Chronic enteritis, as a rule, develops against the background of persistent nutritional disorders, frequent consumption of spicy foods and spices, and eating disorders. The cause of enteritis can be alcoholism, industrial, household, endogenous and drug intoxication.
Symptoms of enteritis may also occur in food allergies, parasitic invasions, helminth infections, radiation damage. Often, chronic enteritis is associated with gastritis that occurs with secretory insufficiency of the stomach, chronic pancreatitis, colitis.
The disease develops with a long-term direct effect of the damaging factor on the wall of the small intestine, as well as with dysbacteriosis. In some cases, immunological mechanisms become the cause of the disease, resulting in the lesion of the lean or ileum.
Symptoms of chronic enteritis
Pain in chronic enteritis occurs infrequently and is mild. The patient is worried about dull pain, in rare cases it is spastic, the localization of pain corresponds to the navel. In the umbilical region, pain also appears during palpation of the patient’s abdomen and strong pressure a little to the left and above the navel (a symptom of Porges).
In addition, Sternberg's symptom is characteristic of chronic enteritis (painful sensations on palpation along the mesentery of the small intestine) and Obraztsov's symptom (rumbling and splashing when palpating the cecum). If during walking the patient is worried about the pain accompanying each shaking of the body, then it can be assumed that the patient has periviscerit.
Intestinal dyspepsia syndrome is accompanied by nonspecific complaints: a feeling of pressure, fullness, rumbling in the abdomen, increased gas formation, nausea. Such manifestations of the disease are especially pronounced after a meal, they occur due to a violation of the digestion of dietary fibers in the intestinal lumen, fast peristalsis and impaired absorption processes in the intestinal area. In severe illness after eating, the patient feels weak, dizzy, which is characteristic of the dumping syndrome.
Coprologic syndrome with enteritis manifests itself in the form of frequent (more than 15 times per day) mushy stool with gas bubbles, which contain undigested food particles without obvious mucus. The stool usually has a fetid odor. Polyfecalia is characteristic of the disease: the volume of fecal masses can reach two kilograms per day.
In some cases, patients have a sharp urge to have a bowel movement, but after emptying the bowels they are worried about severe weakness and hand tremor, and so-called jejunal diarrhea occurs. With a mild course of the disease diarrhea may not be, in addition, a number of patients with enterocolitis may be constipated. The disease is also characterized by milk intolerance, which is manifested by increased gas formation and diarrhea that occur after consuming the product.
The onset of symptoms of enteritis in the chronic course of the disease can be provoked by spicy foods rich in fats and carbohydrates, as well as overeating. The presence of unrestored bilirubin and a high concentration of fat often give stool masses a yellowish and clayey look.
Symptoms of chronic enteritis may progress gradually or violently. Regression of the disease is rare, mainly a favorable outcome of the disease is closely associated with treatment and strict adherence to the diet.
Enteritis - what is it? Types of enteritis
Chronic enteritis is classified by etiology, morphology, clinical and functional symptoms.
According to etiology, parasitic, alimentary, infectious, toxic, radiation, postoperative and drug enteritis are distinguished. In addition, the disease manifests itself in congenital anomalies of the small intestine, valve insufficiency between the colon and small intestine, enzymopathy, secondary enteritis.
According to anatomical and morphological changes, enteritis is isolated without serious violations of the mucous membrane, as well as with moderate or subtotal degree of atrophy of epithelial cells and intestinal villi.
Clinically, the disease manifests mild, moderate or severe form. In chronic enteritis, remission and aggravation phases may occur. Since enteritis is a disease of inflammatory nature, it is necessary to begin treatment at the first signs of pathology in order to preserve the health of the intestines.
Functional disorders are characterized by specific symptoms - impaired absorption of nutrients in the intestines, changes in food hydrolysis, enteric insufficiency and exudative enteropathy.
Causes of the disease
There may be several reasons for the appearance of disorders in the small intestine:
- infectious pathogens, intestinal parasites that progress and multiply in the small intestine,
- toxic substances (arsenic, lead and others),
- self-medication, long-term use of antibiotics and other drugs,
- under-treated acute enteritis,
- insufficient chewing of food, unhealthy food (eating spicy and fatty foods, fast food, overeating, food allergies),
- intestinal enzyme deficiency,
- the presence of comorbidities (pancreatitis, tuberculosis, cirrhosis of the liver, systemic lupus erythematosus, hepatitis).
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Lack of proper treatment for chronic enteritis will contribute to dystrophic changes and inflammations in other parts of the digestive system (pancreas, gall bladder, stomach).
Clinical picture of enteritis
The external manifestations of the disease include any violation of the absorption and assimilation of food. These include:
- sharp and rapid weight loss (a person loses up to 20 kg),
- appearance of insomnia, severe irritability,
- decrease in labor activity
- skin problems (thinning, dryness, peeling), hair loss, thickening of the nail plate and brittleness,
- muscle pain, weakness, paresis and cramps.
