Crohn's disease and ulcerative colitis are inflammatory bowel diseases. All inflammatory bowel diseases cause chronic inflammatory processes in the digestive system. Crohn's disease usually develops in the lower part of the small intestine, more specifically the ileum, and early in the colon, but can affect any part of the gastrointestinal tract.
Difference between Crohn's disease and ulcerative colitis
The two conditions are related, but they are considered separate disorders with slightly different treatment options. The main differences between ulcerative colitis and Crohn's disease lie in the location and severity of the disease. However, in some patients at an early stage, infectious bursal disease, or Gumboro disease, an infectious, contagious, viral inflammatory disease of internal organs that affects the bursa of Fabricius, has features and signs of both disorders. This is called "indeterminate colitis."
Ulcerative colitis is a chronic inflammatory disease of the colon. Ulcers form a cuticle or mucous membrane in the colon or rectum, often resulting in diarrhea, which may be accompanied by blood and pus. The inflammation is usually most severe - in the sigmoid colon and rectum. They usually decrease higher in the colon. The disease does not develop evenly and consistently until, in some people, the colon becomes stiff and shortened.
These and other inflammatory bowel diseases are associated with an increased risk of colorectal cancer.
Crohn's disease, also called regional enteritis, is a chronic, recurrent inflammation of the intestine, similar to ulcerative colitis, characterized by granulomatous inflammation with segmental involvement of different parts of the digestive tract, which usually occurs in the lower part of the small intestine - the ileum. This inflammation, which spreads to the deeper layers of the intestinal wall, is most common in the area across the small and large intestines - specifically in the ileum and cecum (ileocecal region).
In Crohn's disease, the pathological process develops mainly in the intestine, although all parts of the gastrointestinal tract (GIT) can be affected. Nonspecific immune inflammation extends to the entire intestinal wall and is manifested by leukocyte infiltration. Deep ulcers form in the mucous membrane in the infiltration zone, fistulas and abscess develop, followed by scarring and narrowing of the intestinal lumen. Less commonly, Crohn's disease develops in other parts of the gastrointestinal tract, including the anus, stomach, esophagus, and even the mouth. It can affect the entire colon, including ulcers in one part of the colon. It can also develop as multiple scattered clusters of ulcers throughout the gastrointestinal tract, passing healthy tissue between these clusters.
Gastrointestinal tract anatomy
The gastrointestinal tract, or digestive system, is a system of organs that extend from the mouth to the anus. It is a complex or system of organs that carry food from the mouth down the esophagus into the stomach, and then, through the small and large intestines, bring it out through the rectum and anus.
- Esophagus. The esophagus is a narrow and long muscular tube that starts under the tongue and ends in the stomach.
- Stomach. In the stomach, acids move food so small that nutrients can be absorbed in the small intestine.
- Small intestine (small intestine). The small intestine is the longest part of the digestive tract. Food, moving from the stomach to the small intestine, gradually passes through three parts:
The duodenum;
- the small intestine;
- the ileum.
Most of the digestive process takes place in the small intestine.
- Colon. Undigested material - such as plant fibers - passes alongside the colon, mostly in liquid form. The large intestine is wider than the small intestine. The large intestine absorbs excess water and salts in the blood. The rest of the waste is converted into feces through bacteria. The colon is a continuous structure, but it has several components.
- The cecum and its processes. The cecum is the first part of the large intestine and leads to its other parts located in the lower right quadrant of the abdomen. The large intestine continues in several departments:
The first section - the ascending colon - runs upward from the cecum on the right side of the abdomen;
- in the second section - the transverse colon - crosses the upper abdomen on the left side;
- in the third section - runs down on the left side of the abdomen to the pelvic area (descending colon);
- the last, fourth section - the sigmoid colon.
- Rectum and anus. The feces are stored in the descending and sigmoid colon until they pass through those bowels and anus.
CausesCrohn's disease
Doctors don't know exactly what causes inflammatory bowel disease. They appear to be related to the interplay of many complex factors, including genetics, immune system disorders, and environmental factors. As a result, the abnormal response of the immune system, in turn, causes an inflammatory process in the area of the small intestine. Crohn's disease and ulcerative colitis, like other IBDs, are considered autoimmune disorders.
- Inflammatory response. An inflammatory response occurs when the body tries to defend itself against what it perceives as an invasion of foreign substances (antigens). Antigens can be as follows: viruses, bacteria, other harmful substances.
In Crohn's disease and ulcerative colitis, the body mistakenly considers harmless substances (food, beneficial bacteria, or its intestinal tissue) to be harmful. To fight infection, the body produces various chemicals and white blood cells, which in turn produce by-products that cause chronic inflammation of the intestinal lining. Over time, inflammation causes damage and permanent changes to the intestinal lining.
- Genetic factors. While the exact causes of inflammatory bowel disease are not known, genetic factors certainly play a role. Several identified genes and chromosomes play an important role in the development of ulcerative colitis, Crohn's disease, or both. However, genetic factors are more important in Crohn's disease, although there is evidence that both forms of inflammatory bowel disease share common genetic defects.
- Environmental factors. Inflammatory bowel disease is much more common in industrialized countries and cities. It is not yet clear how and why these factors increase the risk of their development. It is possible that lifestyle factors such as smoking, vigorous physical activity, a diet high in fat and sugar, and stress play a significant role in them. However, there is no conclusive evidence that poor diet or stress is causing Crohn's disease or ulcerative colitis, although they can make them worse.
Other possible environmental causes of Crohn's disease include exposure to sunlight and, subsequently, lower levels of vitamin D, and decreased childhood exposure to certain types of bacteria and other microorganisms in the stomach. However, until now these theories have not been confirmed.
Crohn's disease risk factors
- Age. Crohn's disease can occur at any age, but it is most commonly diagnosed in people between the ages of 15 and 35. About 10% of patients are children under 18;
- Floor. Men and women are equally at risk of developing Crohn's disease;
- Family history. 20-25% of patients with Crohn's disease have a close relative with this disease in their families;
- Race and ethnicity. Crohn's disease is more common among whites, although incidence rates are increasing among other races as well;
- Smoking. Smoking increases the risk of Crohn's disease and can worsen the course of the disease (on the other hand, smoking probably decreases the risk of ulcerative colitis. However, due to the danger of smoking, it should never be used to protect against ulcerative colitis);
- Appendectomy. Removing your appendix (appendectomy) may be associated with an increased risk of Crohn's disease, but a reduced risk of ulcerative colitis.
Crohn's disease symptoms
The two major inflammatory bowel diseases, ulcerative colitis and Crohn's disease, share some characteristics:
The symptoms of both diseases usually appear in young people;
- symptoms may develop gradually or have a sudden onset;
- both diseases are chronic. In any disease, symptoms may erupt (relapse) after asymptomatic periods (remission) or, without treatment, symptoms may be continuous;
- Symptoms can be mild or very severe, or even death.
The specific symptoms of Crohn's disease vary depending on where in the GI tract the disease is located (in the ileum, colon, stomach, duodenum, or small intestine).
The common symptoms of Crohn's disease are:
Abdominal pain - usually in the lower right corner;
- diarrhea;
- weight loss;
- bleeding from the rectum;
- fever (high body temperature);
- nausea and vomiting;
- skin lesions;
- joint pain.
Other symptoms:
- Eyes. Inflammation in the eyes is sometimes an early sign of Crohn's disease. Retinal diseases can occur, but are rare. People with arthritis and its complications may have an increased risk of vision problems.
- Joints. Inflammation of the intestines causes arthritis and joint stiffness. The back is often affected. Crohn's disease patients also have a risk of abnormal thickening and enlargement at the ends of the fingers and toes.
- Ulcers in the mouth. Wounds and ulcers are common and, when they occur, remain. Oral infections are also common in people with Crohn's disease.
- Skin diseases. People with Crohn's disease may develop skin swelling, swelling, or other skin lesions such as ulcers (including the arms and legs) far from the colon.
People with Crohn's disease have an increased risk of developing psoriasis.
Difference between mild and moderate Crohn's disease symptoms
- Mild Crohn's disease. The less bowel movements, the milder the disease is considered. In the mild form of the disease, abdominal pain is minimal or absent. The patient has a feeling of well-being that is normal or close to normal. There are several complications, if any, outside the gastrointestinal tract: the doctor will not detect a mass when pressing on the abdomen. Erythrocytes in the blood are normal or close to normal. No fistulas, abscesses, or other chronic changes.
