Crohn's disease is called a chronic inflammatory bowel disease, which is characterized by the formation of ulcerations on the intestinal mucosa, in the place of which granulomas subsequently grow, adhesions and strictures are formed, which narrows the intestinal lumen and disrupts its patency. Most often, Crohn's disease affects the small intestine, namely the ileum (terminal ileitis, regional ileitis, transmural ileitis), but it 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 the small intestine (jejunoileitis).
The disease affects men and women to the same extent, the average age of the sick is from 20 to 30 years. Crohn's disease in children usually manifests itself in adolescence - 12-12 years.
At the moment, the disease is considered incurable, the goal of treating Crohn's disease is to maintain the intestines in a state of long-term remission and relieve symptoms during an 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 of chronic intestinal inflammation, but the starting point in the pathological process is 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 assimilation of food:
- Hereditary predisposition. It is known that in people with Crohn's disease, relatives often suffer from chronic inflammatory bowel diseases, such as ulcerative colitis;
- The damaging effect of 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 lower right iliac region (Crohn's ileitis), is dull, aching in nature. Sometimes there is no pain, and an unpleasant heaviness and distension is felt in the lower right abdomen.
With Crohn's disease, appetite is often reduced, but even if it is not changed, weight loss is still noted, and often very significant.
In about 30% of patients, Crohn's disease symptoms are disorders of 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 the course. Children with this disease are characterized by severe weight loss, loss, sometimes complete, of appetite, developmental delay. One of the symptoms of Crohn's disease in children is a rise in temperature to high numbers, often accompanied by joint pain.
The extraintestinal symptoms of Crohn's disease can be misleading in diagnosis. These include: arthritis, arthrosis, cholelithiasis and kidney stones, hepatitis, inflammation of the mucous membranes of the eyes and mouth, as well as skin manifestations - dermatitis, eczema, rashes and ulcers that do not heal for a long time.
Diagnosing 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 in the introduction into the intestine of an instrument consisting of a flexible tube equipped with a video camera and a light source, with the help of which the mucous membrane of the rectum and colon is examined.
- Intestinal fluoroscopy. Methods with the use of a contrast agent are used to detect neoplasms, granulomas and areas of narrowing in the small intestine;
- Biopsy of the intestinal mucosa. The tissue for histological examination is taken during a colonoscopy. In laboratory conditions, changes in the mucous membrane are analyzed;
- Laboratory research methods. General and biochemical analyzes of blood, urine, analysis and bacterial culture of feces, as well as a detailed immunological blood test are performed.
Crohn's disease treatment
As mentioned above, Crohn's disease is one of the currently incurable diseases. However, treatment for 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 the absence of adequate treatment, Crohn's disease always has an unfavorable prognosis, as it leads to the development of one or more severe complications, and often not only from the intestines, many of which pose an immediate threat to life.
Treatment of Crohn's disease is conservative, with the development of complications, they resort to surgery.
Drug treatment for Crohn's disease during an exacerbation consists in the use of antidiarrheal drugs, anti-inflammatory drugs (hormonal therapy with corticosteroids), antibacterial drugs and drugs that suppress excessive activity of the immune system (immunosuppressants).
During the period of remission, treatment for Crohn's disease is reduced to diet and maintaining a healthy lifestyle.
Diet for Crohn's disease limits the intake of heavy, rough foods that irritate the intestinal mucosa, as well as fat and milk. An easily digestible and easily digestible food is recommended, with limited consumption of fermented milk products, sparing for the gastrointestinal tract. It is extremely important that the diet for Crohn's disease is balanced, as in this disease, anemia and vitamin deficiency are frequent due to poor absorption of food.
Gastroenterologists recommend an 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 response to them. Aggravating foods are completely excluded from the diet. The Crohn's disease diet should be followed continuously, throughout life. It is especially important to follow these rules for Crohn's disease in children, as otherwise the disease can severely affect the entire physical development of the child.
Complications of Crohn's disease
Crohn's disease can cause serious complications, which include: fistulas, fistulas and diverticula of the intestine, cancer of the intestine and biliary tract, intestinal obstruction, peritonitis, intestinal abscesses, intestinal perforation. Most of these complications require urgent surgical attention.
