimes very copious, and these losses must be compensated according to the volume of discharge and the content of electrolytes in it. In most cases, Ringer's lactate solution is sufficient for this. Sodium is added orally as soon as the child can digest tablets containing it to reduce the amount of discharge from the stoma.

Postoperative nutrition for ulcerative colitis is carried out using a lactose-free diet. The amount of sodium supplementation can be monitored according to the sodium content of the urine (urinary stain), which should be maintained above 20 mmol/L. Insufficient sodium administration leads to an increase in the amount and dilution (watery discharge) of the discharge from the stoma.

The stoma should be separated from the surgical wound while the reservoir is being formed and the ileoanal anastomosis is healing. 3-6 weeks after surgery, a contrast X-ray examination is performed through the diverting stoma to assess the integrity of the ileoanal anastomosis and the D-reservoir. The early postoperative period is characterized by the presence of frequent loose stools through the stoma up to 10-12 times a day. To reduce intestinal motility, antiperistaltic drugs (loperamide) are prescribed. Within 3-6 months. stool frequency decreases to 2-7 times a day. During the adaptation period, a “low-slag” diet with salt supplements is effective.

Conclusion

Ileoanal anastomosis was a revolution in the treatment of ulcerative colitis in children. Despite high frequency postoperative complications, long-term results and patient satisfaction are good. Children with ileoanal anastomosis and reservoir also have good functional results in terms of fecal continence. Usually within 6 months. After closure of the stoma, all children achieve full daytime fecal continence. A small number of patients experience slight stooling at night, which requires the use of diapers. In the absence of serious postoperative complications, there is practically nothing significant. After 6-12 months. after surgery, the frequency of spontaneous bowel movements is usually from 2 to 7 times a day. Based on materials from the Children's Hospital of the University of Helsinki, average frequency bowel movements after 6 months. after surgery - 4 times a day with fluctuations from 2 to 7 times.

Early and late complications of ulcerative colitis in children occur in 20-50% of patients. The most common of these are wound infection, usually in children receiving high doses of corticosteroids before surgery, and. Inflammatory septic complications of the pelvis or “departure” of the ileoanal anastomosis occur in less than 10% of cases. Acute or chronic inflammation of the reservoir is a problem quite typical for ileoanal reduction surgery for ulcerative colitis. The incidence of this complication varies from 20 to 50%. More acute cases of pouch inflammation are most often associated with too short an enteral course of antibiotics, such as metronidazole. Chronic inflammation of the reservoir is much less common - less than 10% of patients. Treatment of chronic inflammation of the reservoir consists of long courses of low doses of antibiotics, and in persistent cases, the administration of corticosteroids, mainly budesonide, orally. Chronic inflammation of the pouch may be a manifestation of Crohn's disease; it is known that approximately 5-15% of patients who undergo ileoanal anastomosis for ulcerative colitis actually suffer from Crohn's disease. Another symptom that should raise suspicion of Crohn's disease is the formation of a pouch fistula, especially a recurrent one.

Despite the many and varied potential postoperative problems, the vast majority of children who undergo reconstructive proctocolectomy for ulcerative colitis have a completely satisfactory quality of life, complete fecal continence, and an acceptable number of bowel movements per day.

Nonspecific ulcerative colitis (UC) – severe chronic pathology of the large intestine of an inflammatory-dystrophic nature, which has a continuous or recurrent course and leads to the development of local or systemic complications.

The process is localized in the rectum (ulcerative proctitis) and spreads throughout the large intestine. When the mucous membrane is affected throughout the large intestine, we speak of pancolitis.

The prevalence of the disease prevails among the industrial population developed countries. Over the past 20 years, there has been an increase in incidence not only in adults, but also in children of all ages.

UC can develop at any age in children, ranging from 8 to 15% general morbidity. Infants rarely suffer from this pathology. At an early age, boys are more affected, and in adolescence, the disease affects girls more often.

Scientists have not been able to establish the exact cause of the development of UC. There are many theories about the etiology of the disease. Among them, the most recognized are:

1. Infectious: according to it, the onset of UC can be provoked by:

• bacteria (for intestinal infections such as salmonellosis, dysentery, coli infection);
• microorganism toxins;
• viruses (for ARVI, scarlet fever, influenza).

1. Psychogenic: the development of intestinal ulcers is provoked by stressful situations and psychological trauma.
2. Immunogenic: the disease is caused by underdevelopment or failure of the immune system.

According to some experts, hereditary predisposition plays an important role - the presence of immune or allergic diseases in close relatives.

Damage to the mucous membrane by certain food ingredients cannot also be ruled out, iatrogenic effect some medicines.

With UC, a whole chain of pathological processes occurs that are self-sustaining in the body: at first they are nonspecific, and then turn into autoimmune, damaging target organs.

Some scientists believe that the basis for the development of UC is energy deficiency in the epithelial cells of the intestinal mucosa, since patients have a changed composition of glycoproteins (special proteins).

Classification

Colitis is classified according to the location of intestinal damage:

• distal (damage to the colon in the final sections);
• left-sided (the process is localized in the descending colon and rectum);
• total ( colon affected throughout);
• extraintestinal manifestations of the disease and complications.

There are different forms of UC in children:

• continuous, at which full recovery does not occur, only a period of improvement is achieved, followed by exacerbation;
• recurrent, in which it is possible to achieve complete remission, which lasts for several years in some children.

There are such variants of the course of ulcerative colitis:

• fulminant (fulminant);
• spicy;
• chronic (wavy).

An acute and lightning-fast course is characteristic of a severe form of UC. Moreover, lightning can lead to death in 2-3 weeks; fortunately, it develops extremely rarely in children.

According to the severity, UC can be mild, moderate and severe. The activity of the process can be minimal, moderately expressed and pronounced. The disease may be in an acute or remission phase.

Symptoms

The main symptom of UC is loose, foul-smelling stools with a frequency of up to 20 times a day.

Manifestations of the disease depend on the form and course, the severity of colitis, and the age of the children. The most characteristic symptoms of UC are diarrhea, blood in the stool, and abdominal pain.

The onset of the disease can be gradual or acute, sudden. Almost every second child develops UC gradually. In most cases, the stool is loose and foul-smelling, with the presence of mucus, blood (sometimes also pus). The frequency of stool varies - from 4 to 20 or more times per day, depending on the severity.

With a mild degree of colitis, there are streaks of blood in the stool; with severe colitis, there is a significant admixture of blood; the stool may look like a liquid bloody mass. Bloody diarrhea is accompanied by pain in the lower abdomen (more on the left) or in the navel area. Characterized by tenesmus (painful act of defecation), increased bowel movements at night.

The pain can spread throughout the entire abdomen. They can be cramp-like in nature, precede bowel movements or accompany them. Some children experience pain when eating.

Sometimes UC begins with the appearance of loose, loose stools, and blood and mucus are found in the stool after 2-3 months. With severe ulcerative colitis, body temperature rises within 38 ° C, and symptoms of intoxication appear. Sometimes a child is mistakenly diagnosed with dysentery. Exacerbations of the disease are regarded as chronic dysentery, and UC is diagnosed late.