- Severe Crohn's disease. In severe Crohn's disease, the patient has frequent bowel movements, so strong medicines are needed against diarrhea. Abdominal pain is severe and usually located in the right lower quadrant of the abdomen (the location of the pain may not point to the area of the real problem - a phenomenon known as "reflected pain"). The level of red blood cells is low. The patient has a poor sense of well-being and experience of complications, which may include: weight loss, joint pain, inflammation in the eyes, redness or ulceration of the skin, fistulas (abnormal channels between tissues), abscesses, and fever. Surgical and medical treatments for Crohn's disease with ulcerative colitis have complications that can be serious.
Diagnosing Crohn's disease
There is no specific diagnostic test for Crohn's disease. A doctor makes a diagnosis of Crohn's disease based on medical history, diagnostic examination, and laboratory, endoscopic (biopsy results) and imaging tests.
- Analyzes. Blood tests are used for a variety of purposes, including to check for anemia (low red blood cell count). An increase in white blood cell counts or elevated levels of markers of inflammation - such as C-reactive protein - may indicate the presence of inflammation. Stool can be tested for blood, infectious organisms, or both.
- Flexible sigmoidoscopy and colonoscopy. These are procedures involving a tortuous fiber optic tube - an endoscope that looks through the rectum through the lining of the colon. The doctor can also insert instruments through it to remove tissue samples.
A sigmoidoscopy is used to examine only the rectum and the left (sigmoid) colon, lasts about 10 minutes and is performed without sedation. It may be slightly uncomfortable, but not painful.
Colonoscopy reveals the entire colon and requires sedation, but this procedure is also painless on an outpatient basis. Colonoscopy can also help see colon cancer.
These procedures can help a doctor distinguish between ulcerative colitis and Crohn's disease, and other conditions.
- Wireless capsule endoscopy. Wireless capsule endoscopy is a new imaging approach sometimes used to diagnose Crohn's disease. The patient swallows a capsule containing a tiny camera that records and transmits an image as it passes through the digestive tract.
- Irrigoscopy with barium. Examination of the large intestine is carried out using an X-ray with the simultaneous use of a barium enema. The procedure is called an irrigoscopy. Barium is used to cover the intestinal walls. This enables the doctor to conduct a more informative study than without the use of barium. Barium in the small intestine is found on X-ray images, which can reveal inflammation, ulcers, and other abnormalities. The study of the small intestine is also carried out using barium. However, it is not delivered to the intended purpose using an enema - the patient must drink barium diluted with water. Then you should wait for 2-5 hours until the barium reaches the small intestine through the gastrointestinal tract. Further, X-rays are also taken.
- Visualization methods. Transabdominal ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) can also be used to assess the patient's condition.
Avoiding diseases similar to Crohn's disease
- Ulcerative colitis. The diarrhea associated with ulcerative colitis is generally more severe than the diarrhea associated with Crohn's disease. Abdominal pain is more constant with Crohn's disease than with ulcerative colitis. Fistulas and strictures are common in Crohn's disease, but are very rare in ulcerative colitis. Endoscopy and imaging tests often show a greater involvement of Crohn's disease than ulcerative colitis throughout the GI tract.
- Irritable bowel syndrome (IBS). Irritable bowel syndrome, also known as "mucous colitis" - a functional bowel disease known as spastic colitis - can cause some of the same symptoms as inflammatory bowel disease - IBD (however, it is not the same). Bloating, diarrhea, constipation, and abdominal pain are symptoms of IBS. Irritable bowel syndrome is not caused by inflammation, but it does not cause fever or bleeding. Behavioral therapy can be helpful in treating IBS (psychological therapy does not improve inflammatory bowel disease).
- Celiac disease. Celiac disease is an intolerance to gluten (found in wheat), which causes inflammation in the small intestine, diarrhea, vitamin deficiencies and stool disorders. It occurs in people with inflammatory bowel disease and is usually common in children.
- Acute appendicitis. Crohn's disease can cause soreness in the lower right abdomen, where the appendix is located.
- Crayfish. Colon cancer or rectal cancer should always be ruled out.
- Intestinal ischemia (ischemic colitis). Symptoms similar to IBD (or other intestinal inflammation) can be caused by blockage of blood flow in the intestines, which is more common in older people.
Crohn's disease treatment
Crohn's disease cannot be completely cured, but proper treatment can help suppress the inflammatory response and manage the symptoms of the disease. Crohn's disease treatment plan includes:
Diet, proper nutrition;
- medications;
- surgery.
Diet and healthy eating for Crohn's disease
Malnutrition in Crohn's disease is very common. Patients with Crohn's disease have a dramatic decrease in appetite, from which they greatly lose weight. In addition, diarrhea and poor absorption of nutrients can lead to depletion of fluids and essential vitamins and minerals in the body.
It's important to eat well-balanced healthy foods and focus on getting enough calories, protein, and essential nutrients from various food groups. These include sources of protein such as meat, chicken, fish or soy, dairy products (milk, yogurt, cheese, if a person is lactose-tolerant), and fruits and vegetables.
Depending on the patient's health and nutritional status, the doctor may recommend taking a multivitamin or iron supplement. Although other types of nutritional supplements have been developed for Crohn's disease, such as probiotics ("good bacteria" such as lactobacilli) and omega-3 fatty acids, there is no conclusive evidence that they are effective in combating disease symptoms for or to prevent recurrence.
Certain types of food can worsen symptoms such as diarrhea and gas, especially during active periods of illness. Of course, all people differ in their individual sensitivity to food, however, with an active illness, there are the following recommendations for diet therapy that are common to all patients with Crohn's disease:
Eat small amounts of food throughout the day;
- stay hydrated by drinking plenty of water - often, in small amounts throughout the day;
- eat soft foods, avoid spicy foods;
- avoid high fiber content (bran, beans, nuts, seeds and popcorn);
- avoid fatty or fried foods, sauces, butter, margarine and heavy creams;
- Avoid consuming dairy products if you are lactose intolerant. Otherwise, dairy products are a good source of protein and calcium;
- avoid alcohol and caffeine consumption.
In cases of severe malnutrition, especially in children, patients may require enteral nutrition. Enteral feeding is when a feeding tube is used that is inserted either through the nose and down through the throat, or directly through the abdominal wall in the gastrointestinal tract. It is the preferred method for feeding malnourished patients who cannot tolerate food by mouth. Unfortunately, this will not help patients with malabsorption in case of intense intestinal diseases. Enteral nutrition can be effective in maintaining remission.
Crohn's disease medications
The goals of drug therapy for Crohn's disease are as follows:
Get rid of symptoms (so that the disease goes into remission);
- prevent outbreaks of the disease (maintain remission). The main drugs used for this are Azathioprine, Methotrexate, Infliximab, and Adalimumab.
Depending on the severity of the condition, different types of drugs are prescribed. Essential medicines for Crohn's disease:
- Aminosalicylates. These are anti-inflammatory drugs that are commonly used to treat mild to moderate forms of the disease. The standard aminosalicylate is Sulfasalazine (Azulfidine).
- Corticosteroids. Corticosteroids are used to treat moderate to severe Crohn's disease. These drugs are: Prednisolone (Deltason) and Methylprednisone (Medrol). Budesonide (Entocort) is a new type of steroid. Because corticosteroids can have serious side effects, they are usually used short-term to induce remission, but not for maintenance therapy.
- Immunomodulators. Immunomodulators or immune system modifiers block actions in the immune system that are associated with an inflammatory response. Standard immunomodulators are Azathioprine (Imuran, Azasan), 6-Mercaptopurine (6-MP, Purinethol) and Methotrexate (Reumatrex). These drugs are used for long-term maintenance therapy and to reduce the dose of corticosteroids.
- Immunosuppressants. For very active inflammatory bowel diseases that do not respond to standard treatment, immunosuppressants are used as long-term therapy, which suppress or limit the actions of the immune system and therefore the inflammatory response that causes Crohn's disease. Immunosuppressants can help maintain remission and heal fistulas and ulcers caused by this condition. These drugs, sometimes in combination with corticosteroids, active exacerbations of the disease are treated. Azathioprine (Imuran, Azasan) and Mercaptopurine (6-MP, Purinethol) are standard immunosuppressants. However, treatment may take 3-6 months.