Due to a violation of the absorption of vitamins, the development of concomitant diseases is possible - hemeralopia, neuropathy, myopathy, cheilitis, glossitis, subcutaneous hemorrhages.
Intra intestinal symptoms of enteritis
Enteritis in a person is characterized by a manifestation of abdominal pain in the navel, pain increases during palpation. Syndrome appears 2-3 hours after a meal. The pain may have a different nature (dull, arching, cramping).
This happens because of a violation of the absorption of bile acids in the distal small intestine. As a result, the acids enter the colon and provoke a violation of the processes of absorption and digestion (diarrhea, bloating, flatulence, rumbling in the abdomen appear). These signs manifest enteritis.
What it is? If the ileocecal valve is impaired (it separates the thin and large intestine sections), humus can enter the small intestine, which is why it is disseminated by harmful microorganisms.
Diagnosis of the disease
The primary diagnosis is made on the basis of a survey and a general examination of the patient, which includes palpation and percussion (tapping the abdominal wall). The next step is to conduct a coprogram. Macroscopic examination determines odor, texture and color, and microscopically, the presence of fat, muscle fibers or starch in the analysis.
In order to detect infectious microorganisms and dysbacteriosis in the intestine, it is necessary to conduct a bacteriological examination of feces for enteritis. What it is? In chronic enteritis, signs of insufficient absorption of nutrients in the small intestine (malabsorption syndrome) can be detected in a biochemical blood test.
Endoscopic examination of the small intestine causes many difficulties, since only a small part of it can be examined. During endoscopy, a mucous membrane biopsy specimen is taken, which is necessary for histological analysis. Atrophy and dystrophy of intestinal epithelial cells and villi are most often noted in it.
X-ray examination allows to identify tumors, ulcers, changes in the structure of the folds of the small intestine. Before the study, a contrast agent is injected into the body to identify enteritis. What is it, the doctor will tell you. To differentiate the disease requires a comprehensive survey using modern diagnostic methods.
The symptomatology of the disease has much in common with the clinical manifestations of other gastrointestinal pathologies. Therefore, differential diagnosis of enteritis with gastritis, pancreatic problems and tumors is necessary.
Any disease of the small intestine requires careful examination, since many similar symptoms entail making an incorrect diagnosis and prescribing an ineffective, in some cases even dangerous treatment that can aggravate the condition of the small intestine.
Treatment of acute enteritis
Acute enteritis requires treatment in a hospital. Patients are prescribed diet, bed rest, and abundant drinking. Perhaps the appointment of hydration therapy. The treatment is aimed at general strengthening of the body and reducing the manifestation of unpleasant symptoms of the disease.
If enteritis is accompanied by a severe form of dysbacteriosis, it is necessary to take medication, the action of which is aimed at restoring the intestinal microflora. The elimination of diarrhea is carried out by taking astringents. If there is a violation of protein metabolism, it is necessary to introduce polypeptide solutions into the body.
On average, the duration of treatment is 7-10 days. During this time, acute symptoms of the disease are stopped, and health is enhanced. Enteritis, the treatment of which lasts less, cannot be cured to the end and provokes repeated manifestations of unpleasant and painful symptoms.
If the disease has a toxic or infectious nature, the patient must be hospitalized.
Treatment of chronic enteritis
In chronic enteritis, treatment is almost the same. Requires the same diet and bed rest. In violation of the production of digestive enzymes they are prescribed in the form of enzyme preparations ("Festal", "Pancreatin"). It is also necessary to take medications that absorb and restore the cell membranes of intestinal epithelial cells.
Enteritis, the treatment of which is carried out in accordance with the doctor's prescription, quickly ceases to bother. However, the chronic form is characterized by frequent phases of exacerbations and remissions.
Concomitant dysbiosis should be treated with the help of eubiotics and probiotics, restoring the beneficial intestinal microflora. If symptoms of enteritis occur against the background of the appearance of neoplasms in the small intestine (diverticula, polyps), then their surgical removal is first necessary, and only after that the manifestations of the disease can be stopped.
Diet with enteritis
When enteritis prescribed diet number 4. It includes lean meat or fish that can be boiled, baked or fried. It is imperative to cook soups in meat, fish, vegetable or mushroom broths. Vegetables are recommended to be cut into small pieces, in some cases even cereals should be rubbed through a sieve.
Of dairy products, preference is given to kefir and yogurt. Such drinks allow you to quickly restore the intestines, improve its performance and inhabit the beneficial microorganisms.
Vegetable products are best consumed after heat treatment. Vegetables need to boil, bake or fry, and fruit can be cooked compote, jelly or rub with sugar. Tea with lemon, wild rose tea, berries and bran will be very useful.
Prevention of enteritis
Any disease is easier to prevent than to cure. The measures to prevent intestinal enteritis include:
- balanced diet,
- use only high-quality and fresh food,
- lack of toxic substances in food (berries and mushrooms of unknown origin should not be consumed),
- personal hygiene,
- careful processing of food,
- medication in accordance with the prescriptions of doctors,
- timely visits to medical facilities to detect gastrointestinal diseases, as well as disorders of endocrine and metabolic processes in the body.
