Chronic enteritis

Treatment and prevention. Treatment of chronic enteritis with the presence of pronounced histopathological changes in the mucous membrane of the small intestine in acute phase of the disease should be carried out in hospital.
One of the main principles of treatment of chronic enteritis is to release the affected organ. This is achieved by the appropriate medical nutrition. Along with this last pursues also restoration of disturbed currency and entered enough energy substances. In this connection, the main task of the medical nutrition is the introduction of a sufficient amount of proteins, fats, carbohydrates, mineral salts and vitamins and, most importantly, achieve their maximum assimilation and absorption. The latter is achieved of three conditions: diet, reducing motor activity of the small intestine and the introduction of food products that require minimal processing in the small intestine.
The mode of nutrition is expressed in cases of fractional introduction of food 6-7 times a day. In less severe patients meal frequency may be reduced to 4-5 times with equal intervals between them.
In order to reduce the motor function of the small intestine and the corresponding increase time of contact (incubation) food enzymes food is given in hot form, mashed, with coarse fiber, black bread, carbonated soft drinks, fresh milk. Cooked food should aim at the most easy of digestion in the small intestine. This is achieved by assigning mucous soups, well-cooked meat (beef, veal, chicken, lean fish), bouillons, jelly, jelly, soft-boiled eggs.
When expressed exacerbations and still quite satisfactory nutrition valid for maximum unloading of the small intestine appointment for a short term diet with a significant restriction of food ("hungry days"). Treatment of hunger can be no more than 2-4 days of oral administration of 5% glucose solution, which does not need before absorption through hydrolysis, and parenteral introduction protein hydrolyzate (aminomethyl, aminotropin), and vitamins. Gradually it should go to a full composition of the diet. The best of the proposed diets for patients with chronic enteritis should be considered as suggested in the Institute of nutrition of the Academy of medical Sciences of the USSR, the so-called "oral" diet (E. A. Beyul, 1965). It contains 130-150 g protein, 100-110 g fat and 300-400 g of carbohydrates in total energy 4000-4500 kcal. Additionally introduced vitamins (juices) and a sufficient amount of mineral salts.
When medical nutrition therapy should be aware of possible individual intolerance to specific foods. Under this should be understood occurrence in a patient with a number of symptoms (mainly subjective)directly related to the acceptance of those or other food substances. The food in such cases is not the cause of the disease and in most cases not even worsens the condition of the patient according to objective research, but in a short period of time causes a number of unpleasant symptoms. Elimination of appropriate nutrients leads to eliminate the symptoms that are associated with them, but it does not give reason to believe that this will be achieved significant improvement in the patient's condition. Intolerance to certain types of food can be observed in practically healthy people. In these cases, the judgment about it made on the basis of the subjective experiences of the patient about the "harm" of a product. It is not excluded that often such intolerance is imaginary, due to a certain psychological attitude. The latter may be associated with the former previously digestive disease, when after taking any food was observed discomfort, recommending certain diet doctor and, finally, as familiarity with the literature that describes the harm of certain kinds of food diseases, one of which, in the opinion of the patient, he suffers. This intolerance to certain foods is not only seen in chronic enteritis, but in remission or incomplete remission of this disease, often before development of the disease. Intolerance of certain nutrients in these cases, after the development of chronic enteritis is becoming more pronounced, and often exacerbation of chronic enteritis able to link with the reception of this or that food which is not tolerated ill. When asking based on history of intolerance to certain foods latter should be excluded from the diet of the patient chronic enteritis. This is achieved improvement in the condition of the patient due to the disappearance or reduction of the intensity of a number of symptoms. Most often intolerance observed to cabbage, sugar plants, spices (acute), onions, milk (fresh), cheese, tomatoes, eggs.
Medical therapy plays in the treatment of chronic enteritis significant role. Its peculiarity is that the drug used orally, come into direct contact with a sick body (mucosa).
The main principle of treatment of chronic enteritis is the impact (stimulation) on the processes of regeneration of the mucous membrane of the small intestine. To this end are appointed steroid hormones. It is recommended to assign on the principle of "arc": to start with a small dose of 10-15 mg prednisolone per day (0,005 three times a day), and then 4-5 days in the absence of sufficient effect to increase the dose of 0.005 (additional reception in the morning) and then with the same intervals (4-5 days) increase the dose to 35 to 40 mg daily to achieve an optimal effect. A lower dose of steroid hormones should be done gradually (2.5 mg every week). When reaching the dose in 10-7,5 mg should stop and to continue treatment for a further 3-4 months. In simpler cases, may be with the same purpose assigned Metall (0.5 three times a day before meal, with a subsequent increase in 7-10 days the dosage up to 0,75 - 1,0 to receive during 1-IV2 months). These drugs should be combined with parenteral introduction of the b vitamins and ascorbic acid. When expressed diarrhea at the beginning of treatment may be recommended the appointment of sulfa drugs (etazol on 1,0 4 times a day for 5 to 7 days)and some medicines, with astringent properties and reduce the motor function of the small intestine. From the latest I can recommend the following recipe:
Rp.:Tannalbini 0,3
Bismuthi subnitrici 0,5
M. f. pulv.
Herbal medications you can assign "astringent tea", consisting of a mixture of the fruit of the cherry (3 parts) and berries of a bilberry (2 parts). Two tablespoons of this mixture brew two cups of boiling water, boil for 20 minutes, strain and take 3 times a day 1/4-1/2 Cup (50-100 ml). With clear signs sharply increased motor activity of the small intestine (x-ray confirmation) may be recommended tincture of opium 3 times a day for 4-6 drops. Opium preparations should not be given long-term (not more than 7-10 days).
The use of antibiotics in the treatment of chronic enteritis is not shown.
Significant weight loss in patients due to the absence of assimilation of nutrients, requires the application of parenteral protein nutrition in the form of fractional blood transfusion (100 ml 2 times a week 6-8 times), protein hydrolyzate (250 ml intravenously or subcutaneously every other day, and in severe cases, each day), intravenous drip of 5% glucose solution 200-300 ml In the presence of anemia shown iron supplements, large doses of vitamin B12, folic acid.