Inflammatory bowel disease

　　The etiology and pathogenesis of IBD have not been fully elucidated. It is known that the inflammatory response caused by abnormal immune response of the intestinal mucosal immune system plays an important role in the pathogenesis of IBD. It is believed that this is caused by the interaction of multiple factors, mainly including environmental, genetic, infectious, and immune factors.

　　The main complications of inflammatory bowel disease include Crohn's disease (CD) and ulcerative colitis (UC). The disease seriously affects the health of patients, so it is necessary to treat it in time and actively prevent complications.

　　1, The clinical symptoms and signs of pediatric IBD, in addition to common gastrointestinal manifestations, often have obvious extra-intestinal manifestations such as arthritis, growth delay, weight loss, malnutrition, anemia, and nervous anorexia, especially growth delay is the most unique symptom of growing children, often appearing in infancy. Ulcerative colitis, most UC has an insidious onset, or mild diarrhea, hematochezia, only occult blood in feces. About 30% of children have obvious symptoms, onset is acute, more common in infants and young children, diarrhea can reach 10-30 times a day,呈血便或黏液血便、脓血便，involving the rectum has tenesmus. Spasmodic abdominal pain often occurs before or during defecation, and relieves after defecation. There is marked tenderness in the lower left abdomen, and there may be muscle tension or palpation of a rigid colon.

　　2, Systemic symptoms include fever, fatigue, anemia; in severe cases, there may be dehydration, electrolyte imbalance, acid-base imbalance, etc. Lack of weight gain and delayed growth and development are also the earliest clinical manifestations of pediatric UC. There may be extra-intestinal manifestations such as arthritis, joint pain, iridocyclitis, liver enlargement, etc.

　　3, Classification: divided into initial acute fulminant type, chronic recurrent type, and chronic persistent type according to clinical course. The initial acute fulminant type refers to the first onset of severe symptoms with systemic toxic symptoms without a history, which may be accompanied by complications such as toxic megacolon, intestinal perforation, sepsis, etc. In addition to fulminant type, each type has different degrees of classification and interconversion.

　　4, Lesion range: divided into proctitis, sigmoid colonitis, left hemicolitis, right hemicolitis, regional colitis, and total colitis.

　　5, Degree of lesion activity: divided into active phase and remission phase.

　　6, The prevalence of pediatric ulcerative colitis is about 62%.

　　7, Common complications include intestinal bleeding, intestinal stricture, intestinal perforation, sepsis, and toxic megacolon.

　　1, Ulcerative colitis and Crohn's disease are diseases with unknown etiology, so how can we prevent them? By saying 'unknown etiology', we mean that the exact mechanism causing the disease is not clear. However, some phenomena are still known to everyone, such as infections, abnormal immune mechanisms, and even some relationship with heredity. But it is not a typical hereditary disease. Who gets such a disease, through genetic genes or through special examinations, still has some clues. But this thing is still in the research stage and has not been completely used in clinical practice. However, in large hospitals and specialized hospitals, like our hospital now, we have also started to do some corresponding tests, which are very meaningful for differentiation and diagnosis.

　　2. As for how to prevent it, this is a relatively complex issue. Since the etiology and pathogenesis are not very clear, it is relatively difficult to prevent from a preventive point of view. It can only be said that once this problem arises, it is most important to see a doctor early, make an early diagnosis, and start treatment early.

　　2. As for how to pay attention to diet, in fact, these patients with gastrointestinal diseases are more or less the same. The principles of treatment and diet attention are the same. Eat less刺激性 things, cigarettes, alcohol, spicy, sweet and sour things; try to eat less, too oily, greasy things. For ulcerative colitis, some cold medicines (such as aspirin and other non-steroidal anti-inflammatory drugs) need to be particularly careful. Be cautious when taking cold medicine, try not to take them. Because these drugs may easily诱发the aggravation of the disease.

　　One. X-ray abdominal flat

　　For patients with severe active disease, X-ray abdominal plain film examination should be performed. In patients with toxic megacolon, signs such as mucosal edema (finger pressure痕), intestinal loop expansion, or intestinal perforation may be found. In patients with small intestinal CD, signs of intestinal obstruction or displacement of intestinal loops due to肿块 compression may be observed.

　　Two. Colonoscopy examination

　　This is one of the most important means for the diagnosis and differential diagnosis of the disease. It can not only directly observe mucosal lesions and the extent of the lesions, but also obtain histological diagnosis by biopsy. The lesions of UC often start from the rectum and extend upwards in a continuous and diffuse manner. The endoscopic features include:

　　1. The mucosa shows diffuse congestion, edema, blurred and disordered vascular patterns, rough mucosa in the form of fine granules, friable and prone to bleeding, and the attachment of purulent and bloody secretions.