With the observance of all preventive measures, it is possible to prevent the development of digestive diseases and disorders, and a healthy lifestyle will help maintain our health at the highest level.
In dogs, the disease manifested itself relatively recently, but its progression provokes a high mortality rate among puppies. Infection that affects the intestines of animals is not dangerous to humans, but it quickly develops in the body of young dogs and causes serious structural and functional disorders.
Enteritis in a puppy is manifested by lethargy, fever, and when stroking the sides or pressing on the stomach, the dog will bend back and hold the tail, which indicates pain syndrome. With these symptoms, you should contact your veterinarian for an accurate diagnosis and treatment prescription.
Chronic enteritis refers to diseases of the gastrointestinal tract. This pathology is a violation of the activity of the intestines (malfunctions in digestion, absorption). The cause of bowel abnormalities are degenerative changes in the mucous membrane of the small intestine. It becomes thinner and inflamed. This article highlights the signs of the above disease.
Chronic enteritis is a polyetiological pathology that develops as a result of dystrophy and atrophy of all layers of the small intestinal wall, manifested by a disorder of all its functions (transport and absorption of nutrients, barrier, immunological, endocrine function). It was after studying the morphological transformations occurring in the intestines with chronic enteritis, it became clear that this disease has not only an inflammatory nature, but a dystrophic one (associated with an eating disorder and blood supply to the small bowel wall). Depending on the level of the lesion (the initial sections of the small intestine or the final ones), the disease may have features of eunitis (lesion of the jejunum) or ileitis (pathology of the ileum).
Despite the fact that the exact figures indicating the incidence of chronic enteritis are unknown, this pathology is widespread in the population. So, in specialized departments of gastroenterology, engaged in the study of pathogenesis, clinics and treatment of diseases of the small intestine, patients with this pathology constitute at least 90%.
Causes of chronic enteritis
The most frequent culprits of chronic enteritis are infectious diseases that occur with damage to the gastrointestinal tract. Salmonellosis, shigellosis, staphylococcal infections, yerseniosis, giardiasis, infection with campylobacter, pseudomonads, proteins, enteroviruses are of the greatest importance. The role of protozoal and helminthic invasions (roundworm, cryptospores, wide tapeworm, etc.) is not excluded.
The nutritional factors are also relevant: mechanical injury to the mucous membrane of the small intestine is too dry and dense food, an excess in the diet of spices and spicy seasonings, food that is poor in carbohydrates and proteins, and alcohol abuse. However, in isolation, alimentary factors do not provoke the development of pathology. Conventionally, this group of causes includes food allergies, the effect on the intestines of toxins and salts of heavy metals, ionizing radiation, prolonged use of certain drugs (steroids, NSAIDs, cytostatics, antibiotics). Also to the etiological factors include a variety of anomalies of development. Specialists assign an important role to ileocecal valve insufficiency and the development of reflux-related chronic enteritis due to the return of the contents of the large intestine into the small one.
The formation of chronic inflammation is also caused by the failure of the sphincter apparatus of the major duodenal papilla. With this pathology there is a continuous outflow of bile and pancreatic juice into the lumen of the gastrointestinal tract. Digestive juices have an excessive stimulating effect on peristalsis and motility of the small intestine, leading to impaired blood supply and nutrition, and later - intestinal dystrophy. Also, chronic enteritis can cause abnormalities in the structure of the small intestine, megacolon, gastrointestinal surgery, adhesions and ischemia of the abdominal organs.
The main links of pathogenesis are inflammation of the mucous membrane with subsequent violation of its regeneration, violation of local immunity in the small intestine, contributing to the penetration of microorganisms into the thickness of its wall, production of antibodies to the intestinal flora, food, own tissues. An important role is also assigned to the development of intestinal dysbiosis, leading to increased secretion of bacterial toxins, impaired digestion and absorption of nutrients (especially fats), chronic diarrhea, and dehydration. There is a disorder in the function of the gastrointestinal endocrine apparatus of the small intestine, which leads to the progression of changes and exacerbation of violations of reparative processes, a violation of both abdominal and parietal digestion, the development of fermentopathy, changes in intestinal motility of the hypo- or hypermotor type.
All chronic enteritis is classified by:
- etiological factor (toxic, bacterial, parasitic, radiation, drug, nutritional, postoperative, occurring against the background of developmental anomalies or other pathology of the gastrointestinal tract - secondary),
- localization (jejunitis, ileitis, total chronic enteritis),
- morphological changes (moderate, partial or total atrophy),
- current (mild, moderate, severe),
- phase of the disease (remission, exacerbation),
- leading clinical syndrome (indigestion or absorption, enteropathy, total insufficiency of the small intestine),
- the presence of concomitant colitis and extraintestinal manifestations.
