Small Intestinal Inflammation

Definition:

Small intestinal inflammation, also known as enteritis, is an inflammatory condition affecting the mucosal layer of the small intestine. This condition is managed by gastroenterologists or general practitioners. The small intestine comprises the distal portion of the small bowel, followed by the large intestine. Terminal ileitis is a form of Crohn’s disease, which is characterized by inflammation of the terminal portion of the ileum. Crohn’s disease is an inflammatory disorder that affects the gastrointestinal tract from the esophagus to the large intestine, potentially leading to ulceration and strictures. It is more common in women and typically peaks in individuals aged 20-30 years. Crohn’s disease lacks specific clinical diagnostic features, and differential diagnosis relies on endoscopic examination, biomarker evaluation, and radiographic imaging. As the disease progresses, 8-14% of individuals may experience intestinal bleeding, 12-16% may develop acute toxic dilatations, 10-14% may experience bowel perforation, and 40% may develop bowel strictures. Other complications such as anal fissures, abscesses, and intra-abdominal fistulas have been described. Therefore, prompt diagnosis and implementation of a mechanistically driven conservative therapy are crucial.

Small intestinal inflammation may also result from inflammation or toxin exposure to the intestinal membrane. Inflammation may arise from allergic reactions. Small bowel disease is rarely isolated and often coincides with inflammation of other gastrointestinal organs such as gastritis and colitis.

Types of Enteritis:
According to classification, the following types of enteritis are distinguished:

1. Lymphocytic: The disease is based on pathological activation of the lymphoid system in the intestines (a mechanism resembling that of Crohn’s disease).
2. Inflammatory: Superficial inflammation of the mucosal membrane (often occurring in cases of enteric infections).
3. Proliferative: Hyperplasia of the mucosal membrane, which may lead to tumor formation.
4. Insect Allergy: This disease is often associated with allergic reactions.

The disease may follow an acute (more common in children) or chronic course (more frequently observed in adults). Occasionally, a subclinical form is noted.

Based on the degree of enteritis activity, it is classified into the following types:

1. Inactive.
2. Mildly active.
3. Moderately active.
4. Maximal activity.

Symptoms of the Disease:
The main symptoms of enteritis include:

1. Lower abdominal pain on the right side or around the navel.
2. Nausea and vomiting.
3. Abdominal bloating.
4. Gas discharge disturbances.
5. Gastrointestinal disorders (often diarrhea).
6. Intestinal spasms.
7. General weakness.
8. Elevated body temperature (during exacerbations or infections).

Chronic inflammation disrupts the digestive process, resulting in vitamin and mineral deficiencies. In severe cases, pathological conditions such as osteoporosis and anemia may develop. In cases of ileocecal enteritis, protein deficiency in the blood and edema may occur. The disease is often of an allergic nature, including a stimulatory response to worms.

Causes of Enteritis:
The major risk factors and causes of enteritis include:

1. Bacterial factors: such as Salmonella, staphylococci, and streptococci, Yersinia, and enterotoxin-producing E. coli.
2. Viral factors: such as rotavirus and enteric viruses.
3. Worms: such as Giardia lamblia and others.
4. Allergic reactions to food antigens.
5. Aggressive chemical substances.
6. Nutritional errors.
7. Genetic predisposition of the body to autoimmune processes, where the immune system attacks the intestinal wall cells.
8. Enzymatic system defects.
9. Concomitant diseases of the gastrointestinal organs.
10. Previous surgical interventions on abdominal organs.

Diagnosis of Enteritis:
The main methods for diagnosing enteritis include:

1. General blood analysis: Helps detect signs of inflammation (increase in leukocyte count) and aids in differential diagnosis (increase in neutrophil shift count in bacterial infections and an increase in lymphocyte count in viral infections or granulomatous inflammation).
2. Chemical blood analysis: In Crohn’s disease, the level of reactive protein C increases in the blood.
3. Stool analysis: This physical and chemical analysis of feces allows for the assessment of digestive process disturbances.
4. Bacteriological stool analysis: Used in the inflammatory process to detect causative bacteria of importance.
5. Contrast X-ray imaging of the intestines: Allows evaluation of bowel condition, enabling identification of fill defects corresponding to granulomatous changes occurring in Crohn’s disease.
6. Computed tomography (CT) imaging: Can be of importance in complex clinical cases.

As the small intestine is not readily accessible for direct examination, direct mucosal membrane imaging is not feasible.

Diagnosis:

According to clinic recommendations, small intestinal inflammation is treated conservatively. The characteristics of treatment are determined based on the nature of the pathological process.

Conservative Treatment:

• Conservative treatment begins with dietary modifications, where food should be cooked by steaming or boiling. Food should be mashed, at room temperature, and without spices. It is also essential to maintain hydration using special solutions and to consume at least 2 liters of water daily.
• In cases of bacterial infection, antibiotics are prescribed.
• For enzyme deficiencies, enzymatic preparations are used.
• In autoimmune diseases, including Crohn’s disease, the use of corticosteroid preparations is indicated.

Surgical Treatment:

• Emergency surgery is indicated in cases where complications develop due to Crohn’s disease or other forms of enteritis. The scope of surgical intervention is determined based on the nature of the pathological process (such as perforation, penetration, bleeding, etc.).

Sources:

1. Surokova O.A., Geppe N.A., Ratnikova M.A. Ileitis and lymphofollicular hyperplasia of the terminal ileum in children // Doctor. Ru, No. 5 (64), 2011. – p. 67-70.
2. Kornienko E.A., Moiseenkova Yu.A., Volkova N.L., Loboda T.B. Eosinophilic lesions of the stomach and intestines: clinical aspects, diagnosis, treatment // Almanac of Clinical Medicine. 2018; 46 (5): 482–496.
3. Kagramanova A.V., Knyazev O.V., Parfenov A.I. Crohn’s disease: before and after 1932. Therapeutic Archive. 2023;95(2):193–197.