Crohn's disease - symptoms, diagnosis and treatment

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What is Crohn's disease is an inflammatory process that is characterized by granulomatous lesions of various segments of the digestive system.

Foci of inflammation can be located in any part of the gastrointestinal tract - from the oral cavity to the anal canal. However, most often the disease is localized in the lumen of the intestine - in one or more fragments of the small or large intestine, turning it into a bed for granulomas.

According to statistical data, such a disease in men is much more common than in women. In this case, the first signs of ailment, as a rule, arise in a fairly young age - 20-40 years.

Reasons for

Why does Crohn's disease occur, and what is it? The exact cause of this disease is not established. Specialists point to some factors that can trigger the onset of Crohn's disease.

According to the first hypothesis, the pathogenesis of Crohn's disease is the effects of bacteria and viruses. The second hypothesis treats pathogenesis as provoking an abnormal systemic immune response by the food antigen. According to the third assumption, experts believe that the pathogenesis is in the autoantigens located on the intestinal wall. Due to the fact that antibacterial treatment produces positive results, it is believed that the cause of this disease lies precisely in the infectious theory.

Of the main risk factors that affect the development of the disease in adults, the following can be identified:

1. Genetic predisposition .This disease is often detected in siblings or twins. Approximately 19% of cases of pathology are diagnosed in blood relatives.
2. Immunological factors .Since Crohn's disease shows a consistent defeat of organs, scientists hypothesize the autoimmune nature of pathology.
3. Infectious diseases .The role of these factors has not been reliably confirmed, but there are hypotheses about the viral or bacterial nature of the disease.

Most often Crohn's disease affects the intestine, which is located near the large intestine. Although there are cases of localization of lesions in all parts of the digestive tract. With this disease, the entire mucosa of the affected area is covered with abscesses and ulcers.

Symptoms of Crohn's Disease

Because this disease can affect any of the organs of the gastrointestinal tract, the signs will be completely different. Experts share the symptoms of Crohn's disease on:

• common;
• local( depend on the place of injury);
• is an extraintestinal disorder.

The first type of symptoms include fever, fever, malaise( signs of an inflammatory process).If the temperature rises to very high values ​​(40 degrees), this indicates a purulent complication of the disease. The decrease in body weight is due to the fact that the inflamed organs of the digestive tract do not absorb all nutrients necessary for the body.

To the local symptoms of Crohn's disease is attributed to the following:

• regular diarrhea, it is caused by the inability to absorb nutrients in the intestine, in severe cases, decay processes develop;
• often recurring pain in the abdomen, it is similar to pain in appendicitis, occurs due to damage to the intestinal mucosa and constant irritation of nerve endings;
• infiltration( abnormal percolation of substances) and abscesses;
• perforation of intestinal wall;
• intestinal obstruction;
• in the development of perforated fistula and ulcers in the patient are bleeding.

Extraintestinal disorders of are more associated with immunodeficiency disorders that affect the entire body. For example, the defeat of large joints( pain, restriction of mobility), inflammatory process of the sacroiliac region, impaired vision, skin rash.

Chronic form of

In the picture of the symptoms of the chronic form of Crohn's disease, the signs of intoxication appear to the fore: weakness, malaise, increased fatigue, subfebrile body temperature, decreased appetite and body weight, pain in large joints. Over time, regular diarrhea, bloating and pains in the lower abdomen, considerable thinning are added.

When a large intestine is affected, a chair that can contain an admixture of blood becomes more frequent. In some cases, in the right iliac region or in the central parts of the abdomen palpation palpable palpable tugoelasticheskoy mobile formation. The phalanges of the fingers look like drumsticks.

Usually chronic form of Crohn's disease occurs with exacerbations and prolonged remissions, causing severe consequences in the form of anal fissures, ulcers, internal and external fistulas, massive intestinal bleeding, partial or complete intestinal obstruction, sepsis. The resulting infiltrates can give complications, causing the development of cancer tumors and subsequent disability. With a progressive course of the disease, an unfavorable prognosis for the patient's life is noted.

Diagnosis

Before you figure out how to treat Crohn's disease, you must correctly diagnose. Therefore, to exclude other pathologies that have similar symptoms, an instrumental examination is prescribed.

Usually the following methods are used:

1. Colonoscopy .Such a study allows you to visualize the inner surface of the intestine.
2. Irrigation .Provides an opportunity to see partial intestinal lesions, narrowing of its lumen, bowel relief, ulceration or ulcers, thickening of the walls and a decrease in their activity.
3. US .With its help it is possible to estimate the diameter of the loops of the intestine, the presence of free fluid in the abdominal cavity.
4. Computed tomography .It is done in the event that Crohn's disease is complicated by diseases of other organs, and it is difficult to establish an accurate diagnosis. MRI allows more detailed study of the state of the intestine, the degree of its damage, the presence of fistulas, the narrowing of the passage of the small or large intestine, an increase in lymph nodes.
5. Endoscopy study of .It is mandatory, with the help of it is carried out as a visual confirmation of the diagnosis, and take a piece of tissue for later study under a microscope.