Prognosis and prevention
The prognosis of chronic enteritis with a properly organized medical process is a favorable, severe course of the disease usually requires further examination to identify severe comorbidities. Prevention of chronic enteritis is the prevention and timely treatment of intestinal infections and acute enteritis, which can end in a chronic form, respecting a healthy lifestyle and nutrition, eliminating the etiological factors of this disease, health education of the population.
Enteritis - a disease of the digestive tract
There are several classifications of chronic enteritis. It is possible to single out its types, based on the clinical and functional picture, on the morphological changes that this disease entails. But the most important classification is based on the reasons that provoked the development of this pathology. So, according to etiology can distinguish the following types of enteritis:
- infectious (bacterial and viral infections),
- as a result of diseases of the digestive tract,
- as a result of liver disease,
- provoked by nutritional causes (poor diet),
- manifested due to chemical or mechanical effects
In accordance with the peculiarities of distribution, a surface variety is distinguished, accompanied by enterocyte dystrophy, and chronic enteritis, which did not result in atrophy. By functional features, it is possible to distinguish a variety with disaccharidase deficiency (when disruptions in membrane digestion occur), with impaired absorption (when water, electrolytes, proteins, iron, carbohydrates, vitamins, fats) are not absorbed, problems with motility (both hyperkinetic type, and hypokinetic).
The clinical picture of the disease may also proceed differently depending on the severity of the disease. The course sometimes has relapses. The disease has several stages, according to which the manifestation of clinical signs can be characterized. This is aggravation and remission. The disease sometimes has complications (nonspecific mesadenitis, solarium).
Symptoms of enteritis
Diarrhea and abdominal pain are the main symptoms of enteritis.
The main manifestations of enteritis are abnormalities in absorption, diarrhea that does not completely stop. Diarrhea appears as a result of increased intestinal secretion, increased osmolation of the contents of the intestine, the development of dysbiosis, increased speed of movement of the contents of the intestine. All symptoms of the disease are divided into intestinal and extraintestinal.
Intestinal symptoms occur depending on the degree of development of the disease. In the case of the defeat of only the upper parts, the intestinal symptoms are smoothed out. If the process has spread to the ileum, then the absorption of bile acids is disturbed in the distal intestine. When they enter the colon, they provoke diarrhea, because under their influence the secretion of sodium ions, chlorine and water into the intestinal lumen increases.
In addition, there is an acceleration of motor skills. In this case, patients talk about pain in the iliac region on the right side. Then there are malfunctions in the ileocecal valve, this leads to injections into the ileum of everything that is in the colon, from which microbial infection begins in the ileum. If refluxileitis lasts a long time, then the body is threatened with problems with the absorption of vitamins, in particular B 12, this results in an appropriate anemia.
Patients complain of pain in the middle of the abdomen, in the navel. Cramping or dull, bursting sensations make themselves felt after eating, after 3 - 4 hours. If palpation is carried out, then the zone in the region of the projection of the small intestine (to the left and above the navel) will be painful. You can also feel a splash in the intestine (in the caecum). This feature is called the Obraztsov symptom.
Another symptom is abundant liquid stool (yellow). Defecation is 5 - 6 times a day. Steatorrhea is observed. It manifests itself in brilliant stool masses, which have an increased stickiness, this is noticeable by the way they are heavily flushed into the toilet. Another manifestation is flatulence, rumbling, bloating. Ejunal diarrhea is very difficult.
These symptoms appear due to intestinal absorption disorders. This leads to weight loss, nervousness, irritability, fatigue. The condition of a skin, hair, nails worsens. Edema may develop, skin paste will appear. Patients suffer pain in the muscles, weakness, changing the picture of the ECG. Most of the patients lose a lot of calcium, resulting in minor cramps. A severe lack of vitamins also provokes the corresponding severe conditions.
Special research methods
It is also necessary bacteriological examination of feces. After all, the development of microbial flora. Spend the aspiration of the contents of the small intestine, to study the microbes and their number (normally in the intestinal juice the number of microbial bodies should not exceed 104 in 1 ml, with enteritis, the number may increase to 109). Also carried out seeding on the identification of pathogenic environment, analysis on Giardia.
To test the ability to absorb substances entering the body, it analyzes the composition of saliva, urine, feces, and blood after the introduction of special marker substances through a probe. Most often, the sample is taken D-xylose, which is administered in an amount of 5 g. Normally, with urine should be released 30% of the substance taken, D-xylose can show a decrease in the amount of the substance removed.
A lactose absorption test may be carried out. Lactose deficiency is indirectly indicated by an increase in serum glucose.
X-ray examination, sounding
To analyze the changes that have seized the terminal ileum, an x-ray examination of the small intestine is performed. This examination can detect tumors, Crohn's disease, and diverticulosis. To ensure that the data on the mucosa were the most accurate, probe enterography is performed for artificial hypotension with double contrast. This method gives a complete picture of the filling of the intestinal loops, the speed at which the contrast agent is moving, the amount of fluid, mucus, the state of the folds and the uniformity of the substance in them.