Children with UC experience decreased appetite, severe weakness, bloating, anemia, and weight loss. On examination, rumbling is noted, and a painful, spasmodic sigmoid colon is palpable. The liver is enlarged in almost all children, and sometimes there is an enlargement of the spleen. IN in rare cases With this disease, constipation occurs. As the illness continues, abdominal pain occurs less frequently. Persistent pain syndrome is observed in complicated UC.

Complications

Long-term UC can lead to local and systemic complications.

Local complications include:

1. Lesions in the anus and rectum:

• haemorrhoids;
• sphincter failure (incontinence of gases and feces);
• fistulas;
• cracks;
• abscesses.

1. Perforation of the intestine and subsequent development of peritonitis (inflammation of the serous membrane of the abdominal cavity).
2. Intestinal bleeding.
3. Stricture (narrowed lumen) of the colon due to scarring of ulcers.
4. Acute toxic dilatation (expansion) of the large intestine.
5. Colon cancer.

In children local complications develop in rare cases. The most common cause of any form of ulcerative colitis is dysbiosis (imbalance of beneficial microflora in the intestine).

Extraintestinal, or systemic, complications are diverse:

• skin lesions (pyoderma, erysipelas, trophic ulcers, erythema nodosum);
• damage to the mucous membranes (aphthous stomatitis);
• hepatitis (inflammation of liver tissue) and sclerosing cholangitis (inflammation of the bile ducts);
• pancreatitis (inflammatory process in the pancreas);
• arthritis (joint inflammation, arthralgia (joint pain));
• pneumonia (pneumonia);
• eye damage (episcleritis, uveitis - inflammation of the membranes of the eye);

When examining a child, you can identify manifestations of hypovitaminosis and chronic intoxication:

• pale skin with a grayish tint;
• blue circles near the eyes;
• dull hair;
• jams;
• dry, cracked lips;
• brittle nails.

Increased heart rate and arrhythmias are also noted, a heart murmur may be heard, and shortness of breath often occurs. With active hepatitis, yellowness of the skin and mucous membranes appears. The child lags behind not only in physical but also in sexual development. In adolescent girls in the active phase of the disease, menstrual cycle(secondary amenorrhea occurs).

In the chronic process, erythropoiesis (production of red blood cells) is inhibited, which, in addition to bleeding, contributes to the development of anemia.

After 8-10 years from the onset of the disease, the risk of developing malignant tumor in the rectum by 0.5-1% annually.

Diagnostics

The doctor has to differentiate UC from diseases such as Crohn's disease, intestinal polyposis, diverticulitis, celiac disease, intestinal tuberculosis, colon tumor, etc.

UC is diagnosed based on complaints from the child and parents, examination results, and data from additional examination methods (instrumental and laboratory).

Instrumental studies:

1. The main method confirming the diagnosis of UC is endoscopic examination intestines (sigmoidoscopy, colonoscopy) with targeted biopsy for histological examination collected material.

The mucous membrane is easily wounded and edematous upon examination. At the initial stage of the disease, there is redness of the mucous membrane and contact bleeding, which is called the “bloody dew” symptom, thickening of the folds, and incompetence of the sphincters.

Subsequently, an erosive and ulcerative process is detected on the mucous membrane of the colon, folding disappears, anatomical bends are smoothed out, redness and swelling intensify, the intestinal lumen turns into a tube. Pseudopolyps and microabscesses may be detected.

1. X-ray examination of the large intestine, or irrigography, is carried out according to indications. It reveals a violation of haustration (circular protrusions of the colon wall) - deformation of the haustria, asymmetry or complete disappearance, as a result of which the intestinal lumen takes on the appearance of a hose with smoothed bends and thick walls.

Laboratory research:

• a general blood test reveals reduced hemoglobin and a decrease in the number of red blood cells, an increased number of leukocytes, and an accelerated ESR;
• biochemical analysis of blood serum reveals a decrease in total protein and a violation of the ratio of its fractions (decrease in albumin, increase in gamma globulins), positive C- reactive protein, decreased serum iron levels and changes in blood electrolyte balance;
• stool analysis for coprogram reveals an increased number of red and white blood cells, undigested muscle fibers, slime;
• stool analysis for dysbacteriosis shows a reduced amount of E. coli, a reduction or complete absence bifidobacteria.

Treatment

Types of UC depending on the level of damage to the colon.

Treatment of UC must be carried out over a long period of time, sometimes several years. Conservative and surgical methods are used.

Conservative treatment should be comprehensive. The goal of the therapy is to transform a severe form of the disease into a milder one and achieve long-term remission.

The following are important for the effectiveness of treatment:

• adherence to the recommended diet;
• avoiding hypothermia;
• load limitation;
• prevention of infectious diseases;
• psycho-emotional peace without stress;
• avoiding overwork.

Since children with UC develop protein deficiency (due to blood loss) and loss of body weight, the diet should provide the body with proteins to compensate for its deficiency. Moreover, 70% of them should be animal proteins. The diet is recommended in accordance with table No. 4 according to Pevzner.

Optimal composition of the daily diet:

• proteins – 120-125 g;
• fats – 55-60 g;
• carbohydrates – 200-250 g.

The food consumed should be mechanically gentle. The supply of proteins will be provided by fish and meat dishes(in the form of souffles and casseroles), dairy products, eggs. Many children suffering from UC develop food allergy(most often cow's milk). In these cases, all dairy products are excluded from the diet, only melted butter is allowed.

It is recommended to cook food by steaming or boiling in water or in a weak broth (fish or meat). Slimy soups are used as the first course. You can add meatballs, boiled meat, potatoes, and rice to the soup.

The child should be fed 5-6 times a day with warm food. From the menu you need to exclude foods rich in fiber, which increase intestinal motility and gas formation. Spicy foods and seasonings are also prohibited.

Jelly, fruit and berry decoctions (from pear, bird cherry, quince, dogwood, blueberry), strong brewed tea (black, green) will be useful, as they contain tannins and astringents. Coffee and cocoa are excluded.

In case of stable remission, a small amount of vegetables (zucchini, carrots, cauliflower, broccoli) is introduced into the diet. Tomatoes, melons, watermelons, citrus fruits, grapes, and strawberries are excluded from consumption. If well tolerated, you can give your child baked pears and apples, blackberries, blueberries, pomegranates, and cranberries. Chokeberry juice is very useful.

As a side dish you can cook potatoes, porridge (wheat, rice), pasta. Eggs (2-3 per week) can be given in the form of an omelet (steamed) or soft-boiled. It is allowed to eat white bread (day-old baked goods) and biscuits. Fresh baked goods and sweets should be excluded.

Expanding your diet should only be done in consultation with your doctor. criterion proper diet and the effectiveness of therapy is the increase in body weight in the child.

The basis of drug treatment for UC is 5-aminosalicylic acid derivatives - Salofalk, Sulfasalazine, Salazopyridazine. More modern drug is Salofalk (Mesacol, Mesalazine), which can also be used topically in the form of enemas or suppositories. As a basic therapy, a long course of Salofalk in combination with Wobenzym can be used. The dosage of drugs and the duration of the course are determined by the attending physician.

