Nonspecific ulcerative colitis

Nonspecific ulcerative colitis is a chronic relapsing disease, characterized by severe inflammatory lesions of large intestine.
Typical is a chronic course with alternating periods of exacerbation and remission periods of varying duration. Nonspecific ulcerative colitis occurs in people of all ages, mostly women.
The etiology and pathogenesis of the disease is not installed. Among etiological factors nonspecific ulcerative colitis indicate infection, nerve damage, allergies, food and vitamin deficiency, a genetic factor. Currently suggest about the violation in the organism in nonspecific ulcerative colitis immune processes. In the coming endogenous polyvitamins associated with the violation of the synthesis of vitamins, is a violation of individual units interstitial exchange.
Pathological anatomy. The leading characteristic are superficial or deep, penetrating into the muscle layer and serous membrane ulceration, which sometimes cause perforation of the bowel wall. Often the process is localized in the left section of the large intestine, but it can spread to the entire large intestine until ileo-zakalnoe flap. Involved in a pathological process and the distal segment of the jejunum. Occurs when the scarring ulcers sclerotic process leads to deformation of the colon, thickening and tightening its walls.
The clinical picture. The main symptoms of the disease are abundant bloody-mucous or blood-tinged-purulent discharge from the rectum, tenesmus (see), frequent stools (7-20 times a day or more), abdominal pain, weight loss, anorexia (see).
The clinical course share the following forms of non-specific ulcerative colitis: relapsing, continuous and lightning. Recurrent form is characterized by alternation of exacerbations and remissions. The clinical picture during remissions variable. Some patients are healthy, others highlight the weakness, reduced efficiency, unstable chair. Continuous form differs in the fact that its symptoms and activity of the pathological process in the intestine continued unabated for many years. This form of non-specific ulcerative colitis is usually associated with the defeat of the entire colon and may be accompanied by various complications and sometimes requires surgical treatment. Fulminant form is characterized by high fever, depression of consciousness, strong expansion of the colon and its immobility. Clinically, the picture reminds obstruction of the large intestine (see bowel Obstruction). This form may be complicated by perforation and the subsequent development of peritonitis (see) and sepsis (see).
For the diagnosis of nonspecific ulcerative colitis is of great importance rectoromanoscopy study, in which you can install hyperemia, swelling, diffuse bleeding, erosion, ulcers, pseudoprime rectum and sigmoid colon (see Sigmoidoscopy).
Chest x-ray shows the change of the sizes of the colon and rectum, rigidity of the walls of the intestine accompanied with lack of Australia, roughness and the graininess of the paths and narrow its clearance. On the mucous membrane of the colon may be visible erosion and ulcers.
Complications: a perforation of the wall of the diseased colon, hepatitis, is the most common complication), hypochromic anemia, hypoproteinemia, gipokaliemia.
The prognosis is very serious, given the nature of the disease and high mortality rates.
Treatment. In case of exacerbation hospitalization is indicated. Treatment of patients with nonspecific ulcerative colitis should be made to increase the body's defenses, the elimination of hormonal disorders, infection control and surgical removal of the affected part of the colon.
To enhance the body's defenses apply a blood transfusion in a fractional doses (75-100 ml), performed by a doctor every three days (at the rate of 5-8 transfusions), appoint a diet with a high content of protein (120-150 g) and vitamins (a, E, group, ascorbic acid injection). Steroid hormones usually prescribed for the lack of effectiveness of pre-integrated therapy.
Anti-infective therapy to suppress secondary infection. Sulfa drugs (for example, sulgin 1 g 4 times a day) and antibiotics (e.g. sigmameter 250 000 IU 4 times a day) designate short courses for 5-7 days with intervals of 10-15 days. To local effects on infectious process used enema with furatsilinom (1 : 5000) in the amount of 300 ml injected into the rectum drip for 1-172 hour. daily for 10-15 days.
Locally appointed also means containing vitamins a and E and Pro-epithelialization mucosa. This fish oil, seed oil rose hips, giving enemas 50 ml daily or every other day warmed up to temperature 37C (rate of 15-20 enemas).
Surgery (resection, communications and other) used in the absence of clinical effect from conservative therapy, massive bleeding, perforation, cancer of the colon.
Prevention of disease occurrence is difficult because of etiology of the disease. Prevention of progression of the process is reduced to a lengthening of remission and relapse prevention, for which it is recommended that clinical supervision, hormone treatment by a doctor, a course of vitamin therapy and nutrition.