This type of examination, accompanied by a biopsy, allows to exclude serious diseases similar in symptoms (tuberculous ileotiflit, gluten enteropathy, Crohn's disease). During the histological examination, it is possible to detect changes in enterocytes of a dystrophic nature, villous atrophy to a moderate degree, cellular infiltration of the stroma.
Differential diagnosis of enteritis
Differential diagnosis is required (with gastritis, for example)
To exclude other similar signs of the disease differential diagnosis is carried out. Enteritis can be confused with gastritis, accompanied by a reduced secretory activity of the stomach, with pathologies of the pancreas, as well as with other diseases of the small intestine. In particular, with Crohn's disease, with Whipple's disease, gluten enteropathy, tumors, diverticulosis.
With tuberculous intestinal damage there is fever, pain in the right iliac region, partial obstruction of the intestine. Morphological changes are manifested in necrosis of the mucous membrane of the ileum, leukocytosis is present, ESR increases, the Mantoux test gives a positive result, post-tuberculosis changes are observed in the lungs.
If it is necessary to distinguish between enteritis and amyloidosis, then the walls of the arterioles and stroma should be examined. There amyloid itself is detected. It is very difficult to distinguish inflammation in the small intestine and in the large intestine. In doing so, pay attention to the suction function. With the defeat of the colon, this function is almost not disturbed.
The basic principles of treatment
Treatment should be carried out in a hospital. Patients are kept on diet No. 4 (a, b, c). In the diet must be present protein (150 g) in the form of lean meat, fish, cottage cheese and eggs and fats (100 g), only easily digestible. High-melting animal fats are strictly prohibited (mutton, pork). If there is a period of exacerbation, the amount of fat should not exceed 70 g. Carbohydrates should be 450 grams per day, as under normal load.
Products with a high content of fiber should be limited, for this, vegetables and fruits are given in a ground form. If diarrhea does not pass, then you should not eat cabbage, prunes, nuts, black bread, figs, pastries, exclude beer, kvass.
Treatment of enteritis in a hospital setting
Food is carried out by fractional method. You should eat 5-6 times a day. Food should be warm. If there is an aggravation, then it is necessary to take exclusively mechanically sparing food: broths, mucous soups, steam cutlets, souffles, wiped porridges. To normalize stools, drink acidophilus milk (100-200 g three times a day), kissels from berries with tannins, these are blueberry, pomegranate, pear.
If avitaminosis is detected, then vitamin complexes are prescribed. But antibiotics are prescribed in the most extreme cases, as they cause dysbacteriosis and worsen the condition. Therefore, the condition caused by the presence of harmful bacteria is corrected by the preparations Bifidumbacterin, Colibacterin, Bificol and the like. For digestive disorders inside the intestine, enzyme preparations are used: festal, pancreatin, abo-min, and others. When diarrhea take enveloping, astringent: tealbin, tanalbin, decoctions of herbs.
If enteritis has taken a severe form, accompanied by impaired absorption, then intravenous infusion of plasma and protein hydrolysates is performed, and physiotherapy is prescribed. If the disease is severe, then patients are given a disability. To prevent this pathology, it is necessary to treat acute enteritis in a timely manner, to conduct preventive work to eliminate relapses.
The study of feces for dysbacteriosis - how this is done, will tell the video:
Chronic enteritis is an inflammatory disease of the small intestine, which is accompanied by a disorder of digestive function, a persistent violation of defecation. Coping with the chronic form of the disease with standard drugs is often difficult. Therefore, having determined the symptoms, the treatment of chronic enteritis in adults, doctors and patients themselves try to supplement the use of folk remedies.
Chronic enteritis is a long-lasting inflammatory process that affects the mucous membranes of the small intestine. This state develops in the background:
- Acute inflammation of the intestine and duodenum. Weakened immunity can be the first and main reason for the formation of persistent chronic disease. Therefore, physicians with lower body resistance recommend that doctors put less risk for themselves: eat right, avoid large crowds of people as much as possible (especially during the exacerbation of seasonal diseases), spend a lot of time in fresh air, and so on.
- Effects of bacterial, viral, fungal agents. Poorly washed vegetables and fruits, unfiltered boiled water, violation of sanitary norms can cause various infections in the body. They, in turn, quickly attaching to the walls of the stomach and intestines, become provocateurs of the inflammatory process.
- Poisoning household and industrial poisons. Mercury, lead, other chemicals contained in household chemicals and enterprises can cause the development of chronic enteritis and some other diseases that are not amenable to final treatment.
Symptoms of chronic enteritis in the acute stage manifest themselves as follows:
- Appears paroxysmal pain around the navel. Food, getting into the stomach, is mixed and split into simpler components. Further, it passes into the intestine along with gastric juice for easier absorption. It is at that moment when the microparticles of the products and the aggressive alkali touch the damaged areas of the smooth epithelium (mucosa), unpleasant, stabbing and cutting pains occur.
