Crohn's disease - Causes, symptoms and treatment. MF.

Crohn's disease is a chronic inflammatory disease that affects the entire gastrointestinal tract: from the oral cavity to the anus. Unlike ulcerative colitis, with 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 goes to other parts of the intestine. In this case, the symptoms of acute ileitis( inflammation of the ileum) are indistinguishable from the symptoms of acute appendicitis, so patients often operate and during the operation put a true diagnosis.

Crohn's disease is a rare enough pathology. Usually the disease begins at the age of 20 - 40 years, but it can also occur in childhood. Men are more likely to get sick than women.

Causes of Crohn's Disease

To date, it has not been possible to identify the causative agent of Crohn's disease. However, the infectious theory is the main version of the origin of the disease. This is due to the positive effect of antibiotic treatment. In addition, disorders of the immune system play an important role in the development of the disease. Autoimmune processes, in which antibodies against intestinal tissues are produced, and the deficiency of the protective function of the immune system are an important link in the origin of the disease.

Predisposing factors of the disease development are:

• Migrated virus infection( measles);
• food allergy;
• stress and mental overstrain;
• smoking;
• hereditary predisposition.

Symptoms of Crohn's disease

Given that Crohn's disease can affect any part of the gastrointestinal tract, the picture of the disease is very multifaceted and depends on the localization of the main focus of inflammation. In the clinical picture, local, general and extraintestinal manifestations of the disease can be identified.

Common symptoms occur due to disorders of the immune system and the presence of intoxication. They include a fever with chills, weight loss, weakness and malaise.

With fever, which can be caused by purulent complications of Crohn's disease, the temperature reaches 39-40 ° C.

Infringement of absorption of nutrients, microelements, vitamins, bile acids because of the prolonged inflammation of the intestinal wall leads to metabolic disorders, weight loss, osteoporosis( loss of bone strength), the formation of cholesteric stones in the gallbladder.

The main local manifestations of the disease are abdominal pain, diarrhea with an admixture of blood in the stool.

Abdominal pain may be ineffective, cramping with a feeling of heaviness and swelling. Often pains are localized in the right lower quadrant of the abdomen, sometimes they can not be distinguished from those in appendicitis.

Liquid stool with an admixture of blood is a constant symptom, its frequency varies from 3 to 10 times a day. After a stool, the abdominal pain decreases.

Extraintestinal manifestations of the disease are associated with immunological disorders and include:

• arthropathy - asymmetric lesion of large joints, accompanied by pain and mobility restriction;
• sacroiliitis - inflammation of the sacroiliac joint with intense pain in the sacrum;
• decreased vision;
• skin rash( erythema nodosum, pyoderma gangrenous);
• oral ulcers.

Given the presence of pain in the abdomen and upset of the stool, Crohn's disease is difficult to distinguish from an attack of acute appendicitis, inflammation of Meckel's diverticulum, ulcerative colitis, infectious enterocolitis, malignant lymphoma( swelling of blood cells) and intestinal tuberculosis. Therefore, if you have abdominal pain that do not go away within 6 hours, you should consult a surgeon.

If you have pain, you can take antispasmodics, such as no-shpa, buscopan, once or twice a tablet. With the development of diarrhea without signs of bleeding, you can take loperamide or imodium at an initial dose of 4 mg, then 2 mg after each act of defecation, maximum 16 mg per day, not more than 24 hours. If the treatment is ineffective, you should consult a surgeon. Do not apply compresses and warming up the abdominal area of ​​ - this can exacerbate inflammation. Anesthetics for pain in the abdomen can not be taken - they will distort the picture of the disease and prevent the correct diagnosis. Self-medication and belated diagnosis can lead to the development of complications of the disease.

Crohn's disease examination

There is no specific laboratory diagnosis for Crohn's disease. When seeking medical help, you need to undergo a standard examination, including a general blood and urine test, blood sugar, a biochemical blood test.

In the general analysis of blood there is an increase in the level of leukocytes and an increase in ESR, a decrease in the level of hemoglobin( anemia), a decrease in the number of lymphocytes( lymphopenia), an increase in the content of eosinophils( eosinophilia).In the biochemical analysis of blood, the reduction of the total protein content( hypoproteinemia) comes to the fore.

The most characteristic changes can be seen with X-ray and endoscopic examination of the intestine.

Given that the inflammation of the bowel wall in Crohn's disease leads to the formation of a set of narrowing( strictures) along the intestinal tube, to examine the large intestine all over with colonoscopy ( endoscopic method of examination, allows to see the internal lumen of the gut, assess the changes in the mucosa).always possible. But in this case, in the narrowing area, ulcerative defects of the mucous membrane can be detected and a biopsy( a portion of the mucosa for histological examination) can be taken.

The figure shows the endoscopic picture of Crohn's disease with pronounced inflammation and narrowing of the colon's lumen, making it difficult to study.

