Inflammation of the gastrointestinal tract of a chronic nature, which potentially affects any part of this tract, from the mouth to the anus, is Crohn's disease. In this case, all intestinal walls are involved in the inflammatory process. Ulcerations appear on the mucous membrane of this organ, in the place of which granulomas, adhesions and strictures subsequently form, which narrow the intestinal lumen, disrupting its patency.
Reasons
The exact origin of this disease is unknown. Presumably the reasons are as follows:
- environment, including various toxins, tobacco smoke, food components that provoke an autoimmune process and disrupt the structure of the intestine;
- impaired immunity, as a result of which the body recognizes its own cells as foreign and attacks them;
- hereditary diseases:Crohn's disease is a pathology that is formed as a result of a mutation of the genome that has a genetic predisposition;
- infectious in nature, although no specific pathogen has been found to date, presumably caused by the pseudotuberculosis bacterium, treatable with antibiotics.
The chance of having Crohn's disease is increased under the following circumstances:
- measles and pseudotuberculous infection;
- increased physical and emotional stress;
- smoking;
- living in the Middle East;
- genetic predisposition;
- significant hormonal imbalances.
Symptoms
Crohn's disease is a disease classified into acute, subacute and chronic conditions. Each of them has its own non-specific symptoms, with which you can set the stage of development of the disease.
Signs of Crohn's disease:
- acute stage - pain appears in the lower right of the abdomen, body temperature rises, diarrhea appears; this can lead to an incorrect diagnosis, which can be the following: ovarian apoplexy, appendicitis, which leads to the need for surgical intervention, and only after it is carried out, the erroneous diagnosis is discovered;
- subacute - characterized by rapid weight loss, diarrhea is mild, there are cramping pain syndromes of various localization.
The most common chronic form. Symptoms develop slowly, a person is in no hurry to go to a medical institution. This form is characterized by the following features:
- weight gradually decreases due to the fact that food is poorly absorbed in the intestines;
- epithelial maceration and fissures may develop around the anus;
- temperature can increase up to 38°, with purulent complications it can increase even more;
- there is a loss of appetite;
- weakness and fatigue;
- cramping pains in different areas of the abdomen, aggravated after eating and weakened after a bowel movement;
- potential presence of blood in feces;
- bloating;
- diarrhea, with an exacerbation of Crohn's disease, the frequency can increase up to 6 times a day (in the period of remission it is intermittently present).
In addition, there are extraintestinal symptoms of this disease. These include:
- erythema nodosum - pustules or painful red nodules appear on the epidermis, which subsequently turn purple, after which they turn brown and yellow;
- mouth ulcers;
- pain syndromes in large joints;
- decrease in mobility;
- increase in temperature;
- vomit;
- yellowing of epithelial integuments;
- vision deterioration;
- pain syndromes in the right hypochondrium, sacral area, eyes.
In children, most commonly found in the jejunum and duodenum, often found in the small intestine.
Pathologyoccurs equally in both sexes. The average age of patients is 20-30 years old, in children - 12 years old.
A child with this disease often has a developmental delay. He has pain in his joints.
In addition, the following symptoms may occur:
- long time non-healing wounds;
- rash;
- eczema;
- dermatitis;
- inflammation of the mucous membrane of the mouth and eyes;
- hepatitis;
- presence of kidney stones;
- cholelithiasis;
- arthritis and arthritis.
Children always have blood in their stools. For them, when the process is localized in the rectum, damage to the liver, joints, and biliary system is characteristic. With the localization of the inflammatory process in the small intestine, urolithiasis and hydronephrosis may appear. With the active stage of the disease, aphthous ulcers may appear in the oral cavity.
ICD-10 Crohn's disease
The International Classification of Diseases (ICD) acts as a single normative document that takes into account the etiology of various pathologies and the mortality that they cause. There are currently 10 representations of the commission. The eleventh is due out in 2018. Crohn's disease according to ICD-10 has the code K50. A more detailed classification is given below:
- 50.0 - Crohn's disease of the small intestine.
- 50.9 - unspecified form of pathology.
- 50.1 - Crohn's disease of the colon.
- 50.8 - other types of the disease: inflammation of the digestive tract with the formation of fistulas on the inner surface, granulomaintestines, granulomatous enteritis.
Stages of Crohn's disease
The course of this disease has a different pathogenesis. Clinically, there are several stages of pathology:
- Ileitis occurring with the formation of fistulas both from the outside and from the inside.
- Stenosing ileitis, accompanied by complete or partial intestinal obstruction.
- Acute appendicitis-like enteritis occurring in an acute form in the terminal ileum.
- Chronic enteritis, accompanied by bouts of colicky pain with the appearance of mucus, blood in the feces, resembling ulcerative colitis.
Diagnosis
Due to the lack of knowledge on the causative agent of the disease, it is not possible to carry out special tests. Laboratory tests are ordered to detect the following abnormalities:
- inflammatory processes (the number of lymphocytes decreases with an increase in the number of leukocytes);
- they are also tumor pathologies detected in a blood test, as indicated by the presence of calprotectin;
- decrease in total protein levels;
- anemia.