- Increased flatulence, nausea, impaired defecation.Since the damaged intestinal walls can not fully cope with their task - the assimilation of nutrients and the release of unwanted residues, there is a gradual accumulation of toxic substances and their rotting. This leads to the further development of inflammation, as well as to the appearance of multiple symptoms of indigestion.
- Emotional inhibition, fatigue. Due to the fact that nutrients are poorly settled, the patient constantly feels drowsiness, weakness, is experiencing a general malaise. In the most neglected cases there is a breakdown, anemia.
Degrees of severity
Enteritis, like any other disease, is divided into several types and has a certain degree of severity, which characterizes the depth of damage of a particular function of the body.
There are three main degrees of severity, which will be discussed below.
Grade 1 chronic enteritis is manifested by local symptoms of indigestion. The patient noted: heartburn, increased flatulence, relaxation of the chair, heaviness after eating, abdominal discomfort (navel area). Weight loss up to 5 kg inclusive may also occur.
Grade 2 HE - except for the above mentioned phenomena, the patient experiences: difficulty defecating, pain in the process of bowel movements, nausea in the morning. Weight loss in the second stage can be significant, and most often it is combined with a general weakening, development of iron deficiency anemia.
3rd degree - in the feces there are admixtures of pus or blood, the work of intestinal motility is disturbed, useful trace elements are not absorbed at all. The patient has persistent pain in the navel, giving to the groin or lower back. The general condition is very weak, on the verge of exhaustion. In addition to signs of anemia, a slight degree of dehydration can be detected.
Exacerbations of chronic enteritis occur against the background of seasonal infectious viral diseases, malnutrition, non-compliance with doctor's recommendations, prolonged exposure to adverse environmental factors.
Most often, the period of renewal of the inflammatory process begins with a slight indigestion and ends with an emergency hospitalization in the gastroenterology department of a district hospital.
To reliably diagnose the first signs of the resumption of chronic enteritis in adults, it is enough to evaluate:
- The quality of defecation. A regular stool of uniform consistency speaks of the normal functioning of the intestines. Frequent diarrhea or constipation, on the contrary, can serve as the first signals for seeking medical help from a specialist.
- The process of assimilation of food. If you follow the diet and other prescriptions issued by the doctor - problems with the assimilation of food should not arise. But in the event that the appointment was violated or even under the condition of proper nutrition, abdominal distention, constant heaviness in the stomach, discomfort after eating and so on are observed - it is worth undergoing a second examination.
- General state. A sharp decrease in efficiency in combination with frequent bouts of heartburn are a reliable sign of exacerbation of chronic enteritis. In order to prevent recurrence, you should immediately consult a doctor.
Treatment of chronic enteritis in adults with medication should be carried out in the same complex with a strict diet. By and large, the drug method is not aimed at eliminating the disease itself, but at alleviating the symptoms.
The most basic stage of treatment is the fight against dysbacteriosis, namely the colonization of the intestinal microflora with beneficial bacteria. Such agents are probiotics, which actively fight harmful bacteria.
Adsorbents are great helpers in reducing diarrhea and removing toxins from the body. These preparations produce a soft bowel cleansing. They also help with bloating, removing excess gases.
The administration of enzymes for the pancreas is often prescribed, since its functions in enteritis are often impaired. With acute symptoms of enteritis, one cannot do without inpatient observation.
If the disease passes in a severe form, then special steroid hormones are used to reduce inflammation in the intestines.
Anabolic steroids can also be an additional component. They contribute to the normalization of metabolic processes in the body, carrying out better and faster recovery of intestinal microflora.
The most popular herbs that help to cope with inflammation are considered to be:
- marsh calamus root,
- Birch buds,
- the root of Aralia Manchzhur
- immortelle flowers sandy,
- bloody red hawthorn flowers,
- valerian root,
- three-leaf watch leaves,
- Oregano grass,
- calendula flowers,
- nettle leaves,
- Linden flowers heart-shaped,
- dandelion root,
- peppermint leaves,
- flowers of tansy,
- plantain leaves,
- flowers five-lobed motherwort,
- garden dill seeds,
- horsetail grass,
- hop cones,
- the grass of the series is tripartite,
- greater celandine
- brown rosehip fruit.
They make infusions and decoctions.
In the diet of the patient with chronic enteritis should include soups in vegetable broth, allowed light fat-free meat or fish broth. Vegetables must be well wiped and boiled. Porridge should be prepared mainly in water or add a little milk. Also in the diet are allowed to include cheese, kefir and other dairy products. Fruits better finely wipe and make them jelly.
It is allowed to eat vegetables - potatoes, pumpkins, zucchini, cabbage, beets, carrots. If greens are added, it should be finely chopped. Vegetables can be stewed or boiled.
Also in the diet is allowed to include some meat products, preferably low-fat varieties of birds, but also turkey, beef, rabbit. Without skin. Meat dishes must be boiled or baked in the oven. In the same way you can do with lean fish.
Diet for chronic enteritis limits baking and flour products, if you want sweet, you can use honey, jam, marshmallow and candy can also be allowed.
