Colitis

　　The etiology of colitis has not been completely clarified. At present, the etiologies that are widely recognized include:

　　1. Autoimmune reaction:

　　A large number of patients with colitis have concurrent autoimmune diseases. Corticosteroids can alleviate the condition, and anti-colonic epithelial cell antibodies can be detected in the serum of some patients, so it is believed that the occurrence of the disease may be related to autoimmune reactions. In addition, some patients may have immune reactions with colonic epithelial cell antigens after infection with intestinal bacteria, causing damage to the colonic mucosa, and the patient's lymphocytes have cytotoxic effects on fetal colonic epithelial cells, suggesting that the occurrence of colitis may also be related to abnormal cell immunity.

　　2. Infection:

　　The pathological changes and clinical manifestations of the disease are similar to some colonic infectious diseases (such as bacterial dysentery), so some people believe that infection is the cause of the disease. Among various factors such as bacteria, fungi, and viruses, current research indicates that the possibility of viruses is greater.

　　3. Genetics:

　　The incidence of the disease in families with a blood relationship is relatively high. According to statistics from European and American literature, about 15-30% of people in the direct blood relatives of patients with ulcerative colitis have the disease. In addition, studies on twins show that monozygotic twins are more prone to the disease, which means that the occurrence of the disease may be related to genetic factors.

　　4. Neuro-psychological factors:

　　Psychological factors may also play a certain role in the onset of the disease. Patients often have certain personality traits, poor psychological tolerance and adaptability to major events in life, and belong to the category of psychosomatic diseases. Psychosomatic diseases emphasize the importance of psychological factors in the occurrence or course of the disease.

　　Colitis is a chronic inflammatory disease with a long-term recurrent course and cannot be well controlled, which can lead to serious complications:

　　1. Toxic megacolon: This is a serious complication of the disease, mostly occurring in patients with generalized colitis. The clinical manifestations include rapid deterioration of the condition, marked toxic symptoms, accompanied by diarrhea, abdominal tenderness, and rebound pain, decreased or absent bowel sounds, increased white blood cell count, and prone to complications such as intestinal perforation.

　　2. Intestinal stricture: It often occurs in cases with extensive lesions and a course lasting for 5 to 25 years or more. The location is mostly in the left half of the colon, sigmoid colon, or rectum. Clinically, it is usually asymptomatic, and can cause intestinal obstruction in severe cases. When intestinal stricture occurs in this disease, one should be vigilant for tumors and differentiate between benign and malignant.

　　3. Intestinal perforation: It is mostly a complication of toxic megacolon, and can also occur in severe cases, mostly in the left half of the colon. The use of corticosteroids is considered a risk factor for intestinal perforation.

　　4. Intestinal polyps, colon cancer: When colitis lasts for more than five years, the intestinal ulceration surface is prone to abnormal hyperplasia under the long-term stimulation of inflammation, leading to intestinal polyps. The canceration rate of intestinal polyps over 1 centimeter is extremely high; in addition, about 5% of colitis cases can develop into cancer, which is more common in patients with lesions involving the entire colon, onset in childhood, and a history of more than 10 years.

　　The onset of colitis is usually gradual, with a few cases presenting as acute onset. The course is chronic and protracted, lasting from several years to more than a decade, often alternating between attack and remission periods or gradually worsening, occasionally presenting as an acute outbreak, with clinical manifestations including:

　　1. Diarrhea: Mucous stools and pus-containing stools, mild cases may have diarrhea 3 to 4 times a day, severe cases may have diarrhea dozens of times or diarrhea alternating with constipation.

　　2. Abdominal pain: Mild patients have no abdominal pain or only discomfort. Generally, there is mild to moderate abdominal pain, which is colicky pain in the lower left abdomen or lower abdomen, and the pain subsides after defecation following the urge to defecate.

　　3. Constipation: The stool is hard and dry, defecation once every 4 to 5 days, and the stool is like sheep dung. In severe cases, it is not possible to defecate without laxatives.

　　4. Other symptoms: abdominal distension, weight loss, fatigue, bowel sounds, insomnia, frequent dreams, aversion to cold, etc.

　　The prevention of colitis should pay attention to diet

　　1. Keep a regular diet, make sure to have three meals a day at fixed times and amounts, do not overeat or overeat, which is conducive to intestinal digestion balance and avoid intestinal dysfunction due to uncontrolled diet.

