Colitis is an inflammatory bowel disease in which the epithelial layer of its mucous membrane is gradually distorted. The process of dystrophy is manifested in the thinning and weakening of the mucous membrane, as well as in the deterioration of its regenerative properties.
Due to the peculiarities of nutrition and development, children of middle and high school age often get sick with colitis, but the danger of its occurrence is preserved in infants and in kindergarten children.
The development of the disease is affected by a combination of negative, both exogenous (external) and endogenous (internal) factors.
- congenital predisposition;
- fetal abnormalities;
- wrong diet;
- poor diet;
- infection with intestinal parasites;
- predisposition to allergies;
- intestinal infections;
- infection of the digestive tract by the bacterium Helicobacter pylori;
- uncontrolled intake of antibacterial and other drugs;
- intestinal dysbiosis.
Colitis in children under one year most often develops on the background of congenital malformations of the organs of the gastrointestinal tract with the addition of frequent viral infections, a tendency to allergies and lactose intolerance. In the case of children who are bottle-fed, the risk factors also include improper selection of the formula.
It is more difficult to determine the inflammation of the intestines, the smaller the child's age. Often, the manifestations of the disease are accepted by parents for a temporary problem. This is especially true for infants - in their case, the symptoms are blurred and may resemble a normal digestive disorder due to a mild intestinal infection or a violation of the diet by the nursing mother. Such a picture is misleading not only parents, but also pediatricians.
In children older than one year, it is easier to determine the disease, since the symptoms become more pronounced and it is easier to determine what is worrying him by the behavior of the child at this age.
Common symptoms for children of all ages include:
- Disorder of the bowel. Digestive disorders can manifest themselves in different ways and alternate with each other: from watery frequent stools to constipation lasting several days.
- Increased gas formation. Due to the violation of the mucosal structure, the intestinal immunity suffers, which causes an imbalance of microflora. It notes the predominance of pathogenic microorganisms, the result of their vital activity is an increase in the volume of gases in the intestine. The abdomen of the child becomes swollen, the skin on it is stretched, belching appears, frequent discharge of gases.
- Nausea and vomiting occur at stages when a child’s colitis is at a developmental stage - this is how the body signals the beginning of the pathological process in the gastrointestinal tract (GIT). Also, vomiting can be a companion of chronic colitis during periods of exacerbations.
- Impurity in feces - pus, blood, bile, mucus. Sometimes the number of blotches is so insignificant that their presence can only be determined using laboratory analysis (coprograms).
- Dehydration occurs with frequent loose stools. In this case, along with the feces, the body leaves a large amount of water. Dehydration can be determined by dry, flaky skin, the smell of acetone from the mouth, pallor, lethargy.
- Abdominal pain localized below the navel.
Note. The intestinal mucosa is of important functional importance - with its help is the absorption of nutrients. Therefore, dystrophic changes of this organ are fraught with avitaminosis, which is manifested by deterioration of the skin, hair loss, brittle nails. In preschool and school children, a lack of vitamins and nutrients also affects mental activity: they become forgetful, inattentive, restless.
In babies up to one year, frequent regurgitations, anxiety, crying, refusal to eat, and pressing the legs to the stomach are added to the symptoms.
Colitis intestinal has a complex classification. When making an accurate diagnosis, a pediatric gastroenterologist examines such factors as the course of the disease, the causes of its occurrence and development, the location of the site undergoing dystrophy. Correct determination of the form of colitis allows you to assign effective treatment and quickly save the child from painful manifestations.
In the acute form of a child, a severe cutting pain in the abdomen suffers; the body temperature can rise to febrile (38.5-39 ° C). The disease is accompanied by pronounced intestinal symptoms - frequent stools (3-6 times a day), fluid, frothy, there may be residues of uncooked food, as well as bloody mucous blotches. Sometimes the clinical picture is complicated by nausea and vomiting.
