Crohn's disease is a long-term disease that can affect any part of the digestive system. Sometimes the whole gastrointestinal tract, from the oral cavity to the anus, is affected by the inflammatory process. Unlike ulcerative colitis, all layers of the intestine are involved in the inflammatory process.
About the disease
For Crohn's disease is characterized by the alternation of acute attacks and remissions. The first manifestations usually find themselves in persons 15-35 years old. With the same frequency, the disease occurs in men and women. Sometimes it occurs in childhood.
Photo of the gut affected by Crohn's disease
The disease itself was named after American gastroenterologist Barilla Crone. He in 1932 for the first time published, together with his colleagues, 18 cases of this disease.
The ICD-10 code:
- K50.0.- Crohn's disease of the small intestine.
- K50.1 is a disease affecting the large intestine.
- K50.8 - other varieties of gastrointestinal lesions. KD509 - Crohn's disease, unspecified.
Reasons for
Researchers have not been able to detect the causative agent of this disease to this day. But many believe that infectious theory is the main one. This is due to the fact that a positive result of treatment is observed from antibiotic therapy.
It is believed that in Crohn's disease the main role is played by the pathological reaction of immunity to the intestinal flora, as well as food.
The immune system recognizes these factors as foreign, saturates the intestinal wall with leukocytes. This leads to inflammatory processes.
For reasons and genetic predisposition. Often the disease occurs in those people whose parents have gastrointestinal diseases. Additionally among the causes are:
- viral infections,
- immunosuppression against a background of serious illnesses,
- smoking,
- drug intake,
- ecology.
Symptoms of Crohn's Disease in Adults and Children
Symptoms are affected by the localization and rate of development of the disease. Common symptoms in adults and children are divided into intestinal and extra-intestinal. The first group includes:
- Stool disorder. It is manifested by diarrhea, which is rare and abundant or frequent and meager. May be with an admixture of blood and mucus.
- Abdominal pain. They can be blunt, prolonged. Sometimes patients complain of harsh, but short-term.
- Inflammation of the anal area.
To the extra-intestinal refers:
- rise in body temperature,
- a sharp decrease in weight,
- weakness, fatigue,
- anemia.
Patients may experience symptomatic relief. The process of remission sometimes lasts for several years. To foresee when the next aggravation is impossible.
When pregnancy is
The issue of pregnancy of women suffering from Crohn's disease is still in question.
This is mainly due to the fact that a serious treatment is prescribed, which can badly affect both the health of the woman and the fetus.
Among complications in pregnant women, miscarriage and hypotrophy are noted.
The degree of activity of the inflammatory process is directly related to the prognosis and the likelihood of complications. With high activity, the percentage of pregnancies taking place without complications is only 54%.
If the disease is in the inactive phase, then the probability of successfully bearing and giving birth reaches 80%.In general, the prognosis for perinatal outcomes is favorable if there are no acute periods during pregnancy.
Classification of
Crohn's disease is divided by location:
- 45% of the affected area is the ileocecal region,
- 30% of the proximal small intestine,
- 40% of the patients have multiple localization of the process,
- 25% of the disease affects the large intestine.
Depending on the location of the inflammatory process, two types of disease are distinguished:
- The first type. The lesion occurs only one site of the
- Second type. The defeat of several segments at once. Combination of bowel damage and lesions of the stomach or mucous membrane of the mouth.
There is also a classification according to the peculiarities of the course of the disease. The debut can have an acute current. Then the symptoms are moderately expressed, duration usually up to 6 months.
The onset of the development of the disease can have a gradual onset. In this situation, there is a lack of clear manifestations of the disease, a prolonged appearance of symptoms.
Isolate chronic course. With him, the period of absence of symptoms is absent. Duration not more than 6 months. If there is a re-occurrence of symptoms with periods of remission that lasts more than 6 months, then they speak of a relapsing form.
Complications of
In the absence of proper treatment there is:
- perforation of ulceration,
- acute toxic dilatation of the colon,
- bleeding,
- fistula formation.
Perforation of ulcers is often covered due to damage to the serosa of the intestine. The latter leads to the formation of adhesions. Massive bleeding can manifest itself in vomiting or during the process of defecation. They are usually associated with damage to a large vessel.
In 20-25% of cases, intestinal strictures are observed. The symptomatology of such complications is cramping pains, constipation, intestinal obstruction.
Difference from nonspecific ulcerative colitis
The difference is with the manifestation of symptoms. With nonspecific ulcerative colitis the lower parts of the colon are affected. Therefore, the disease is characterized by the development of diarrhea with an admixture of blood.
Crohn's disease is characterized by the fact that the normal mucosa alternates with the affected areas. At the site of inflammation, an ulcer and constriction is formed.
With NNC all mucous membranes loose and edematous. There are bleeding polyps and granulations.
Diagnostics
Diagnostic procedures are based on the conduct of a radiographic and endoscopic examination with biopsy. The most informative methods are:
- Computed tomography( virtual CT colonography).There is an opportunity to make images of layered sections of anatomical structures. For better visualization, a small volume of air is supplied to the large intestine.
- Colonoscopy. It is carried out with the help of a flexible optical probe, which is injected through the anus in front of the rectum. The method allows to study the entire large intestine.
Calp analysis for calprotectin is mandatory. This method allows you to determine the nature of inflammation at an early stage, identify the causes of the appearance of symptoms and confirm or exclude the presence of tumors.
Calcprotektin is a protein that is produced in leukocytes. A certain concentration is observed in both children and adults. The method proved its validity in the early diagnosis of Crohn's disease.
