The absence of a single factor causing ulcerative colitis makes the treatment of this disease difficult. Success is achieved through adequately selected complex therapy. Preventive treatment is mandatory to ensure a sufficiently high quality of life.
You can read about the causes, symptoms, diagnosis and prevention of ulcerative colitis here .
Content
What to do when diagnosed with ulcerative colitis?
If ulcerative colitis is diagnosed against the background of an exacerbation, then a comprehensive examination is necessary. In this case, hospitalization is recommended, as serious metabolic and blood disorders are possible. In addition, it is necessary to establish the prevalence and nature of intestinal damage.
Diet
In case of illness, strict adherence to the diet is necessary:
- exclude fresh fruits, vegetables, canned food,
- food should be mechanically and chemically gentle,
- food temperature - 30-35 degrees,
- fractional meals 4-5 times a day,
- Therapeutic diet No. 4 .
An imbalance of vitamins and impaired absorption of microelements is compensated by taking complex medications (duodevit, oligovit, unicap, etc.)
Patients with severe forms during a period of severe exacerbation with loss of body weight may be prescribed parenteral nutrition .
Should I take sedatives?
To normalize psychological status, various methods of psychotherapy are recommended.
Medications should be used with extreme caution in severe forms of the disease. For patients with severe anxiety, tranquilizers (Elenium, Seduxen, Rudotel) are recommended; for depression, small doses of tranquilizers and minor antipsychotics (Frenolone).
Drug treatment
In uncomplicated forms of ulcerative colitis, conservative treatment is carried out.
Since ulcerative colitis is an inflammatory disease and is often associated with bacterial disorders, medications that have anti-inflammatory and antibacterial properties are used.
Such drugs are salazopyridazine, sulfasalazine, salazodimethoxin, salofalk.
Sulfasalazine is a derivative of sulfapyridine and 5-aminosalicylic acid (5-ASA). The mechanism of its action is not well understood. The active principle of this drug is 5-ASA. This served as the basis for the creation of new drugs that are free of the side effects of sulfasalazine. These are drugs such as salofalk, mesacol, salosan, tidokol.
Mesalazine is registered in Russia with three types of coating:
- salofalk: release of mesalazine occurs gradually throughout the intestine with an optimum pH>6.0, 20-30% in the terminal ileum and 70-75% in the colon;
- pentase: maximum release of mesalazine is observed at pH = 1.0, 20% of the active substance is released in the stomach, 25-30% in the terminal small intestine, 25-30% in the colon; the drug can remain in microspheres and be excreted in the feces;
- mesacol: release occurs at pH>6.0, 90% of the substance is released within 15 minutes.
Experimental studies show varying concentrations of 5-ASA in different colon cells. It was revealed that 5-ASA selectively induces apoptosis of tumor cells and is considered as an effective means of cancer prevention.
The drug is prescribed at a dose of 2-6 g/day for the entire period of active inflammation. When the exacerbation subsides, the dose is adjusted to the therapeutic dose. It differs from patient to patient and must be verified by a physician.
To prevent relapses, 5-ASA drugs are prescribed in small doses, if necessary, for several years. The tablets should be taken after meals and washed down with plenty of water.
When the rectum is affected, the administration of 5-ASA in suppositories is effective. The therapeutic effect of local therapy with 5-ASA suppositories in patients with newly diagnosed and uncomplicated ulcerative colitis appears after 3-21 days, so treatment should be continued for at least 3-6 weeks.
As a preventive measure, suppositories are used 0.5 g 3 times a day.
The suspension is used in enemas; it should be administered once a day before bedtime after a cleansing enema.
Antibacterial drugs
In the treatment of UC and CD, drugs are used that have the properties of inhibiting the anaerobic intestinal flora and modulating the body's immune response.
A medicine that has this property is metronidazole. However, the need for long-term use increases the likelihood of side effects.
It is safer to take this antibiotic rectally in the form of a suspension at a dose of 40 mg 1-4 times a day for 2-3 days.
Recently, the drug alpha-normix has become more popular, which has a selective effect against both gram-positive and gram-negative flora.
Diarrhea medications
Mild forms of diarrhea are recommended to be treated first with infusions of the following herbs:
- belladonna tinctures and extracts;
- decoction of pomegranate peels;
- infusion of bird cherry fruits;
- blueberry infusion;
- infusion of serpentine rhizomes;
- infusion of gray alder cones.