This condition is typical for the early stage, as well as for periods when the chronic form of the disease is exacerbated due to the influence of external and internal factors. The cause of the appearance is often the infection of the digestive tract with the pathogenic bacterium Helicobacter pylori.
Acute forms also include spastic colitis, a condition in which the intestine spasms more often than with other types of diseases. In this regard, the nature of the pain changes - they become paroxysmal. Among the symptoms of the disease is also present "sheep" feces - solid, with pronounced individual segments.
Even with timely and adequate treatment, the acute form in most cases spills over into the chronic. At the same time, the symptoms become more blurred - the pains dull, become aching, vomiting and nausea cease. After eating, belching appears, in very young children - regurgitation. There are signs of increased gas formation: swollen abdomen, feeling of fullness, periodic discharge of gases.
If a patient undergoes systematic treatment and follows a diet under the supervision of parents, chronic colitis may be asymptomatic, with rare exacerbations or without them. At the same time, the intestinal mucosa is gradually restored, although complete regeneration is impossible.
Nonspecific ulcerative colitis
The most common form of the disease, the causes of which are often unclear. Usually, ulcerative colitis in children develops as a result of a combination of genetic predisposition and eating disorders. Often, the picture is exacerbated by other diseases of the gastrointestinal tract - gastritis, gastric ulcer, duodenitis, problems with the pancreas.
The name of the disease was due to the similarity of its clinical picture with gastric ulcer and duodenal ulcer, namely: dystrophy of the mucous membrane, where in some places the affected areas are transformed into ulcers. Sometimes these areas capture a large area of the intestine, but in most cases are located fragmentary. Ulcerative colitis can occur in chronic and acute forms.
- Acute form
It is characterized by severe manifestations of the disease: severe pain in the left abdomen, fever to febrile and subfebrile levels. During periods of exacerbation, the ulcerated areas open and begin to bleed. As a result, laboratory analysis shows the presence of blood in the feces of a sick child, and his general condition is deteriorating: weakness, apathy, appetite, weight loss, joint pain are observed.
- Chronic form
Unlike acute, it proceeds more gently, since during remission the intestinal mucosa tends to partially recover, the ulcerated areas are tightened with a new layer of epithelium. The disease may be exacerbated due to inappropriate medication, failure to diet, stressful situations, overwork. Chronic colitis can be manifested by difficulties in emptying the bowels - constipation, false urge to defecate, feelings of incomplete bowel movement.
The danger of this form of the disease lies in the fact that with the disappearance of the pronounced symptoms, the parents of the child may mistakenly decide that he has fully recovered, stop following a diet and undergo tests.
Examination of the patient reveals swelling of the affected areas of the intestine, destruction at different depths of the mucosa, in rare cases reaching the submucosal layer. Sometimes the inflammatory process is accompanied by the formation of polypous growths.
Infectious (allergic) colitis
This type of disease occurs as a complication of acute intestinal infections (most often in the defeat of the digestive tract with salmonella, shigella, streptococcus), helminthic invasions, fungi. The disease is characterized by rapid onset and development, accompanied by vomiting, diarrhea, sharp pain in the abdomen. Among the reasons that provoke this pathology of the mucous membrane, there is a long-term use of antibacterial drugs, especially in children under 6 years of age.
Features of diagnosis. Accurate diagnosis of infectious colitis is difficult due to the frequent mixed etiology of the disease - chronic diseases of the digestive organs are usually associated with a viral or bacterial infection. To complete the picture requires a wide range of laboratory tests, as well as a number of hardware research.
One of the most severe types of infectious colitis is pseudomembranous colitis (PMC), the development of which is provoked by the bacterium Clostridium difficile. As with the defeat of other pathogenic microorganisms, PMK is characterized by an increase in the number of leukocytes in the blood, diarrhea of varying severity, a state of dehydration, and other manifestations of intoxication.
