Ulcerative colitis in children is an inflammatory chronic bowel disease of unknown etiology, characterized by ulcerative and destructive changes in the mucous membrane of the colon.
Literally, colitis is an inflammation of the large intestine. Since the disease is chronic, it proceeds with exacerbations and periods of remission (recovery).
"Ulcerative" - characterizes the nature of the inflammation, when ulcers form on the mucous membrane of the colon. Non-specific - emphasizes the ambiguity of the cause of the disease and excludes other colitis, the etiology of which is known.
Ulcerative colitis (UC) is considered a common disease and occurs in almost all countries of the world. Its frequency is also very high among children, recently there has been a "rejuvenation" of the disease.
In order not to miss UC in children, the manifestations of which are similar to an intestinal infection, it is necessary to get acquainted with this disease in more detail.
The causes of ulcerative colitis
Despite numerous studies, the etiology of the disease remains unknown. Currently, ulcerative colitis is believed to be a multifactorial disease.
The development of necrotic inflammation of the mucous membrane is based on:
- genetic predisposition;
- violation of the intestinal immune function;
- the influence of environmental factors, in particular the intestinal microflora.
All these factors together lead to disruption of the protective function of the intestinal epithelium, resulting in the formation of chronic inflammation.
6 possible signs of ulcerative colitis in children
Ulcerative colitis is characterized by intestinal symptoms and general manifestations of the disease.
Intestinal symptoms
- Diarrhea - most often it is the debut of the disease. Initially, there is multiple loose stools, frequent false urge to defecate. The frequency of bowel movements can be up to 20 times per day. Then, impurities of mucus and blood begin to appear in the stool. Gradually, the amount of blood in the stool increases, and can even reach 50-100 ml. Sometimes there is a discharge of blood without stool. Frequent stool is observed mainly at night and in the early morning, when feces enter the lower intestine, where the inflamed part of the intestine is most excitable and stimulates emptying. The intensity of diarrhea depends on the severity of the disease and the prevalence of the inflammatory process.
- Pain - a symptom that is not observed in all children and has no distinctive features from pain in intestinal infection. Most often, there are acute abdominal pains localized in the lower left sections.
- The pain is not constant, spastic in nature, intensifies before defecation, and after bowel movement - subside. Abdominal pains are also accompanied by general anxiety, moodiness of the child.
- Constipation - a very rare, but still sometimes occurring symptom. The disease begins with constipation when the lowest parts of the intestine are affected and the soreness of the inflamed mucosa prevents the release of feces. At first, the stool will be decorated with an admixture of blood, later it will become mushy, and after 3-6 months it will change to liquid.
- Common symptoms of ulcerative colitis: decreased appetite, general weakness, fatigue, progressive weight loss, intoxication (pallor of the skin, dry mucous membranes, nausea, vomiting). The occurrence of general symptoms will depend on the prevalence of colitis and the activity of the inflammatory process. To assess the activity of ulcerative colitis, doctors use a special pediatric ulcerative colitis activity index.
This index is calculated in points, which take into account the intensity of abdominal pain, the frequency and consistency of the stool, the severity of blood in the stool, the number of nighttime bowel movements and the general activity of the child. Depending on the scores obtained, the severity of ulcerative colitis is set, on which the tactics of treatment and possible complications of the disease depend.
Extraintestinal manifestations
In addition to the main symptoms, ulcerative colitis can have extraintestinal manifestations... Manifestations from other organs and systems can occur as a result of intestinal dysfunction, and may also be in no way associated with manifestations of the underlying disease.
To extraintestinal manifestations include several signs:
- anemia... It can be posthemorrhagic (as a result of blood loss in the stool) or autoimmune (as a result of systemic hematopoiesis);
- skin syndrome... Various changes appear on the skin of the body and limbs (rash, vasculitis, necrotic gangrene);
- articular syndrome (joint pain, synovitis);
- damage to the liver and biliary tract (hepatitis, hepatosis, cholangitis);
- pancreatic pathology (acute pancreatitis);
- kidney damage (nephropathy);
- eye damage (conjunctivitis);
- delayed physical and sexual development, decreased intelligence;
- damage to the thyroid gland (autoimmune thyroiditis).
Most often, a combination of several extraintestinal manifestations is noted at once, and sometimes they are so pronounced that they come to the fore and complicate the diagnosis of the underlying disease.
Possible complications of UC in children
Ulcerative colitis in itself is a serious disease, moreover, it has formidable complications. You need to know about possible complications in order to be able to recognize them in time.
