Treatment of intestinal colitis with medications. Nonspecific ulcerative colitis Proteins, fats, carbohydrates

2012-07-26 04:43:57

Maria asks:

Hello, can you please tell me if it is possible to add onions to soup for UC? And what vitamins can you take? I have severe vitamin deficiency, I eat fruit anyway, but my fingers still peel off. Thanks in advance for your answer.

Answers Lukashevich Ilona Viktorovna:

Dear Maria, come to our proctology department, I will give you a whole book on the nutritional habits of patients with inflammatory diseases of the colon, both during exacerbation and in remission. Regarding onions, if you are in remission - yes. B vitamins can be taken in courses of 2 months in spring and autumn. In a word, come to us for a consultation. My my. 067-504=73-78.

2012-04-16 15:51:19

Tatiana asks:

Dear Fedot Gennadievich! I meant - for hypovitaminosis, the doctor prescribed Calcemin-Advance, but it must be taken with Fish Oil for better absorption of calcium, and fish oil is not allowed for UC, what should I do? What complex of vitamins can I take, maybe droppers with Vit. C., glucose, Vit. B. --- to support the body, it’s not a secret - the body is depleted with such a diet and the person loses weight. During an exacerbation, mainly protein foods are consumed, but fiber The intestines also need it; without it, in most cases, oncology develops. What should I do? Is it possible to take fiber in its pure form - tablets? Which product is better - apples, pumpkin, wheat...? What is better for the intestines? If you have problems with blood pressure, headaches begin - what do you recommend - baralgin, no-shpa, ketanov ?The general practitioner and other doctors prescribe the drugs that the distributors of the pharmacy chain recommend to them, but they don’t read the anatomy, and the sick person in the pharmacy doesn’t re-read everything. Now the cervical lymph node is inflamed - what anti-inflammatory drugs can I take so as not to provoke an exacerbation of the intestines? Me myself The operating room nurse knows in the operating room what UC is. The doctor treats in the hospital with medications, the patient is left to his own devices at home. That’s why I’m asking you, excuse me, meticulously. There is conflicting information on the Internet about diet. It’s almost impossible to find a good nutritionist. Maybe you need to conduct classes lectures on UC and diabetes. diabetes or glaucoma... There is little information and not everyone has the Internet. Is it possible to change Salofalk to Pentasa and vice versa, so that there is no overuse. With uv. Tatiana.

Answers Tkachenko Fedot Gennadievich:

Hello Tatiana. It is not entirely correct to treat a disease such as UC in absentia. Therefore, I would strongly recommend that you find yourself a qualified proctologist and gastroenterologist and constantly see the same specialist. However, speaking in general, I would answer your questions as follows: 1) During an exacerbation of the disease, the treatment regimen includes vitamins B1, B6, B12, C - all of them are administered by injection; outside of an exacerbation during the period of remission, you can also take multivitamin complexes in tablet form. . 2) You can find all the information about the diet for inflammatory bowel diseases in special dietetic manuals or on the Internet, I won’t add anything special to this information - you can use stewed vegetables as a source of fiber (in moderation, carefully when the process worsens ), baked apples, porridge, etc. 3) It is not worth changing Salofalk for Pentasa to prevent the development of addiction - unless allergic or other adverse reactions develop. 4) If you currently have cervical lymphadenitis, then it is advisable to see a surgeon and agree with him on the need for drug treatment; local treatment may be sufficient.

2011-11-27 18:28:09

Valeria asks:

Hello. 11/16/11. the husband was hospitalized in the gastroenterology department, where he was diagnosed with UC, active phase, subtotal damage to the colon, moderate condition. Chronic gastroduodenitis, active phase. Stage 1-2 reflux esophagitis. Chronic cholecystopancreatitis, active phase.
In a month I lost 14 kg. I had diarrhea with red blood (for a month (they treated hemorrhoids for 2 weeks until they turned to a gastroenterologist)) I spent 10 days in the hospital. I took duspatalin, Creon-10, loseprazole... Gaviscon.phys.r -n., papaverine, platiphylline, ACC, analgin, diphenhydramine, ascorbic acid, riboxin. mildronate, thiotriazoline, essentiale, enterozermine, bifiform, salofalk, norfloxacin. dexon, budenofalk.
He was discharged home with recommendations: take Duspatalin, Creon, Budenofalk 3 mg X 3 times per day per month, then ZMG 2 times per day per month, Salofalk suppositories 500 mg 2 times per month, Loseprazole 20 mg 2 times per day for 20 days, then in the morning 20 mg while taking budenofalk, bifiform 1 caps 3 times a day for 20 days.

I came back from the hospital with ARVI. The temperature fluctuates from 37 to 38.7.
Question: How can I knock down the t-ru (except vinegar and water (wiping))?
Is it possible to take AMIZON, Engystol, and VITRUM vitamins?
What drugs can boost immunity?
What kind of nutrition can increase hemoglobin (his Hb-119, and before the hospital it was 136).
What herbs can be used for UC?
Which clinic in Ukraine specializes in UC?

He has 2 stools in the morning and 1 stool in the evening (soft consistency, foul-smelling).

Thank you in advance for your answer, best regards, Valeria.

Answers Tkachenko Fedot Gennadievich:

Hello Valeria. The clinic of the Proctology Center of Ukraine, where I have the honor to work, has the greatest experience in treating patients with inflammatory diseases of the colon (UC, Crohn's disease). As for all other questions, I will try to answer them in order: 1) You can bring down the temperature with any antipyretics and analgesics (analgin, paracetamol, etc.) 2) Amizon, vitamins can be taken. 3) You can increase hemoglobin by eating meat, fish, and liver - however, it is better to take them boiled or stewed. To normalize hemoglobin, you can also take the following medications, for example, Durules-sorbifer 1t 3 times a day + folic acid 1t 3 times a day. 4) As for herbs, herbalists do more of this; it’s better to ask them about it. I do not have much experience using herbs to treat patients with UC.

2011-02-08 14:59:00

Lyudmila asks:

Thank you in advance for your answers to my questions.

Answers Tkachenko Fedot Gennadievich:

2015-08-11 19:03:38

Svetlana asks:

Hello! My diagnosis is UC, left-sided lesion, chronic relapsing course of moderate severity. For the last two years, constant abdominal pain, frequent and loose stools with blood (up to 10-15 times a day). I receive treatment in Ufa, but there are no results due to the fact that I am allergic to medications: Sulfalazine, Salcofak, Pentasa. During the complex intake of vitamins with Prednisolone, the result was positive, but immediately after stopping Prednisolone, the condition worsened. Against the background of the disease and the absence of a period of remission, over the last 2 years the weight has decreased from 75 to 46 and continues to decrease with a height of 153 cm, hemoglobin has dropped to 90, immunity has decreased, constant colds, herpes (everywhere), candidiasis (everywhere). Help, please, where and who can help me select drug treatment for me? How to stop weight loss? Our doctors in Ufa just shrug their shoulders and offer to remove the colon. Maybe you can do without surgery? Help!!!

