Patient: Onset in 1998, stools were small, segmented and less formed, with thick staining and sometimes thick paste-like liquid. She had alternating diarrhea and constipation. At night, she had abdominal pain and a feeling of stool, but she could not pass stool, and all she could get out by force was some liquid. The body is thin, pale and weak. Western medicine: take an antibiotic for enteritis internally; Chinese medicine: take a medicine and soup, also an enema, but the effect is not satisfactory, but also lost confidence in the treatment. Western medicine: take an antibiotic for enteritis internally; Chinese medicine: take a medicine and soup, also an enema, but the effect is not satisfactory, but also lost confidence in the treatment. You are an authoritative expert with excellent medical skills and high medical ethics, and I am looking for you by name. I will be eternally grateful! By the way, is the new 5-aminosalicylic acid the name of the medicine? Where can I buy it? I have a severe allergic reaction to vomiting from sulfonamides. I would like to try this medicine. Huang Haili, Department of Gastroenterology, Beijing 301 Hospital: From your description, it is not certain whether it is ulcerative colitis. It is recommended that a colonoscopy be performed and the diagnosis made clear before treatment. Usually, the classic drugs for ulcerative colitis are 5-aminosalicylic acid. Currently, the most commonly used drugs in the market are “salazosulfapyridine” or the more effective “mesalazine enteric tablets” with fewer side effects or the imported “mesalazine granules” with the trade name “Addisha”. Note that before taking the above mentioned drugs, it is crucial to have a colonoscopy to determine the diagnosis. Patient: Dear Director Huang: Hello! You can reply to me in your busy schedule, I thank you very much for your concern! I was also a soldier in the 1980s, and after returning to the local area, I suffered from colon disease due to the difficult working environment. When I had a barium enema, I found that the whole colon was in a beaded pattern. (Barium meal of the whole gastrointestinal tract, without intestinal lavage.) The wound from the Cambodian tail infection surgery ten years ago healed well, but two years later, while riding a bus, a passenger next to me backhanded a heavy blow on my wound due to inertia, and since then this area has been in constant pain. Is it suspected that ulcerative colitis is a blood-stained stool? Can I be basically diagnosed with ulcerative or general colitis without a colonoscopy for this kind of thick liquidy stool? Can both types of colitis be treated with 5-aminosalicylic acid or mesalazine enteric-coated tablets? The main reason for this is that it is not a good idea to use the same type of tablets. It can be treated according to ulcerative colitis. The diagnosis is usually supported by the short-term effect of treatment. Since the risk of colon cancer is higher in ulcerative colitis than in normal people, regular colonoscopy is recommended. Patient: What is the most appropriate medication for ulcerative colon? How many times a day do I take a few tablets? How long is a course of treatment? How many courses of treatment are usually needed to achieve results? Once again, I would like to ask the esteemed Director Huang for his advice. The first treatment is recommended for at least one year, with the amount of medication decreasing from high to low. The initial dose of medication is determined by the severity of the disease. The severity of the disease is determined by the endoscopic manifestations, the number of pus and blood stools, the high and low blood sedimentation and blood protein levels. Usually, for severe cases, the initial dose is given as follows: mesalazine enteric coated tablets or (powder) 4-4.8g/day in 3-4 oral doses for 1 month, effective, then adjust the dose. Eventually, the treatment is maintained with 1.5-2g/day for about 1 year, and subsequent medication is judged according to the effectiveness of treatment. If the above drugs are not effective, hormones, enemas, suppositories, etc. can also be added. Patient: My wound from appendicitis surgery ten years ago recovered completely. Unfortunately, two years later when I was riding a bus due to a sharp turn, a passenger next to me backhanded a heavy blow on my incision scar under the effect of inertia, and this area was often painful thereafter, but later returned to normal. At the end of November last year, while playing with a child after a meal, the pain started again due to violent running back and forth, and it was a hot and constant pain, very uncomfortable, the pain subsided at night when I slept, and gradually started again after getting up and moving around, the frequency of stools increased significantly, and sometimes I had the urge to poop but could not, the stools were small and segmented with white or thick staining. It has been so long now, but the pain has not improved at all. What kind of tests should be done to get a definite diagnosis and how to treat it? Is it a symptom of Crohn’s disease? Or is it intestinal adhesions? Huang Haili, Department of Gastroenterology, Beijing 301 Hospital: Differential diagnosis is needed between Crohn’s disease and ulcerative colitis. We suggest you to do a barium enema examination of the small intestine. Because, Crohn’s disease is more common in the small intestine and ileocecal region. Patient: When you do a small intestine barium enema, will the barium pass through the inflammatory colon and bring a lot of bacteria into the small intestine, causing secondary infection in the small intestine? Huang Haili, Department of Gastroenterology, Beijing 301 Hospital: No. Because most of the bacteria in the barium is absorbed by the stomach, it can cause secondary infection. Because most of the bacteria in the barium are killed by stomach acid. A small number of bacteria will be swallowed by the immune cells in the small intestine when they enter the intestine. Moreover, the human digestive tract, especially the end of the small intestine and the colon itself, is full of bacteria. However, if the inflammatory bowel disease is already severe, with the presence of peritonitis, perforation or obstruction, it is better not to do a barium contrast examination. Patients: So without barium examination, can there still be other methods of examination? Huang Haili, Department of Gastroenterology, Beijing 301 Hospital: It is best to do a barium enema. CT-enhanced scan of the abdomen is also a second choice, but is rarely chosen. Patient: Under what circumstances can a barium enema test confirm the diagnosis of Crohn’s disease? Huang Haili, Department of Gastroenterology, Beijing 301 Hospital: First of all, we must exclude chronic intestinal infections such as intestinal tuberculosis, amoebic dysentery, Yersinia pestis infection, intestinal lymphoma, diverticulitis, ischemic enteritis and Behcet’s disease. If you only do a barium enema, all of the following criteria must be combined to diagnose Crohn’s disease: non-continuous or segmental lesions, fissure-like ulcers or pavement polyp-like changes, intestinal strictures, and fistulas found.