In case of intolerance to these drugs and in severe cases of the disease with extraintestinal manifestations, glucocorticosteroid drugs (Metypred, Prednisolone, Medrol) can be prescribed. If a child has contraindications to the use of hormonal drugs, cytostatics (Azathioprine) can be used.

If purulent microflora is cultured from the intestines, then antibacterial drugs are prescribed. To normalize intestinal dysbiosis, bacterial medications are used (Bifiform, Hilak-Forte, Bifikol, etc.).

Smecta, iron supplements, and wound healing agents (topically, in microenemas) can be prescribed as symptomatic therapy. Herbal medicines and homeopathic remedies (Coenzyme compositum, Mucosa compositum) can be used in treatment.

Indications for surgical treatment are:

• complications that arise (intestinal perforation, severe bleeding, intestinal obstruction);
• fulminant UC that does not respond to therapy;
• ineffectiveness of conservative treatment.

A subtotal resection of the large intestine is performed and an ileorectal anastomosis is performed (connection of the small intestine to the rectum).

Forecast

The prognosis for full recovery is unfavorable. In most children, it is possible to achieve stable remission and prevent the development of relapse during puberty.

The prognosis for life depends on the severity of UC, its course and the development of complications.

Prevention

Preventive measures are aimed at preventing relapses of the disease. It is necessary to try to prevent the child from contracting intestinal infections that can provoke an exacerbation of UC.

You should not take medications without a doctor's prescription. Experts believe that drugs from NSAID groups contribute to the development of relapse.

An indispensable condition is compliance with the diet. Children must be provided with a protective regime: they are exempt from physical education lessons, labor camps and other stress. The best option is homeschooling. Vaccination is carried out only according to epidemiological indications (after consultation with an immunologist) with weakened vaccines.

After discharge from the hospital, the child is registered with a pediatric gastroenterologist. If the disease lasts more than 10 years, annual colonoscopy with biopsy is indicated for timely detection of malignant degeneration of the intestinal mucosa.

Summary for parents

It's hard to prevent this serious disease, moreover, its exact cause is unknown. It is necessary to try to exclude the factors that have been identified by scientists as provoking the occurrence of UC. If ulcerative colitis develops, it is important to follow your doctor’s instructions in order to achieve long-term remission of the disease.

• Causes
• Symptoms
• Classification
• Diagnostics
• Treatment and prevention
• Complications and prognosis

Colitis is an inflammatory disease of the intestine, in which the epithelial layer of the intestinal mucosa gradually degenerates. The process of dystrophy manifests itself in the thinning and weakening of the mucosa, as well as in the deterioration of its regenerative properties.

Due to the characteristics of nutrition and development, colitis is more common among middle-aged and older children. school age, but the danger of its occurrence remains in both infants and kindergarteners.

Causes

The development of the disease is influenced by a combination of negative, both exogenous (external) and endogenous (internal) factors.

Colitis in children under one year of age most often develops against the background birth defects organ development gastrointestinal tract with the addition of frequent viral infections, a tendency to allergies and lactose intolerance. In the case of formula-fed children, risk factors also include incorrect selection of formula.

Symptoms

Determining intestinal inflammation is more difficult the younger the child is. Often the manifestations of the disease are mistaken by parents for a temporary problem. This is especially true for infants - in their case, the symptoms are blurred and may resemble a common digestive disorder due to a mild intestinal infection or a violation of the diet by the nursing mother. This picture misleads not only parents, but also pediatricians.

In children older than one year, it is easier to determine the disease, since the symptoms become more pronounced and it is easier to determine from the child’s behavior at this age what exactly is bothering him.

Symptoms common to children of all ages include:

1. Intestinal disorder. Digestive disorders can manifest themselves in different ways and alternate with each other: from watery, frequent stools to constipation that lasts several days.
2. Increased gas formation. Due to disruption of the mucosal structure, intestinal immunity suffers, which causes an imbalance of microflora. It notes the predominance of pathogenic microorganisms, the result of whose vital activity is an increase in the volume of gases in the intestines. The child’s belly becomes swollen, the skin on it becomes tense, belching appears, and gases are often passed out.
3. Nausea and vomiting occur at stages when a child’s colitis is at the development stage - this is how the body signals the onset of a pathological process in the gastrointestinal tract (GIT). Vomiting can also be a companion chronic colitis during periods of exacerbation.
4. Impurities in feces - pus, blood, bile, mucus. Sometimes the number of inclusions is so small that their presence can only be determined using laboratory analysis (coprogram).
5. Dehydration occurs with frequent loose stools. In this case, a large amount of water leaves the body along with feces. Dehydration can be determined by dry, flaky skin, the smell of acetone from the breath, pallor, and lethargy.
6. Abdominal pain localized below the navel.

Note. The intestinal mucosa has an important functional significance - with its help, nutrients are absorbed. Therefore, dystrophic changes in this organ are fraught with vitamin deficiency, which is manifested by deterioration of the skin, hair loss, and brittle nails. In children of preschool and school age, a lack of vitamins and nutrients also affects mental activity: they become forgetful, inattentive, and restless.

In babies under one year of age, symptoms include frequent regurgitation, restlessness, crying, refusal to eat, and pressing of the legs to the stomach.

Classification

Intestinal colitis has a complex classification. When setting accurate diagnosis pediatric gastroenterologist considers factors such as the course of the disease, the causes of its occurrence and development, and the location of the area affected by degeneration. Correct definition forms of colitis allows you to prescribe effective treatment and quickly relieve the child from painful manifestations.

Classification of colitis:

Acute colitis

In the acute form, the child suffers severe cutting pain in the abdomen, body temperature may rise to febrile (38.5-39°C). The disease is accompanied by pronounced intestinal symptoms– stool is frequent (3-6 times a day), liquid, foamy, it may contain remnants of undigested food, as well as bloody and mucous inclusions. Sometimes the clinical picture is complicated by nausea and vomiting.

This condition is typical for the early stage, as well as for periods when the chronic form of the disease worsens due to exposure to external and internal factors. The cause of the appearance is often infection of the digestive tract with the pathogenic bacterium Helicobacter pylori.

Acute forms also include spastic colitis, a condition in which the intestines spasm more often than in other types of the disease. In this regard, the nature of the pain changes - they become paroxysmal. Among the symptoms of the disease there is also “sheep” feces - hard, with distinct individual segments.

Chronic colitis

Even with timely and adequate treatment acute form in most cases it becomes chronic. At the same time, the symptoms become more blurred - the pain dulls, becomes aching, vomiting and nausea stop. After eating, belching appears, and in very young children - regurgitation. Signs of increased gas formation appear: a bloated abdomen, a feeling of fullness, periodic passing of gas.

If the patient systematically undergoes courses of treatment and follows a diet under parental supervision, chronic colitis can be asymptomatic, with rare exacerbations or without them at all. In this case, the intestinal mucosa is gradually restored, although complete regeneration impossible.

Nonspecific ulcerative colitis

The most common form of the disease, the causes of which often remain unclear. Typically, ulcerative colitis in children develops as a result of a combination of genetic predisposition and eating disorders. Often the picture is intensified by other gastrointestinal diseases - gastritis, stomach ulcers, duodenitis, problems with the pancreas.