Answers Tkachenko Fedot Gennadievich:

Hello Svetlana. Most likely, you have a hormonal-dependent form of UC - this is when stopping hormonal medications or reducing the dose leads to an exacerbation of the disease. Taking into account the fact that you cannot use drugs containing mesalazine, I see only two options for further drug treatment: 1) Prescribing immunomodulatory therapy (azathioprine or immuran). 2) Prescription of biological therapy (Remicade or Humira). However, this is just my logical conclusion. It is impossible to answer your question in absentia. If your local proctologists cannot cope with the treatment of such a disease, then consult other more reputable proctology clinics - get a “second opinion” about your disease and possible ways to solve this problem.

2014-10-21 21:18:17

Julia asks:

Hello Doctor, I have been ill with Nyak for two years now, there has been practically no remission, it feels like the intestines have stopped working, I am tormented by constipation and there is mucus and blood (a lot of blood), during this period the hair has come out terribly, please tell me how to normalize the stool and what vitamins can I take or will they help me at all?...my doctor didn’t prescribe any vitamins, he said that it’s impossible....and one more question: can I take probiotics symbiter....I would be very grateful for your answer

Answers Tkachenko Fedot Gennadievich:

Hello Julia. Constipation is not typical for UC. Perhaps you have some other disease. I think that you need to go for an in-person examination to a specialized state proctology center, where doctors have experience in treating inflammatory bowel diseases for adequate examination and treatment.

2013-02-23 18:51:06

Olga asks:

Hello! Help me please. I am 29 years old, doctors cannot diagnose: bacterial colitis? UC? BC? IBS? It all started on September 1, I felt unwell, weak, aching all over my body, a little nausea, my temperature rose to 37.8. For three days I treated the flu with Aflubin and Coldrex, but it didn’t get any better. On the second day, the temperature dropped, but the weakness and aches remained. On the fourth day, watery, very frequent diarrhea began. I took enterosgel, the aches in my body went away immediately, I didn’t eat anything all these days and called an ambulance because... I had a business trip to Kyiv. I was advised to do a cleansing enema, continue to fast, drink chloramphenicol 1 tablet. 4 days a week 7 days, sorbex ultra. It became easier with stool, but my stomach was rumbling very much and there was severe weakness. I came home and slowly began to eat according to diet No. 4. I thought I had recovered, but I ate some grapes and the diarrhea returned the next day. On September 19, the same thing happened to my 3-year-old daughter and the two of us were hospitalized in the inf. department. I was prescribed: Ciprolet, Filtrum, Subalin, Enterozermina, diet. My culture did not show anything (this was after chloramphenicol, of course), they took it from my daughter after an enema - also nothing. In the hospital everything returned to normal: appetite, stool, well-being. I was discharged home, I developed cystitis, the doctor prescribed the antibiotic Monural and Urolesan. The next morning the diarrhea returned, but with pain in the abdomen and sides. I was again hospitalized in the infectious diseases department, given an enema, prescribed a course of antibiotics, IV drips, Atoxil, rotabiotic. After two days of such therapy, I ran to a gastroenterologist and was already treated with Intetrix, Smecta, glutargin, Creon 25 thousand, Erbisol intramuscularly. During the treatment everything was fine. Two days after the end, green, unformed stools began with foam and pieces of undigested food. I was prescribed Phthalazole 2 t. 4 days a week for 10 days, I drank it for a week and couldn’t take it anymore. My weight reached 38 kg with a height of 169 cm. I began to be afraid of any food, there was rumbling in my stomach, flatulence, pain in the navel area, visible spasms. I received medications: lactofiltrum, atoxil, Creon 25,000, mezim forte 10,000, rotabiotic, linex, mutaflor, meverin, mebsin retard, legalon, de -nol, zakofalk, salofalk 1 g per day, vitamins supradin. The psychotherapist prescribed eglonil and thioprilan. Now my weight is 41,800. Blood pressure 96/52. Menstruation stopped. Before this, I had never had any problems with the intestines; I had regular bowel movements every morning. Examinations: Ultrasound of the abdominal organs: liver without structural changes, normal picture of the spleen, echo signs of deformation of the gallbladder, pancreas without structural changes. Transabdominal ultrasound of the colon: echo signs of colitis with a spastic component against the background of dolichocolon with FCI deficiency. Lactate 3.8. Triglycerides 0.18. Gilbert's syndrome. Total bilirubin 49.7. Direct 18. AlAT 0.38. AST 0.28. Thymol sample 5.2. Hemoglobin 150. Red blood cells 4.2. Leukocytes 6.2 g/l. ESR 3 mm/g, platelets 273 g/l. Reticulocytes 0.4%. Band cells 3%. Segmented 60%. Eosinophils 3%. Lymphocytes 26%. Monocytes 8%. Endoscopy: the colonoscope is passed to the splenic angle. Severe pain syndrome in response to air insufflation and colonoscopy. The intestinal tone is normal, the relief is preserved, haustation is pronounced. The mucous membrane is smooth, pale pink shiny. The vascular pattern is clearly visible. In the sigmoid and rectum there are many foci of hyperemia up to 0.4-0.6 cm in diameter. Unexpressed procto-sigmoiditis. BIOPSY: in the mucous membrane of the colon there is a focal deformation of the crypts, there are many goblet cells in them, but the RAS reaction is sharply reduced in them, up to the loss of color along the periphery of the vacuole, while maintaining a narrow rim. There is a weak to moderate me... plasmacytic infiltration with an admixture eosinophils. In one area, it predominates in the superficial part of the mucous membrane, where sclerosis is also expressed. Interepithelial leukocytes are rare; there is one memphoid follicle. There is little data for CD, there is no tendency to change the deeper sections, the focality of the process. The diagnosis fluctuates between bacterial colitis and UC in remission. Coprogram: single leukocytes in the field of view, red blood cells, protozoa, helminth eggs, crystals, soaps, indigestible muscle fibers, starch grains, connective tissue were not found. Digestible muscle fibers in large quantities, without striations. Neutral fat, fatty acids, indigestible and digestible fiber iodophilic bacteria - in small quantities. Neoforml, brown, acidic reaction. Analysis for dysbiosis: UPF 2*10 in 7. No pathogenic microflora was detected. Five months have passed and I am still suffering. Is a cure possible? What kind of colitis do I have? What other studies need to be done to make a diagnosis? There was no blood in the stool, but it doesn’t want to take shape: (and constant pain that doesn’t allow me to live. My daughter alternates loose stools with constipation, this never happened before the illness. HELP!!!