Another group of complications are extraintestinal manifestations, which can reach any degree of severity.
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Crohn's disease is a non-infectious disease of the alimentary canal, in which inflammation develops not only in one or more of its sections, but there are also extraintestinal manifestations. A distinctive feature of this pathology is that the entire wall thickness is involved in the process. The area where the small intestine meets the large intestine is most often affected.
This pattern 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 a chronic course, but if its acute form develops, patients often end up on the operating table, where the correct diagnosis is made.
The mechanism of development of the disease
Let us examine in more detail what is Crohn's disease of the intestine. Under the influence of certain factors, discussed below, a process is triggered in which its own immune system mistakenly recognizes intestinal cells as "enemy", and begins to produce antibodies against them.
This causes inflammation, in which at first only the intestinal mucosa is affected in the area of the grooves between the intestinal cells, then small abscesses develop in the same place. The latter give rise to the formation of ulcers, necrosis, penetrating most of the thickness of the intestinal wall, which therefore acquires the characteristic appearance of a "cobblestone pavement", clearly delimited from the healthy areas of the alimentary canal.
A warning! Inflammation isn't just limited to the intestines. It involves both the lymph nodes and the mesentery (the formation in which vessels and nerves pass to the intestines), and nearby organs. Intoxication and manifestations associated with impaired 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 assigned either to the bacteria of pseudotuberculosis, or to one of the measles-like viruses. It is also not excluded that pathology develops under the influence of such provoking factors as:
- smoking;
- stress;
- food allergy;
- special properties of immunity.
What types of disease exist
The most common classification of Crohn's disease is according to the localization of the inflammatory process. So, pathology can proceed in the form of:
- ileocolitis, when both the ileum (part of the small intestine) and the large intestine are affected. This is the most common cobblestone localization, occurring in 45% of cases;
- ileitis - inflammation of the ileum only, which develops in 35% of cases;
- jejunoileitis - lesions of both - the skinny and ileal - parts of the small intestine;
- granulomatous colitis - a specific inflammation of the colon;
- gastro-duodenal form;
- lesions of the 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 the endoscopic picture of inflammation.
How pathology manifests itself
Symptoms of Crohn's disease in adults depend on which form the patient has: acute, subacute, or chronic.
Persistent abdominal pain is the main symptom of Crohn's disease
Acute form
This is the very form of pathology, the manifestations of which are very similar to those of acute appendicitis, which is why the diagnosis is often made on the operating table. There are such signs of acute Crohn's disease:
- pain on the right side of the pubis, which is progressive;
- diarrhea, while blood is often mixed with feces;
- nausea and vomiting;
- bloating.
Advice! It is not worth waiting for seeking medical attention when these symptoms appear. In this case, it is better to overdiagnose appendicitis or ruptured ovarian cysts than to skip them.
Subacute form
In this case, symptoms of Crohn's disease will be recurrent diarrhea, cramping abdominal pains, the localization of which may be different. The exhaustion of the patient develops.
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.
So, 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, fatigue, fever up to low numbers). In addition, at first, periodic, and then constant pains in some area of the abdomen are noted, which are practically not relieved after the act of defecation. The stool in this disease is semi-formed, sometimes there may be mucus or blood in it, an admixture of foam.
Malabsorption of nutrients is manifested by:
- increased volume of excreted urine;
- cramps in the muscles of the limbs and face;
- swelling;
- violation of potency / menstrual cycle;
- increased skin pigmentation;
- signs of hypovitaminosis: cracks in the corners of the mouth, blurred vision at dusk, bleeding gums.
If Crohn's disease of the colon develops, the following symptoms are observed:
- pain in the abdomen: cramping, localized above the navel, on the right or left lateral surfaces of the abdomen, of varying intensity, aggravated by the use of "harmful" food;
- the stools are mushy, bloody, frequent. Desires can occur at night and closer to the morning;
- if the rectal area near the anus is affected, a person may have frequent paraproctitis, anal fissures or fistulas that go from the rectum to the skin around the anus, bladder, prostate or vagina;
- the skin becomes pale, loses its elasticity.