These include:
- profuse bleedingthat will lead to the development of severe anemia;
- bowel perforation with the development of peritonitis (release of intestinal contents into the abdominal cavity);
- sepsis - against the background of reduced immunity, the spread of pathogenic flora throughout the body is possible;
- development of intestinal obstruction - against the background of chronic inflammation and disturbance of the intestinal microflora, even if the inflammation subsides, chronic constipation may develop;
- colon cancer - chronic inflammation of the intestinal mucosa is a predisposing factor for the development of the oncological process.
8 methods for the diagnosis of ulcerative colitis
When making a diagnosis, complaints, the development of the disease and the patient's examination data are taken into account. But in order to confirm the diagnosis, additional methods of examination are needed, which are carried out for children upon admission to any Russian children's clinical hospital.
In the diagnosis of the disease, not only high-tech modern methods are important, but also simple laboratory tests.
Additional methods of examination for ulcerative colitis the following procedures apply:
- General blood analysis - will show the activity of the inflammatory process in the body (leukocyte count, leukocyte formula, ESR) and the severity of anemia (hemoglobin and erythrocyte levels).
- Blood chemistry - will reflect the functioning of the liver and pancreas, which will help exclude extraintestinal manifestations. C-reactive protein will show the activity of inflammation. In addition, violations of the electrolyte composition of the blood are possible.
- Coprogram - the presence of a large number of leukocytes, erythrocytes and mucus in the feces will confirm the inflammatory process in the large intestine.
- Bacteriological examination of feces - will exclude the infectious nature of colitis.
- Plain X-ray of the abdominal cavity - excludes the development of formidable intestinal complications: toxic expansion of the large intestine and its perforation.
- Irrigography - filling the sections of the large intestine with a radiopaque substance through the anus. There are signs characteristic of NNC: accelerated filling with contrast of the affected area of the intestine, smoothness of intestinal folds (haustrats), thickened walls of the affected intestine, swollen intestinal loops.
- Abdominal ultrasound - a less specific method that will show a thickening of the intestinal wall and a narrowing or expansion of the intestinal lumen. But this method is good for excluding concomitant damage to the liver, biliary tract, pancreas and kidneys.
- Colonofibroscopy - is the "gold standard" for the diagnosis of ulcerative colitis. In this study, using a camera, the mucous membrane of the entire large intestine is examined. This method will accurately determine the activity of the inflammatory process, its length and the presence of bleeding ulcers. In addition, colonoscopy allows you to take a biopsy of the mucous membrane of the affected intestine for histological examination, which will accurately confirm the diagnosis.
Treatment of ulcerative colitis in children
NUC is a very serious disease for children and requires an integrated approach. Therapy is selected depending on the activity of inflammation and the prevalence of the affected intestinal tract.
Treatment of NUC includes several points:
- medical and protective regime - in the acute period, it is important to limit physical activity, increase night and day sleep. When the inflammation subsides and the general condition improves, physiotherapy exercises, water procedures, massage of the anterior abdominal wall are prescribed;
- diet - the goal is thermal and mechanical sparing of the affected intestine. Nutrition depends on the age of the child. In young children, special mixtures are used based on a split protein (hydralizate). For older children, foods that contribute to increased gas production, increase peristalsis and intestinal secretion, and increase and thicken fecal masses are excluded from the diet. Limit dairy products;
- drug therapy - the choice of medication depends on the age of the patient and the severity of the colitis. The drugs of choice are 5-ASA (5-aminosalicylic acid) and corticosteroids. Due to their components, 5-ASA preparations are not degraded in the small intestine and reach the large intestine, where they directly have an anti-inflammatory effect on the large intestine. Systemic glucocorticosteroids have a general anti-inflammatory effect and are prescribed for patients with severe NUC or those who are not helped by 5-ASA drugs. Second-line therapy is immunosuppressive therapy - these are drugs that suppress the immune activity of the body's cells. This treatment helps with ulcerative colitis in those resistant to hormonal therapy, but has many side effects;
- colectomy - if long-term drug treatment of the child is ineffective or there are serious intestinal complications (perforation, massive bleeding, toxic megacolon), they resort to surgical treatment - the affected area of the large intestine is removed with an anastomosis.
Ulcerative colitis, as mentioned earlier, is a chronic disease and even in the presence of remission, long-term medical supervision is necessary. The child should be under dynamic supervision, since constant monitoring of analyzes and regular colonoscopy is necessary. In the absence of remission for a long time, children are issued disability.
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