Crohn's disease where the stomach hurts. Crohn's disease - symptoms, diagnosis and treatment at home. Get treatment in Korea, Israel, Germany, USA

Crohn's disease is a chronic inflammatory bowel disease, which is characterized by the formation of ulcerations on the intestinal mucosa, in place of which granulomas subsequently grow, adhesions and strictures form, which narrows the intestinal lumen and impairs its patency. Most often, Crohn's disease affects the small intestine, namely the ileum (terminal ileitis, regional ileitis, transmural ileitis), but can occur throughout the intestine (granulomatous enteritis, granulomatous colitis, regional enteritis, etc.). In addition, this disease has multiple extraintestinal manifestations.

Crohn's disease in children has a favorite localization in the duodenum and jejunum, often completely affecting small intestine(jejunoileitis).

The disease affects men and women equally, average age sick people aged 20 to 30 years. Crohn's disease in children usually manifests itself in adolescence– 12-12 years old.

On this moment The disease is considered incurable, the goal of treatment for Crohn's disease is to maintain the intestines in a state of long-term remission and relieve symptoms during exacerbation, as well as prevent complications.

The causes of Crohn's disease are still unclear. Researchers have identified several factors that are important in the mechanism chronic inflammation intestines, however, the trigger point in pathological process not known. Contributing factors include:

• Failure in the body's immune system. In the mechanism of maintaining inflammation, the autoimmune component plays an important role, that is, the pathological reaction of the immune system to the body’s own tissues, as well as to those intestinal microorganisms that are not pathogenic and are necessary for the absorption of food:
• Hereditary predisposition. It is known that people with Crohn's disease often have relatives suffering from chronic inflammatory bowel diseases, such as ulcerative colitis;
• Damaging effects external factors: unhealthy diet, bad habits, unhealthy lifestyle, infection.

The triad of main symptoms of Crohn's disease includes abdominal pain, chronic diarrhea and weight loss.

Abdominal pain (abdominal pain) most often manifests itself in the right lower part of the iliac region (Crohn's ileitis) and is dull and aching in nature. Sometimes there is no pain, but an unpleasant heaviness and fullness is felt in the lower right part of the abdomen.

With Crohn's disease, appetite is often reduced, but even if it is not changed, weight loss is still observed, and often quite significant.

In about 30% of patients, symptoms of Crohn's disease include problems with the anus and rectum: rectal fissures, swelling and irritation of the anus, which can cause pain during bowel movements, as well as the discharge of mucus and blood from the anus.

Crohn's disease in children has some features of its course. Children with this disease are characterized by severe weight loss, loss, sometimes complete, of appetite, and developmental delays. One of the symptoms of Crohn's disease in children is a rise in temperature to high numbers, often accompanied by joint pain.

Extraintestinal symptoms of Crohn's disease can be misleading when making a diagnosis. These include: arthritis, arthrosis, cholelithiasis and kidney stones, hepatitis, inflammation of the mucous membrane of the eyes and mouth, as well as skin manifestations– dermatitis, eczema, rashes and ulcers that do not heal for a long time.

Diagnosis of Crohn's disease

Diagnosis of the disease is carried out in the presence of characteristic symptoms of Crohn's disease using the following studies:

• Endoscopy. A method consisting of inserting into the intestine an instrument consisting of a flexible tube equipped with a video camera and a light source, with which the mucous membrane of the rectum and colon is examined.
• X-ray of the intestines. Techniques using a contrast agent are used to detect neoplasms, granulomas and areas of narrowing in the small intestine;
• Biopsy of the intestinal mucosa. Tissue for histological examination is taken during colonoscopy. IN laboratory conditions analyze changes in the mucous membrane;
• Laboratory research methods. Conduct general and biochemical tests blood, urine, stool analysis and culture, as well as a comprehensive immunological blood test.

Treatment of Crohn's disease

As mentioned above, Crohn's disease is a currently incurable disease. However, treatment of Crohn's disease is not only necessary, but must be consistent and constant in order to maintain the patient's normal quality of life. In case of absence adequate treatment Crohn's disease always has a poor prognosis, as it leads to the development of one or more severe complications, often not only from the intestines, many of which pose an immediate threat to life.

Treatment of Crohn's disease is conservative; if complications develop, surgical intervention is used.

Drug treatment of Crohn's disease during exacerbation consists of the use of antidiarrheals, anti-inflammatory drugs ( hormone therapy corticosteroids), antibacterial drugs and drugs that suppress excessive activity immune system (immunosuppressants).

During the period of remission, treatment of Crohn's disease comes down to diet and maintenance healthy image life.

Diet for Crohn's disease limits the consumption of heavy, rough foods that have irritant effect on the intestinal mucosa, as well as fats and milk. Easily digestible and easily digestible food is recommended, with limited consumption fermented milk products, gentle for gastrointestinal tract. It is extremely important that the diet for Crohn's disease is balanced, since anemia and vitamin deficiencies are common with this disease due to poor absorption of food.

Gastroenterologists recommend individual selection of dishes: during an exacerbation, a strictly limited diet of the first table, then the gradual introduction of individual products and monitoring the body’s reaction to them. Foods that cause aggravation are completely excluded from the diet. The diet for Crohn's disease must be followed constantly throughout life. It is especially important to follow these rules if you have Crohn's disease in children, as otherwise the disease can have a serious impact on everyone physical development child.