Such manifestations from the large, small intestine or combined lesions of the parts of the 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 impaired absorption 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 initially turns red, then turns purple, and then turns brown and yellow;
- symptoms of stone formation in the biliary tract;
- mouth ulcers;
- pain in the sacrum;
- decreased mobility of large joints.
How is the diagnosis made?
Endoscopic picture in norm and in Crohn's disease
The diagnosis of Crohn's disease is based on:
- human complaints;
- general analysis of feces;
- X-ray examination of the intestine with contrast - barium;
- endoscopic diagnostics of the intestine - colonoscopy, colonoileoscopy, fibrogastroscopy. This is the most informative diagnostic method, in which it is possible not only to visually assess the picture of the intestine, but also to conduct a biopsy of its section for further histological examination.
Blood tests do not confirm the diagnosis, but help to determine the degree of disorders that occur when the absorption of vitamins, nutrients and microelements is impaired by the affected intestine: anemia, a decrease in the level of protein, vitamin B 12, D, folic acid.
Crohn's disease is a chronic recurrent disease of unknown etiology, characterized by granulomatous inflammation with segmental lesions in different parts of the digestive tract. Unlike ulcerative colitis, in Crohn's disease, all layers of the intestinal wall are involved in the inflammatory process. Inflammation in most cases first occurs in the ileum, and then spreads to other parts of the intestine.
In more detail about what kind of disease it is, what symptoms it has, as well as methods of treatment, we will consider in this article.
What is Crohn's disease?
Crohn's disease is a severe chronic inflammatory bowel disease. Progression leads to damage to the deeper layers, leading to an increase in pain and an increase in the depletion of the body, sometimes ending in the development of serious complications that threaten the patient's life.
Absolutely any parts of the gastrointestinal tract are involved in the inflammatory process, from the anus to the oral cavity, however, the most often observed lesion of the large (rectal or colon) intestine and / or the final part 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 proceeds chronically, with alternating acute attacks and remissions. The first signs of the disease (first attack), as a rule, appear at a young age - in persons 15 - 35 years old.
- A genetic predisposition of Crohn's disease has been revealed - if relatives of a straight line suffer from this disease, the risk of developing it increases 10 times.
- Women are less prone to such diseases. It is rather due to the peculiarities of diet and lifestyle.
- According to ICD 10, it has the K90 code.
At the moment, the disease is considered incurable, the goal of treating Crohn's disease is to maintain the intestines in a state of long-term remission and relieve symptoms during an exacerbation, as well as prevent complications.
Causes
So far, there is no exact answer what causes the development of the disease. In some cases, acute Crohn's disease can be mistaken for inflammation of appendicitis or.
There are the following possible reasons for the development of pathology:
- Hereditary predisposition. It is known that in people with Crohn's disease, relatives often suffer from chronic inflammatory bowel diseases, for example -;
- In addition, an important role is played by disorders of the immune system. The fact is that autoimmune processes, accompanied by the production of antibodies that act against their own tissues of the affected area (intestine), as well as an insufficiently effective protective function on the part of the immune system - all this serves as a serious background for the appearance and development of Crohn's disease.
- The damaging effect of external factors: unhealthy diet, bad habits, unhealthy lifestyle, infection.
The predisposing factors for the development of the disease are:
- Postponed viral infection ();
- food allergy;
- stress and mental strain;
- smoking;
- hereditary predisposition.
It is noted that Crohn's disease occurs with the same frequency in both sexes, and the prevalence is 50-95 people per 100,000 population.
Degrees
The disease tends to spread to the healthy intestine. It proceeds with exacerbations and incomplete remissions. Among patients in remission, about 30% of patients undergo an exacerbation within a year and about 50% of patients suffer an exacerbation within 2 years. Gradually, remissions become short, and symptoms intensify during an exacerbation.
