Symptoms of intestinal colitis in a child. Nonspecific ulcerative colitis in children: causes, symptoms, treatment, diet. Treatment of acute colitis in a child

Colitis is an inflammatory disease of the intestine, in which the epithelial layer of the intestinal mucosa gradually degenerates. The process of dystrophy manifests itself in the thinning and weakening of the mucosa, as well as in the deterioration of its regenerative properties.

Due to the characteristics of nutrition and development, children of middle and high school age are more likely to suffer from colitis, but the risk of its occurrence remains in infants and kindergarteners.

The development of the disease is influenced by a combination of negative, both exogenous (external) and endogenous (internal) factors.

These include:

Colitis in children under one year of age most often develops against the background of congenital malformations of the gastrointestinal tract with the addition of frequent viral infections, a tendency to allergies and lactose intolerance. In the case of formula-fed children, risk factors also include incorrect selection of formula.

Symptoms

Determining intestinal inflammation is more difficult the younger the child is. Often the manifestations of the disease are mistaken by parents for a temporary problem. This is especially true for infants - in their case, the symptoms are blurred and may resemble a common digestive disorder due to a mild intestinal infection or a violation of the diet by the nursing mother. This picture misleads 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 from the child’s behavior at this age what exactly is bothering him.

Symptoms common to children of all ages include:

Intestinal disorder. Digestive disorders can manifest themselves in different ways and alternate with each other: from watery, frequent stools to constipation that lasts several days.
Increased gas formation. Due to disruption of the mucosal structure, intestinal immunity suffers, which causes an imbalance of microflora. It notes the predominance of pathogenic microorganisms, the result of whose vital activity is an increase in the volume of gases in the intestines. The child’s belly becomes swollen, the skin on it becomes tense, belching appears, and gases are often passed out.
Nausea and vomiting occur at stages when a child’s colitis is at the development stage - this is how the body signals the onset of a pathological process in the gastrointestinal tract (GIT). Vomiting can also be a companion to chronic colitis during periods of exacerbation.
Impurities in feces - pus, blood, bile, mucus. Sometimes the number of inclusions is so small that their presence can only be determined using laboratory analysis (coprogram).
Dehydration occurs with frequent loose stools. In this case, a large amount of water leaves the body along with feces. Dehydration can be determined by dry, flaky skin, the smell of acetone from the breath, pallor, and lethargy.
, localized below the navel.

Note. The intestinal mucosa has an important functional significance - with its help, nutrients are absorbed. Therefore, dystrophic changes in this organ are fraught with vitamin deficiency, which is manifested by deterioration of the skin, hair loss, and brittle nails. In children of preschool and school age, a lack of vitamins and nutrients also affects mental activity: they become forgetful, inattentive, and restless.

In babies under one year of age, symptoms include restlessness, crying, refusal to eat, and pressing their legs to their stomach.

Classification

Intestinal colitis has a complex classification. When making an accurate diagnosis, a pediatric gastroenterologist considers factors such as the course of the disease, the causes of its occurrence and development, and the location of the area affected by degeneration. Correct determination of the form of colitis allows you to prescribe effective treatment and quickly relieve the child from painful manifestations.

Classification of colitis:

Acute colitis

In the acute form, the child suffers from severe cutting pain in the abdomen, and 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), liquid, foamy, it may contain remnants of undigested food, as well as bloody and mucous inclusions. Sometimes the clinical picture is complicated by nausea and.

This condition is typical for the early stage, as well as for periods when the chronic form of the disease worsens due to the influence of external and internal factors. The cause of the appearance is often infection of the digestive tract with the pathogenic bacterium Helicobacter pylori.

Acute forms also include spastic colitis, a condition in which the intestines spasm more often than in other types of the disease. In this regard, the nature of the pain changes - they become paroxysmal. Among the symptoms of the disease there is also “sheep” feces - hard, with distinct individual segments.

Chronic colitis

Even with timely and adequate treatment, the acute form in most cases becomes chronic. At the same time, the symptoms become more blurred - the pain dulls, becomes aching, vomiting and nausea stop. After eating, belching appears, and in very young children - regurgitation. Signs appear: bloated stomach, feeling of fullness, periodic passing of gas.

If the patient systematically undergoes courses of treatment and follows a diet under parental supervision, chronic colitis can be asymptomatic, with rare exacerbations or without them at all. In this case, 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 often remain unclear. Typically, ulcerative colitis in children develops as a result of a combination of genetic predisposition and nutritional disorders. Often the picture is intensified by other gastrointestinal diseases - gastritis, stomach ulcers, duodenitis, problems with the pancreas.

The disease received its name due to the similarity of its clinical picture with peptic ulcer of the stomach and duodenum, namely: mucosal degeneration, in which in some places the affected areas transform into ulcers. Sometimes these areas cover a large area of the intestine, but in most cases they are located fragmentarily. Ulcerative colitis can occur in chronic and acute forms.

Acute form

It is characterized by pronounced manifestations of the disease: severe pain in the left side of the abdomen, increased body temperature to febrile and subfebrile levels. During periods of exacerbation, the ulcerated areas open and begin to bleed. As a result, a laboratory analysis shows the presence of blood in the stool of a sick child, and his general condition worsens: weakness, apathy appear, appetite worsens, weight loss, and joint pain are observed.

Chronic form

Unlike acute, it proceeds more mildly, since during remission the intestinal mucosa tends to partially recover, ulcerative areas are covered with a new layer of epithelium. The disease can worsen due to inappropriate use of medications, non-compliance with diet, stressful situations, and overwork. Chronic colitis can be manifested by difficulties in bowel movements - false urge to defecate, sensations of incomplete bowel movement.