The disease got its name because of its similarity clinical picture With peptic ulcer stomach and duodenum, namely: degeneration of the mucosa, in which in some places the affected areas transform into ulcers. Sometimes these areas cover a large area of ​​the intestine, but in most cases they are located fragmentarily. Ulcerative colitis can occur in chronic and acute forms.

• Acute form

Characterized by pronounced manifestations of the disease: severe pain in the left side of the abdomen, an increase in body temperature to febrile and subfebrile levels. During periods of exacerbation, the ulcerated areas open and begin to bleed. As a result, a laboratory analysis shows the presence of blood in the stool of a sick child, and his general condition worsens: weakness, apathy appear, appetite worsens, weight loss, and joint pain are observed.

• Chronic form

Unlike acute, it proceeds more mildly, since during remission the intestinal mucosa tends to partially recover, ulcerative areas are covered with a new layer of epithelium. The disease can worsen due to inappropriate use of medications, non-compliance with diet, stressful situations, and overwork. Chronic colitis can be manifested by difficulties in bowel movements - constipation, false urge to defecate, sensations of incomplete bowel movement.

The danger of this form of the disease is that when the pronounced symptoms disappear, the child’s parents may mistakenly decide that the child has fully recovered and stop following the diet and undergoing examinations.

When examining the patient, swelling of the affected areas of the intestine is detected, destruction at different depths of the mucosa, in rare cases reaching the submucosal layer. Sometimes the inflammatory process is accompanied by the formation of polypous growths.

Infectious (allergic) colitis

This type of disease occurs as a complication of acute intestinal infections (most often when the gastrointestinal tract is affected by salmonella, shigella, streptococci), helminthic infestations, and fungi. The disease is characterized by a rapid onset and development, accompanied by vomiting, diarrhea, and severe abdominal pain. Among the reasons that provoke this pathology of the mucous membrane, long-term use is noted. antibacterial drugs, especially in children under 6 years of age.

Features of diagnostics. Accurate diagnosis infectious colitis is difficult due to the often mixed etiology of the disease - chronic diseases are usually associated with a viral or bacterial infection digestive organs. To complete the picture it is necessary wide range laboratory tests, as well as a number of hardware studies.

One of the most severe types of infectious colitis is pseudomembranous colitis (PMC), the development of which is provoked by the bacterium Clostridium difficile. As with damage to other pathogenic microorganisms, MVP is characterized by an increase in the number of leukocytes in the blood, diarrhea of ​​varying severity, a state of dehydration, and other manifestations of intoxication.

Diagnostics

During examination great importance It has differential diagnosis colitis in children, since it is very important to exclude the possibility of more serious diseases, such as diverticulitis and intestinal tuberculosis, neoplasms (polyps, malignant and benign tumors, cysts), Crohn's disease, celiac disease.

To confirm established chronic colitis in a child, as well as other types of inflammation of the intestinal mucosa, a number of laboratory and hardware examinations are prescribed:

1. Detailed blood test: leukocytosis, a decrease in the level of hemoglobin and the number of red blood cells in the blood are detected, increase in ESR and protein levels.
2. Colonoscopy: at the initial stage of the disease, swelling, sensitivity of the mucous membrane, increased local temperature are detected, at more later stages a characteristic picture is revealed with the presence of erosive and ulcerative lesions, which begin to bleed if they are touched with a hard object. There is no vascular pattern on the surface of the epithelial layer.
3. Stool analysis for colitis shows the presence of mucus, blood, and sometimes inclusions of bile in the stool.

If, during an examination of the intestine, a neoplasm is discovered in its cavity - single or multiple polyps, cysts - they are removed and the biological material is subsequently sent for histology and biopsy. This eliminates the possibility of a malignant origin of the tumors.

Treatment and prevention

Treatment of colitis in children under three years of age and older is carried out to a large extent by normalizing the diet and diet. To alleviate the child’s condition and reduce the intensity of symptoms, a dairy-free diet enriched with meat, fish dishes, eggs. Artificial children up to one year old are transferred to lactose-free hypoallergenic milk formula.

In the case of breastfed children, identifying the etiology of the disease is of great importance, since some cases of allergic colitis require urgent transfer of the child to artificial nutrition or a strict diet for a nursing mother.

From the diet of older children during periods of exacerbation, it is necessary to exclude all foods that complicate the digestion process, corrode the walls of the mucous membrane, and contribute to increased gas formation.

Such products include flour sweets, chips, crackers, salty and spicy crackers, all fast food, sweet carbonated drinks, mayonnaise, ketchup, store-bought and homemade pickles and preserves, cocoa, coffee, chocolate. It is necessary to minimize the consumption of legumes, raw fruits and berries (apples, grapes, plums, peaches, bananas, currants, raspberries, etc.), fatty meats, yeast baked goods, corn and rice cereals.

The basis of the menu should be soups based on boiled vegetables and meat, stewed and boiled beef, rabbit, chicken, turkey, porridge (especially oatmeal, buckwheat, pearl barley). For flour products, you can eat hard pasta, rye and slightly dried white bread, and bran buns. Herbal drinks, jelly, black and green teas are useful.

Drug treatment for colitis involves taking oral medications that improve digestion, protect and restore the intestinal mucosa. Local therapy in the form of therapeutic enemas helps well. Taking painkillers, laxatives or restoratives, antiviral and antibacterial drugs, glucocorticoids, and antipyretics will help relieve symptoms. In the most severe cases, which are not amenable to conservative therapy, resection is performed - removal of a section of the intestine.

Preventive measures include annual medical examination with mandatory drug treatment, maintenance proper nutrition, moderate physical activity.

Complications and prognosis

Acute colitis in a child can be complicated by such local manifestations, such as the formation of hemorrhoids, anal fissure, weakening of the sphincter, leading to gas incontinence and involuntary defecation during physical exertion, coughing, sneezing.

More serious consequences include intestinal cancer and diverticulitis, intestinal bleeding, inflammation of the gallbladder and pancreas, liver disease, trophic ulcers. Infectious colitis often entails the spread of infection through digestive tract and the entire body, as a result of which the child may experience complications in the form of stomatitis, sore throat, bronchitis, pneumonia.

Colitis is a serious disease, often exacerbating, difficult to treat, entailing many complications, requiring systematic examination and treatment. However, with the right approach and following all the doctor’s recommendations, inflammation becomes chronic, which may not appear for several years. In general, the prognosis for life is conditionally favorable, but complete recovery is impossible.

Nonspecific ulcerative colitis in children is an inflammatory chronic intestinal disease of unknown etiology, characterized by ulcerative-destructive changes in the colon mucosa.

Literally, colitis is an inflammation of the large intestine. Since the disease is chronic, it occurs with exacerbations and periods of remission (recovery).

“Ulcerative” - characterizes the nature of inflammation when ulcers form on the colon mucosa. Nonspecific - emphasizes the uncertainty of the cause of the disease and excludes other colitis, the etiology of which is known.

Nonspecific ulcerative colitis (UC) is considered a common disease and occurs in almost all countries of the world. Its frequency is also very high among children, and recently there has been a “rejuvenation” of the disease.

