Crohn’s disease is a granulomatous inflammation of various parts of the digestive tract, characterized by a chronic recurrent and progressive course. Crohn’s disease is accompanied by abdominal pain, diarrhea, intestinal bleeding. Systemic manifestations include fever, weight loss, damage to the musculoskeletal system (arthropathy, sacroiliitis), eyes (episcleritis, uveitis), skin (nodular erythema, gangrenous pyoderma). Diagnosis of Crohn’s disease is carried out using colonoscopy, intestinal radiography, CT. Treatment includes diet therapy, anti–inflammatory, immunosuppressive, symptomatic therapy; in case of complications – surgical intervention.
ICD 10
K50 Crohn’s disease [regional enteritis]
Meaning
Crohn’s disease is a chronic disease of the gastrointestinal tract of an inflammatory nature. In Crohn’s disease, the inflammatory process develops in the inner mucous membrane and submucosal layers of the wall of the gastrointestinal tract. The mucous membrane can be affected in any areas: from the esophagus to the rectum, but the most common is inflammation of the walls of the end sections of the small intestine (ileum).
The disease proceeds chronically, with alternating acute attacks and remissions. The first signs of the disease (the first attack), as a rule, occur at a young age – in persons 15-35 years old. Pathology is equally common in both men and women. A genetic predisposition to Crohn’s disease has been revealed – if relatives of the direct line suffer from this disease, the risk of developing it increases by 10 times. If the disease is diagnosed in both parents, the disease in such patients occurs earlier than 20 years in half of the cases. The risk of developing Crohn’s disease increases with smoking (almost 4 times), there is a connection between the disease and oral contraception.
Causes of Crohn’s disease
The causes of Crohn’s disease have not been definitively determined. According to the most common theory, the pathological immune response to intestinal flora, I write, entering the intestine, and other substances plays a major role in the occurrence of the disease. The immune system marks these factors as foreign and saturates the intestinal wall with leukocytes, resulting in an inflammatory reaction, erosion and ulcerative lesions of the mucosa. However, this theory has no reliable evidence.
Factors contributing to the development of Crohn’s disease:
- genetic predisposition;
- tendency to allergies and autoimmune reactions;
- smoking, alcohol abuse, medications;
- environmental factors.
Symptoms of Crohn’s disease
Intestinal manifestations of the disease: diarrhea (in severe cases, the frequency of bowel movements can interfere with normal activity and sleep), abdominal pain (severity depending on the severity of the disease), appetite disorder and weight loss. With severe ulceration of the intestinal wall, bleeding and the detection of blood in the feces are possible. Depending on the localization and intensity, blood can be detected by bright scarlet veins and dark clots. Latent internal bleeding is often noted, with severe blood loss can be very significant.
With a prolonged course, abscesses may form in the intestinal wall and fistula passages into the abdominal cavity, into neighboring organs (bladder, vagina), on the surface of the skin (in the anus). The acute phase of the disease is usually accompanied by fever, general weakness.
Extra-intestinal manifestations of Crohn’s disease: inflammatory diseases of the joints, eyes (episcleritis, uveitis), skin (pyoderma, erythema nodosum), liver and biliary tract. With the early development of Crohn’s disease in children, there is a delay in physical and sexual development.
Complications
Complications of Crohn’s disease can be the following conditions.
- Ulceration of the mucosa, perforation of the intestinal wall, bleeding, the exit of feces into the abdominal cavity.
- The development of fistulas in neighboring organs, the abdominal cavity, on the surface of the skin. The development of abscesses in the intestinal wall, the lumen of fistulas.
- Anal fissure.
- Colon cancer.
- Weight loss up to exhaustion, metabolic disorders due to insufficient absorption of nutrients. Dysbiosis, hypovitaminosis.
Diagnostics
Diagnosis of Crohn’s disease is carried out with the help of laboratory and functional studies. The most informative methods are computed tomography and colonoscopy. On the tomogram, fistulas and abscesses can be detected, and colonoscopy gives an idea of the state of the mucosa (the presence of inflamed areas, erosions, ulceration of the intestinal wall) and allows you to take a biopsy if necessary. Additional diagnostic methods are intestinal radiography with a barium mixture. You can get pictures of both the small and large intestines – a contrasting barium mixture fills the intestinal cavity and reveals narrowing of the lumen and ulcerative wall defects, fistulas.