The danger of this form of the disease is that when the pronounced symptoms disappear, the child’s parents may mistakenly decide that the child has fully recovered and stop following the diet and undergoing examinations.

When examining the patient, swelling of the affected areas of the intestine is detected, 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 when the gastrointestinal tract is affected by salmonella, shigella, streptococci), helminthic infestations, and fungi. The disease is characterized by a rapid onset and development, accompanied by vomiting and severe abdominal pain. Among the reasons that provoke this mucosal pathology is long-term use of antibacterial drugs, especially in children under 6 years of age.

Features of diagnostics. Accurate diagnosis of infectious colitis is difficult due to the often mixed etiology of the disease - a viral or bacterial infection is usually accompanied by chronic diseases of the digestive organs. To complete the picture, a wide range of laboratory tests, as well as a number of instrumental studies, are required.

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 damage to other pathogenic microorganisms, MVP 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.

Diagnostics

During the examination, the 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 diverticulitis and intestinal tuberculosis, neoplasms (polyps, malignant and benign tumors, cysts), Crohn's disease,.

To confirm 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:

Detailed blood test: leukocytosis, a decrease in hemoglobin levels and the number of red blood cells in the blood, an increase in ESR and protein levels are detected.
Colonoscopy: at the initial stage of the disease, swelling, sensitivity of the mucous membrane, and an increase in local temperature are detected; at later stages, a characteristic picture is revealed with the presence of erosive and ulcerative lesions, which begin to bleed if they are touched with a hard object. There is no vascular pattern on the surface of the epithelial layer.
Stool analysis for colitis shows the presence of mucus, blood, and sometimes inclusions of bile in the stool.

If, during an examination of the intestine, a neoplasm is discovered in its cavity - single or multiple polyps, cysts - then they are removed and the biological material is subsequently sent for histology and biopsy. This eliminates the possibility of a malignant origin of the tumors.

Treatment and prevention

Treatment of colitis in children under three years of age and older is carried out to a large extent by normalizing the diet and diet. To alleviate the child’s condition and reduce the intensity of symptoms, a dairy-free diet enriched with meat, fish, and eggs is prescribed. Artificial children up to one year old are transferred to lactose-free.

In the case of breastfed children, identifying the etiology of the disease is of great importance, since some cases of allergic colitis require an urgent transfer of the child to artificial nutrition or a strict diet for the nursing mother.

From the diet of older children during periods of exacerbation, it is necessary to exclude all foods that complicate the digestion process, corrode the walls of the mucous membrane, and contribute to increased gas formation.

Such products include flour sweets, chips, crackers, salty and spicy crackers, all fast food, sweet carbonated drinks, mayonnaise, ketchup, store-bought and homemade pickles and preserves, cocoa, coffee, chocolate. It is necessary to minimize the consumption of legumes, raw fruits and berries (apples, grapes, plums, peaches, bananas, currants, raspberries, etc.), fatty meats, yeast baked goods, corn and rice cereals.

The basis of the menu should be soups based on boiled vegetables and meat, stewed and boiled beef, rabbit, chicken, turkey, porridge (especially oatmeal and pearl barley). For flour products, you can eat hard pasta, rye and slightly dried white bread, and bran buns. Herbal drinks, jelly, black and green teas are useful.

Drug treatment for colitis involves taking oral medications that improve digestion, protect and restore the intestinal mucosa. Local therapy in the form of therapeutic enemas helps well. Taking painkillers, laxatives or restoratives, antiviral and antibacterial drugs, glucocorticoids, and antipyretics will help relieve symptoms. In the most severe cases, which are not amenable to conservative therapy, resection is performed - removal of a section of the intestine.

Preventive measures include annual medical examination with mandatory drug treatment, maintaining proper nutrition, and moderate physical activity.

Complications and prognosis

Acute colitis in a child can be complicated by such local manifestations as the formation of hemorrhoids, anal fissure, weakening of the sphincter, leading to gas incontinence and involuntary defecation during physical exertion, coughing, sneezing.

More severe consequences include intestinal cancer and diverticulitis, intestinal bleeding, inflammation of the gallbladder and pancreas, liver disease, and trophic ulcers. Infectious colitis often entails the spread of infection throughout the digestive tract and throughout the body, as a result of which the child may experience complications in the form of stomatitis, sore throat, bronchitis, etc.

Colitis is a serious disease, often exacerbating, difficult to treat, entailing many complications, requiring systematic examination and treatment. However, with the right approach and following all the doctor’s recommendations, inflammation becomes chronic, which may not appear for several years. In general, the prognosis for life is conditionally favorable, but complete recovery is impossible.

Ulcerative colitis is an inflammatory bowel disease that occurs in a chronic form. From which it follows that ulcerative and chronic are the same form of colitis.

What are the characteristics of chronic colitis in children? Colitis, in general, is an inflammation of the mucous membrane of the large intestine. When the diseased organ becomes inflamed, it becomes red, swollen, and painful.

With ulcerative colitis, the disease in children, entering the active phase, forms ulcers on the inner walls of the intestine.

In children, symptoms of active ulcerative colitis include diarrhea, blood in the stool, and pain in the iliac region.

However, this disease must be distinguished from another one known as Crohn's disease. The symptoms of ulcerative colitis and Crohn's disease or granulomatous enturitis are similar, however, there are some differences. In Crohn's disease, the focus of inflammation may be located no matter in which segment, from the oral cavity to the anus. The symptoms of the disease change depending on the location of the inflammation. However, only a specialist who can prescribe the correct treatment can determine what kind of disease it is. Fortunately, Crohn's disease is extremely rare in children.