For severe diarrhea, when basic medications do not help, Sandostatin is recommended for people with mild to moderate disease.
Sandostatin is a synthetic analogue of somatostatin. It has the following effects:
- decreased secretion and improved absorption in the intestine;
- decreased motility and inhibition of visceral blood flow;
- slowing down the transit of contents through the intestines;
- increasing the contact time of chyme with the mucous membrane,
- suppression of cytokine synthesis.
According to modern concepts, cytokines trigger the process of inflammation in the colon.
When using sandostatin, diarrhea decreases and blood excretion in feces decreases. The drug should be used for 7 days at a dose of 0.1 mg 2 times, administered subcutaneously.
In the phase of subsiding exacerbation, it is recommended to take bacterial drugs to correct dysbacteriosis.
Glucocorticosteroids
For severe ulcerative colitis, glucocorticosteroids (prednisolone) are used.
Their effectiveness is due to cellular effects, they are:
- change the mobility of leukocytes and lymphocytes;
- suppress phagocytosis;
- suppress the release of inflammatory mediators;
- suppress antibody production;
- suppress cell-mediated cytotoxicity.
At the peak of an exacerbation, to achieve a quick effect, the drug is administered intravenously during the first day, then intramuscularly for 5 days. If the effect is positive (decreased intoxication, decreased body temperature), switch to oral administration (by mouth). Long-term administration of hormones during remission is not advisable.
In the treatment of distal ulcerative colitis of any severity (proctitis, proctosigmoiditis), short courses of administration of glucocorticosteroid drugs in enemas (prednisolone 20-40 mg/day, hydrocortisone 100-250 mg/day), suppositories, and foam are effective. It should be noted that rectally administered drugs cause fewer side effects compared to oral administration.
However, traditional glucocorticosteroids, even when applied locally, have a significant drawback - side effects are observed in 55-70% of patients. In the 1980s, new corticosteroids were developed for topical use in distal forms of ulcerative colitis.
It has been established that enemas with locally acting glucocorticosteroids in low-viscosity solutions spread from the rectum to the left flexure of the colon. These drugs are highly active, quickly absorbed and quickly inactivated. They have the same anti-inflammatory activity as traditionally used corticosteroids.
However, non-systemic glucocorticosteroids are free of side effects.
Non-systemic corticosteroids include drugs such as:
- prednisolone metasulfobenzoate;
- thixocortol pivalate;
- budesonide (budenofalk).
Immunosuppressants and antimetabolites
5-ASA drugs and glucocorticosteroids are most effective for ulcerative colitis and Crohn's disease. But 10-15% of patients may have complications or the drugs may not have the desired effect. In these cases, immunosuppressants and antimetabolites are used.
Cyclosporine (Sandimmune) is an effective drug in the treatment of acute ulcerative colitis. Its main advantage is obtaining a quick positive result in cases where traditional treatment does not help. But side effects are possible (kidney damage, etc.).
However, data from most controlled studies show that high-dose intravenous administration of this drug causes remission in 60-80% of patients with severe ulcerative colitis. Most side effects with this therapy are mild.
Anathioprine - often used in conjunction with corticosteroids to prevent relapses.
Recently, new drugs of this type have appeared.
Infliximab, adalimumbab, certolizumab are drugs that inhibit the activity of tumor necrotizing factor. A good effect was obtained in 67% of patients, of which 46% achieved remission of the disease with a single administration of the drug.
The use of these drugs in severe forms of ulcerative colitis has reduced the number of surgical interventions by 85-95%.
When using a group of immunosuppressants, the following rules should be followed:
- screen for tuberculosis;
- strictly adhere to the dose and schedule of administration of the drug;
- monitor leukocyte levels (complete blood count monthly).
Local treatment
For the treatment of distal forms of ulcerative colitis, the administration of drugs using enemas, suppositories, and foam is widely used. The advantage of this type of treatment is that
- the drugs reach directly the affected tissues,
and a high concentration of the active substance is observed in the intestinal wall (which increases the effectiveness of treatment), - low concentration in the bloodstream (which reduces the risk of side effects of the drug).
Suppositories have a therapeutic effect in the rectum.
The foam is distributed evenly in the rectosigmoid region.
The contents of a 100 ml enema can reach the splenic angle in the intestine.
In case of impaired anal continence, suppositories, gel or foam are used first, and only then liquid enemas in increasing volumes.
