Intestinal inflammation: causes and methods of treatment

Intestinal inflammation: causes and methods of treatment

I. Understanding of inflammatory diseases of the intestine (BCC)

Inflammatory diseases of the intestine (BCC) are a group of chronic diseases characterized by inflammation of the gastrointestinal tract (gastrointestinal tract). The most common forms of OZK are Crohn’s disease and ulcerative colitis. It is important to understand that ZAK is not the same as the syndrome of irritable intestines (SRK), which is a functional disorder, and not an inflammatory disease.

II. Crohn’s disease: from the oral cavity to the anus

Crohn’s disease can affect any part of the digestive tract, from the oral cavity to the anus. Inflammation in the disease of the crown is often segmental, that is, the affected areas of the intestine alternate with healthy ones. Inflammation penetrates deep into the intestinal wall, causing transmural inflammation.

A. Pathogenesis of Crohn’s disease:

The pathogenesis of Crohn’s disease is complicated and includes the interaction of a genetic predisposition, environmental factors and impaired immune system.

• Genetic predisposition: About 20% of people with Crohn’s disease have a relative of the first degree of kinship with OZK. More than 200 genes associated with the risk of developing Crohn’s disease, including the NOD2/Card15 gene, which plays a role in recognizing bacteria and activation of the immune response, has been identified.
• Environmental factors: Smoking, diet and infections can play a role in the development of Crohn’s disease. Smoking is the established risk factor for the development and deterioration of the course of the disease of the Crohn. A diet, rich in refined sugar, fats and processed products, can also contribute to the development of OKK.
• Immune system disorders: In people with Crohn’s disease, the immune system reacts excessively to bacteria and other microorganisms in the intestines, causing chronic inflammation. This includes the activation of T cells, the development of pro-inflammatory cytokines, such as TNF alpha, and a violation of the barrier function of the intestine.

B. Symptoms of Crohn’s disease:

Symptoms of Crohn’s disease can vary depending on localization and severity of inflammation. General symptoms include:

• Diarrhea: Often chronic and may contain blood or mucus.
• Abdominal pain: Usually in the right bottom of the abdomen.
• Weight loss: Due to a decrease in appetite and violation of the absorption of nutrients.
• Fatigue: Often associated with chronic inflammation and anemia.
• Fever: Especially during exacerbations.
• Perianal manifestations: Anal cracks, fistulas and abscesses.
• Extra -mesh manifestations: Arthritis, uveitis (inflammation of the eyes), knotted erythema (painful skin nodules) and primary sclerosing cholangitis (inflammation of the bile ducts).

C. Diagnosis of Crohn’s disease:

Diagnosis of Crohn’s disease includes a combination of clinical evaluation, laboratory research and visualizing methods.

• Clinical assessment: The doctor collects an anamnesis of the disease and conducts a physical examination.
• Laboratory research:
  • Blood test: Determination of the level of hemoglobin, leukocytes, C-reactive protein (CRB) and the rate of erythrocyte (ESR), which may indicate inflammation. You can also determine the level of albumin, which can be reduced by violation of absorption.
  • Analysis: Determination of fecal calprotectin and lactoferrin, which are markers of inflammation in the intestines. Calais analysis is also carried out for infections.
• Visualizing methods:
  • Colonoscopy: Allows you to visualize the mucous membrane of the colon and the terminal part of the ileum (the last section of the small intestine). During colonoscopy, you can take a biopsy for histological examination.
  • Ileokolonoscopy: Colonoscopy with the advance of the endoscope in the ileum.
  • Upper endoscopy (esophagogastroduodenoscopy): Allows you to visualize the esophagus, stomach and duodenum.
  • Capsule endoscopy: It is used to visualize the small intestine, which is difficult to access for ordinary endoscopy. The patient swallows a capsule with a camera that transfers images to a recorder.
  • CT Enterography and MRI Enterography: They are used to visualize the small intestine and detect inflammation, strictures (narrowing) and fistulas.
• Histological study of biopsy: A study of tissue taken during endoscopy under a microscope to confirm the diagnosis and assess the severity of inflammation. The characteristic signs of Crohn’s disease are granulomas (accumulations of inflammatory cells) and transmural inflammation.