Complications of Crohn's disease

Crohn's disease can cause severe complications, which include: fistulas, intestinal fistulas and diverticula, intestinal and biliary tract cancer, intestinal obstruction, peritonitis, intestinal abscesses, intestinal perforation. Most of these complications require emergency surgery.

Another group of complications are extraintestinal manifestations, which can reach any degree of severity.

Video from YouTube on the topic of the article:

Crohn's disease is a non-infectious disease alimentary canal, in which inflammation develops not only of one or more of its parts, but there are also extraintestinal manifestations. Distinctive feature This pathology is that the entire thickness of the wall is involved in the process. The area where the small intestine connects to the large intestine is most often affected.

This picture is observed in the intestines affected by Crohn's disease.

Crohn's disease is a fairly rare pathology. It develops most often in men 20-40 years old. This disease is characterized by chronic course, but, if it develops acute form, patients often end up on the operating table, where the correct diagnosis is established.

Mechanism of disease development

Let's take a closer look at what Crohn's disease is. Under the influence of certain factors discussed below, a process is launched in which one’s own immunity mistakenly recognizes intestinal cells as “enemy” and begins to produce antibodies against them.

This causes inflammation, which first affects only the intestinal mucosa in the area of ​​the depressions between the intestinal cells, then small abscesses develop there. The latter give rise to the formation of ulcers, necrosis, penetrating most the thickness of the intestinal wall, which because of this acquires a characteristic “cobblestone” appearance, clearly demarcated from healthy areas of the digestive canal.

Warning! Inflammation is not limited to just the intestines. It involves the lymph nodes, the mesentery (the formation in which vessels and nerves pass to the intestines), and nearby organs. Intoxication and manifestations associated with disruption of the normal absorption of nutrients by the intestinal wall also develop.

Why does the disease develop?

No one knows the exact cause of Crohn's disease. It is believed that the disease develops in a genetically predisposed organism when an infectious agent enters it. The role of the latter is attributed to either pseudotuberculosis bacteria or one of the measles-like viruses. It is also possible that pathology develops under the influence of such provoking factors as:

• smoking;
• stress;
• food allergies;
• special properties of immunity.

What types of disease exist

The most common classification of Crohn's disease is based on the location of the inflammatory process. So, the pathology can occur in the form of:

1. ileocolitis, when both the ileum (part of the small intestine) and the large intestine are affected. This is the most common cobblestone location, occurring in 45% of cases;
2. ileitis - inflammation only ileum, which develops in 35% of cases;
3. jejunoileitis - lesions of both - jejunum and ileum - parts small intestine;
4. granulomatous colitis - specific inflammation of the colon;
5. gastroduodenal form;
6. defeats anal area.

Frequency of different sites of Crohn's disease

There is also a classification that takes into account not only the localization of the inflammatory process, but also the age when it was discovered, clinical manifestations and endoscopic picture of inflammation.

How does pathology manifest itself?

Symptoms of Crohn's disease in adults depend on what form the patient has: acute, subacute or chronic.

Persistent abdominal pain is the main symptom of Crohn's disease

Acute form

This is the same form of pathology, the manifestations of which are very similar to the symptoms of acute appendicitis, which is why the diagnosis is often made on the operating table. There are the following signs of acute Crohn's disease:

1. pain with right side from the pubis, which is progressive;
2. diarrhea, with blood often mixed into the stool;
3. nausea and vomiting;
4. bloating.

Advice! Wait with the request for medical care If such symptoms appear, you should not. IN in this case It is better to overdiagnose appendicitis or a ruptured ovarian cyst than to miss them.

Subacute form

In this case, symptoms of Crohn's disease will include periodic diarrhea, cramping pain in the abdomen, the location of which may vary. The patient becomes exhausted.

Chronic course

This is the most common form of the disease. Its manifestations will differ depending on in which part of the intestine the pathological process develops.

Thus, with Crohn's disease of the small intestine, the main symptoms are impaired absorption of nutrients in the intestine, as well as signs of intoxication (weakness, increased fatigue, temperature rise to low numbers). In addition, periodic and then constant pain in some area of ​​the abdomen, which practically do not ease after defecation. With this disease, the stool is semi-formed, sometimes it may contain mucus or blood, or an admixture of foam.

Malabsorption of nutrients is manifested by:

• increased volume of urine excreted;
• cramps in the muscles of the limbs and face;
• swelling;
• potency/menstrual cycle disorders;
• increased skin pigmentation;
• signs of hypovitaminosis: cracks in the corners of the mouth, deterioration of vision at dusk, bleeding gums.

If Crohn's disease of the colon has developed, the following symptoms are observed:

• abdominal pain: cramping, localized above the navel, along the right or left lateral surfaces of the abdomen, of varying intensity, aggravated by eating “junk” food;
• stool is pasty, bloody, frequent. The urge may occur at night and towards the morning;
• if the area of ​​the rectum near the anus is affected, a person may experience frequent paraproctitis, anal fissures or fistulas extending from the rectum to the skin around the anus, bladder, prostate or vagina;
• the skin becomes pale and loses elasticity.

