The disease is chronic, with alternation of acute attacks and remissions. The first signs of the disease (first episode), usually occur at a young age - in people 15 - 35 years. The disease occurs with equal frequency in men and women. Identified genetic predisposition Crohn's disease - if relatives straight line suffer from this disease, the risk of developing it increases 10 times.
If the disease is diagnosed in both parents, the disease in these patients occurs before 20 years in half of the cases. The risk of Crohn's disease increases when smoking (almost 4 times), and the bond marked diseases with oral contraception.
What it is?
Crohn's Disease - Chronic inflammation in the gastrointestinal tract, capable of hitting all its parts, starting from the mouth and ending with the rectum. Inflammation develops simultaneously in the inner shell of the intestine and its submucosal layers, mainly affecting the terminal ileum.
Causes of
Predisposing factors for the disease are:
- a viral infection (measles);
- food allergies;
- stress and mental strain;
- smoking;
- genetic predisposition.
It failed to identify the causative agent of Crohn's disease today. However, the infectious theory - the basic version of the origin of the disease. This is due to the positive effect of treatment with antibacterial drugs. In addition, the development of the disease play an important role disorders of the immune system. Autoimmune processes in which antibodies are produced against one's own intestinal tissue, and the lack of protective function of the immune system is an important link in the origin of the disease.
The symptoms of Crohn's disease
On symptomatology affects the localization and speed of developing Crohn's disease. Common symptoms in adults and children are divided into intestinal and extra-intestinal. The first group includes:
- Frustration of a chair. It is manifested by diarrhea, which is a rare and abundant or frequent and scanty. It can be mixed with blood and mucus.
- Stomach ache. They can be dull, persistent. Sometimes patients complain of a sharp, but short.
- Inflammation of the anal area.
By extraintestinal include:
- increased body temperature,
- a sharp decrease in weight,
- weakness, fatigue,
- anemia.
Additionally defeat affects the joints, skin, liver, eyes, gums. Any wounds are beginning to heal poorly. Periodically there are pains in the bones. whites of the eyes are painted in yellow color, there is a reduction in visual acuity.
Patients may experience symptomatic relief. remission process sometimes lasts for several years. To predict when the next exacerbation impossible.
The chronic form
This is the most common form of the disease. Its manifestations are different depending on the order in which intestine develops a pathological process.
Thus, when the small bowel Crohn's disease are the main symptoms - malabsorption of nutrients in intestine, as well as signs of intoxication (weakness, fatigue, increased temperature to low numbers). In addition, it marked the beginning periodic, and then persistent pain at some abdomen, which practically relieved after defecation. Chair poluoformlenny in this disease, it may sometimes be mucus or blood foam impurity.
Malabsorption of nutrients is shown:
- increased volume of urine;
- cramps in the muscles of the limbs and face;
- swelling;
- violation of potency / menstrual cycle;
- Increased pigmentation of the skin;
- signs of hypovitaminosis: cracks in the corners of the mouth, blurred vision at dusk, bleeding gums.
If developed Crohn's disease, colon cancer, symptoms such:
- abdominal pain: cramping, above the umbilicus localizes at the left or right side surfaces of the belly, different intensity, aggravated by the use of "harmful" food;
- pappy stool, blood, frequently. Desires can occur at night and towards morning;
- if struck by the area of the rectum near the anus, the person can identify the frequent paraproctitis, anal fissures or fistulas extending from the rectum to the skin around the anus, bladder, prostate or vagina;
- the skin becomes pale, it loses its elasticity.
Such manifestations from the colon, small intestine, or combined lesions of the digestive tract have a feature. They occur with periods of remission, when the person feels almost healthy (with the exception of extraintestinal manifestations and symptoms of malabsorption of nutrients), which are replaced by exacerbations.
How long is the exacerbation of Crohn's disease depends on the duration of the period when medical care is not provided, the nature of the treatment used, location of the lesion. With adequate therapy, the disease becomes aggravated every 1-3 years. On what methods of treating the disease are currently used, can be found in the article: How is the treatment of Crohn's disease.
In addition to intestinal illness and has extra-intestinal manifestations:
- Pain in the eyes;
- nodular rash, which first is red, then it turns purple, and then turns brown and yellow;
- symptoms of the formation of stones in the biliary tract;
- oral ulcers;
- pain in the rump;
- reduction of mobility of large joints.
Diagnosis of Crohn's disease
Diagnosis of the disease is carried out in the presence of the characteristic symptoms of Crohn's disease using the following studies:
| intestinal fluoroscopy | They used a technique using a contrast agent that detect neoplasms, granulomas and restriction sites in the small intestine. |
| endoscopy | The method consists in the introduction into the tool intestine, consisting of a flexible tube provided with a camera and light source, with which the studied mucosa rectum and colon. |
| Laboratory Methods | Hold general and biochemical blood tests, urine analysis and bakposev feces, as well as a detailed immunological analysis of blood. |
| A biopsy of the intestinal mucosa | Tissue for histological examination taken during a colonoscopy. Under laboratory conditions analyzed changes in the mucosa. |
complications
Crohn's disease is dangerous not only for its unpleasant symptoms, but severe complications, which can be removed only by surgery. These include:
- The perforation of the intestinal wall, with the addition of peritonitis;
- Bowel obstruction;
- Heavy bleeding;
- External and internal fistulas, ulcers;
- Inflammatory infiltrates and stricture (narrowing of the lumen) intestine;
- The risk of adenocarcinoma;
- Moist cracks and maceration of the rectum;
- Outbreaks suppuration (abscess).
Crohn's disease is characterized by chronic, prolonged course, exacerbation of the disease may continue throughout the patient's life. Course of the disease in each individual case is different and in some patients the symptoms may be mild and not particularly affect state of health, while others may be accompanied by worsening of the disease severe, life-threatening complications.
