Crohn's disease - a predominantly gastrointestinal tract, a chronic inflammatory disease that can repeatedly worsen throughout the life of a person. In the inflammatory process, absolutely any part of the digestive tract, from the anus to of the oral cavity, but the most common lesion is the thick (rectus or colon) and / or the terminal section of the small (ileum) gut.
Crohn's disease is closely related to such a chronic disease as ulcerative colitis, which manifests itself only in the large intestine. As for Crohn's disease, and for ulcerative colitis to date, an effective method of treatment has not been developed. Both diseases have a recurring chronic course, during which the periods of relapse (exacerbation) change the periods of remission (calm).
Only in the US Crohn's disease is diagnosed in the order of two million people. Racial and sexual separation is not determined, but a little more common in Middle Eastern and North African people. Typically, the onset of the disease occurs in adolescence and adolescence, but there are cases of manifestation of the disease in more mature age and in childhood, which, however, may well be due to imperfect diagnostic methods
Crohn's disease - causes
There are many theories about the possible causes of the development of Crohn's disease, but none of them has been finally proven to date, so it remains to be seen for sure what the disease is caused. Most scientists agree that Crohn's disease is caused by predisposing factors of the environment, congenital predisposition and diseases of the immune system.
Hypothesis of environmental factors
There is an assumption that the development of Crohn's disease is facilitated by environmental factors such as viral and bacterial infections, tobacco smoke, substances or components of food consumed, and other factors that are not yet known.
Presumably external factors contribute to the development of Crohn's disease as follows:
• Immediately damage the intestinal mucosa, which can lead to both the development of Crohn's disease, and to increase the severity of relapses
• Provoke a reaction of the immune defense, which, having started, is no longer able to stop
Hypothesis of congenital predisposition
According to the conducted studies, it was noted that about 15% of patients with Crohn's disease, at least one of the relatives has the same disease. It was also noted that the disease in some ethnic groups (Ashkenazi Jews) is more common.
This trend and prompted the idea of a possible genetic nature of Crohn's disease. There was actually a gene that is directly related to Crohn's disease, a gene that tells the human body to decide how to react to certain microbes. In the event of a change or mutation of the gene, the body will react to microbes with a deviation, which in time can lead to the development of inflammatory bowel diseases and Crohn's disease. It was noted that the altered gene in patients with Crohn's disease is observed twice as often as in completely healthy people. Despite this, the presence of a mutated gene in the body does not always predetermine the development of the disease
Some scientists associate the development of IBD (inflammatory bowel disease) and among them Crohn's disease with disorders of the immune system. Being in norm, cells of the immune system protect the body from the attack of various harmful microorganisms (fungi, viruses, bacteria and other foreign agents). In this case, immune defense reacts differently to all microorganisms, since a considerable number of bacteria benefit (participate in digestive processes, etc.) and the immune system does not "touch" them.
In the case of an aggressor, an immediate protective response begins, which at the local level is manifested by an inflammatory reaction. Specialized immunocompetent cells are sent to the inflammatory focus, which destroy the harmful origin and release substances aimed at binding and neutralizing toxins. After the localization and elimination of the aggressor, the immunocompetent cells return to their positions, the inflammation gradually subsides and the processes of regeneration and recovery begin.
With Crohn's disease, the immune system behaves paradoxically for reasons unknown so far, erroneously directing its aggression to absolutely harmless, and sometimes vitally necessary (symbionite bacteria) microorganisms. In some cases, for an unknown reason also does not stop the inflammatory reaction, so over time, chronic inflammation leads to ulceration and other damage to the intestine
Risk factors for Crohn's disease: smoking, emotional and physical stress, hormonal changes, infections, certain medications, family history, descent from countries in northern Africa and the Middle East
Crohn's disease - symptoms
Symptoms of Crohn's disease, depending on the localization of the pathological process and the form of the disease vary. There are two forms of clinical development of this disease - acute and chronic.
The acute form of Crohn's disease develops lightning fast. The body temperature rises, the blood sedimentation rate of erythrocytes and the number of leukocytes increase. In the right iliac fossa there are pains (due to the fact that there is an appendix in this area, the patients often erroneously operate because they suspect acute appendicitis). The morphological data obtained during the operation clarify the diagnosis. In more than 95% of cases, the acute form of Crohn's disease, even without treatment, results in complete recovery. In other cases, the disease becomes chronic.
Chronic form of Crohn's disease is determined by the slow development and gradual increase in symptoms. Patients usually seek specialized care only after the onset of the first complications of the disease.
Patients complain of abdominal pain (more often after eating), bloating, two to three times a day they have transient diarrhea. There may be a slight increase in body temperature. A characteristic symptom of Crohn's disease is a significant weight loss. In case the rectum is involved in the process, cracks and fistulas can be observed in the anal area.
