Crohn's disease causes symptoms treatment. Why does the disease develop?

Crohn's disease is a disease that is based on a chronic inflammatory process that affects all membranes (mucous, submucosal, muscular) gastrointestinal tract.

The incidence of Crohn's disease in the world is 45-95 cases per 100,000 population.
This chronic disease begins in young age between 15 and 35 years old.

Anatomy and physiology of the small intestine

Anatomy of the small intestine

1. The duodenum is the widest and at the same time the shortest section of the small intestine. The length of the duodenum is 20 centimeters.
The ducts of the liver and pancreas open into the lumen of the duodenum. The digestion of food that began in the stomach continues in the intestine. The duodenal mucosa contains glands. These glands secrete mucus to protect the intestine from mechanical and chemical irritation.

2. The jejunum is a section of the intestine containing villi and many folds.

3. The ileum - contains Feather's plaques (a kind of lymph nodes) that protect the intestine from harmful bacteria.

The small intestine is made up of 4 layers:
- The serosa is the outer layer of the small intestine.
- The muscular layer. Consists of smooth muscle fibers.
- Submucosal layer. The layer is represented by connective tissue with vessels and nerves located in it.
- Mucous membrane. Consists of the intestinal epithelium, which is involved in the process of digestion and absorption.

Physiology of the small intestine

1. Contractile function. With the help of rhythmic movements (peristalsis), food is pushed through the small intestine. Peristalsis serves not only to move food through the intestines, but also to divide the food bolus into smaller parts. The separation process serves to better grind and mix food with intestinal juice.
Contractility is under neurohumoral control.
The nervous system is controlled by vagus nerve and sympathetic nerve fibers.
Humoral regulation is carried out with the help of biologically active substances. For example, the drug motilin stimulates peristalsis, and various peptides reduce peristaltic activity.

2. Digestive function.
Fats are broken down by pancreatic lipase and bile.

Proteins are digested with the help of so-called proteases (trypsin, chymotrypsin), which break down proteins into amino acids.

Carbohydrates are digested in the duodenum by the action of pancreatic amylase.

3. Suction function. Fats after splitting before fatty acids enter the cells of the small intestine, from where they combine with various transport systems, enter the lymph, and only then into the blood.

Proteins digested to amino acids are absorbed by active transport.

Carbohydrates are absorbed by various mechanisms and enter the cells of the intestinal epithelium.

Water and electrolytes. Water is absorbed by osmosis and passive diffusion. Sodium and chlorine are absorbed by attaching to organic compounds. Calcium absorption occurs through active transport.

4. endocrine function- consists in the release of various biologically active substances into the blood.
Secretin is a peptide that stimulates the production of pancreatic juice, stimulates the release of bile. It also inhibits the production of hydrochloric acid by the stomach.
Cholecystokinin stimulates the release of bile from the gallbladder.
There are also many other biologically active substances that affect the processes of digestion and absorption.

5. Immune function. The mucous membrane of the small intestine is a barrier to pathogenic microbes.

Causes of Crohn's Disease

1. Infection theory. Adherents of this theory believe that the cause of the disease is pathogenic (capable of causing disease) flora. Various types of bacteria and viruses cause inflammation in the small or large intestines.

2. Theory of antigen formation. This theory is based on the appearance of antigens to any food product or non-pathogenic (not capable of causing disease) flora. These antigens, along with food product or bacteria remain on the walls of the intestine. The body produces antibodies against them. These antibodies then combine with antigens. An immune response is carried out with the production of various factors leading to inflammation.

3. autoimmune theory. This theory says that the basis of the inflammatory process is the process of the appearance of autoantigens (normal antigens of the body's own cells). Normally, the immune system recognizes its antigens and there is no immune response. The authors of the theory believe that for inexplicable reasons, autoantigens appear in various parts of the digestive tract. The body begins to destroy its own cells, which leads to inflammation.

The presence of a genetic factor is also suggested. The so-called family predisposition.

What happens in the digestive tract?

Crohn's disease often affects the small intestine in 75-80% of cases. In 20% of cases, the lesion is located in other parts of the digestive tract (large intestine, stomach, esophagus). Most often found combined lesion(for example, part of the small intestine and a segment of the large intestine).
The intestinal lesion is intermittent, that is, after the affected area, normal follows, and then again affected.
Typical macroscopic (which can be seen with the naked eye) signs of the disease:
- erosion of various forms

ulcers different depth that alternate with normal mucosa. This feature was figuratively called "cobblestone pavement"

Stenosis (narrowing) where the segment of bowel becomes thick and hard

Fistula - a channel that forms a message between various organs or tissues. Normally, there are no fistulas.

Microscopic (only visible under a microscope) signs:
- inflammation of all intestinal membranes

Lymphedema

Epithelial granuloma - consists of many different cells of epithelial origin. These granulomas can be located in various layers of the intestine, but are more often found in the mucosa or submucosa.

Symptoms of Crohn's disease

Local symptoms:

• pain in the abdomen of varying intensity. The pains may be aching or cutting. Usually appear shortly after eating flatulence (bloating)
• diarrhea (loose stools) - the severity of diarrhea depends on the degree of intestinal damage
• stool with blood (the amount of blood depends on the degree of damage)
• possible near rectal abscesses (limited purulent disease)

• Weight loss in severe disease can be significant (tens of kilograms)
• The temperature is usually not high up to 38 degrees
• Eye symptoms (uveitis - inflammation of the choroid, conjunctivitis - inflammation of the mucous membrane of the eye)
• Skin symptoms (redness)
• Myalgia (muscle pain), arthralgia (joint pain)
• Vasculitis - inflammation of blood vessels
• Violation of blood clotting with the formation of blood clots

2. Average degree
- diarrhea more than 6 times a day
- bloody stool
- pulse 90
- possible complications

3. Severe disease
- diarrhea more than 10 times a day
- chair with large quantity blood
- temperature around 38 degrees
- pulse over 90
- the presence of complications

The course of the disease

Diagnosis of Crohn's disease

Conversation with a doctor
The doctor will ask you about complaints. Especially in depth will ask about the chair and its characteristics. At the end of the conversation, he will ask you about nutrition.

Inspection
On visual inspection, you can see an increase in the volume of the abdomen (bloated abdomen). The doctor will examine the eyes and skin. In the event that there are any eye symptoms an appointment with an ophthalmologist. If they are present skin symptoms appointment with a dermatologist.

Palpation (palpation) of the abdomen.
Superficial palpation reveals areas hypersensitivity in the projection of the small intestine.
Deep palpation reveals areas of pain.

General blood analysis
In a blood test, the characteristic features are:
- decrease in the amount of hemoglobin less than 110 grams / liter
- an increase in the number of leukocytes (leukocytosis) more than 9x10 to the 9th degree
- increase in erythrocyte sedimentation rate more than 15

Blood chemistry
- Decreased albumin levels
- the presence of a C reactive protein indicates acute phase inflammation
- increase in the fraction of gam - globulins
- increase in the amount of fibrinogen

Immunological blood test
There are different types of antibodies in the blood. Especially often find cytoplasmic anti-neutrophil antibodies.

X-ray examination
1. X-ray belly. It is done to exclude such complications as perforation (perforation) of any part of the intestine, toxic expansion of the colon.

2. Irigography - x-ray studies using double contrast (barium-contrast and air).
Radiological signs of the disease
- segmental (partial) intestinal lesion
- thickening and decreased mobility of the intestinal walls
- ulcers or ulcers at an early stage
- ulcerations of irregular shape (in the form of stars or round)
- the relief of the intestine resembles a "cobblestone pavement"
- stenosis (narrowing of the lumen) of the intestine
- partial obstruction of the intestinal lumen

Endoscopy is a required study. This study is necessary both for visual confirmation of the diagnosis, and for taking a biopsy (a piece of tissue) for examination under a microscope. Moreover, it is made in various parts of the digestive tract. Sometimes the lesion can be in the stomach and esophagus, so fibrogastroduodenoscopy is done to exclude damage to these departments. Colonoscopy is used to visualize the large intestine. Examination of the entire small intestine is very expensive and problematic, and therefore limited to the above studies.
Any endoscope consists of a tube of various lengths, a camera and a light source. The camera enlarges the image several times, and then transfers it to the monitor.