In order not to miss UC in children, the manifestations of which are similar to an intestinal infection, it is necessary to become more familiar with this disease.

Causes of nonspecific ulcerative colitis

Despite numerous studies, the etiology of the disease remains unknown. It is currently believed that ulcerative colitis is a multifactorial disease.

The development of necrotic inflammation of the mucous membrane is based on:

• genetic predisposition;
• impaired intestinal immune function;
• the influence of environmental factors, especially intestinal microflora.

All these factors together lead to disruption of the protective function of the intestinal epithelium, resulting in the formation of chronic inflammation.

6 possible signs of ulcerative colitis in children

Nonspecific ulcerative colitis is characterized by intestinal symptoms and general manifestations of the disease.

Intestinal symptoms

1. Diarrhea– most often is the debut of the disease. Initially, multiple loose stools and frequent false urges to defecate occur. The frequency of bowel movements can reach 20 times per day. Then mucus and blood begin to appear in the stool. Gradually, the amount of blood in the stool increases, and can even reach 50-100 ml. Sometimes there is bleeding without stool. Frequency of bowel movements occurs mainly at night and early morning, when feces enter the lower intestines, where the inflamed part of the intestine is most excitable and stimulates bowel movements. The intensity of diarrhea depends on the severity of the disease and the extent of the inflammatory process.
2. Pain– a symptom that is not observed in all children and has no distinctive features from pain due to intestinal infection. Most often, acute abdominal pain is observed, localized in the lower left region.
3. The pain is not constant, spastic in nature, intensifies before defecation, and subsides after bowel movement. Abdominal pain is also accompanied by general anxiety and moodiness of the child.
4. Constipation– a very rare, but still sometimes encountered symptom. The disease begins with constipation when the lowermost parts of the intestine are affected and the soreness of the inflamed mucosa prevents the passage of feces. At first, the stool will be mixed with blood, later it will become mushy, and after 3-6 months it will change to liquid.
5. General symptoms of ulcerative colitis: loss of appetite, general weakness, fatigue, progressive weight loss, intoxication (pallor of the skin, dry mucous membranes, nausea, vomiting). Appearance common symptoms will depend on the prevalence of colitis and the activity of the inflammatory process. To assess the activity of ulcerative colitis, doctors use a special pediatric ulcerative colitis activity index. Important! This index is calculated by points that take into account the intensity of abdominal pain, the frequency and consistency of stool, the severity of blood in the stool, the number of bowel movements at night and the general activity of the child. Depending on the points received, the severity of ulcerative colitis is determined, which determines treatment tactics and possible complications of the disease.

Extraintestinal manifestations

In addition to the main symptoms, ulcerative colitis may have extraintestinal manifestations. Manifestations from other organs and systems may arise as a result of intestinal dysfunction, and may also be in no way related to the manifestations of the underlying disease.

To extraintestinal manifestations include several signs.

• Anemia. It can be posthemorrhagic (as a result of blood loss in stool) or autoimmune (as a result of a systemic disorder of hematopoiesis).
• Skin symptom. Various changes appear on the skin of the body and limbs (rash, vasculitis, necrotic gangrene).
• Joint syndrome(joint pain, synovitis).
• Damage to the liver and biliary tract(hepatitis, hepatosis, cholangitis).
• Pathology of the pancreas(acute pancreatitis).
• Kidney damage(nephropathy).
• Eye damage(conjunctivitis).
• Delayed physical and sexual development, decreased intelligence.
• Damage to the thyroid gland(autoimmune thyroiditis).

Most often, there is a combination of several extraintestinal manifestations at once, and sometimes they are so pronounced that they come to the fore and complicate the diagnosis of the underlying disease.

Possible complications of UC in children

Nonspecific ulcerative colitis in itself is a serious disease, and it also has serious complications. You need to know about possible complications in order to be able to recognize them in time.

These include:

• heavy bleeding which will lead to the development of severe anemia;
• perforation of the intestine with the development of peritonitis(exit of intestinal contents into the abdominal cavity);
• sepsis– against the background of reduced immunity, the spread of pathogenic flora throughout the body is possible;
• development of intestinal obstruction– against the background of chronic inflammation and disruption of intestinal microflora, even when inflammation subsides, chronic constipation may develop;
• colon cancer– chronic inflammation of the intestinal mucosa is a predisposing factor for the development of the oncological process.

8 methods for diagnosing ulcerative colitis

When making a diagnosis, complaints, development of the disease and examination data of the patient are taken into account. But in order to confirm the diagnosis, additional examination methods are needed, which are carried out on children upon hospitalization in any Russian children's clinical hospital.

In diagnosing a disease, not only high-tech technologies are important modern methods, but also simple laboratory tests.

TO additional methods examinations for nonspecific ulcerative colitis The following procedures apply.

1. General blood analysis– will show the activity of the inflammatory process in the body (the number of leukocytes, leukocyte formula, ESR) and severity of anemia (hemoglobin and red blood cell levels).
2. Blood chemistry– will reflect the functioning of the liver and pancreas, which will help eliminate extraintestinal manifestations. C-reactive protein will show inflammatory activity. In addition, disturbances in the electrolyte composition of the blood are possible.
3. Coprogram– the presence of a large number of leukocytes, red blood cells and mucus in the stool will confirm the inflammatory process in the large intestine.
4. Bacteriological examination of stool– will exclude the infectious nature of colitis.
5. Plain radiography of the abdominal cavity– will eliminate the development of serious intestinal complications: toxic expansion of the large intestine and its perforation.
6. Irrigography- filling parts of the large intestine with a radiopaque substance through anal hole. There are signs characteristic of UC: accelerated filling of the affected area of ​​the intestine with contrast, smoothness of intestinal folds (haustrations), thickened walls of the affected intestine, swollen intestinal loops.
7. Abdominal ultrasound- a low-specific method that will show thickening of the intestinal wall and narrowing or expansion of the intestinal lumen. But this method is good for excluding concomitant damage to the liver, biliary tract, pancreas and kidneys.
8. Colonofibroscopy– is the “gold standard” for diagnosing nonspecific ulcerative colitis. In this study, a camera is used to examine the lining of the entire large intestine. This method will accurately determine the activity of the inflammatory process, its extent and the presence of bleeding ulcers. In addition, colonoscopy allows you to take a biopsy of the affected intestinal mucosa for histological examination, which will accurately confirm the diagnosis.

Treatment of nonspecific ulcerative colitis in children

UC is a very serious disease for children and requires integrated approach. Therapy is selected depending on the activity of inflammation and the extent of the affected parts of the intestine.

Treatment of UC includes several points.

