Crohn's disease - what is it? Description of the disease, symptoms, treatment and prognosis of life

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. At the same time, all the walls of the intestine are involved in the inflammatory process. On the mucous membrane of this organ ulcerations appear, on the site of which granulomas, adhesions and strictures are formed in the future, which narrow the intestinal lumen, disrupting its patency.

Causes

The exact sources of this disease are unknown. The reasons are presumably the following:

• the external environment, including various toxins, tobacco smoke, constituents of food, provoking an autoimmune process and disrupting the structure of the intestine;
• violation of the immune system, as a result of which the body recognizes its cells as strangers and attacks them;
• hereditary diseases: Crohn's disease is a pathology that is formed as a result of a mutation in a genome that has a genetic predisposition;
• infectious nature, although no specific pathogen has been discovered to date, presumably caused by the pseudotuberculosis bacterium, can be cured with antibiotics.

The possibility of the presence of Crohn's disease increases under the following circumstances:

• transferred measles and pseudotuberculosis infection;
• increased physical and emotional stress;
• smoking;
• living in the Middle East;
• genetic predisposition;
• significant hormonal imbalance.

Symptoms

Crohn's disease is a disease classified into an acute, subacute, and chronic condition. Each of them has its own nonspecific symptoms, with which you can establish the stage of development of the disease.

Signs of Crohn's disease:

• acute stage - pain appears in the lower right abdomen, body temperature rises, diarrhea appears; this can lead to an incorrect diagnosis, which can be made as follows: ovarian apoplexy, appendicitis, which leads to the need for surgical intervention, and only after it is found the error of the diagnosis is detected;
• subacute - characterized by rapid loss of body weight, diarrhea is mild, there are cramping pain syndromes of various localization.

The most common chronic form. Symptoms develop slowly, a person in a medical institution is in no hurry to contact. The following symptoms are characteristic of this form:

• body weight gradually decreases due to the fact that food is poorly absorbed in the intestine;
• around the anus maceration of the epithelium and fissures may develop;
• the temperature can increase to 38 °, with purulent complications, it can increase even more;
• loss of appetite is noted;
• weakness and fatigue;
• cramping pains in different areas of the abdomen, aggravated after eating and weakening after bowel movement;
• potential presence of blood in the stool;
• bloating;
• diarrhea, with exacerbation of Crohn’s disease, the frequency can increase up to 6 times a day (in the period of remission it is not constant).

In addition, extraintestinal symptoms of this ailment are found. These include:

• erythema nodosum - pustules or painful nodules of red color appear on the epidermis, which subsequently acquire a purple color, after which they turn brown and yellow;
• mouth ulcers;
• pain syndromes in large joints;
• decreased mobility;
• temperature increase;
• vomiting
• yellowing of the epithelial integument;
• visual impairment;
• pain syndromes in the right hypochondrium, sacral zone, eyes.

In children, it is most often localized in the jejunum and duodenum, and is often found in the small intestine.

Pathology is found equally in both sexes. The average age of patients is 20-30 years, in children - 12 years.

A child with this disease often has a developmental delay. He has joint pain.

In addition, the following symptoms may occur:

• non-healing wounds for a long time;
• rash;
• eczema
• dermatitis;
• inflammation of the mucous membranes of the mouth and eyes;
• hepatitis;
• the presence of kidney stones;
• cholelithiasis;
• arthrosis and arthritis.

Children always have blood in their stools. For them, with the localization of the process 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.

Crohn's disease according to ICD-10

The International Classification of Diseases (ICD) acts as a single regulatory document that takes into account the etiology of various pathologies and the mortality that they cause. Currently, there is a 10 representation of the commission. In 2018, the eleventh should be released. Crohn's disease according to ICD-10 has the code K50. A more detailed classification is presented below:

1. 50.0 - Crohn's disease of the small intestine.
2. 50.9 is an unspecified form of pathology.
3. 50.1 - Crohn's disease of the colon.
4. 50.8 - other varieties of the disease: inflammation of the digestive tract with the formation on the inner surface of the fistula, intestinal granuloma, granulomatous enteritis.

Crohn's disease stages

The course of this disease has a different pathogenesis. Clinically, there are several stages of pathology:

1. Ileitis occurring with the formation of fistulas from both the external and internal sides.
2. Stenosing ileitis, accompanied by complete or partial intestinal obstruction.
3. Acute enteritis, resembling appendicitis, proceeding in an acute form in the terminal ileum.
4. Chronic enteritis, accompanied by bouts of colicky pain with the appearance in the feces of mucus, blood, resembling ulcerative colitis.