- Biological preparations. Biological response modifiers are genetically engineered drugs intended for specific proteins associated with the body's inflammatory response. Biologics are typically used to treat moderate to severe illness. These include: Infliximab (Remikad), Adalimumab, Certolizumab (Tsimzia), and Natalizumab (Tisabri). Infliximab, Adalimumab and Certolizumab are targeted inflammatory immune factors - tumor necrosis factors (TNFs), also targeting the immune system.
- Antibiotics. Antibiotics can be used as a first line of treatment for fistulas, bacterial overgrowth, abscesses, and any infection around the anus and genital areas. Common antibiotics include: Ciprofloxacin (Cipro) and Metronidazole (Flagil).
- Antidiarrhealdrugs. Mild to moderate diarrhea can be relieved and replaced by daily use of psyllium (Metamusil). Standard antidiarrheal medicines: Loperamide (Imodium) or a combination of Atropine and Diphenoxylate (Lomotil). In some cases, Codeine may be prescribed.
Drug therapy for Crohn's disease is considered successful if it can push the disease into remission and keep it in remission without causing significant side effects. The patient's condition is usually considered to be in remission, when the intestinal mucosa has healed and symptoms such as diarrhea, abdominal pain and tenesmus (painful bowel movements) disappear and the condition is normal or close to normal.
Crohn's disease surgery
Most patients with Crohn's disease eventually need some type of surgery. However, surgery cannot cure Crohn's disease. Problems with fistulas and abscesses can occur after surgery. New diseases usually recur in other areas of the intestine. Surgery can be helpful in relieving symptoms and correcting intestinal blockages, bowel perforation, fistulas, or bleeding.
The main types of surgery that are used for Crohn's disease include:
- Strictureroplasty. Chronic inflammation of Crohn's disease can ultimately lead to scarring, which leads to narrowing in certain segments of the intestine. This procedure is used to open strictures - narrowed areas of the intestine.
- Resection and anastomosis. Resection is used to remove damaged areas of the intestine. Resection involves removing the diseased portion of the intestine and then reattaching the ends of the healthy intestine. Resection can be performed by open surgery involving a wide incision through the abdominal cavity, or through less invasive laparoscopy. The procedure for joining the cut ends of the intestine in a resection procedure is called an "anastomosis".
Anastomosis is of 3 types:
End-to-end anastomosis;
- Side to side anastomosis;
- Anastomosis end to the side.
Repetition of the resection may be necessary if the disease recurs at another site near the anastomosis. In Crohn's disease, patients may require surgical resection of the bowel, especially for patients who show signs of small or large bowel perforations (when holes in the bowel allow waste from the contents to flow into the abdomen).
About half of patients have an active recurrence of Crohn's disease within 5 years, and those who have had a resection require a second operation. Medicines - aminosalicylates and immunosuppressive drugs - prevent or delay the onset of relapse.
- Colectomy, proctocolectomy and ileostomy. Colectomy (surgical removal of the entire colon) or proctocolectomy (removal of the colon and rectum) can be performed in cases of the most severe form of Crohn's disease. After the proctocolectomy is completed, the surgeon performs an ileostomy, in which the end of the small intestine (ileum) is connected to a small opening in the abdominal cavity, called "stomas". Patients who have had both a proctocolectomy and an ileostomy should carry a bag behind the stoma to collect waste. Patients who have had a colectomy can continue to defecate naturally.
If Crohn's disease becomes extremely severe and no other treatment is working, the patient may need to have their entire colon removed. The same can be with the rectum - and it can be removed. Proctocolectomy is the surgical removal of the entire colon and entire rectum.
Proctocolectomy with ileostomy includes the following:
To perform a proctocolectomy, the surgeon removes the entire colon, including the lower rectum and sphincter, which control bowel movements;
- To perform an ileostomy, the surgeon makes a small hole in the lower right corner of the abdomen (stoma). The surgeon then connects the cut ends of the small intestine to this opening. Ostomas are in an open area and accumulate waste. This requires emptying several times a day.
Other surgical procedures include: treating fistulas when medication fails, and draining abscesses. Surgery can be performed to treat fistulas or abscesses, to control excessive bleeding and remove obstructions in the bowel.
What is Crohn's disease is an inflammatory process characterized by granulomatous lesions of various segments of the digestive system.
The 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 intestinal lumen - in one or more fragments of the small or large intestine, turning it into a bed for granulomas.
According to statistics, this disease occurs in men much more often than in women. At the same time, the first signs of the disease, as a rule, appear at a fairly young age - 20-40 years.
Causes
Why does Crohn's disease occur and what is it? The exact cause of the development of this disease has not been established. Experts point out some of the factors that can trigger the onset of Crohn's disease.
Of the main risk factors affecting the development of the disease in adults, the following can be distinguished:According to the first hypothesis, the pathogenesis of Crohn's disease is the effect of bacteria and viruses. The second hypothesis interprets pathogenesis as the provocation of an abnormal systemic immune response by a food antigen. According to the third assumption, experts believe that the pathogenesis lies in autoantigens located on the intestinal wall. Due to the fact that antibacterial treatment gives positive results, it is believed that the causes of this disease lie precisely in the infectious theory.
- Genetic predisposition... This disease is often diagnosed in siblings or twins. In approximately 19% of cases, pathology is diagnosed in blood relatives.
- Immunological factors... Since in Crohn's disease there is a consistent damage to organs, scientists put forward a hypothesis regarding the autoimmune nature of the pathology.
- Infectious diseases... The role of these factors has not yet been reliably confirmed, however, there are hypotheses regarding the viral or bacterial nature of the disease.
Crohn's disease most often affects the part of 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 mucous membrane of the affected area becomes covered with abscesses and ulcers.
Crohn's disease symptoms
Since this disease can affect any of the organs of the gastrointestinal tract, the symptoms will be completely different. Experts divide the symptoms of Crohn's disease into:
- are common;
- local (depending on the location of the lesion);
- extraintestinal disorders.
The first type of symptoms includes fever, fever, malaise (signs of an inflammatory process). If the temperature rises to very high rates (40 degrees), this indicates purulent complications of the disease. The decrease in body weight is due to the fact that the inflamed organs of the gastrointestinal tract do not absorb all the nutrients necessary for the body.
To local symptoms Crohn's disease includes the following:
- regular diarrhea, it is caused by the inability to assimilate nutrients by the intestines, in severe cases, decay processes develop;
- often recurring pain in the abdomen, it is similar to, arises from damage to the intestinal mucosa and constant irritation of the nerve endings;
- infiltration (abnormal oozing of substances) and abscesses;
- perforation of the intestinal walls;
- intestinal obstruction;
- with the development of perforated fistulas and ulcers, the patient has bleeding.
Extraintestinal Disorders are more associated with immune disorders that affect the entire body. For example, damage to large joints (pain, limitation of mobility), inflammation of the sacroiliac region, visual impairment, skin rash.
Chronic form
In the picture of the symptoms of the chronic form of Crohn's disease, the signs of intoxication come to the fore: weakness, malaise, increased fatigue, low-grade body temperature, decreased appetite and body weight, pain in large joints. Over time, regular diarrhea, bloating and significant emaciation are added.
With the defeat of the large intestine, stools become more frequent, which may contain an admixture of blood. In some cases, in the right iliac region or in the central parts of the abdomen, palpation reveals a tight-elastic mobile formation. The phalanges of the fingers take the form of drumsticks.
Usually the chronic form of Crohn's disease proceeds with exacerbations and long-term 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 cause complications, causing the development of cancerous tumors and subsequent disability. With a progressive course of the disease, there is an unfavorable prognosis for the patient's life.
Diagnostics
Before figuring out how to treat Crohn's disease, you need to get the diagnosis right. Therefore, to exclude other pathologies with similar symptoms, an instrumental examination is prescribed.
The following methods are commonly used:
- Colonoscopy. This study allows you to visualize the inner surface of the intestine.
- Irrigography. Provides an opportunity to see partial intestinal lesions, narrowing of its lumen, bowel relief, ulceration or ulceration, thickening of the walls and a decrease in their activity.
- Ultrasound. It can be used to assess the diameter of the bowel loops, the presence of free fluid in the abdominal cavity.