Crohn's disease symptoms
In different people, inflammation spreads to different parts of the intestine: in some (80%) only the end segment of the small intestine (ileum) is affected, while in others (about 20%) the focus is located in the rectum (part of the large intestine). These are the most common sites for Crohn's disease.
Symptoms:
- The main local manifestations of the disease are abdominal pain, diarrhea mixed with blood in the stool.
- Abdominal pain can be mild, cramping in nature with a feeling of heaviness and bloating. Pain is often localized in the right lower quadrant of the abdomen, sometimes it is impossible to distinguish them from those with appendicitis.
- Loose stools mixed with blood is a constant symptom, its frequency fluctuates from 3 to 10 times a day. After stool, abdominal pain is relieved.
- With Crohn's disease, appetite is often reduced, but even if it is not changed, weight loss is still noted, and often very significant.
Signs of Crohn's disease by form:
- Sharp. The disease has a bright beginning: diarrhea (diarrhea), body temperature rises, pain appears in the lower right segment of the abdomen. These symptoms are often mistaken for inflammation, ovarian apoplexy, leading to surgery. A diagnostic error is detected during operation.
- Subacute. The exhaustion of the patient develops (the weight decreases rapidly), there is unexpressed diarrhea, cramping pains of any localization.
The disease is also characterized by extraintestinal manifestations, which are determined by specific immunological disorders. Such manifestations, in particular, include:
- sacroiliitis - an inflammatory process in the sacroiliac joint, accompanied by severe pain, concentrated in the sacrum;
- arthropathy - in this case we are talking about an asymmetric lesion affecting large types of joints, which, in turn, leads to the appearance of pain with a 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;
- drop in vision;
- hepatitis;
- dermatitis;
- gallstone disease, kidney stone disease;
- arthrosis, arthritis;
- inflammatory processes in the area of the mucous membranes of the mouth, eyes, etc.
With a prolonged course, abscesses may form in the intestinal wall and fistulous passages into the abdominal cavity, into neighboring organs (bladder, vagina), on the surface of the skin (in the anus). The acute phase of the disease, as a rule, is accompanied by fever, general weakness.
During periods of exacerbation, the symptoms of Crohn's disease are most pronounced. Patients complain of cramping rather severe abdominal pains, diarrhea is observed five to six times a day, due to indigestion, the patient significantly loses body weight.
Complications
Crohn's disease is dangerous not only for its unpleasant manifestations, but also for the most serious 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 cracks and maceration of the rectum
- Foci of suppuration (abscesses)
Crohn's disease disability can only be delivered in some cases. The following conditions become the basis for this pathology:
- complications have arisen;
- disability due to pathology;
- the disease is difficult even with treatment;
- unable to find therapy.
Diagnostics
Primary diagnosis consists of:
- collecting anamnesis (taking into account symptoms, age, seasonality of exacerbation, family diseases, the presence of other pathologies, etc.);
- visual examination of the patient (palpation of the abdominal cavity, examination of the skin and mucous membranes, probing of the lymph nodes, for example, on the neck, etc.);
During diagnostic tests, the doctor should exclude diseases that are similar in symptomatology to Crohn's disease. So, it is necessary to differentiate diseases such as irritable bowel syndrome, acute appendicitis, ischemic and ulcerative colitis.
The patient is referred to undergo the following examination:
- Endoscopic examination is required. This examination is necessary both for visual confirmation of the diagnosis and for taking a biopsy (piece of tissue) for examination under a microscope. Moreover, it is made in various parts of the digestive tract.
- Colonoscopy. Allows you to get the most complete picture of the state of the large intestine. It helps to identify the presence of ulcers, foci of inflammation and bleeding. Probing the colon allows you to examine it completely - from the cecum to the rectum.
- Ultrasound examination of the abdominal organs allows you to assess the diameter of the intestinal loops, the presence of free fluid in the abdominal cavity, which helps in the diagnosis of complications (perforation of the intestinal wall with development).
- Fluoroscopy. 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 area of the small intestine.
- Laboratory research methods. General and biochemical analyzes of blood, urine, analysis and bacterial culture of feces, as well as a detailed immunological blood test are performed.