Nonspecific ulcerative colitis (colitis ulcerosa gravis) - cyclically flowing disease characterized by lesions of large intestine with the development in severe inflammatory process.
A distinctive feature of nonspecific ulcerative colitis is a chronic relapsing course with alternating periods of exacerbation and remission periods of unequal length. Rarely observed acute.
Statistics often difficult due to the large number of errors at diagnosis without rectoromanoscopy research. In some countries, for example in Norway, there is a tendency to increase of number of diseases. Nonspecific ulcerative colitis can occur at any age. However, the most commonly occurs between the ages of 20 and 40 years.
The etiology and pathogenesis. A large number of isolated from patients with a variety of microbes (diplostraca-, entero-, staphylococci and anaerobic bacteria, viruses, enteroviruses), the lack of therapeutic effect (and even worsening of the pathological process) from antimicrobial drugs, including antibiotics, impossibility of creation of experimental model of nonspecific ulcerative colitis with the introduction of dedicated microbes allowed to reject the theory of infectious (including dysentery) nature of this disease. Microbes intestine (not only pathological, but the normal microflora) can penetrate damaged mucous membrane ulcers (secondary factor in the development of disease), significantly burdening for nonspecific ulcerative colitis.
There is no evidence that occur when nonspecific ulcerative colitis degenerative lesions in different parts of the nervous system belong to the primary, not secondary manifestations of non-specific ulcerative colitis. Nervous factors affect the nature of the disease, but they cannot be considered primary. Swelling and fibrinoid necrosis of collagen fibers in the mucous and submucous shells diseased colon should be seen as a consequence, not a cause nonspecific ulcerative colitis. Despite some features characteristic of collagenoses, yet you cannot include nonspecific ulcerative colitis group collagen diseases (T. F. Cogoi). Allergic factor, especially food Allergy (in particular, caused by milk), plays a significant role in the development of the disease, but there is no data for recognition allergies cause nonspecific ulcerative colitis. Inhibition of functional state of adrenal cortex in nonspecific ulcerative colitis (C. K. Gerasimov) is also considered as a secondary manifestation of nonspecific ulcerative colitis due to the impact of a pathological process in the metabolism of proteins, electrolytes, vitamins. Currently installed [Hardin (C. A. Hardin) et al.], the intestines of humans and experimental animals can participate in different types of immunological reactions.
In the literature there are statements about hereditary predisposition in some families to this disease. However, the proportion of genetic factors in the appearance of nonspecific ulcerative colitis is extremely small. Thus, these data with the most convincing evidence of the role of autoimmunize as the main causes of non-specific ulcerative colitis.
Initially various reasons (emotional stress, food error, intercurrent infections, including dysentery) cause sensitisation of the body, and place resulting in further maximum response becomes large intestine. The last and gives rise to an autoimmune process: is pathological secretion stimulation colon antigen followed by the formation of antibodies and the onset of reaction antigen - antibody. Re irritation as a result of new emotional stress, violations of food, excessive use of antibiotics, etc. can cause re-sensitization of the colon, combined with a new wave of reaction antigen - antibody and recurrent disease. Thus, the reaction of the antigen - antibody is a secondary phenomenon, occurring due to primary sensitization of the colon. However, the resulting autoimmunity becoming leading a major factor in the pathogenesis of non-specific ulcerative colitis causes a peculiar features of the clinical picture and the nature of the disease. Additional factors that play a role in the pathogenesis of non-specific ulcerative colitis: a bacterial infection (normal microflora of the intestine or other germs intestines as a result of an accompanying dysbacteriosis), penetrating into the thickness of the mucosa of the colon, leading to local tissue necrosis, cryptonym abscesses, the anorectal fistula and so on; developing secondary lesions of the Central and predominantly autonomic nervous system; food and vitamin deficiencies affecting the organism reactivity and contributing to the development of fatty liver; increased formation of histamine, serotonin, hyaluronic acid and other enzymes, explained by the increase in the number of overweight and argentophile cells throughout gastric-intestinal tract, especially in the diseased colon.
Pathological anatomy. Postmortem nonspecific ulcerative colitis is characterized by a deathly-ulcerative process in the wall of the colon. A typical lesion localization in nonspecific ulcerative colitis is the distal segment of the colon - direct and sigmoid colon. Beginning in the distal, the process is extended to the whole large intestine; in severe cases, there may come a defeat of the entire colon or most of it. Primary isolated defeat of the proximal colon cancer is rare. In some cases, the process involves the distal segment of the jejunum - the so-called retrograde ileit.
There are two main forms of non-specific ulcerative colitis, acute and chronic (more frequent); in the chronic form can be acute with all morphological changes inherent in the acute form of the disease.
Macroscopically for acute nonspecific ulcerative colitis (and at exacerbation of chronic current forms) wall of the colon flabby, tears easily, the bowel lumen sometimes dramatically expanded, especially in cases of toxic dilation of the colon; swollen mucosa, full-bodied, with bleeding and ulceration. Ulcers of various sizes, with uneven edges tend to spread over the surface on the vast territory, capturing the mucosa and submucosa of the shell; in some cases necrotic process also applies to muscle and serous membrane, which leads to the perforations. In the form of chronic nonspecific ulcerative colitis deformation of the colon: a wall of her sharply sclerotic (fibrous) and thickened, the shortened colon lumen is significantly narrowed. The relief of the mucous violated, semilunar fold missing. This is due to ongoing processes of scarring ulcers.
Especially sharp sclerosis, shortening and stenosis cancer develops in the colon for long-existing ileostoma (the first stage of surgical treatment). Ulcers in the form of chronic nonspecific ulcerative colitis of various sizes, with smooth, sometimes overhanging edges, bottom ulcers clean or made granulation tissue. Is characterized by the formation of pseudopolyps on a broad basis or on the leg up to 1.5 cm in diameter. They either are the Islands of the mucosa and submucosa of shells, preserved among ulcerations (Fig. 1), or arise in the course of regeneration and consist of granulation tissue or glandular growths of the epithelium (granulation and adenomatous pseudoprime; Fig. 2).

