Crohn’s Disease – a chronic inflammatory bowel disease affecting all layers.
The most frequent complications are irreversible changes (narrowing of the intestinal segments, fistulas). Also this disease is characterized by numerous extraintestinal lesions.
The prevalence of Crohn’s disease in different countries ranges from 50-150 cases per 100 000 population.
The first manifestations of the disease usually appear at a young age (15-35 years), and it can be both intestinal and extraintestinal manifestations.
Causes of Crohn’s disease
The causal factor of the disease is not installed. It is assumed provoking role of viruses, bacteria (for example, measles virus, Mycobacterium paratuberculosis).
The second hypothesis is related to the assumption that some dietary antigen or nebraskaterry microbial agent can cause an abnormal immune response.
The third hypothesis States that the role of provocateur in the development of the disease play autoantigens (i.e. the body’s own proteins) on the intestinal wall of the patient.
Symptoms of Crohn’s disease
In Crohn’s disease mucosa of the colon is inflamed, covered with superficial ulcers that causes:
– abdominal pain,
– admixture of blood and mucus in the stool,
– 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 in continuous or nocturnal diarrhea, abdominal pain, intestinal obstruction, weight loss, fever, night sweats.
May be affected not only fat, but also the small intestine and the stomach, esophagus and even oral mucosa.
The occurrence of fistulas in Crohn’s disease ranges from 20 to 40 %.
Often develop narrowing of the intestine with subsequent intestinal obstruction, pseudopolyps.
To manifestations of Crohn’s disease include:
– skin manifestations,
– lesions of the joints,
– inflammatory diseases of the eye,
– diseases of the liver and biliary tract,
– vasculitis (inflammation of blood vessels),
– disorders of hemostasis and thromboembolic complications,
– diseases of the blood,
– disorders of bone metabolism (osteoporosis bone tissue loss).
Crohn’s disease is a relapsing or nepreryvnolitoy disease in 30% of cases gives spontaneous remission without treatment.
Sometimes, patients complain of pain in various parts of the abdomen, bloating, often vomiting.
This variant of the disease with predominant development of the syndrome of intestinal failure, which occurs with lesions of the small intestine.
Diagnosis of Crohn’s disease
Diagnosis of Crohn’s disease based on data from x-ray and endoscopic examination with biopsy that detect inflammatory lesions in one or more areas of the gastrointestinal tract, usually covering all layers of the intestinal wall.
About inflammation of the intestinal wall showed leukocytes in the stool. With diarrhea (in the beginning of the disease or during relapse) cal research on the causative agents of intestinal infections, protozoan, helminth eggs and clostridia.
In the diagnosis of Crohn’s disease is an important role for x-ray studies with contrast (barium enema double-contrast study of the passage of barium, endotracheal enterography is a study of the small bowel with barium, which is administered through a nasogastric tube into the duodenum).
Scintigraphy with labeled leukocytes to differentiate inflammatory lesions from non-inflammatory; it is used in cases where the clinical picture is not consistent with the data of x-ray.
Endoscopy of the upper or lower gastrointestinal tract (if necessary, a biopsy) allows to confirm the diagnosis and to specify the localization of the lesion.
At colonoscopy in patients undergoing surgery, it is possible to assess the condition of the anastomoses, the likelihood of recurrence and the effect of treatment given after surgery.
A biopsy can confirm the diagnosis of Crohn’s disease, in particular to distinguish it from ulcerative colitis, to exclude acute colitis, identify dysplasia or cancer.
Treatment for Crohn’s disease
The importance of the lifestyle of the patient. It is very difficult to ensure that he became less stress, but we should remember that stress can play a significant role in the development of recurrence of Crohn’s disease.
Smoking significantly worsens the prognosis, therefore, such patients advised to quit Smoking.
The choice of treatment for Crohn’s disease depends primarily on the severity of the disease. Measured by any single indicator is not possible, it is necessary to consider the nature of the lesion of the gastrointestinal tract, systemic manifestations, the presence of exhaustion and General condition.
Treatment depends on the location, severity of the lesion and presence of complications. Preparations are selected individually, assessing their efficacy and tolerability in the dynamics.
Surgical treatment of Crohn’s disease shows a narrowing of the intestine, purulent complications and failure of medical treatment.
Mild Crohn’s disease
With the defeat of the ileum and colon designate derivatives aminosalicylic acid inside (mesalazine, 3,2 to 4 g/day, or sulfasalazine, 3-6 g/day in divided doses).
The ineffectiveness of sulfasalazine can help metronidazole (10-20 mg/kg/day).
Ciprofloxacin (1 g/day) is as effective as mesalazine.
The effectiveness of each drug evaluated after several weeks of treatment. If the drug is effective, the treatment is continued until remission is achieved or the maximum possible improvement, then move on to maintenance treatment.
If the drug is ineffective, just adjust it from above or pass on one of the circuits shown in moderate form of the disease.
Secondary form of Crohn’s disease
Prescribed prednisone, 40-60 mg/day orally, before the disappearance of symptoms and start to gain weight (usually within 7-28 days).
In case of infection (eg, abscess) spend antibiotics, open or percutaneous drainage.
If corticosteroids are ineffective or contraindicated, often helps infliximab in the form of infusions; it can be used as an adjunct to corticosteroid therapy.
Severe form of Crohn’s disease
If, despite taking prednisone and infusion of infliximab, status in Crohn’s disease is not improving or has a high fever, frequent vomiting, intestinal obstruction, symptoms of peritoneal irritation, exhaustion, signs of an abscess, then hospitalization is shown. Surgical consultation is required for intestinal obstruction and the presence of a painful mass in the abdominal cavity.
In the latter case, to exclude abscess conduct an ultrasound or a CT scan. When abscesses percutaneous or open drainage.
If the abscess is expelled or the patient has already taken corticosteroids, administered intravenously (by injection or long-term infusion) at a dose equivalent to 40-60 mg of prednisone.
Gavage feeding elemental mixtures or parenteral nutrition administered, if the patient cannot eat 5-7 days after the start of treatment.
When shown abscess, open drainage. When fistulas and anal fissures prescribe antibiotics, corticosteroids, infliximab.
Indications for surgical treatment
Surgical treatment of Crohn’s disease is shown with the development of complications (stricture formation, abscesses) and the failure of medical treatment.