Endoscopic Criteria:
- damage to various parts of the intestine
- lack of vascular pattern
- longitudinal ulcers
- the relief of the intestine is similar to the "cobblestone pavement"
- defects in the intestinal wall (fistulas)
- mucus mixed with pus in the intestinal lumen
- narrowing of the intestinal lumen

Complications of Crohn's disease

• fistulas (messages between different organs or tissues). As a rule, they are accompanied by a purulent process, so the treatment is surgical.

• abscesses in soft tissues. Abscess - limited purulent inflammation, in this case near intestinal structures. Treatment is surgical only.

• massive bleeding most often leads to anemia (decrease in red blood cells and hemoglobin), as well as in severe cases and to shock.

• bowel perforation followed by peritonitis. Peritonitis (inflammation of the peritoneum) is a very severe complication of Crohn's disease, as it leads to severe intoxication of the body.

Vasculitis is an inflammation of predominantly small blood vessels.

Crohn's disease treatment

Mode
During an exacerbation, bed rest is recommended until the patient's condition improves. During the period not complete remission normal mode.

Diet for Crohn's disease

The temperature of food should not be lower than 18 degrees and not higher than 60 degrees Celsius. Fractional meals 5-6 times a day are recommended in small portions.

In case of severe exacerbation, 2 fasting days are recommended. That is, 2 days without food, but with the obligatory intake of 1.5-2 liters of water per day. If the exacerbation is not severe, fasting days are recommended instead of fasting days. For example, the following options are possible:
- 1.5 liters of milk per day
- 1.5 liters of kefir per day
- 1.5 kilograms of finely grated carrots per day
- or 1.5 kilograms of peeled and finely chopped apples

After 2 fast days or unloading days move on to a diet that needs to be kept constantly.

Prohibited Products
- alcohol
- fatty meats and fish
- any kind of spices
- spicy seasonings
- horseradish, mustard, ketchup
- ice cream, iced drinks
- wheat, barley porridge
- legumes
- any semi-finished products
- canned food
- highly salted and smoked products
- fried foods
- mushrooms
- chips, crackers
- carbonated drinks
- products from rich and warm dough, cakes
- chocolate, coffee, strong tea

Products recommended for consumption
- mucous (oatmeal and semolina) porridges
- dried bread from flour of the 2nd grade, biscuits
- low-fat cottage cheese, milk, a small amount of sour cream
- soft-boiled eggs one per day
- soups on non-fat meat (beef, chicken), with the addition of, for example, rice or potatoes
- vermicelli
- boiled and baked vegetables
- meat of non-fat varieties in boiled, baked and chopped (cutlets) form
- non-fatty fish in boiled form or jellied fish
- it is recommended to make compotes, fruit drinks, preserves, jams from berries and fruits
- juices are not acidic and preferably diluted with water and in limited quantities (a glass a day)
- low-fat cheese, home-made low-fat meat pates

If the patient has severe diarrhea and significant weight loss, the diet is adjusted to more high-calorie foods (more meat products in the diet).

Drug treatment of Crohn's disease

Corticotropic drugs:
1. Prednisolone is used orally or intravenously at a dose of 40-60 milligrams per day for 1-4 weeks, followed by a dose reduction. The dose is reduced by 5 milligrams during the week.
2. In recent times the most commonly used budesonide. This drug causes fewer side effects than prednisolone. Budesonide is used at a dose of 9 milligrams per day.

Metronidazole - antibacterial drug used to suppress intestinal microbes. It is used at a dosage of 10-20 milligrams per kilogram of body weight.

As a rule, these drugs are combined in the acute phase, for example, Sulfosalazine with Metronidazole or Prednisolone with Metronidazole.
After the onset of remission, as a rule, Mesalazine is used in small doses.

Drugs that are used if the above drugs do not help.
Azathioprine 2.5 milligrams per kilogram of body weight or Methotrexate 10-25 milligrams per week with mandatory folic acid intake.

With a very pronounced exacerbation, or with the appearance of any complications of the disease, infliximab is used at a dosage of 5 milligrams per kilogram of body weight. The dose should be divided into 3 parts. This drug administered intravenously mixed with saline. Moreover, the first dose is prescribed immediately, then the 2nd dose after 2 weeks, and the 3rd dose after 4 weeks. Infliximab is an immunomodulatory drug.

In case of infectious complications, antibiotics from the group of cephalosporins or macrolides are prescribed.

Surgery prescribed in case of severe complications. For example, with intestinal obstruction (blockage) or fistulas. As a rule, resection (removal) of the affected area is used.
According to statistics, 60% of patients need surgery within 10 years. And also 45% of patients who underwent surgery due to Crohn's disease need a second operation over the next 5 years.

Prevention of Crohn's disease

An important element of prevention is proper nutrition, including the exclusion of excessively fatty foods, as well as limiting the use of highly salted, smoked and peppery foods.

Unwashed food should be avoided to reduce the risk of intestinal infection.

It is necessary to avoid stress, mental or physical strain at work.
If the work involves constant stress, you should change it to a lighter one.

It is necessary to strengthen the nervous system. In case of stress, use sedatives.

What are the characteristics of Crohn's disease in children?

Features of the symptoms of Crohn's disease in children:

• The main symptom is diarrhea. The frequency of stool can reach 10 times a day or more. Blood may occasionally be present in the stool.
• Pain worries all children. As in adults, they can be of varying intensity.
• Growth delay, sexual development. Especially in severe cases of the disease.
• From extraintestinal manifestations Crohn's disease in children is most common: arthritis, joint pain , aphthous stomatitis, erythema nodosum, visual impairment.

Can Crohn's disease turn into cancer?

• Crohn's disease sufferers nonspecific ulcerative colitis, polyposis and other precancerous bowel diseases.
• Long-term abdominal pain, the cause of which is unknown, and it could not be identified using other diagnostic methods.
• People over 50, even those with normal health.

What are the prognosis for Crohn's disease?

• Prevalence of the lesion- the length of the part of the intestine affected by the pathological process.
• The severity of malabsorption- the degree of dysfunction of the intestine due to the disease.
• Presence of complications. For example, if Crohn's disease is complicated by the development of a malignant tumor, - adenocarcinomas, - the forecast worsens.

When defeated anus and rectum usually improve after surgery.

On average, mortality among patients with Crohn's disease is about 2 times higher than among healthy people of the same age. Most often, patients die from complications and operations.

The doctor must constantly monitor the patient's condition and timely prescribe examinations aimed at identifying complications. This helps improve predictions. In Europe and some cities of Russia (Moscow, Irkutsk, St. Petersburg) for this purpose, specialized centers diagnosis and treatment of inflammatory bowel disease.

What is the difference between Crohn's disease and ulcerative colitis?

Are Crohn's Disease Disabled?

Differential diagnosis in Crohn's disease: what diseases can be accompanied by similar symptoms?

• Malignant tumors of the intestine.
• Chronic infections.
• Diffuse diseases connective tissue: systemic lupus erythematosus, dermatomyositis, systemic scleroderma.
• Dysentery, salmonellosis and other intestinal infections.
• Nonspecific ulcerative colitis (NSA).
• Chronic non-ulcerative colitis.
• Chronic enteritis.

How does Crohn's disease progress during pregnancy? Is it possible to give birth with such a diagnosis?

In 2008, under the leadership of the European organization for Crohn's disease and colitis (European Crohn's and colitis organization), a study was conducted in which 500 women took part. It and some other studies helped answer many questions.

Can a woman with Crohn's disease get pregnant?

• A woman's reluctance to have a child. Or the doctor may unreasonably tell the patient that she has contraindications for pregnancy. Such women constantly use contraception.
• High activity of Crohn's disease. In this case, menstruation is violated.
• Adhesive process in the pelvis. Often occurs after surgery.

The favorable outcome of pregnancy depends on how active the disease is at the time of conception. Therefore, during pregnancy planning, it is important to visit a doctor on time and follow all the recommendations.

How does Crohn's disease affect pregnancy?

Major complications during pregnancy associated with Crohn's disease:

• premature birth(with active disease, the risk increases by 3.5 times);
• spontaneous miscarriages(with active disease, the risk increases by 2 times);
• fetal hypotrophy;
• more likely to require a caesarean section.

