Under enteropathy gastroenterologists it is customary to designate the pathology of the intestinal mucosa that is not inflammatory, characterized by a deficiency of secretory activity in the production of enzymes.
There are extreme forms of enteropathy with a complete lack of enzymatic secretion of a certain type. The lack or lack of enzymes affects the ability of microvilli to adsorption.
When a painful sensation occurs in the intestines accompanied by diarrhea, a patient is examined for radiography, endoscopy, and visual examination of urine and feces.
Treatment of enteropathy consists of the exclusion from the diet of those foods that contain non-digestible substances, the appointment of various eubiotics and enzymes for oral administration.
Causes of development of
The development of enteropathy occurs under the influence of factors determining a variety of the disease. Among the biotic effects are viral, mycotic, bacterial agents, the effects of toxic effects of helminths and parasitic protozoa.
Abiotic factors are drugs, food substances that cause allergic reactions, gluten of cereals in the absence of sufficient enzymatic activity of the intestine.
A number of pathologies develop due to a recessive mutation in the genotype, for example, celiac disease, during which the digestion of cereal proteins( glutenes) is disrupted due to insufficient( absent) secretion of enzymes.
Reliably identified cause helps to eliminate the provoking factor for enteropathy and to build the correct scheme of treatment and prevention of the disease after undergoing a comprehensive diagnostic examination. Clinical forms of the disease become more mild, the villi of the intestinal mucosa after the treatment go to the stage of remission.
Not all pathologies of the intestine reveal the causative factors of the development of the disease. With autoimmune enteropathy, the formation of intestinal villi is difficult due to the formation of antibodies in cell proliferation. An unclear nature is of a sprue of different nature: collagen, hypo-γ-globulinemic, refractory, etc.
Gastroenteritis of idiopathic, eosinophilic and granulomatous( Crohn's disease) and ileitis not of granulomatous form belong to the pathologies of the intestine of an unclear nature.
The exudative form of enteropathy( Crohn's disease) has a special form, the symptoms of which can accompany any form of enteropathy. Primary and secondary enteropathy can equally be accompanied by exudative syndrome.
Forms of intestinal enteropathy and their symptoms
The main forms of intestinal enteropathy 2: primary, due to hereditary pathology and secondary, developing after inflammatory or destructive phenomena in intestinal microvilli.
The congenital form of enteropathy is differentiated by the enzymatic absence or deficiency of enzymes that break down the disaccharides. Hence, a special group of disaccharidic enteropathy is isolated.
Intestinal enzymes secreted in deficiency or completely absent, cause non-digestibility of dairy, malt, beet, cane, mushroom sugars and their intermediate cleavage products( isomaltoses).
As a result of enzymatic disruption, disaccharides are not cleaved to monosaccharides, which normally should be absorbed into the blood. The accumulation of unquenched food particles causes an increase in osmotic pressure in the intestinal cavity, which leads to excessive discharge of fluid into the intestinal lumen and, as a result of increased peristaltic movements, the disaccharides with water and caloric masses prematurely tend to leave the intestine. So the main symptom of all forms of enteropathy is formed - diarrhea.
The intensity of manifestation of symptoms with enteropathy does not depend on the forms of the disease and is influenced by the amount of the enzyme formed and the presence of a substance corresponding to the cleavage in the food.
Monosaccharide enteropathy develops as a primary form in the autosomal recessive type. The lack of malabsorption in monosaccharide form is associated with a deficiency in the secretion of transport proteins that bind monosugars before absorption.
With disaccharide and monosaccharide enteropathy, diarrhea is accompanied by rumbling sounds in the abdomen, flatulence, acidic reaction of stool after diarrhea.
Gluten enteropathy is associated with deficiency of the intestinal enzyme that cleaves gluten proteins. Gluten is a polypeptide contained in grains of cereal crops( wheat, rye, barley, oats).Gluten-free grains of other cereal crops( corn, rice), as well as potatoes, seeds of leguminous plants, berries, vegetables and fruits.
Non-observance of the diet and prolonged manifestation of symptoms of diarrhea can lead to disruption of electrolyte balance, hypovitaminosis of various types, general exhaustion of the body.
The defeat of intestinal microvilli is usually not a provoking factor for weight loss in the patient. Therapeutic treatment is reduced to excluding the cause of diarrhea and eliminating the main symptom.
If all intestinal microvilli are damaged by food allergens contained in food or medications taken orally, allergic enteropathies occur. Hyperallergenic products are dairy, citrus, chocolate, fish, nuts, etc.
Several varieties are distinguished among the allergic form of enteropathy.
- Firstly, , allergens cause clinical manifestations by the hematogenous route.
- Secondly, , allergens are provoking factors for the inflammatory processes of the intestinal mucosa.
- Thirdly, , allergens directly contact the intestinal microvilli, causing symptoms( gluten enteropathy).
- Fourthly, , with the contact of intestinal microvilli with allergens, degenerative processes in the mucosa begin.
Features of the clinical picture for allergic enteropathy are swelling of the respiratory and oral cavity, accompanying diarrhea, abdominal pain and nausea.
A special form is autoimmune enteropathy in connection with its inheritance. A recessive gene responsible for a deficiency of enzymatic deficiency or other intestinal disorder is localized in the X chromosome. For this reason, most sick infants turn out to be boys, and women are the carriers of the recessive gene.
In case of localization in a newborn girl of both alleles of recessive genes, the mutation is considered as semi-lethal. With the observance of diet and exclusion of provoking factors, one can exclude the dependence of life expectancy on the presence of a recessive gene.
Diagnosis
The diagnosis of "enteropathy" is not a large-scale phenomenon in medicine. This does not mean a small incidence of the disease, but indicates the complexity of the diagnostic procedures.
So, in the absence of enzymes for gluten, antibodies to the corresponding enzyme are not always found in the blood. Violation of malabsorption and enzymatic insufficiency are detected not only during the course of enteropathy, but also in other abnormalities of the functions of the gastrointestinal tract.
The primary diagnostic method for detecting enteropathy is a general and biochemical blood test.
Indices of enteropathy are a decrease in electrolyte composition, especially magnesium, calcium, cholesterol, chlorine. The decrease in the amount of albumin fraction in the blood indicates a severe development of enteropathy.
Crohn's disease is detected by the introduction of barite water followed by radiography of the intestine. The condition of the mucosa is displayed with greater certainty in endoscopic examination.
To determine the specific form of enteropathy, the "load test" method is used, in which the alleged enzymatic deficiency is detected by an increase in the diet of the product with the corresponding substance.
Treatment of
There is no single-valued treatment regimen for enteropathy, therefore independent treatment not only does not eliminate the cause of the disease, but it can aggravate the further course of the disease.
In the inflammatory nature of the disease, antibacterial agents are selected. With gluten enteropathy, they exclude from the diet cereal products and cereals with a high content of gluten.
The diet is saturated with rice, meat, fish, eggs, fruits, vegetables, legumes.
In order to increase the enzymatic activity of the intestinal mucosa, patients are assigned enzyme preparations, eubiotics. With a reduced level of albumin prescribed intravenous administration of albumin.
After prolonged diarrhea, the diet is enriched with protein products, minerals and vitamins. With any form of enteropathy, vitamin therapy is prescribed.