Causes of the disease

Despite the fact that ulcerative colitis has been the subject of numerous scientific studies, its causes have not yet been established. However, a hereditary mode of transmission of ulcerative colitis has been established. A child whose parents or siblings have it has a high risk of also getting the disease. The percentage of cases in boys is slightly higher than in girls. However, in adolescent children, colitis is more common in girls.

So, the occurrence of ulcerative colitis in a child can be triggered by the following factors:

Genetic;
Unfavorable environment and product quality;
Weakened immune system;
Infections: dysbacteriosis, helminthiasis, etc.

Where does the disease live?

Ulcerative colitis is located only in the intestines. Those. ulcers spread to only one segment of the intestine. Ulcerative colitis can appear as a form of pancolitis, which is located throughout the intestine, localized on the right or left side. The prescribed treatment depends on the location of the inflammation.

Symptoms

Symptoms of ulcerative colitis in a child occur in various variations: stomach colic, diarrhea, bleeding from the anus, diarrhea, weight loss, chronic fatigue, loss of appetite. The child may have a fever, joint pain, multiple acne on the body, and red eyes. Someone may have one or two signs, while others may have all the symptoms at once.

Measles, ARVI, flu, abdominal injuries, stress - all these factors can serve as a favorable environment for the occurrence of ulcerative colitis. Among children, boys are more often susceptible to this disease.

Treatment

Treatment for colitis depends on the location of the ulcers and the presence of symptoms. There is dietary and drug treatment - pills, anal suppositories, enemas, intravenous injections.

Nonspecific ulcerative colitis

Sometimes, with ulcerative colitis in children, symptoms that are nonspecific to the digestive system appear.

Pallor of the skin,
Conjunctivitis,
Red, painful nodes under the skin
Inflammation of the iris of the eye,
Stomatitis,
Joint pain,
Temperature increase.

The consequences of ulcerative colitis in children are anemia, secondary intestinal infections, bleeding, intestinal obstruction, peritonitis and joint damage.

To date, the causes of nonspecific ulcerative colitis in children have not been fully elucidated. However, most doctors are inclined to believe that the provocateurs are allergens: food, inhalation.

In children, as a result of nonspecific ulcerative colitis, special changes are formed that differ from the changes that occur in the body of an adult. The rectum in children often remains intact.

Treatment of this colitis in children consists, first of all, of prescribing a dietary table. The nutritionist will create a menu for the child depending on the location of the source of the disease and pain, tolerance or intolerance to certain types of foods.

In addition, drug treatment for nonspecific ulcerative colitis is prescribed:

Sulfasalazine for normalization of biopsy data,
Antibiotics,
Spasmalholics.

With a timely diagnosis and correctly prescribed treatment, the prognosis is more favorable for a child than for an adult. However, more often the peak of the disease occurs during puberty in children.

Colon irritation

The process of excreting feces immediately after eating in a 6-month-old baby is normal. Often such urges can be observed in older children.

The risk of disease in an infant occurs from 6 to 18 months. An infant has bowel movements up to 6 times a day. The first feces are copious, partially formed. All subsequent bowel movements are scanty and contain undigested food. However, children retain a good appetite and there is no weight loss.

After diagnosis, the doctor prescribes treatment. The basic point of treatment is diet and medications that calm peristalsis.

Spastic colitis

Irritable bowel syndrome or irritable bowel syndrome is also called spastic or mucous colitis, which is characterized by bloating, cramps, and intestinal dysfunction.

The reason may be food that is poor in waste (brown bread, vegetables, cereals). The second possible reason is suppression of the urge to defecate.

Symptoms: dry “sheep” feces several times during the day, sometimes accompanied by pain and bleeding. The child sleeps poorly, gets tired quickly, and complains of a headache.

Spastic colitis is not a serious disease; rather, it refers to disorders of the gastrointestinal tract and manifests itself against the background of chronic fatigue, stress or overexcitement.

Like other types of colitis in children, spastic colitis is treated, first of all, with proper nutrition - following a diet and eating regimen.

Some tips for those diagnosed with spastic colitis: eat foods high in fiber, coarse bread, cereals, raw vegetables and fruits. It is recommended to minimize foods rich in carbohydrates.

Colitis is an inflammatory disease of the large intestine that affects the epithelial layer of the mucous membrane. In the case of a prolonged pathological process, dystrophy of the intestinal mucosa occurs with its thinning.

Why does colitis occur and how does it progress?

There is no exact answer to why colitis occurs in children due to the characteristics of each child’s body and social differences. When favorable conditions arise, colitis develops, sometimes due to a combination of factors and the appearance of an infectious agent.

Various provoking factors can contribute to the development of colitis:

hereditary predisposition;
stress and emotional excitability;
food poisoning;
long-term drug treatment;
immunity deficiency;
autoimmune diseases;
helminthic infestations;
defect of the digestive system or underdevelopment;
past infectious diseases.

In infants, colitis occurs with inflammation of the small intestine due to anatomical features. In older children, colitis is an isolated inflammation of the large intestine. Symptoms in children are severe from the first days of the disease. Colitis most often develops in children after suffering from an intestinal disease.

The main causative agents of colitis:

staphylococci;
coli;
streptococcus;
Mycobacterium tuberculosis;
viruses.

The herbal drug successfully relieves inflammation, cleanses the body, neutralizes pathogenic bacteria, viruses and fungi.