- CT scan... It is done if Crohn's disease is complicated by diseases of other organs, and it is difficult to establish an accurate diagnosis. MRI allows you to study in more detail the state of the intestine, the degree of its lesion, the presence of fistulas, narrowing of the passage of the small or large intestine, and enlargement of the lymph nodes.
- Endoscopic examination... It is mandatory, with the help of it, both a visual confirmation of the diagnosis is carried out, and a piece of tissue is taken for further examination under a microscope.
Be sure to use laboratory methods, including blood and feces tests, to exclude infectious bowel diseases.
Crohn's disease treatment
When Crohn's disease is diagnosed, the main treatment regimen is to use drug therapy aimed at localizing and reducing inflammation in the intestine, reducing the frequency and duration of exacerbations, as well as maintaining a state of stable remission, that is, anti-relapse treatment.
Severe cases may require the prescription of stronger drugs, complex treatment, and periods of exacerbation - surgery. The choice of treatment method depends on the severity of Crohn's disease, the dominant symptoms, and the general health of the patient.
Drug therapy
Currently, there is no universal treatment for Crohn's disease, but therapy with one or more drugs is aimed at treating the disease early and relieving its symptoms.
The most common medications are:
- salicylates (5-ASA) - sulfasalazine, mesalazine, Pentasa;
- topical hormones - budenofalk;
- glucocorticoids - prednisolone, methylprednisolone;
- immunosuppressants - azathioprine, methotrexate, 6-mercaptopurine;
- tumor necrosis factor blockers - adalimumab, infliximab, golimumab, etanercept, certolizumab pegol.
- integrin receptor blockers: Vedolizumab.
Also actively used:
- antibiotic treatment: ciprofloxacin, metronidazole, and the new antibiotic rifaximin;
- (VSL # 3, faecal transplant of live donor bacteria);
- vitamin of group D .;
- hyperbaric chambers (oxygen treatment);
- in severe cases, bowel transplant from a donor.
For more common and complex cases of Crohn's disease, surgery may be indicated. Sometimes, with the development of formidable complications of the disease, such as bleeding, acute intestinal obstruction or bowel perforation, it is necessary to perform emergency surgical interventions.
Other, less urgent indications for surgery include the formation of abscesses, intestinal fistulas (pathological messages from various parts of the gastrointestinal tract), severe forms of perianal lesions, and the absence of the effect of conservative treatment.
Diet
During remission of the disease, patients are shown adherence to a strict diet so as not to provoke an exacerbation of the inflammatory process in the intestinal wall. The diet should be balanced, contain a large amount of protein and vitamins, and fats should be limited. The diet for Crohn's disease is not very strict, the main thing in it is respect for the intestines.
- Drink plenty of fluids;
- Limit the use of flour and baked goods;
- Eat small meals 5-6 times a day;
- Give preference to foods that are low in fat;
- Refuse to use spicy foods, alcohol;
- Take a multivitamin supplement.
Diet for Crohn's disease limits the intake of heavy, rough foods that irritate the intestinal mucosa, as well as fat and milk. An easily digestible and easily digestible food is recommended, with limited consumption of fermented milk products, sparing for the gastrointestinal tract. It is extremely important that the diet for Crohn's disease is balanced, as in this disease, anemia and vitamin deficiency are frequent due to poor absorption of food.
Operation
If diet, lifestyle changes, drug therapy, and other methods are ineffective, surgery is recommended. About half of all patients with Crohn's disease undergo at least one surgical procedure during treatment, during which doctors remove the damaged area of the intestine.
Unfortunately, surgery cannot completely eliminate Crohn's disease, as is possible, for example, with ulcerative colitis. Even if a large segment of the intestine is removed during the operation, the disease may reappear. In this regard, some experts recommend postponing the operation as long as possible. This tactic allows you to reduce the number of operations that a person will have to undergo.
Complications
Crohn's disease can be accompanied by complications such as:
- Intestinal bleeding.
- Perforation (violation of the integrity of the intestinal wall).
- Urolithiasis disease.
- The appearance of abscesses (abscesses) in the intestine.
- The development of intestinal obstruction (violation of the movement of intestinal contents through the intestines).
- Formation of fistulas (absent normal channels) and intestinal strictures (constrictions).
If the fistula develops into the abdominal cavity, food entering the intestines can bypass the absorption of nutrients and enter organs such as the bladder or vagina. The development of a fistula is a formidable complication, since there is a high risk of suppuration and the formation of an abscess. Left unattended, this condition can become a threat to the patient's life.
Forecast for life
The mortality rate in Crohn's disease is 2 times higher than that in the healthy population. Most of the causes of death are associated with complications and surgery for them.
The disease has a relapsing course and almost all patients have at least one relapse within 20 years. This requires constant dynamic monitoring of the patient to correct therapy and identify complications of the disease.
The prognosis for life varies greatly and is determined individually. The course of Crohn's disease can be asymptomatic (when the focus is located only in the anus in the elderly) or it can be extremely severe.
If you have recently been diagnosed with Crohn's disease most likely, you have not thought about what effect it can have on other body systems. The main symptoms of this disease are stomach pain and diarrhea... Crohn's disease most commonly affects the ileum, which is the lower part of the small intestine that extends after the jejunum and in front of the upper colon. But inflammation can subsequently spread to other sites, including the eyes, skin, and joints.
Complex blow to the body
“In active Crohn's disease, inflammation can spread to other areas of the body. The gastrointestinal tract includes organs from the mouth to the anus, so it should come as no surprise that these areas can also be affected by disease, ”says Shannon Chang, MD, a gastroenterologist at New York University Langon Medical Center who specializes in Crohn's and ulcerative colitis.
The disease can cause malabsorption of nutrients vital for the functioning of some organs, so if you are lacking, for example, iron and calcium, bones and brain can. Here are some classic symptoms and ways to detect Crohn's disease:
1. Dry eyes
People with Crohn's disease may experience, which is important for maintaining good vision. Because of this, many patients experience blurred vision and dry eyes, which can lead to redness, irritation, and burning.
Two other common eye complications in Crohn's patients are uveitis and episcleritis, according to Dr. Chang. Uveitis Is an inflammation of the choroid of the eyeball - the middle membrane of the eye, located directly under the sclera, and episcleritis- This is an inflammation of the surface layers of the eye protein, or episclera.
"They [uveitis and episcleritis] can cause eye pain and inflammation, so it is important that patients see an ophthalmologist immediately if they have these symptoms," she says.
2. Oral ulcers
People with Crohn's disease can develop oral ulcers, also known as aphthous stomatitis. These sores can appear on the gums and lower lip, as well as on the sides of the mouth and at the base of the tongue. Dr. Chang says patients sometimes experience flare-ups of ulcers during flare-ups. "The best way to treat these symptoms is with Crohn's disease, because other treatments for ulcers provide only short-term relief," says Dr. Chang. Some doctors prescribe mouthwash to suppress infection and multivitamins to help correct nutrient deficiencies.
3. Redness and rash on the skin
“Erythema nodosum is red bumps on the legs of various sizes, up to one and a half centimeters in diameter,” says Dr. Chang. These red bumps can appear on the shins, ankles, and arms. Like many other symptoms, they usually occur during a flare-up of Crohn's disease. Some patients may also develop pyoderma gangrenosum, which is a purulent skin lesion around the legs or ankle that can also be seen on the hands. Pyoderma gangrenous begins with the appearance of small blisters, which then merge and form deep ulcers. Treatment is to control Crohn's disease, but your doctor may also prescribe topical creams and antibiotics.
4. Cracked anus
Chronic diarrhea and painful bowel movements can cause anal fissures in people with Crohn's disease. Anal fissures are small tears in the tissues of the anus. Inflammation from Crohn's disease can also lead to anal fissures, even if there are no bowel problems.
5. Joint pain
Vitamin D and calcium deficiencies are likely due to Crohn's disease, so many people with Crohn's disease may also develop osteoporosis... “When the ileum is inflamed, it is difficult for your body to absorb vitamin D, and malabsorption of vitamin D interferes with the absorption of calcium into the bones,” explains Ellen Sherl, MD, director of the Jill Roberts IBD Center at New York Presbyterian Hospital / Weill Cornell Medicine.