Answers Tkachenko Fedot Gennadievich:

Hello Olga. The situation is difficult enough for you to clearly say in a virtual consultation what problem you have. However, the symptoms that you described may indicate the presence of some kind of inflammatory disease of the colon (for example, Crohn's disease, antibiotic-associated colitis, etc.) or some kind of enteropathy. To clarify the diagnosis, I would recommend that you undergo the following examinations:
1) Fibrogastroduodenoscopy.
2) Total fibroclonoscopy under intravenous anesthesia.
3) Consultative examination by a proctologist.
4) If necessary, capsule endoscopy Upon receipt of all these examinations, a repeated consultation with a qualified proctologist and gastroenterologist is necessary.

2012-11-26 18:45:26

Anton asks:

Hello! I am 25 years old, for 1.5 years now doctors have been diagnosing UC. Bowel movements are infrequent up to 3 times a day, there is no fever or severe abdominal pain. Sometimes there is a "rumbling in the stomach." During an examination in the hospital in March of this year, a colonoscopy showed subtotal colitis and ileitis. Discharged in April. The first time mucus with blood in the stool appeared in the summer in June, I was treated for 1 class. salofalk + 3 g of salofalk tablets, the condition has improved. I removed the enemas and left 1.5 grams per day, and two months later mucus appeared in the stool again, and the color of the stool changed. I would like to ask you what additional medications are prescribed for my diagnosis, I was prescribed omez, vitamins, bifiform
smecta, omez and what drugs can be used instead of salofalk? I also wanted to ask whether the dose of tablets of 1.5 grams per day is not too high, but when it is reduced to 1 - 2 tablets, an exacerbation begins to occur.

Answers Lukashevich Ilona Viktorovna:

Dear Anton, the minimum therapeutic dose of salofalk is 4 g/day and should be taken during the first exacerbation for 3 to 6 months. If symptoms of exacerbation appear, the maintenance dose, under the supervision of a doctor, is increased to the minimum therapeutic dose and you need to have a colonoscopy, determine the intensity of inflammation and prevalence, and only then adjust the dose, up to increasing it to the maximum therapeutic dose. Moreover, it is better to be observed by the same doctor, who knows how the disease develops, constantly looks at your rectum, knows the peculiarities of the course of the disease and adjusts your prescriptions accordingly. Accompanying medications are also prescribed by your doctor, usually these are long-term enzymes, B vitamins, Linex or Bifacil.

2011-10-09 16:15:59

Taras Bugaenko asks:

Hello. I am 22 years old. On the eve of my birthday, as soon as I got up, I went straight to the toilet. I suffered from diarrhea for half a day - I decided to take lapiridol for the disorder. At the end of the day, blood and mucus appeared... the next day everything was the same, and I also continued to eat as usual... on Monday I went to the doctor - irrigoscopy, colonoscopy - everything confirmed UC. Treatment with salofalk 500 (3 g per day) and budenofalk (9 mg per day), salofalk enemas for two weeks and 10 droppers with rheosorbilact and KCl, then they also attributed riboxin from which there was a reaction + then it turned out there was also a reaction to potassium chloride. As a result, Riboxin was replaced with vitamin C + all this time they injected Neurobion every other day + another month in tablets) so they prescribed Sembiter 20 packs for 10 days and another 20 packs for 20 days, and enemas with chamomile and trichopolum for a month. Upon discharge, the diagnosis was AE proctosigmoiditis.

During treatment, the diarrhea stopped immediately, and even after 6 enemas I didn’t go to the toilet for 3 days, and there was no blood either. 18 days in the hospital - everything is fine. But literally a week and a half after discharge I noticed a little blood in my stool. At first I didn’t pay attention, I thought it would go away - after a few days it happened again and then more and more often and after a week it was with every stool. But the stool is normal and once a day. Sometimes once every two days. Around the time it started, I caught a cold and my runny nose still doesn’t go away - could this influence the fact that I can’t achieve remission. I followed diet 4c, while 4b worsened, now the condition has worsened - more blood and mucus have appeared, I returned to diet 4a and for the time being refused sex, exercise and going out in the cold - it has become better, but there is still blood. The attending physician says continue on a maintenance dose of 2g Salofalk and 6 mg Budenofalk + enemas with trichopolum and chamomile.
Briefly about me - I’m 22 years old, I don’t smoke, I don’t drink (the last time I drank homemade wine on New Year’s Eve), I’m a hip-hop choreographer, and in general I lead a fairly active lifestyle, although in the last year, in my opinion, I’ve not been so active. I was very, very worried this summer. The main question is how much does my runny nose affect the course of the disease. Thanks a lot.

Answers Lukashevich Ilona Viktorovna:

Dear Taras! UC is a chronic relapsing disease of the colon, which is characterized by exacerbations and remissions. Any external and internal factors can influence the course of the disease, regardless of your wishes. Viral infections also have their impact. With common colds and poisoning, stress, UC can worsen. You have no control over most of these factors. To monitor your disease, you must be constantly monitored by a proctologist and if clinical symptoms change (increased frequency of stools, the appearance of blood in the stool, changes in general condition), perform a control sigmoidoscopy. This way you can assess the condition of the mucous membrane and adjust the treatment.

In the presence of neurotic reactions, patients with nonspecific ulcerative colitis are prescribed sedatives(bromides, valerian root) and tranquilizers. In cases of anxiety and depression, use meprotan (andaxin, meprobamate) 200 mg 3 times a day or trioxazine 300 mg 2-4 times a day. Instead, chlordiazepoxide (Elenium) is sometimes used, 5 mg per dose. Seduxen, Valium, and apaurin (2-5 mg 2-3 times a day) also have a sedative and hypnogenic effect. If patients have severe anxiety, fear, as well as nausea and vomiting, small doses can be used antipsychotics- phenothiazine derivatives (for example, aminazine).

Used in the treatment of diarrhea antidiarrheals. Reacek (Lomotil), which is a combination of a codeine derivative - diphenoxylate hydrochloride with atropine sulfate, is effective. The drug is prescribed 1 - 2 tablets 3 times a day for 2 - 4 weeks. Codeine phosphate tablets (15-30 mg 3 times a day), which are best taken in combination with bismuth and tanalbin, have good antidiarrheal properties. In order to normalize intestinal function, it is necessary to prescribe antispasmodics(no-spa, platifillin, cerucal, etc.), however, these drugs must be used with caution, because they can contribute to the occurrence of acute toxic dilatation of the colon.

Patients with nonspecific ulcerative colitis need an increased amount vitamins not only to replenish the deficiency in the body, but also to accelerate detoxification, to have a positive effect on other aspects of the pathological process, including the synthesis of steroid hormones, which is disrupted when the intestines are damaged. The use of B vitamins is especially important. In this case, patients are often prescribed thiamine 10 - 20 mg per day orally and a 0.05% solution of vitamin B12 is administered 1 ml intramuscularly. For intestinal bleeding, vitamin K is indicated, even if the level of prothrombin in the blood is not reduced. Treatment with vitamins is recommended in 2-week courses with an interval of 1 - 2 months. For anemia they should be combined with iron supplements. A decrease in body weight by more than 15% from the original or normal requires intravenous infusions mixtures of amino acids (alvesin, m-riamine, polyamine, etc.), which contain essential amino acids, protein hydrolysates. In the absence of hyperlipidemia, fat emulsions (intralipid, lipofundin, lipophysian, etc.) with concentrated glucose solutions, which have a beneficial and rapid effect on the nitrogen balance, can be parenterally administered as an energy material. In the absence of intravenous nutrition, acute loss of 30% of initial body weight leads to death in 100% of cases. Infusion therapy is carried out over several days or weeks, depending on the patient’s condition and laboratory biochemical tests. Blood transfusions indicated to combat anemia and as a hemostatic agent. Transfusions of canned blood are performed in 250.0 ml doses at intervals of 3-4 days. In addition to blood transfusions, ascorbic acid, cobalt preparations, and folic acid are used orally to combat anemia.