Classification of colitis

Colitis can be classified according to dystrophic changes in the intestines:

atrophic;
catarrhal;
erosive-ulcerative.

Inflammation can occur isolated in one place or in several, therefore colitis is distinguished:

Typhlitis. Inflammation of a limited nature of the cecum.
Typhlocolitis. Inflammation of the large and ascending intestines.
Transversit. Colitis, characterized by inflammation of the transverse colon.
Sigmoiditis. Inflammation of the sigmoid intestine.
Angulite. Inflammation of the area of the intestine located between the descending and transverse colon.
. Inflammation of the rectum.
Simple sigmoiditis. Inflammation of the sigmoid and rectum.
Pacocolite. Generalized intestinal inflammation.

Symptoms in a child

The disease begins suddenly and acutely with severe intoxication of the child’s body.

The disease is accompanied by the following complaints from the child:

nausea;
vomit;
weakness;
abdominal pain;
frequent stool.

Colitis is characterized by hyperthermia, nausea, and vomiting. Due to intestinal spasms, the child experiences pain and tenesmus localized in the iliac region. The frequency of stool reaches up to 15 times a day. The stool becomes greenish in color with mucus or streaks of blood. , the reasons can be found here.

Infants may experience rectal prolapse; symptoms of dehydration are severe: lethargy, dry mucous membranes and a decrease in the amount of urine and frequency of urination.

Chronic colitis has a wave-like nature, that is, remission of the disease is replaced by relapses. During relapses, symptoms of acute colitis appear.

Stool disorder in children with chronic colitis is expressed by alternating constipation with diarrhea. The feces have the appearance of undigested food, “sheep” or ribbon-like feces. Children often suffer from rectal fissures due to the passage of hard feces.

Psychovegetative disorders may appear in children with chronic colitis:

headache;
weight loss;
weakness;
sleep disturbance;
irritability.

Treatment should be started immediately! Protect yourself and your loved ones!

Causes of colitis in children

Colitis appears in children for the following reasons:

intestinal infection;
allergy;
eating disorder;
food poisoning;
unfavorable state of residence;
antibacterial therapy;
stress;
helminths;
heredity;
dysbiosis.

I didn't expect such an effect. The body was restored, even the skin became smooth and even, the stool returned to normal. I'm very happy with this result."

Diagnostics

It is very important to differentiate colitis from other diseases with similar symptoms. After all, treatment tactics and the outcome of the disease depend on the diagnosis.

List of diseases for differential diagnosis:

Crohn's disease;
hemorrhagic vasculitis;
intestinal infection;
helminths;
shigellosis;
abdominal form of tuberculosis;
appendicitis syndrome;
tumors and polyps of the colon;
celiac disease.

Necessary laboratory and instrumental studies:

general blood analysis;
blood chemistry;
stool analysis;
X-ray of the intestine;
intestinal endoscopy;
biopsy of material.

Treatment of colitis

A therapeutic diet is necessary for patients with acute forms of colitis, and is also recommended for its chronic forms. The diet helps reduce the inflammatory process in the intestines as a result of reducing the processes of fermentation and rotting of food in the digestive system.

Diet No. 4

Table No. 4 implies limiting the intake of fats and carbohydrates in the diet and using a gentle regime for the intestines to avoid irritation of the digestive organs. The recommended energy value of the diet should be no more than 2050 kcal.

Diet features:

Indications for prescribing the diet:

inflammatory bowel diseases.
dysentery;
gastroenteritis;
colitis;
gastritis.

Diet principles:

The treatment table should be high in protein.
In case of diarrhea, food is consumed in crushed and pureed form. Which one, read here.
The frequency of meals is 6 times a day, warm.
All products must be boiled.
The duration of the diet is no more than 7 days.
Mandatory carbohydrate restriction.
Eating cold and hot foods is prohibited.
You can't overeat.

What is possible and what is not?

low-fat varieties of fish;
dairy products with fat content less than 2.5%;
dishes made from chicken eggs in the form of an omelet;
pasta and vermicelli;
lean meat;
weak tea, jelly and compotes;
butter;
decoctions of buckwheat and rice groats.

Prohibited products:

cereals;
sauces;
lemonades and any sweet drinks;
vegetables;
fruits;
bread;
flour products;
canned food;
seasonings and spices.

Approximate menu for the day

Approximate daily diet menu for a child:

Breakfast: glass of rosehip decoction, 150 gr. egg white omelette. A couple of crackers.
2nd breakfast: 100 gr. cottage cheese.
Dinner: 100 gr. liquid soup with shredded chicken breast, 100 gr. noodles with boiled cutlet. A glass of blueberry jelly.
Afternoon snack: from one container of rice broth.
Dinner: 200 gr. vermicelli with boiled fish. A glass of weak tea.
2nd dinner: from takana kefir 1%, cracker.

Diet depending on the type of colitis

Colitis may occur with constipation or diarrhea. Depending on the nature of the stool disorder, the list of prohibited foods may change.

List of prohibited foods for colitis with constipation:

rich soups;
fatty meat and mushrooms;
pasta;
semolina;
fresh bread;
chocolate, strong tea;
spicy seasonings.

List of prohibited foods for colitis with diarrhea:

legumes;
milk;
vegetables and side dishes made from them;
sugar;
candies, cookies.

