1 What is Crohn's disease?

Crohn's disease is an inflammatory process that can affect any part of the gastrointestinal tract. Most often this concerns the terminal segment of the ileum and the initial segment of the large intestine. The inflammatory process can spread to the entire wall of the intestine.

Crohn's disease has an autoimmune origin, which means that it arises under the influence of some( in this case unknown) factor, to which the body produces autoantibodies. Every day, the human body produces antibodies against attacking bacteria, viruses, fungi, and the goal of this reaction is the destruction of these microbes.

In the case of autoimmune diseases, autoantibodies arise, that is, antibodies that cause inflammation of one of the organs of one's own organism. With Crohn's disease, this is the gastrointestinal tract. In the group of chronic nonspecific inflammations of the gastrointestinal tract, non-specific ulcerative colitis should also be included. This disease often has a very similar clinical picture with Crohn's disease, and a thorough diagnosis is needed to establish the correct diagnosis.

2 What causes the disease?

The exact cause of Crohn's disease has not yet been known. It is assumed that the following factors are important in pathogenesis:

• genetic predisposition( gene mutations);
• the wrong composition of the bacterial flora of the gastrointestinal tract;
• impaired function of the immune system;
• transferred infections by Mycobacterium paratuberculosis bacteria, Pseudomonas spp.or Listeria spp.;
• smoking( the risk of disease among smokers is increased fourfold, and the course of the disease is more severe);
• fatty foods.

There are two peaks in the incidence of this disease. The first and largest occurs at the age of 15-30 years, and the second, much smaller, is 60-80 years.

Among adults, the incidence rate is slightly higher in women, among children, the disease is more common in boys.

3 Symptoms of pathology

In the initial stage, terminal ileitis usually develops slowly. Characterized by the emergence of periods of exacerbations and periods of remission. There is often a decrease in the activity of the disease.

Symptoms of the disease:

• malaise;
• weakness;
• fever;
• lack of appetite;
• weight loss;
• anemia;
• abdominal pain;
• chronic diarrhea;
• admixture of blood in the stool;
• changes in the rectal area( cracks, fistulas, abscesses);
• intestinal obstruction;
• delay in puberty and growth in children;
• pain and swelling of large joints;
• osteoporosis;
• conjunctivitis, inflammation of the iris;
• inflammatory skin lesions.

4 How to recognize an ailment?

Terminal ileitis is diagnosed based on the results of endoscopic and histopathological examination and X-ray. The basis of diagnosis is the performance of endoscopy. Endoscopic examination consists in the fact that the doctor scans the organ from the inside( endo) with the help of the apparatus. There is no typical localization for this disease. Inflammation can reach any part of the gastrointestinal tract, so the type of study depends on the symptoms.

Gastroscopy is performed if symptoms indicate a disease of the esophagus, stomach or duodenum. Colonoscopy allows you to evaluate other areas of the intestinal tract.

Capsular endoscopy is performed in patients with a high probability of involvement in the small intestine. The patient swallows a small capsule with a miniature digital camera. The capsule, moving along the gastrointestinal tract, performs thousands of photographs, and then exits through the anus. All photos are analyzed on the computer. Capsular endoscopy does not make it possible to perform a biopsy.

Gastroscopy and colonoscopy allow a biopsy( take samples of the mucous tissue in the digestive tract).Fragments of tissues are assessed under a microscope( in a microscopic study).

Contrast X-ray examination should always be performed. Liquid contrast substance is administered orally or rectally( depending on the location of the lesion), and then X-rays are performed.

In laboratory studies, there are signs of inflammation( ↑ white blood cell count, ↑ ESR, ↑ CRP), as well as anemia and antibodies ASCA( allow to differentiate Crohn's disease from ulcerative colitis).In patients with diagnosed disease, the diagnosis is supplemented with ultrasound, tomography or MRI, which allows to determine the severity of the disease.

The appearance of the first attack of the disease can cause diagnostic doubts, since the symptoms arising from an attack of ulcerative colitis may resemble an acute infection of the gastrointestinal tract. Examination of feces allows to exclude bacterial infection.

5 The healing process can be divided into 2 types:

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• treatment during exacerbation of the disease;
• maintenance therapy, is used during periods of remission.

The severity of the symptoms and the precise localization of the inflammatory process in the gastrointestinal tract are the determining factors in the choice of medications. Variants of therapeutic agents include glucocorticoids. They are used inside, and in severe cases of the disease intravenously. Treatment begins with large doses, which gradually decrease, and together with the easing of symptoms, if possible, cancels. There is a fairly large group of patients who should take glucocorticoids permanently.

Immunosuppressive drugs are prescribed - this is a group of drugs that suppress the work of the immune system, thereby effectively removing inflammation. The drugs are used for autoimmune diseases, including Crohn's disease. In this group of drugs used immunomodulators Azathioprine, Mercaptopurine, Methotrexate. They have the ability to change and suppress the functions of the immune system. The drugs are used for severe exacerbation of symptoms.

Biological therapy is the intravenous administration of specific antibodies that have the ability to block TNF-α particles. When these particles are destroyed, the inflammation disappears or decreases significantly. Biological therapy is used in case of ineffectiveness of glucocorticoids and immunomodulators. As part of this treatment, Infliximab and Adalimumab are used;

Assign aminosalicylates - Sulfasalazine, Mesalazine. This group has an anti-inflammatory effect, and is used in mild or moderate severity of the disease.

Antibiotics - Metronidazole and / or Ciprofloxacin, are used in the case of fistula. Prescribed drugs with symptomatic effect - painkillers, antidiarrheals.

Patients with a mild exacerbation of the disease do not always receive medication. Sometimes treatment with a change in diet leads to remission. This is an alternative to the use of glucocorticoids, especially for young people, when there are concerns that the side effects of these drugs can inhibit the growth of children. Diet treatment is often used as an element supplementing standard pharmacological therapy. Its goal is to equalize the nutritional deficiency, since people with Crohn's disease suffer from malnutrition.

The operation is performed if medication is not effective. In the case of changes in the intestine, the procedure consists of cutting out the altered area and restoring the continuity of the gastrointestinal tract. However, in many patients the disease resumes after a while. A few years after surgery, there is a need for a second operation.

Remember: without knowing the exact cause of Crohn's disease, it is impossible to cure it.

The aim of the treatment is to bring to remission, improve the quality of life of the patient and prevent possible complications.