"Joint pain can be migratory, which means it travels from one part of the body to another," says Dr. Sherl. For example, it is a common complaint, but Crohn's disease patients may also complain of stiffness in the wrists, hips and knees. Dr. Chang recommends treating joint pain with heat, ice and stretching, but avoiding NSAIDs as they can interfere with the development of Crohn's disease in the gut. Dr. Sherl and Dr. Chang say doctors also order x-rays to rule out the possibility of stress fractures and rheumatic conditions that are common in patients with Crohn's disease.
6. Fatigue
Another classic example of how malabsorption of nutrients can lead to Crohn's disease, fatigue and anemia is. “Iron deficiency can also be the result of bleeding from active bleeding associated with colitis and anal fistulas, which are small holes or tunnels that form inside the anus and in the skin around the anus,” explains Dr. Sherl. Dr. Sherl also says that Crohn's disease is often seen in the background, so having celiac disease can also affect how your body absorbs iron and vitamin C, which helps the body absorb iron.
7. Significant weight loss
Unexpected weight loss is a classic symptom of Crohn's disease. “The physician should ask the patient if weight loss is due to the fact that he refuses to eat because of a feeling of fullness in the stomach and intestines, or because of seizures or vomiting. Many patients refuse food simply because they are afraid of how the food will affect them, ”says Dr. Sherl.
Dietitians who work with people with Crohn's disease usually recommend a diet low in fiber and limited in processed foods, especially for patients with stenosis (narrowing) of the intestine. But for those without stenosis, “we recommend a diet high in anti-inflammatory foods such as fruits and vegetables, lean protein and whole grains,” says Dr. Chang. Cutting out fiber in Crohn's disease is a common misconception. But it all depends on the condition of the patient.
Illustrations: Yulia Prososova
After a diagnosis is made, the first question that many patients ask a doctor is, "Can Crohn's disease be cured?" Unfortunately, there is currently no cure for this disease. The only thing you can do is to stop the symptoms, prevent the "flare-up" of the disease and get a long-term remission. To do this, you must reduce or control the inflammation that causes the symptoms of the disease. In children, treating Crohn's disease symptoms helps promote healthy lifestyles.
The article is based on the findings of 14 scientific studies
- Inflammatory Bowel Disease Clinic University of Calgary, Canada
- Department of Gastroenterology, Örebro University Hospital, Sweden
- Mucosal Biology Research Center, University of Maryland, USA
- Department of Internal Medicine, University of Bologna, Italy
- and other authors.
To read the research - use the links at the end of the article
Crohn's disease is a disorder of the immune system
Crohn's disease is a chronic condition that causes inflammation of your gastrointestinal (GI) tract. Any area of the gastrointestinal tract can be affected, from the mouth to the anus, but most often it affects the lower part of the small intestine, known as the ileum. The swelling from the inflammation can be very painful and often leads to diarrhea.
Crohn's disease occurs in equal numbers in men and women and appears to carry a genetic component. About 20% of patients with this disease have relatives, usually a parent or sister, who have inflammatory bowel disease (IBD).
Crohn's disease has many, very similarities to ulcerative colitis, which includes them in one group of diseases - inflammatory bowel disease.
ACTIVATION OF INFLAMMATION IN THE REGIONS OF THE INTESTINAL IN CROWN DISEASE AND IN ULTRA COLITIS Conventional Crohn's Disease Treatment
If you are experiencing moderate or severe symptoms of an illness, then this means that the disease is in an "active" form. In this case, you will be prescribed a set of medications, including. Surgery may also be indicated, with at least 60% to 80% of people with Crohn's disease receiving surgery at some point in their lives.
Surgical treatment for Crohn's disease usually involves removing part of the damaged digestive tract, leaving areas of healthy tissue behind. Fistulas can also be closed and abscesses drained.
However, be careful, conventional treatments such as medication and surgery can cause further harm to your health. Medicines cause side effects that are just as, if not more, serious than the debilitating symptoms of Crohn's disease.
For example, corticosteroids can cause thinning and weakening of bones (osteoporosis and osteopenia), facial swelling, and an increased risk of infections. In the meantime, surgery can lead to complications and increase the risk of hospital or blood-borne infections. The consequences of operations are also temporary., because the disease can recur (especially near areas of removed tissue).
NORMAL INTESTINAL IMMUNITY RESPONSE 
INTESTINAL IMMUNITY REACTION IN CROWN DISEASE Try the following natural safe treatments for Crohn's disease
At least 30% of patients who undergo surgery relapse within 3 years, and 60% of these patients experience a relapse within 10 years. This is why many people are now turning to safer natural therapies to treat or relieve their Crohn's disease symptoms.
Improve the ratio of good to bad bacteria in your gut
You can do this by regularly consuming fermented foods (such as sauerkraut) and / or high quality ones. A study presented at the annual meeting of the American College of Gastroenterology showed that people with inflammatory bowel disease (IBD) who took bifidobacteria for eight weeks showed lower levels of inflammation than people who were given a placebo. The study was conducted by researchers from University College Cork in Ireland.
Pay special attention to your diet
Nutrition plays a major role in treating or preventing the symptoms of Crohn's disease. Consuming the right healthy foods can replace lost nutrients and promote healing of body tissues. Ideally, you should avoid all types of processed foods (fast foods, convenience foods) as they contain additives such as emulsifiers and sugars that can damage your health and contribute to inflammation. It is also worth minimizing or avoiding eating flour products that are very fast in your body. It is best to avoid artificial sweeteners, which can worsen Crohn's disease symptoms, because these substances inactivate stomach enzymes and affect gut bacteria.
Increase Omega-3 Fatty Acids in Your Diet
These are fatty acids that can help reduce the symptoms of Crohn's disease and other inflammatory diseases. A study published in the New England Journal of Medicine found that patients who took fish oil stayed in remission 2 times more often compared to those taking a placebo. Note that if you can afford to choose, it is recommended that you consume krill oil, which is less prone to ocean pollution and oxidation during supplement manufacture than fish oil. But you should check with your doctor before taking high-dose omega-3 supplements or in combination with blood thinners that can lead to bleeding.
Ppractice acupuncture
This ancient practice is believed to stimulate your brain to release endorphins, which are pain-blocking chemicals that help strengthen your immune system to fight infection. Besides acupuncture, you can also try meditation, which can help relieve pain and reduce overall inflammation.
Take herbal supplements and teas
Certain herbal teas can help relieve symptoms of Crohn's disease. This list includes - aloe vera juice, slippery elm bark, chamomile and mint. The spice turmeric, which contains the polyphenol curcumin, has been shown in numerous studies to have superior medicinal properties for reducing inflammation. And an Ayurvedic herb like Boswellia is considered a good and safe way to treat the symptoms of Crohn's disease.
There is another possible strategy for improving the composition of bacteria in the intestine. This procedure is called fecal microbiota transplant... This involves collecting feces from healthy donors (ideally your relative or spouse) and then transferring them into your intestines during a colonoscopy. This procedure allows the patient to gain healthy intestinal flora, which helps with gastrointestinal and other health problems. Studies have shown that this transfer of healthy microflora has shown encouraging results in the treatment of ulcerative colitis and Crohn's disease - in some patients, symptoms improved after a few days or weeks.
Decreasing the level of interleukin IL-1a reduces the manifestation of Crohn's disease
Scientists at Case Western Reserve University School of Medicine found that blocking interleukin-1α (IL-1a), which controls inflammation in the gut, markedly reduced intestinal inflammation in Crohn's disease mice.
Interestingly, the administration of the anti-IL-1α drug resulted in a decrease in the ratio of proteobacteria to, which reduced the number of species Helicobacter, and improved performance Mucispirillum schaedleri and Lactobacillus salivarius .
Some of the available IL-1a lowering agents include:
- (Caffeic acid phenethyl ester) ()
- Green tea (EGCG) ()
- Chlorophyll ()
- Genistein (soy isoflavones) ()
- Hydrogen peroxide ()
- Puerarin (plant Pueraria lobular) ()
- Green coffee (chlorogenic acid) ()
- Parthenolide (Tansy maiden) ()
VitaminDfights Crohn's disease
A recent study has shown that vitamin D can help fight the development of Crohn's disease. Scientists have discovered how vitamin D acts directly on gene beta defensin, which encodes an antimicrobial peptide, and gene NOD2 that alerts cells to the presence of invading microbes.
Both beta-defensin and NOD2 genes are associated with Crohn's disease. If the work of the NOD2 gene is insufficient or inadequate, then it does not help in the fight against invading microbes and viruses in the gastrointestinal tract.