• Therapeutic and protective regime– in the acute period, it is important to limit physical activity, increase nighttime and nap. When inflammation subsides and improves general condition appoint physical therapy, water procedures, massage of the anterior abdominal wall.
• Diet– the goal is thermal and mechanical sparing of the affected intestine. Nutrition depends on the age of the child. In young children, special mixtures based on split protein (hydralyzate) are used. For older children, foods that contribute to increased gas formation, enhancing peristalsis and intestinal secretion, increasing and compacting feces. Limit dairy products.
• Drug therapy– the choice of drug depends on the patient’s age and the severity of colitis. The drugs of choice are 5-ASA (5-aminosalicylic acid) and corticosteroids. 5-ASA preparations, due to their components, are not broken down in small intestine and reach the large intestine, where they directly have an anti-inflammatory effect on the large intestine. Systemic glucocorticosteroids have a general anti-inflammatory effect and are prescribed to patients with severe UC or those who do not respond to 5-ASA medications. Second-line therapy is immunosuppressive therapy - these are drugs that suppress the immune activity of body cells. This treatment helps with nonspecific ulcerative colitis in those resistant to hormone therapy, but has many side effects.
• Colectomy– if long-term drug treatment of the child is ineffective or there are serious intestinal complications(perforation, massive bleeding, toxic megacolon) resort to surgical treatment - remove the affected area of ​​the colon with anastomosis.

Nonspecific ulcerative colitis, as previously mentioned, is a chronic disease and even in the presence of remission, many years of medical supervision are necessary. The child should be under dynamic supervision, as it is necessary constant control tests and regular colonoscopy. In the absence of remission for a long time, children are issued with disability.

Ulcerative colitis is a serious disease of the intestines (rectum, sigmoid and colon) that occurs in adults and children. The exact causes of this pathology have not been established. However, according to gastroenterologists, this diagnosis is appearing more and more often in the clinic. In this article we'll talk about the features of the manifestation of ulcerative colitis in childhood, its treatment and prevention.

What kind of disease is this?

Ulcerative colitis is a collective name for pathologies affecting the intestines. These diseases are similar in symptoms. These include:

1. nonspecific ulcerative colitis (UC);
2. Crohn's disease (CD);
3. undifferentiated colitis.

From the term itself it can be understood that the disease is accompanied by the formation of ulcerations of the mucous membrane. Most often, ulcers occur in the rectal area, but different forms of the disease cause different localization defeats.

The term "colitis" stands for inflammation of the intestine. In this case, swelling of the mucous membrane occurs, the formation of submucosal infiltrates, abscesses and the appearance of pus.

Ulcerative colitis in children is rare pathology. At this age, the disease is widespread (not limited to direct and sigmoid colon), moderate or severe course. The frequency of surgical interventions in young patients exceeds that in adults. That is why it is important to recognize the disease as early as possible and begin its treatment.

Why does colitis occur in children?

The exact mechanisms of the occurrence and development of the disease have not been studied. And yet, scientists have some hypotheses that reveal the mystery of the origin of this disease.

1. Viruses. Doctors noticed that the first symptoms of ulcerative colitis were observed after viral infections. This provoking factor could be ARVI, rotavirus infection, measles or rubella. Viruses disrupt the stable functioning of the immune system. This failure gives rise to aggression of protective cells against intestinal tissue.
2. Heredity. A patient whose relatives had UC is 5 times more likely to develop the disease.
3. Features of the diet. Scientists say that the lack of plant fibers and great content dairy products can stimulate the development of colitis.
4. Intestinal bacteria. Thanks to gene mutations, patients with colitis react too strongly to the normal microflora of the colon. This failure starts the process of inflammation.

There are many theories, but no one knows for sure what will trigger the development of this disease. That's why adequate measures There is no prevention for ulcerative colitis.

Symptoms

In this part of the article, we will highlight the most striking signs of ulcerative colitis that occur in childhood. The appearance of these signs should prompt parents to active actions. After all, childhood colitis progresses very quickly.

Pain. Abdominal pain varies in intensity. Some babies don't pay any attention to them, but for most children they cause severe discomfort. The pain is localized in the left abdomen, in the left iliac region, sometimes diffuse pain covers the entire abdominal wall. As a rule, the pain goes away after defecation. The occurrence of pain is not associated with food intake.

Very often colitis is accompanied by gastritis and peptic ulcers. Therefore, the presence of pain after eating does not exclude the diagnosis of UC.

Pain in the rectal area appears before and after stool. The disease most often begins in the rectum, so ulcers, cracks, ruptures and erosions appear in this place. The passage of feces causes severe pain.

Discharge of blood from the anus. The symptom is often present in UC and CD. This sign characterizes the severity of the disease. When bleeding from the rectum, the blood is scarlet, and from upper sections dark, altered blood is secreted from the gastrointestinal tract.

Diarrhea. Liquid and frequent stool appears at the onset of colitis. This sign can easily be mistaken for infectious diarrhea.

Tenesmus. This is a false urge to defecate. Sometimes tenesmus is accompanied by the discharge of mucus or pus.

Secondary symptoms of malnutrition: weight loss, pallor and weakness. In children, these signs appear quite early. This is due to the increased need for nutrition in a growing organism. And during illness, the supply of nutrients is disrupted.

Developmental delay.

During an exacerbation of colitis, children often develop a fever. As a rule, it does not reach high numbers, as with infectious diarrhea, but lasts quite a long time.

How to make a correct diagnosis?

Diagnosis of ulcerative colitis is very difficult. It requires careful medical history, laboratory and instrumental studies. To begin with, the doctor conducts a long conversation with the patient. Given the age, the child’s parents should take an active part in this conversation. Here is a list of questions to which it is recommended to know the answers:

1. Does your child have abdominal pain? Where are they most often located? How does the child react to them (the severity of pain is assessed)?
2. How often does the patient have stool (once a day)? Its consistency? Presence of impurities?
3. Is defecation accompanied by bleeding? What is the intensity of blood flow?
4. Do you have bowel movements at night?
5. Is the child active during an exacerbation?

Further management of the patient consists of prescribing instrumental studies. In children, a colonoscopy with biopsy, gastric probing, and ultrasound of the abdominal organs are required.

Gastric endoscopy makes it possible to distinguish UC from CD, and also often reveals concomitant pathology.

Laboratory tests include general blood, liver enzymes, erythrocyte sedimentation rate, reactive protein, ANCA antibody test. In case of severe pallor and anemia, ferritin tests are prescribed, serum iron. The doctor must examine the stool for infection.

Children get ulcerative colitis quite rarely (15 people out of 100), but in last years such cases have become more frequent. Moreover, in half of them the disease is chronic and is treated for a fairly long period of time.

Ulcerative colitis in of different ages children are called special shape diseases of the colon mucosa. With it, purulent and erosive blood inflammations of unknown origin appear in the specified organ and interfere normal operation Gastrointestinal tract. As a result, particles of such formations can be passed out along with the child’s feces. Together with them, complications of a local nature or affecting the entire body may appear.

Types of ulcerative colitis in children

There are several types of this disease:

1. Non-specific.
2. Spastic.
3. Crohn's disease.
4. Colon irritation.
5. Undifferentiated.

The first type of disease does not have a clear location and can manifest itself throughout the colon mucosa. It is worth noting that in children under 2 years of age, nonspecific ulcerative colitis is more common among boys, and at older ages it is more common among girls. Moreover, it is very dangerous for both the former and the latter, and the course of the disease is usually moderate or severe.

The spastic appearance is manifested by the presence of dry feces in small quantities with bloody discharge, gas and spasmodic pain in the abdominal area. You can cure it by eating right. Considered the most mild form diseases.