Recommended use enzyme preparations that do not contain bile acids (pancreatin, trienzyme, mezim-forte, etc.). For the treatment of intestinal dysbiosis, they are used eubiotics- bifidumbacterin, bifacol (5 doses 2 times a day 30 minutes before meals), for 1.5 - 2 months.

For the treatment of nonspecific ulcerative colitis, which occurs in the form of proctitis, it is used in addition to microenemas and suppositories with 5-ASA preparations microenemas from a solution of phthalazole (5 - 10 tablets per 30 - 50 ml of boiled water are administered in the morning and evening). Microenemas made from a 0.3% solution of collargol, which has astringent and bactericidal properties, are widely used. 60 - 100 ml of the drug is injected into the rectum immediately after stool and the patient must hold it for at least half an hour. Collargol microclysters are especially indicated during the period of subsidence of acute phenomena. The course of treatment is usually 2 weeks. Treatment with microenemas made from refined sunflower oil, Shostakovsky balsam, rosehip seed oil, and sea buckthorn oil is successfully carried out. All these drugs are prescribed after the elimination of an acute process in the intestines (30 ml each).

Repeated courses are effective, especially in the early stages of the disease. hyperbaric oxygen therapy every 10-14 months for 6-8 sessions (in the remission phase, during exacerbation - more) at a working oxygen pressure of 1.5-1.7 atm. In nonspecific ulcerative colitis of mild to moderate severity and a relapsing course of the process after the third course of HBOT, the observed remission averages 3.5 years. In moderate and severe forms of ulcerative colitis with a chronic continuous course of the process and total damage to the colon during the first three years of receiving HBOT, colonoscopy reveals a gradual decrease in signs of inflammation in the proximal parts of the colon and long-term persistence of erosive and ulcerative changes in the distal parts, especially in the rectum gut. After the third course of HBOT, the bottom of the ulcer is morphologically cleared of necrotic masses and the appearance of granulation tissue. After the sixth course, epithalization of the bottom of the ulcers and the formation of crypts were already detected, i.e., the picture of atrophic colitis (remission of the disease) was determined. In most cases, improvement in condition and well-being is not felt by patients immediately, but after 2 or even 3 weeks. after completing the HBOT course. In 70% of cases, HBOT allows one to stop taking glucocorticoids. Hyperbaric oxygen therapy should be used after relief of the severity of the disease in combination with medications and then repeated annually until complete morphological restoration of the colon mucosa.

In the development and course of the disease, mental disorders should be given importance. Emotional disorders are a consequence of illness. Long-term symptoms of intestinal damage contribute to the development of secondary neurotic layers. A fairly common feature can be considered a state of anxiety in patients. Sometimes they are so sensitive that even minor failures can cause worsening symptoms or relapse of the disease. In such cases, the most favorable effect is achieved by consistent psychotherapy, that is, a complex of psychological influences that strengthen the patient’s strength in the fight against the disease. Creating therapeutic optimism and eliminating mental trauma are important.

Proper nutrition for UC is one of the keys to a good, rich life with all its advantages.

What do we know about proper nutrition as such? Food should be varied, rich in vitamins and minerals; You need to drink at least 1.5 liters of clean water per day. But in the case of patients with ulcerative colitis, there are some nuances. This is what we will talk about today.

For patients with ulcerative colitis, it is extremely important to saturate their body with various beneficial substances. It doesn't matter whether you get them through food or capsule form. Patients with IBD are characterized by a decrease in the secretory activity of all digestive glands. Therefore, for normal hematopoiesis and maintaining normal blood composition, the body must receive proteins, vitamins and microelements.

Which foods contain the most beneficial nutrients? In fresh fruits and vegetables, dairy products, meat and various grains (buckwheat, rice, lentils, millet are favorites).

Let's talk about the quality composition of food, i.e. about proteins, fats and carbohydrates.

Proteins fats carbohydrates

Squirrels consist of amino acids. The body needs them to build cells of all organs. The protein content in food should be sufficient, but not excessive, because... in the case of UC, it is extremely undesirable to once again overstrain the gastrointestinal tract (the body requires fiber contained in fruits and vegetables to digest protein). Since the body cannot itself synthesize proteins from other substances, they must constantly come to us from the outside.

Squirrels are found in both plant and animal foods (meat, milk, cottage cheese, fish, eggs, nuts and legumes), but priority should be given to animal proteins due to their more complete amino acid composition. As I wrote in one of the past, protein (or rather, the amino acids in its composition) is extremely important for people with UC.

Carbohydrates and fats- This is the source of energy that our brain, heart and other organs consume. Due to their not so complex structure, the body itself can create carbohydrates from proteins and fats, fats from carbohydrates, but their consumption should also be sufficient. This is why excessive consumption of carbohydrates with insufficient physical activity leads to obesity.

Carbohydrates found in plant products (cereals, bread, vegetables, sugar), and fats are of both plant and animal origin. Fats are found in large quantities in butter, eggs, chocolate, nuts, pork and fatty fish; help break down and absorb fat-soluble vitamins A, D. E. For patients with UC, it is recommended to focus on Omega-3 fatty acids, i.e. eat a lot of fatty sea fish and add olive oil to your food. Oleic acid found in the above foods has been shown to help heal ulcers in the colon.

And perhaps the most important element of our nutrition is water. Every cell in our body consists of 80–90% of it, which is no coincidence. Few people know how to drink water.

Clean water should be consumed 15-20 minutes before meals and at least two hours after meals.. This scheme is very simply explained: clean water on an empty stomach begins to deliver useful microelements to every cell of our body in the shortest possible time. If you drink water immediately after a meal or, even worse, wash it down with food, your stomach will have to produce an additional amount of gastric juice, because. the existing one will be diluted with water supplied from outside.