How can pregnancy affect the course of Crohn's disease?

• If Crohn's disease was in remission at the time of pregnancy, in 2/3 of women it continues to be inactive.
• Similarly, if the disease was active at the time of pregnancy, the activity will remain or increase in about 2/3 of women.

• in the first trimester of pregnancy;
• after childbirth;
• after an abortion;
• if, with the onset of pregnancy, the woman stopped treatment on her own.

Can a woman with Crohn's disease give birth on her own?

Indications for caesarean section in pregnant women with Crohn's disease:

• high disease activity;
• Availability ileostomy- communication of the ileum with the skin;
• skin lesions around the anus;
• perineal scars.

Name of the sanatorium	Where is?	Description
"Krainka"	Tula region	Healing factors: drinking mineral water; peat mud; calcium, sulfate mineral waters; forest climate.
"Krasnozersky"	Novosibirsk region	Healing factors: brine(saturated salt solution); sulphide-silt mud; blue and yellow clays; curative climate of the ecological zone.
"Red Glinka"	Samara Region	Healing factors: mineral water; carboxytherapy; hirudotherapy; pressotherapy;
"Crystal"	Kemerovo region	Healing factors: silt sulfide therapeutic mud; phytotherapy; physiotherapy; physiotherapy, massage.
"Krasnoyarsk Zagorye"	Krasnoyarsk region	Healing factors: mineral baths; dry carbonic baths; mineral water "Kozhanovskaya"; hirudotherapy; ozone therapy; phytotherapy; mud therapy by Plakhinsky sapropel(relic healing ointment); halotherapy (staying in a chamber, the walls and floor of which are covered with salt).
"Mashuk"	Stavropol region	Healing factors: mud treatment; hydrotherapy; electrophototherapy; thermotherapy; phytotherapy; therapeutic inhalations; ozone therapy.
"Martial Waters"	Karelia	Healing factors: mud treatment; mineral water; halotherapy; SPA treatments; bathing in infusions of medicinal herbs; mud wraps; hirudotherapy; ozone therapy.

Can Crohn's disease be permanently cured?

However, many patients can live full lives. In the most favorable cases, a person may not experience symptoms of the disease for many years or decades.

Is Crohn's disease contagious?

Also, Crohn's disease is not an oncological pathology, although it is called a precancerous disease. It only increases the risk of bowel cancer. If you undergo examinations in a timely manner, then, in the event of a tumor, it can be detected in the early stages, and the chances of a cure are greatly increased.

What are the extraintestinal manifestations of Crohn's disease?

Such manifestations of the disease are called extraintestinal.

monoarthritis- inflammation in one joint;

ankylosing spondylitis- an inflammatory process in the intervertebral joints, which leads to adhesions and impairs mobility.

Leather

• nodular erythema - inflammation of the vessels of the skin and subcutaneous fatty tissue;
• angiitis- inflammation of the vessels of the skin;
• pyoderma gangrenosum– chronic necrosis(death) of the skin.

Liver and bile ducts

• fatty hepatosis- violation of metabolism in the liver cells, the accumulation of fat in them and the development of dystrophy;
• sclerosing cholangitis- a chronic disease of the biliary tract, in which connective tissue grows in their walls;

Crohn's disease is a chronic autoimmune disease that is accompanied by damage to the intestinal mucosa. The pathological process can capture any department.

Classification

In accordance with the characteristics of the course, 5 types of Crohn's disease are distinguished. These include:

1. Colitis;
2. Ileocolitis;
3. Ileitis;
4. sharp shape;
5. Chronic illness.

The course of Crohn's disease can be strictoring, panetrating, non-stricting, and non-penetrating. The pathological condition may progress to upper divisions digestive system, colon, terminal section. In the presence of a more pronounced course, the development of ileocolitis is observed.

Crohn's disease - causes

The exact cause of the development of the disease to date is not certain. Chronic inflammation is observed against the background of the influence of bacteria and viruses. There are a huge number of provoking factors that contribute to the development of the disease. In most cases the disease

The disease is diagnosed when:

• genetic predisposition. The pathological process often develops in twins or blood relatives.
• age. In most cases, the disease is diagnosed in patients 15-35 years of age.
• Race and ethnicity. Inflammatory reaction in most cases diagnosed in white-skinned patients.

At risk are patients who have such a bad habit as smoking. In most cases, the disease develops after the removal of the appendix. When drinking alcohol in excessive quantities, the development of pathological process. It can also appear in constant stressful situations, nervous strain or chronic. At risk for the course of pathology are people who suffered measles in childhood and adolescence. A fairly common cause of the development of the disease is food.

Crohn's disease can be diagnosed in patients for a variety of reasons, so patients are advised to treat diseases in a timely manner and lead a healthy lifestyle.

Symptoms of the disease

In Crohn's disease, the walls of the intestine become inflamed, which leads to the appearance of the corresponding symptoms. In most cases, the disease is accompanied by:

• An increase in body temperature;
• nausea;
• vomiting;
• Decrease in body weight.

During the course of the pathological condition, the patient experiences joint pain. In some cases, the fingers are abnormally thickened. Also, people can be diagnosed with back damage. In this case, they complain about the appearance of a feeling of stiffness. The disease is accompanied by pain in the abdomen.

Inflammation can lead to skin lesions, which are accompanied by ulcers, swelling, swelling. In Crohn's disease, patients complain of ulcers, the location of which is oral cavity. Pathology is accompanied by discomfort in the abdomen,. In the area of ​​the rectum can be observed. Patients complain of discomfort and soreness in the intestinal area. The disease can lead to the development of inflammatory processes in the eyes.

Diagnostics

When visiting a doctor, it is necessary to talk about the symptoms present. This will enable the diagnosis of Crohn's disease to be made. Computer diagnostic methods are often used to confirm it. The patient needs to undergo a colonoscopy and X-ray, which will allow an assessment of the condition of the intestine. Also, these research methods make it possible to determine the location of inflammation in the digestive tract.

In order to evaluate general state patient, he is advised to take a urine test. An intestinal biopsy is recommended for an accurate diagnosis. Patients need a blood test to distinguish between ulcerative colitis and Crohn's disease. If the patient has an inflammatory process, then this leads to an increase in leukocytes in the blood.

Diagnosis and treatment are interrelated concepts. That is why the doctor uses a variety of diagnostic methods, which makes it possible to accurately determine the disease and prescribe effective treatment.

How to cure Crohn's disease

There are various ways to treat the pathological process. In most cases, patients are recommended to use traditional medicines. As maintenance therapy, you can use funds traditional medicine. Also, the patient must strictly adhere to the diet.

Medical therapy

Drug treatment is carried out at all stages of the course of the disease. Therapy is aimed at eliminating the symptoms and stopping the inflammatory process. For treatment, glucocorticoids, immunostimulants, antibiotics, corticosteroids and other drugs are used. The choice of certain drugs should be carried out only by a doctor after appropriate diagnosis and taking into account the individual characteristics of the patient.

Corticosteroids

Medication is recommended if the patient is diagnosed with a moderate to severe course of the disease. With the help of drugs, in most cases, a long-term remission of the disease is observed. The use of steroids should be carried out in short courses. If the left sections of the large intestine are affected, then it is recommended to use the drugs rectally. A fairly effective drug in this group is Budesonide.

Antibiotics

In most cases, the use of Metranidazole is carried out, which is characterized by the presence of an antibacterial action. During the period of use of the drug, the severity of the disease decreases.

Immunosuppressants

If a reflex course of the disease is observed, then Azatropine must be used to achieve remission. Taking the medication should be carried out as carefully as possible, since there is a possibility of developing undesirable effects. In most cases, they are manifested by fever, rash, arthralgia, hepatitis.

Surgery

With the ineffectiveness of drug treatment, patients are most often prescribed surgical treatment. If the disease is accompanied by fistulas and abscesses, then resection is necessary. Surgical intervention is performed only on that segment of the intestine, in the area of ​​\u200b\u200bwhich there is pain. Peri narrowing of the intestine is most often used strictureplasty.

Traditional medicine recipes

Sage. Crohn's disease treatment folk methods is directed to support the body's performance. With the help of this medicine, the prevention of putrefactive formations is ensured, as well as the fight against the inflammatory process.

