What is Crohn's disease?
Crohn's disease
is a chronic inflammatory disease that can cover the entire gastrointestinal tract (GIT): from the oral cavity to the anal area. With this pathology, the resulting inflammation affects the entire thickness of the wall of the affected area of the gastrointestinal tract, which leads to the development of deep ulcers. The cause of this inflammation is a pathological reaction of the immune system: our own “defender” cells attack the cells of the gastrointestinal tract. In approximately 80% of cases, the disease affects the final section of the small intestine - the ileum; damage to both the small and large intestines is slightly less common.
The clinical picture of the disease is often multifaceted and ambiguous, so in some cases years pass before a correct diagnosis is made.
The incidence and prevalence of the pathology is growing all over the world: most often the onset of the disease occurs in people aged 15 to 30 years, the second peak incidence occurs at the age of 50-80 years, however, it is worth noting that this inflammatory bowel pathology can manifest itself at any age. age; with Crohn's disease, there is also a tendency towards a slight predominance of women compared to men among the number of cases.
Crohn's disease cannot be cured, however, with the help of modern drug therapy and surgical treatment, it is possible to achieve stable remission of the disease - a significant reduction in symptoms, taking the disease “under control”.
Causes
Predisposing factors for the development of the disease are:
- previous viral infection (measles);
- food allergies;
- stress and mental strain;
- smoking;
- hereditary predisposition.
To date, the causative agent of Crohn's disease has not been identified. However, the infectious theory is the main version of the origin of the disease. This is explained by the positive effect of treatment with antibacterial drugs. In addition, disorders of the immune system play an important role in the development of the disease. Autoimmune processes, in which antibodies are produced against one’s own intestinal tissues, and the insufficiency of the protective function of the immune system are an important link in the origin of the disease.
The essence of the disease
The exact cause of Crohn's disease is not completely clear, but it is known that the inflammation is based on an autoimmune reaction - a reaction of a person's immune system against its own body. This process does not occur in everyone, but only in people with a certain genetic predisposition.
As a result of this immune reaction, the protective cells of our body, T-lymphocytes, which are supposed to fight microbes, begin to attack their own mucous membrane of the gastrointestinal tract, which leads to the destruction of the villi. Due to the destruction of villi, the intestines partially lose their ability to absorb liquids and nutrients - diarrhea occurs.
In place of the destroyed villi, small “abscesses” form, which then progress, turning into ulcerations. Subsequently, the lesions progress and take the form of deep slit-like longitudinal and transverse ulcers, alternating with areas of edematous intestinal mucosa, which gives it the appearance of a “cobblestone pavement” - this is a characteristic sign of pathology that can be detected during endoscopic examination - colonoscopy.
In some patients, the affected areas of the intestine may “scar”; the resulting scars lead to the appearance of areas of narrowing of the intestinal lumen, which is often complicated by symptoms of intestinal obstruction - nausea, vomiting, abdominal pain.
It should be remembered that the pathological immune reaction underlying Crohn's disease can occur not only within the gastrointestinal tract, but also beyond it. The pathological changes listed above lead to the following symptoms of the disease.
Colonoscopy of the intestine: are patients’ fears justified?
An illness diagnosed at an early stage creates the least amount of problems for the patient. Therefore, highly informative screening colonoscopy is included in government programs to combat colon cancer in the USA, Israel and European countries. Citizens of developed countries are constantly informed about the need for regular examinations for the prevention and early diagnosis of colorectal cancer.
The specifics of such an intimate procedure do not evoke the most positive emotions among Russians. Pain is a major deterrent even for those people who are fully aware of the need for testing. But is it possible to compare the sensations that arise during a colonoscopy with the torment experienced by patients suffering from already developed oncology!
It should be understood that gentle diagnostic technology, which can be performed under anesthesia, will allow you to avoid dangerous symptoms, frightening diagnoses and a solid set of diagnostic procedures in the future.
Symptoms of the disease
Common intestinal manifestations:
- Diarrhea is often long lasting, more than 6 weeks.
- Abdominal pain and cramps.