Vitamins

It's time to talk in more detail about what we need:

• Vitamin A. Contained in foods rich in animal fats (eggs, liver, fish). Plant foods contain carotene (carrots, tomatoes, onions, peas). To “transform” it into vitamin A, such products must be consumed together with fats (olive/linseed oil, for example).
• B vitamins. Contained in cereals, eggs, cabbage, apples, black bread. Increase cellular metabolism.
• Vitamin C. Contained only in plants (rose hips, currants, onions, tomatoes, citrus fruits). The high liquid content in these plants allows it to be well absorbed by the body. As you know, vitamin C is very useful during colds.
• Vitamin D. Contained in liver, eggs, fish. Necessary for normal bone formation (remember the side effects from).
• Vitamin H. Contained in fruits and berries; is water soluble. Promotes tissue growth in the body, i.e., in our case, healing of wounds in the large intestine.
• Vitamin E. Contained in wheat germ, eggs and vegetable oils. Promotes enhanced healing and rapid tissue restoration.
• Vitamin K Contained in parsley, lettuce, cabbage. Strengthens the walls of blood vessels and stimulates the healing of damaged tissues. If intestinal diseases threaten ulcer formation (just like in ulcerative colitis), then this vitamin should be consumed in increased quantities.
• Vitamin F. Contained in vegetable oils. Restores fat metabolism and oxidation processes in cells. This is important for UC, since all types of metabolism are often disrupted in this disease.

There are quite a lot of different diets recommended for UC at its different stages. The main recommendation is to prevent irritation of the walls of the large intestine. From this it follows that food in UC should pass without difficulty throughout the gastrointestinal tract. Light soups with water, ground meat, overcooked rice/buckwheat, fish soufflé, white bread crackers - these are your friends on the path to remission. In no case should you forget about vegetables, because... they contain what is necessary for proper digestion of food. There is a problem with this point: fresh vegetables are in most cases contraindicated in severe UC, because enhance already reactive peristalsis.

As your condition stabilizes, be sure to gradually add new foods to your diet. This could be baked apples, stewed zucchini, offal, bananas, for example. Listen carefully to your body's reaction! You should definitely get the required amount of nutrients regularly.

Contrary to the established opinion that with UC you need to eat 5-6 times a day in small portions, I am a fan of large meals 3-4 times a day. Man is not created to digest foods every minute.

Nonspecific ulcerative colitis and Crohn's disease, especially during an exacerbation, lead to the fact that nutrients from incoming food cannot be fully absorbed.

What is the result of a deficiency of vitamins and microelements? As a rule, hypo- and avitaminosis lead to functional disorders of body systems of varying severity and, as a result, the appearance of symptoms of various diseases, often incurable. And if you also remember about the immune nature of IBD, you feel completely uneasy.

Hypovitaminosis and vitamin deficiency

I offer a little theory. Hypovitaminosis– a condition of the body in which it receives any provitamins and vitamins in an amount insufficient for its normal functioning. Avitaminosis- this is the complete absence of a specific vitamin or group of vitamins in the body.

For patients with UC and CD, the main reasons for the lack of vitamins and microelements may be:

• Unbalanced diet. If any product is omitted or limited in consumption, then the corresponding beneficial substances will not enter the body in sufficient quantities. Most food products are sources of not one, but several vitamins, which means the lack of them will affect different systems and organs.
• Long-term painful condition. The body will squeeze all the juice out of its reserves in the name of creating “patches” for holes in its health. This means that the vast majority of incoming nutrients will go towards attempts at recovery, while neglecting other organs.
• Disturbances in the gastrointestinal tract. Exacerbation of IBD leads to difficulty digesting and absorbing nutrients from food.
• Prolonged and severe stress. I have already written more than once that a negative impact on our spiritual balance can disrupt the metabolic functions occurring in various organs, which will ultimately lead to disruptions in biochemical processes.

Consequences of vitamin deficiency

So, what can a deficiency of one or another vitamin lead to? I will give the most “strong” examples.

• Vitamin A. Eye diseases (hemeralopia, xerophthalmia); deterioration of the condition of teeth, hair and nails; excessively dry and flaky skin (we recall the various ones that patients with UC and CD so often complain about, as well as side effects from).
• Vitamin C. Bleeding gums, tooth loss, fragility of vessel walls, anemia, hemorrhagic rash.
• Vitamin B1. Polyneuritis; damage to nerve fibers (including dysfunction of the nervous system) and the cardiovascular system; paresis of muscle tissue. Severe weight loss occurs.
• Vitamin B2. Diseases of the mucous membranes (including microcracks in the rectum), flatulence, cramps in the intestines; diarrhea and
• VitaminB9 (folic acid). Anemia, poor appetite, tendency to intestinal disorders.
• Vitamin B12. Damage to hematopoietic tissues, gradual destruction of the spinal cord and nervous system, anemia and memory impairment.
• VitaminB7. Dermatitis, anemia, disorders of the nervous system, etc.
• VitaminD. Bone tissue will stop forming, which will lead to pain in the bones and joints and skeletal deformation; teeth will begin to decay.
• VitaminPP. General weakness, difficulty concentrating, increased nervousness, diarrhea, various dermatitis, muscle paralysis, neuritis, cardiac dysfunction.

It will help to identify the missing vitamin in your body. blood test to determine the concentration of this vitamin. You can only take synthetic vitamins under the supervision of your doctor!

When carrying out vitamin therapy, do not forget about the dangers hypervitaminosis, as well as the compatibility of vitamins with each other and with medications.

We have come to the topic of our article. The most “popular” extraintestinal manifestations of nonspecific ulcerative colitis and Crohn’s disease:

• and hair loss, which is associated with a deficiency of vitamins A, vitamins B, PP and the presence of increased concentrations in the blood.
• Damage to the oral cavity. They are associated with the appearance aft(small ulcers on the mucous membranes of the mouth). Goes away during remission.
• Eye damage associated with vitamin A deficiency.
• Damage to joints and bones. Most often they manifest themselves in the form of arthritis and osteoporosis. The reason is a lack of vitamin D and calcium (let me remind you that calcium is “washed out” from the bones during the course).
• Damage to the respiratory system. Due to the fact that with UC the walls of the large intestine become too permeable, there is a high risk of manifestations in the form of asthma.
• Damage to the pancreas, liver and bile ducts. The reason, as a rule, is our favorite synthetic hormones.

How to deal with such unpleasant extraintestinal manifestations of IBD?

1. Review yours. Try to include as many different foods as possible that won't harm you.
2. Donate blood to determine the level of a particular vitamin, a deficiency or surplus of which could provoke additional disruption in the functioning of your body.
3. If you are taking Prednisolone, Metypred or other glucocorticoids, focus your meals on

In the tenth edition of the International Classification of Diseases, this disease is designated as ulcerative colitis (nonspecific), code K51 - “necrotizing inflammation of the mucous membrane of the colon and rectum, characterized by exacerbations.”

Peak age of onset is in the second and third decades of life, but the disease occurs in both infants and the elderly. Nonspecific ulcerative colitis (UC), characterized by a progressive course and causing a number of complications, is therefore a big social problem, as it disrupts the child’s lifestyle and leads to early disability. All this indicates the severity of the disease.

Despite the commonality of many therapeutic approaches, the peculiarities of the physiological development of the child and differences in the clinical course of UC in children and adults, as well as insufficient experience in the use of modern drugs in pediatric practice, determine the difference in approaches to the treatment of children and adults.