D. Treatment of Crohn’s disease:

The purpose of the treatment of Crohn’s disease is to reduce inflammation, relieve symptoms, prevent complications and improve the quality of life. Treatment usually includes a combination of drug therapy, diet and, in some cases, surgical intervention.

• Drug therapy:
  • Aminosalicylate (TEC 5): Drugs, such as mesalazine and sulfasalazine, are used to reduce inflammation in the colon. They are often used for mild and moderate Crohn’s disease, especially for damage to the colon.
  • Corticosteroids: Preparations, such as prednisolone and boulestonide, are used to quickly reduce inflammation during exacerbations. However, they are not intended for long-term use due to side effects. Budesonide has fewer systemic side effects than prednisone, and is often used to damage the ileum.
  • Immunomodulator: Preparations, such as Azatioprine, 6-Merkaptopurin and Metorsat, are used to suppress the immune system and maintain remission. They act more slowly than corticosteroids, but can be used for a long time.
  • Biological drugs: Preparations, such as infliximab, adalimumab, Cerentolyzumab Pegol and Golimumab, are inhibitors of TNF alpha, cytokine, which plays a key role in inflammation in Crohn’s disease. Ustekinumab is an inhibitor of Interleukin-12 and Interleukin-23, other cytokines involved in inflammation. Vedasumab is an inhibitor of integrated molecules, which prevents the migration of leukocytes in the intestines. Risankizumab is an inhibitor of Interleukin-23. These drugs are used to treat a moderate and serious Crohn disease, especially with the ineffectiveness of other treatment methods.
  • Yanus-Kinaz inhibitors (JAK): Topacitinib is an inhibitor of JAK, which blocks the transmission of signals inside the cells and reduces inflammation. Padadacitinib is also a JAK inhibitor, which is used to treat Crohn’s disease.
  • Antibiotics: Metronidazole and cyprofloxacin can be used to treat complications of Crohn’s disease, such as perianal abscesses and fistulas.
• Diet:
  • Element diet: A liquid diet containing nutrients in an elementary form can be used to reduce inflammation and provide nutrition for exacerbations.
  • Special diets: Some people with Crohn’s disease may improve symptoms, subject to certain diets, such as low residues diet, a diet without gluten or low -content diet. It is important to consult a doctor or nutritionist before making any significant changes to the diet.
• Surgical intervention:
  • Surgical intervention may be required to treat complications of Crohn’s disease, such as strictures, fistulas, abscesses and perforations. Surgical intervention does not heal Crohn’s disease, but can alleviate the symptoms and improve the quality of life. The most common surgical procedures are the resection (removal) of the affected area of ​​the intestines and stricturoplasty (expansion of the narrowed area of ​​the intestine).

III. Ulcerative colitis: inflammation of the colon

Ulcerative colitis is an inflammatory bowel disease that affects only the colon (rectum and colon colon). Inflammation with ulcerative colitis usually begins in the rectum and spreads proximally (up the colon). Inflammation is limited to the mucous membrane (the most inner layer) of the colon.

A. Pathogenesis of ulcerative colitis:

The pathogenesis of ulcerative colitis, like Crohn’s diseases, is complex and includes the interaction of a genetic predisposition, environmental factors and impaired immune system.

