Ulcerative colitis (ulceIat-ve colltls) is a non-specific inflammatory bowel disease, also known as idiopathic ulcerative colitis, which is mainly ulcerative and invades the rectum and colon. It can develop in all age groups, but is mostly seen in young adults, and the ratio of men to women is close. The incidence in China is much lower than that in Europe and the United States.
Its etiology has not been fully elucidated, and may be related to the following factors.
① autoimmune factors;
②Infection factors;
③Hereditary quality;
④Psychoneurological factors.
Diagnostic criteria.
① with typical clinical manifestations and one of the characteristic changes of colonoscopy or X-ray;
② atypical clinical manifestations, but with typical colonoscopic or x-ray manifestations or pathological biopsy confirmation;
③Exclude bacillary dysentery, amebic dysentery, schistosomiasis, intestinal tuberculosis and Crohn’s disease, radiation enteritis and other colonic inflammatory diseases.
Treatment
(a) General treatment
1, rest, diet and nutrition: patients in the active phase should emphasize adequate rest, acute exacerbation, especially in severe patients should be hospitalized. It is generally advisable to give a liquid diet during the exacerbation period, and change to a high-calorie, high-protein, vitamin-rich low residue diet after the condition improves. Some patients may be allergic to cow’s milk protein, and the consumption of cow’s milk may aggravate abdominal pain and diarrhea, so the intake of dairy products should be restricted for these patients. Patients with iron deficiency, folic acid deficiency or anemia can be supplemented with oral or injectable supplements, and blood transfusion if necessary. Patients with hypoproteinemia can receive intravenous infusion of serum albumin, plasma, etc.
2. Correction of disorders of water and electrolyte balance: Severely ill patients with severe diarrhea and fever are prone to disorders of water and salt metabolism and acid-base imbalance, and high-dose hormone therapy increases urinary potassium excretion, which is more likely to cause hypokalemia, and the latter can induce toxic intestinal dilatation. Therefore, these patients should be closely observed for changes in their condition and timely correction of water and electrolyte balance disorders and acid-base imbalance.
3, symptomatic treatment: abdominal pain is obvious that the appropriate application of antispasmodic analgesics such as atropine, probenecid and other compound phenylephrine, although it helps to reduce diarrhea and relieve abdominal pain, but the risk of inducing toxic intestinal dilatation in patients with severe disease, should be used with caution.
(II) drug treatment
1, salazosulfapyridine (SASP), generally as the drug of choice, for light, medium or severe patients by adrenocorticotropic hormone therapy has been remission, withdrawal of hormone for the consolidation of efficacy, reduce recurrence.
It is believed that 5-AsA is the therapeutic component that may control and eliminate inflammation by inhibiting prostaglandin synthesis, xanthine oxidase or leukocyte-mediated oxygen free formation pathways.
The usual adult dose is 2g/d-4g/d in 4 oral doses, but some advocate starting with small doses and gradually increasing the dose to improve patient tolerance. Usually the duration of action is 2-3 weeks, and the maintenance dose is usually 2g/d after the symptoms are relieved.
Currently there are also suppositories inserted into the anus, so that the drug is slowly released in the rectum; more suitable for the distal rectal type.
There are now a number of new 5-ASA enteric-coated preparations that allow the drug to be released slowly in alkaline intestinal fluid to maintain an effective concentration in the colon for therapeutic purposes. These drugs include Osalazine, Pentasa, and Asacol. l. 5-ASA can also be used for retention enemas, 1g/d, for 2-4 weeks, which are more effective for mild and moderate rectal and colitis.
Some patients may experience the following side effects: nausea, vomiting, rash, headache, leukopenia, hemolytic reactions, etc., and the absorption of folic acid may be inhibited by sulforaphane, leading to megaloblastic anemia, so folic acid should be supplemented during the drug administration. If rash, leukopenia or hemolytic reaction and other toxic side effects occur, the drug should be changed to other drugs.
2.Adrenocorticotropic hormone is recognized as an apparently effective drug for patients with severe acute exacerbations or chronic moderate patients for whom other therapies are ineffective. Its mechanism of action is mainly non-specific anti-inflammatory effect. It can also suppress autoimmune processes and reduce toxic symptoms.
In patients with severe disease, larger doses of corticosteroids are usually used as intravenous drip therapy, commonly used preparations are hydrocortisone or hydrocortisone sodium succinate, 200mg/d to 300mg/d, which can control the symptoms faster. After a week, prednisone can be changed to 40mg/d～60rng/d. After the symptoms are relieved, the dosage can be gradually reduced, and the rate of reduction should be slow, usually 5mg for 7-10 days to avoid rebound. Maintenance dose of 10mg/d-15mg/d can be maintained for more than a month or several months, and then gradually reduce the dose until discontinuation. Maintenance therapy or after discontinuation of the drug may be given with salazosulfapyridine to avoid recurrence.
Patients with distal rectal type or left hemicolectomy can be treated with hydrocortisone succinate 50mg-100mg dissolved in saline 60ml-100ml as a retention enema once a night, and then changed to 2-3 times a week for 1 to 3 months after the condition improves. This method can reduce the side effects of hormones, and is a better treatment for light and medium-sized patients.
When applying hormones, attention should be paid to their side effects. Especially in the acute stage, the application of high dose hormone can cover up the fever and colon perforation caused by sepsis, as well as the increase of urinary potassium excretion causing hypokalemia and inducing toxic intestinal dilatation, therefore, close observation and attention should be paid to the change of signs and appropriate potassium supplementation.
3. Azathioprine is an immunosuppressant. It produces mercaptopurine by decomposition in the body and exerts its immunosuppressive effect. Generally, azathioprine 50mg/d~75mg/d, divided into oral doses, can be used cautiously when salbutamol or corticosteroid treatment is ineffective. It is generally considered to take 3 months of medication to have a better effect.
Side effects of the drug include gastrointestinal reactions, granulocyte deficiency and bone marrow suppression. It is not suitable for use during pregnancy because it can cause malformation through the placenta.
4.Chinese medicine Chinese medicine includes colonicin (composed of Pu huang, polygonum cuspidatum, etc.), tin type san (containing pearl, niu huang, ivory shavings, ice chips, etc.) or tin type san plus Huang Lian Su mixture as a reserved enema, which can relieve mild to moderate ulcerative colitis by activating blood stasis, anti-inflammatory and anti-diarrheal treatment. In addition, evidence-based treatment can alleviate the patient’s symptoms and enhance physical fitness.
(iii) Surgical treatment
Indications for surgery include: severe intractable total colitis or toxic intestinal dilatation that has failed medical treatment, or complicated by colon cancer, intestinal perforation, abscess and fistula formation. Surgery is usually performed by ileostomy or total colectomy if necessary.