Fig. 1. Pseudopolyps.
Fig. 2. Adenomatous pseudopolyps.


In the basis of nonspecific ulcerative colitis are destructive-necrotic process and intensive proliferation reticulohistiocytosis elements in the wall of the intestine. Acute destructive necrotic changes prevail in acute disease. They are expressed in swelling and fibrinogen necrosis of collagen fibers, mainly in the submucosa of the. In the wall of the colon is also a focal or diffuse BioMalaysia actually muscular layer; deep degenerative and necrobiotic changes in intramural nerve ganglia. The most typical reaction for nonspecific ulcerative colitis is a proliferation reticulohistiocytosis elements in the wall of the intestine, in lymphoid follicles and regional lymph nodes. In the large intestine, mainly in the mucous and submucous shells, are determined by the massive infiltration of the plasma cells of different degrees of maturity, with mixture of lymphoid, fat cells and eosinophilic
leukocytes. In some cases, in the intestinal wall and regional lymph nodes are formed granuloma reticulohistiocytosis nature, sometimes like TB, but without caseous necrosis. Such tissue reaction is especially pronounced the chronic course of the disease and the majority of researchers is considered as morphologic confirmation immune processes, played out in the colon. Changes intramural vessels: fibrinoid necrosis, productive endovascular, chromoendoscopy, the defeat of vessels of type of periarteritis nodosa - testify about the allergic mechanisms in the pathogenesis of non-specific ulcerative colitis. A number of authors critical in the pathogenesis of non-specific ulcerative colitis gives the defeat of vessels with subsequent circulatory disorders in the intestine wall type of heart attacks. When nonspecific ulcerative colitis is always a greater or lesser extent, also expressed exudative reaction in the form of a purulent inflammation, which begins deep Oberkovych glands - the so-called purulent criptithe and crypt abscesses. Some researchers tend to consider purulent criptithe and crypt abscesses as the initial stage of the formation of ulcers. In addition, a large number of pus produces granulation tissue, performing ulcerous defects in the course of regeneration. In cases of chronic in parallel with the above changes in the regeneration in the form of scarring and epithelization ulcers; however, as a rule, regeneration remains incomplete. Ulcerative process is delayed for years. One of the reasons defective regeneration are deep dystrophic changes intramural nerve ganglia.
When nonspecific ulcerative colitis in parenchymatous organs dystrophic changes in the liver during the portal tract possible proliferation reticulohistiocytosis elements, brutalization stroma.

The diagnosis is established on the basis of all clinical symptoms, but remains crucial for data rectoromanoscopy studies (see Sigmoidoscopy). Differential diagnosis virtually must be bacillary and amoebic dysentery. The combination decorated feces and blood, or even rectal bleeding in good health and without any signs of toxemia is typical only for non-specific ulcerative colitis. Rectoromanoscopy research at last reveals the peculiar form ulcers and already in the early stages of the disease - pseudopodia. And finally, negative research data mucus and fecal dysentery Bacillus and amoeba, as well as relevant serological reactions confirm the diagnosis of non-specific ulcerative colitis.

The forecast. Mortality in nonspecific ulcerative colitis, according to ALMI (1965), 8% in the first attack, and 12-15% over a 20-year period of the disease. After the introduction into practice of treatment of steroid hormones that the number of deaths has decreased in 3 times: from 14.5% to 4.5% [Trulov and Edwards (C. Truelove, F. S. Edwards), 1963]. Thus, despite the decline in mortality, the Outlook remains serious.