CC BY
6Received by the Editor 08.02.2021
IRSTI 76.29.34
UDC 616-071
CLINICAL MANIFESTATIONS OF ULCERATIVE COLITIS
A. Japparkulova1, N. Aitymbetova2 N.A., S. Tuktibayeva1
^'International Kazakh-Turkish University named after Khoja Ahmed Yasavi ", Kazakhstan, 161200, Turkestan region, Turkestan city, B. Sattarkhanov Avenue, building 29B
2South Kazakhstan Medical Academy, Republic of Kazakhstan 160019, Shymkent, pl. Al-Farabi, 1/1
Inflammatory diseases are a serious problem in gastroenterology. They are characterized by unknown etiology, complex pathogenesis, the possibility of relapse and the appearance of complications, often leading to disability.
Purpose of the work: to clarify the clinical features of ulcerative colitis depending on the variants of diseases, to develop schemes for the management of patients with ulcerative colitis, depending on the various options.
Research objectives. To study the features of the initial clinical manifestations of ulcerative colitis in various forms of diseases and to highlight individual variants of clinical debut.
Materials and research methods. A group of 30 patients from GKB No. 1 of the gastroenterology department in 2016-2019 was examined.
Results. In the largest number of cases, the onset of the disease occurred at the age of 20-35 and 45-50 years.
Findings. According to the clinical picture of the initial stage of ulcerative colitis, the following variants of the onset of the disease were identified: diarrheal (23.3%), diarrheal-hematochezial (36.6%), hematochezial (16.6%), painful (13.3%) and mixed (10 %).
Key words: ulcerative colitis, chronic disease, intestines.
КЛИНИЧЕСКИЕ ПРОЯВЛЕНИЯ ЯЗВЕННОГО КОЛИТА
Джаппаркулова А.Б. 1, Айтымбетова Н.А. 2, Туктибаева С.А.1
Международный казахско-турецкий университет имени Ходжи Ахмеда Ясави", Казахстан, 161200, Туркестанская область, город Туркестан, Проспект Б. Саттарханова, строение 29В
2Южно-Казахстанская медицинская академия, Республика Казахстан 160019,
Шымкент, пл. Аль-Фараби, 1/1
Воспалительные заболевания являются серьезной проблемой гастроэнтерологии. Для них характерна неизвестная этиология, сложный патогенез, возможность рецидива и появления осложнений, нередко приводящих к инвалидности.
Цель работы: уточнить клинические особенности язвенного колита в зависимости от вариантов заболеваний, разработать схемы ведения больных язвенным колитом в зависимости от различных вариантов.
Задачи исследования: изучить особенности начальных клинических проявлений язвенного колита при различных формах заболеваний и выделить отдельные варианты клинического дебюта.
Материалы и методы исследования: обследована группа из 30 пациентов из ГКБ №1 гастроэнтерологического отделения 2016-2019 гг.
Результаты. В наибольшем числе случаев дебют заболевания приходился на возраст 20-35 и 45-50 лет.
Заключение. По клинической картине начальной стадии язвенного колита выделены следующие варианты дебюта заболевания: диарейный (23,3%), диарейно-гематохезийный (36,6%), гематохезийный (16,6%), болевой (13,3%) и смешанный (10%).
Ключевые слова: язвенный колит, хроническое заболевание, кишечник.
ОЙЬЩ ЖАРАЛЫ КОЛИТТЩ КЛИНИКАЛЬЩ К0РШ1СТЕР1
Джаппаркулова А.Б.1, Айтымбетова Н.А.2, Тукт1баева С.А.1
1«^ожа Ахмет Ясауи атындагы Халыкаралык казак-^р^ университет», ^азакстан, 161200, ТYркiстан облысы, ТYркiстан каласы, Б. Саттарханов дацгылы, 29Б гимарат
2Ощуспк ^азакстан медициналы; академиясы, ^азакстан Республикасы 160019, Шымкент к. Эл-Фараби, 1/1
Кабыну аурулары гастроэнтерологиянын манызды мэселесi болып табылады. Олар белгiсiз этиологиямен, кYPделi патогенезмен, кайталану мумшндтмен жэне жш MYreAeKTÍKKe экелетiн аскынулармен сипатталады.