Crohn's disease treatment 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 patient tolerance 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 lesion of the gastrointestinal tract, systemic manifestations, the presence of exhaustion and the 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 respects, the final result of recovery depends on the patient's emotional background.
Medications
The goals of drug therapy for Crohn's disease are 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 the defense mechanisms of the immune system that attacks the gut; can cause brain dysfunction and other problems);
- There is a group of drugs with anti-inflammatory effects, which 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 course of the disease, the age of the patient and the stage of the disease.
- hormonal drugs;
- antibacterial drugs (in rare cases);
- antagonists of leukotriene receptors (reduce the activity of antibodies);
- homeopathy (some doctors consider homeopathy to be ineffective);
- articular syndromes can be additionally treated with GCS injections 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
The benefits of surgery for Crohn's disease are usually temporary. The disease often recurs, causing inflammation in the vicinity of the previous focus. The best tactic is to continue supportive drug therapy after surgery.
Surgical treatment is indicated for:
- the development of fistulas and abscesses (opening of abscesses and their sanitation, elimination of fistulas);
- the development of deep wall defects with prolonged profuse bleeding or a severe course of the disease that does not respond to conservative therapy (resection of the affected area of the intestine).
Diet
In combination with drug therapy, doctors pay great attention to a 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 take food 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;
- Salt - no more than 8 g per day;
- You need to eat more foods containing potassium and calcium;
- Liquids - 1.7-2 liters per day;
- Food should be cooked by baking, boiling, steaming;
The patient's diet should consist of the following foods:
- stale wheat bread;
- poultry without skin, low-fat varieties of rabbit meat, veal, beef;
- lean fish;
- scrambled eggs;
- cracker;
- pilaf from vegetables;
- porridge on the water;
- pudding;
- dry biscuit.
Food processing should be done using a steam bath, it should be boiled or stewed.
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But the diet with an exacerbation of Crohn's disease is preventive fasting, which lasts for 1-2 days. The patient is only allowed to consume liquid in volumes from 1.7 to 2 liters per day.
With an exacerbation, the diet includes:
- liquid and mashed cereals (rice, semolina) in water, since milk and broths are excluded.
- It is convenient to use cereals for baby food, but they must be diluted with water.
- It should be borne in mind that buckwheat porridge enhances motor skills, therefore, it is not recommended during an exacerbation.
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Traditional methods
Before using any folk remedies for Crohn's disease, consult a gastroenterologist.
- Flaxseed oil or pumpkin seed oil should be regularly added to dietary meals, which will support the immune system and have a beneficial effect on the digestive processes.
- 40 g of ground caraway seeds are infused in a thermos, 400 ml of water, at an initial temperature of 70-80⁰С. Drink 60-80 ml before meals.
- Rosehip oil is prepared at home and drunk in a tablespoon according to the scheme: an hour before breakfast, 30 minutes before lunch and 2 hours after dinner. You need to take the crushed fruits (a full liter jar) and pour 1.5 liters of olive oil. Insist 2 weeks in a warm place.
Prophylaxis
Due to the unclear etiology of Crohn's disease, it is possible to definitely prevent the disease. That is why all preventive measures are reduced to the timely detection of the problem and the prevention of relapses.
Secondary prevention methods:
- quitting smoking and alcohol abuse;
- limiting physical and emotional stress;
- strict adherence to the recommended diet;
- observance of the optimal regime of 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
The prognosis for adults with the right treatment is good. The question of how long they live with Crohn's disease is of interest to all patients, but the initial stage does not affect life expectancy. Late diagnosis can be difficult.
Doctor must constantly observe the patient's condition and timely prescribe examinations aimed at identifying complications. This helps improve forecasts.
It is worth noting that several factors will affect the quality and duration of life:
- the time of the onset of the first symptoms and the beginning of treatment;
- the frequency of exacerbations;
- the body's response to treatment and susceptibility to it;
- the level of a person's responsibility to their health and to the recommendations of doctors.
