Crohn's disease: symptoms, treatment, causes, what is it?

What it is? Crohn's disease is called an intestinal pathology, in which the inflammation of its entire wall develops.

Any part of the digestive tract may be affected, but the ileum( end of the small intestine) is most often affected when it passes into the cecum.

Other organs may also be involved in the pathological process. Such inflammation of all three layers of the intestine is a good substratum for the development of a significant number of complications of the disease, the major majority of which is treated only surgically.

The disease belongs to rare pathologies, it develops more often in people 20-40 years, less often - in childhood. She has a tendency to chronic current;with the help of drug therapy it is possible to achieve her remission, which can last even several years. It is impossible to determine when the symptoms will resume again.

Risk factors and causes of Crohn's disease

The exact cause of the disease is still unspecified. It is believed that Crohn's disease can cause:

1. 1) Infection. A specific pathogen has not been identified, but the theory is confirmed by the fact that the introduction of wash water from the intestine of the patient causes a pathology similar to that in humans in laboratory animals. In addition, treatment with antibacterial drugs leads to the development of remission of the disease."Guilty" is considered a bacterium pseudotuberculosis, korepodobny virus, other microorganisms.
   
2. 2) Genetic predisposition. Since Crohn's disease is often detected in blood relatives, the genome of people suffering from this pathology was studied. They had a mutation of one of the genes, which can be transmitted by inheritance, having a certain repetition of amino acids. These repeats are the receptors for some components of microorganisms.
   
3. 3) Immunity factors: when studying the nominal system, the patient has signs indicating that the disease can have an autoimmune character( that is, its own immunity recognizes its structures as alien and "attacks" them).
   
4. 4) Environmental factors: structural components of food, tobacco smoke, other substances that can trigger an autoimmune process or damage the bowel structure.

It is believed that the highest risk of developing the disease under these conditions:

• Crohn's disease is diagnosed in a close relative;
  
• is a native of the Middle East;
  
• there was a sharp change in the hormonal background;
  
• was transferred pseudotuberculosis or measles infection;
  
• is a smoker;
  
• has changed the way of life in terms of increasing emotional and physical exertion.

Symptoms of Crohn's Disease

By the nature of the development of symptoms, three forms of Crohn's disease can be distinguished: acute, subacute and chronic.

The acute form has a rapid onset: the body temperature rises, there is pain in the lower right segment of the abdomen, diarrhea. Often at this stage, patients are mistakenly diagnosed with appendicitis or ovarian apoplexy, which results in their operation. The diagnosis is found on the operation.

The subacute form is characterized by unexpressed diarrhea, abdominal pain( any localization) of a cramping character. Depletion of the patient develops.

The chronic form is characterized by a slow and gradual development of symptoms:

1. 1) Bloating;
   
2. 2) Cramping pains in different parts of the abdomen, intensifying after eating, decreasing after the person has recovered;
   
3. 3) Diarrhea 2-3 times a day( not every day), with exacerbation can be up to 5-6 times a day;
   
4. 4) In most cases of disease in the stool, blood is detected;
   
5. 5) Temperature rise: usually not higher than 38 ° C, high figures will be noted in purulent complications of this disease;
   
6. 6) Gradual weight loss, which occurs due to the fact that the inflamed intestines poorly digest food;
   
7. 7) Weakness, fatigue;
   
8. 8) Lack of appetite
   
9. 9) Cracks and maceration of the skin in the area around the anus can develop.

There are Crohn's disease and extraintestinal symptoms:

• pain in the sacrum( inflammation of the joint between the pelvic bone and sacrum);
  
• decreased visual acuity;
  
• pain in the eyes;
  
• pain and decreased mobility in large joints;
  
• rash on the skin in the form of pustules or red dense and painful knots, which soon change color to violet, then - brown, after - yellow( erythema nodosum);
  
• formation of ulcers in the oral cavity;
  
• pain in the right upper quadrant, yellowing of the skin and sclera, fever, vomiting - signs of damage to the liver and / or bile ducts.

Diagnosis of Crohn's disease

There are no specific tests for diagnosis of Crohn's disease. It is possible to reveal only laboratory:

• inflammation( increase in the level of leukocytes with a decrease in the relative number of lymphocytes);
  
• anemia( decreased hemoglobin);
  
• decrease in the amount of total protein;
  
• detection in the blood of the protein kalprotektina( its level will be higher for all inflammatory and tumoral diseases of the intestine).

