Modern and promising ways of bowel preparation for instrumental research

A review is presented to summarize data on intestinal preparation approaches and methods for research. The historical background and main stages in the development of the intestinal lavage method are highlighted, and traditional and modern methods of evaluating its effectiveness are characterized. Dietary recommendations and information about the basic drugs used nowadays in preparation of the intestine for instrumental research are adduced. Clinical aspects of different types of osmotic action of drugs are considered. The composition of laxatives for salt and electrolyte components in terms of potential benefit and risk in patients is analyzed. The main positions of the current recommendations of domestic, European and American expert communities concerning the discussed topic are taken into account. Demonstrated “no less efficacy” of sulfate solution compared with macrogol in adult patients. Clinical case is presented: patient A., 22 years old, admitted to the clinic with complaints of recurrent pain in the left abdomen, frequent stools, sometimes with blood, loss of hair, flaky spots on the skin of the upper extremities. The patient was prepared for the examination – colon cleansing with a sulfate drug, endoscopic examination of the colon - colonoscopy was performed. Diagnosis: nonspecific ulcerative colitis. The treatment scheme is presented, clinical remission of the disease is achieved.

Clinicopathologic peculiarities of nonspecific ulcerative colitis and Crohn's disease

Currently, inflammatory bowel diseases (IBD), in nonspecific ulcerative colitis (NUC) and Crohn's disease (CD), are an extremely urgent problem. The incidence of both ulcerative colitis and Crohn's disease worldwide is increasing every year, and mainly among the working-age population, which makes inflammatory bowel disease (IBD) a socially significant disease. The clinical picture of IBD is diverse, which often makes it difficult to timely diagnose and prescribe adequate therapy and inevitably negatively affects the prognosis of diseases. Here are some of the characteristics of the NUC and CD. The histogram results of numerous studies indicate the following: in Crohn's disease (CD), the thickness of the intestinal wall is often significantly increased. In the mucous membrane, slit-like ulcerative defects are detected, in the bottom of which there are signs of inflammation in the form of infiltration of the bottom of the ulcers by leukocytes, lymphocytes, histiocytes. As for colitis, based on these clinical cases, it can be concluded that children and adolescents are characterized by a total lesion of the colon and the appearance of segmental forms. In adult patients, distal colitis, the so-called proctosigmoiditis, prevails. On examination, the mucous membrane was edematous, vividly hyperemic, edematous, with superficial erosions.

Tendency Of Incidence With Nonspecific Ulcerative Colitis In Kazakhstan

Nonspecific ulcerative colitis is a chronic inflammatory bowel disease of an immune nature with frequent localization in the large intestine. A pattern is noted that in the northern and western continents they suffer more often than in Asia. To identify risk factors in a population, epidemiological studies must firstly assess the incidence of disease. Aim. To study the trends of nonspecific ulcerative colitis (NUC) incidence in Kazakhstan. Material and methods. The research material was compiled summary reporting form number 12 of the Ministries and the Health of the Republic of Kazakhstan on new cases of nonspecific ulcerative colitis (ICD-10 – K51), established for the first time. A retrospective study was used as the main method for studying the incidence of NUC. According to generally accepted methods of biomedical statistics, extensive, intensive and equalized indicators of the incidence of NUC were calculated. Results and discussion. For 2013-2018 14,079 new cases of NUC were registered in the republic, of which 15 were in children – 15.3%, teenagers – 4.8% and adults – 79.8%. The average annual incidence rate of NUC in the entire population of Kazakhstan was 13.5±2.10/0000 (95% CI=9.4-17.50/0000), and for population groups having been studied was: in children – 7.2±2.10/0000 (95%CI=3.8-12.00/0000), among teenagers – 18.7±5.00/0000 (95% CI=9.0-28.50/0000) and the adult population 15.4±1.90/0000 (95% CI=11.8-19.10/0000). The difference in morbidity between groups was statistically significant. Disease tended to decrease in all age groups: in the adult population (Т=−12.3%), children (Т=−43.7%) and in adolescents (T=-50.1%). Conclusion. According to the dynamics, NUC incidence in Kazakhstan has a decreased tendency due to the child and adolescent population. The results obtained are recommended to be taken into account by health authorities when making managerial decisions. Keywords: nonspecific ulcerative colitis, morbidity, trends, Kazakhstan.

EFFECTS OF BIOLOGICAL THERAPY ON QUALITY OF LIFE AND PSYCHOEMOTIONAL STATUS OF PATIENTS WITH ULCERATIVE COLITIS

The aim: To compare the effects of tofacitinib, adalimumab and budesonide on the quality of life and psychoemotional status of patients with moderate UC. Materials and methods: The study included 104 patients with moderately severe UC aged between 18 and 75 years old. Patients were divided into 3 groups. Group I consisted of patients with UC treated with budesonide 9 mg 1 g / d (BUD; n = 34). Group II – of patients receiving adalimumab at an initial dose of 160 mg and 80 mg at week 2, followed by maintenance dose of 40 mg weekly (ADA; n = 38) and group III, who received tofacitinib 10 mg 2p / d (TOF; n = 32). Evaluation of quality of life and psycho-emotional status of patients was performed using IBDQ, SF-36 and MMRI questionnaires. Results: According to the IBDQ-questionnaire, all groups after treatment had a statistically significant increase in their results: BUD (from 146,44 ± 2,23 to 151,36 ± 2,40), ADA (from 144,28 ± 3,10 to 172,36 ± 3,12), TOF (from 149,22 ± 2, 86 to 184.36 ± 2.88), respectively, p <0.05. Also, after treatment statistically significant changes were seen in patients of all groups in regards to the psychological and physical components of the SF-36 scale. Analysis of the personality profile using MMRI of all groups of patients showed a change in scales 2 (depression), 3 (hysteria), 5 (tenderness-femininity), 6 (paranoia) and 0 (social introversion), which significantly improved in the ADA and TOF groups. Conclusions: Tofacitinib and adalimumab in patients with nonspecific ulcerative colitis of moderate severity had a better effect on quality of life and psychoemotional status compared with budesonide treatment.

Ulcerative colitis in the practice of a medical assistant

Ulcerative colitis (UC) is a chronic nonspecific inflammatory disease caused by immune disorders, mental disorders, genetics, and other factors. Its main clinical manifestations are accompanied by abdominal pain, diarrhea, bloody stools, weight loss, etc. A distinctive feature of nonspecific ulcerative colitis from Crohn's disease is its limitation by the large intestine, as well as the limited inflammation of the mucous membrane [1]. The disease affects various age groups from infants to the elderly, with a maximum incidence rate between the ages of 15 to 30 years and between 50 and 70 years. UC seriously affects human health and quality of life because of its long duration and repeated attacks, and also there is a risk of developing colorectal cancer. The disease violates the quality of life and leads to disability [2]. The article presents the causes of ulcerative colitis and describes the mechanisms for the development of pathological changes in the intestine. The principles of patient management, taking into account the severity of the disease, and the tactics of rational drug therapy are presented.