Be sure to apply laboratory methods, including blood tests and feces, to exclude infectious diseases of the intestine.

Treatment of Crohn's Disease

In diagnosed Crohn's disease, the main treatment regimen is to use medical therapy aimed at localizing and reducing inflammation in the intestines, reducing the frequency and duration of exacerbations, and maintaining a state of stable remission, that is, in anti-relapse treatment.

Severe cases may require the appointment of stronger medications, comprehensive treatment, and periods of exacerbations - surgical intervention. The choice of method of treatment depends on the severity of the course of Crohn's disease, the dominant symptoms, the overall health of the patient.

Medication Therapy

Currently, there is no universal remedy for Crohn's disease, but therapy with one or more drugs is aimed at early treatment of the disease and alleviation of its symptoms.

The most common drugs are:

• salicylates( 5-ASA) - sulfasalazine, mesalazine, Pentasa;
• topical hormones - budenofalk;
• glucocorticoids - prednisolone, methylprednisolone;
• immunosuppressants - azathioprine, methotrexate, 6-mercaptopurine;
• blockers of tumor necrosis factor-adalimumab, infliximab, golimumab, etanercept, cerolizumab pegol.
• integrin receptor blockers: Vedolizumab.

Also actively used:

• antibiotic treatment: ciprofloxacin, metronidazole and a new antibiotic rifaximin;
• treatment with probiotics( VSL # 3, fecal transplantation of live donor bacteria);
• vitamin D group;
• hyperbaric chamber( oxygen treatment);
• in severe cases of intestinal transplantation from the donor.

In more common and complex cases of Crohn's disease, surgery may be indicated. Sometimes, with the development of severe complications of the disease, such as bleeding, acute intestinal obstruction or perforation of the bowel, emergency surgical interventions are necessary.

Other, less urgent indications for surgery include the formation of abscesses, intestinal fistula( pathological reports of various parts of the gastrointestinal tract), severe forms of perianal injury, the absence of the effect of conservative treatment.

Diet

During the remission of the disease, patients are shown to follow a strict diet in order not to provoke an aggravation of the inflammatory process in the intestinal wall. Food should be balanced, contain a large amount of protein and vitamins, and fats should be limited. Diet in Crohn's disease is not very strict, the main thing in it is a careful attitude to the intestines.

Recommendations regarding nutrition:

1. Drink plenty of fluids;
2. Restrict the consumption of flour and baking;
3. Eat small meals 5-6 times a day;
4. Give preference to foods that are low in fat;
5. Refuse from eating spicy foods, alcohol;
6. Take multivitamin complexes.

Diet in Crohn's disease limits the use of heavy, rough food, which irritates the intestinal mucosa, as well as fats and milk. Recommended easily digestible and easily digestible food, with limited use of fermented milk products, sparing for the gastrointestinal tract. It is extremely important that the diet in Crohn's disease is balanced, since in this disease, anemia and vitamin deficiency are frequent due to poor digestion of food.

Operation

If a diet, lifestyle change, drug therapy and other methods have proved ineffective, the patient is recommended surgical treatment. About half of all patients with Crohn's disease during the treatment suffer at least one surgical intervention, during which the doctors remove the damaged area of ​​the intestine.

Unfortunately, the operation can not completely eliminate Crohn's disease, as it is possible, for example, with ulcerative colitis. Even if a large segment of the intestine is removed during surgery, the disease may reappear. In this regard, some experts recommend as long as possible to postpone the operation. This tactic allows you to reduce the number of operations that a person will have to endure.

Complications of

Crohn's disease may be accompanied by complications such as:

1. Anemia.
2. Intestinal bleeding.
3. Perforation( intestinal wall integrity).
4. Urolithiasis.
5. Gallstone disease.
6. The appearance of abscesses( ulcers) in the intestine.
7. Development of intestinal obstruction( impaired intestinal contents movement through the intestine).
8. Formation of fistulas( absent in normal canals) and stricture( narrowing) of the intestine.

If the fistula develops into the abdominal cavity, food entering the intestine can pass the departments responsible for absorbing nutrients, and also penetrate into organs such as the bladder or vagina. Fistula development is a formidable complication, as there is a high risk of suppuration and abscess formation. Left unattended, this condition can become a threat to the life of the patient.

Prognosis for life

Mortality in Crohn's disease is 2 times higher than that of a healthy population. Most causes of death are associated with complications and surgical operations on their behalf.

The disease has a recurrent course and almost all patients have at least one relapse within 20 years. This requires constant dynamic observation of the patient for correction of therapy and detection of complications of the disease.

The prognosis for life varies considerably and is determined individually. The course of Crohn's disease may be asymptomatic( if the focus is located only in the anus in the elderly) or proceed in extremely severe form.