For these types of colitis, it is necessary to follow several recommendations that can speed up the recovery process:

It is recommended to have light dinner no later than 20.00.
Products consumed by the patient must be fortified with calcium and potassium.
Liquid intake should be limited.
It is necessary to eat in small portions, but often every 3 hours.
The diet should include foods containing proteins up to 150 grams.
Food should be eaten warm.
You only need to steam or boil foods.

carrot;
cabbage;
greenery;
radish;
fruits;
smoked products;
legumes;
juices;
semi-finished products;
chocolate.

Nutrition for spastic colitis

This type of colitis requires strict abstinence from sweets.

In addition, it is necessary to increase the amount of fiber-rich foods consumed, so the basis of the diet is the following foods:

vegetables;
bran bread;
legumes;
fruits.

In the absence of pain, cereals and juices diluted with water are allowed. In case of relapse, these products are prohibited from consumption.

List of prohibited products:

fatty meats;
oil;
dairy products;
cheeses with a high percentage of fat.

Diet for colitis during exacerbation

During the period of exacerbation of colitis, it is recommended to drink tea and rosehip decoction. It is necessary to exclude sweet foods and juices from the diet. From the 2nd day, the table can be expanded, and permitted foods are allowed to be consumed. All products must be boiled.

slimy porridge;
wheat crackers;
decoctions of rosehip and quince;
soups with weak broth;
weak tea.

Nutrition for colitis in remission

During the period of remission, a large number of foods are allowed, only cooking involves: boiling, stewing, baking.

List of permitted products:

porridges and cereals, with the exception of pearl barley and millet;
dairy products;
eggs in the form of an omelet;
vegetables only stewed or baked;
fruits are best consumed baked;
dried bread;
tea and coffee with milk;
lean meats and semi-finished products;
jelly and compotes;
fresh cucumbers and tomatoes.

Rehabilitation after treatment

After recovery and in the remission stage of colitis, it is recommended to undergo a rehabilitation course.

Rehabilitation includes:

treatment in a sanatorium;
Exercise therapy, massage and breathing exercises;
taking a course of probiotics and enzymes.

Forecast

With timely diagnosis and treatment, the prognosis is favorable. The disease can go into a stage of stable remission. With frequent relapses of the disease, the physical development of the child and their social development in society suffers.

Complications

With untimely treatment and late consultation with a doctor, the risk of developing the following complications increases:

perforation of the ulcer;
intestinal obstruction;
peritonitis;
sepsis;
vascular thrombosis;
necrosis of intestinal tissue;
fistulas;
haemorrhoids;
sphincter weakness.

Prevention

For primary prevention of the disease, the following recommendations must be followed:

proper nutrition;
sanitation of foci of infection;
timely treatment of infectious diseases;
compliance with personal hygiene rules;
instilling correct eating habits;
exemption from physical activity at school.

clinical examination;
drug therapy once every 2 years.

Colitis in children is an inflammation of the intestines, which over time leads to degeneration of the mucous layer of this organ - such a process is fraught with its dysfunction. In the vast majority of cases, the disease is diagnosed in patients of the middle and older age categories, but the risk of formation remains in infants and children in the kindergarten group.

A large number of predisposing factors, both external and internal, can cause the development of inflammation. The possibility of a genetic predisposition and an inadequate course of pregnancy cannot be ruled out.

This disease does not have characteristic clinical signs - all the symptoms characteristic of colitis are also found in other gastrointestinal pathologies. The basis of the symptoms is a violation of the process of bowel movement, pain in the abdomen of varying intensity, as well as malaise and attacks of nausea.

A correct diagnosis can be made only after performing a whole complex of laboratory and instrumental examinations, which must necessarily be supplemented by primary diagnostic manipulations carried out directly by the clinician.

The tactics of how to cure inflammation of the colon directly depend on the etiological factor, but in the vast majority of situations, conservative methods are sufficient.

Etiology

The sources of intestinal inflammation in children are quite varied, but often the trigger is:

Acute intestinal colitis in children is often provoked by:

pathogens of intestinal infections, namely salmonella, retrovirus, shigella and;
any nature;
acute course;
radiation exposure of a child's body;
individual intolerance to a particular product.

Chronic inflammation of the large intestine is caused by:

pancreatic dysfunction;
poisoning with toxic substances;
uncontrolled use of certain medications, for example, non-steroidal anti-inflammatory drugs or substances with a laxative effect;
congenital or acquired secretory deficiency - this should also include other metabolic disorders.

The following also take part in the implementation of inflammation of this localization:

unfavorable environmental conditions;
burdened heredity;
psychogenic disorders;
lack of physical activity in a child’s life;
disruption of the endocrine system;
pathologies of the central nervous system;
addiction to bad habits is typical for children in the teenage age category.

It is worth noting that in some situations it is impossible to find out the source of such a disease in babies and older children.

Classification

According to the etiological factor, such a disease is divided into:

Depending on endoscopic and morphological changes, the inflammatory process occurs:

catarrhal;
atrophic;
ulcerative-erosive.

According to the clinical form of the course, there are the following types of inflammation:

acute colitis in children;
chronic colitis in children;
nonspecific ulcerative colitis;
spastic colitis in children.

Classification according to the nature of the course divides inflammatory lesions of the large intestine into the following types:

monotone;
recurrent;
progressive;
latent.

Depending on the severity there are:

mild colitis;
moderate colitis;
severe colitis.

In addition, there is a division of such a disease, which is dictated by the location of the inflammatory focus:

typhlitis - corresponds to damage to the cecum;
typhlocolitis - indicates the simultaneous involvement of the cecum and ascending colon in the pathology;
transversitis - indicates inflammation of the transverse colon;
intestinal angulitis - diagnosed when the inflammatory process affects the transverse colon and descending part of the large intestine;
– caused by inflammatory lesions of the sigmoid colon;
– characterized by inflammation of not only the sigmoid, but also the rectum;
- talks about inflammation of the rectum.