Diagnostics

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 prescribed to identify the following deviations:

• inflammatory processes (the number of lymphocytes decreases with an increase in the number of leukocytes);
• they are also tumor pathologies detected by a blood test, as indicated by the presence of calprotectin;
• lower total protein levels;
• anemia.

After identifying these deviations, instrumental research methods are prescribed to diagnose Crohn's disease. These include the following:

• electrogastroenterography for the study of intestinal motor function;
• MRI with a contrast in the form of water injected into this organ to determine the degree of damage, diagnose an increase in lymph nodes and the presence of fistulous passages;
• Ultrasound to detect peritonitis, which is a characteristic sign of Crohn's disease;
• X-ray examination of the intestine with barium, which shows cracks and narrowing of the passage;
• CT scan with which abscesses and infiltrates are detected;
• endocapsular colonoscopy, in which a pill equipped with a camera is swallowed, which, passing through the organ in question, takes pictures, which are then studied by appropriate specialists;
• gastroduodenoscopy using a special device for examining the duodenum, esophagus and stomach;
• colonoscopy - a study of the colon with a tool resembling a camera probe built into the tube, with the help of which pathologies of the mucosa and its surface are observed on the screen (in the presence of ulcerative defects, a biopsy can be taken 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 treatment effectiveness, three methods are used simultaneously:

• dieting;
• symptomatic treatment of complications, leading, as a rule, to surgical intervention;
• drug therapy.

Drug use

Therapy for Crohn's disease is the use of drugs. They are selected in such a way as to affect the maximum possible number of pathogens in connection with the uncertain etiology of the disease.

The following tools are used:

• antibiotics: Ciprofloxacin, Metronidazole;
• probiotics: "Bifidum-bacterin", "Bifiform", "Linex";
• antidiarrheal drugs "Loperamide", "Imodium", which are prescribed in the absence of blood and negative results of bacteriological studies;
• antibodies to tumor necrosis: Golimumab, Infliximab, Adalimumab;
• immunosuppressants: "Methotrexate", "Prednisolone", "Azathioprine", "Methylprednisolone";
• aminosalicylic acid derivatives: Sulfasalazine, Mesalazine;
• vitamin D.

Surgical intervention

How to treat Crohn's disease? Mostly surgery is needed. It is used in cases where drug therapy, diet and lifestyle changes have not helped. More than half of the patients who have suffered this ailment survive at least one surgical procedure 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 it is possible to do, 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 condition of the patient, relieve pain syndromes and some symptoms that appear periodically. What does that require?

As a folk remedy for Crohn's disease, the following can be used:

• Collection of herbs, 5 g each: chamomile, sage, yarrow. Brew boiling water in a glass, boil for 5 minutes, leave for 2 hours, cool, strain and take 2 tbsp every 2 hours. l
• In one liter of boiling water, 20 g of chamomile flowers are brewed, left for insisting 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 with 250 ml of boiling water, after which they are boiled for another 10 minutes, cooled, filtered. Take a morning and evening half a cup.
• Valerian root, mint leaves, chamomile flowers and caraway seeds are mixed in equal amounts, 1 tbsp. l the mixture is added to 1.5 cups boiling water and left to infuse for 1 hour. Reception is carried out three times a day for half a glass.

Pain syndromes and inflammatory processes can be reduced using the following folk remedies for Crohn's disease:

• Add 2 tbsp to the pan. l dry chopped yarrow, 250 ml of warm water are placed there, placed on a fire for 15 minutes, then insisted in a warm place for 45 minutes, after which the broth is filtered and consumed 4 times a day 30 minutes before eating 1 tbsp. l
• 2 tsp fresh hyssop is poured into the pan, pour 250 ml of previously boiled water, brought to a boil, cooled for 5 minutes and filtered.
• When using dry hyssop, the proportions are the same, but they do not boil, pour it with boiling water and insist for a third of an hour. And in that and in another case, the infusion is taken in 1 glass in the morning and in the evening for two weeks, after which they take a one-week break and again repeat the course.
• 1 tbsp. l crushed sage is poured with a quarter liter of boiling water and insisted for 1 hour, filtered and taken half a glass four times a day.