　　2. The diet should be light, easy to digest, and low in greasiness as the basic principle. It is advisable to eat: spleen-strengthening foods, such as yam, adzuki bean, lotus seed, lily, jujube. Eat less cold drinks, and less food that is easy to cause bloating, such as watermelon, honeydew, chive, onion, garlic, fried food, coffee, carbonated drinks, etc.

　　3. Eat less high-fat foods to avoid increasing the burden on the gastrointestinal tract due to difficult digestion, for example, eat less high-fat fast food.

　　4. Avoid excessive alcohol consumption.

　　5. Do not consume too much fibrous food every day, you can choose whole wheat products, as well as citrus, spinach, carrots, etc.

　　6. Avoid allergic foods, if you find that you have a similar reaction every time you eat a certain food, be careful whether you are allergic to it, and you can choose other foods to replace it.

　　The examinations needed for colitis include:

　　1. Sigmoidoscopy: Sigmoidoscopy is the main examination item for diagnosing colitis. Colonoscopy is simple and easy to perform, safe and reliable, and has clinical value. Although the examination may cause some pain, most patients can tolerate it, and complications are rare.

　　2. Fiberoptic colonoscopy: Through the fiberoptic colonoscopy, there is a long light guide fiber tube that can be bent, reaching deep into all segments of the colon, even beyond the ileocecal valve into the terminal ileum, which can observe the entire colon lumen, suitable for examining diseases in all segments of the colon.

　　3. Barium enema X-ray examination: It is generally not advisable to perform barium enema examination during the acute stage; in cases of severe or fulminant type, it is generally not advisable to perform barium enema examination to avoid exacerbating the condition or inducing toxic megacolon.

　　The routine barium enema X-ray examination shows: barium shadow with small sawtooth-like projections along the colon wall margin and railway-like folds; intubation defects, pseudopolyps formation, in a few cases, due to fibrosis of the colon wall and hyperplasia of polyps, can lead to narrowing of the intestinal lumen; disappearance or shallowing of the colon pouches, shortening and rigidity of the colon, even like a water pipe; snowflake sign: due to micro-ulcers and erosion, barium adheres, barium spots, and double-contrast barium enema shows like snowflakes; abnormal excretion of barium; the posterior rectal space is increased to more than 2cm, indicating severe inflammation between the rectum and the posterior rectal tissue.

　　4. Blood examination: Routine blood examination may show mild to moderate anemia, and the white blood cell count and erythrocyte sedimentation rate increase in severe patients. In severe cases, serum albumin, sodium, potassium, and chlorine decrease. Immunological examination shows a slight increase in IgG and IgM, and a positive anti-colonic mucosal antibody. Accelerated erythrocyte sedimentation rate and increased C-reactive protein are signs of the active stage.

　　5. Stool examination: Routine stool examination often shows mucus, pus, and blood under the naked eye, and red blood cells and pus cells are seen under the microscope. Repeated stool culture and hatching have not found any specific pathogens. The purpose of stool pathogen examination is to exclude infectious colitis and is an important step in the diagnosis of the disease.

　　In addition to paying attention to rest and actively treating the cause of acute colitis, dietary principles should be adopted, such as easy digestion, low stimulation, moderate temperature, rich nutrition, eating small and frequent meals, and timely water supplementation.

　　The dietary principles for colonitis include: limiting low-fiber, low-fat foods; paying attention to the supplement of protein and vitamins; those with dehydration and low sodium should supplement dilute salt water in time, and eat vegetable soup to supplement the loss of water, salt, and vitamins; when flatulence and diarrhea are strong, it is advisable to eat less sugar and foods that are easy to ferment; persimmons, pomegranates, and apples all contain tannins and pectin, which have astringent and anti-diarrheal effects, and chronic colitis can be eaten in moderation.

　　The early stage of colitis is the stage of acute congestion, edema, inflammation, and exudation of the intestines. At this time, the intestinal peristalsis is active or in a spastic state, and its digestive and absorption functions are relatively weak. Therefore, within 8-12 hours after the onset, patients can eat liquid foods such as rice porridge, lotus root powder, and thin noodles. If diarrhea is severe or sweating is more, some soup should be given to the patient appropriately, such as rice gruel, vegetable soup, fruit juice, and dilute salted water, to supplement the deficiency of water, vitamins, and electrolytes in the body.