During the examination, differential diagnosis of colitis in children is of great importance, since it is very important to exclude the possibility of more serious diseases such as intestinal diverticulitis and tuberculosis, neoplasms (polyps, malignant and benign tumors, cysts), Crohn's disease, celiac disease.
To confirm the established chronic colitis in a child, as well as other types of inflammation of the intestinal mucosa, a number of laboratory and hardware examinations are prescribed:
- A detailed blood test: leukocytosis is detected, the level of hemoglobin and the number of erythrocytes in the blood are reduced, the ESR is increased and the protein level is increased.
- Colonoscopy: at the initial stage of the disease, edema, mucosal sensitivity, local temperature increase are detected, at later stages a characteristic pattern is revealed with the presence of erosive-ulcerative lesions that begin to bleed if touched with a hard object. There is no vascular pattern on the surface of the epithelial layer.
- The analysis of feces during colitis shows the presence of mucus, blood in the stool, and sometimes bile blotches.
If, during the examination of the intestine, a neoplasm is found in its cavity — single or multiple polyps, cysts — then they are removed with the subsequent sending of biological material for histology and biopsy. This eliminates the likelihood of malignant origin of tumors.
Treatment and Prevention
Treatment of colitis in children under three years old and older is carried out to a large extent with the help of normalization of the diet and diet. To alleviate the condition of the child and reduce the intensity of symptoms, a non-dairy diet enriched with meat, fish dishes, eggs is prescribed. Artificial children up to a year are transferred to a lactose-free hypoallergenic milk mixture.
In the case of breastfed babies, it is important to identify the etiology of the disease, since some cases of allergic colitis require an urgent transfer of the child to an artificial diet or a strict diet of the nursing mother.
From the diet of older children during periods of exacerbation, it is necessary to exclude all products that impede the process of digestion, corrode the walls of the mucous membranes, contribute to an increase in gas formation.
Such products include flour sweets, chips, crackers, salty and spicy crackers, whole fast food, sweet fizzy drinks, mayonnaise, ketchup, purchased and homemade pickles and canned foods, cocoa, coffee, chocolate. Minimize the need to eat legumes, raw fruits and berries (apples, grapes, plums, peaches, bananas, currants, raspberries, etc.), fatty meats, yeast pastries, corn and rice cereals.
The basis of the menu should be soups based on boiled vegetables and meat, stewed and boiled beef, rabbit meat, chicken, turkey meat, porridge (especially oatmeal, buckwheat, barley). Of the flour products can be used hard pasta varieties, rye and slightly dried white bread, buns with bran. Herbal drinks, jelly, black and green teas are useful.
Drug treatment of colitis is reduced to taking oral medications that improve digestion, protect and restore the intestinal mucosa. Well helps local therapy in the form of therapeutic enemas. Pain relief, laxatives or fixatives, antiviral and antibacterial drugs, glucocorticoids, and antipyretic drugs will help relieve symptoms. In the most severe cases that are not amenable to conservative therapy, resection is performed - removal of the intestinal section.
Preventive measures include annual medical examination with mandatory medical treatment, maintaining proper nutrition, moderate physical exertion.
Complications and prognosis
Acute colitis in a child may be complicated by such local manifestations as the formation of hemorrhoids, anal fissure, weakening of the sphincter, causing incontinence of gases and involuntary defecation during exercise, coughing, sneezing.
More serious consequences include cancer and intestinal diverticulitis, intestinal bleeding, inflammation of the gallbladder and pancreas, liver disease, and trophic ulcers. Infectious colitis often leads to the spread of infection in the digestive tract and throughout the body, as a result of which the child may experience complications such as stomatitis, tonsillitis, bronchitis, pneumonia.
Colitis is a serious disease, often exacerbated, difficult to treat, with many complications, requiring systematic examination and treatment. However, with the right approach and the implementation of all the recommendations of the doctor, the inflammation becomes chronic, which may not appear for several years. In general, the prognosis for life is conditionally favorable, but full recovery is impossible.