In Crohn's disease, it is irresponsible not to measure vitamin D levels in patients with Crohn's disease. And if necessary, it is imperative to bring the level of this vitamin to therapeutic levels in 55-65 ng / ml... Most adults need at least 5,000 units of vitamin D per day, but some people may need up to 50,000 units per day. It is worth understanding that it can be harmful if you get too much vitamin D, so vitamin D supplementation is not the best way to get your vitamin D levels healthy. The only thing you need is daily access to good sunshine.
SCHEME OF VITAMIN D SYNTHESIS Vitamin D is essential for your immune system
One of the reasons why vitamin D works is because it helps your body produce over 200 antimicrobial peptides that help fight infections. There are many experts who believe the sources of inflammatory diseases are infections.
Here's an excerpt from a press release from Oregon State University:
New research shows vitamin is one of the key nutrients for the immune systemD and its ability to regulate anti-bacterial proteins. It is important to understand that such proteins arose almost 60 million years ago in the course of evolution and are common only in primates, including humans, but are not present in any other known animal species.
The fact that such a vitamin isD- The mediated immune response has arisen and persists over millions of years of evolutionary selection, occurring in various primate species ranging from squirrel monkeys, baboons and humans, suggesting that it must be critical to their survival.
ThoughKatelicidin (Cathelicidin) - antimicrobial peptide has several different types of biological activity in addition to killing pathogens, it is unclear if only one vitamin is neededD or a combination of several substances to regulate this peptide. But research suggests that there is significant biological importance of adequate vitamin D levels in humans, as in other primates.
The existence and importance of this part of our immune response clearly shows that humans and other primates must maintain adequate levels of vitamin D, ”said Adrian Gombart, associate professor of biochemistry and investigator at the Linus Pauling Institute at Oregon State University.
Simply put, if you are found to be deficient in vitamin D, then your immune system will not actively do its job. And since vitamin D also regulates your immune response by reducing the overreaction of inflammation, a lack of this vitamin can lead to autoimmune disorders such as Crohn's disease.
How much vitamin D do you need?
Choosing the right test is the first step in the vitamin D determination process, as laboratories today offer two vitamins D for analysis: 1.25 (OH) D and 25 (OH) D.
The most correct test that your doctor should recommend is to determine the level 25 (OH) D, also called 25-hydroxyvitamin D. It is the value of this substance that is the best indicator of the total level of vitamin D. It is the marker that is most strongly associated with overall health.
Today, the “normal” 25 (OH) D level is considered to be in the range of 30-100 ng / ml, which show too wide a spread in values. But, in fact, the optimal level of this substance should be values within 55-65 ng / ml
The information on this site has not been evaluated by any medical organization. We do not seek to diagnose and treat any disease. The information on this site is provided for educational purposes only. You should consult your doctor before acting on the information received from this site, especially if you are pregnant, nursing, taking medication, or have any medical condition.
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Crohn's disease treatment
Treatment Crohn's disease should begin as early as possible, since the longer the inflammatory process progresses, the more tissue is damaged and the more likely it is to develop complications. Which doctor treats Crohn's disease?
The diagnosis and treatment of Crohn's disease is carried out by a gastroenterologist. He prescribes all the necessary diagnostic tests, based on the results of which he selects certain therapeutic measures. If necessary (in case of complications), the gastroenterologist can refer the patient for consultation to specialists from other fields of medicine.In the process of diagnosing and treating Crohn's disease, you may need to consult:
- Immunologist- to determine the nature and degree of impairment of the functions of the immune system.
- Hepatologist- with liver damage and the development of gallstone disease.
- Nephrologist- with kidney damage and the development of urolithiasis.
- Hematologist- with the development of anemia, when there is a need for transfusion of erythrocytes or other blood products to the patient.
- Infectionist- when signs of intestinal infection are detected or when pathogenic microorganisms are isolated from feces.
- Surgeon- with the development of complications requiring surgical treatment (for example, with perforation of the intestinal wall, with massive intestinal bleeding).
- Dermatologist- in the presence of complications from the skin.
Drug therapy for Crohn's disease
Drug therapy is the main therapeutic method that allows you to slow down the progression of the inflammatory process and bring the disease to the stage of remission, as well as prevent the development of relapses (repeated exacerbations). Also, all patients during an exacerbation are prescribed substitution therapy with multivitamin preparations, since due to a malabsorption in the intestine, many vitamins do not enter the body in the required amount.Crohn's disease treatment with medications
Group of drugs | Representatives | The mechanism of therapeutic action | Method of administration and dosage |
Intestinal anti-inflammatory and antimicrobial drugs | Mesalazine | Acting on the focus of inflammation in the intestinal wall, they inhibit the formation of prostaglandins, leukotrienes and other biologically active substances, which leads to a decrease in the activity of the inflammatory process. They also have a certain antibacterial activity against Escherichia coli and other types of microorganisms. | If the small or large intestine is affected, it is prescribed in the form of tablets of 400 - 800 mg 2 - 4 times a day for 2 - 3 months. |
Sulfasalazine | Inside, after eating:
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Metronidazole | Damages the genetic apparatus of microorganisms, which leads to their death. | Inside, after meals, 5-10 mg per kilogram of body weight 2 times a day. |
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Steroid anti-inflammatory drugs | Prednisone | A hormonal drug with a pronounced anti-inflammatory, decongestant and antiallergic effect. Quickly and effectively inhibits the activity of the inflammatory process during exacerbation of the disease, and also prevents the development of relapses ( repeated exacerbations). | During the period of exacerbation of the disease, it is prescribed orally 10 - 20 mg 3 times per knock. After a decrease in the activity of the inflammatory process, the dose of the drug decreases slowly ( 5 mg per week), since, otherwise, the development of the phenomenon of cancellation ( relapse of the disease, characterized by a more pronounced and aggressive course). |
Biological preparations | Infliximab | It binds the so-called tumor necrosis factor, which is responsible for the development and maintenance of the inflammatory process. Its neutralization leads to a decrease in the rate of formation of interleukins and other inflammatory mediators, which eliminates the clinical manifestations of the disease and contributes to the development of remission. | It is administered intravenously, slowly at a dose of 5 mg per kilogram of body weight. Re-administration of the drug is indicated after 2 and 6 weeks. |
Immunosuppressants | Cyclosporine | It is prescribed for severe disease activity. It inhibits the formation of specific antibodies and the severity of immune responses in general. | It is administered intravenously, slowly, only in a hospital setting. The daily dose should not exceed 4.5 mg per kilogram of body weight. |
Vitamins | Vitamin A(retinol) | It is necessary for the normal development and functioning of the retina, and also takes part in many biochemical processes in various organs and tissues. | Intramuscularly at a dose of 33 thousand International Units ( IU) Once a day. |
Vitamin E | It is necessary for the normal functioning of the nervous and muscular systems, as well as for the provision of many enzymatic reactions in the body. | Intramuscularly, 8-10 mg once a day. |
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Vitamin B12 | Participates in the process of hematopoiesis in the red bone marrow. Increases regenerative ( restorative) the capabilities of body tissues. | Intramuscularly 1 mg 1 time per day for 7-14 days. |
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Folic acid | Stimulates the process of hematopoiesis in the red bone marrow, and is also necessary for normal cell division in all tissues of the body. | Inside, 150 - 200 micrograms 1 time per day. The course of treatment is 3 - 4 weeks. |
Diet for Crohn's disease
Proper nutrition of the patient is an important stage of treatment both during an exacerbation of the disease and during remission (a gross violation of the diet can cause a relapse). Patients with Crohn's disease are shown diet number 4 according to Pevzner, the purpose of which is to provide the body with all the necessary nutrients in conditions of impaired digestion and absorption, as well as to protect the gastrointestinal tract mucosa (gastrointestinal tract) and reduce the severity of inflammatory phenomena in the intestinal wall.- Take food in small portions 5 - 6 times a day. This mode prevents over-distension of the stomach and intestines, promotes better interaction of foods with digestive enzymes, and ensures optimal absorption of nutrients.
- Eat food no later than 3 hours before bedtime. Overeating at night leads to a delay in the food eaten in the upper digestive tube, which can lead to belching and heartburn.
