What Is Microscopic Colitis?

Colitis refers to inflammatory lesions of the colon caused by various reasons. It can be caused by bacteria, fungi, viruses, parasites, protozoa and other organisms, and can also be caused by allergic reactions and physical and chemical factors. According to different causes, it can be divided into specific inflammatory lesions and non-specific inflammatory lesions. The former refers to infectious colitis, Ischemic colitis and pseudomembranous colitis. The latter include ulcerative colitis and Crohn's disease of the colon. The main clinical manifestations are diarrhea, abdominal pain, mucus and pus and bloody stools, severe after anxiety, even constipation, and inability to pass stool within a few days; often accompanied by weight loss and fatigue, often repeated attacks. The incidence of ulcerative colitis in China is gradually increasing, the course is lengthy, and there is a risk of concurrent colon cancer. Therefore, more and more people pay more attention to it. The following mainly introduces ulcerative colitis.

Basic Information

English name: colitis
Visiting department: Gastroenterology
Multiple groups: People with an unhealthy diet

Common causes: Heredity, autoimmune response, neuropsychological factors, etc.
Common symptoms: Diarrhea, abdominal pain, mucus and pus and bloody stools, severe after anxiety, constipation

Causes of colitis

The cause of ulcerative colitis has not been fully clarified. At present, it is believed that the occurrence of this disease is the result of a combination of immune factors, genetic factors, environmental factors and infection factors.

Heredity

According to foreign literature statistics, 15% to 30% of the immediate family members of patients with ulcerative colitis develop disease. In addition, studies of twins have shown that monozygotes are more likely to develop than twins, suggesting that the occurrence of this disease may be related to genetic factors.

2. Autoimmune response

Most scholars believe that this disease is an autoimmune disease. Because the disease is complicated by autoimmune diseases, adrenocortical hormone can alleviate the disease. Anti-colonial epithelial cell antibodies can be found in the serum of some patients. Some patients with intestinal bacteria can react with colonic epithelial cell antigens, so it is suspected that the occurrence of colitis may be related to abnormal cellular immunity.

3. Environmental factors

Ulcerative colitis has a higher incidence in developed countries and regions, and may be related to lifestyle and lifestyle. Smoking, appendectomy, and taking contraceptives can increase the risk of ulcerative colitis.

4. Infectious factors

Although an infectious factor closely related to the onset of ulcerative colitis has not been isolated so far, and its direct relationship with bacterial and viral infections cannot be determined, most of them have a history of intestinal infection before the onset of this disease. Infection may be a predisposing factor.

5. Other

Some people think that mental factors play a certain role in the onset, and patients often have certain personality characteristics. They have poor psychological tolerance and adaptability to major events in life, and they belong to the psychosomatic diseases. Some patients are allergic to certain types of food, such as milk. When eating such foods often cause recurrence, the condition can be improved or disappeared after fasting. Some scholars believe that the imbalance of the ratio of pathogenic bacteria to normal flora in the intestine is the trigger point for the onset of ulcerative colitis.

Clinical manifestations of colitis

Diarrhea

Mucus and pus and bloody stools, 3 to 4 times a day in light cases, dozens of times in severe cases, bloody.

Abdominal pain

Mild patients have no abdominal pain or only abdominal discomfort. Generally, there is mild to moderate abdominal pain, which is a pain in the left lower abdomen or lower abdomen, involving total abdominal pain, and the law of relief after defecation.

3. After the emergency

Caused by rectal inflammation.

4. Other symptoms

Anemia, fever, bloating, weight loss, fatigue, bowel sounds, insomnia, dreaminess, cold and other symptoms.

5. Complications

Toxic megacolon, colonic stenosis and obstruction, major bleeding, colon polyps, colon cancer, etc. There may also be parenteral complications related to autoimmune reactions, such as arthritis, erythema cutaneous nodules, refractory ulcers of the oral mucosa, irisitis, and so on.

Colitis examination

Palpation of abdomen

Mild patients may have no positive signs or tenderness in the left lower abdomen and lower abdomen. In severe cases, abdominal tenderness and abdominal muscle tension may occur, such as a rigid tubular descending colon or sigmoid colon.

2. Laboratory inspection

(1) Fecal examination Blood, pus, and mucus are visible to the naked eye, and a large number of red blood cells and white blood cells can be seen under the microscope during the acute phase. Stool culture is free of pathogenic bacteria.

(2) Blood examination Neutrophils increase and erythrocyte sedimentation increases in the acute phase. Most patients have mild to moderate anemia.

(3) Immunological examination Immunoglobulins were measured during the active phase, and it was found that IgG, IgM, and IgA increased, and the most obvious increase was IgG.