- Decreased appetite and weight loss.
- Increased body temperature.
- Blood in the stool (more often with damage to the colon).
- Nausea, vomiting (especially if intestinal obstruction occurs).
- Formation of ulcers in the mouth.
- Long-term non-healing, reoccurring anal fissures.
Common extraintestinal manifestations:
- Eye damage: iridocyclitis, iritis, uveitis - redness of the eye, lacrimation, photophobia, pain and pain.
- Joint damage: arthritis - redness, swelling, tenderness of the joint area.
- Skin lesions: erythema nodosum - the appearance of raised areas of skin similar to a “bruise”. Areas of skin can merge with each other and have varying degrees of color - from dark yellow to purple-blue.
Complications
Complications of the disease often lead to surgical interventions. Most patients with Crohn's disease undergo at least one surgical intervention on the gastrointestinal tract during their lifetime.
Common complications include:
- intestinal perforation;
- abscess of the intestinal wall, infiltration of the abdominal cavity;
- intestinal bleeding;
- stricture (pathological narrowing) of the intestine;
- intestinal fistulas (communication of the intestinal lumen with the surface of the body or the lumen of another hollow organ);
- toxic dilatation (expansion) of the colon;
- neoplastic pathology (bowel cancer).
Diagnostics
First of all, to verify the disease, it is necessary to carry out the following examinations:
- CLINICAL AND BIOCHEMICAL BLOOD TESTS (with mandatory determination of hemoglobin levels, blood electrolytes, C-reactive protein, liver enzymes, blood iron).
- FECAL ANALYSIS (to exclude intestinal infections, as well as the study of fecal calprotectin).
- ENDOSCOPIC EXAMINATION: EGDS and colonoscopy (with mandatory examination of the terminal portion of the small intestine and biopsy of the affected area).
- X-RAY EXAMINATION: plain radiography of the abdominal cavity or X-ray examination of the intestine (CT) with barium (if there are signs of intestinal obstruction - nausea, vomiting, abdominal pain, diarrhea followed by constipation, as well as for the diagnosis of fistulas, perforations, infiltrates, abscesses).
- MRI with contrast (for the diagnosis of fistulas, perforations, infiltrates, abscesses).
Treatment
The goal of treatment is to achieve stable remission of the disease in the form of reducing symptoms and improving quality of life. Treatment measures include prescription of medications and surgical treatment.
The choice of the type of conservative or surgical treatment is determined by the severity of the disease, the extent and localization of gastrointestinal lesions, the presence of extraintestinal manifestations and intestinal complications, and the risk of developing complications of Crohn's disease.
The following drugs are used:
- Anti-inflammatory therapy (5-aminosalicylic acid and its derivatives).
- Hormonal therapy: systemic and topical (local) glucocorticosteroids.
- Cytostatic therapy: azathioprine, methotrexate.
- Biological therapies: infliximab, adalimumab, certolizumab pegol and vedolizumab.
Medicines are prescribed by a doctor according to certain regimens.
Indications for surgical intervention in Crohn's disease include acute and chronic complications (listed in the “Complications” section), as well as the ineffectiveness of drug therapy. Approximately 80% of patients with Crohn's disease will require surgical treatment during their lifetime. Modern tactics of surgical treatment of Crohn's disease are aimed at performing limited resections of affected areas of the intestine and organ-preserving interventions.
Patients with intestinal PERFORATION undergo immediate resection of the perforated area.
ABSCESSES are drained.
The extent of intervention in patients with emerging BLEEDING is determined by the patient’s hemodynamics (blood pressure level, heart rate): for patients with stable dynamics, endoscopic treatment of the bleeding area is available, for patients with unstable geodynamics, urgent surgical intervention is indicated.
The approach to the treatment of GIT STRICTURES is determined by the length, location, and characteristics of the stricture. Focal small bowel strictures with a short segment (<5 cm) that are not associated with any complications (eg, perforation, abscess, fistula, or malignancy) can be treated with endoscopic dilatation (widening the pathologically narrowed area) provided that the location of the stricture available for endoscopic intervention. Long strictures (≥5 cm), multifocal structures require surgical treatment in the form of strictureplasty. Small bowel resection is preferred for the treatment of strictures complicated by perforation, abscess, fistula, or malignancy.
