Pediatric ulcerative colitis

　　The etiology of pediatric ulcerative colitis is not yet clear. The current consensus is that both immune factors and genetic factors exist in the pathogenesis of the disease, while other various factors are mostly triggering factors. There may be the following multiple causes:

　　1, Autoimmune reasons:Ulcerative colitis often complicates with autoimmune hemolytic anemia, rheumatoid arthritis, lupus erythematosus, Hashimoto's disease, uveitis, etc., and treatment with adrenocorticosteroids or other immunosuppressants is effective. Therefore, it is considered that this disease may be an autoimmune disease.

　　2, Infection reasons:Some children respond well to antibiotic treatment.

　　3, Allergic dietary reasons:Certain foods can cause the recurrence of lesions, and the removal of these foods can alleviate the condition.

　　4, Genetic reasons:15% to 30% of patients in the patient's family have the disease.

　　5, Psychological factors:Clinical findings often show that some children have symptoms of anxiety, tension, suspicion, and autonomic nervous disorder, and psychiatric treatment can achieve certain effects.

　　The main complications of pediatric ulcerative colitis are divided into gastrointestinal complications and extra-gastrointestinal complications, as follows:

　　1, Gastrointestinal complications

　　1, Acute fulminant ulcerative colitis: It can cause acute colon dilation and ulcer perforation; lower gastrointestinal bleeding, colon pseudo-polyps, which are multiple, of unequal size, and sometimes resemble pebbles. Colon stricture is common in the rectum and transverse colon, and can also be seen in other parts.

　　2, Toxic megacolon: A severe complication with an incidence rate of 1.6% to 2.5% and a mortality rate of 13% to 50%, commonly seen in acute fulminant and severe patients. The triggering factors are often related to the excessive intake of anticholinergic drugs, hypokalemia, and bismuth enema. The colon lesions are extensive and severe, involving the muscular layer of the intestine and the interspersed nerve plexus, causing the intestinal canal to dilate and fail to contract. The diameter of the intestinal lumen can reach more than 10 cm. The toxic symptoms are prominent, with abdominal distension, abdominal tenderness, rebound pain, weakened or absent bowel sounds, significantly elevated white blood cells, and X-ray films showing colon expansion and the disappearance of colon pouches. Due to intestinal dilation, ischemia and necrosis can occur, leading to acute intestinal perforation (acute intestinal perforation).

　　3, Colon perforation and massive rectal bleeding: The incidence rate is about 1%, with a mortality rate of 40% to 50%, due to the occurrence on the basis of toxic megacolon expansion.

　　4, Polyp: A late-stage complication with an incidence rate of 9.7% to 39%, caused by inflammation, usually colon pseudo-polyp.

　　5, Canceration: Canceration can occur in the late stage, with an incidence rate of 5% to 10%, mainly occurring in severe patients, involving the entire colon and patients with a long course of disease, canceration is less common in pediatric cases, the longer the course, the higher the tendency to canceration, the canceration rate in the first 10 years after onset is about 3%, and it increases by 0.5% to 1.0% each year thereafter, reaching 10% to 20% in the second 10 years, so children should have a colonoscopy once a year. Late complications also include perianal infection, anal fistula, etc.

　　Two, Extraintestinal complications

　　1, Joint involvement: Joint involvement in ulcerative colitis is about 25%,表现为non-deforming migratory acute arthritis, such as swelling and pain; at the same time, it can be involved in one or more joints, and all joints can be involved, but the knee, ankle, and wrist joints are more common.

　　2, Skin damage: It is relatively common, and about 15% of severe active ulcerative colitis cases have skin damage. Erythema nodosum is common, and scars do not form after healing; necrotizing pyoderma is a type of ulcerative damage, common in the trunk, leaving scars after healing, with an incidence rate of 5% to 10% during the active phase of the disease, but it can be cured.

　　3, Massive hemorrhage: The incidence rate is 1.1% to 4.0%, and the cause is bleeding due to ulcers involving large blood vessels and hypoprothrombinemia.

　　Most cases start slowly, with a persistent course, often with alternating episodes and remissions. Acute onset cases account for 5%, with rapid disease progression, obvious systemic toxic symptoms, common complications, and high mortality. The condition in the remission period may also suddenly worsen. Emotional stress, fatigue, intestinal inflammation, and dietary disorders are common triggers for the disease.

　　One, Gastrointestinal manifestations

　　1, Diarrhea (diarrhea): The severity of diarrhea varies, with mild cases defecating 3 to 4 times a day, or alternating between diarrhea and constipation, and severe cases defecating frequently, up to once every 1 to 2 hours. At the beginning of the disease, stools are loose, 4 to 6 times per day, and progressively worsen, with mucous blood stools, blood stools, watery stools, loose stools, and purulent stools. Particularly, mucous blood stools almost become an inevitable symptom of all active patients with the disease. Common symptoms include urgent defecation. Acute onset cases start with blood stools accompanied by abdominal pain, vomiting, fever, and other toxic symptoms.

　　2, Abdominal pain (abdominal pain): Mild and remission patients may not have abdominal pain. Abdominal pain is usually mild to moderate, often localized to the lower left abdomen or lower abdomen, and may also involve the entire abdomen. It follows the pattern of pain-poop-relief after defecation.

　　3, Other symptoms: Abdominal distension is common. Severe cases may have symptoms such as loss of appetite, nausea, and vomiting.

　　4, Signs and Symptoms: Mild cases usually have no other signs and symptoms except for mild tenderness in the lower left abdomen. Severe and fulminant cases may have abdominal distension, abdominal muscle tension, abdominal tenderness, or rebound tenderness. Some patients may feel spasm or thickened sigmoid colon or descending colon wall.