Treatment of Crohn's disease
Comprehensive treatment of uncomplicated Crohn carried pharmaceuticals. Surgical intervention is made only in the presence of certain indications. Currently the disease is considered incurable, and there is no special universal method suitable for each patient. There are two different methods of therapy, "bottom-up" by the application of light to the destination more drugs potent agents or "downward", involving the use of potent drugs initially treatment.
The goal of drug therapy - reduction in the activity of the inflammatory process that eliminates the symptoms and signs of disease. In addition, it is necessary to plan the treatment in such a way as to ensure the prevention of possible complications and to achieve persistent long-term remission. For the patient, who developed Crohn's disease characterize symptoms, treatment should be started as early as possible. Timely spent therapy can significantly reduce the severity of symptoms of the disease and reduces the duration of exacerbations.
Apply the following medications:
- topical hormones - budesonide. It is recommended at low / moderate Crohn's disease activity with isolated lesions ileocecal region.
- salicylates (medicines 5-ASA) - sulfasalazine, mesalazine. There are both oral and topical (topical (rectal foam and slurry suppositories)) forms. Unlike ulcerative colitis have a low efficiency can be recommended for use as monotherapy in mild forms of the disease with minimal activity [2]
- immunosuppressants - azathioprine, methotrexate, 6-mercaptopurine. Used as maintenance therapy. Not suitable for the induction of remission in monotherapy.
- glucocorticoids - prednisolone, methylprednisolone. Used for induction, but for the maintenance treatment of Crohn's disease. Long-term use of hormone-dependent glyukokortisteroidov entails development of exogenous Cushing syndrome, in contrast to the genetically inzhnernyh biologicals (GIBP) to a lesser extent, affects the endoscopic disease activity (does not cause healing mucosa).
- antibiotics: ciprofloxacin, metronidazole, and new antibiotic local action - rifaximin;
- genetically engineered biological agents (GIBP). Currently in clinical practice widely used mnonoklonalnye chimeric or human antibodies to tumor necrosis factor alpha (TNF-alpha) - infliximab and adalimumab. Also apply other GIBP: golimumab, etanercept, certolizumab pegol. Promising to use blockers of integrin receptors are considered: Vedolizumab.
Prospective and alternative therapies:
- treatment with probiotics (VSL # 3, fecal transplantation of living donor bacteria);
- enzymes and sorbents;
- conjugated linoleic acid;
- Treatment with autologous (own) stem cells (US, England, Spain, etc...);
- Hyperbaric chambers (treatment with oxygen);
- in severe cases of intestinal transplantation from a donor;
- plazmofarez and plazmasorbtsiyu.
- stem cell therapy (drug polychrome, USA);
- nanotechnology (drugs at the minimum level, that is, the action point);
- IBD vaccine;
- sequencing of DNA;
- Activity of the test drug TSO (pork tapeworm eggs, DR FALK, Germany, USA, Austria, Switzerland);
- genetically modified bacteria for the treatment of IBD.
In the presence of fistulas, abscesses, sowing abnormal flora of the bowel contents can be used broad-spectrum antibiotics and be sure to metronidazole, clotrimazole.
It should be noted that the treatment of Crohn's disease is currently the most correct conduct, based on the European Consensus. It is based on evidence-based medicine.
Diet
In combination with drug therapy, doctors pay much attention to a special diet, which is very important to reduce the mechanical, thermal and chemical irritable bowel. Diet for Crohn's disease is not very strict, the main thing in it - respect for the intestines.
Prohibited products in this disease include:
- All kinds of legumes, mushrooms;
- Pasta, pastry and confectionery;
- Ice cream;
- Any spices, seasonings, hot sauces, mustard;
- Oil-rich fish and meat;
- Kashi from barley or wheat;
- Chips, crackers, canned food, semi-finished products;
- Fizzy drinks and cold drinks;
- Coffee, chocolate, strong tea;
- Pickles and smoked;
- Spicy, fried foods;
- Alcohol.
We do not recommend the use of hot food, all food is served warm, with a flow temperature of not less than 18 ° and not more than 60 ° C. Nutrition should be a fraction, the food should be small meals 5-6 times a day.
Operation
If diet, lifestyle change, medication and other methods have been ineffective, the patient is recommended surgery. About half of all patients with Crohn's disease during treatment carry at least one surgical intervention. However, it does not provide a cure for the disease.
Surgical treatment is the removal of a damaged intestine, followed by anastomosis between the health sector. Surgical intervention is also necessary to treat fistulas and drainage of abscesses, as well as the development of intestinal obstruction.
The positive effect of surgical treatment in Crohn's disease usually temporary. The disease often recurs, causing inflammation in the vicinity of the previous outbreak. The best tactic - to continue supporting the drug therapy after surgery.
Prevention and prognosis of Crohn's disease
Ways to complete recovery from the disease so far not been developed due to the fact that the etiology and pathogenesis of the disease are not fully understood. However, regular and adequate treatment of exacerbations and dieting regime, medical advice and regular spa treatment help to reduce the frequency of exacerbations, decreased severity and Quality life.
Basically, the key points of prevention of exacerbations:
- dietetics, nutrition balance, the application of vitamin complexes, essential trace elements;
- avoidance of stress, the development of stress, regular rest, a healthy mode of life, normalization of biorhythms;
- physical activity (light physical activity reduces the effect of stress, normalize intestinal activity);
- cessation of smoking and alcohol abuse.
In 13-20% of patients have a chronic course of the disease. When properly conducted treatment duration of remission periods of up to several decades. As an independent disease, Crohn's disease is a very rare cause of death of patients and percentage of mortality remains very low. Typically, patients receiving maintenance therapy, live to a ripe old age.