Laboratory methods of investigation: general blood test, in which inflammatory changes are noted, anemia is possible, as a result of regular internal bleeding; coprogram, examination of feces for hidden blood. Sometimes capsule endoscopy of the digestive tract is used – the patient swallows a capsule with a mini-video camera and a transmitter. The camera captures the picture in the digestive tract as it progresses.
Crohn’s disease treatment
Since the causes of the disease are unknown, pathogenetic treatment has not been developed. Therapy is aimed at reducing inflammation, bringing the patient’s condition to prolonged remission, prevention of exacerbations and complications. Treatment of Crohn’s disease is conservative, carried out by a gastroenterologist or proctologist. Surgical intervention is resorted to only in case of life-threatening complications.
All patients are prescribed diet therapy. Prescribe diet No. 4 and its modifications depending on the phase of the disease. The diet helps to reduce the severity of symptoms – diarrhea, pain syndrome, and also corrects digestive processes. In patients with chronic inflammatory foci in the intestine, there are violations of the absorption of fatty acids. Therefore, foods with a high fat content contribute to increased diarrhea and the development of steatorrhea (fatty stools).
The diet limits the use of foods that have an irritating effect on the mucous membrane of the digestive tract (spicy, smoked, fried foods, high acidity of food), alcohol, carbonated drinks, coffee abuse. Smoking cessation is recommended. Fractional nutrition is used – frequent meals in small portions according to the regime. In severe cases, they switch to parenteral nutrition.
Pharmacological therapy of Crohn’s disease consists in anti-inflammatory measures, normalization of immunity, restoration of normal digestion and symptomatic therapy. The main group of drugs is anti–inflammatory drugs. In Crohn’s disease, 5-aminosalicylates (sulfazalin, mesazalin) and drugs of the corticosteroid hormone group (prednisone, hydrocortisone) are used. Corticosteroid medications are used to relieve acute symptoms and are not prescribed for long-term use.
Immunosuppressants (azathioprine, cyclosporine, methotrexate) are used to suppress pathological immune reactions. They reduce the severity of inflammation by reducing the immune response, the production of white blood cells. Infliximab is used as an anti-cytokine agent for Crohn’s disease. This drug neutralizes proteins-cytokines – tumor necrosis factors, which often contribute to erosion and ulcers of the intestinal wall. With the development of abscesses, general antibacterial therapy is used – broad-spectrum antibiotics (metronidazole, ciprofloxacin).
Symptomatic treatment is carried out with antidiarrheal, laxatives, analgesics, hemostatic drugs, depending on the severity of symptoms and their severity. To correct the metabolism, vitamins and minerals are prescribed to patients. Surgical treatment is indicated for the development of fistulas and abscesses (opening of abscesses and their sanitation, elimination of fistulas), the formation of deep wall defects with prolonged profuse bleeding, severe course of the disease that does not respond to conservative therapy (resection of the affected area of the intestine).
Prognosis and prevention
Methods for the complete cure of Crohn’s disease have not been developed to date due to the fact that the etiology and pathogenesis of the disease are not completely clear. However, regular adequate therapy of exacerbations and adherence to diet and regimen, medical recommendations and regular spa treatment contribute to reducing the frequency of exacerbations, reducing their severity and improving the quality of life.
According to experts in the field of clinical gastroenterology, the key points of prevention of exacerbations are diet therapy, balanced nutrition, the use of vitamin complexes and essential trace elements; stress avoidance, stress resistance development, regular rest and a healthy lifestyle; moderate physical activity; quitting smoking and alcohol abuse.
Literature
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- Cellular and molecular mechanisms underlying NOD2 risk-associated polymorphisms in Crohn’s disease. Strober W, Asano N, Fuss I, Kitani A, Watanabe T. Immunol Rev. 2014 Jul;260(1):249-60. link
- Crohn’s disease: on the occasion of the 80th anniversary of description. Parfenov AI. Ter Arkh. 2013;85(8):35-42. link
- Colobronchial fistula: an unusual complication of Crohn’s disease. Singh D, Cole JC, Cali RL, Finical EJ, Proctor DD. Am J Gastroenterol. 1994 Dec;89(12):2250-2. link
- Cytokine gene expression in intestinal tuberculosis and Crohn’s disease. Pugazhendhi S, Jayakanthan K, Pulimood AB, Ramakrishna BS. Int J Tuberc Lung Dis. 2013 May;17(5):662-8. link