The third variety can be localized in several places. In this case, cracked wounds appear, the walls of the large intestine become thicker, and pain is felt in the abdomen on the right. After tissue examination, the disease is identified by the granulomas formed.

Ulcerative colitis with irritation of the large intestine in a child is characterized by frequent fecal discharge (up to 6 times a day), accompanied by painful sensations. The food does not have time to be completely digested. First, bowel movements occur in large volumes, and then gradually. At the first signs of this type of illness, you should seek help from a specialist in order to avoid serious consequences and prevent it from becoming chronic.

The last type of disease combines those colitis that are difficult to attribute to any other group based on test results (1 out of 10 cases). Its symptoms are similar to various of those described above, so it must be treated with gentle drugs, selecting them individually.

Factors that provoke ulcerative colitis in a child

Scientists are still studying the etiology of this disease, but cannot come to a consensus. Today it is believed that the factors that provoke ulcerative colitis are:

1. Decreased immunity.
2. Poor nutrition.
3. The presence of various infections in the body (dysentery bacillus, salmonella, etc.).
4. Taking certain medications against inflammation.
5. Mental trauma.
6. Transmission of the disease by genes (the risk of getting sick increases fivefold).

Each of these reasons is a possible factor that can trigger the development of the disease.

The main symptoms of ulcerative colitis in children

Depending on the symptoms of ulcerative colitis of the intestine in children, treatment is prescribed certain type diseases. In a child, the disease usually progresses quickly, so to avoid surgical intervention, you need to see the first signs of the disease without wasting time and contact a specialist. Therefore, it is very important to know how this disease manifests itself in a particular case, in order to be able to diagnose it as quickly as possible and begin to treat it, preventing it from becoming chronic and causing various kinds complications.

The main symptoms of ulcerative colitis of the colon in children are:

1. Diarrhea (stools up to 6 – 10 times a day) or constipation.
2. Bloody discharge from the anus and in the stool.
3. Feces do not have clear shapes and come out with mucus or purulent discharge.
4. Constant general fatigue of the child.
5. Sudden loss of body weight.
6. Significant decrease in appetite.
7. Colic in the stomach.
8. Painful sensations in the abdomen or navel area.

During frequent urge to defecate, only liquid with mucus and blood comes out. Due to frequent bowel movements, irritation, itching, and cracks appear in the anus. As a result of a decrease in the number of bifidobacteria in the intestines, the functioning of other internal organs may change.

One of the symptoms of ulcerative colitis of the intestine in children of different ages is pale facial skin with bruises under the eyes. It loses its healthy appearance, acquiring a grayish-greenish tone. Rashes appear, and in some places, in severe forms of the disease, ulcers may appear. When listening to the heart, arrhythmia is noticeable.

When an ultrasound of the internal organs is prescribed, an enlargement of the liver or spleen may be observed with this disease. The gallbladder and ducts are damaged.

Symptoms of ulcerative colitis in young children can be expressed, in addition to these manifestations, also:

1. Hives.
2. High body temperature (about 38°C).
3. Redness of the iris.
4. Aches and pain in the joints.

Due to the disease, children may experience delays in sexual and physical development.

As soon as any of the symptoms of ulcerative colitis in children described above are noticed, it is necessary to immediately consult a doctor for treatment. In no case should you self-medicate, because, firstly, an accurate diagnosis is necessary, and secondly, some types of ulcerative colitis in children can develop at lightning speed and even lead to death.

Diagnosis of ulcerative colitis in a child

Diagnosis of ulcerative colitis by a specialist occurs through communication with the patient’s parents and identification of complaints. This is followed by the assignment:

1. Stool studies.
2. Ultrasound of the abdominal cavity.
3. Probing.
4. Biopsies.
5. Colonoscopy.
6. Sigmoidoscopy.
7. Sigmoidoscopy.
8. Irrigography (x-ray of the colon).

Clinical blood tests show low hemoglobin, increase total number leukocytes and band cells, the erythrocyte sedimentation rate in the patient’s blood increases. An increase in the number of leukocytes and red blood cells, mucus, and undigested food is detected in the stool.

Treatment and prevention of ulcerative colitis in children

Treatment of ulcerative colitis of the intestine in children is prescribed by a doctor after identifying the reasons why the disease could occur. The disease can be treated in two ways:

1. Medication.
2. Promptly.

In the first case, the baby is prescribed therapy medicines 5-aminosalicylic acid to reduce inflammation in the mucous membrane (for example, Sulfasalazine), immunosuppressants (Azathioprine). They are available in both tablets and suppositories. If their influence is not enough, clinical guidelines for ulcerative colitis in children, glucocorticoid drugs (“Prednisolone”), intended to reduce local immunity, due to which the body’s antibodies will stop responding to the rectal mucosa. If there are contraindications to hormonal drugs, children can rarely be prescribed drugs from the group of cytostatics (“Azathioprine”). The dosage and period of use of these medications is determined by the doctor individually and depends on both the age of the child and the complexity of the disease.

Surgery for nonspecific ulcerative colitis in children as a treatment is possible if the disease worsens too quickly and medications do not have the necessary effect. In this case, the part of the intestine in which inflammation has occurred is removed, which allows the child to resume normal food intake, and sometimes becomes a vital necessity.

1. Adhere to the necessary nutritional therapy.
2. Provide the child with drink in the form of still mineral water and herbal medicinal infusions and decoctions.

In addition to the diet (food should be as high in calories as possible), it is important to reduce physical activity for the child to a minimum and not to overcool the young body. It is also necessary to protect as much as possible from possible infectious diseases, mental stress and fatigue. The doctor may also prescribe vitamins, iron-containing preparations, Smecta, and dietary supplements in addition to therapy.

Prevention of ulcerative colitis in a child consists of proper nutrition, complete cure from a variety of infectious diseases, avoiding contact with carriers of infections. Hardening and exercise will also help eliminate the disease. Exercise and be healthy!

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The diagnosis of “ulcerative colitis” given to a child usually confuses parents. It turns out that it is not so easy to understand what kind of illness has attacked your precious child, and the doctor’s explanations, full of medical terms, mostly turn into mush in the head.

Let’s decipher the tricky abbreviation “NYAK” word by word to clarify:

• nonspecific - means that the cause of the disease or the specific pathogen is unknown;
• ulcerative – speaks about the condition of the intestinal mucosa during illness;
• Colitis is the medical term for inflammation of the colon.

That is, the diagnosis of UC hides ulcerative inflammation of the colon mucosa of unknown origin. Nonspecific ulcerative colitis occurs infrequently in children, and the disease is more common in boys. The typical age of onset of symptoms is teenage years. Children aged 3 to 10 years are less likely to suffer from colitis.

There are several theories about the origin of the disease, and none of them is exhaustive.

Today, the disease is considered polyetiological, that is, arising for a number of reasons (infections, nutritional disorders, allergies, enzyme deficiency, stress), as a result of which the immune system begins to work against the host. The cause for the immediate development of colitis can be any infection suffered by a child: influenza, sore throat, dysentery.