In addition, colitis in a child can be complicated or uncomplicated.

Symptoms

It is worth noting that it is more difficult to determine inflammatory bowel disease the older the child is. Quite often, external manifestations are mistakenly mistaken by parents for temporary phenomena, for the elimination of which it is not worth seeking medical help. Moreover, it is noteworthy that the clinical picture of the disease in acute and chronic cases will be somewhat different.

In children, symptoms of an acute inflammatory process may be as follows:

increase in temperature indicators;
general weakness and lethargy;
severe pain in the iliac region;
attacks of nausea ending in vomiting - while vomiting brings only temporary relief;
violation of the act of defecation - often there is a predominance of diarrhea over constipation;
the frequency of the urge to empty the bowel with a mild version of the course does not exceed 5 times, and with a severe case it reaches 15;
feces have a watery and foamy consistency and also have a greenish tint. In this case, the presence of pathological impurities in excrement is often noted - mucus and blood;
dry mucous membranes and skin;
reduction in the daily volume of urine excreted;
aversion to food.

The chronic form of the disease, including pseudomembranous colitis, occurs with alternating periods of exacerbation of symptoms and remission. In such situations, the clinical picture of the disease can be presented:

right-sided or left-sided localization of pain in the iliac region. Basically, the pain is aching in nature, but tends to increase in intensity after a meal or before defecation;
bowel disorder – expressed in alternating constipation and diarrhea;
increase in size and distension of the abdomen;
sleep disturbance;
headaches;
lethargy and fatigue;
irritability and frequent mood swings.

Diagnostics

A pediatric gastroenterologist knows how to treat colitis in children and diagnose it, based on information obtained during a physical examination, laboratory and instrumental procedures.

Thus, the first stage of diagnosing pathology is aimed at:

familiarizing the clinician with the medical history of not only the patient, but also his relatives - to identify the etiological factor that is most suitable for a particular person;
collection and study of the child’s life history – this should include information regarding the course of the period of intrauterine development of the fetus;
a thorough examination, involving palpation of the anterior wall of the abdominal cavity - to establish its location, which will indicate the affected part of the large intestine;
a detailed survey of the patient or his parents is necessary to determine the intensity of clinical manifestations, which, in turn, will provide information about the severity of the inflammatory process.

The following laboratory tests are considered the most valuable:

general and biochemical blood test;
coprogram;
bacterial culture of feces;
analysis of stool for dysbacteriosis.

The last step of diagnostic manipulations is instrumental procedures, among which it is worth highlighting:

colonoscopy and rectoscopy;
endoscopic biopsy of the affected segment;
X-ray of the intestine using a contrast agent;
Ultrasound of the peritoneum;
CT and MRI.

Colitis in children should be differentiated from:

celiac disease;
enteritis;
chronic inflammation of the appendix;

Treatment

Treatment of pseudomembranous colitis and other variants of the disease in children involves the use of conservative methods. Thus, therapy includes:

compliance with therapeutic nutrition - the basis of the menu should be dietary first courses, water-based porridges, steam omelettes, jelly and weak tea. All food must be prepared by boiling and steaming. All dietary recommendations are provided by the attending physician;
taking antibiotics under the strict supervision of a clinician, as well as bacteriophages and enterosorbents;
oral rehydration;
the use of enzyme substances and prokinetics, probiotics and prebiotics;
physiotherapeutic procedures – electrophoresis and mud therapy;
acupuncture;
massotherapy;

Therapy using folk remedies and surgery is not used for colitis in children, particularly newborns.

Possible complications

Even early diagnosis and timely treatment of colitis in children does not exclude the possibility of the following consequences:

delayed weight gain and growth – this is most common in infants.

Prevention and prognosis

To prevent the development of such a disease, you should:

monitor the adequate course of pregnancy;
provide rational nutrition to children in accordance with their age category;
Do not give medications to children unless absolutely necessary;
give up bad habits – applicable for teenagers;
regularly show the child to the pediatrician to identify in the early stages the progression of those pathologies against which colitis develops.

Complex treatment provides a favorable prognosis for the disease, which is observed in the vast majority of cases. Chronic colitis in a child can often recur without following medical recommendations.

Colitis- a disease that occurs as a result of inflammatory-dystrophic changes in the colon.

The inflammatory process can be limited or spread over several segments.

The distal colon (proctitis) or the rectum and sigmoid colon (proctosigmonditis) are most often affected.

There are acute and chronic colitis. The most common colitis is non-infectious, acute colitis ulcerative, spastic colitis (irritable bowel syndrome), chronic non-infectious colitis, ulcerative colitis. A large group of colitis consists of infectious colitis (dysentery, etc.).

Acute non-infectious colitis in a child

Acute non-infectious colitis is the most common disease. Main reasons colitis in children are pathogenic agents coming from food, individual ideosnikrosia to some food components. Often the disease is associated with eating poor quality food. The disease is more common in older children.

The main symptoms are general malaise, nausea, and loose stools. Pain occurs as a result of intestinal spasm and is localized in the iliac region. Patients feel pressure in the rectal area. Stools are frequent, feces are foul-smelling, then they lose their fecal character and are gradually replaced by mucus and blood.

When examining a child, attention is paid to pallor and decreased tissue turgor due to dehydration. The tongue is dry and coated. Flatulence is pronounced. Dry mouth. Hypothermia develops, facial features become sharper, and little urine is produced.

is based on anamnesis, examination of the patient, and sigmoidoscopy, which reveals swelling of the mucous membrane of the large intestine. Usually it is loosened, full-blooded, covered with mucus and pus.