- Eat only warm. Eating cold foods can cause muscle spasm at the level of the stomach, which can lead to increased pain. Hot food with damage to the mouth, esophagus or stomach can injure the already inflamed mucous membrane, which will cause complications.
- Drink plenty of fluids. Patients with Crohn's disease are advised to drink at least 2 - 2.5 liters of fluid per day, and in the presence of diarrhea or vomiting - up to 3 - 3.5 liters (to compensate for body losses and maintain the volume of circulating blood at the desired level).
What foods should you eat? | What foods should you not eat? |
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Crohn's disease surgery
Surgical treatment consists in removing the damaged area of the gastrointestinal tract and imposing an anastomosis (that is, stitching the resulting ends of the digestive tube together). It should be noted right away that this method does not cure the disease, but only temporarily eliminates its clinical manifestations (repeated damage to other parts of the gastrointestinal tract is observed in most patients who underwent surgery). That is why, and also because of the high risk of postoperative complications, surgical treatment is now prescribed only with the aim of eliminating life-threatening complications of Crohn's disease.The absolute indications for surgery are:
- Perforation of the intestinal wall, accompanied by the release of feces into the abdominal cavity and the development of peritonitis (inflammation of the peritoneum).
- Massive intestinal bleeding.
- The transition of the inflammatory process to the urinary tract (fistula formation).
In the postoperative period, the whole range of therapeutic and preventive measures shown to patients with Crohn's disease is carried out.
Crohn's disease treatment with folk remedies
Traditional medicine suggests using herbs and other plants that can positively affect the severity of the inflammatory process in the digestive tract, as well as the general condition of the patient. It is worth remembering that Crohn's disease is a serious disease, the untimely and inadequate treatment of which can lead to fatal complications. That is why treatment with folk remedies must always be coordinated with the attending physician.For the treatment of Crohn's disease, the following can be used:
- Enema with a decoction of marshmallow root. To prepare the broth, 4 tablespoons of crushed raw materials need to be poured with 1 liter of water, brought to a boil and boiled for 3 - 5 minutes, then cooled for 2 hours. Apply warm for bowel lavage 1 - 2 times a day. Has a local anti-inflammatory effect, which is effective in Crohn's disease of the large intestine.
- Infusion of yarrow. The essential oils and tannins included in this plant cause its anti-inflammatory, anti-allergic, wound-healing and antibacterial action, which determines the effectiveness of the drug both during an exacerbation of the disease and during remission. To prepare the infusion, 5 tablespoons of crushed raw materials need to be poured with 500 milliliters of warm boiled water and heated in a water bath (not boiling) for 15 - 20 minutes. Strain and take warm 2 - 3 tablespoons 30 minutes before each meal.
- Infusion of chamomile flowers. This plant has an antispasmodic (eliminates spasm of the intestinal musculature), anti-inflammatory, antibacterial and wound-healing effects. The infusion should be prepared directly on the day of use. To do this, pour 2 tablespoons of raw materials with 1 glass of hot boiled water and heat in a water bath for 20 minutes. After cooling, take 1 to 2 tablespoons orally 3 to 4 times a day 30 minutes before meals. Also, the resulting infusion can be used for bowel lavage (in the form of an enema).
- Infusion of celandine herb. When administered orally, it has an anti-inflammatory and antibacterial effect at the level of the mucous membrane of the stomach and intestines. It also has a pronounced immunosuppressive and cytostatic effect (that is, it inhibits the formation of leukocytes and their destruction in the focus of inflammation, which reduces the activity of the inflammatory process). In addition, it has a certain antispasmodic effect at the level of the muscular layer of the gastrointestinal tract, biliary and urinary tract. To prepare the infusion, 4 tablespoons of crushed raw materials need to be poured with 400 ml of boiled water and heated in a water bath for 15 minutes. Then cool to room temperature, strain and add another 100 ml of warm boiled water. Take orally 2 tablespoons 3-4 times a day before meals.
Complications and consequences of Crohn's disease
With timely initiated and adequately carried out treatment, it is sometimes possible to achieve a stable remission of the disease. In the case of a late visit to a doctor and prolonged progression of the inflammatory process, a number of complications from the intestines and other organs may develop. Crohn's disease can be complicated by:
- perforation of the intestinal wall;
- the formation of fistulas;
- the formation of abscesses;
- massive intestinal bleeding;
- intestinal obstruction;
- toxic expansion of the colon (toxic megacolon);
- malignancy;
It can develop as a result of the destruction of all words of the intestinal wall (mucous, muscular and serous) by the inflammatory process. The feces and pathogenic microorganisms released in this case into the abdominal cavity lead to the development of peritonitis (inflammation of the peritoneum - a thin serous membrane lining the inner surface of the abdominal walls and abdominal organs). The peritoneum has a very high absorption capacity, so toxic substances that enter it very soon enter the bloodstream, which leads to the development of severe systemic reactions (an increase in body temperature over 40 degrees, profuse sweating, chills, pronounced leukocytosis and an increase in the erythrocyte sedimentation rate). Diagnosis of perforation of the intestinal wall or peritonitis requires an urgent operation, during which the damaged area of the intestine is removed, the abdominal cavity is cleared of feces and washed with antiseptic and antibiotic solutions.
Fistula formation
Fistulas are pathological channels between the affected area of the intestine and another organ or tissue. This happens due to the fact that the inflammatory process destroys all layers of the intestinal wall and passes to the organ that is directly adjacent to the affected area of the intestine (this can be the bladder, abdominal wall, another intestinal loop, and so on). The result of such a pathological message may be the transfer of feces from the intestinal cavity to other organs and tissues, which is an indication for surgical treatment (removal of the fistula and cleaning of an organ contaminated with feces).
Abscess formation
An abscess is a limited cavity filled with purulent masses. In Crohn's disease, abscesses usually form in the perianal region and are a consequence of the development of a pyogenic infection. Due to the activity of the immune system, the focus of infection is limited (many leukocytes accumulate around it, which form a kind of capsule that prevents further spread of the infection). Further, neutrophils (a type of cells of the immune system) begin to migrate to the focus of infection and absorb (destroy) pyogenic microorganisms, which leads to the formation of pus.
If an abscess is found, it is shown opening (in a sterile operating room), removing purulent masses and washing the resulting cavity with antiseptic solutions (for example, with a solution of furacilin at a concentration of 1: 5000).
Massive intestinal bleeding
Damage to a large blood vessel can lead to profuse intestinal bleeding. This condition requires emergency surgery in order to save the patient's life. After the incision of the anterior abdominal wall, first of all, a bleeding vessel is found and compressed, after which the damaged section of the intestine is removed.
Intestinal obstruction
The cause of intestinal obstruction can be characteristic of Crohn's disease adhesions (growth of scar tissue in the intestinal cavity). The clinical picture of intestinal obstruction is determined by the level of overlap of the intestinal lumen. If the small intestine is affected, feces and gas will be released over time. With the defeat of the end sections of the large intestine, feces and gases are not released at all, the patient's abdomen swells up, becomes sharply painful. On examination and palpation (palpation), it is possible to determine excessively strong peristaltic waves to the site of obstruction (lumen overlap) and the complete absence of peristalsis after it. Lack of effectiveness from conservative measures (bowel lavage) is an indication for urgent surgery.
Toxic enlargement of the colon
This condition is characterized by inflammatory damage to all layers of the intestinal wall in a certain area of the large intestine, which leads to a dysregulation of its tone, excessive relaxation of muscle fibers and expansion of the affected section. The intestinal peristaltic activity completely disappears, as a result of which the feces accumulate in stretched loops. A few hours after the onset of the disease, the barrier function of the overstretched intestinal wall is disrupted, as a result of which toxic substances from the intestinal lumen begin to be absorbed into the bloodstream. This causes the appearance of symptoms of severe intoxication (an increase in body temperature over 38 degrees, an increase in heart rate over 120 per minute, muscle and headaches, and so on).
Clinical examination reveals severe flatulence (abdominal distention due to the accumulation of gases in stretched bowel loops), protective tension of the abdominal muscles, and a complete absence of peristalsis noise. The diagnosis can be confirmed by a plain X-ray of the abdominal cavity, in which enlarged loops of the large intestine filled with gases are determined.
If, within a day after the establishment of this diagnosis, conservative treatment (including the use of antibiotics, hormonal anti-inflammatory and detoxification drugs) does not give positive results, surgical treatment is indicated (removal of the affected area of the large intestine).