Such manifestations from the large, small intestine or combined lesions of the departments digestive tract have a peculiarity. They occur with periods of remission, when a person feels practically healthy (with the exception of extraintestinal manifestations and symptoms of malabsorption of nutrients), which are replaced by exacerbations.

In addition to intestinal, the disease also has extraintestinal manifestations:

• Pain in the eyes;
• a nodular rash that is initially red, then turns purple, and then turns brown and yellow;
• symptoms of stone formation in the bile ducts;
• mouth ulcers;
• pain in the sacrum;
• decreased mobility of large joints.

How is the diagnosis made?

Endoscopic picture in normal conditions and in Crohn's disease

Diagnosis of Crohn's disease is based on:

1. human complaints;
2. general stool analysis;
3. X-ray examination of the intestine with contrast - barium;
4. endoscopic diagnostics of the intestine - colonoscopy, colonoiloscopy, fibrogastroscopy. This is the most informative method diagnostics, in which it is possible not only to visually assess the picture of the intestine, but also to perform a biopsy of its area for further histological examination.

Blood tests do not confirm the diagnosis, but help determine the degree of disorders that occur when the absorption of vitamins, nutrients and microelements is impaired by the affected intestine: anemia, decreased levels of protein, vitamin B 12, D, folic acid.

Crohn's disease is a chronic, relapsing disease unknown etiology, characterized by granulomatous inflammation with segmental lesions different departments digestive tract. Unlike ulcerative colitis, in Crohn's disease, all layers of the intestinal wall are involved in inflammatory process. In most cases, inflammation first occurs in the ileum and then spreads to other parts of the intestine.

We will look in more detail about what this disease is, what its symptoms are, as well as treatment methods in this article.

What is Crohn's disease?

Crohn's disease is a severe chronic inflammatory bowel disease. Progression leads to damage to deeper layers, leading to increased pain and increasing exhaustion of the body, sometimes ending in the development serious complications threatening the patient's life.

Absolutely any part of the gastrointestinal tract is involved in the inflammatory process, from the anus to oral cavity However, the most common lesions are the large (rectal or colon) intestine and/or the final section of the small (ileum) intestine.

Systemic manifestations include fever, weight loss, damage to the musculoskeletal system (arthropathy, sacroiliitis), eyes (episcleritis,), skin ( erythema nodosum, pyoderma gangrenosum).

• The disease is chronic, with alternating acute attacks and remissions. The first signs of the disease (first attack) usually occur in at a young age– in persons 15–35 years old.
• Revealed genetic predisposition Crohn's disease - if direct line relatives suffer from this disease, the risk of developing it increases 10 times.
• Women are less susceptible to such diseases. This is more likely due to the characteristics of nutrition and lifestyle.
• According to ICD 10 it has code K90.

At the moment, the disease is considered incurable; the goal of treatment for Crohn's disease is to maintain the intestines in a state of long-term remission and relieve symptoms during exacerbation, as well as prevent complications.

Causes

There is still no exact answer to what causes the development of the disease. In some cases, acute Crohn's disease may be mistaken for inflammation of appendicitis or.

The following are distinguished: possible reasons development of pathology:

• Hereditary predisposition. It is known that people with Crohn's disease often have relatives suffering from chronic inflammatory bowel diseases, for example -;
• In addition, immune system disorders also play an important role. The fact is that autoimmune processes, accompanied by the production of antibodies acting against their own tissues of the affected area (intestines), as well as insufficiently effective protective function from the immune system - all this serves as a serious background for the appearance and development of Crohn's disease.
• The damaging effects of external factors: unhealthy diet, bad habits, unhealthy lifestyle, infection.

Predisposing factors for the development of the disease are:

• Past viral infection ();
• food allergies;
• stress and mental strain;
• smoking;
• hereditary predisposition.

It is noted that Crohn's disease occurs with equal frequency in both sexes, and the prevalence is 50-95 people per 100,000 population.

Degrees

The disease tends to spread the process to the healthy intestine. It occurs with exacerbations and incomplete remissions. Among patients in remission, approximately 30% of patients experience an exacerbation within a year and approximately 50% of patients experience an exacerbation within 2 years. Gradually, remissions become short, and symptoms intensify during exacerbations.

Symptoms of Crohn's disease

U different people inflammation spreads to various parts of the intestine: in some (80%) only the final segment of the small intestine (ileum) is affected, in others (about 20%) the lesion is located in the rectum (large intestine). These are the most common sites for Crohn's disease to develop.

Symptoms:

• The main local manifestations of the disease are abdominal pain, diarrhea with blood in the stool.
• Abdominal pain may be mild, cramping in nature with a feeling of heaviness and bloating. Often the pain is localized in the right lower quadrant of the abdomen, sometimes it is impossible to distinguish it from that of appendicitis.
• Loose stool mixed with blood - persistent symptom, its frequency ranges from 3 to 10 times a day. After stool, abdominal pain decreases.
• With Crohn's disease, appetite is often reduced, but even if it is not changed, weight loss is still observed, and often quite significant.