• Genetic predisposition: As with Crohn’s disease, there is a genetic predisposition to ulcerative colitis. Many genes associated with the risk of ulcer colitis, including genes involved in the immune response and barrier function of the intestine, are identified.
• Environmental factors: Environmental factors, such as smoking, diet and infection, can also play a role in the development of ulcerative colitis. Unlike Crohn’s disease, smoking can have a protective effect with ulcerative colitis.
• Immune system disorders: With ulcerative colitis, the immune system also reacts excessively to bacteria and other microorganisms in the intestines, causing chronic inflammation. However, the specific mechanisms of the immune response in ulcerative colitis differ from the mechanisms in the disease of the crown.

B. Symptoms of ulcerative colitis:

Symptoms of ulcerative colitis can vary depending on localization and severity of inflammation. General symptoms include:

• Diarrhea: Often chronic and contains blood and mucus.
• Abdominal pain: Usually in the lower left of the abdomen.
• Tensoma: A constant feeling of need to empty the intestines, even if the intestines are empty.
• Rectal bleeding: Blood in the chair.
• Fatigue: Often associated with chronic inflammation and anemia.
• Fever: Especially during exacerbations.
• Extra -mesh manifestations: Arthritis, uvet, knotted erythema and primary sclerosing cholangitis.

C. Diagnostics of ulcerative colitis:

Diagnosis of ulcerative colitis includes a combination of clinical assessment, laboratory research and visualizing methods.

• Clinical assessment: The doctor collects an anamnesis of the disease and conducts a physical examination.
• Laboratory research:
  • Blood test: Determination of the level of hemoglobin, leukocytes, CRC and ESR. You can also determine the level of albumin.
  • Analysis: Determination of fecal calprotectin and lactoerrin. Calais analysis is also carried out for infections.
• Visualizing methods:
  • Sigmoidoscopy: Allows you to visualize the rectum and sigmoid intestine (part of the colon).
  • Colonoscopy: Allows you to visualize the entire colon. During colonoscopy, you can take a biopsy for histological examination. Colonoscopy can be dangerous with severe exacerbation of ulcerative colitis due to the risk of perforation.
  • The radiography of the abdominal cavity: It can be used to identify complications, such as toxic megacolon (expansion of the colon).
• Histological study of biopsy: A study of tissue taken during endoscopy under a microscope to confirm the diagnosis and assess the severity of inflammation. The characteristic signs of ulcerative colitis are inflammation, limited by the mucous membrane, cryptitis (inflammation of the crypt of a liberty, glandular recesses in the mucous membrane) and exhaustion of gorgeous cells.

D. Treatment of ulcerative colitis:

The purpose of the treatment of ulcerative colitis is to reduce inflammation, relieve symptoms, prevent complications and improve the quality of life. Treatment usually includes a combination of drug therapy, diet and, in some cases, surgical intervention.

• Drug therapy:
  • Aminosalicylate (TEC 5): Preparations, such as mesalazine and sulfasalazine, are cornerstone of ulcerative colitis treatment. They are available in various forms, such as tablets, candles, enemas and suspensions.
  • Corticosteroids: Preparations, such as prednisolone and boulestonide, are used to quickly reduce inflammation during exacerbations.
  • Immunomodulator: Preparations, such as Azatioprine and 6-Merkaptopurin, are used to suppress the immune system and maintain remission.
  • Biological drugs: Preparations, such as infliximab, adalimumab, golimumab and Vedilizumab, are used to treat moderate and severe ulcerative colitis. Ustekinumab is also used to treat ulcerative colitis.
  • Yanus-Kinaz inhibitors (JAK): Topacitinib and Padadacitinib are used to treat ulcerative colitis.
• Diet:
  • During exacerbations, a low content of residues may be required.
  • Avoiding products that cause bloating and discomfort.
• Surgical intervention:
  • Proctocoloactomy with an ileoanal tank (J-mech): Removing the colon and rectum with the formation of the tank from the small intestine, which is connected to the anus. This allows the patient to maintain a normal defecation process.
  • Proctocoloectomy with ileostoma: Removing the colon, rectum and anus with the formation of a hole (stoma) in the abdominal wall through which waste into a bag is removed.