Treatment colitis in children

Gastric lavage and laxative administration are performed. A gentle diet is prescribed, consisting of tea without sugar, rice water, slimy soups, pureed porridges. In the presence of pain, symptomatic medications are prescribed.

Chronic colitis

Chronic colitis is a polyetiological disease characterized by inflammatory-dystrophic processes in the large intestine. The disease is most often observed in school-age children.

The cause of the disease is often acute infectious colitis (dysentery, etc.), insufficiently adequate treatment of helminthic infestations, and a monotonous, irregular diet. Chronic foci of infection can contribute to the development of the disease. Typically, acute intestinal infections cause degenerative changes in the mucous membrane and neuromuscular apparatus of the intestinal wall, which are the basis for the subsequent development of a chronic non-bacterial inflammatory process in the colon.

The main symptoms are aching abdominal pain, intensifying after eating and decreasing after defecation, and stool disturbances. Stools are usually scanty, frequent, with mucus, often after meals, and sometimes develop. An unpleasant taste in the mouth and belching appear. When palpating the abdomen, pain is noted along the large intestine. The intensity of the pain decreases after the passage of gas. Stool disorders: constipation or their alternation are accompanied by a deterioration of the condition. When the upper parts of the colon are affected, the stool remains normal; when proctosigmonditis develops, it is scanty. With the development of constipation, pain similar to intestinal colic is noted. The stool may look like sheep feces with a lot of mucus present.

To clarify the diagnosis, bacteriological and x-ray examinations of the colon are used.

Bacteriological examination of stool determines a decrease in the normal intestinal flora, accompanied by a violation of its functional properties. Against this background, the number of opportunistic bacteria - Proteus, staphylococci, and candida - is increasing.

An X-ray examination reveals spastically narrowed areas of the colon.

An endoscopic examination reveals swelling, zones of hyperemia and atrophic changes in the mucous membrane of the large intestine. There may be eroded areas.

During a scatological examination, pathological impurities in the stool are determined: blood, mucus, pus.

Treatment of chronic colitis

During an exacerbation, a mechanically and chemically gentle diet is prescribed: white crackers, weak broths with the addition of mucous decoctions, steamed dishes from minced meat, porridge, soft-boiled eggs, omelettes, jelly. If the condition improves, the diet is expanded and vegetables and fruits are allowed. If you are prone to constipation, beets, carrots, plum and apricot juices, apples, and bread with a high bran content are introduced into the diet. When alternating diarrhea and constipation, milk wheat bran is prescribed in a dose of 1 tsp. 3 times a day. Mineral waters (Essentuki No. 17) are also prescribed, 1/3-1/2 glass before meals.

In the presence of loose stools, astringents are prescribed, especially herbal decoctions, including chamomile, St. John's wort, oak bark, and pomegranate. A course of 1 month of 1 tsp is recommended. 5-6 times a day. The grass is changed every 10 days.

In order to restore the permeability of cell membranes and stimulate normal microflora, vitamins C and group B are prescribed for a course of 10-15 days.

Nonspecific ulcerative colitis

Non-specific ulcerative colitis is a non-infectious inflammatory disease with a chronic course and necrotic lesions of the mucous membrane of the colon and rectum.

Causes of non-infectious ulcerative colitis have not been precisely established; there are immune, infectious, and allergic theories. Most likely, the basis of the disease is a change in the immune-allergic reaction of the body, especially the large intestine, to various infectious, food, traumatic and other influences. In recent years, the autoimmune theory has received more and more confirmation.

According to it, it is believed that in the occurrence of nonspecific ulcerative colitis What matters is the production of antibodies to cellular proteins in the pathologically altered colon, which causes interaction between antigens, which in this reaction is the wall of the colon, and antibodies. As a result, changes occur in various parts of the colon, necrotic ulcerative foci are formed, the mucous membrane swells, becomes hyperemic, ulcerates, and loses its integrity. The intestinal wall may perforate. When ulcers become scarred, deformation of the colon occurs.

Classification.

The following forms are distinguished along the flow:

spicy;
recurrent;
continuous.

Depending on the localization of the process, there are:

distal limited form;
left-handed;
subtotal;
total.

According to the degree of severity, they are distinguished:

light form;
moderate form;
severe form.

Nonspecific according to the degree of activity ulcerative colitis distinguish:

minimal activity;
average activity;
high activity.

There are a variety of forms of the disease in children. In most children, the disease begins gradually with the appearance of fever, abdominal pain, constipation; in young children there are signs of intoxication. When the entire large intestine is involved in the process, a serious condition of the child is noted: high fever, abdominal pain along the colon, bloody mucus, severe intoxication.

Subacute and chronic forms occur with low-grade fever, arthralgia, intermittent abdominal pain preceding defecation, and weakness. At the beginning of the disease, the feces are formed or mushy.

In the acute form, the clinical picture can be expressed as follows: the predominant symptom is loose stools with a frequency of up to twelve times a day, mushy or watery feces mixed with blood and mucus, pus; fickle ones appear; Increased peristalsis, rumbling, tenesmus and bowel movements with visible blood may be observed.

For nonspecific ulcerative colitis in a child Symptoms that are not characteristic of the digestive system often appear:

pallor;
urticarial rash;
erythema nodosum;
iridocyclitis;
unmotivated increase in temperature;
pain in large joints.