Signs of Crohn's disease by form:

1. Spicy. The disease has a clear onset: diarrhea (diarrhea), body temperature rises, and pain appears in the lower right segment of the abdomen. These symptoms are often misdiagnosed as inflammation, ovarian apoplexy, which leads to surgery. The diagnostic error is detected during surgery.
2. Subacute. The patient develops exhaustion (weight decreases quickly), mild diarrhea, and cramping pain of any localization are present.

The disease is also characterized by extraintestinal manifestations, which are determined by specific immunological disorders. Such manifestations include in particular:

• sacroiliitis - an inflammatory process in the sacroiliac joint, accompanied by severe pain concentrated in the sacral area;
• arthropathy - in this case we are talking about an asymmetrical lesion affecting large species joints, which, in turn, leads to pain with forced limitation of the patient’s mobility;
• skin rash (in particular, this includes pyoderma gangrenosum, erythema nodosum);
• the appearance of ulcerative formations in the oral cavity;
• loss of vision;
• hepatitis;
• dermatitis;
• gallstone disease, kidney stone disease;
• arthrosis, arthritis;
• inflammatory processes in the mucous membranes of the mouth, eyes, etc.

With a long course, it is possible to form abscesses in the intestinal wall and fistulous tracts in abdominal cavity, V neighboring organs(bladder, vagina), on the surface of the skin (in the anus area). The acute phase of the disease is usually accompanied by elevated temperature, general weakness.

During periods of exacerbation, the symptoms of Crohn's disease are most pronounced. Patients complain of cramping quite severe pain in the abdomen, diarrhea is observed five to six times a day; due to digestive disorders, the patient significantly loses body weight.

Complications

Crohn's disease is dangerous not only for its unpleasant manifestations, but also for its severe complications that can only be eliminated surgically. These include:

• Perforation of the intestinal wall, with the addition of peritonitis
• Intestinal obstruction
• Heavy bleeding
• External and internal fistulas, ulcers
• Inflammatory infiltrates and strictures (narrowing of the lumen) of the intestine
• Risk of adenocarcinoma
• Weeping fissures and maceration of the rectum
• Foci of suppuration (abscesses)

Disability due to Crohn's disease can only be diagnosed in some cases. The basis for this pathology are the following conditions:

• complications arose;
• loss of ability to work due to pathology;
• the disease is severe even with treatment;
• it is not possible to select a therapy.

Diagnostics

Primary diagnosis consists of:

• collecting anamnesis (symptoms, age, seasonality of exacerbation, family diseases, presence of other pathologies, etc. are taken into account);
• visual examination of the patient (palpation of the abdominal cavity, examination skin and mucous membranes, palpation lymph nodes, for example, on the neck, etc.);

During the diagnostic studies The doctor must exclude diseases similar in symptoms to Crohn's disease. Thus, it is necessary to differentiate diseases such as irritable bowel syndrome, acute appendicitis, ischemic and ulcerative colitis.

The patient is directed to undergo the following examination:

• Endoscopic examination is mandatory. This study is necessary both for visual confirmation of the diagnosis and for taking a biopsy (a piece of tissue) for examination under a microscope. Moreover, it is done in various parts of the digestive tract
• Colonoscopy. Allows you to get the most complete picture of the condition of the large intestine. It helps to identify the presence of ulcers, areas of inflammation and bleeding. Probing of the colon allows you to examine it completely - from the cecum to the rectum.
• Ultrasound examination of the abdominal organs makes it possible to assess the diameter of intestinal loops, the presence free liquid in the abdominal cavity, which helps in diagnosing complications (perforation of the intestinal wall with development).
• X-ray. The implementation of the techniques is carried out in combination with the use of a contrast agent, on the basis of which it is possible to detect areas of narrowing, granulomas and other types of neoplasms in the small intestine.
• Laboratory research methods. General and biochemical blood and urine tests, stool analysis and culture, as well as a comprehensive immunological blood test are performed.

Treatment of Crohn's disease in adults

The main methods of treatment for Crohn's disease should be aimed at reducing the inflammatory process, stabilizing the patient's condition and preventing the development of complications. The drugs are selected individually, their effectiveness and tolerability by the patient are assessed over time.

Therapy depends primarily on the severity of the disease. It is impossible to assess it by any one indicator; it is necessary to take into account the nature of the damage to the gastrointestinal tract, systemic manifestations, the presence of exhaustion and general condition.

The treatment plan includes:

• diet, proper nutrition;
• medications;
• surgery.

It is extremely important for the patient, regardless of the stage of progression of the disease, to maintain physical and mental rest. In many ways, the final result of recovery depends on the emotional background of the patient.

Medications

Target drug therapy for Crohn's disease is as follows:

• relieve symptoms (so that the disease goes into remission);
• prevent disease outbreaks (maintain remission). The main drugs used for this are Azathioprine, Methotrexate, Infliximab and Adalimumab.

If the patient encounters the disease at a later stage, complex treatment is used:

• immunosuppressants (suppress defense mechanisms the immune system that attacks the intestines; may cause brain dysfunction and other problems);
• There is a group of drugs with anti-inflammatory effects that are designed specifically for the treatment of Crohn's disease (Sulfasalazine, Mesalazine, Pentasa). The dosage of drugs is prescribed only by a doctor, depending on the severity of the disease, the age of the patient and the stage of the disease.
• hormonal drugs;
• antibacterial drugs (in rare cases);
• leukotriene receptor antagonists (reduce antibody activity);
• homeopathy (some doctors consider homeopathy ineffective);
• articular syndromes can be additionally treated with injections of corticosteroids into the joints (contraindications - gold preparations);
• analgesics;
• vitamins.