Symptoms of nonspecific ulcerative colitis in children

If the symptoms are clear, pediatric gastroenterologists have no doubts. In cases where the disease is mild or in a non-ulcerative form, diagnosis is not so simple. To make a diagnosis, specific laboratory and instrumental studies are carried out. At home, trying to recognize UC and attempting to treat it is not worth it. The best way to help your child is to see a doctor.

There is a triad of symptoms typical for ulcerative colitis.

Wherein clinical manifestations Each of the symptoms may vary depending on the severity of the disease:

1. Diarrhea. The frequency of urge to stool is from 4 to 20 times.
2. Blood in the stool. From small veins at mild flow to a liquid, foul-smelling bloody mass with pus and mucus in severe cases.
3. Stomach ache. Occurs before defecation or during eating. Localized in the lower abdomen (usually on the left) or around the navel, they are cramping in nature.
4. Additional symptoms include loss of appetite and body weight, general weakness, fever up to 38°C and anemia.

ATTENTION! There may be complications

Nonspecific colitis in a child can become more complicated. Systemic complications occur more often:

• joint pain;
• rashes on the skin and mucous membranes;
• hepatitis;
• inflammation of the eyes.

Local, that is, localized in the intestines, complications in children rarely occur:

• haemorrhoids;
• intestinal bleeding;
• fistulas and abscesses of the rectum.

Treatment of nonspecific ulcerative colitis in children

Therapy is aimed at obtaining stable remission.

Treatment of ulcerative colitis in children consists of anti-inflammatory (Sulfasalazine) and immunomodulatory (Azathioprine) therapy. The drugs are taken both in the form of tablets and, for example, in the case of damage to the lower intestines, in the form of suppositories. In particular difficult cases Treatment with glucocorticoids (Prednisolone) is allowed, the duration and dose of which is prescribed individually in accordance with the age of the child and the severity of the disease.

Nutrition for nonspecific ulcerative colitis in children

A diet for nonspecific ulcerative colitis in children is prescribed from the very beginning of treatment and for a long period.

The bulk of the diet consists of high-calorie and easily digestible foods, rich in protein: low-fat varieties meat, cream, fish, rice porridge, white bread or crackers.

Marinated foods, citrus fruits, and whole milk are excluded from the diet.

Pasta, sweet flour products are limited as containing carbohydrates to prevent gas formation.

Ulcerative colitis is also called nonspecific. Doctors did not come to the conclusion about the reasons for its occurrence. general opinion, the controversy still does not subside. The etiology of the disease remains questionable. However, there is a lot of evidence and statistics about the hereditary component of its origin. Simply put, if close relatives have or have had ulcerative colitis, then there is a possibility that it will also appear in younger generations.

Factors that provoke this disease include:

• decline protective forces body (immunity);
• genetic predispositions;
• infections: helminthiasis, dysbacteriosis, etc.;
• unfavorable environment;
• low quality food products.

Symptoms

According to statistics, in early childhood, boys suffer from ulcerative colitis more often than girls of the same age. Most often in children the disease manifests itself between the ages of 3 and 10 years. Symptoms of the disease can be different:

• diarrhea;
• bloody discharge from the anus;
• decreased appetite;
• sudden weight loss;
• chronic fatigue;
• stomach colic, etc.

All of the above phenomena can occur either simultaneously or separately. Provoking factors can also be influenza, acute respiratory viral infections, abdominal injuries, severe stress, poor nutrition etc. This is not a complete list of symptoms that appear with this disease. Nonspecific ulcerative colitis is characterized by individual manifestations, such as:

• stomatitis;
• hives;
• elevated temperature;
• painful red nodes under the skin;
• conjunctivitis;
• noticeable pallor of the skin;
• inflammation of the iris;
• severe pain in joints, etc.

Many experts are inclined to believe that the main cause of ulcerative colitis in most cases is food and inhalation allergens.

Diagnosis of ulcerative colitis in a child

Having carefully read the symptoms of ulcerative colitis listed above, you can understand that its diagnosis can only be diagnosed by a specialist, the manifestations of the disease are so diverse and non-specific. You cannot diagnose ulcerative colitis in your child on your own. At the first suspicion of illness, you need to consult a doctor. A timely diagnosis and correctly prescribed treatment are the key to a speedy and complete recovery of the child.

The doctor makes a diagnosis based on the following studies and tests:

• endoscopic;
• X-ray;
• instrumental;
• physical;
• laboratory analysis;
• anamnesis data;
• clinical picture.

To clarify in detail the severity of inflammation and its degree, the child undergoes irrigography. This is an X-ray examination of the large intestine after filling it with a radiopaque substance. IN in this case barium suspension is used.

Complications

If ulcerative colitis is not treated, the consequences can be very dire. Complications and consequences of ulcerative colitis in advanced cases may include:

• malignant intestinal tumor (cancer);
• heavy bleeding from the rectum;
• rupture (perforation) of the large intestine;
• acute toxic intestinal dilatation;
• damage to the liver, joints, eyes.

The severity of the complications speaks for itself - the disease must be treated intensively and in a timely manner. Under no circumstances should it be launched. Relapses of ulcerative colitis in children are possible. And yet, the prognosis for children is more favorable than for adults.

Treatment

What can you do

In case of chronic colitis of a child, the following will be recommended:

• appropriate diet;
• therapeutic nutrition;
• use mineral waters without gas;
• infusions and decoctions of medicinal herbs.

What does a doctor do

In addition to the above measures, the nutritionist will draw up an individual menu for the child, excluding those foods that the child cannot tolerate and do not suit him. The location of the source of the disease will be taken into account. The doctor will also prescribe appropriate medication. If necessary, the following are also used:

• anal suppositories;
• intravenous injections;
• enemas.

Also, in the complex of measures in accordance with the diagnosis, the following are often prescribed:

• physiotherapy;
• abdominal massage;
• warm compresses on the abdominal area;
• physiotherapy;
• electrophoresis;
• mud therapy.

If all medical prescriptions are strictly followed, the prognosis for the disease in children is favorable. The disease is completely cured, leaving no consequences or complications.

Prevention

Prevention of ulcerative colitis in children comes down to following a healthy diet and age-appropriate diet. It is necessary to completely cure intestinal infections if they appear in a child. Worm infestations, as well as dysbacteriosis can also provoke the development of ulcerative colitis in a child. Accordingly, you need to avoid these diseases or treat them until complete recovery.

We should not forget about simple and effective general strengthening measures - physical education, rubbing, walking fresh air, outdoor games. All these measures are aimed at raising the overall tone of the body, strengthening the immune system and its defenses. A healthy and strong child is less susceptible to various infections and diseases. In any case, it is easier to prevent a disease than to treat it.

Remember that other diseases may have similar symptoms. Therefore, do not rely on outside advice. Only experienced specialist can give the correct diagnosis of the disease. Do not delay your visit to the doctor. This way you can avoid complications and serious consequences of the disease.

You will also learn what can be dangerous untimely treatment the disease ulcerative colitis in children, and why it is so important to avoid the consequences. All about how to prevent ulcerative colitis in children and prevent complications.

And caring parents will find on the service pages complete information about the symptoms of ulcerative colitis in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat ulcerative colitis in children?

Take care of the health of your loved ones and stay in good shape!