Malignancy
Impaired activity of the immune system in combination with a long-term progressive inflammatory process at the level of the intestinal wall creates favorable conditions for the formation of malignant (tumor) cells. The process of malignancy is characterized by a decrease in the severity of pain, indigestion (frequent diarrhea and constipation), even during remission of the underlying disease. X-ray examination of the abdominal cavity may reveal a tumor-like formation that blocks the intestinal lumen. Invasive research methods (biopsy - intravital removal of a part of tissue in order to study its cellular structure) are contraindicated, since during the sampling of material, tumor cells can enter damaged blood vessels and spread throughout the body.
If a tumor is detected in the early stages, surgical treatment is indicated - the removal of the malignant neoplasm and normal intestinal tissue at a distance of several centimeters to both sides of it, as well as the removal of regional lymph nodes (into which tumor cells could penetrate). With the development of metastases (the spread of tumor cells to other organs and tissues), chemotherapy and symptomatic treatment are indicated.
Osteoporosis
This term denotes a chronic disease characterized by a violation of metabolic processes in the bones, which leads to a decrease in their strength. The cause of osteoporosis in Crohn's disease is a violation of intestinal absorption of trace elements (calcium, magnesium, phosphorus, fluoride) and vitamins (D, A, C, E) necessary for the normal growth, development and functioning of bone tissue.
The main clinical manifestations of osteoporosis are pathological bone fractures that occur when exposed to minor loads (which normally do not cause any damage). Treatment of the disease is based on a complete and balanced diet (containing all the necessary trace elements and vitamins). If this is not possible (for example, with damage to the initial sections of the small intestine), these substances should be introduced into the body parenterally (intravenously or intramuscularly, bypassing the gastrointestinal tract).
Crohn's disease and pregnancy
Contrary to popular belief, conceiving and carrying a child in Crohn's disease is not contraindicated. With the right approach to the treatment and prevention of this disease, many women can conceive, bear and give birth to an absolutely healthy child. Nevertheless, do not forget that Crohn's disease refers to chronic autoimmune diseases that affect not only the gastrointestinal tract, but also other organs and systems. That is why it is extremely important for both spouses to undergo a thorough examination at the stage of pregnancy planning, to identify all kinds of organ abnormalities and to correct them in advance.
Impact of Crohn's disease on conception
During the period of remission, a woman's ability to conceive is practically not impaired. Difficulties can be observed with the development of complications of the disease itself or as a result of previous treatment. For example, the development of an adhesions in the abdominal cavity (often observed after surgery for Crohn's disease) can lead to compression of the fallopian tubes, which makes the process of conception impossible. In this case, it is recommended to first treat the existing complications, and then try to conceive the child again.
The effect of Crohn's disease on the male body
The presence of this disease usually does not affect a man's ability to conceive a child (even during an exacerbation). However, when planning a pregnancy, a man should consult a doctor in order to review and possibly change the treatment. The fact is that sulfasalazine (an anti-inflammatory drug often used to treat and prevent recurrence of Crohn's disease) has a depressing effect on the synthesis of male germ cells in the testes, which can cause oligospermia (decrease in the amount of ejaculate) and male infertility.
The solution to this problem is to replace sulfasalazine with another anti-inflammatory drug at least one month before the intended conception. Also, three months before conception, both partners should stop taking immunosuppressants and cytostatics (methotrexate, azathioprine and other drugs from this group), since they have a toxic effect on germ cells and make pregnancy impossible.
What difficulties can arise during gestation?
Many studies carried out in this area have established that if conception occurred during the period of remission of the disease, the probability of its exacerbation during gestation does not exceed 30%. In this case, the cause of an exacerbation may be the effect on the female body of predisposing factors (in case of a violation of the diet, with the development of intestinal infectious diseases, with smoking, and so on) or refusal to take preventive treatment (many women, fearing to harm the child, refuse to take any medications). It is important to note that the possible consequences of an exacerbation of the disease during pregnancy are much more dangerous than the consequences of taking prophylactic doses of anti-inflammatory drugs.
Exacerbation of the disease during gestation is an unfavorable prognostic sign. In addition to a lack of nutrients (due to a violation of their absorption in the intestine) and anemia (which is a consequence of frequent intestinal bleeding), immune complexes are formed and circulate in the maternal body, which can damage blood vessels in various organs, including the placenta. This condition is further aggravated by the fact that a pregnant woman cannot be prescribed the entire range of anti-inflammatory drugs (including cytostatics and immunosuppressants). This is why the risk of spontaneous abortion or stillbirth increases significantly with active Crohn's disease.
Is it possible to give birth with Crohn's disease?
If during childbirth the disease is in complete remission, the method of delivery is determined depending on the complications present. So, for example, the presence of an adhesive process in the abdominal cavity or in the pelvic area is an absolute indication for delivery by cesarean section. If the onset of the disease was noted relatively recently, if the disease was mild and was not accompanied by the development of complications, it is possible to consider the issue of delivery through the vaginal birth canal.If in the third trimester of pregnancy there is an increased activity of the inflammatory process, this is also an indication for a cesarean section. If during this period complications develop that pose a danger to the life of the mother (intestinal bleeding, intestinal perforation), the question of their surgical treatment is decided by the medical commission and the patient herself individually in each case.
Prevention of Crohn's disease
Since the specific cause of Crohn's disease has not been established, there is currently no primary prevention of Crohn's disease (aimed at preventing the onset of the disease). That is why the main emphasis is on secondary prevention, the purpose of which is to prevent exacerbations and relapses of the disease. Secondary prevention of Crohn's disease includes:
- Elimination of risk factors. The patient should follow a diet throughout his life (in particular, products that irritate the intestinal mucosa and often cause the development of allergic reactions should be abandoned). Also, such patients are advised to quit smoking and timely and fully treat infectious bowel diseases.
- Preventive use of drugs. For prophylactic purposes, the same medications are prescribed that are used to treat exacerbations of the disease, but in smaller doses (mesalazine, 2 grams per day, methotrexate at a dose of 25 mg, used daily for 3 to 4 months, and so on). Preventive treatment is prescribed by repeated courses at regular intervals, which should ensure a stable remission of the disease throughout the patient's life.
- Regular consultations with a gastroenterologist. Even if the patient has developed a complete remission of the disease, he is advised to visit a doctor and undergo the necessary examinations at least once a year (in order to identify signs of a possible activation of the pathological process in time). When symptoms of the disease appear, as well as during the first year after surgical treatment for Crohn's disease, you should visit a gastroenterologist every 3 to 6 months.
- Timely treatment of relapses of the disease. When the first signs of Crohn's disease appear (even while taking prophylactic doses of anti-inflammatory drugs), you should consult a doctor as soon as possible, who will conduct the necessary examinations and prescribe a course of treatment in order to prevent the progression of the inflammatory process and damage to the tissues of the intestinal wall in time.
Crohn's disease prognosis
Today, Crohn's disease is incurable, however, thanks to a complex of therapeutic and preventive measures, it is possible to achieve a stable remission of the disease, which will ensure a full life for the patient for many years. The quality of life of people with Crohn's disease is determined by:
- The time of the onset of the disease. The earlier the first clinical symptoms appear, the greater the likelihood of an aggressive course of the disease and an unfavorable outcome.
- The severity of clinical manifestations. Frequent exacerbations of the disease, accompanied by severe damage to the intestines and other organs, are an unfavorable prognostic sign.
- The time of initiation of treatment. The earlier the patient begins to take medications, the less tissue will be damaged by the inflammatory process and the more favorable the prognosis will be.
- The effectiveness of the treatment. If, against the background of taking the entire spectrum of drugs (anti-inflammatory drugs, immunosuppressants, and so on), the activity of the inflammatory process does not decrease (or decreases slightly), the prognosis is unfavorable.
- The degree of patient cooperation. This point is extremely important, because if the patient does not strictly follow the doctor's instructions, interrupts treatment and exposes himself to risk factors (continues to smoke, does not follow a diet), the prognosis for him can be very sad (up to death). for the developed complications).
- profuse (massive) intestinal bleeding;
- toxic megacolon;
- acute intestinal obstruction;
- the development of a malignant tumor;
- intestinal perforation and the development of peritonitis;
- postoperative complications (bleeding, infections, and so on).
Before use, you must consult a specialist.
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