Drug therapy for Crohn's disease is considered successful if it can push the disease into remission and keep it in remission without causing significant side effects.

Operation

Positive effect from surgical treatment in Crohn's disease is usually temporary. The disease often recurs, causing inflammation near the previous site. The best policy is to continue supportive drug therapy after surgery.

Surgery shown when:

• development of fistulas and abscesses (opening of abscesses and their sanitation, elimination of fistulas);
• development of deep wall defects with prolonged heavy bleeding or a severe course of the disease that is not amenable to conservative therapy (resection of the affected area of ​​the intestine).

Diet

In combination with drug therapy doctors pay great attention special diet, which is very important for reducing mechanical, thermal and chemical irritation of the intestines. The diet for Crohn's disease is not very strict, the main thing in it is respect for the intestines.

• You need to eat at least 5 times a day;
• Proteins per day – up to 150 g, fats – 70-80 g, carbohydrates – 250 g;
• Energy value – about 2100 kcal;
• Salts – no more than 8 g per day;
• You need to consume more foods containing potassium and calcium;
• Liquids – 1.7-2 liters per day;
• Food should be prepared by baking, boiling, steaming;

The patient's diet should consist of the following products:

• stale wheat bread;
• skinless bird low-fat varieties rabbit meat, veal, beef;
• lean fish;
• scrambled eggs;
• cracker;
• vegetable pilaf;
• porridge on water;
• pudding;
• dry biscuit.

Food should be processed using a steam bath; it should be boiled or stewed.

Allowed foods for Crohn's disease

Prohibited Products

Vegetable soups with slimy porridges (barley, oatmeal) and pureed meat (turkey, quail, chicken) Fish and meat cutlets and steamed meatballs (minced meat should be minced 3-4 times in a meat grinder with a fine sieve) Cereals, boiled and ground (rice, buckwheat, semolina, oatmeal) Eggs (quail and chicken) steamed as an omelet (no more than 1-2 pieces per day) Rich berries and fruits tannins(bird cherry, blueberries, ripe pears, etc.) prepared in the form of jelly or jelly Fresh cottage cheese mashed into a soufflé, butter(in dishes no more than 20 g per day) Liquids 1.5-2 l. (decoction of blueberries, rose hips, weak tea, cocoa in water) Untoasted white bread crumbs.

alcohol fatty meats and fish any kind of spices spicy seasonings horseradish, mustard, ketchup ice cream, iced drinks wheat, pearl barley porridge legumes any semi-finished products canned food highly salted and smoked products fried foods mushrooms chips, crackers carbonated drinks products made from rich and warm dough, cakes chocolate, coffee, strong tea

But the diet for exacerbation of Crohn's disease is preventive fasting, which lasts for 1-2 days. The patient is only allowed to consume liquid in volumes of 1.7 to 2 liters per day.

During an exacerbation, the diet includes:

• liquid and pureed porridges (rice, semolina) in water, since milk and broths are excluded.
• It is convenient to use porridge for baby food, but they need to be diluted with water.
• It must be taken into account that buckwheat enhances motor skills, so it is not recommended during periods of exacerbation.

Menu

Breakfast	rice porridge with butter; steam cutlet;
Lunch	baked apple; jelly.
Dinner	meatball soup; crackers; casserole with minced chicken and zucchini; compote.
Afternoon snack	jelly, biscuits.
Dinner	boiled sea fish; stewed carrots; weak tea.
For the night	jelly or baked apple.

Traditional methods

Before using any folk remedies during Crohn's disease, consult a gastroenterologist.

1. Should be added regularly dietary dishes flax or pumpkin seed oil, which will support the immune system and have a beneficial effect on digestive processes.
2. 40 g of ground cumin seeds are infused in a thermos, 400 ml of water, at an initial temperature of 70-80⁰С. Drink 60-80 ml before meals.
3. Rosehip oil is prepared at home and taken one tablespoon at a time according to the following schedule: an hour before breakfast, 30 minutes before lunch and 2 hours after dinner. You need to take crushed fruits (a full liter jar) and fill with 1.5 liters olive oil. Leave for 2 weeks in a warm place.

Prevention

Due to the unclear etiology of Crohn's disease, it is possible to definitely prevent the disease. That's why everyone preventive actions boil down to timely detection of the problem and prevention of relapses.

Methods of secondary prevention:

• cessation of smoking and alcohol abuse;
• limiting physical and emotional stress;
• strict adherence to the recommended diet;
• compliance optimal mode work and rest;
• prevention of exacerbations and progression of symptoms of Crohn's disease;
• taking medications only as prescribed by a doctor;
• examination by a gastroenterologist at least once a year.

Forecast for life

Prognosis for adults with proper treatment good. The question of how long people live with Crohn's disease interests all patients, but initial stage does not affect life expectancy. At late diagnosis there may be difficulties.

