Inflammation of the small intestine (enteritis)
Enteritis is an inflammation of the small intestine. If the stomach is also affected by the inflammation, this is called gastroenteritis (gastro = stomach). This combination is particularly common in children.
If the large intestine is also affected, this is called enterocolitis (colon = large intestine).
- Cause:In about one third of those affected, viruses, especially the so-called norovirus, are the cause of small intestine diseases. They also occur mainly seasonally.
Noroviruses are mainly found in late autumn and the winter months, while infections caused by the rotavirus occur primarily in spring. The viruses are able to penetrate into the intestinal cells and destroy them. This leads to an inflammatory reaction in the small intestine, which in addition leads to the destruction of affected intestinal cells by the body’s defence cells and influences their function.
The viruses are transmitted from person to person, usually via so-called smear and droplet infections. Patients excrete the viruses via stool and vomit. If they do not wash and disinfect their hands sufficiently after going to the toilet, they contaminate objects such as door handles, towels and stair rails.
The viruses can still be detected in the stool up to two weeks after recovery; the person affected is therefore still infectious. As a prophylactic measure, even healthy people should therefore wash their hands thoroughly during the months with a high infection rate, especially before meals.During the summer months and early autumn, mainly bacterial pathogens such as Campylobacter and Salmonella are detected. The bacteria damage the small intestine, especially its mucous membrane, in various ways.
Infections caused by Salmonella and Campylobacter occur mainly through contaminated food. Salmonella is found in raw eggs, in egg dishes such as mayonnaise or ice cream, in meat products, especially poultry, in milk and dairy products and in seafood. Infection with Campylobacter usually occurs in connection with the consumption of contaminated, insufficiently heated poultry meat and poultry products, such as eggs.
The bacterium Clostridium difficile has a special feature, which can infect the small intestine, especially after a long period of antibiotic therapy, because the antibiotics have damaged the normal, benign germ flora in the intestine to such an extent that this malignant germ can spread unhindered.
- Symptoms: The symptoms, their temporal occurrence and duration depend on the pathogen itself as well as on the constitution of the person affected. Classically, nausea occurs first, in some cases in combination with vomiting, as well as cramp-like pain in the intestinal and abdominal area. The pain is usually combined with the occurrence of diarrhea.
In the further course of the disease fever and general weakness are added. The symptoms may last up to two weeks, or even less. The danger is that the strong loss of fluid and electrolytes can lead to dehydration of the body and thus to circulation problems.
In the worst case this can lead to a life-threatening circulatory collapse. This is particularly feared in children, the elderly and immunocompromised persons. The special feature of a Salmonella infection, especially in immunocompromised persons, is that the pathogens enter the blood via the intestines and can cause life-threatening blood poisoning.
- Diagnosis:The diagnosis of an intestinal inflammation can usually be made on the basis of the symptoms and the history of the affected person.
It is important to consider possible stays abroad, contact with potentially or actually ill persons and which food and beverages were consumed in the last days. If a bacterial cause is suspected, a stool sample is usually examined for the corresponding pathogens in order to provide the patient with the best possible therapy.
- Therapy:Top priority is given to the replacement of lost fluids and electrolytes, if necessary. Depending on the physical condition of the sick person, this can be done by drinking enough, as well as by the intake of salt (salt sticks) and dextrose.
If a great deal of fluid has already been lost and the affected person is already very dehydrated, consideration should be given to admission to the clinic to supply fluid and electrolytes via the vein. In addition, in the case of a severe form of intestinal inflammation (severe, frequent diarrhea with vomiting), it should also be avoided to compensate for fluid and electrolyte deficiency through food. In this state, the gastrointestinal tract is so irritated that the patient often vomits afterwards, which would make the situation increasingly worse.
Even in such a case, admission to a clinic is advisable. There are drugs available on the market that thicken the stool and thus reduce diarrhoea. However, this measure should not be taken over a long period of time, but rather as an emergency measure, for example during a trip, as this delays the excretion of the pathogens.
If a bacterial pathogen has been identified as the cause as a result of an examined stool sample, the use of antibiotics by the treating physician can be useful. In the majority of cases, however, no medication at all is necessary to cure the enteritis. Usually, the replacement of fluid and electrolytes is sufficient.
However, do not hesitate to consult a doctor if you have any questions or are unsure.
The term CED is used to describe inflammatory changes in the bowel, some of which are intermittent and recurrent, others permanent. The most important representatives are Crohn’s disease and ulcerative colitis. In Crohn’s disease, individual parts of the digestive tract with healthy areas in between are affected.
This is called segmental affection, whereas ulcerative colitis is characterized by a progressive, continuous inflammation starting from the anus and continuing mouthwards.The special feature of Crohn’s disease is that the entire digestive tract, i.e. from mouth to rectum, can be affected by the inflammatory changes. However, it is particularly common in the terminal part of the small intestine and in the large intestine, which is why the disease is included in this section. The age peak of chronic inflammatory bowel diseases lies between the 2nd and 4th decade of life.
Crohn’s disease sufferers are, however, sometimes even younger.
- Cause: A clear cause could not be determined for both diseases until today. Sometimes, autoimmunological causes are discussed, in which the body of the affected person produces antibodies against healthy structures of the intestine.
These antibodies attack the corresponding structures in the intestine and thus initiate an immune reaction, which ultimately damages the intestine and impairs its function.
- Symptoms: In both diseases, symptoms usually occur intermittently with symptom-free intervals in between. The patients often complain of cramp-like abdominal pain, often accompanied by diarrhea, sometimes even bloody. Occasionally a fever occurs.
Elevated inflammation values are noted in the blood. The danger with Crohn’s disease is that, as a result of recurring inflammations, the affected intestinal sections become narrower due to scarring, so that the stool can no longer be transported properly. Those affected suffer from cramp-like abdominal pain after eating and a change between diarrhea and constipation.
- Diagnostics: At the beginning of the diagnosis, the patient is questioned about his or her clinical picture and then physically examined by the doctor.
If the presence of a chronic inflammatory bowel disease is suspected, further measures such as a blood test and an ultrasound examination of the abdomen are performed. In addition, it is advisable to have a mirror image of the intestine using a small camera, since the physician can then assess its condition and appearance, and small tissue samples can also be taken. The disease can thus be determined quite reliably.
- Therapy: For long-term therapy, especially for the prevention of a further inflammatory flare, anti-inflammatory drugs are considered, which inhibit messenger substances that are involved in the development of inflammation.
One of these is mesalazine, for example. The treatment of an acute episode depends on its severity. A diet, i.e. the intake of light foods such as soups, rusks, tea and water, should be started first.
This serves to protect the damaged intestine so that it has the opportunity to recover. In the case of severe attacks, so-called glucocorticoids (colloquially cortisone), such as budesonide, are available. Above all, budesonide locally inhibits the immune reaction in the intestine, which is ultimately the reason for its inflammation and the complaints of the patient.