Here is an approximate daily ration for a person who is sick with enteritis:
- Breakfast: you can eat a boiled egg (preferably soft-boiled), porridge (mostly oatmeal), drink tea.
- Lunch: broth, steamed patties, drink jelly.
- Dinner: fish and vegetable salad, tea. An hour before bedtime, you can drink a glass of fresh (1-2 day) kefir.
The main thing is to remember that the doctor prescribes adequate treatment, diet and daily regimen. In no case can not self-medicate.
Regime and diet therapy of enteritis
In case of severe exacerbation or severe course of the pathology, the patient is recommended hospitalization in a gastroenterology with the obligatory observance of bed restraint.
In the case of mild enteritis, the patient can be treated on an outpatient basisHowever, the patient is forbidden to physically hard work and psycho-emotional stress.
One of the main objectives of diet therapy is the thermal, chemical and mechanical sparing of the eneum (small intestine). In cases of acute exacerbation and severe diarrhea, the patient prescribed several "hungry" days, during which strong tea, black currant juice and so on, with a total volume of 2 liters, are taken.
“Hungry” days can be replaced by kefir, apple, carrot days (with normal tolerance). After that the patient goes on diet table number 4 or its variations (46, 4c). Such a diet provides for a complete (in terms of the amount of vitamins, protein and minerals) nutrition in combination with maximum intestinal cleansing (due to the characteristics of culinary processing).
Meals allowed to receive
The diet provides the minimum amount of carbohydrates, fats and a full amount of protein (total calorie 2100 kcal / day). The dishes are steamed or boiled and rubbed. Meal fractional (up to 6 times per day). Among the products recommended by patients, there are:
- bakery products (white thinly chopped crackers),
- soups on mucous broths with the addition of pureed boiled meat, sausages, meatballs,
- fish and meat (meat / fish steam cutlets, meat souffle, low-fat boiled and ground (rabbit, beef) meat),
- cereals (porridge (oatmeal, buckwheat, semolina) on low-fat broth or water. Pasta and legumes are prohibited),
- eggs (boiled or in the form of a steam omelet) 1−2 per day,
- dairy products (only fresh ground coffee),
- fats (butter 5 g / porc.),
- sweets, berries, fruits: sugar 40 g / day, jelly and jelly from pears, bird cherry trees, blueberries,
- drinks: cocoa and coffee on the water, tea, decoction of blueberries, wild rose,
Prohibited: snacks, alcohol, sauces, spices.
After 5 days, the patient goes on a diet 46.
Restoration of normal microflora
If enteritis is a result of infections or its exacerbations are associated with reinfection with intestinal infections and helminthic invasion, then antibacterial / antiviral / anthelmintic drugs are prescribed: erythromycin, chloramphenicol, etc. depending on the cause of infection.
As a rule, almost all patients with chronic enteritis dysbacteriosis is detected. To eliminate this condition, it is recommended to receive:
These drugs include “good” bacteria inherent in a healthy person, they help reduce the manifestations of dysbiosis and achieve enteritis remission. Therapy with these agents usually lasts up to 1.5 months.
Adsorbents, coating and astringents
These groups of drugs are mandatory for prescribing enteritis in patients with severe diarrhea.
Astringents. The astringent effect of drugs is realized due to their ability to precipitate proteins with the formation of albuminates, to form a protective film and reduce inflammation.
Among such means the most effective are: calcium carbonate and basic bismuth nitrate.
Drugs with sorbing action are prescribed for a pronounced exacerbation of the disease, which is accompanied by severe intoxication. The most popular among sorbents: "Enterodez "," Polyphepan "," Activated coal "," Belasorb».
Herbal medicine for chronic enteritis
Treatment of pathology with the use of pharmacological agents is often combined with the use of medicinal plants. Among such herbal remedies:
- with bactericidal and bacteriostatic effects: pomegranate and cranberry juice, blueberries, strawberries, raspberries, rosehip,
- with analgesic and antispasmodic actions: St. John's wort, chamomile, calendula, sage, yarrow,
- with anti-inflammatory, astringent and antidiarrheal effects: blueberries and bird cherry (fruit), oak (bark), alder (seed), St. John's wort (grass), burnet (root and rhizome).
Phytotherapy normalizes intestinal functions, improves digestion processes, restores the “right” intestinal microflora, eliminates dysbacteriosis, reduces inflammation from the intestinal mucosa, and has a beneficial effect on the patient's nervous system.
Normalization of digestion and absorption
Chronic enteritis is often combined with disorders in the stomach and pancreas. That is why the treatment of ailment provides supportive treatment for these organs that directly affect the digestive processes in the intestine.
- In the case of secretory gastric insufficiency, they are prescribed: gastric juice, Pepsidil, Betacil, Limontar.
- With insufficient production of pancreatic enzymes, they are used: Pancreatin, Solizim, Festal, Enzistal, Somilazu, Mezim Forte, and so on.