After identifying these abnormalities, instrumental research methods are prescribed to make a diagnosis of Crohn's disease. These include the following:
- electrogastroenterography to study the motor function of the intestine;
- MRI with contrast in the form of water introduced into this organ to determine the degree of damage, diagnosing enlarged lymph nodes andthe presence of fistulous passages;
- Ultrasound for peritonitis, which is a hallmark of Crohn's disease;
- examination of the bowel with x-rays using barium, which shows cracks and narrowing of the passage;
- CT, which detects abscesses and infiltrates;
- Endocapsular colonoscopy, in which a pill is swallowed, equipped with a camera, which, passing through the organ in question, takes pictures, which are then examined by the appropriate specialists;
- gastroduodenoscopy using a special device to examine the duodenum, esophagus and stomach;
- colonoscopy - examination of the large intestine using a probe-like instrument A camera built into a tube, with which pathologies of the mucosa and its surface are observed on the screen (in the presence of ulcerative defects, it is possible to take a biopsy for examination).
Therapy
How to treat Crohn's disease? It can be cured in the early stages. When it goes into a chronic form, you need to take medicines constantly and follow a diet. For maximum effectiveness of treatment, three methods are used simultaneously:
- diet;
- symptomatic treatment of complications, usually leading to surgery;
- drug therapy.
Medication use
Therapy for Crohn's disease is the use of drugs. They are selected in such a way as to influence the maximumpossible number of pathogens due to the undetermined etiology of the disease.
The following means are used:
- antibiotics: Ciprofloxacin, Metronidazole;
- probiotics: "Bifidum-Bacterin", "Bifiform", "Linex";
- antidiarrheal drugs "Loperamide", "Imodium", which are prescribed in the absence of blood in the feces and negative results of bacteriological studies;
- antibodies to tumor necrosis: Golimumab, Infliximab, Adalimumab;
- immunosuppressors: Methotrexate, Prednisolone, Azathioprine, Methylprednisolone;
- aminosalicylic acid derivatives: Sulfasalazine, Mesalazine;
- vitamin D.
Surgery
How to treat Crohn's disease? Basically, surgery is needed. It is used in cases where drug therapy, diet and lifestyle changes have not helped. More than half of patients who have had this ailment undergo at least one surgical intervention associated with the removal of part of the intestine. But even such treatment does not eliminate the risk of recurrence of the disease. In this regard, you can often find advice on postponing surgery as long as possible, which will reduce the number of operations.
Folk remedies
They are used as an additional aid to the main treatment. With the help of folk remedies for Crohn's disease, you can alleviate the patient's condition, relieve pain syndromes and some symptoms,appearing periodically. What does it take?
The following can be used as folk remedies for Crohn's disease:
- Collection of herbs, 5 g each: chamomile, sage, yarrow. Brew in a glass of boiling water, boil for 5 minutes, leave for 2 hours, cool, strain and take 2 tbsp every 2 hours. l.
- 20 g of chamomile flowers are brewed in one liter of boiling water, left to infuse for 1 hour. Then the infusion is poured into a thermos and taken 200 g every 4 hours.
- 10 g of buckthorn and yarrow bark are mixed with 30 g of bare licorice, 20 g of mustard seeds and anise fruits are added. 2 tablespoons of this mixture are poured into 250 ml of boiling water, after which they are boiled for another 10 minutes, cooled, filtered. Carry out reception in the morning and in the evening for half a glass.
- Mix equal amounts of valerian root, mint leaves, chamomile flowers and cumin fruits, 1 tbsp. l. the mixture is added to 1.5 cups of boiling water and left to infuse for 1 hour. Reception is carried out three times a day for half a cup.
Pain syndromes and inflammation can be reduced with the following folk remedies for Crohn's disease:
- Add 2 tbsp. l. dry crushed yarrow, put 250 ml of warm water there, put on fire for 15 minutes, then insist in a warm place for 45 minutes, after which the broth is filtered and consumed 4 times a day 30 minutes before meals, 1 tbsp. l.
- 2 tsp fresh hyssop is poured into a saucepan,pour 250 ml of previously boiled water, bring to a boil, cool for 5 minutes and filter.
- When using dry hyssop, the proportions are the same, but boiling is not carried out, it is poured with boiling water and infused for a third of an hour. In both cases, the infusion is taken 1 cup in the morning and evening for two weeks, after which they take a one-week break and repeat the course again.
- 1 tbsp l. chopped sage is poured with a quarter liter of boiling water and infused for 1 hour, filtered and taken half a glass four times a day.
In addition, other prescriptions can be used to relieve symptoms:
- With flatulence and colic, chamomile flowers, centaury and sage are mixed in equal proportions, to 3 tbsp. l. of this collection, add 500 ml of boiling water, insist until the solution cools down. Take 1 tbsp. l. up to 8 times a day, reducing the number of doses after 3 months to 3 and reducing the dose to 1 tsp.
- With bloating and pain syndromes, you can make an anise infusion by adding 250 ml of boiling water to 1 tsp. seeds. Infuse for 5 minutes and take throughout the day.