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 digestive system, with the development of extraintestinal symptoms in most cases. In Crohn's disease, the inflammatory granulomatous process affects the musculoskeletal, articular, integumentary tissues, and the organ of vision. A feature of Crohn's disease is the formation of a granuloma that affects the entire thickness of the digestive tube(various parts of the large and small intestine, stomach).
Crohn's disease causes
It has not yet been possible to reliably find out the cause of Crohn's disease. Undoubtedly, several causal factors and initiating factors must be involved in the development of a disease such as Crohn's disease. Hereditary conditioning (mutations in certain genes) is proved by the more frequent occurrence of Crohn's disease in blood relatives.
Crohn's disease develops more often in patients with certain changes in the microbial landscape of the large intestine (dysbiosis). Long-term malnutrition often occurs in the form of processed, refined dietary nutrients with minimal fiber and fiber in the diet. Crohn's disease (inflammation in the granulomatous process) can be aggravated by the harmful effects of nicotine, alcohol, and the frequent, unreasonable use of certain drugs (antibiotics).
Crohn's disease is reliably associated with the inflammatory process in the intestine and with special forms of E. coli, which becomes capable of attaching to the epithelial cells of the digestive tube, penetrating into them and multiplying. Pro-inflammatory substances (cytokines) initiate the migration of macrophages and cells responsible for the synthesis of local antibodies into the inflammatory focus. This is how Crohn's disease differs from other bowel diseases.
As a result of the reproduction of the pathogen in macrophages (without their subsequent death) and the stimulation of cells of the immune system, granulomas are formed - a characteristic sign of a disease such as Crohn's disease.
With intestinal localization, Crohn's disease often affects the small intestine - ileitis (its distal part) and the large intestine (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 level of the digestive tract is usually affected at the same time as the intestines. Crohn's disease is almost always associated with granulomatous inflammatory changes (granulomas) in the perianal region.
Crohn's disease, depending on age, the originality of the immune response and the presence of concomitant pathology, can proceed in different ways. The course can be acute (gradual or fulminant), chronic (persistent or continuously recurrent). In all cases, there is a specific response from the immune lymphoid tissue (aphthae or accumulation of lymphocytes), which determines the symptoms of Crohn's disease.
Crohn's disease symptoms
Crohn's disease often has nonspecific manifestations and symptoms (common to many bowel diseases). Therefore, often, Crohn's disease is not immediately detected, often patients with discomfort and numerous complaints cannot be diagnosed correctly for years. The disease is characterized by segmental lesions (inflammatory changes are limited in length), which determines the following symptoms of Crohn's disease:
- intestinal pain (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 gas discharge (pain in the intestines tends to decrease after stool). Pain in the intestines can be localized in the right iliac region (with ileitis) and mimic acute appendicitis. Often, pain in the intestines is localized in the anal region (cracks, ulcers);
- frequent loose loose stools is a characteristic symptom of Crohn's disease during exacerbation. The number of bowel movements can vary significantly. Sometimes there may be delayed bowel movements (constipation);
- pathological impurities in the feces (blood, mucus)... Bloody discharge with feces can have the character of little changed blood (if the localization of Crohn's disease corresponds to the distal parts of the colon, sigmoid and rectum). With gastroduodenal localization (stomach and duodenum), Crohn's disease is characterized by melena-type stools (black, tar-like, unformed stools). Impurities in feces (blood, pus) are always present during an exacerbation;
- increased temperature response- a common symptom of Crohn's disease during exacerbation;
- nausea due to intoxication and fever, sometimes vomiting- an important symptom in Crohn's disease, lack of appetite can reach the degree of anorexia;
- asthenic manifestations characteristic of any long-term inflammatory process, weight loss, decreased intake of nutrients (decreased appetite) are nonspecific symptoms of Crohn's disease, as they can occur in other pathologies;
- arthritis (inflammation of the articular surfaces) with damage to extra-articular tissues (granulomas), skin lesions (pyoderma), changes in the skin of the lips and cheeks of an inflammatory nature are extraintestinal symptoms of Crohn's disease and are not observed in isolation from manifestations from the intestines.