　　2. At the obvious lesion site, there may be diffuse multiple erosions or superficial ulcers of different sizes and shapes, which may merge.

　　3. Chronic lesions may show shallowening, blunting, or disappearance of the colon pouches, pseudopolyps, bridging mucosa, and other signs. Under colonoscopy, histological examination of the mucosal tissue in the active phase shows diffuse chronic and acute inflammatory cell infiltration, cryptitis, crypt abscesses, erosion, ulcers. In the remission phase, changes such as glandular deformation, disordered arrangement, and reduction of goblet cells are observed, indicating mucosal atrophy.

　　4. The CD lesions are segmentally distributed, showing aphthous-like or longitudinal or creeping ulcers. The mucosa around the ulcers is normal or hyperplastic and presents with pebble-like appearance. The intestinal lumen is narrowed, the intestinal wall is rigid, and inflammatory polyps may be present. The mucosa between the affected intestinal segments appears normal. Deep biopsy at the site of the lesion can reveal non-caseating granulomas or lymphocytic aggregates in the lamina propria of the mucosa.

　　Three. X-ray造影 examination

　　Barium enema or barium swallow examination should be performed according to clinical manifestations, and combined if necessary. Its sensitivity is not as good as colonoscopy, and biopsy cannot be performed. It is generally not advisable to perform barium enema examination in patients with severe or fulminant ulcerative colitis (UC). The X-ray characteristics of UC mainly include:

　　1. The mucosa is rough and (or) granular in appearance.

　　2. The marginal edges of the intestine show bristle-like or serrated shapes, with multiple small depression shadows and defects in the filling of the intestinal wall.

　　3. The colon pouches disappear, the intestinal tract shortens, and can be lead-like.

　　4. The X-ray manifestations of CD are multiple, segmental intestinal inflammatory lesions, which can be seen in rough mucosal folds, longitudinal fissure-like ulcers, pebble sign, stricture, fistula, formation of pseudopolyps, etc.

　　Patients with inflammatory bowel disease should pay special attention to their diet, especially focusing on the following points: provide low-residue, high-nutrient diet, appropriately supplement folic acid, vitamin B12 and various vitamins and trace elements. Severe cases should be fasting.

　　1. Drug Treatment

　　1. Salazosulfapyridine suppository SASP is a commonly used drug for the treatment of this disease.

　　2. Glucocorticoids, with good efficacy for acute attacks. Suitable for mild to moderate patients with poor response to salicylate preparations, especially suitable for severe active phase and explosive type patients.

　　3. Immunosuppressants, for chronic active cases with poor response to glucocorticoids or dependence on glucocorticoids, the addition of such drugs can reduce the dosage of glucocorticoids or even discontinue their use.

　　2. Surgical Treatment

　　Emergency surgery indications: concurrent with massive hemorrhage, intestinal perforation, severe patients, especially those with toxic megacolon complicated with severe sepsis after active medical treatment and accompanied by serious sepsis. Elective surgery indications: 1 concurrent with colorectal cancer; 2 chronic active cases with unsatisfactory response to medical treatment and significantly affecting the quality of life; or those who can control the condition with glucocorticoids but have too many side effects that are intolerable.

　　3. General Treatment

　　Emphasize dietary adjustment and nutritional supplementation, provide high-nutrient, low-residue diet. Appropriate amounts of folic acid, vitamin B12 and various vitamins and trace elements. Anticholinergic drugs or antidiarrheal drugs can be given for abdominal pain and diarrhea when necessary, and broad-spectrum antibiotics via intravenous route for patients with concurrent infection.

　　4. Drug Treatment

　　1. Aminosalicylic acid preparations SASP have certain efficacy in controlling the activity of mild to moderate patients, mainly suitable for those with lesions limited to the colon.

　　2. Glucocorticoids, the most effective drug for controlling the activity of the disease, is used during the active phase of the disease. For those with strong activity, aminosalicylic acid preparations or immunosuppressants can be added.

　　3. Immunosuppressants, for chronic active cases with poor response to glucocorticoids or dependence on glucocorticoids, the addition of such drugs can reduce the dosage of glucocorticoids or even discontinue their use.

　　5. Surgical Treatment

　　Surgical indications: concurrent complete intestinal obstruction, formation of fistula and abscess, acute perforation, or uncontrollable massive bleeding.