- As an antispasmodic and anti-inflammatory, antihistamine, onion peel can be used. About 1 cup is poured with 8 cups of water, the solution is brought to a boil, not completely covered with a lid and boiled for 1 hour over low heat, cooled and filtered. They use 3-6 times a day, 100 ml each, while taking it, a remission of the disease may occur, in which case the number of doses is reduced by three times.
- Ifthere are intestinal colic, then use a tincture of dry lily of the valley, which is poured into 0.5 liters of alcohol per half a glass of dry grass, insist 2 weeks, use 20 drops diluted in water, 3 times a day.
Diet
One of the main he alth measures for Crohn's disease is to maintain an optimal diet. At the same time, bowel function improves and pain syndromes decrease.
Allowed dishes:
- vegetable soups cooked on the second broth;
- teas;
- compotes prepared on the basis of non-acidic berries;
- stewed or steamed meat;
- boiled eggs;
- low-fat cottage cheese, sour cream, milk in small quantities;
- biscuits;
- croutons;
- mucous porridge;
- boiled and baked vegetables.
Forbidden foods:
- pickles;
- semi-finished products;
- barley and wheat porridge;
- legumes;
- fresh fruits and vegetables;
- confectionery;
- strong tea;
- coffee;
- carbonated drinks;
- sour juices;
- fried;
- canned food;
- mushrooms.
Nutrition for Crohn's disease should be balanced, as anemia and beriberi may occur due to the fact that food is poorly absorbed.
The selection of dishes should be individual. With an exacerbation of Crohn's disease, it is recommended to adhere to a strict diet of the first table, after which you can startintroduce some products, following the reaction of the body. The diet must be followed throughout life. This is especially important for children, because if it is not observed, the disease affects the physical and mental development of the child.
Complications
Due to the fact that the symptoms of the disease are nonspecific, it is difficult to make a timely diagnosis in most cases, which leads to the development of various complications.
In Crohn's disease, the main ones are:
- paraproctitis - inflammation of fatty tissue with discharge of pus around the rectum;
- fistula;
- anal fissures;
- intestinal bleeding (rarely observed);
- toxic dilatation leading to bowel dilatation induced by antidiarrheals or colonoscopy;
- intestinal obstruction - most commonly seen in Crohn's disease of the small intestine, with constriction of peristalsis and narrowing of the lumen;
- infiltration and abscess in the abdominal cavity;
- perforation - the contents of the intestine enter the abdominal cavity due to ulcerative defects, leading to peritonitis requiring immediate surgical intervention.
In some cases, Crohn's disease can be disabled. The grounds for its acquisition by a specific person are as follows:
- impossibility of selection of therapeutic treatment;
- severe illness;
- disability;
- complications inthe result of pathology.
Forecast
The prognosis of Crohn's disease depends on the individual characteristics of the organism and the focus of damage. Mortality can occur due to ongoing surgical interventions and complications. A recurrence of the disease is possible on average once every 20 years, although it can occur more often. This disease should be accompanied by constant monitoring of the patient in order to adjust the therapy used if necessary.
Pregnancy with illness
This disease affects mainly young people, so they have a reasonable question about the possibility of planning a pregnancy in the presence of this pathology. Many modern doctors categorically do not recommend carrying and giving birth to a child in the presence of this disease. However, studies by Western experts indicate that it is possible to plan a pregnancy during this period. It is important to study the medical history of Crohn's disease. If a period of remission occurs, then the pregnancy process proceeds mainly without pathological changes. A woman can have he althy babies, but only if the disease is in stable remission.
The biggest problem in pregnancy is that differential diagnosis cannot be performed, which means that sigmoidoscopy and colonoscopy are difficult due to the fact that the colon is displaced by the uterus, and fluoroscopic examination of the intestine is impossible.
Activity influences pregnancy complicationsinflammatory process occurring in the digestive organs. During the active form of the disease, the risk of preterm birth, spontaneous miscarriages and fetal malnutrition increases many times over.
If the conception of a child occurred during the period of remission of Crohn's disease, then it persists throughout the entire period of pregnancy. In this regard, a woman who decides to have a child, but suffers from this ailment, must undergo a diagnostic study and consult a specialist.
In the first months of gestation, an exacerbation is sometimes observed, but a competent doctor can prescribe drugs that will not harm either the woman or the unborn child.
The birth of such women is mainly carried out by caesarean section. It is used even if the pregnancy proceeded without pathological dynamics, since in the perineum of a woman with Crohn's disease, prianal lesions and scarring are observed.
In closing
Crohn's disease is a severe bowel disease, the symptoms of which can appear in any part of the gastrointestinal tract, as well as on the skin. Stones may appear in the kidneys, gallbladder. The disease has no clear etiology, so it is difficult to treat. Therapy and diet are applied throughout life. The disease is accompanied by various complications and has a favorable prognosis only with early diagnosis and adequate treatment. In most cases, surgery is required. But even it does not guarantee that there will be no recurrence of the disease. Treatment can be supplemented by the use of folk remedies. There are differentpoint of view on pregnancy planning in such a disease. This is relevant due to the fact that the disease is mainly found in young people. Western experts believe that childbearing and childbirth are possible when pregnancy occurs during remission.