IV. Differential diagnosis of Buke

It is important to differentiate VSK from other diseases that can cause similar symptoms.

• Infectious colitis: Infections, such as Clostridium difficile, Campylobacter, Salmonella and Shigella, can cause diarrhea, abdominal pain and bleeding from the rectum.
• Irritable intestine syndrome (SRK): SRK is a functional intestinal disorder, which is characterized by abdominal pain, bloating and changes in the frequency and consistency of the stool. Unlike BIK, with the IPC there is no inflammation.
• Diverticulitis: Inflammation of diverticulums (bags) in the wall of the colon.
• Ischemic colitis: Inflammation of the colon caused by a decrease in blood flow.
• Medicinal colitis: Inflammation of the colon caused by taking certain drugs, such as non -steroidal anti -inflammatory drugs (NSAIDs).
• Microscopic colitis: Inflammation of the colon, which can only be seen under a microscope.

V. Complications of Buke

Priv can lead to various complications, both intestinal and extracurricular.

• Intestinal complications:
  • Strict: The narrowing of the intestine caused by inflammation and the formation of scar tissue.
  • Fistula: Abnormal compounds between two organs or between the organ and the skin.
  • Abscesses: Closing pus in the abdominal cavity or around the anus.
  • Perforation: Gap of intestinal wall.
  • Toxic megacolon: The expansion of the colon, which can lead to perforation.
  • Bleeding: Can lead to anemia.
  • Tolstoy Cancer: People with OZK have an increased risk of developing colon cancer.
• Extracurricular complications:
  • Arthritis: Joint inflammation.
  • Uveitis: Eye inflammation.
  • Knotted erythema: Painful skin nodules.
  • Primary sclerosing cholangitis: Inflammation of the bile ducts.
  • Anemia: Reducing the level of hemoglobin in the blood.
  • Osteoporosis: Reducing bone density.
  • Growth delay: In children.

VI. Monitoring Builder

Regular monitoring is important for monitoring the activity of the disease, identifying complications and evaluating treatment effectiveness.

• Clinical assessment: Regular visits to the doctor to evaluate symptoms and general health.
• Laboratory research: Regular determination of the level of CRC, ESR and fecal calprotectin.
• Endoscopy: Periodic colonoscopy to assess the state of the mucous membrane of the colon and identify signs of cancer.
• Visualizing methods: KT-Enterography and MRI Enterography can be used to monitor the small intestine.

VII. New directions in the treatment of IPC

Studies in the field of IPC continue, and new treatment methods are being developed.

• Transplantation of fecal microbiots (TFM): Calais transplant from a healthy donor to the recipient with BCC. TFM can change the composition of the intestinal microbiots and reduce inflammation.
• Cell therapy: The use of stem cells to restore damaged intestinal tissue.
• Development of new biological drugs and JAK inhibitors.
• Personalized medicine: The use of genetic information and other factors to develop individual treatment plans.

VIII. The influence of LAS on the quality of life and psychological health

Priv can have a significant impact on the quality of life and psychological health of patients. Chronic symptoms, such as diarrhea and abdominal pain, can limit everyday activity and lead to social isolation. Patients with OZK often have anxiety and depression. It is important that patients with OZK receive support not only from medical workers, but also from family, friends and support groups. Psychotherapy and antidepressants can be useful for treating anxiety and depression.

IX. Pregnancy and OKK

Pregnancy in women with OKK requires special attention. It is important that the disease is in the stage of remission before conception. Many drugs used for the treatment of OKK are safe during pregnancy, but it is important to consult a doctor before taking any medicine.

X. ZKK in children

ISC can occur in children of all ages. Symptoms of OZK in children can be similar to symptoms in adults, but children may also have a growth retardation and puberty delay. Treatment of ISC in children usually includes drug therapy, diet and, in some cases, surgical intervention. It is important that children with ZAK receive support from the family, school and medical workers.

