What is Crohn's disease is an inflammatory process that is characterized by granulomatous lesions of various segments of the digestive system.
The inflammation can be located in any of the sections of the gastrointestinal tract - from the oral cavity to the anal canal. However, most often the disease is localized in the intestinal lumen - in one or several fragments of the small or large intestine, turning it into a bed for granulomas.
According to statistics, this disease in men is much more common than in women. In this case, the first signs of illness, as a rule, occur at a fairly young age - 20-40 years.
Why does Crohn's disease occur, and what is it? The exact cause of this disease has not been established. Experts point out some factors that can trigger the onset of Crohn's disease.
The main risk factors affecting the development of the disease in adults include the following:
According to the first hypothesis, the pathogenesis of Crohn's disease lies in the effects of bacteria and viruses. The second hypothesis treats pathogenesis as provoking the food antigen abnormal systemic immune response. According to the third assumption, experts believe that the pathogenesis lies in autoantigens located on the intestinal wall. Due to the fact that antibacterial treatment gives positive results, it is believed that the causes of this disease lies precisely in the infectious theory.
- Genetic predisposition. This disease is often detected in siblings or twins. In approximately 19% of cases, pathology is diagnosed in blood relatives.
- Immunological factors. Since there is consistent organ damage in Crohn's disease, scientists hypothesize the autoimmune nature of the pathology.
- Infectious diseases. The role of these factors has not yet been reliably confirmed, but there are hypotheses about the viral or bacterial nature of the disease.
Most often, Crohn's disease affects the intestinal region, which is located near the colon. Although there are cases of localization of lesions in all parts of the digestive tract. In this disease, the entire mucous membrane of the affected area is covered with abscesses and ulcers.
Symptoms of Crohn's Disease
Since this disease can affect any of the organs of the gastrointestinal tract, the signs will be completely different. Experts share the symptoms of Crohn's disease in:
- are common;
- local (depending on the place of defeat);
- extraintestinal disorders.
The first type of symptoms include fever, fever, malaise (signs of inflammation). If the temperature rises to very high rates (40 degrees), this indicates purulent complications of the disease. The decrease in body weight is due to the fact that the inflammatory organs of the gastrointestinal tract do not absorb all the necessary nutrients for the body.
Local symptoms of Crohn's disease include the following:
- regular diarrhea, it is caused by the inability of the intestines to absorb nutrients, in severe cases, the processes of decay develop;
- often recurring pain in the abdomen, it is similar to pain in appendicitis, occurs due to intestinal mucosa lesions and constant irritation of nerve endings;
- infiltration (abnormal leakage of substances) and abscesses;
- perforation of the intestinal walls;
- intestinal obstruction;
- with the development of perforated fistula and ulcers in a patient there are bleeding.
Extraintestinal disorders are more associated with disorders of the immune system that affect the entire body. For example, the defeat of large joints (pain, limited mobility), inflammation of the sacroiliac area, visual impairment, skin rash.
In the picture of the symptoms of chronic form of Crohn's disease, the signs of intoxication come to the fore: weakness, malaise, fatigue, low-grade body temperature, loss of appetite and body weight, pain in large joints. Over time, regular diarrhea, bloating and abdominal pain, significant weight loss are added.
With the defeat of the large intestine increases stool, which may contain an admixture of blood. In some cases, in the right iliac region or in the central regions of the abdomen, a palpation of palpable palpable formation is palpated. The phalanges of the fingers take the form of drum sticks.
Usually, the chronic form of Crohn's disease occurs with exacerbations and prolonged remissions, causing severe consequences in the form of the appearance of anal fissures, ulcers, internal and external fistulas, massive intestinal bleeding, partial or complete obstruction of the intestine, sepsis. The resulting infiltrates can give complications, causing the development of cancer and subsequent disability. With a progressive course of the disease there is an unfavorable prognosis for the life of the patient.
Before you figure out how to treat Crohn's disease, you must correctly diagnose. Therefore, to exclude other pathologies with similar symptoms, instrumental examination is appointed.
The following methods are commonly used:
- Colonoscopy. This study allows you to visualize the inner surface of the intestine.
- Irrigology It provides an opportunity to see partial lesions of the intestine, narrowing of its lumen, relief of the intestine, ulceration or ulcers, thickening of the walls and a decrease in their activity.
- Ultrasound. It can be used to estimate the diameter of the intestinal loops, the presence of free fluid in the abdominal cavity.
- CT scan. This is done if Crohn's disease is complicated by diseases of other organs, and it is difficult to establish an accurate diagnosis. MRI allows you to study in more detail the condition of the intestine, the degree of its damage, the presence of fistulas, narrowing of the passage of the small or large intestines, an increase in lymph nodes.