Максаты: аурудьщ щскаларына байланысты ойык жаралы колиттщ клиникалык ерекшелiктерiн нактылау, эртYрлi щскаларга байланысты ойык жаралы колитпен ауыратын наукастарды баскару кестелерiн жасау.
Зерттеу мшдеттерк аурудын эртYрлi формаларында ойык жаралы колиттщ бастапкы клиникалык кврiнiстерiнiн ерекшелжтерш зерттеу жэне клиникалык дебюттiн жеке щскаларын бвлiп керсету.
Зерттеу материалдары мен эдктерь 2016-2019 жж. гастроэнтерологиялык бвлiмшенiн № 1 ККА-дан 30 пациенттен т^ратын топ тексерiлдi.
Нэтижелерь Квптеген жагдайларда аурудын дебютi 20-35 жэне 45-50 жас аралыгында болды.
Т^жырымдар. Ойык жаралы колиттiн бастапкы сатысынын клиникалык кврiнiсi бойынша аурудын дебютшщ мынадай щскалары бвлiнген: диареялык (23,3%), диареялык-гематохезиялык (36,6%), гематохезиялык (16,6%), ауыру (13,3%) жэне аралас (10%).
ТYЙiндi свздер: ойык жаралы колит, созылмалы ауру, iшек.
Relevance of the topic
Ulcerative colitis is a chronic disease leading to prolonged inflammation of the mucosa and submucosa of the colon without granulomas during biopsy, affecting the rectum and, to varying degrees, the colon, characterized by a remitting course with periods of exacerbations. Systemic and extraintestinal manifestations are also a characteristic feature [1].
Unclassified IBD is a term used to monitor cases of difficult differential diagnosis between ulcerative colitis and Crohn's disease or other colitis, taking into account data from anamnesis, endoscopic and histopathological examination of several biopsies, and radiological examination [2].
Undifferentiated colitis is a term used by morphologists to describe the overlap between ulcerative colitis and Crohn's disease. The presence of such serves as a predictor of the risk of surgical intervention [3].
The definition of inflammatory bowel disease (IBD) is given in accordance with the ECCO consensus, the recommendations of the British Society of Gastroenterology [4].
The constant interest in the study of chronic inflammatory bowel diseases (IBD) is associated with a significant increase in the incidence of these nosological forms throughout the world. Despite a significant number of works devoted to the etiology and pathogenesis of IBD, the causes of the disease remain relevant. The currently known mechanisms of ulcerative colitis (UC) development are mostly hypothetical, which does not allow the development of an adequate etiopathogenetic therapy for these diseases [5].
A variety of clinical manifestations of UC, extraintestinal lesions, the presence of severe, sometimes fatal complications, as well as an absolute increase in the number of patients determine the need for further serious research of these nosological forms [6].
The importance of a detailed presentation of issues related to the onset of clinical manifestations of UC is due to the fact that a large number of errors are still allowed in their diagnosis. Unfortunately, from the moment the first symptoms of chronic inflammatory bowel disease appear until the correct diagnosis is made, on average, it takes 10 months to 5 years, and in most cases, the diagnosis is made not by general practitioners, but by narrow specialists in hospitals [7].
All of the above necessitates further study of the features of the initial clinical manifestations of UC. The problem of studying and predicting the course of the inflammatory process depending on various variants of diseases remains unresolved.
Purpose of the work
To clarify the clinical features of ulcerative colitis, depending on the variants of diseases, to develop schemes for the management of patients with ulcerative colitis, depending on the various options.
Research objectives
To study the features of the initial clinical manifestations of ulcerative colitis in various forms of diseases and to highlight individual variants of clinical debut.
Materials and research methods
A group of 30 patients was examined.