Red onion. The product is characterized by the presence of healing properties. That is why its use in inflammatory processes in the intestines.

Sea buckthorn oil. In the treatment of Crohn's disease folk remedies the use of this particular remedy is recommended, as it has healing properties. The drug is recommended to be taken daily by mouth.

Flax seeds. If the patient has Crohn's disease, then treatments that require the use of this product should be used. It has enveloping properties, which makes it possible to protect inflamed areas. Flax seeds are often used for diseases of the digestive system.

Despite the fact that folk remedies for Crohn's disease are characterized high level safety, before using them, it is recommended to consult a doctor. Symptoms and treatment with folk remedies are inseparable concepts, since with the help of the latter, signs of pathology can be eliminated.

Diet

Enough important aspect is the diet for Crohn's disease. It is formulated by a specialist and contains proteins, calories and nutrients in optimal amounts. The menu for patients is developed on the basis of:

• meat;
• Fish;
• Dairy products.

If necessary, multivitamins and iron-containing substances are taken. Consumption of foods that increase gas production is strictly prohibited. Patients need to give up cabbage, beans, peas, etc.

With Crohn's disease, it is necessary to adhere to the rules of fractional nutrition. The patient should consume food 5 times a day. In this case, portions of the patient should be minimal. During the course of the disease, it is recommended that drinking regime. A person should drink 2 liters daily clean water. Patients are advised to consume only soft foods. It is strictly forbidden to consume foods that contain large amounts of fiber. Nuts, seeds, bran and legumes must be discarded. Oily and fried food in pathology it is strictly forbidden to use.

Diet therapy is quite important in the treatment of the disease, since it significantly reduces the severity of symptoms.

Can Crohn's disease be cured?

Unfortunately, there is no cure for Crohn's disease. But, when the first symptoms of a pathological condition appear, it is necessary to immediately begin its treatment. With the defeat of the small intestine of the ileum and other parts of the digestive system, it is recommended to follow a diet. Also, as maintenance therapy, the patient must take medication.

Complications

With untimely treatment of pathology, various complications can be diagnosed. In most cases, the development of ulcerative colitis of the intestine is observed. In some cases, the appearance of a necrosis factor is established. In some patients, during the course of the disease worsens.

Improper treatment of pathology can lead to the development of complications in the form of acute intestinal obstruction. In this disease, scar tissue closes the intestinal lumen. A rather severe complication is bleeding into the intestinal lumen, which is acute. The cause of this complication are ulcers in the affected area.

Untimely treatment of the pathological process can lead to rupture of the intestinal walls. The disease is accompanied by complications such as cancer, peritonitis. Some patients develop internal fistulas. Ignoring the disease can lead to an intra-abdominal abscess. An undesirable consequence of the pathological condition is toxic megacolon.

In order to avoid the occurrence of the above complications, timely treatment of complications is recommended.

Crohn's disease prevention

Since the exact cause of the pathological process has not been established, then specific prevention there is no disease. In order to avoid irritation of the intestinal wall and eliminate the possibility of the development of the inflammatory process, it is necessary to adhere to general recommendations. Patients are advised to avoid stressful situations and depression. Man must give up bad habits. The patient is recommended proper nutrition.

Crohn's disease is serious illness, in which the mucous layer of the digestive system is affected. If signs of illness appear, the patient should consult a doctor who, after the diagnosis, will prescribe adequate supportive therapy.

Crohn's disease is a chronic inflammatory process in the gastrointestinal tract that can affect all of its departments, from the oral cavity to the rectum. Inflammation develops simultaneously in the inner lining of the intestine and in its submucosal layers, with a predominant lesion of the terminal ileum.

In the intestinal mucosa, over time, deep ulcers develop, an abscess develops, leading to a narrowing of the intestinal lumen and other unpleasant complications. In most cases, the disease is characterized chronic course, with alternating periods of exacerbation and remission.

For the first time, the symptoms of the disease were described in 1932 by the American gastroenterologist B. Kron. In honor of him, the disease got its name. It is noted that Crohn's disease occurs with the same frequency in both sexes, and the prevalence of the disease is 50-95 people per 100,000 population.

At the same time, Europeans get sick much more often than Asians or Africans, and the most high frequency disease is noted in such an ethnic group as Ashkenazi Jews. The first signs of the disease may appear in adolescence are sometimes diagnosed with Crohn's disease in children. Most often, the disease manifests itself at the age of 13 to 35 years, the second peak of the increase in the incidence falls on age category over 60 years old.

Modern medicine still cannot determine the exact causes that trigger the mechanism this disease. Although there are several theories about what causes Crohn's disease, none of them are scientifically proven. Most scientists note the following factors that provoke the development of the disease:

1. The genetic factor is noted by many scientists. It has been observed that the risk of developing Crohn's disease increases 10 times if the family has direct relatives suffering from this disease. Very often, the disease is detected in siblings or identical twins.
2. infection theory. The followers of this theory argue that the cause of Crohn's disease can be pathogenic microflora, that is, various pathogenic bacteria and viruses that can cause inflammation in different parts of the intestine.
3. immunological theory. Many experts say that systemic organ damage in Crohn's disease may indicate an autoimmune nature of the disease. It manifests itself in disorder immune system, in which the body begins to produce antibodies against its own cells, destroying them and causing inflammation in the intestinal tissues.

In addition, many experts call smoking, alcohol abuse, unfavorable ecological environment, stress and mental strain among the provoking factors. Others attribute the risk of developing the disease to increasing age, taking certain medications, or an unbalanced diet, which is dominated by fats and refined foods.

In Crohn's disease, a classification is most often used based on the localization of inflammatory phenomena in various parts of the gastrointestinal tract. According to her, there are several main forms of the disease:

• Ileitis - an inflammatory process that affects the ileum.
• Ileocolitis is the most common form, affecting the ileum and colon.
• Gastroduodenitis - characterized by the development of an inflammatory process in the stomach and duodenum.
• Colitis - inflammation affects only the large intestine, otherwise this process is called Crohn's disease of the colon, since other parts of the gastrointestinal tract are not affected.
• Eunoileitis - an inflammatory process covers the ileum and small intestine.

According to the form of the course of the process, Crohn's disease is:

1. Chronic
2. Acute

Since Crohn's disease can affect any part of the gastrointestinal tract, the clinical picture of the disease is very diverse, and the symptoms depend on the localization of the inflammatory process. All manifestations of the disease can be divided into local, extraintestinal and general. The main local intestinal symptoms include:

• Abdominal pain. Pain may be mild or may have an acute cramping character and be accompanied by a feeling of bloating and heaviness in the lower right abdomen. Such pains are often confused with manifestations acute appendicitis.
• Diarrhea. loose stool with an admixture of blood is considered a constant symptom of the disease. Its frequency can reach 10-20 times a day and be accompanied by painful sensations. After a chair, the pain usually subsides.
• Nausea, vomiting, loss of appetite (anorexia). These symptoms may be accompanied by a feeling of fullness and heaviness in the abdomen, bloating and increased pain after eating.
• Weight loss. As a result of a prolonged inflammatory process in the intestine, there is a violation of absorption processes nutrients and vitamins, which leads to metabolic disorders and contributes to weight loss, the formation of gallstones and osteoporosis.

Extraintestinal manifestations of the disease include:

• Eye lesions (keratitis, conjunctivitis, uevitis)
• Skin lesions (erythema nodosum, pyoderma)
• Joint damage (spondylitis, monoarthritis)
• Oral lesions (stomatitis)
• Biliary tract lesions (cirrhosis, fatty liver, cholangiocarcinoma)
• Kidney damage (cystitis, pyelonephritis, hydronephrosis)
• Increased risk of developing cancer (colon carcinoma).

General symptoms of the disease occur due to intoxication of the body and a decrease protective functions immune system. These include:

Constant fatigue
Weakness
Malaise
Fever with chills
Wave-like rise in temperature
Blood clotting disorders, anemia

Sometimes, due to characteristic symptoms(abdominal pain, upset stool), Crohn's disease is difficult to distinguish from other diseases (acute appendicitis, ulcerative colitis or irritable bowel syndrome). Therefore, if there are cramping pains in the abdomen that do not go away within 6 hours, you should seek medical help.

