Crohn's disease - a chronic inflammatory bowel disease affecting all of its layers.
The most common complications are irreversible changes (contraction of intestinal segments, fistulas). Also for this disease is characterized by numerous extra-intestinal lesions.
The prevalence of Crohn's disease in various countries ranges from 50-150 cases per 100 000 population.
The first signs of the disease usually appear at a young age (15-35 years), and this can be both intestinal and extra-intestinal manifestations.
The causes of Crohn's disease
The causative factor of the disease is not established. It is assumed the provocative role of viruses, bacteria (eg, measles virus, Mycobacterium paratuberculosis).
The second hypothesis is linked to the assumption that some food antigen or neboleznetvorny microbial agent can cause an abnormal immune response.
The third hypothesis states that the role of agent provocateur in the development of the disease play a self-antigens (ie. e. the body's own proteins) on the wall of the patient's intestine.
The symptoms of Crohn's disease
In Crohn's disease colon mucosa inflamed, coated surface ulcerations, which causes
- abdominal pain,
- impurity blood and mucus in the stools,
- diarrhea, Often accompanied by pain during defecation.
In addition, there are often general malaise, loss of appetite and weight loss.
The presence of Crohn's disease can be suspected when persistent or nocturnal diarrhea, abdominal pain, ileus, Weight loss, fever, night sweats.
May be affected not only thicker but also the small intestine, and stomach, esophagus, and even oral mucosa.
Occurrence fistula in Crohn's disease is between 20 to 40%.
Often develop bowel narrowing, followed by intestinal obstruction, pseudopolyposis.
By the extraintestinal manifestations of Crohn's disease include:
- cutaneous manifestations,
- joint damage,
- inflammatory diseases of the eye,
- liver and biliary tract,
- vasculitis (inflammation of blood vessels),
- hemostatic disorders, and thromboembolic complications,
- blood disease
- amyloidosis,
- disorders of bone metabolism (osteoporosis - bone loss).
Crohn's disease - is nepreryvnotekuschee or relapsing disease, which gives 30% of spontaneous remission without treatment.
It happens that the patients complain of pain in various parts of the abdomen, bloating, vomiting often.
It is a variant of the disease with predominant development of intestinal insufficiency syndrome, flowing from the small bowel lesions.
Diagnostics
Diagnosis of Crohn's disease based on data from X-ray and endoscopy with biopsy, which reveal inflammation of one or more sections of the gastrointestinal tract, typically applies to all layers of the intestinal wall.
On inflammation of the intestinal wall leukocytes evidenced in feces. Diarrhea (early in the disease or recurrence) cal tested for pathogens of intestinal infections, protozoa, and helminth eggs clostridia.
In the diagnosis of Crohn's disease, an important role belongs to X-ray examination with contrast (irrigoscopy with double contrast, research passage barium endotracheal enterograph - study of the small intestine with barium, which is administered through a nasogastric tube into the duodenum).
Scintigraphy with labeled leukocytes to distinguish inflammatory from noninflammatory lesion; it is used in cases where the clinical picture does not correspond to the data of X-ray.
Endoscopy of the upper or lower gastrointestinal tract (if necessary - with a biopsy) allows you to confirm the diagnosis and to clarify the location of the lesion.
at colonoscopy in patients undergoing surgery, you can assess the condition of the anastomoses, the likelihood of recurrence and the effect of treatment post-surgery.
A biopsy can confirm the diagnosis of Crohn's disease, in particular, to distinguish it from ulcerative colitisExclude acute colitis, identify dysplasia or cancer.
Treatment of Crohn's disease
Important way of life of the patient. It is very difficult to ensure that it was less stress, but keep in mind that stress can play a significant role in the development of relapse of Crohn's disease.
Smoking significantly worsens the prognosis, so in these patients it is recommended to quit smoking.
The choice of method of treatment of Crohn's disease primarily depends on the severity of the disease. Rate it on any one indicator is impossible, it is necessary to take into account the nature of lesions of the gastrointestinal tract, systemic manifestations, the presence of exhaustion and general condition.
Treatment depends on the location, severity of injury and the presence of complications. Preparations are selected individually, their efficacy and tolerability in the dynamics.
Surgical treatment of Crohn's disease is shown in the intestinal contraction, purulent complications and inefficiencies medication.
easy for
In lesions ileum and colon aminosalicylic acid derivatives are administered orally (mesalazine, 3,2-4 g / day, or sulfasalazine, 3-6 g / day in divided doses).
When sulfasalazine inefficiency can help metronidazole (10-20 mg / kg / day).
Ciprofloxacin (1 g / day) was as effective as mesalazine.
The effectiveness of each drug was assessed after a few weeks of treatment. If the drug is effective, the treatment is sustained until remission or improvement as possible and then transferred to maintenance treatment.
If the drug is ineffective, it is changed to the other of the above or rotate one of the schemes shown in moderate form of the disease.
moderate flow
Assign prednisone, 40-60 mg / day orally until the disappearance of symptoms and start of an increase in weight (usually 7-28 days).
In the case of infection (e.g. abscess) Is carried out antibiotic therapy, open or percutaneous drainage.
If corticosteroids are ineffective or contraindicated, often it helps to infliximab in the form of infusion; it can be used as an adjunct to corticosteroid therapy.
severe course
If, despite taking prednisone and infusion of infliximab in Crohn's disease condition does not improve or there is a high fever, frequent vomiting, ileus, peritoneal irritation symptoms, exhaustion, signs of an abscess, it shows hospitalization. The consultation requires a surgeon with intestinal obstruction and availability of disease formation volume in the abdominal cavity.
In the latter case, in order to avoid an abscess carried ultrasound or computed tomography. When abscesses shown percutaneous or open drainage.
If the abscess is excluded or patient is already taking corticosteroids, they administered intravenously (in the form of injection or continuous infusion) in a dose equivalent to 40-60 mg of prednisone.
Elemental tube feeding or parenteral nutrition mixtures prescribed if the patient can not eat within 5-7 days after starting treatment.
If an abscess is shown open drainage. When fistulas and anal fissures prescribe antibiotics, glucocorticoids, infliximab.
Indications for surgical treatment
Surgical treatment of Crohn's disease is shown at the development of complications (scarring strictures, abscesses) and ineffective medication.
Forecast
Crohn's disease is quite unpredictable, yet remains true to the rule that the majority of patients the type and severity of the disease are the same as in the diagnosis.