Doctor must constantly watch monitor the patient’s condition and timely prescribe examinations aimed at identifying complications. This helps improve forecasts.

It is worth noting that the quality and length of life will be influenced by several factors:

• time of onset of first symptoms and initiation of treatment;
• frequency of exacerbations;
• the body's reaction to treatment and susceptibility to it;
• the level of responsibility of a person towards his health and doctors’ recommendations.

Watch your lifestyle, eat right and avoid stressful situations. We wish you good health, thank you for your visit!

Crohn's disease is a multicomponent inflammatory disease that affects all parts of the body digestive system, with the development in most cases of extraintestinal signs. In Crohn's disease, the inflammatory granulomatous process affects the musculoskeletal, joint, integumentary tissues, and the organ of vision. A feature of Crohn's disease is the formation of granulomas that affect the entire thickness of the digestive tube(various parts of the large and small intestines, stomach).

Causes of Crohn's disease

It has not yet been possible to reliably determine the cause of Crohn's disease. Undoubtedly, several factors must be involved in the development of a disease such as Crohn's disease. causal factors and initiating moments. Hereditary causation (mutations in certain genes) is proven by the more frequent occurrence of Crohn's disease in blood relatives.

Crohn's disease develops more often in patients who have certain changes in the microbial landscape of the large intestine (dysbiosis). Often there is a long-term malnutrition in the form of processed, refined food nutrients with minimal amounts of fiber and fiber in the diet. Crohn's disease (inflammation due to granulomatous process) may worsen harmful effects nicotine, alcohol, frequent, unjustified use of certain drugs (antibiotics).

Crohn's disease is significantly associated with inflammatory processes in the intestines and with specific forms coli, which becomes able to attach to the epithelial cells of the digestive tube, penetrate into them and multiply. Pro-inflammatory substances (cytokines) initiate the migration of macrophages and cells responsible for the synthesis of local antibodies into the inflammatory focus. This makes Crohn's disease different from other intestinal diseases.

As a result of the multiplication of the pathogen in macrophages (without their subsequent death) and stimulation of cells of the immune system, a granuloma is formed - a characteristic sign of a disease such as Crohn's disease.

With intestinal localization, Crohn's disease most often affects the small intestine - ileitis (its distal section) and colon(proximal part). Often Crohn's disease has a combined localization of inflammatory-granulomatous changes. An isolated lesion involving the stomach and duodenum is rarely observed. In Crohn's disease, the upper floor of the digestive tract is usually affected simultaneously with the intestines. Crohn's disease is almost always associated with granulomatous inflammatory changes (granuloma) in the perianal area.

Crohn's disease, depending on age, the uniqueness of the immune response and the presence of concomitant pathology, can occur in different ways. The course can be acute (gradual or fulminant), chronic (persistent or continuously recurrent). In all cases, a specific response from the immune system is observed. lymphoid tissue(aphthae or accumulations of lymphocytes), which determines the symptoms of Crohn's disease.

Symptoms of Crohn's disease

Crohn's disease often has nonspecific manifestations and symptoms (common to many intestinal diseases). Therefore, Crohn's disease is often not detected immediately; often patients who have discomfort and numerous complaints cannot be correctly diagnosed in a timely manner for years. The disease is characterized by segmental lesions (inflammatory changes are limited in extent), which determines the following symptoms of Crohn's disease:

• pain in the intestines (caused by damage to the large or small intestine). The difference between pain lies in its nature (in the form of contractions, spasms), dependence on bowel movements and the passage of gases (pain in the intestines tends to decrease after stool). Pain in the intestines can be localized in the right iliac region (with ileitis) and imitate acute appendicitis. Often pain in the intestines is localized in the anal area (fissures, ulcers);

• frequent loose loose stools is characteristic symptom Crohn's disease during exacerbation. The number of bowel movements may vary significantly. Sometimes there may be a delay in bowel movements (constipation);

• pathological impurities in the stool (blood, mucus). Bloody issues with feces may have the character of slightly changed blood (if the localization of Crohn's disease corresponds to the distal parts of the colon, sigmoid and rectum). For gastroduodenal localization (stomach and duodenum), Crohn's disease is characterized by melena-type stool (black, tar-like unshaped chair). Impurities in the stool (blood, pus) are always present during an exacerbation;

• increase in temperature response- a common symptom of Crohn's disease during exacerbation;

• nausea due to intoxication and fever, sometimes vomiting - important symptom with Crohn's disease, lack of appetite can reach the level of anorexia;

• asthenic manifestations, characteristic of any long-term inflammatory process, weight loss, decreased consumption nutrients(decreased appetite) are nonspecific symptoms of Crohn’s disease, as they can also occur with other pathologies;

• arthritis (inflammation of the articular surfaces) with damage to extra-articular tissues (granuloma), skin lesions (pyoderma), inflammatory changes in the skin of the lips and cheeks are extraintestinal symptoms of Crohn's disease and are not observed in isolation from intestinal manifestations.