In addition, other recipes 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 in it, you can make an anise infusion by adding 250 ml of boiling water for 1 tsp. seed. Insist 5 minutes and take during the day.
• As an antispasmodic and anti-inflammatory, antihistamine, onion peel can be used. About 1 cup is filled with 8 glasses of water, the solution is brought to a boil, not completely covered and boiled for 1 hour on low heat, cooled and filtered. They consume 3-6 times a day, 100 ml each, with this administration a remission of the disease may occur, in which case the number of doses is reduced by three times.
• If intestinal colic is present, then use a tincture of dry lily of the valley, which is poured with 0.5 l of alcohol per half a glass of dry grass, insisted for 2 weeks, consumed 20 drops diluted in water, 3 times a day.

Diet

One of the main health-improving measures for Crohn's disease is to maintain an optimal diet. At the same time, bowel function improves, and pain syndromes decrease.

Allowed meals:

• vegetable soups prepared on the second broth;
• teas
• stewed fruit based on non-sour berries;
• stewed or steamed meat;
• boiled eggs;
• low-fat cottage cheese, sour cream, milk in small quantities;
• biscuits;
• crackers;
• mucous porridge;
• boiled and baked vegetables.

Forbidden dishes:

• pickles;
• semi-finished products;
• pearl barley and wheat cereal;
• legumes;
• fresh fruits and vegetables;
• confectionery;
• strong tea;
• coffee;
• carbonated drinks;
• sour juices;
• roast;
• canned food;
• mushrooms.

Nutrition in Crohn's disease should be balanced, since anemia and vitamin deficiency may occur due to the fact that food is poorly absorbed.

Selection of dishes should be individual. With exacerbation of Crohn's disease, it is recommended to adhere to a strict diet of the first table, after which you can begin to introduce some products, monitoring the body's reaction. Diet should be followed throughout life. This is especially important for children, since when it is not observed, the disease affects the physical and mental development of the child.

Complications

Due to the fact that the symptomatology of the disease is 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 the following:

• paraproctitis - inflammation of adipose tissue with discharge of pus around the rectum;
• fistulas;
• anal fissures;
• intestinal bleeding (rarely observed);
• toxic dilatation leading to an expansion of the intestine caused by antidiarrheal agents or colonoscopy;
• intestinal obstruction - most often manifested in Crohn’s disease of the small intestine, with a narrowing 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 surgery.

In Crohn's disease, in some cases, disability may be imposed. The grounds for its acquisition by a specific person are as follows:

• the inability to select a therapeutic treatment;
• severe course of the disease;
• disability;
• complications as a result of pathology.

Forecast

The prognosis of Crohn's disease depends on the individual characteristics of the body and the lesion. Mortality can occur due to ongoing surgical interventions and complications. Relapse of the disease is possible on average 1 time in 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 ailment

This ailment affects mainly young people, so they have a reasonable question about the possibility of pregnancy planning in the presence of this pathology. Many modern doctors categorically do not recommend bearing and giving birth to a child if this disease is present. 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 there is a period of remission, then the pregnancy process proceeds mainly without pathological changes. A woman can have healthy babies, but only if the disease is in stable remission.

The biggest problem during pregnancy is that it is impossible to perform differential diagnostics, which is expressed in the fact that sigmoidoscopy and colonoscopy are difficult due to the fact that the colon is displaced by the uterus, and x-ray examination of the intestine is impossible.

The appearance of pregnancy complications is affected by the activity of the inflammatory process that occurs in the digestive system. During the active form of the disease, the risk of premature birth, spontaneous miscarriage and fetal malnutrition increases many times.

If the conception of a child occurred during the period of remission of Crohn's disease, then it remains during the entire period of pregnancy. In this regard, a woman who decides to have a baby, but suffers from this ailment, must undergo a diagnostic study and consult a specialist.

In the first months of gestation, exacerbation is sometimes observed, however, a competent doctor may prescribe such drugs that will not harm either the woman or the unborn child.

Childbirth in 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, pranal lesions and cicatricial changes are observed.

Finally

Crohn's disease is a serious bowel disease, the symptoms of which can occur in any part of the digestive tract, as well as on the skin. Kidney stones and gall bladder may appear. The disease does not have a clear etiology, so it is difficult to treat. Therapy and diet are used 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 relapse of the disease. Treatment can be supplemented by the use of folk remedies. There are different points of view on pregnancy planning for such a disease. This is true due to the fact that the disease is mainly found in young people. Western experts believe that bearing a child and giving birth are possible when pregnancy occurs during remission.