To detect the lesions of the stomach and duodenum, fibroadastroduodenoscopy ( FGDS) is used.

The most safe and informative method of examination in the presence of strictures - radiography with a passage of barium .A distinctive feature of the X-ray picture of Crohn's disease is the presence of ulcer-cracks in the internal relief of the mucosa and multiple narrowing of the intestinal tube, alternating with normal, uninfected areas of the intestine.

The ultrasound study of the abdominal cavity allows to estimate 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 the development of peritonitis).

Computer tomography allows you to assess the presence of complications - the formation of an abscess or infiltrate in the abdominal cavity.

Treatment of Crohn's disease

Since Crohn's disease affects the entire gastrointestinal tract, treatment of Crohn's disease is mainly medicated. Surgical treatment is used only in the presence of complications for their correction.

The diet for this disease should include a high-calorie food containing a large amount of protein and vitamins with a restriction of fat and coarse-fiber plant products that cause irritation of the intestine. It is necessary to exclude the use of alcohol. You can eat soups with low-fat skimmed meat and fish broth, boiled and grated meat( chicken, beef, rabbit), oatmeal, buckwheat porridge in water, eggs( up to 2 per day) soft-boiled or as a steam omelet, jelly, jellyblueberries, ripe pears, unleavened cottage cheese, curd soufflé.All other dairy dishes should be excluded, since they can contribute to the development of diarrhea. From drinks you can tea, cocoa on the water, broths of dogrose, bird cherries, blueberries. It is necessary to exclude all fresh vegetables, sauces, spices.

During an exacerbation of the disease, antibacterial therapy is performed. Assign ciprofloxacin and metronidazole in doses up to 1 g per day. At the same time, they can be combined or sequentially assigned. They take drugs for up to 6 weeks. The most effective use of antibiotics in the defeat of the colon.

As an anti-relapse treatment, mesalazine is used in a daily dose of 3 to 4 g for a long time up to 6 months, then a control examination is performed, with positive dynamics the drug is canceled, in the absence of positive shifts, treatment is continued.

Complications of Crohn's disease

With late diagnosis or prolonged course of the disease, the following complications may develop.

• Intestinal obstruction - a specific symptom, especially in the defeat of the small intestine, is the narrowing of the lumen of the gut and the violation of the normal passage of food. Usually, complete obstruction of the lumen does not develop, so expectant conservative treatment with the appointment of antibacterial drugs, hormones( prednisolone), spasmolytic drugs( no-shpa, papaverine).However, if the conservative treatment is unsuccessful, the operation is performed - resection of the intestine( remove the narrowed part of the intestine).

The figure shows an x-ray picture of intestinal obstruction with swollen loops of the small intestine, overflowing with gas and liquid levels.

• Perforation into the free abdominal cavity - violation of the integrity of the intestinal wall due to deep ulcerous defects with outflow of contents into the abdominal cavity, accompanied by the development of peritonitis( inflammation of the peritoneum).In this case, an emergency operation is shown.

• Infiltration and abscess in the abdominal cavity - occur due to a previous complication. Due to the activation of the protective properties of the peritoneum, the inflamed area is distinguished from the formation of a conglomerate of inflamed tissues( infiltrate) with purulent contents( abscess).If these complications occur, the drug therapy described above is performed, if it is ineffective, the operation is performed.

• Intestinal bleeding is less common than, for example, ulcerative colitis, however, is possible. In such cases, prescribe hemostatic drug therapy, which is usually successful.

• Toxic dilatation( pronounced expansion of the intestine) of the affected bowel occurs extremely rarely in contrast to ulcerative colitis. Its development can be provoked by the use of antidiarrhoeal agents, irrigoscopy and colonoscopy. In this case, anti-inflammatory drugs( prednisolone) and antibacterial drugs, together with the cessation of food intake, help to eliminate this complication.

• Anal cracks, fistulas and paraproctitis( a purulent inflammation of fatty tissue around the rectum) is a frequent complication from which the disease can begin. It is formed in the formation of ulcers of the mucous membrane of the anal canal with the transition to the surrounding skin, fistulous passages are formed as a result of the breakthrough of abscesses of the near-rectum fatty tissue. To correct these complications, the excision is performed on the background of drug therapy.

Prevention of Crohn's Disease

There is currently no effective prophylaxis of Crohn's disease. Therefore, the only way to some degree to protect yourself from the development of this disease is a healthy lifestyle, the exclusion of predisposing factors.

In order to prevent the development of complications, early diagnosis of Crohn's disease and timely started medical therapy are necessary. Therefore, self-treatment with the appearance of these symptoms is unacceptable.

As Seneca said: "One of the conditions for recovery is the desire to recover."Therefore, take care of your health. It is better to overestimate the severity of your symptoms than it is too late to seek medical help.

Surgeon-physician Tevs DS