Complications of Crohn's disease

• strictures (intestinal stenosis) of one or another part of the intestine. Bowel stenosis can lead to acute obstruction intestines, since the inflammatory process is granulomatous in nature (that is, it covers the entire thickness of the intestinal wall). With scarring, stenosis of the organ lumen (intestinal obstruction) is observed. Sometimes intestinal stenosis is incomplete.
• abscess formation of the inflammatory focus and formation of infiltrate - severe complication Crohn's disease;
• acute intestinal bleeding in Crohn's disease can pose an immediate threat to life for the patient;
• perforation of the entire thickness of the intestinal wall, sometimes with the formation of fistula tracts (between intestinal loops, external, internal);
• dilatation (expansion) of the colon as a result toxic effects to the intestinal wall.

Diagnosis of Crohn's disease

A diagnosis of Crohn's disease can be made using certain instrumental diagnostic techniques (endoscopy, X-ray methods). Colonoscopy in Crohn's disease reveals segmented lesions, linear ulcerative defects, erosions with a rim of hyperemic tissue. X-ray (survey) examination of the colon allows you to identify motor disorders, expansion or narrowing of the intestine, complications (megacolon, intestinal obstruction).

To clarify the nature of complications of Crohn's disease, computed tomography and MRI are used.

When conducting endoscopic examination, a piece of the affected tissue is taken for subsequent histological evaluation of the biopsy (clusters of lymphoid cells (epithelioid, giant) and a characteristic sarcoid granuloma are revealed. Upon examination, ulcerative and erosive surfaces with redness on the periphery and covered with an inflammatory plaque, granulomas, can be visualized.

Blood tests for Crohn's disease usually show an acute inflammatory process. In the blood, an increased content of CRP, leukocytes, a decrease in red blood counts (anemia of varying severity), and an increase in the erythrocyte sedimentation rate are determined.

A scatological examination in Crohn's disease reveals an inflammatory component (impurities of leukocytes, pus, mucus in the stool).

Principles of treatment of Crohn's disease

Crohn's disease, at the moment, cannot be completely cured. But it is really possible to help the patient, significantly improve his condition, thereby reducing exacerbations and prolonging remissions (when all manifestations of the disease disappear or become less painful).

Crohn's disease is treated by a gastroenterologist; complicated forms are treated by a surgeon.

Mandatory in case of exacerbation is bed rest and a special gentle diet, enzyme, adsorbent, anti-inflammatory drugs. For fever, antipyretic and detoxifying medications are used.

The main method of treating Crohn's disease, as prescribed by a doctor, is the prescription of hormonal (glucocorticosteroid) drugs (budesonide, prednisolone). GCS can be used for topical and general effects. Doses and duration of their administration are determined only by the doctor (taking into account side effect and contraindications).

In severe cases, without a tendency to fast healing defects, resort to immunosuppressive therapy and the use of antimetabolites.

Specific treatment for Crohn's disease can last several months or even years. With the right approach to treatment and compliance with all medical prescriptions, you can achieve long-term remission and good quality life of patients with Crohn's disease. Treatment of Crohn's disease during periods of exacerbation and maintenance therapy during remission may differ.

is a granulomatous inflammation of various parts of the digestive tract, characterized by a chronic recurrent and progressive course. Crohn's disease is accompanied by abdominal pain, diarrhea, intestinal bleeding. Systemic manifestations include fever, weight loss, damage to the musculoskeletal system (arthropathy, sacroiliitis), eyes (episcleritis, uveitis), skin (erythema nodosum, pyoderma gangrenosum). Crohn's disease is diagnosed using colonoscopy, intestinal radiography, and CT. Treatment includes diet therapy, anti-inflammatory, immunosuppressive, symptomatic therapy; in case of complications - surgical intervention.

General information

Crohn's disease - chronic illness inflammatory gastrointestinal tract. In Crohn's disease, the inflammatory process develops in the inner mucous membrane and submucosal layers of the wall of the gastrointestinal tract. The mucous membrane can be affected in any area: from the esophagus to the rectum, but the most common is inflammation of the walls of the final sections of the small intestine (ileum).

The disease is chronic, with alternating acute attacks and remissions. The first signs of the disease (first attack), as a rule, occur at a young age - in persons 15-35 years old. Pathology occurs equally often in both men and women. A genetic predisposition to Crohn's disease has been identified - if direct line relatives suffer from this disease, the risk of developing it increases 10 times. If the disease is diagnosed in both parents, the disease in such patients occurs before 20 years in half of the cases. The risk of developing Crohn's disease increases with smoking (almost 4 times); there is a connection between the disease and oral contraception.

Causes

The causes of Crohn's disease have not been fully determined. According to the most common theory, the pathological reaction of the immune system to the intestinal flora, food entering the intestines, and other substances plays a major role in the occurrence of the disease. The immune system marks these factors as foreign and saturates the intestinal wall with leukocytes, resulting in inflammatory reaction, erosion and ulcerative lesion mucous membrane. However, this theory does not have reliable evidence.

Factors contributing to the development of Crohn's disease:

• genetic predisposition;
• tendency to allergies and autoimmune reactions;
• smoking, alcohol abuse, drug abuse;
• environmental factors.

Symptoms of Crohn's disease

Intestinal manifestations of the disease: diarrhea (with severe course frequency of bowel movements may interfere with normal activities and sleep), abdominal pain (severity depending on the severity of the disease), appetite disturbance and weight loss. With severe ulceration of the intestinal wall, bleeding and detection of blood in the stool are possible. Depending on the location and intensity, blood can be detected as bright scarlet streaks and dark clots. Hidden internal bleeding is often observed; in severe cases, blood loss can be quite significant.