- Endoscopic examination. It is obligatory, with the help of it is carried out as a visual confirmation of the diagnosis, and take a piece of tissue for further examination under a microscope.
Be sure to use laboratory methods, including blood and feces to exclude infectious diseases of the intestine.
Crohn's disease treatment
With diagnosed Crohn's disease, the main treatment regimen is to use drug therapy aimed at localizing and reducing inflammation in the intestine, reducing the frequency and duration of exacerbations, as well as maintaining a state of sustained remission, that is, in anti-relapse treatment.
Severe cases may require the appointment of stronger drugs, complex treatment, and periods of exacerbations - surgery. The choice of treatment method depends on the severity of Crohn's disease, the dominant symptoms, the general health of the patient.
Currently there is no universal remedy for the treatment of Crohn's disease, however, therapy with the use of one or more drugs is aimed at early treatment of the disease and alleviating its symptoms.
The most common drugs are:
- salicylates (5-ASA) - sulfasalazine, mesalazine, Pentas;
- topical hormones - budenofalk;
- glucocorticoids - prednisone, methylprednisolone;
- immunosuppressants - azathioprine, methotrexate, 6-mercaptopurine;
- tumor necrosis factor blockers - adalimumab, infliximab, golimumab, etanercept, certolizumab pegol.
- Integrin receptor blockers: Vedolizumab.
Also actively used:
- antibiotic treatment: ciprofloxacin, metronidazole and new antibiotic rifaximin;
- probiotic treatment (VSL # 3, fecal transplantation of live donor bacteria);
- vitamin D;
- hyperbaric chambers (oxygen treatment);
- in severe cases, intestinal transplantation from the donor.
In more common and difficult cases of Crohn's disease, surgery may be indicated. Sometimes with the development of terrible complications of the disease, such as bleeding, acute intestinal obstruction or bowel perforation, emergency surgical interventions have to be performed.
Other, less urgent indications for surgery include the formation of abscesses, intestinal fistulas (pathological messages of various parts of the gastrointestinal tract), severe forms of perianal lesions, lack of effect of conservative treatment.
During remission of the disease, patients are shown to follow a strict diet in order not to provoke an exacerbation of the inflammatory process in the intestinal wall. Food should be balanced, contain large amounts of protein and vitamins, and fats should be limited. The diet for Crohn's disease is not very strict, the main thing in it is respect for the intestines.
Recommendations regarding nutrition:
- Drink enough fluids;
- Limit the use of flour and baking;
- Eat small meals 5-6 times a day;
- Give preference to low-fat foods;
- Refuse from the use of spicy dishes, alcohol;
- Take multivitamin complexes.
A diet for Crohn's disease limits the consumption of heavy, coarse foods that irritate the intestinal mucosa, as well as fat and milk. Recommended easily digestible and easily digestible food, with limited consumption of fermented milk products, sparing for the gastrointestinal tract. It is imperative that a diet with Crohn's disease be balanced, since in this disease anemia and beriberi due to poor absorption of food are frequent.
If diet, lifestyle changes, drug therapy, and other methods have been ineffective, surgical treatment is recommended for the patient. About half of all patients with Crohn's disease in the course of treatment suffer at least one surgical procedure, during which doctors remove the damaged part of the intestine.
Unfortunately, surgery can not completely eliminate Crohn's disease, as it is possible, for example, in ulcerative colitis. Even if a large segment of the intestine is removed during surgery, the disease may reappear. In this regard, some experts recommend to postpone the operation as long as possible. Such tactics can reduce the number of operations that a person will have to move.
Crohn's disease may be accompanied by such complications as:
- Intestinal bleeding.
- Perforation (violation of the integrity of the intestinal wall).
- Urolithiasis disease.
- The occurrence of abscesses (ulcers) in the intestine.
- Development of intestinal obstruction (violation of the movement of intestinal contents through the intestines).
- The formation of fistulas (missing channels normally) and strictures (narrowing) of the intestine.
If a fistula develops inside the abdominal cavity, food that enters the intestine may bypass the sections responsible for the absorption of nutrients, as well as penetrate organs such as the bladder or vagina. The development of a fistula is a terrible complication, as there is a high risk of suppuration and abscess formation. Left without attention, this condition can be a threat to the life of the patient.
Prediction for life
Mortality in Crohn's disease is 2 times higher than in the healthy population. Most of the causes of death are associated with complications and surgery for them.
The disease has a relapsing course and in almost all patients at least one relapse occurs within 20 years. This requires constant dynamic monitoring of the patient to correct the therapy and identify complications of the disease.
The prognosis for life varies considerably and is determined individually. The course of Crohn's disease may be asymptomatic (with localization of the lesion only in the anus area of the elderly) or to proceed in an extremely severe form.