- When chronic enteritis is combined with cholecystitis and biliary duct diskinesis, choleretic drugs are used: Liobil, Allohol, Cholensim or Oksafenamid, Berberin (with increased diarrhea).
Therapy for diarrhea with enteritis
Treatment of frequent stools (diarrhea) is one of the important stages in achieving remission. To rid the patient of this unpleasant and dangerous symptom, the following actions are recommended:
- Correction of diet: the inclusion in the diet of food that contains tannin contribute to the containment of emptying. These products include: jelly, cereal, mucous soups, cocoa, tea, blueberries.
- The appointment of antibiotics (it is advisable if enteritis is caused by foreign microflora).
- Normalization of intestinal motility.
- The use of antidiarrheal drugs.
There are five types of such tools:
- inhibitors of the nervous parasympathetic system: adrenomimetics ("Ephedrine") and anticholinergics (belladon extract, "Atropine", "Platyphylline"),
- drugs that affect intestinal motility (Codeine, Raecec, Loperamide, Nufenoxol)
- means for consolidation of feces (calcium carbonate, bismuth preparations),
- drugs with antisecretory effect ("Berberine", nicotinic acid, "Indomethacin", salicylic acid and neuroleptics),
- drugs that contribute to the secretion of bile with feces (aluminum hydroxide, "Polyphepan", "Cholestyramine").
In cases of the prevalence of hypermotorics and intense pain, myotropic antispasmodics are prescribed: “Galidor "," No-shpa "," Fenibaberan».
In order to reduce the speed of evacuation, the patient is prescribed "Metatsin, Platifillin, or Atropine».
In case of constipation (rarely found with enteritis), it is recommended to take laxatives.
“Metoclopramide” (“Zeercal”) is taken as a stimulator of intestinal motor activity.
Correction of electrolyte and metabolic disorders
Such violations most often occur in patients with malabsorption syndrome (that is, a 2–3 degree of enteritis). Correction of disorders in protein metabolism is carried out as follows:
- increase the amount of protein in the diet, the use of white enpitov,
- use of anabolitic steroids ("Metylandrostendiol", "Retabolil", "Nerobol"),
- the introduction of protein nutrition through a probe drip into the stomach ("Aminazol", "Casein", "Alwezin"),
- administration of albumin, plasma and a mixture of amino acids ("Polyamine", "Aminoplasmol") by intravenous drip,
- the introduction of protein hydrolysates ("Aminotroph", "Aminokrovin", "Infusamin") intravenously.
To restore fat metabolism:
- adjust the daily diet by adding foods rich in fatty acids (olive oil, margarine, sunflower oil),
- take Essentiale (intravenous),
- in case of significant weight loss and a decrease in the amount of phospholipids in the blood, “Lipofundin” is administered.
Elimination of electrolyte and vitamin deficiency
Most often, patients with chronic enteritis suffer from hypocalcemia, magnesium, phosphate and iron deficiency, along with an increase in sodium levels, due to the activation of the adrenal mineralocorticoid activity. On this basis, it is recommended that patients:
- in case of hypocalcemia, calcium gluconate / glycerophosphate is administered orally, in case of severe shortage - intravenous sodium chloride,
- with hypokalemia - intravenous administration of potassium chloride in combination with glucose. With a slight deficiency - Panangin tablets inside,
- with prolonged and severe diarrhea, it is necessary to restore the water balance; for this, patients are prescribed Ringer's Solution, glucose, Disol, sodium chloride, Trisol intravenously and an increase in the total volume of liquid consumed to 4 liters / day.
- Vitamin and microelement deficiencies are replenished with the use of multivitamin complexes (Duovit, Vitrum, etc.) and rationalization of nutrition. In case of severe impairment of the absorption function, the vitamins PP, B, C are administered parenterally.
Treatment of anemia in chronic enteritis
Most often in patients with malabsorption syndrome, iron deficiency anemia is found, less often B12-deficient or a combination thereof.
To eliminate iron deficiency anemia, patients are advised to take "Ferrum-lek "," Ferroplekt" and so on.
To combat the B12 deficiency state, intramuscular administration of vitamin B12 is prescribed.
Clinical supervision of patients
The examination of patients is carried out by the therapist, and the patient is examined twice a year. Consultation of a gastroenterologist and carrying out diagnostic measures (ultrasound, FGDS, level of trace elements, proteins, etc.). After achieving remission, it is recommended:
- therapeutic diet
- in case of dysbacteriosis - restoration of microflora for 3 months,
- taking multivitamins,
- repeated exchange (2−3 months / year) reception of enzymes,
- taking drugs to normalize intestinal motility,
- treatment in dispensaries.
Dispensary observation includes patient disability issues. So, with a mild degree of chronic enteritis, the patient is able-bodied after achieving a stable remission. In the case of enteritis of moderate severity - the ability to work is limited, such patients are banned heavy nat. loads, long trips and work, in which it is impossible to follow a therapeutic diet. In severe malabsorption syndrome and exhaustion (that is, a severe course of enteritis), patients are recognized as disabled.