• diet therapy;
• antibacterial agents;
• immunomodulators;

Treatment of UC in children should be comprehensive, always with careful adherence to the daily regimen and nutrition. An important condition for treating children in a hospital is to create for them an atmosphere of physical and mental peace. If your condition and well-being are satisfactory, only restriction of outdoor games is indicated. Quiet walks in the fresh air are necessary. If there is a significant disturbance in the general condition, fever, exhaustion, metabolic changes, etc., bed rest should be done.

Nutrition

For UC, a mechanically and chemically gentle diet with a high content of protein and vitamins is prescribed, milk is excluded, and the amount of fiber is limited. Sometimes even the slightest violation of the diet in children can lead to a worsening of the condition. Strict adherence to the diet is especially important in the presence of secondary malabsorption syndrome.

In the acute stage, fruits and vegetables are excluded. Pomegranate juice is allowed, and pomegranate peels are dried and used in decoctions as an astringent. Decoctions and jelly from dry blueberries, bird cherry, chokeberry juice, and black currant are widely used.

In addition, the so-called “astronaut food” is recommended, consisting of highly refined products that require almost no additional enzymatic breakdown. For this purpose, an elemental diet is used (isocal, cosylate, enshur, nutrichim, renutril, etc.). These drugs are also used for enteral tube feeding. This diet is especially indicated for patients with intestinal fistulas or obstructions, as well as for children who are stunted.

Most children with UC have severe protein deficiency due to protein loss, malabsorption, anorexia and vitamin deficiency, which leads to body weight deficiency. Therefore, in any form and phase of the disease, food should be as high in calories as possible, mainly from protein.

It is very important to exclude additional sensitization of patients with food allergens, therefore a hypoallergenic (elimination) diet is recommended: extractive substances, eggs, chocolate, cocoa, coffee, citrus fruits, strawberries, wild strawberries, red apples, baked goods, industrial canned products are prohibited, individual intolerance should also be taken into account food products.

Because cross-allergy is possible (children with a cow's milk allergy may have an allergic reaction to beef), it is often recommended to exclude beef from the diet.

The diet for UC is less strict only if remission is achieved.

Parenteral nutrition is prescribed for children with severe UC. For this purpose, infusion solutions such as alvesin, aminosol, aminopeptide, vamine, casein hydrolyzate, combined with glucose and polyionic solutions are used.

Preparations of 5-aminosalicylic acid (5-ASA)

The basis of basic therapy for UC is 5-aminosalicylic acid (5-ASA) preparations, or salicylates.

For many years, sulfasalazine, the active component of which is 5-ASA, has remained the preferred drug for the treatment of ulcerative colitis.

5-ASA inhibits the activity of neutrophil lipoxygenase and the synthesis of arachidonic acid metabolites (prostaglandins and leukotrienes), which become mediators of inflammation. It inhibits the migration, degranulation and phagocytosis of neutrophils, as well as the secretion of immunoglobulins by lymphocytes, inhibits the production of free oxygen radicals and is their inactivator. 5-ASA also acts on the surface receptors of epithelial cells, electrolyte transport and permeability of the intestinal epithelium. In addition, 5-ASA affects adhesion molecules, chemotactic peptides and inflammatory mediators (eikanoids), platelet-activating factor, and cytokines.

In addition to 5-ASA, sulfasalazine contains sulfapyridine, an inert substance that ensures the delivery of 5-ASA to the colon, which is the direct cause of frequently occurring side effects. Treatment with sulfasalazine in 10-30% of cases is accompanied by the development of side effects: gastrointestinal manifestations (anorexia, nausea, vomiting, pain in the epigastric region); general symptoms (headache, fever, weakness, arthralgia); hematological disorders (agranulocytosis, pancytopenia, anemia, hemorrhagic syndrome); signs of damage to the reproductive sphere, etc.

Sulfasalazine blocks the conjugation of folic acid in the brush border of the jejunum, inhibits the transport of this vitamin, and inhibits the activity of the enzymatic systems associated with it in the liver, therefore, it is necessary to include folic acid in an age-specific dosage in the complex of therapeutic measures carried out in patients with ulcerative colitis receiving treatment with sulfasalazine.

Sulfasalazine is prescribed 3 times a day after meals: children under 5 years old - 1-3 g per day, from 6 to 10 years old - 2-4 g, over 10 years old - up to 5 g, depending on the severity of the disease. When the condition stabilizes, the dose is gradually reduced - initially by 1/3, after 2 weeks in the absence of deterioration - by another 1/3. The minimum dose at which the patient’s condition stabilizes is determined; if deterioration occurs, return to the previous dose.

The incidence of complications with sulfasalazine has led to the development of new drugs that do not contain sulfapyridine, such as mesalazine. To ensure that drugs enter the colon unchanged, they are covered with special coatings. There are three types of such drugs. The first are 5-ASA coated with acrylic gum (claverzal, salofalk, asakol, rovaza), so such drugs are broken down only at pH = 6-7, characteristic of the large intestine. The drug Pentasa (5-ASA, encapsulated in ethylcellulose) begins to act already at pH>4.5 in the small intestine. Pentasa is prescribed at a rate of 20-30 mg/kg per day.

The second type of drugs is azo compounds of two 5-ASA molecules, which are broken down in the colon by the bacterial enzyme azoreductase (olsalazine). The third type is the non-absorbable polymer 5-ASA (balsalazide).

A number of 5-ASA preparations are available not only in the form of tablets, but also in the form of enemas and suppositories, for example, ready-made Pentasa and Salofalk suppositories, foam for microenemas, which are used rectally for distal lesions of the colon. Suppositories with sulfasalazine (sulfasalazine and cocoa butter) and microenemas with sulfasalazine (sulfasalazine tablets and distilled water), etc. are also prepared.

Salofalk tablets contain 250 mg or 500 mg of mesalazine and are prescribed in a dose of 500-1500 mg/day (30-50 mg/kg). In addition, the drug is used in the form of suppositories (250 mg, 500 mg) 1-2 times a day, in the form of enemas (2 g/30 ml and 4 g/60 ml) 1-2 times a day.

Mesacol (tablet contains 400 mg of 5-ASA) is prescribed in a dose of 400-1200 mg/day, depending on the child’s body weight and the severity of UC.

When using 5-ASA drugs, in some cases a dose-dependent effect is observed, which forces the drug dose to be increased to achieve remission. Maintenance therapy (half the prescribed therapeutic dose) is carried out over a long period of time, which allows for stable remission and reduces the risk of colon malignancy. When carrying out maintenance therapy from 6 months to a year, every 2 weeks the dose is reduced to 1/4 tablet and increased to 1/2-1/4 tablet (general blood and urine analysis - once every 2 weeks).

With long-term use of sulfasalazine (maintenance therapy), the side effects of the drug are taken into account, primarily hepatotoxicity.