With a long course, the formation of abscesses in the intestinal wall and fistulous tracts in the abdominal cavity, in neighboring organs (bladder, vagina), and on the surface of the skin (in the anus area) is possible. The acute phase of the disease is usually accompanied by fever and general weakness.

Extraintestinal manifestations of Crohn's disease: inflammatory diseases joints, eyes (episcleritis, uveitis), skin (pyoderma, erythema nodosum), liver and biliary tract. With the early development of Crohn's disease in children, delays in physical and sexual development are noted.

Complications

Complications of Crohn's disease may include the following conditions.

• Ulceration of the mucous membrane, perforation of the intestinal wall, bleeding, exit feces into the abdominal cavity.
• Development of fistulas in neighboring organs, the abdominal cavity, and on the surface of the skin. Development of abscesses in the intestinal wall, lumens of fistulas.
• Weight loss to the point of exhaustion, metabolic disorders due to insufficient absorption of nutrients. Dysbacteriosis, hypovitaminosis.

Diagnostics

Diagnosis of Crohn's disease is carried out using laboratory and functional studies. The most informative techniques are computed tomography and colonoscopy. A tomogram can detect fistulas and abscesses, and a colonoscopy gives an idea of ​​the condition of the mucous membrane (the presence of inflamed areas, erosions, ulcerations of the intestinal wall) and allows, if necessary, to take a biopsy. Additional Methods diagnostics - X-ray of the intestine with a barium mixture. You can take pictures of both the small and large intestines - a contrast barium mixture fills the intestinal cavity and reveals narrowing of the lumen and ulcerative defects of the wall, fistulas.

Laboratory research methods: general blood test, which shows inflammatory changes, anemia is possible, as a result of regular internal bleeding; coprogram, stool examination occult blood. Sometimes capsule endoscopy of the digestive tract is used - the patient swallows a capsule with a mini-video camera and transmitter. The camera captures the picture in the digestive tract as it progresses.

Treatment of Crohn's disease

Since the causes of the disease are unknown, pathogenetic treatment has not been developed. Therapy is aimed at reducing inflammation, bringing the patient's condition to long-term remission, and preventing exacerbations and complications. Treatment of Crohn's disease is conservative, carried out by a gastroenterologist or proctologist. Surgery is resorted to only in case of life-threatening complications.

All patients were prescribed diet therapy. Diet No. 4 and its modifications are prescribed depending on the phase of the disease. The diet helps reduce the severity of symptoms - diarrhea, pain, and also corrects digestive processes. In patients with chronic inflammatory foci in the intestines, there are malabsorption fatty acids. Therefore, foods high in fat contribute to increased diarrhea and the development of steatorrhea (fatty stools).

The diet limits the consumption of foods that irritate the mucous membrane of the digestive tract (spicy, smoked, fried foods, high acidity of food), alcohol, carbonated drinks, and excessive coffee. Smoking cessation is recommended. Fractional meals are used - frequent meals in small portions according to the regimen. In severe cases, they switch to parenteral nutrition.

Pharmacological therapy for Crohn's disease consists of anti-inflammatory measures, normalization of immunity, restoration of normal digestion and symptomatic therapy. The main group of drugs is anti-inflammatory drugs. For Crohn's disease, 5-aminosalicylates (sulfazaline, mesazaline) and drugs from the group of corticosteroid hormones (prednisolone, hydrocortisone) are used. Corticosteroid drugs are used to relieve acute symptoms and are not prescribed for long-term use.

To suppress pathological immune reactions, immunosuppressants (azathioprine, cyclosporine, methotrexate) are used. They reduce the severity of inflammation by reducing the immune response and the production of leukocytes. Infliximab is used as an anticytokine agent for Crohn's disease. This drug neutralizes cytokine proteins - tumor necrosis factors, which often contribute to erosion and ulcers of the intestinal wall. When abscesses develop, general antibacterial therapy is used - antibiotics wide range actions (metronidazole, ciprofloxacin).

Symptomatic treatment is carried out with antidiarrheal, laxatives, painkillers, hemostatic drugs, depending on the severity of symptoms and their severity. To correct metabolism, patients are prescribed vitamins and minerals. Surgical treatment is indicated for the development of fistulas and abscesses (opening of abscesses and their sanitation, elimination of fistulas), the formation of deep wall defects with prolonged heavy bleeding, and severe disease that is not amenable to conservative treatment (resection of the affected area of ​​the intestine).

Prognosis and prevention

To date, no methods have been developed to completely cure Crohn's disease due to the fact that the etiology and pathogenesis of the disease are not completely clear. However, regular adequate therapy exacerbations and adherence to diet and regimen, medical recommendations and regular Spa treatment help reduce the frequency of exacerbations, reduce their severity and improve the quality of life.

According to experts in the field of clinical gastroenterology, the key points in the prevention of exacerbations are diet therapy, nutritional balance, use vitamin complexes And essential microelements; avoiding stress, developing stress tolerance, regular rest and healthy regime life; moderate physical activity; quitting smoking and alcohol abuse.