Complications of Crohn's disease
- strictures (intestinal stenosis) of one or another part of the intestine. Intestinal stenosis can lead to acute intestinal obstruction, since the inflammatory process has a granulomatous total character (that is, it captures the entire thickness of the intestinal wall). With scarring, stenosis of the lumen of the organ (intestinal obstruction) is observed. Sometimes bowel stenosis is incomplete.
- abscess formation of the inflammatory focus and the formation of infiltration - a serious complication of Crohn's disease;
- acute intestinal bleeding in Crohn's disease can pose an immediate threat to the life of the patient;
- perforation of the entire thickness of the intestinal wall, sometimes with the formation of fistulous passages (between the intestinal loops, external, internal);
- dilation (expansion) of the colon as a result of toxic effects on the intestinal wall.
Diagnosing Crohn's disease
It is possible to diagnose Crohn's disease with the help of certain instrumental diagnostic techniques (endoscopy, X-ray methods). During colonoscopy in Crohn's disease, segmental lesions, linear ulcerative defects, erosion with a corolla of hyperemic tissues are revealed. X-ray (survey) examination of the large intestine reveals motor disorders, enlargement 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.
During an endoscopic examination, a piece of the affected tissue is taken for subsequent histological evaluation of a biopsy (accumulations of lymphoid cells (epithelioid, giant) and characteristic sarcoid granulomas are detected. On examination, ulcerative and erosive surfaces with reddening on the periphery and covered with inflammatory plaque, granulomas can be visualized.
Blood tests in 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), an increase in the erythrocyte sedimentation rate are determined.
A coprological study in Crohn's disease reveals an inflammatory component (in the feces there are impurities of leukocytes, pus, mucus).
Treatment principles for Crohn's disease
Crohn's disease, at the moment, is not completely cured. But it is really possible to help the patient, significantly improve his condition, thereby reducing the exacerbation and lengthening remission (when all manifestations of the disease disappear, or become less painful).
Crohn's disease is treated by a doctor - gastroenterologist, complicated forms - by a surgeon.
Mandatory for exacerbation is bed rest and a special sparing diet, enzymatic, adsorbent, anti-inflammatory drugs. For fever, antipyretic and detoxifying drugs are used.
The main method of treating Crohn's disease, as prescribed by a doctor, is the appointment of hormonal (glucocorticosteroid) drugs (budesonide, prednisolone). GCS can be used for topical and general exposure. Doses and duration of their administration are determined only by a doctor (taking into account side effects and contraindications).
In severe cases, without a tendency to rapid healing of defects, they resort to the appointment of immunosuppressive therapy and the use of antimetabolites.
Specific treatment for Crohn's disease can last for months or even years. With the right approach to treatment and adherence to all medical prescriptions, you can achieve long-term remission and a good quality of life for patients with Crohn's disease. Treatment for Crohn's disease during periods of exacerbation and maintenance therapy in remission may differ.
- This 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, and 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 X-ray, CT. Treatment includes diet therapy, anti-inflammatory, immunosuppressive, symptomatic therapy; in case of complications - surgical intervention.
General information
Crohn's disease is a chronic inflammatory disease of the 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 inflammation of the walls of the end sections of the small intestine (ileum).
The disease proceeds chronically, with alternating acute attacks and remissions. The first signs of the disease (first attack), as a rule, appear 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 revealed - if relatives of a straight line 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 reasons for the development of Crohn's disease have not been definitively determined. According to the most common theory, the pathological reaction of immunity to the intestinal flora, food entering the intestine, and other substances plays the main role in the onset of the disease. The immune system notes these factors as foreign and saturates the intestinal wall with leukocytes, resulting in an inflammatory reaction, erosion and ulcerative lesions of the mucous membrane. However, this theory has no reliable evidence.
Factors contributing to the development of Crohn's disease:
- genetic predisposition;
- tendency to allergies and autoimmune reactions;
- smoking, alcohol abuse, drugs;
- environmental factors.