In spring and autumn, anti-relapse courses are carried out with 5-ASA drugs (0.25-0.5-1 g once a day, depending on age).

Hormone therapy

Glucocorticoids (GC) occupy a leading place in the treatment of severe forms of UC. This is due, firstly, to the fact that 5-ASA drugs are not always effective in treating this disease. Secondly, the use of GCs gives a relatively quick positive effect, which is associated with their anti-inflammatory and immunosuppressive properties.

Indications for hormone therapy: acute course of the disease; severe forms; moderate forms (if a 2-week course of treatment with aminosalicylates was ineffective); chronic forms that are difficult to treat with other methods; systemic (extraintestinal) manifestations (polyarthritis, uveitis, hepatitis, high fever); intolerance to aminosalicylates.

For UC, GCs are used: locally (rectal administration); systemically - low doses, high doses, alternating therapy, pulse therapy, combination therapy (with 5-ASA, cytostatics).

Typically, the dose of GC (prednisolone, methylprednisolone) varies from 1 to 2 mg/kg. First, the daily dose of the drug is divided into three doses, then switched to a single dose in the morning.

If prednisolone is well tolerated, therapy at the prescribed dose is recommended until the desired result is achieved (within 3-4 weeks), after which the dose is reduced according to a stepwise scheme - by 10 mg every 5-7 days. Starting from 1/2 the initial dose, a single dose of prednisolone in the morning is recommended, which practically does not cause serious complications. The dose of prednisolone is reduced to 1/3 of the initial dose gradually, 5 mg every 7-10 days for 2-2.5 months. The full course of hormonal therapy takes from 10 to 20 weeks, depending on the form of UC.

If a long course is required, it is possible to switch to an alternating regimen of GC therapy, which consists of prescribing short-acting GCs without pronounced mineralocorticoid activity once, in the morning (about 8 hours) every 48 hours (every other day). The goal of alternating (decade) therapy is to reduce the severity of side effects of GCs while maintaining therapeutic effectiveness.

In severe forms of UC, “hormone dependence” is observed, when hormone withdrawal leads to an exacerbation of the disease. In such cases, an alternating regimen of GC therapy is prescribed for a long time, for 3-6-8 months.

Sometimes, in severe forms of UC, pulse therapy is used, which involves intravenous administration of large doses of GC once a day for three days (methylprednisolone is often the drug of choice).

In addition to prednisolone, metypred is used, which is devoid of unwanted mineralocorticoid activity. The dose ratio of prednisolone-metipred is 5:4.

When the dose of prednisolone is reduced by half, sulfasalazine or 5-ASA is prescribed in a minimum dose (1/3 of the therapeutic dose). Next, the dose of 5-ASA is increased and, with complete withdrawal of hormones, it is brought to the maximum (therapeutic dose), selected depending on age (1-2 g per day). When remission is achieved, the dose of 5-ASA can be reduced to maintenance (1/2 therapeutic dose).

For distal lesions of the colon, prednisolone is prescribed in the form of microenemas and suppositories (microenemas are made from prednisolone tablets and distilled water, suppositories are made from prednisolone tablets and cocoa butter). “Drip” microenemas with hydrocortisone (hydrocortisone and distilled water) are successfully used, the doses of which depend on the child’s body weight and the severity of the disease.

The use of corticosteroids is associated with the development of a number of complications (immunosuppression, osteoporosis, hyperglycemia, Cushing's syndrome, growth retardation, peptic ulcers, hypertension, etc.). In addition, refractory forms of inflammatory bowel diseases are becoming increasingly common, treatment of which with glucocorticoids does not give the expected effect.

In recent years, “local” hormones (enterocort, budenofalk, budesonide) have been developed and are widely used in clinical practice (especially in hormone-resistant forms). They are distinguished by high affinity for hormonal receptors and first-pass metabolism. As a result, side effects are minimized.

Budesonide is a local, potent, non-halogen glucocorticoid with anti-inflammatory, anti-allergic, anti-exudative and decongestant properties. The advantage of the drug is that it has a local effect and, due to poor absorption and rapid metabolization, does not have systemic effects. High affinity for hormonal receptors in the mucous membrane of the colon enhances the local therapeutic effect of budesonide (budenofalk). Due to its chemical composition, budesonide is highly lipophilic, it is able to perfectly penetrate cell membranes and distribute into tissues, quickly undergoing hepatic and extrahepatic metabolism. A gradual dose reduction is not required, since withdrawal syndrome does not occur.

Antibacterial agents

Antibiotics for UC are used only according to indications: after surgical treatment, in febrile patients with septic complications, with toxic dilatation of the colon. Trichopolum (metronidazole) is often used in long courses at a dose of 10-20 mg/kg per day. Antibiotics, if necessary, are prescribed cephalosporins.

Immunosuppressants

Immunosuppressants (cytostatics) are prescribed to children very rarely due to the large number of side effects. The question of their use arises only in the case of ineffectiveness of corticosteroids and with a continuous course of the disease. For UC, especially when it comes to hormone-resistant forms, immunosuppressants are prescribed 6-mercaptopurine, azathioprine, methotrexate, cyclosporine, etc.

Azathioprine is close in its chemical structure and biological action to mercaptopurine, has cytostatic activity and has an immunosuppressive effect. However, compared to mercaptopurine, the immunosuppressive effect of the drug is relatively stronger with slightly less cytostatic activity.

Azathioprine is prescribed at a dose of 100 mg per day for 9-12 months, beginning to act by the 3rd month.

Methotrexate is a metabolite and antagonist of folic acid. It interferes with the synthesis of purine nucleotides, disrupts the synthesis of DNA and RNA, inhibits cell division and growth, causing their death. For UC, the drug is used intramuscularly at a dose of 25 mg once a week for 12 weeks.

Cyclosporine has a selective effect on T-lymphocytes, inhibits the reactions of cellular and humoral immunity and is currently considered as a reserve method when other treatments are ineffective.

Immunomodulators

The mechanism of action of immunomodulatory drugs in UC is associated with the suppression of the activity of natural killer cells and the function of cytotoxic T-lymphocytes.

It has been proven that the use of immunomodulators thymalin and tactivin in the complex treatment of patients with UC helps to correct the state of immunological imbalance, in particular eliminates the deficiency of the T-link of immunity, normalizes helper-suppressor ratios and the index of immune regulation, which leads to the elimination of the inflammatory process, as it relieves autosensitization and increases the body's defenses.

It is known that inflammatory bowel diseases are characterized by excessive production of anti-inflammatory cytokines. Recently, reports have begun to appear about the use of biotechnological drugs that can suppress inflammation. Particular attention is paid to two molecules: interleukin-1 and tumor necrosis factor (TNF-a), since at the present stage they are the main targets of anti-inflammatory therapy for various diseases. In 2001, a new generation drug infliximab (Remicade), which is a monoclonal antibody to tumor necrosis factor, was registered in our country. Remicade has increased anti-inflammatory activity.