Dangerous Complications

Crohn's disease is dangerous not only for its unpleasant manifestations, but also for the most severe complications that can only be eliminated surgically. These include:

1. Perforation of the intestinal wall, with the addition of peritonitis
2. Profuse bleeding
3. External and internal fistulas, ulcers
4. Inflammatory infiltrates and strictures (narrowing of the lumen) of the intestine
5. Risk of adenocarcinoma
6. Foci of suppuration (abscesses)

Crohn's disease is characterized by a chronic, long-term course, exacerbations of the disease can continue throughout the patient's life. The course of the disease in each specific case in some patients, the symptoms may be mild and not particularly affect the well-being, while in others, an exacerbation of the disease may be accompanied by severe, life-threatening complications.

Therefore, if you suspect the presence of Crohn's disease, you should seek the advice of a therapist. He, if necessary, will give a referral to a gastroenterologist or surgeon.

Diagnosis: necessary tests

Diagnosis of Crohn's disease in most cases is difficult, since its implicit manifestations are ignored by patients, and pain, arising in the abdomen, rarely have a permanent localization. This leads to the fact that the disease remains without diagnosis and treatment for many years and over time causes more and more severe lesions and changes in the intestinal mucosa.

When a patient addresses with characteristic complaints, the doctor begins with a patient questioning, anamnesis and external examination. During examination and palpation, attention is paid to the skin, an increase (bloating) of the abdomen, with deep palpation, characteristic zones of sensitivity and pain are found.

• The patient is prescribed a general, biochemical and immunological blood test. They do this to detect signs of inflammation, anemia, and nutritional deficiencies.
• Urinalysis can confirm infection urinary tract and define functional state kidneys.
• Fecal analysis will help, since the manifestations of these diseases are in many ways similar. Detection of leukocytes in the feces will be a sign of Crohn's disease.
• An analysis for specific antibodies allows you to diagnose inflammation of the intestine and distinguish Crohn's disease from ulcerative colitis. In addition to laboratory tests, the patient will be prescribed instrumental methods research:

An effective screening test for detecting Crohn's disease does not yet exist. But if you have been diagnosed with this disease for a long time (more than 10 years), you need to conduct a study to rule out the presence cancerous growths. The screening procedure will consist of taking tissue samples (biopsies) from different parts of the intestine during a colonoscopy.

During diagnostic studies, the doctor must exclude diseases similar in symptoms to Crohn's disease. Thus, it is necessary to differentiate diseases such as irritable bowel syndrome, acute appendicitis, ischemic and ulcerative colitis. Let's take a closer look at how ulcerative colitis differs from Crohn's disease.

Crohn's disease and ulcerative colitis: what's the difference?

Ulcerative colitis or is a chronic inflammation of the colon mucosa due to the interaction hereditary causes and environmental factors. Ulcerative colitis and Crohn's disease, only with colitis the nature of the course of diarrhea is more severe. In addition, abdominal pain with colitis is rarely permanent.

In Crohn's disease, the inflammatory process affects not only the surface of the mucosa, but also penetrates into the deeper layers, and the disease can affect any part of the intestine. In ulcerative colitis, inflammation occurs only in the large intestine. UC and Crohn's disease are distinguished by the nature of intestinal lesions.

In ulcerative colitis, areas of the mucosa are loose and edematous, normal mucosa may be completely absent, and instead of it, an ulcerated bleeding surface is observed during the study. Whereas in Crohn's disease, the affected areas of the mucosa alternate with normal ones, polyps, deep ulcers, fistulas, granulomas, and anal fissures can be diagnosed.

The main methods of treatment for Crohn's disease should be aimed at reducing the inflammatory process, stabilizing the patient's condition and preventing the development of complications. Drugs are selected individually, their effectiveness and tolerability by the patient is assessed over time.

With an exacerbation of the disease, broad-spectrum antibiotics (metronidazole, rifaximin, ciprofloxacin, clotrimazole) are usually prescribed. They are taken for a long time, from one and a half to three months.
For cupping unpleasant symptoms salicylates are used: sulfasalazine or mesalamine. Corticosteroids (prednisolone, methylprednisolone) are prescribed to reduce the inflammatory process.

They need to be taken for a long time, sometimes from several weeks to two months, while it should be borne in mind that these drugs have serious side effects. They cause an increase in blood pressure and the development of osteoporosis. Therefore, the drug budesonide, which has less pronounced side effects and quickly leads the disease to a state of remission, is more acceptable.

In many cases, the use of immunosuppressants that suppress the malfunctioning of the immune system (methotrexate, azathioprine) is justified. Patients are actively prescribed probiotics and vitamins of group D. In some cases, when antibiotics do not cope with the treatment of fistulas, the doctor may prescribe the antagonist infliximab.

Currently, doctors are trying to apply new methods of treatment, for which they use enzymes, immunomodulators, sorbents. Plasmaphoresis and plasmasorption procedures are prescribed to patients.
After the disease returns to remission, you will need to re-take tests every three months and see a doctor every six months if the condition is stable. If exacerbations occur, you will have to visit the doctor more often.

If conservative drug therapy does not help, and complications develop that threaten the life of the patient, surgical operation, while it is important to consider how long the exacerbation of Crohn's disease lasts.

During surgery, the surgeon removes the affected part of the intestine, drains purulent abscesses, closes fistulas or expands the narrowed intestinal lumen and removes scar tissue. Most patients with Crohn's disease have to undergo surgery at some point in their treatment.

Moreover, it is noted that the removal of the affected part of the intestine does not guarantee a cure and gives only a temporary remission, and the disease returns after a while. More than half of the operated patients have to do one or more operations repeatedly.

Diet for Crohn's Disease: Do's and Don'ts

In combination with drug therapy, doctors pay great attention to special diet, which is very important for reducing mechanical, thermal and chemical irritation of the intestine. The diet for Crohn's disease is not very strict, the main thing in it is respect for the intestines.

With the development of severe exacerbations, the patient is recommended to refuse food altogether for two days. During this time, the patient should definitely drink up to two liters of fluid per day. If an exacerbation of moderate severity is diagnosed, it is better for the patient to arrange fasting days.

If there is no intolerance to dairy products, you can drink 1.5 liters of kefir or milk during the day. If the patient is lactose intolerant, you can eat up to 1.5 kg of apples or finely grated carrots per day. After hungry or unloading days, you must constantly adhere to the diet. Prohibited products for this disease include:

It is recommended to minimize the amount of daily absorbed fat (no more than 70g per day), the amount of foods rich in carbohydrates should not exceed 250g per day. Limit salt intake and increase protein content in the diet. Foods that cause fermentation in the intestines are excluded from the menu. It is recommended to drink up to 2 liters of fluid per day.

What dishes and products are allowed to eat? Without fear, you can cook low-fat fish and meat soups, but the cereals in them should be well boiled, and the vegetables finely chopped or grated. Mucous decoctions are welcome, you can cook mashed soups. You can not use cold soups and broths seasoned with millet or barley.

Lean meat is best boiled or stewed and eaten pureed. It is better to cook meat cutlets, dumplings, meatballs, pates. You can not eat fatty duck, goose meat, fatty pork, lard, stew.
Allowed low-fat river or sea ​​fish boiled or stewed. excluded salty fish, canned fish. Nutritionists do not advise eating hard-boiled eggs, it is better to cook steam omelettes or boil soft-boiled eggs. Porridges are cooked in water or low-fat broth, they need to be well boiled or wiped.

Vegetables are best eaten after heat treatment. It is undesirable to use garlic, radish, radish, hot and bell pepper, that is, products that can irritate the mucous membrane. Whole milk is better to exclude from the diet, you can eat three-day dairy products, which have a fixing effect and low-fat, fresh cottage cheese in a pureed form. Kissels, jelly and compotes from fruits and berries are useful. You can drink weak tea, but it is better to brew tea with herbs or drink rosehip broth. Fast food, cabbage, nuts, corn, which are difficult to digest, should be excluded from the menu, as well as alcohol, kvass, beer, and grape juice should be completely excluded.

A diet for Crohn's disease will bring undoubted benefits, improve well-being, help eliminate unpleasant symptoms and prolong the period of remission. Patients note a significant improvement in the combination of drug treatment, diet and light physical activity.