XI. Alternative and additional methods of treatment of IPC

Many people with OZK use alternative and additional treatment methods such as acupuncture, herbs and probiotics. Although some of these methods can alleviate the symptoms, it is important to discuss them with a doctor before using them. Some alternative methods of treatment can interact with drugs or be unsafe. Probiotics can be useful to restore the balance of intestinal microbiota, but it is necessary to choose probiotics that contain strains that have proved their effectiveness in the UPC.

XII. The role of nutrition for BAC

Food plays an important role in the OPC management. Although there is no universal diet for all people with ZAK, there are some general recommendations that may be useful.

• Balanced nutrition: It is important to eat balanced by using a variety of products from all food groups.
• Avoiding products that cause symptoms: Some products can aggravate the symptoms of BCC. It is important to determine which products cause symptoms and avoid them. General products that can cause problems include dairy products, gluten, sugar, caffeine and alcohol.
• The use of a sufficient amount of liquid: It is important to use a sufficient amount of liquid to avoid dehydration, especially during diarrhea.
• Consultation with a nutritionist: A nutritionist can help develop an individual nutrition plan, which corresponds to the needs of a particular person with OKK.

XIII. Life with LAC: Tips and Strategies

Living with OKK can be difficult, but there are many ways to cope with this disease and improve the quality of life.

• Education: It is important to understand your illness and know what can be done to control it.
• Support: Get support from family, friends, support groups and medical workers.
• Activity: Try to stay active as possible. Physical exercises can help reduce stress and improve the overall health.
• Stress management: Find the ways to cope with stress, such as meditation, yoga or tai-chi.
• Planning: Plan in advance to avoid situations that can aggravate the symptoms. For example, if you know that a certain product causes you diarrhea, avoid its use before an important event.
• Rest: Provide for yourself enough rest. Fatigue can aggravate the symptoms of BCC.
• Positive attitude: Try to maintain a positive attitude. Remember that ZAK is a chronic disease, but you can live a full life with it.

XIV. Glossaria of terms associated with OKK

• Abscept: Closing pus.
• Aminosalicylate (TEC 5): Medicines used to reduce inflammation in the colon.
• Biological drugs: Medicines that are aimed at certain molecules in the immune system that are involved in inflammation.
• Biopsy: Removing a small fabric sample for research under a microscope.
• Crohn’s disease: Inflammatory bowel disease, which can affect any part of the digestive tract.
• Diarrhea: Frequent and liquid bowel movements.
• Diverticulitis: Inflammation of diverticulums (bags) in the wall of the colon.
• Ileostoma: A hole (stoma) in the abdominal wall through which waste into a bag is displayed.
• Immunomodulator: Medicines that suppress the immune system.
• Yanus-Kinaz inhibitors (JAK): Medicines that block the transmission of signals inside the cells and reduce inflammation.
• Colonoscopy: The procedure that allows you to visualize the mucous membrane of the colon.
• Corticosteroids: Medicines that quickly reduce inflammation.
• Perforation: Gap of intestinal wall.
• Primary sclerosing cholangitis: Inflammation of the bile ducts.
• Tolstoy Cancer: Cancer that develops in the colon.
• Fistula: An anomalous connection between the two organs or between the organ and the skin.
• Irritable intestine syndrome (SRK): Functional intestinal disorder, which is characterized by abdominal pain, bloating and changes in the frequency and consistency of the stool.
• Stricture: The narrowing of the intestine.
• Toxic megacolon: The expansion of the colon, which can lead to perforation.
• Uveitis: Eye inflammation.
• Knotted erythema: Painful skin nodules.
• Ulcerative colitis: Inflammatory bowel disease, which affects only the colon.

XV. Resources for patients with OKK

• Crohn’s & Colitis Foundation: The leading organization providing information and support to people with ZKK.
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Part of the national healthcare institutions (NIH), which conducts research in the field of Black Sea.

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