　　During the improvement period of colitis, patients can be given easily digestible and nutritious liquid or semi-liquid foods, such as rice porridge and thin noodles. It is advisable to adopt the method of eating small and frequent meals, eating 4-5 times a day. It should be noted that milk and a large amount of sugar should not be consumed at this time, as these foods are easy to ferment and produce a large amount of gas in the intestines, causing abdominal distension and pain, and increasing the patient's suffering.

　　During the recovery period of colitis, due to the pathological and physiological changes of the gastrointestinal tract, especially the intestines, the intestines are very sensitive to food at this time. Therefore, it is necessary to pay special attention to the restriction of diet, and it is advisable to eat light, soft, and warm food, avoiding eating greasy meat, fried food, cold and hard food, and high-fiber foods such as celery in advance. After about 2-3 days after the recovery period, you can eat meals as usual.

　　The foods that colonitis patients need to avoid mainly include the following:

　　Milk

　　Milk is rich in various essential nutrients and vitamins for the human body and is a popular food among people.

　　Fruits and vegetables

　　It mainly refers to various fresh fruits and vegetables, such as watermelons, cantaloupes, cucumbers, bananas, peaches, persimmons, loquat, and fresh pears. Although fruits and vegetables are rich in vitamins, minerals, inorganic salts, and other nutrients, they are also on the list of禁忌 for most patients with chronic colitis.

　　Greasy food

　　It mainly refers to food with animal fats, such as braised pork, spareribs, meat stuffing buns, wontons, and thick soups cooked with chicken and duck.

　　General treatment for colitis

　　1. Rest: Colonitis patients, especially those in the active phase, should emphasize sufficient rest and reduce mental and physical burden. After the condition improves, the amount of activity can be gradually increased, but generally heavy physical activity should be avoided.

　　2. Diet and nutrition: During the diarrhea phase, attention should be paid to nutritional supplementation, and the fiber content in the diet should be appropriately reduced, such as leeks, celery, garlic sprouts, etc. Low residue diet should be used to reduce the mechanical injury that high fiber content may cause to the colonic mucosa. For patients with colitis allergic to cow's milk protein, diarrhea may occur due to a lack of lactase in the intestines when consuming milk, and the intake of dairy products should be restricted, which may sometimes have an antidiarrheal effect. Factors such as diarrhea, hematochezia, long-term insufficient intake, and malnutrition can lead to malnutrition in patients. Patients can be supplemented with iron and nutritional elements through oral or intravenous administration, and the use of traditional Chinese medicine for invigorating the spleen and nourishing the kidneys can also achieve the purpose of strengthening the body and supplementing nutrition. Long-term diarrhea patients should be supplemented with calcium as well as trace elements such as magnesium and zinc.

　　Principles of drug treatment for colitis

　　1. Adequate fluid and electrolyte supplementation, vitamin C and calcium supplementation, iron preparations and folic acid for anemia treatment. Severe malnutrition can be treated with enteral or parenteral nutrition.

　　2. Antimicrobial therapy: Salicylate azosulfapyridine has good efficacy in treating various forms of colitis and preventing complications.

　　3. Hormonal therapy: Adrenal cortical hormones, hydrocortisone, and prednisone can improve the overall condition, alleviate the course of the disease, reduce the frequency of defecation, alleviate recurrence symptoms, and increase appetite. However, some patients may not respond well, and it can also cause ulcer perforation, bleeding, and slow healing.

　　4. Immunosuppressants: Azathioprine can change the course of the disease, suppress clinical manifestations, but cannot change the underlying disease. It is commonly used to reduce recurrence during the stationary phase and may cause toxicity.

　　5. Antidiarrheal drugs: They can reduce the frequency of defecation, alleviate abdominal pain, and are commonly used with compound phenylbutazone, codeine, and compound camphorated tincture. Antidiarrheal drugs may cause toxic megacolon in acute attacks of ulcerative colitis, and should be used with caution. Sedatives and antispasmodics can also be administered.

　　6. Retention enema: Often used for rectal and sigmoid colonitis, it can alleviate symptoms and promote ulcer healing.