During periods of exacerbation, the symptoms of the disease are most pronounced. Patients complain of cramping quite strong pain in the abdomen, five to six times a day, diarrhea is observed, as a result of digestive disorders, the patient significantly loses body weight. The most frequent complications during the exacerbation include perforation of the intestinal wall, internal bleeding, against intestinal stenosis, intestinal obstruction develops, penetration of the ulcer into adjacent organs, toxic-allergic involvement of the joints and eyes, and fistula formation. During the periods of remission (can last several years) the symptomatology of the illness subsides
Crohn's disease - diagnosis
Diagnosis of Crohn's disease almost always causes certain difficulties, this is partly because its manifestations are not always obvious and are often ignored by the patient. In addition, there are many diseases that have the same symptomatology and pain of the same localization.
Diagnosis begins with a general examination and collection of anamnestic data. The doctor should pay attention to the presence of classical symptoms of Crohn's disease: weight loss, digestive disorders, anemia, the formation of external fistulas, prolonged pain in the region of the right ileal region. During the examination, special attention is paid to the condition of the mucous membranes and skin (nail bundle, brittle hair, dry and pale skin). When palpation of the right iliac fossa, a painful formation is often found, which consists of the solitary loops of the small intestine.
To clarify the diagnosis, the following diagnostic studies are indicated:
• Colonoscopy. With this endoscopic examination, an optical fiber imaging system is introduced into the colon of the patient, which makes it possible to identify the characteristic lesion of the intestine, which looks like deep ulcers, with dense uneven edges that are located along the longitudinal axis of the intestine. Absolutely all the intestinal mucosa acquires the so-called "paved bridge" type. During the colonoscopy, a biopsy specimen is taken for histological examination. It is the histological analysis that makes it possible to differentiate Crohn's disease from other diseases with similar symptoms ( malignant tumors , ulcerative colitis , intestinal tuberculosis) and to establish a definitive diagnosis
• Radiological study using barium sulphate suspension allows to clarify the presence of narrowing of the intestinal lumen. At the very beginning of the course of the disease, the lumen practically does not narrow, however the folds of the mucosa begin to acquire the wrong direction. With the progression of Crohn's disease, the narrowing (stenosis) of the intestinal lumen increases to such an extent that on the X-ray, these areas of the intestine acquire the appearance of a hose or cord, with healthy areas alternating with the affected
• A general blood test shows an increase in ESR (indicates the presence of an inflammatory process) and the presence of leukocytosis (in the blood there is an increased number of leukocytes)
Crohn's disease - treatment
Treatment of Crohn's disease presents certain difficulties, since even with adequate timely treatment this disease is prone to progression, development of complications and the formation of continuously recurring forms. Two treatment options are used: conservative and surgical. It should be noted that surgical treatment is a difficult non-standard task, in which surgical interventions are carried out in stages, and the treatment itself can be delayed for several years. Nevertheless, there are a number of definite indications for mandatory surgical treatment - the formation of internal and external fistula (interintestinal, vaginal or near -along) and the development of stenosis (impaired intestinal peristalsis and developing intestinal obstruction).
In order to reduce the frequency of exacerbations in the treatment of Crohn's disease, the main focus is on anti-relapse therapy, which includes immunosuppressors, glucocorticoids, chimeric monoclonal antibodies, 5-aminosalicylic acid preparations (sulfasalazine and mesalazine). For today, it is mesalazine and sulfasalazine that give the longest good effect and are the prevailing drugs of choice.
In the case of insufficient effect in the treatment of Crohn's disease with aminosalicylates, ciprofloxacin and metronidazole are administered in the course of treatment. If in this case there is no adequate therapeutic effect, glucocorticosteroids of systemic value are prescribed. In the case of long-term treatment of Crohn's disease, immunomodulating drugs (azathioprine) are used, whose action is aimed at reducing the activity of the cells of the immune system (thereby inhibiting the inflammatory process passing in the intestine).
Surgical treatment of Crohn's disease is indicated in the absence of positive dynamics in conservative treatment and in the development of complications. The purpose of surgical intervention is to remove the developed complication (abscess, stenosis, fistula), or the affected area of the intestine.
Diet in Crohn's disease is not too strict, but certain restrictions are still present. It should be remembered that with this disease, a vital need is a careful attitude to the organs of the digestive tract. Diet in Crohn's disease allows you to use almost the entire set of products to which the patient is accustomed. To a minimum, you should reduce the intake of carbohydrates and fats, and increase the proportion of proteins on the contrary. To the use of categorically forbidden pickles, canned foods, spices, smoked and fried, peas, kvass, eggs, spirits and fatty meat. All products must be heat treated before use. To achieve a long-term remission, a doctor must monitor the diet, monitor and treat Crohn's disease without fail.