The survey program included:
1. Detailed questioning of complaints and anamnesis of the patient with the completion of a special questionnaire.
2. General examination of the patient.
At the first stage of the examination, a detailed questioning of complaints and anamnesis of the patient was carried out with the completion of a special questionnaire. When studying the history of the disease, significant clinical significance was attached to: the duration of the disease, the duration of the period from the onset of the first symptoms of the disease to the moment of correct diagnosis, the number of exacerbations per year, the seasonality of exacerbations, previous treatment (its duration, maintenance therapy, the development of complications of IBD, the presence of bad habits - smoking, alcohol abuse).
According to the data obtained, the following options are highlighted:
- diarrheal - manifested by frequent loose stools up to 10-30 times a day (mainly at night) without pathological impurities;
- diarrheal-hematochezial - characterized by frequent loose stools up to 10-30 with an admixture of blood;
- hematochezial - manifested by the release of blood during bowel movements;
- painful - characterized by pain of a different nature and severity in the right iliac region and along the colon;
- febrile pain - manifested by an increase in body temperature and pain in the right iliac region or along the colon;
- mixed - characterized by a combination of the above symptoms.
Objective research
During the physical examination of patients, a comprehensive and systematic study of all organs and systems of the body was carried out. Taking into account the probable development of various extraintestinal lesions and concomitant diseases, the condition of the skin, visible mucous membranes, as well as subcutaneous fat was assessed visually and palpably to assess the trophological status of the patient.
When examining patients with ulcerative colitis (UC), a digital examination of the colon was carried out (taking into account the high risk of developing colorectal carcinoma in this group of patients).
Research results and their discussion
Thirty patients were examined: 13 of them were men (43.3%), and 17 (56.6%) were women. The average age was: the general group of patients with UC - 38.3 ± st = 13.01 years. In the largest number of cases, the onset of the disease occurred at the age of 20-35 and 45-50 years.
Findings
According to the clinical picture of the initial stage of ulcerative colitis, the following variants of the onset of the disease were identified: diarrheal (23.3%), diarrheal-hematochezial (36.6%), hematochezial (16.6%), painful (13.3%) and mixed (10 %).
Practical advice
In connection with the later date of the correct diagnosis in patients with suspected painful onset of UC, it is advisable to conduct a thorough comprehensive clinical and instrumental examination with the inclusion of endoscopic, morphological, ultrasound and CT methods of investigation.
References
1. Gomollon F., Dignass F., Annese V. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1-2: Diagnosis and Medical Management // Journal of Crohn's and Colitis. - 2017. - P. 3-25.
2. Grigorieva G.A. Ulcerative colitis and Crohn's disease - the problem of the XXI century // Bulletin of the Smolensk State Medical Academy. - 2011. - No. 1. - P. 1 - 4.
3. Zunirah A., Shashank S. Value-Based Health Care in Inflammatory Bowel Disease // Oxford University Press. - 2018. - No. 1. - P. 118 - 144.
4. Wintjens D. S., Jong M. J. Novel perceived stress and life events precede flares of inflammatory bowel disease: a prospective 12-month follow-up study // Journal of Crohn's and Colitis. - 2018. - No. 3. - P. 118 - 237.
5. Vize-Khripunova MA Clinical and endoscopic characteristics of inflammatory bowel diseases // Ulyanovsk medical and biological journal. - 2014. - No. 3. - P. 38 - 45
6. Valitova ER Lesion of the esophagus in Crohn's disease and ulcerative colitis // Experimental and clinical gastroenterology. - 2011. - No. 3. - P. 6 - 10
7. Denisova M.F. Comparative clinical and paraclinical characteristics of ulcerative colitis and Crohn's disease in children // Health of the child. - 2016. - No. 2. - P.10-16.
Corresponding author: Tuktibaeva Saule Aktleuovna - PhD, head. Department of the International Kazakh-Turkish University named after Kh.A. Yasawi. +7 702 651 23 79; saule79s@mail.ru
Information about authors:
Tuktibaeva Saule Aktleuovna - PhD, head. Department of the International Kazakh-Turkish University named after Kh.A. Yasawi
Aitymbetova N.A. - Assistant of the Department of GP-2 of the South Kazakhstan Medical Academy
Tuktibaeva S.A. - Head Department of Human Morphology and Anatomy Kazakh-Turkish University named after Kh.A. Yasawi