Differential Diagnosis
Because the symptomatology of Crohn's disease is similar to the manifestation of ulcerative colitis, their differential diagnosis is quite complex.
With sigmoidoscopy and morphological examination, specific changes are revealed. For example, for initial manifestations, the infiltrative phase is characteristic: puffiness, infiltration of the intestinal wall, the appearance of small erosions.
Differential diagnosis is also performed in order to exclude appendicitis, stomach ulcers, acute intestinal obstruction, intestinal swelling. Sometimes the final diagnosis is made only during surgical intervention.
In the acute phase, differential diagnosis is difficult. Therefore, usually a reason for surgery is the suspicion of acute appendicitis or intestinal obstruction.
How to treat Crohn's disease?
In addition to medicines, a diet is prescribed. It is possible to use the methods of traditional medicine as an auxiliary therapy. Surgical treatment is not excluded.
Diet
The severity of the menu depends on the severity of the disease. If the lesion affects only the ileum or rectum, then the diet is not very strict.
In severe cases, nutrition is administered enterally. The tube is inserted into the nose and laid through the throat. This approach allows you to extend the periods of remission.
Allowed to use:
- Tea or cocoa.
- Uncomfortable buns, yesterday's bread.
- Cottage cheese products, a little sour cream. Cream or olive oil.
- Soups on low-fat broth. Vegetable mashed potatoes and puddings.
- Water-diluted juices.
- Mucous porridges( barley, oatmeal).
- Fish cutlets, steamed.
When the state improves, stewed vegetables, fish slices, small vermicelli, raw berries and fruits, not strong coffee are allowed.
Fresh juices, strong tea, rose hips, clean water without gas will do. A day should drink at least two liters of liquid.
Folk remedies
The tincture of unopened sunflower hats is used. She will relieve pain in the intestine. It will take 50-70 gr.fresh hats. They are crushed and poured with alcohol. Allow to infuse for one week. Then 25-30 drops are diluted in 100 ml.water. You can drink no more than 6 times a day.
Help and decoctions of sage, chamomile, yarrow. Each herb should be taken by 0.5 teaspoon. This volume is filled with boiling water in a volume of 250 ml. The broth is infused 2-3 hours. Then take 1 large spoon every two hours.
In the folk medicine is used and red onions. It has healing properties. It can be added during the preparation of food, and before eating it, pull it out and throw it away.
Useful properties and has a sage. It disinfects, prevents the appearance of putrefactive processes. A tablespoon of dried leaves is brewed in 200 ml.boiling water. Then it is infused for an hour. To drink it is necessary on 150 ml.every 4 hours. After alleviating the condition, the reception frequency decreases to 2-3.
Surgical treatment
The main goal of surgical treatment is to combat complications to improve the quality of life of patients. The reason for an emergency operation is the suspicion of intestinal perforation.
With Crohn's disease of the small intestine, removal of the affected area is performed. Previously, a bypass anastomosis operation was used. But today it is advisable to conduct it only with stenosis of the duodenum.
The most commonly used laparoscopic technique. This method of resection is safer, almost no complications. But it can be used to treat complicated cases. When performing ileo-colonic resection, this method has one more advantage: the patient is made only one small linear incision near the navel 3-5 cm long.
With segmental lesion, resection of the large intestine is done. If there are fistulas, the operation is carried out in two stages. The first is necessary for stoma application.
If there are pranalnye complications( purulent leakage), sigmostomy or ileostomy is performed. Stoma is closed only after 2-12 months.
Medications
Drug therapy is aimed at carrying out anti-inflammatory measures, restoring immunity and normalizing digestion processes. The main group is anti-inflammatory drugs.
To reduce the severity of inflammation by reducing the immune response and speeding up the development of immunity, immunosuppressants are prescribed. It can be Methotrexate, Cyclosporine.
Reviews of patients
Patients' comments about the treatment are contradictory. Some try to remove the symptoms with starvation, but this does not always bring the desired results. To support the body, many start to follow their diet, exercise exercise therapy, refuse to smoke. This allows you to reduce the likelihood of relapse.
Patients with uncomplicated form note that more often exacerbation appears in the off-season. Helps hormones together with oatmeal, sage and chamomile to help remove symptoms.
Where is it treated?
Conservative treatment is performed by a gastroenterologist or proctologist. They are treated in many hospitals in our country, where there are doctors of the appropriate profile. Studies and new therapies are being studied in the US and Israel. For example, in these countries, stem cells are transplanted for successful treatment.
Answers to Frequent Questions
Many are interested in whether Crohn's disease can be cured. Doctors believe that you can heal completely only if you completely exclude the cause. It is very difficult to do this, because first of all an effect on immunity is required. Therefore, until the full recovery will take years. Note that the disease has a chronic, recurrent nature.
Another question is whether the disease is contagious. Inflammatory processes occurring in the digestive tract in this disease, are not contagious. Therefore, you can not limit yourself in communicating with other people.
And the last question often asked by patients is whether the disease is inherited. Yes, the probability of occurrence is quite large. If one of the parents had this ailment, the probability of his appearance in the child is 20%.
Life expectancy forecast
If there are consequences after the transferred illness( the exit of stool to the peritoneum, internal bleeding and others), then the disability is possible. With adequate treatment of death can be avoided.
The prognosis for the patient will be positive if the relapse stage does not occur for a long time.
The immune system in this situation is restored, the attacks of lymphocytes cease.
Video about Crohn's disease: