Hospital therapy. Treatment of ulcerative colitis (most important)

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Hospital therapy. Treatment of ulcerative colitis (most important)

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53. Treatment of nonspecific ulcerative colitis

Treatment. The absence of a single etiological factor and the complexity of the pathogenesis of nonspecific ulcerative colitis make it difficult to treat this disease. Anti-inflammatory and antibacterial drugs are used: salazopyridazine, sulfasalazine, salazodimethoxin, salofalk. Ingested sulfasalazine, with the participation of intestinal microflora, breaks down into 5-aminosalicylic acid and sulfapyridine. Unabsorbed sulfapyridine inhibits the growth of anaerobic microflora in the intestine, including clostridia and bacterioids. And thanks to 5-amino-salicylic acid, the drug not only causes changes in the intestinal microflora, but also modulates immune responses, blocks the mediators of the inflammatory process. The drug is prescribed at a dose of 2-6 g per day for the entire period of active inflammation. When the colitis syndrome subsides, the dose of sulfasalazine is reduced gradually, bringing it to a maintenance dose (an average of 1-1,5 tablets per day).

In severe diarrheal syndrome in persons with mild and moderate course of the disease, the appointment of sandostatin is indicated, which inhibits the synthesis of gastrointestinal hormones and biogenic amines (vasoactive intestinal peptide, gastrin, serotonin), the production of which is sharply increased in ulcerative colitis and Crohn's disease. And also the drug reduces secretion and improves absorption in the intestine, inhibits visceral blood flow and reduces motility. When using sandostatin (within 7 days at a dose of 0,1 mg 2 times, subcutaneously), diarrhea decreases, tenesmus practically disappears, and blood excretion with feces decreases.

In a severe form of nonspecific ulcerative colitis, treatment is carried out against the background of parenteral nutrition. The protein content of these preparations should be approximately 1,5-2,0 g/kg of body weight. Corticosteroids, which are administered parenterally, are a pathogenetic treatment for a severe form of the disease: during the first day, prednisone is administered intravenously at intervals of 12 hours (90-120 mg or more), in the next 5 days - intramuscularly, gradually reducing the dose. With a positive effect, they switch to oral medication (prednisolone 40 mg per day).

In the moderate form of the course of nonspecific ulcerative ulcer, a strict diet is required with a restriction of fiber, dairy products and a high protein content. Prednisolone is administered orally at an initial dose of 20-40 mg per day. Treatment can be supplemented with sulfasalazine and its analogues, which are taken orally or administered in microclysters and suppositories into the rectum. The initial dose of sulfasalazine is 1 g per day, then it is increased to 4-6 g.

As an auxiliary method of treatment, decoctions of herbs with anti-inflammatory and hemostatic effects (burnet root, nettle leaf, lichen, gray alder cones, licorice root) can be used, herbal medicine often allows you to reduce the dose of salazopreparations, prolong remission.

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