Symptomatic (“accompanying”) therapy

As additional therapy aimed at normalizing digestive processes and increasing the body's immunoreactivity, angioprotectors, enterosorbents, intestinal antiseptics, antidiarrheal drugs, enzymes, biological products, vitamins, minerals, sedatives, and herbs are prescribed.

Of the angioprotectors, parmidine (0.125-0.25 mg 3 times a day) and trental (0.05-0.15 mg 3 times a day) are used to improve microcirculation.

Often there is a need to prescribe enterosorbents (polyphepane, carbolene), the most promising of which are considered to be enterosgel, algisorb, SUMS, vaulin.

Intestinal antiseptics from the quinoline series (intestopan, intetrix, enterosediv) and nitrofuran series (furazolidone, ercefuril), etc. are successfully used in children.

For persistent diarrhea, coatings and astringents (almalox) are prescribed, which, however, should be used very carefully. For the same purpose, atropine-containing antidiarrheal drugs (reasec-lomotil, which contains codeine and atropine; the drug has not only antidiarrheal but also antispasmodic effects), lispafen (atropine sulfate and diphenoxin hydrochloride) are sometimes prescribed. In recent years, imodium has become more popular (it has an opioid effect). Long-term use of this drug for ulcerative colitis is fraught with toxic dilatation of the colon.

Sandostatin should be recognized as a new and promising drug, which affects the absorption of water and electrolytes in the small intestine, reduces the concentration of vasoactive peptides in the blood, reduces the frequency of bowel movements and fecal weight.

Among enzyme preparations for UC, Mezim Forte, Creon, Lycrease, and Pancreatin are used.

Today, the most promising is the use of the drug Creon 10,000. It meets all the requirements for modern enzyme preparations: Creon 10,000 is characterized by an optimal qualitative composition of enzymes in physiological proportions, is resistant to acid, the size of the mini-microspheres of the drug ensures its uniform mixing with food and simultaneous chyme passage through the pylorus. Upon entering the stomach, the capsule containing minimicrofers dissolves within 1-2 minutes. More than 90% of enzyme activity is achieved after 45 minutes at a pH of more than 5.5. Creon 10000 is a safe drug and can be used in all groups of patients, regardless of gender and age.

Since in UC the colon mucosa provides favorable conditions for the development of dysbiosis, there is often a need to prescribe biological products. When the normal flora decreases, bifidumbacterin, lactobacterin, and bificol are prescribed. Metronidazole affects the anaerobic flora (clostridia, bacteroides), while drugs of the nitrofuran series are effective for Proteus dysbiosis.

You can prescribe enemas with preparations of sodium salts of propionic and butyric acids, as well as pantothenic acid (a coenzyme precursor) to regulate the metabolism of colon epithelial cells and ensure the normalization of colonocyte metabolism.

All patients should receive a complex of vitamins - potassium, calcium, a complex of microelements, and for iron deficiency anemia - iron supplements.

For UC, bromine, valerian root, rudotel, glycine, novopassit, etc. have a calming effect on the central nervous system.

Herbal medicine (chamomile, St. John's wort, burnet, kolgan, etc.) is one of the components of the complex treatment of UC in children.

For UC, astringents are also used: common oak (bark), St. John's wort (herb), gray alder (cones), bird cherry, common blueberry (fruits), common quince (fruits, seeds), common pomegranate (skin), burnet (burnet). roots); hemostatic: kolgan, burnet, pepper knotweed (herb), stinging nettle (leaves), alder, horsetail (herb), etc.

Above is a treatment plan for UC depending on the severity of the disease.

The problem of surgical treatment of ulcerative colitis has not yet been resolved. There are very conflicting opinions regarding palliative and radical operations, as well as the timing and scope of reconstructive operations.

An operation (colectomy) is performed for emergency indications (intestinal perforation or its threat, massive bleeding), as well as when carcinoma develops in the affected intestine. Often, the indication for surgical intervention is a long, debilitating course of colitis, especially growth retardation, which developed against the background of unsuccessful intensive drug therapy.

The most common surgical treatment for UC is subtotal resection of the colon with ileosigmostomy. After 10-12 months, when the condition has stabilized, reconstructive operations are performed - anastomosis between the ileum and the rectum or sigmoid colon, as well as the formation of a small intestinal reservoir.

Literature

1. Zlatkina A. R. Treatment of chronic diseases of the digestive system. M., 1994. pp. 163-217.
2. Kanshina O. A. Experience in the treatment of nonspecific ulcerative colitis in children and adolescents // Pediatrics. 1992. No. 1. P. 78-82.
3. Levitan M. Kh., Fedorov V. D., Kapuller L. L. Nonspecific colitis. M., 1980. S. 201-205.
4. Loginov A. S., Parfenov A. I. Intestinal diseases. M., 2000. P. 32.
5. Nosonov E. L. General characteristics and mechanisms of action of glucocorticoids // Breast Cancer. 1999. No. 8. T. 7. P. 364-371.
6. Paykov V. L. Pharmacotherapy in pediatric gastroenterology. St. Petersburg, 1998. pp. 188-189.
7. Ryss V.S., Fishzon-Ryss Yu.I. Some features of the clinical picture and treatment of nonspecific ulcerative colitis and Crohn's disease // Ter. archive. 1990. No. 2. P. 25-32.
8. Frolkis A.V. Modern pharmacotherapy in gastroenterology. St. Petersburg, 2000. pp. 56-57, 62.
9. Eaden J. A., Abrams K., Mayberry J. F. The true risk of colorectal cancer in ulcerative colitis: a meta-analysis // Castroenterology. 1999. Vol. 116. P. A398.
10. Evans R. S., Clarce I., Heath P. et al. Treatment of ulcerative colitis wits an engineered human anti-TNF-a antibody CD P571//Aliment Pharmacol Ther. 1997. P. 1031-1035.
11. Hanacur S. B. Inflammatory bowel disease // N. Engl. J. Med. 1996. Vol. 334. P. 841-848.
12. Kirschner B. S. Safety of Azathioprine and 6-Mercaptopurine Pediatric patients with inflammatory bowel disease // Gastroenterology. 1998. Vol. 115. P. 813-821.
13. Prantera C., Scribano M. L., Berto E. Antibiotic use of Crohn's disease: Why and how? Bio Drugs, 1997. Vol. 8. P. 293-306.
14. Reimund J. M., Duclos B., Baumann R. Cyclosporin treatment for severe ulcerative colitis Seven cases // Ann Med Int. 1997. Vol. 148. P. 527-529.
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16. Worcester S. Biologic Agent Promising for Children with Crohn's disease // Pediatric News. 1999. Vol. 33. P. 8.

Note!

Conservative treatment of UC in children is based on the following principles:

• diet therapy;
• basic therapy with 5-aminosalicylic acid and/or glucocorticoids (systemic and local action);
• antibacterial agents;
• cytostatics (immunosuppressants);
• immunomodulators;
• symptomatic (“accompanying”) therapy.