Ileitis is an acute or chronic inflammation of the ileum (distal small intestine). It is manifested by dyspeptic disorders, abdominal pain, fever to subfebrile numbers, weakness and malaise. To confirm the diagnosis, it is necessary to conduct a general blood test, bacteriological and clinical stool tests, an X-ray examination of the intestine with contrast. Bacterial ileitis requires the use of antibiotics, all patients are prescribed a special diet, enterosorbents and astringents, enzymes, intestinal motility correctors, probiotics and multivitamins.
Ileitis is a fairly common disease, usually combined with an inflammatory process in other parts of the intestine (duodenitis, eunitis, tiflitis, etc.). Pathology affects mainly young people from 20 to 40 years old, somewhat more common in men. Residents of large cities and megacities have ileitis twice as often as the rural population.
Specialists in the field of modern gastroenterology have found that pain in the right iliac region in 70% of cases is a sign of chronic ileitis (most often yersiniosis). Chronic ileitis accounts for approximately 6% of all inflammatory bowel diseases. The urgency of the problem of ileitis lies in the fact that the ileum is practically inaccessible to endoscopic research methods, and clinically ileitis manifests itself only with nonspecific symptoms, which is the reason for underdiagnosis and erroneous treatment tactics.
Causes of ileitis
Pathology can develop acutely, and may have a chronic recurrent course. Acute ileitis is more typical for children, often have a bacterial or viral nature. Chronic course is more common in adults. The most common infectious cause of the disease is the invasion of yersinia, less often the inflammatory process in the ileum is initiated by salmonella, staphylococci, E. coli. Acute viral ileitis can be caused by rotaviruses, enteroviruses. Worm infestations, giardiasis usually lead to the development of chronic ileitis.
There are also common causes that can contribute to the occurrence of both acute and chronic inflammation of the ileum. These include allergic reactions of the body, bad habits (smoking, alcoholism), improper diet (eating a large amount of extractive, fatty, spicy food), poisoning with poisons, heavy metals and chemical reagents. The pathology can be provoked by taking certain medications, hereditary predisposition (fermentopathy), operations on the intestine.
Most often, the chronic inflammatory process develops in patients leading a sedentary lifestyle, abusing fatty foods and alcohol, having adhesions in the abdominal cavity and concomitant diseases of the digestive system (chronic pancreatitis, cholelithiasis, etc.). Ileitis can be one of the manifestations of tuberculosis, yersiniosis, typhoid fever, Crohn’s disease, ulcerative colitis.
According to the localization of the process, isolated ileitis is isolated or combined with an inflammatory process in the stomach, other parts of the small intestine, colon, as well as with a total lesion of the entire intestine. Due to the occurrence of the disease, it can be parasitic, infectious, medicinal, alimentary, toxic, enzymatic, postoperative.
Ileitis can be primary and secondary, arising against the background of another pathology of the digestive tract. According to enzymatic activity, ileites are atrophic and non-atrophic. Downstream, there is a light form, medium and heavy, flowing with or without complications. Also, such stages of pathology as exacerbation, complete and incomplete remission are particularly noted.
The acute process is characterized by a rapid manifestation of symptoms, and in the future – a rapid recovery, sometimes spontaneous (without treatment). It is characterized by pain in the right iliac region, rumbling and bloating, loose stools up to 20 times a day. The patient is concerned about nausea and vomiting, fever up to 39 ° C, headaches and weakness. Severe dyspepsia can lead to severe dehydration, untimely assistance with exicosis – to the development of hypovolemic shock, convulsions, disorders of the blood coagulation system.
Chronic ileitis is characterized by a gradual onset of the disease, moderate severity of symptoms. Patients complain of moderate pain in the right iliac region and around the navel, rumbling and bloating, the appearance of watery yellowish stools with an admixture of undigested food immediately after eating. The act of defecation does not bring relief, but can provoke increased pain, collapse. Due to a violation of the absorption of nutrients, vitamins and minerals, there is a gradual weight loss, hypovitaminosis, osteoporosis.
In diagnostics, great importance is attached to laboratory research methods, since the distal part of the small intestine is practically inaccessible for examination with an endoscope. A general blood test is performed – inflammatory changes can be detected in it (leukocytosis, a shift of the leukoformula to the left, an increase in ESR). Virological and bacteriological examination of feces is prescribed, a large amount of undigested dietary fiber, carbohydrates, and a decrease in enzymatic activity are determined in the coprogram.
It is mandatory to perform a stool analysis for hidden blood, since chronic bleeding often complicates the course of ileitis. In the biochemical analysis of blood, there is a lack of protein and trace elements. An informative diagnostic method is the radiography of the passage of barium through the small intestine – during the study, it is possible to detect intestinal motility disorders, dynamic intestinal obstruction. The images may reveal areas of ileum spasm, fistulas and strictures. Pathological changes in the intestinal wall lead to a violation of the passage of intestinal contents, which can be manifested by the clinic of intestinal obstruction.
Consultation of an endoscopist will help diagnose concomitant pathology of the digestive tract; EGDS is carried out to exclude gastritis, inflammation of the initial parts of the small intestine. Ultrasound of the abdominal cavity is performed if there is a suspicion of gallstone disease, pancreatitis. Ultrasound will also allow you to assess the condition of the intestinal wall, the presence of effusion in the abdominal cavity (ascites). MSCT of the abdominal cavity makes it possible to comprehensively assess the condition of all internal organs, develop the right treatment tactics.
Ileitis should be differentiated from other diseases occurring with diarrhea: thyrotoxicosis, ulcerative colitis, thyrotoxicosis, irritable bowel syndrome, Addison’s disease.
All patients with suspected inflammatory process in the ileum are advised to consult a gastroenterologist. The specialist will be able to differentiate complaints, identify patterns of the course of the disease, develop the right tactics of diagnostic search and therapy. In the presence of acute infectious ileitis, an infectious disease specialist must take part in the treatment. Treatment of acute ileitis is carried out only in a hospital. With verified bacterial genesis of ileitis (after determining the sensitivity of the isolated microflora to antibiotics), antibacterial therapy is prescribed.
A mandatory component of treatment is a diet – food should be mechanically, chemically and thermally gentle, easily digestible and rich in vitamins. In the presence of persistent vomiting and diarrhea, infusion therapy with glucose solutions, saline solutions is prescribed. To normalize the absorption of food, enzyme preparations are necessarily prescribed. If diarrhea persists, it is recommended to take astringents, sorbents, rice broth. Vitamins and probiotics are an important component of ileitis therapy.
The tactics of treatment of chronic ileitis are somewhat different. A sparing diet is prescribed, containing lactic acid products, a small amount of coarse dietary fiber, excluding the intake of spicy, fried and fatty dishes. The menu includes a sufficient amount of protein, vitamins and minerals. It is advisable to take food 4-5 times a day, in small portions. When verifying hereditary fermentopathy, such a diet is observed for life. Enzymes, preparations for normalization of intestinal motility, probiotics, vitamins and minerals, astringent herbal remedies are necessarily prescribed. Treatment can last several months, but after normalization of the condition, relapses are not excluded.
Prognosis and prevention
The prognosis for acute ileitis is favorable, and for chronic course depends on the cause and degree of damage to the intestinal wall. Dieting and taking enzyme preparations significantly improve the quality of life of patients, avoid significant exhaustion, and improve the prognosis. Prevention consists in timely detection and treatment of chronic pathology of the digestive tract, observance of a proper lifestyle and nutrition.