3. Endoscopy

It is the most important test for ulcerative colitis, but it should be postponed for acute and severe patients. Microscopic observation of intestinal mucosa congestion, edema, granular protrusions, multiple spot-like or patchy shallow erosions or ulcers, and mucus or yellow-white moss on the surface. The intestinal mucosa is fragile. It is easy to bleed when the lens is rubbed. Due to edema and lymphoid hyperplasia, pseudopolyps can be seen.

4. Barium enema

Early intestinal mucosal fold texture disorder, blurred bowel edges, severe bowel edges saw burr-like or jagged changes. The late colonic pouch disappeared, and the intestine was in the form of a narrow lead tube. Barium enema should not be used in acute and severe patients.

5. Mucosal pathological examination

See mucosal inflammatory cell infiltration, heteroepithelial cell proliferation, abnormal gland arrangement, epithelial fibrosis, and crypt formation.

Colitis diagnosis

A diagnosis can be made based on the history, typical symptoms, physical examination and various auxiliary examinations (laboratory examination, imaging examination, colonoscopy, histological examination). In addition to the qualitative diagnosis, you should also make judgments on the clinical type, severity, stage of the disease, and whether there are complications.

(I) Diagnosis basis

1. Abdominal pain accompanied by acute and severe diarrhea, continuous or recurrent diarrhea, discharge of mucus, pus and blood, patients with specific enteritis treatment is invalid. Clones, bacillary dysentery, amebic dysentery, intestinal tuberculosis, colon cancer, etc. were excluded.

2. Systemic and parenteral manifestations.

3. Pathogens were not found in routine stool inspection and culture.

4. X-ray barium enema, showing rough edema of the intestinal mucosa, multiple small filling defects, granular or nodular, thick and disordered folds. The intestinal wall is jagged. In the later stage, the bowel became short and stiff, the colonic bag disappeared, and the lead was tubular.

5. Colonoscopy revealed diffuse hyperemia, edema, erosion, ulcers and increased fragility at the lesion site. The surface is often accompanied by purulent discharge and blood. Multiple false polyps and bowel stenosis, bridge-shaped mucosa. The colonic bag becomes shallow or disappears.

6. On biopsy, there are inflammation, erosion, and ulcers that are mainly infiltrated by monocytes in the mucosa. Cryptitis and crypt abscess are still visible. At the same time, the glands are disordered and atrophied. Goblet cells are reduced and Pan's cell metaplasia can be seen.

(Two) staging

Clinical type

Divided into initial hair style, chronic recurrence type, chronic persistence type and violent hair style.

2. Degree of illness

Divided into mild (diarrhea less than 3 times a day, light or no blood in the stool, no fever), moderate (between mild and severe), severe (diarrhea more than 6 times a day, pulse 90 or more per minute).

3. Lesion range

Divided into proctitis, rectal sigmoiditis, left semicolitis, extensive colitis and pancolitis.

4. Staging of disease

Divided into active period and remission period.

Differential diagnosis of colitis

It needs to be distinguished from acute self-limiting colitis, Crohn's disease, amebic dysentery, ischemic colitis, colonic diverticulosis, colorectal polyps, colorectal cancer, and reflex arthritis.

Colitis treatment

Individualized and comprehensive treatment is given according to the patient's condition. In principle, the symptoms of the disease should be controlled as early as possible to promote remission, maintenance treatment, prevent recurrence, prevent complications, and grasp the timing of surgical treatment.

General therapy

Pay attention to rest to prevent overwork. Eat high-nutrition, digestible foods, low-fat, low-residue foods. Patients with severe illness or patients with complications such as megacolon and intestinal fistula were given total parenteral nutrition.

2. Drug treatment

(1) Aminosalicylic acid sulfasalazine (SASP): suitable for mild and moderate UC, intermittent period to prevent recurrence. Dosage is taken under the guidance of a doctor. Attention should be paid to two points during use. Those who are allergic to sulfa are disabled and their liver and kidney functions are checked for three consecutive months. Mesalazine: 5-aminosalicylic acid (5-ASA), the active ingredient in SASP, has relatively low side effects. Olsalazine: It is a coupling of two molecules of 5-ASA. The effect is similar to SASP, but the side effects are low.

(2) Glucocorticoids Commonly used drugs are prednisone and prednisone. It is one of the effective drugs for inhibiting inflammation in the acute active phase of ulcerative colitis.

3. Surgical treatment

Patients with major bleeding, perforation or impending perforation, and persistent or progressive exacerbation of toxic colitis should be treated urgently.

Symptoms of intensive drug treatment have been unable to completely control symptoms, or have long-term dependence on hormones and azathioprine, or there are high risk factors for canceration, which are also indications for surgery.