Hippocrates said that illness does not fall from the sky, but is the result of all the little mistakes we make every day.

Inflammatory bowel disease (IBD) is common name two diseases - ulcerative colitis and Crohn's disease. The incidence of nonspecific ulcerative colitis is 30-100 people per 100,000 people, Crohn's disease is 50-150 cases per 100,000 people. But recently the number of patients increases by 3-5 cases per year. Moreover, men get sick 8 times more often than women.

Crohn's disease (CD) - chronic inflammatory disease intestine, affecting to one degree or another all parts of the alimentary canal from the mouth to the anus and perianal folds, for which transmural lesions of the intestinal wall are typical

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with predominant localization in the mucosa of the large intestine.

The causes of Crohn's disease and Ulcerative colitis remain unclear.

Most experts believe that ulcerative colitis and Crohn's disease are caused by different etiological factors, which, when exposed to the human body, trigger the same universal pathogenetic mechanisms of autoimmune inflammation. Although the causes of inflammatory bowel disease have not been elucidated, the role of the following groups of factors can now be considered with certainty.

Genetic factors.

The role of hereditary factors is confirmed by the increased prevalence of IBD in families where there are cases of CD or UC. For example, the Americans Jewish origin The prevalence of UC is several times higher than the incidence observed in other ethnic groups USA.

Most often, the disease is transmitted to blood relatives, twins and siblings. To date, there are 34 known variants of the gene that causes Crohn's disease.

Allergic theory.

Sensitization to cow's milk protein plays a certain role. Children with CD were several times less likely to be breastfed than healthy children.

neurogenic theory.

The provocative influence of psychosocial factors and emotional stress on the occurrence and exacerbation of IBD has been proven.

Infection theory.

The main etiological role in Crohn's disease is assigned by supporters of the infectious theory Mycobacterium paratuberculosis and the measles virus. The commonality of the clinical picture of Crohn's disease and intestinal tuberculosis, as well as the presence of granulomas, make us think about the tuberculous etiology of Crohn's disease. However, the absence of Mycobacterium tuberculosis in the granulomas, negative attempts to infect guinea pigs, a negative Mantoux test, and unsuccessful attempts at anti-tuberculosis treatment indicate a non-tuberculous nature of this disease. Proponents of the viral etiology of Crohn's disease believe that the measles virus can cause vascular disorders in the intestinal wall, which determine the originality of the clinical picture. However, in Crohn's disease with the help of modern virological research fails to detect measles virus in intestinal tissue. One of the arguments in favor of the infectious etiology of Crohn's disease is the positive clinical effect of antibiotic therapy.

Violations of local immunity.

The role of disorders of the immune system of the intestinal mucosa cannot be discounted. Immune dysregulation leads to the activation of T-lymphocytes, which initiate tissue damage and a chronic inflammatory process. The mechanism of tissue damage is realized by lymphokines and cytokines produced by T-lymphocytes. In addition, there is the production of antibodies to antigens of intestinal epithelial cells.

An important link in the pathogenesis is a decrease in the production of leukocyte interferon, which contributes to insufficient activation of macrophages for antigen processing.

In patients with inflammatory bowel diseases, the mucosa showed an increase in the number of immature macrophages that did not actively produce anti-inflammatory cytokines, in particular interleukin 1 and tumor necrosis factor.

Also, development Crohn's disease and ulcerative colitis associated with trauma, purulent infection, helminthiasis, roughage and vascular disorders. Defeat is celebrated lymphatic vessels submucosa with subsequent ulceration of the mucous membrane and the development of the inflammatory process. The disease can be acute or chronic with frequent exacerbations.

The disease is usually treated with medication. Therapy is aimed at eliminating the symptoms, since there is no specific cure for Crohn's disease.

How to treat chronic inflammatory bowel disease (Crohn's disease and Ulcerative colitis)?

1. It is extremely important that a person and the bacteria that live in his small intestine “friendly” coexist together. If the balance of microflora in the small intestine is disturbed, inflammatory processes and associated damage may occur in the body. various bodies and fabrics. Disturbance of the intestinal microflora can lead to Crohn's disease or ulcerative colitis. A change in the ratio of bacterial strains in the intestine also provokes the development of liver diseases. Fiber - food for intestinal microflora.

Plant foods that we habitually eat - leaves, vegetables, fruits - contain fiber. Many people (especially those with stomach ulcers, bowel ulcers, or Crohn's disease) are sensitive to any type of fiber, raw foods generally.

Ulcerative colitis and Crohn's disease are among the so-called autoimmune diseases (as are rheumatoid arthritis, lupus, diabetes, inflammation thyroid gland etc.), when the immune system "attacks" the tissues of its own body. The factors that trigger these autoimmune reactions can be very different in different people. One such factor, for example, is eating foods that contain wheat (due to its high gluten content). Wheat grains contain both types of fiber, while wheat bran is widely used as a source of insoluble fiber.

Psyllium has all the virtues of fiber, plus its mild effect - even irritable bowel syndrome or chronic ulcerative colitis is not a contraindication in this case. Research shows other additional benefits of Psyllium fiber. It is, for example, recommended for people suffering from hormone-dependent cancers, including prostate cancer. This is because fiber binds excess hormones like estrogen and removes them from the system, reducing them. undesirable consequences. Relief of menopausal symptoms associated with fluctuating hormone levels is another reason to try Psyllium.

2. Let's pay attention to where these diseases develop. In the gastrointestinal tract. And what does it serve? For the body to accept everything new, and most importantly - to get rid of everything unnecessary. And the main emotion that leads to the development of such a disease is the unwillingness to part with old ideas about life, with outdated thoughts. A person is afraid to give up something old, because he is not sure of himself.

You need to get rid of old grudges and accept everything with joy.

3. In the process of treating Crohn's disease and nonspecific ulcerative colitis, the following tasks are set: suspension of the inflammatory process, normalization of the immune system (stopping of autoimmune and allergic reactions), stimulation of tissue regeneration, normalization of metabolism, treatment of complications resulting from the disease.

Therapy of active Crohn's disease with Boswellia serrata extract H 15. February 2011
http://www.ncbi.nlm.nih.gov/pubmed/11215357

The aim of this clinical study was to compare the efficacy and safety of Boswellia serrata extract H15 with mesalazine for the treatment of active Crohn's disease. Patients and Methods: A randomized, double-blind, Verum-controlled, parallel group comparison in which 102 patients were randomized. The per capita protocol included 44 patients treated with H15 and 39 patients treated with mesalazine. As the primary outcome of the change in Crohn's Disease Activity Index (CDAI) between enrollment status and end of therapy was chosen. H 15 was tested to be no less than standard mesalazine treatment. RESULTS: CDAI between enrollment status and end of therapy after H15 treatment was reduced by 90 and after mesalazine treatment by 53 points on average. In this not inferior to the investigative test, the hypothesis was confirmed by statistical analysis. The difference between the two treatments could not be shown to be statistically significant in favor of H15 for the primary outcome. Secondary efficacy endpoints validate the comparison between H15 and mesalazine. The proven tolerability of H15 completes the results showing clinical efficacy.

CONCLUSIONS: The study confirms that H15 therapy is not inferior to mesalazine. This can be interpreted as evidence of the state-of-the-art efficacy of H15 in the treatment of Crohn's disease of the active extract of Boswellia serrata, as the efficacy of mesalazine for this indication has been approved by the health authorities. Given how safe and effective Boswellia serrata H15 extract is, it appears to be superior to mesalazine in terms of benefit and risk assessment.

The main task of Zenslim Arthro is to restore metabolism (metabolism), eliminate systemic inflammation andhelp the body find its own direction of healing.

Depression leads to gut inflammation

Depression leads to gut inflammation

Depressive symptoms are associated with a two-fold increase in the risk of developing Crohn's disease, a chronic inflammatory disease of the digestive tract that typically affects the terminal small intestine and large intestine (jejunum and caecum).

Ashwin Anantakrishnan of Harvard Medical School in Boston and colleagues collected data on 152,461 women participating in the Nurses Health Study I and II. The researchers sought to determine whether there was an association between depressive symptoms, Crohn's disease, and ulcerative colitis disease of the large intestine, which is characterized by the appearance of ulcers on the intestinal mucosa).