Medications introduced into the intestines by drip over 20-30 minutes are highly effective.
Cytomegalovirus and ulcerative colitis
It has now been proven that cytomegalovirus infection is often the cause of the development of ulcerative colitis. Moreover, this type of disease cannot be treated with steroids.
In this case, antiviral therapy with ganciclovir or foscarnet helps, which achieves remission in more than 70% of cases.
Probiotics
Many researchers argue that intestinal microflora plays a large role in the pathogenesis of ulcerative colitis. They believe that taking probiotics is necessary in the treatment of the disease.
A positive effect was obtained from the use of drugs that restore the content of lactoflora and reduce the number of opportunistic microorganisms.
Detoxification of the body
Patients with moderate and severe UC require elimination of metabolic disorders and detoxification therapy.
For this purpose, hemolysis, isotonic sodium chloride solution and glucose solution, mixtures of amino acids, potassium and calcium preparations, vitamins B and C are used.
In case of persistent disease, the presence of extraintestinal symptoms and pronounced changes in immune status, hemosorption is indicated. It helps remove toxic products, circulating immune complexes, and correct immunity.
After the procedure, significant positive changes are observed in the clinical picture of the disease, signs of intoxication are reduced, extraintestinal complications are mitigated, toxic reactions to medications are eliminated, the protein composition of the blood and endoscopic parameters are improved.
Surgery
There are absolute and relative indications for surgery.
Absolute readings:
- suspected perforation;
- acute toxic dilatation of the colon that does not stop within 6-24 hours;
- profuse intestinal bleeding;
- paracolic infiltrates;
- intestinal obstruction;
- colon cancer;
- severe perianal lesions;
- fulminant course of ulcerative colitis lasting more than 7-10 days in the absence of effect from conservative treatment.
Relative readings:
chronic continuously relapsing course of UC for 10 years without positive dynamics in the morphology of the colon wall.
The following types of surgical interventions exist:
- palliative operations - ileostomy;
- radical operations - subtotal resection of the colon with the application of ileo- and sigmostoma, colproctectomy with ileostomy according to Brooke or retaining ileostomy according to Kock;
- restorative and reconstructive operations.
Palliative operations
These operations involve temporarily or permanently disconnecting all (ileostomy) or part (colostomy) of the colon.
Recently, ileostomy is more often performed, since in UC the inflammatory process can spread above the stoma.
The most adequate is Brooke's ileostomy - terminal eversion (inverted). It is more secure. With this type of operation, the likelihood of complications (fistulas, abscesses, hernias and retraction of the removed intestine) is minimal. In addition, an ileostomy is easy to care for and can be used with different types of colostomy bags.
In obese patients, a double-barreled ileostomy with one protrusion above the skin according to Thornebull is often performed. However, after its implementation, significant difficulties arise in regulating the release of liquid contents and gases. Recently, a “holding” ileostomy according to Kock has been developed, which minimizes this disadvantage.
There is another type of ileostomy - anal. In this operation, the ileum is brought down into the perineum and a direct ileoanal anastomosis is performed. Many patients insist on this type of surgery to preserve the natural way of excrement. However, in this case, great difficulties may arise when using a colostomy bag.
Radical operations
In severe forms of ulcerative colitis and acute conditions, operations are reduced to ileostomy (preferably with the creation of a valve reservoir according to Kock).
The planned radical operation is a subtotal colectomy with the application of a reservoir small intestinal ileorectal anastomosis. Often this surgical intervention is performed with the imposition of a temporary (unloading) ileostomy.
In young patients with fulminant ulcerative colitis, total colectomy with the formation of an ileorectal pouch should be chosen.
Restorative and reconstructive operations
Some time after the colectomy, it is possible to perform an operation to restore the continuity of the colon and remove the colostomy.
Currently, modern technologies for carrying out such operations have been developed (in particular, at the A.A. Vishnevsky Central Military Clinical Hospital).
These surgical interventions are an important part in the complex treatment of colostomy patients. Medical practice shows that it is advisable to perform operations no earlier than 6 months after the first operation in cancer patients and, if possible, strive for early elimination of colostomy in other cases.
Carrying out restorative and reconstructive operations allows patients to return to a full lifestyle.
Under no circumstances should you self-medicate if you are diagnosed with UC. This disease requires the prescription of serious medications, which only a doctor can correctly determine. However, we hope that this article will help you navigate modern treatment methods.
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