Patients with intestinal fistula require resection of the involved segment of bowel and closure of the fistula opening into the adjacent organ.
Long-term chronic inflammation associated with Crohn's disease can lead to MALIGNANT TRANSFORMATION of the intestinal mucosa. If a malignant formation is suspected in patients with Crohn's disease, an additional examination should be carried out aimed at clarifying the nature of the formation, based on the results of which the extent of resection of the intestinal segment should be determined.
Preparing for a visit and a doctor's visit
A gastroenterologist diagnoses and treats gastrointestinal diseases. Before visiting a specialist, prepare for the fact that you may be asked the following questions:
- the onset of symptoms when ailments manifest themselves for the first time;
- symptoms are present all the time or unpleasant phenomena occur periodically;
- Do the symptoms intensify due to some events, provoking factors (after stressful situations, taking certain medications, certain foods, etc.);
- your general condition - how uncomfortable the manifestations of the disease are, how much your well-being has worsened and how this is manifested, whether your quality of life has decreased, whether there are any restrictions on any type of activity or taking certain foods;
- whether you took medications after the first signs of the disease appeared and whether you are currently taking certain medications (list).
Based on the information received and a comprehensive clinical examination (palpation of the abdomen, examination of the oral cavity), the specialist draws up a subsequent examination regimen.
Questions for the doctor
Which doctor should I see?
If you have complaints of abdominal pain, diarrhea, loss of appetite and body weight, or increased body temperature, you should consult a physician or gastroenterologist.
In case of long-term healing of anal fissures, it is advisable to consult a coloproctologist.
When will I get better?
Crohn's disease usually occurs cyclically: periods of disease attack (the onset of disease symptoms to varying degrees) are followed by periods of remission (when inflammation is under control and there are no symptoms of the disease).
There is no clear temporal pattern between these states. Currently, 10 to 20 percent of patients experience long-term remission of the disease after the initial outbreak.
When should I have surgery?
As discussed, medications can help control the symptoms and complications of Crohn's disease and may help you avoid or delay surgery. However, surgery may be recommended if your symptoms are not controlled by medication or if the disease is complicated by surgical pathology (outlined in the section "Complications of disease").
Surgery (or drug therapy) does not cure Crohn's disease, but it can help you feel better and return to normal activities. The disease eventually returns after surgery; most people will need to continue taking medications to control symptoms long-term. However, 85 to 90 percent of people have no symptoms of the disease for a year after surgery. Up to 20 percent of people have no symptoms 15 years after surgery.
What should I avoid?
1) Don't smoke. Smoking worsens symptoms and increases the risk of complications.
2) Avoid using non-steroidal anti-inflammatory drugs (such as Paracetamol, Aspirin, Ibuprofen). Take them only for strict indications and after the advice of a doctor.
3) Do not be afraid of consuming foods with gluten or dairy products - there is no clear evidence that they are harmful to health in this disease.
When to see a doctor
The symptoms of Crohn's ulcer disease are similar to many other pathologies. To diagnose it, you need a comprehensive, comprehensive examination. The disease is most often diagnosed by a specialist such as a gastroenterologist.
You should consult a doctor if the following phenomena occur:
- frequent diarrhea that does not go away;
- incessant pain in the gastrointestinal tract;
- rapid weight loss without objective reasons;
- traces of blood in the stool.
In all these cases, you must make an appointment with a gastroenterologist. A gastroenterologist will conduct an in-depth diagnosis of the disease, prescribe treatment, and, if necessary, give a referral for consultation to other specialists.
A general examination will also be carried out, laboratory and instrumental tests will be prescribed. In difficult cases, doctors of other specializations may be involved. For example, you may need to consult an infectious disease specialist, surgeon or coloproctologist. All these and many other specialists work at JSC “Medicine” (clinic of academician Roitberg).