During the observation of volunteers, specialists identified a total of 170 cases of Crohn's disease and 203 patients with ulcerative colitis. They found that women who had had depressive symptoms in the last four years prior to the start of the study were twice as likely to be diagnosed with Crohn's disease. And ladies with the same symptoms by the beginning of the experiment - one and a half times more often. However, no association was found between the presence of depressive symptoms (regardless of the period of their onset) in all participants and an increased risk of ulcerative colitis.

"We found that depressive symptoms were associated with a two-fold increase in the risk of developing Crohn's disease, but not ulcerative colitis. Although both recent symptoms of the disorder and those noted at the beginning of the study influence the onset of the disease, the association with recent symptoms was stronger "Our results support the potential importance of the biopsychosocial model in the pathogenesis of Crohn's disease and point to the need for further research on the effects of depression and stress on immune function," comments A. Anantakrishnan.

Criteria for establishing disability in children with Crohn's disease

Criteria for establishing disability in children with Crohn's disease

Crohn's disease is a chronic inflammatory disease of the digestive tract, mainly of the colon, characterized by steady progression of the process and the development of severe complications.
The frequency is 3.5 per 100,000 of the population, of which in 20-25% the onset of the disease is attributed to childhood.
The etiology is unknown. The disease is classified as multifactorial. polygenic; identified genetic markers predisposition - HLA antigens DR1, Drw5. As a result of exposure to various antigens (antigens of cow's milk and other food ingredients, infectious agents, of which the role of clostridia has recently been noted, medicines etc.) there is an immunopathological process (immunocomplex) in the form of a regional undulating current primary vasculitis, developing mainly at the microcirculatory level. accompanied by hypercoagulation, ischemia up to the development of multifocal microinfarcts, necrobiological and dystrophic changes in the intestinal wall, leading to a violation of its permeability, penetration of infection and catabolism products.
In Crohn's disease, various sections of the digestive tract are affected: most often the caecum and distal ileum, but the left sections of the large intestine, small intestine, and even the esophagus, stomach, and duodenum can be affected.
The main morphological criterion for the diagnosis of Crohn's disease in adult patients are sarcoid-like granulomas with multinucleated giant cells found in the biopsy.
In children, a complex of signs is more common: perifocal fibrosis around the lymphoid follicles and dystrophic changes epithelium above them, adhesion of lymphoid tissue to the surface of the epithelial layer, vascular structures in the lamina propria of the mucous membrane, similar to the tissue of an amputation neuroma.
The disease is characterized by a strict limitation of the affected area from healthy tissues, the alternation of pathological and healthy tissues ("kangaroo jumps", "cobblestone" relief).
Inflammation captures the entire thickness of the intestine down to the serous layer, accompanied by local lymphostasis and occlusion of arterioles. The process spreads from the inside, from the thickness of the intestine, so the ulcers are always deep, aphthous or slit-like (fissures), the development of external adhesions and fistulas is characteristic.
Clinical picture: the disease develops gradually, there may be a latent course for a long time - melena, diarrhea, weight loss, growth retardation, abdominal pain, more often in the right iliac region, damage to the anal and perianal region (chronic deep fissures, fistulas, paraproctitis). The disease is characterized by a slow but steadily progressive course, poorly amenable to therapy.
Complications: intestinal bleeding, perforation, fistula formation, paraproctitis and other infectious complications up to sepsis; intestinal obstruction as a result of intestinal stenosis.
Laboratory and instrumental methods necessary to confirm the diagnosis:
1. x-ray examination (segmental lesion with narrowing of the intestine up to stenosis);
2. endoscopic signs;
3. biopsy and histological examination.
Treatment: diet (table N 4), basic therapy with non-hormonal anti-inflammatory drugs (sulfasalazine), immunomodulators (interferon preparations), eubiotics, angioprotectors.
In severe cases - the appointment of hormonal drugs and cytostatics (see Section "Ulcerative nonspecific colitis").
Forecast: unfavorable in relation to recovery.
It is advisable to send children to the ITU no earlier than 6 months after the debut, as well as with UC. The disease is primarily chronic from the moment of debut, however, it is possible to determine the severity of the disease as chronic only after assessing the effectiveness of basic therapy.
At mild form remission of the disease is achieved during therapy with non-steroidal anti-inflammatory drugs, which indicates persistent minor disorders of the digestive function that do not lead to limitation of the life of patients in any category.
In moderate and severe cases, corticosteroids are included in the basic therapy.
The prevalence and activity of the process, as well as aggressive therapy, lead to persistent moderate, pronounced and significantly severe violations, both digestive functions and immune functions, to metabolic disorders, multiple organ failure in colitis, which limits the child, respectively, in the categories of movement, self-service, education.

Korean doctors help every patient with Crohn's disease

Korean doctors help every patient with a dangerous pathology - Crohn's disease.

Based on the principle of individuality, Korean doctors help each patient with dangerous pathology- Crohn's disease. It is considered one of the most terrible and most difficult to treat diseases of the gastrointestinal tract.
Crohn's disease is characterized by a chronic course, accompanied by an atypical inflammatory process with segmentation, the formation of deep ulcers and damage to all layers of the gastric mucosa. It can affect absolutely any part of the gastrointestinal tract, but most often it affects the small and large intestines. Despite the fact that this disease is quite rare, everyone needs to know its manifestation in order to consult a doctor in time for treatment.
Today, scientists suggest three main factors that can be the impetus for the development of the disease:
Genetic: most often the disease is transmitted to blood relatives, twins and siblings. To date, 34 gene variants are known to cause symptoms;
Infectious: was found only in rats, in humans, doctors also suggest the possibility of an infectious effect, for example, pseudotuberculosis bacteria;
Immune: It is possible that Crohn's disease is autoimmune in nature, as the analysis shows a significant increase in the number of T-lymphocytes.
Symptoms of Crohn's disease:
The mucosa of the large intestine is inflamed, covered with superficial ulcerations, which causes pain in the abdomen, blood and mucus in the stool, diarrhea, often accompanied by pain during defecation. In addition, general malaise, loss of appetite, and weight loss are common.
Crohn's disease can be suspected with persistent or nocturnal diarrhea, abdominal pain, intestinal obstruction, weight loss, fever, night sweats.
When the disease can affect not only the large intestine, but also the small intestine, as well as the stomach, esophagus, and even the mucous membrane of the mouth. The incidence of fistula in Crohn's disease ranges from 20% to 40%. Often develop narrowing of the intestine with subsequent intestinal obstruction, pseudopolyposis.
Extraintestinal manifestations of Crohn's disease include: skin manifestations, joint damage, inflammatory eye diseases, liver and biliary tract diseases, vasculitis (vascular inflammation), hemostasis disorders and thromboembolic complications, blood diseases, amyloidosis, metabolic disorders bone tissue(osteoporosis is bone thinning).
Crohn's disease is a relapsing or continuous disease that spontaneously resolves in 30% of cases without treatment.
Initial treatment in Korea is almost always conservative. Currently does not exist universal remedy for Crohn's disease, but one or more drug therapy is aimed at treating the disease early and relieving its symptoms.
With more common and difficult cases operation may be indicated. Sometimes, with the development of formidable complications of the disease, such as bleeding, acute intestinal obstruction or perforation of the intestine, it is necessary to perform emergency surgical interventions. Others, less urgent indications, include the formation of abscesses, intestinal fistulas (pathological messages various departments gastrointestinal tract), severe forms of perianal lesions, lack of effect of conservative treatment.
In Korean clinics, surgical treatment often leads to long-term relief of symptoms of the disease, reduces or eliminates the need for constant use of drugs. Surgical treatment is best done by a coloproctologist.
Although medical (conservative) treatment is preferred as initial stage, it is important to understand that about 3/4 of all patients eventually need surgical intervention. Surgery is not a "panacea", however, after one operation, many patients will not need additional operations. The most common treatment is conservative therapy with partial resection intestines (removal of only the affected part of the intestine).
A timely and adequate treatment program makes it possible to control the disease. Due to the high percentage of people predisposed to this disease, much attention is paid to the treatment of Crohn's disease in Korea.