Crohn's disease symptoms
Intestinal manifestations of the disease: diarrhea (in severe cases, the frequency of bowel movements can interfere with normal activities and sleep), abdominal pain (severity depending on the severity of the disease), appetite disorder and weight loss. With severe ulceration of the intestinal wall, bleeding and detection of blood in the feces are possible. Depending on the location and intensity, blood can show up as bright scarlet streaks and dark clots. Latent internal bleeding is often noted; in severe cases, blood loss can be very significant.
With a prolonged course, abscesses may form in the intestinal wall and fistulous passages into the abdominal cavity, into neighboring organs (bladder, vagina), on the surface of the skin (in the anus). The acute phase of the disease, as a rule, is accompanied by fever, general weakness.
Extraintestinal manifestations of Crohn's disease: inflammatory diseases of the joints, eyes (episcleritis, uveitis), skin (pyoderma, erythema nodosum), liver and biliary tract. With the early development of Crohn's disease in children, a delay in physical and sexual development is noted.
Complications
Complications of Crohn's disease can include the following conditions.
- Ulceration of the mucous membrane, perforation of the intestinal wall, bleeding, release of feces into the abdominal cavity.
- The development of fistulas to adjacent organs, the abdominal cavity, to the surface of the skin. Development of abscesses in the intestinal wall, fistula lumen.
- Weight loss to the point of exhaustion, metabolic disorders due to insufficient absorption of nutrients. Dysbacteriosis, hypovitaminosis.
Diagnostics
Crohn's disease is diagnosed using laboratory and functional studies. The most informative techniques are computed tomography and colonoscopy. Fistulas and abscesses can be detected on a tomogram, and a colonoscopy gives an idea of the state of the mucous membrane (the presence of inflamed areas, erosions, ulcerations of the intestinal wall) and allows a biopsy to be taken, if necessary. Additional diagnostic methods - X-ray of the intestine with a barium mixture. You can get images of both the small and large intestines - the contrast barium mixture fills the intestinal cavity and reveals narrowing of the lumen and ulcerative wall defects, fistulas.
Laboratory research methods: a general blood test, in which inflammatory changes are noted, anemia is possible as a result of regular internal bleeding; coprogram, fecal occult blood test. Sometimes capsule endoscopy of the digestive tract is used - the patient swallows a capsule with a mini-video camera and a transmitter. The camera captures the picture in the digestive tract as it moves.
Crohn's disease treatment
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, preventing exacerbations and complications. Crohn's disease is treated conservatively by a gastroenterologist or proctologist. Surgery is only used for life-threatening complications.
All patients are prescribed diet therapy. Diet No. 4 and its modifications are prescribed depending on the phase of the disease. The diet helps to reduce the severity of symptoms - diarrhea, pain syndrome, and also corrects the digestive processes. In patients with chronic inflammatory foci in the intestine, fatty acid absorption disorders are present. Therefore, foods high in fat contribute to increased diarrhea and the development of steatorrhea (fatty stools).
The diet is limited to the use of products that irritate the mucous membrane of the digestive tract (spicy, smoked, fried foods, high acidity of food), alcohol, carbonated drinks, coffee abuse. 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. In Crohn's disease, 5-aminosalicylates (sulfasaline, mesazalin) and drugs of the group of corticosteroid hormones (prednisolone, hydrocortisone) are used. Corticosteroid medications 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, 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. With the development of abscesses, general antibiotic therapy is used - broad-spectrum antibiotics (metronidazole, ciprofloxacin).
Symptomatic treatment is carried out with antidiarrheal, laxative, analgesic, hemostatic drugs, depending on the severity of the 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 profuse bleeding, severe course of the disease that is not amenable to conservative therapy (resection of the affected area of the intestine).
Forecast and prevention
To date, no methods for a complete cure for Crohn's disease have been developed due to the fact that the etiology and pathogenesis of the disease are not completely clear. However, regular adequate therapy of exacerbations and adherence to diet and regimen, medical recommendations and regular spa treatment help to 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, the use of vitamin complexes and essential microelements; avoidance of stress, development of stress resistance, regular rest and a healthy lifestyle; moderate physical activity; quitting smoking and alcohol abuse.
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