The diagnosis is based on the following instrumental studies:

1. 1) Colonoscopy is a study in which a special instrument resembling a probe is inserted into the intestine. The image obtained by moving such a colonoscope over the intestine is controlled and displayed on the monitor. With Crohn's disease in the bowels ulcerous defects are revealed, from the surface of which you can take a biopsy.
   
2. 2) Endocapsular colonoscopy : a person swallows a capsule-video camera, which, passing through the intestine, displays an image of its internal structure on the monitor.
   
3. 3) Gastroduodenoscopy is a method of investigation based on the same principle as colonoscopy. It is necessary for examination of the duodenum, stomach and esophagus.
   
4. 4) Radiographic contrast study of the intestine : a person drinks barium, which is a contrast for X-rays, after a time make a series of pictures of his intestines. With Crohn's disease, this method reveals cracks in the intestinal mucosa and its narrowing, which alternate with normal areas of the intestines.
   
5. 5) Computed tomography is used to detect such complications of Crohn's disease as an abscess or infiltrate.
   
6. 6) Ultrasonic examination of the intestine is used to diagnose free fluid in the abdominal cavity( peritonitis), which is a complication of Crohn's disease.
   
7. 7) MRI with contrasting ( the contrast is water introduced into the intestine) allows to estimate the volume of intestinal lesions, diagnose complications such as fistulous passages, enlarged lymph nodes.
   
8. 8) Study of the motor function of the of the intestine with the help of electrogastroenterography.

Treatment of Crohn's disease

The stages of treatment for Crohn's disease include:

1. 1) Medical therapy of the pathology itself;
   
2. 2) Dietotherapy;
   
3. 3) Treatment of complications( almost always with this disease they require surgical correction).

Dietotherapy. With Crohn's disease, the food should not be rough, not acute, not hot and not cold.

You can eat:

• mucous porridge;
  
• biscuit biscuits, crackers;
  
• low-fat cottage cheese, sour cream, milk - in small amounts;
  
• boiled eggs;
  
• vegetable soups on the second broth;
  
• boiled and baked vegetables;
  
• boiled, steamed or stewed meat and fish;
  
• tea;
  
• compotes of berries and fruits, which should not be acidic.

Can not be used:

• fried food;
  
• mushrooms;
  
• canned food;
  
• fizzy drinks, sour juices, coffee, strong tea;
  
• beans;
  
• fresh vegetables and fruits;Pickles
  
• ;
  
• confectionery;
  
• semi-finished products;
  
• pearl and wheat porridge.

Medical treatment of Crohn's disease

The following groups of drugs are used:

1. 1) Aminosalicylic acid derivatives: "Sulfasalazine", "Mesalazine".
   
2. 2) Antibacterial therapy: "Ciprofloxacin", "Metronidazole".
   
3. 3) Immunosuppressors: hormones-glucocorticoids( "Prednisolone", "Methylprednisolone") and cytostatics( "Azathioprine", "Methotrexate").
   
4. 4) Antibodies to the tumor necrosis factor: Golimumab, Infliximab, Adalimumab.
   
5. 5) Probiotics: "Bifidum-bacterin", "Bifiform", "Linex" and others.
   
6. 6) Vitamin D.
   
7. 7) Antidiarrhoea( Loperamide, Imodium) - in the absence of blood in the feces and a negative result of bacteriological examination.

Prophylaxis of Crohn's disease

No specific vaccine against this disease has been developed, since its infectious nature is not proven. For the prevention of Crohn's disease, the following measures can be proposed:

1. 1) Proper nutrition with a high content of plant fiber in the diet, with the exception of fatty, salty and spicy food;
   
2. 2) Use only washed or thermally treated products;
   
3. 3) Avoid stress and nerve stress.

Complications of

Crohn's disease can be complicated by such pathologies:

• intestinal wall perforation;
  
• intestinal obstruction;
  
• abscess or infiltrate in the abdominal cavity;
  
• intestinal bleeding;
  
• is rare - the expansion and disappearance of peristalsis in the gut area;
  
• fistulas between the loops of the intestine or the intestines and adjacent organs.

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