　　Two, General symptoms

　　Mild cases are often not obvious. Severe cases may have fever, water and electrolyte imbalance; children may have long-term diarrhea, hematochezia, anorexia, tachycardia, weakness, and listlessness, which may eventually lead to weight loss, hypoalbuminemia, anemia, and malnutrition. About 3% of patients may have emotional instability, such as depression, anxiety, and insomnia; severe cases may also have growth and development disorders, delayed puberty. Some children may have mental, psychological, and emotional abnormalities.

　　Three, Extra-intestinal symptoms

　　25% of the children may have arthritis, mainly affecting the limbs and spine, and joint symptoms sometimes occur before diarrhea. 10% of the children may develop skin lesions, such as nodular erythema, necrotizing pyoderma, and so on. 2% may have retinitis, oral ulcers, and other symptoms.

　　At present, there is no definitive measure to prevent pediatric ulcerative colitis. It is recommended to have a reasonable diet, good eating habits, enhance physical fitness, promote physical and mental health, avoid stress, prevent malnutrition and gastrointestinal infectious diseases, and so on.

　　The main examinations for pediatric ulcerative colitis include routine blood examination, immune function examination, stool examination, barium enema examination, and sigmoidoscopy. Among them, barium enema and sigmoidoscopy are valuable diagnostic and differential diagnostic methods.

　　One, Routine blood examination

　　There may be an increase in white blood cell count, anemia, and an accelerated erythrocyte sedimentation rate (which can be used as an indicator of the progression of the disease). In severe cases, the prothrombin time is prolonged, the activity of coagulation factor VIII increases, serum potassium, sodium, and chloride levels decrease, and plasma protein levels decrease. In severe cases, α2-globulin increases, while γ-globulin decreases, and in the remission phase, the increase in α2-globulin is a sign of recurrence of the disease.

　　Two, Immune function examination

　　1, Humoral immunity: The immunoglobulins of patients with this disease are often elevated, with a significant increase in IgM, and an increase in IgG and IgA in serum as well as in the interstitium and glandular cavities of the intestinal mucosa. Various non-specific anti-colonic antibodies can also be found in the serum.

　　2, Cellular immunity: The number and ratio of T lymphocytes, lymphocyte transformation rate, and leukocyte and phagocyte migration blocking test in the peripheral blood of patients with this disease are all reduced, indicating that the occurrence of this disease is related to the decline in cellular immune function. In the active phase, the Th/Ts ratio of T lymphocyte subsets is significantly increased, mainly due to a decrease in Ts cell numbers.

　　3, Immune complexes: There are immune complexes with deposits of IgG, complement, and fibrinogen in the固有膜of the colonic mucosa of patients with this disease.

　　Three, Stool examination

　　There are often mucous and bloody stools. Microscopy shows red blood cells, white blood cells, and phagocytes, and repeated examinations have not found any specific pathogens.

　　Four, Barium enema examination

　　This method is mainly used for diagnosing colonic lesions, which involves inserting a rectal tube through the anus, injecting barium contrast, and then performing an X-ray examination to diagnose colonic tumors, polyps, inflammation, tuberculosis, intestinal obstruction, and other lesions.

　　Fifth, sigmoidoscopy

　　It is a simple and practical examination method that can detect lesions at higher positions that cannot be felt by rectal examination, and can also take tissue biopsies of suspicious lesions to determine their nature. Therefore, sigmoidoscopy can be used for diagnosis and also as a treatment instrument, which is of great significance for preventing and early detection of rectal and sigmoid colon cancer. Sigmoidoscopy is used to examine the inflammation, ulcers, polyps, tumors, parasitic lesions, and unknown causes of diarrhea in the rectum and sigmoid colon. It can be used to take living tissue samples during the examination.

　　Patients with pediatric ulcerative colitis should consume high-calorie, high-nutritious, low-fiber, low-irritant, low-fat, and easily digestible foods to supplement the nutrients lacking in the body. Foods that are suspected of being intolerant, such as shrimp, turtle, peanuts, etc., should be avoided. Milk can worsen diarrhea, so milk and dairy products should be avoided, and chili, frozen, and cold foods should be avoided.

　　The herbal formula for pediatric ulcerative colitis is Da Huang, Tu茯苓, Huang Bai each 10 grams, Huang Lian, Bai Shao, Bai Ji, Wu Mei each 15 grams, Bai Tou Weng, Ku Shen each 25 grams, Dan Shen 20 grams, Yunnan Baiyao 1 gram. This formula is taken once a day, soaked in 500 milliliters of water for two hours, boiled twice with low heat for 30 minutes each time, and then the two batches of liquid are combined and boiled until about 120 milliliters, then allow to settle and remove the dregs, leaving about 80 milliliters for use.

　　The method of rectal medication is to warm the drug solution to 38℃～39℃ before use. Before the child goes to bed late, let them empty their bowels, take a head-low and buttocks-high left lateral position, elevate the buttocks by 10 centimeters, gently insert a 18-gauge catheter about 15 centimeters into the anus, keep the child in the original position for 30 minutes after the enema is completed. If the lesion is above the sigmoid colon, change the child's position to chest-knee position for 15 minutes after the enema is completed, so that the drug solution reaches the entire colon and retains it for more than 4 hours. If the drug solution is excreted quickly after enema, another enema should be performed after half an hour. This treatment is given once a night, and 30 times make up one course of treatment. After a two-day rest, the second course begins, and the child must undergo at least two courses of treatment.