Complications may include: anemia, massive bleeding, stenosis of the intestinal lumen with the development of intestinal obstruction, secondary intestinal infection, intestinal perforation with the development of peritonitis, joint damage.

An objective examination reveals pallor, weight loss, signs of vitamin deficiency, pain along the large intestine, and enlarged liver. Emotional lability and depression are typical.

With a mild course of the disease, the condition of the patients is satisfactory, stool no more than four times a day, there is a small admixture of blood in the stool, hemoglobin is not lower than 110 g/l, the disease is recurrent in nature, remission lasts 2-3 years.

In moderate cases, stools are observed up to six times a day mixed with a moderate amount of blood, tachycardia, and weight loss are detected. The disease continuously recurs. Hemoglobin decreases to 90 g/l, ESR accelerates, moderate leukocytosis is noted.

A severe course is characterized by stool up to eight times a day with a significant amount of blood, an increase in temperature is noted, tachycardia is pronounced, a sharp decrease in body weight, hemoglobin is below 120 g/l, ESR is over 35 mm/h.

Diagnosis is based on anamnesis, objective examination and laboratory and instrumental methods. During irigoscopy, shortening and narrowing of the large intestine is noted, and defects in the mucous membrane are detected. With rectoscopy - swelling, diffuse redness, with a progressive process - erosions and ulcers, sometimes covered with purulent plaque. A biopsy of the rectal mucosa reveals infiltrates containing mono- and polynuclear cells, mucosal erosions, abscesses, and crypts.

Treatment of ulcerative colitis

Treatment is prescribed primarily dietary in the form of table 4b and table 4c, which reduce inflammation, fermentation and putrefactive processes in the intestines, and help normalize its function. The diet contains a physiologically normal protein content with a slight restriction of fat. Avoid foods rich in nitrogenous extractives, purines, oxalic acid, essential oils, and fat oxidation products that occur during frying. Dishes are prepared boiled, less often stewed. Stringy meat and fiber-rich vegetables are pureed; flour and vegetables are not sautéed. Very cold dishes are excluded. Milk and dairy products should be avoided as children develop acquired lactose intolerance. Among fruits, preference is given to bananas, melons, pumpkins, apples, quince jelly and other fruits containing pectins.

Table 4b is prescribed in the attenuation stage of a chronic process. The main goal of the diet is to provide nutrition in case of disruption of the physiological function of the intestine, reduce inflammation, eliminate the processes of fermentation and putrefaction, and provide moderate chemical and mechanical sparing. All dishes are prepared pureed, boiled or baked without a rough crust.

Table 4c is prescribed for chronic processes during remission. The main goal is to provide nutrition in cases of disruption of the physiological function of the intestine, to promote the restoration and stabilization of intestinal function. All food is prepared in crushed form, vegetables are not pureed, boiled fish and meat can be served in pieces. The diet is prescribed for 2-4 weeks with a transition to a balanced diet.

Among medications, preference is given to sulfasalazine for 20-30 days, after which a maintenance course of treatment is prescribed for a month until the biopsy data normalizes.

Antibiotics and sulfonamide drugs are prescribed to suppress the vital activity of secondary microflora. Among the symptomatic drugs, antispasmodics and M-anticholinergics are prescribed.

Treatment of dysbiosis

It is important to have a favorable psycho-emotional climate and maintain the psychotherapeutic influence of others. If there is no effect from conservative treatment, surgical intervention is indicated.

The prognosis for young children is more favorable than for adolescents. It depends on timely diagnosis and the use of comprehensive treatment.

Irritable bowel syndrome

Many healthy infants have a bowel movement after each feeding in the first six months of life. This urge soon after the start of feeding or after its end is also observed in older children.

It is believed that hereditary factors are important, as well as psychosomatic disorders, which lead to increased tone of the parasympathetic nerve and increased peristalsis of the large intestine.

In most cases, children become ill between the ages of 6 and 18 months. In these cases, stool is observed from 3 to 6 times a day, mainly in the morning. The first bowel movement is copious, partially formed; subsequent bowel movements are small, watery or mushy, containing mucus, undigested food, and blood. Children suffer from bloating and colic. Children's appetite does not suffer, body weight is normal or exceeds age norms. The use of diet has no effect on clinical symptoms. With upper respiratory tract infections and changing teeth, relapses are possible. There is an increase in the amount of ammonia associated with the predominance of putrefactive processes.

The diagnosis is made on the basis of anamnestic data, objective examination, physical development, dynamics of stool frequency and changes in the nature of bowel movements.

The most effective treatment measure is to transfer the child to a free diet. Avoid cold drinks and dishes, coarse fiber, sour fruits and others that stimulate gastro-cecal-rectal reflux, which increases intestinal motility, resulting in its premature release.

Medications that calm peristalsis are prescribed.

Chronic spastic colitis

Chronic spastic colitis in children is considered a functional bowel disease.

The cause of colitis may be insufficient nutrition, which does not contain bulky, waste-rich foods, as well as suppression of the urge to defecate.

There is a delay in defecation. Feces in the form of sheep feces are typical; bowel movements occur in several stages. Sometimes mucus is released in the stool. Children experience increased fatigue and insomnia.

X-ray shows retention of the contrast mass in the large intestine.

Treatment of chronic spastic colitis

The correct dietary regimen is prescribed in accordance with the child’s age. Food rich in coarse fibers is prescribed: black bread, cereals, vegetables. The skills of bowel movement at a certain time are developed. Inflammatory processes of the intestinal mucosa, such as rectal fissures, are eliminated. Enema and laxatives are used in case of prolonged absence of independent stool.