In contact with

Classmates

Crohn's disease is a chronic inflammatory disease that affects the entire gastrointestinal tract (GIT), from the mouth to anus. Unlike ulcerative colitis, in Crohn's disease, all layers of the intestinal wall are involved in the inflammatory process.

Inflammation in most cases first occurs in the ileum, and then moves to other parts of the intestine. At the same time, the symptoms of acute ileitis (inflammation of the ileum) are indistinguishable from the symptoms of acute appendicitis, so patients are often operated on and a true diagnosis is made during the operation.

In the past few decades, Crohn's disease has become more common in both developed and developing countries. It occurs about equally often in men and women and often in members of the same family. As a rule, the disease begins before the age of 30; usually between 14 and 24 years of age. According to statistics, men get sick more often than women.

In each person, the disease affects certain areas of the intestine, and sometimes the affected areas alternate with healthy ones. In 35% of people with Crohn's disease, only the ileum is affected, about 20% only the colon, and 45% both the ileum and colon.

Crohn's disease affects not only the intestines, but also the skin, liver, eyes and joints.

Normally, the intestinal mucosa has villi, which increase its absorption surface, promote the absorption of nutrients that a person receives from food.

In Crohn's disease unknown reason the body's own immune cells destroy the villi, expose the intestinal mucosa, so the ability of nutrients to be absorbed is minimized.

Symptoms of Crohn's disease

With fever, which can be caused by purulent complications of Crohn's disease, the temperature reaches 39 - 40 ° C.

Most frequent early symptoms Crohn's disease:

• Chronic diarrhea (diarrhea)
• Blood in stool. Loose stools with blood persistent symptom, its frequency ranges from 3 to 10 times a day. After stool, the pain in the abdomen is relieved.
• Sharp abdominal pain
• Increase in body temperature
• Loss of appetite and weight loss.

The doctor may feel swelling in the lower abdomen, most often on the right side.

In children, gastrointestinal symptoms such as abdominal pain and diarrhea are often minor or absent, with joint inflammation, fever, anemia, or growth retardation being the main manifestations of the disease.

Some patients recover completely after a single attack affecting the small intestine. But usually, Crohn's disease flares up at irregular intervals throughout a person's life. These exacerbations may be mild or severe, brief or prolonged.

Why symptoms come and go, what provokes new exacerbations or determines their severity, is unknown. The inflammation tends to recur in the same part of the intestine, but after the affected part is surgically removed, it can spread to other areas.

Common complications of inflammation include the development of intestinal obstruction, the formation of pathological channels (fistulas) and pus-filled cavities (abscesses). Fistulas can connect two different parts of the intestine, as well as the intestine and bladder or intestines and skin surface, especially around the anus.

Perforation (perforation) of the small intestine is a rare complication. When Crohn's disease affects the colon, there is usually bleeding from the rectum. After many years of illness, the risk of developing a malignant tumor of the colon increases. Approximately 30% of people with Crohn's disease have some form of anal disorder.

Crohn's disease often co-occurs with other disorders such as gallstones, malabsorption of nutrients (malabsorption), and deposition of amyloid in tissues (amyloidosis). Aggravation gastrointestinal symptoms with Crohn's disease, it can be accompanied by inflammation of the joints (arthritis), the formation of sores in the mouth (aphthous stomatitis); inflamed nodules appear on the skin of the hands and feet (erythema nodosum) and blue-red sores on the skin containing pus
(pyoderma gangrenosum).

Even when there is no exacerbation of gastrointestinal symptoms, inflammation of the spine (ankylosing spondylitis), pelvic joints (sacroiliitis), internal structures eyes (uveitis) and bile ducts (primary sclerosing cholangitis).

Causes of Crohn's disease

The cause of Crohn's disease has not been established. Research has shown that the main possible causes three: dysfunction of the immune system, infections and dietary habits.

Diagnosis of Crohn's disease

A doctor suspects Crohn's disease if the patient has recurrent spasmodic abdominal pain and diarrhea, especially with inflammation of the joints, eyes, and skin. None laboratory research does not allow accurate diagnosis of Crohn's disease, but a blood test reveals anemia, an increase in the number of leukocytes, low level certain proteins and other signs of inflammation.

Barium x-ray can detect characteristics Crohn's disease in the colon.

If the diagnosis is still in doubt, a colonoscopy is performed - an examination of the colon with a flexible fiber-optic medical instrument and a biopsy (a piece of the mucous membrane is taken for microscopic examination). Although CT scan(CT) can show changes in the intestinal wall and abscesses, it is rarely used in the early stages of diagnosis.

Crohn's disease treatment

Because Crohn's disease affects the entire gastrointestinal tract, treatment for Crohn's disease is primarily medical. Surgical treatment is used only in the presence of complications for their correction.

There is no cure for Crohn's disease, but inflammation and symptoms can be reduced.

The doctor will prescribe remedies for stomach pain and diarrhea. Broad-spectrum antibiotics (effective against many types of bacteria) are also often prescribed. The antibiotic metronidazole (trichopolum) reduces the symptoms of the disease

Crohn's, especially when it affects the colon or is accompanied by the formation of abscesses and fistulas around the anus. However, if metronidazole is used for a long time, it can affect the nerves, resulting in tingling in the arms and legs. This side effect usually disappears when the medication is stopped, but then a recurrence of the disease is very likely.

Sulfasalazine and similar drugs help to suppress minor inflammation, especially in the colon. However, this remedy is less effective in sudden severe exacerbations of the disease.

Corticosteroids (hormonal anti-inflammatory drugs), such as prednisone, can dramatically lower body temperature, reduce abdominal pain and diarrhea, and improve appetite and general well-being. However, long-term corticosteroid therapy invariably causes significant side effects. Typically, high doses are given first to reduce inflammation and symptoms; then the dose is reduced and the drug is withdrawn as soon as possible.

Drugs such as azathioprine and mercaptopurine (cyclophosphamide) alter the activity of the immune system. They are effective in cases where the disease cannot be suppressed by other drugs, and also to maintain long periods remissions. These drugs significantly improve the general condition of the patient, reduce the need for corticosteroids, and often cure fistulas, but they are effective only after 3-6 months from the start of use and can cause serious side effects.
effects.

That is why the doctor carefully monitors the use of these drugs and monitors for allergies, inflammation of the pancreas (pancreatitis), and a decrease in the number of white blood cells.

The diet for this disease should include high-calorie foods containing a large amount of protein and vitamins with a restriction of fat and coarse-fibrous vegetable products that cause intestinal irritation. A carefully chosen diet for at least a short time can improve bowel obstruction or fistula and is especially needed in children as it promotes growth. It is prescribed before the operation or in addition to it.

Sometimes patients need parenteral (by injection) nutrition, then concentrated nutrients are given intravenously to compensate for the poor absorption of nutrients from the gut, which is typical of Crohn's disease.

If the bowel is blocked or the abscesses and fistulas do not heal, the question arises of an operation in which the affected parts of the bowel are removed. It may reduce symptoms indefinitely long term but does not cure the disease.

Inflammation usually recurs at the junction of the remaining parts of the intestine. In almost half of the cases, a second operation is necessary. Therefore, surgical intervention is resorted to only in cases where certain complications or ineffectiveness of drug therapy make it necessary. However, in most cases, patients believe that after surgery, the disease interferes less with normal life.

With Crohn's disease, foods containing coarse fibers should be excluded from the diet. Eat foods rich in vitamins and minerals. It is necessary to exclude the use of alcohol!

You can relieve inflammation in the intestines with the help of anti-inflammatory drugs that your doctor will recommend to you.

Prevention of Crohn's disease

Currently, there is no effective prevention of Crohn's disease. Therefore, the only way to protect yourself to some extent from the development of this disease is a healthy lifestyle, the exclusion of predisposing factors.

To prevent the development of complications, early diagnosis Crohn's disease and timely drug therapy. Therefore, self-medication when these symptoms appear is unacceptable.

Crohn's disease usually does not shorten a person's life expectancy. However, some patients die from malignant tumors of the gastrointestinal tract, which may develop as a result of long course Crohn's disease.

Important! Treatment is carried out only under the supervision of a doctor. Self-diagnosis and self-treatment are unacceptable!