Circulatory system diseases // Diseases of the gastrointestinal tract

Crohn's Disease


Crohn Crohn's disease - primarily affecting the gastrointestinal tract of a chronic inflammatory disease that can often worsen throughout life.The inflammatory process involved absolutely any gastrointestinal tract from anus to mouth , but the most frequently observed damage colon (direct or colorectal) cancer and / or the end of the small (ileum) ulcers.

Crohn's disease is closely associated with a chronic disease like ulcerative colitis, which is manifested only defeat of the colon.As for Crohn's disease and ulcerative colitis today effective treatment method has not been developed.Both diseases are chronic relapsing, during which periods of relapse (exacerbations) followed by periods of remission (quiet).

only in the United States diagnosed with Crohn's disease have about two million people.Racial and sexual division is not defined, but a little more often the disease occurs in people of the Middle East and North Africa.Typically, the onset of disease falls on adolescence and early adulth

ood, but there were cases manifestations of the disease in adulthood and childhood, which, however, may well be explained by imperfect diagnostic methods

Crohn's Disease - Causes

theories about the possible causes of Crohn's diseaseThere are many, but none of them so far has not been proven conclusively, so long as it is for certain is unknown what exactly caused the disease.Most scientists agree that Crohn's disease is caused by predisposing environmental factors, congenital predisposition and disorders of the immune system.

hypothesis of environmental factors

There is speculation that contribute to the development of Crohn's disease, environmental factors such as viral and bacterial infections, tobacco smoke, substances or components of food consumed and other factors not yet known.

Presumably external factors contribute to the development of Crohn's disease as follows:

• directly damage the intestinal mucosa, which may lead to the development of Crohn's disease and enhance the severity of relapses

• provoke the immune defense, which began, no longer able tostop

hypothesis innate predisposition

According to studies, it was observed that about 15% of patients with Crohn's disease at least one family member has the same disease.It was also noted that the disease in some ethnic groups (Ashkenazi Jews) occurs more often.

This trend and prompted the idea of ​​the possible genetic nature of Crohn's disease.It was actually identified a gene that is directly linked to Crohn's disease, a gene that directs the human body to decide how to react to certain microbes.In case of change or mutation of this gene, the body will react to microbes with a deviation that may eventually lead to the development of inflammatory bowel disease and Crohn's disease.It was noted that the altered gene in patients with Crohn's disease occurs twice as often than in otherwise healthy people.Despite this, the presence of the mutated gene in the body is not always determines the development of the disease

immune hypothesis

Some scientists have linked the development of IBD (inflammatory bowel disease) and Crohn's disease, including disorders of the immune system.While in normal cells of the immune system protects the body from the attacks of various harmful microorganisms (fungi, viruses, bacteria and other foreign agents).At the same immune defenses react differently to all microorganisms, as a considerable number of beneficial bacteria (involved in the digestive process and so forth.) And the immune system does not "touch".

In the case of the aggressor begins an immediate protective response of the organism, which manifests itself at the local level inflammatory response.The inflammatory focus directed specialized immune cells that destroy harmful start and release substances directed to binding and neutralization of toxins.After localization and liquidation of the aggressor, immunocompetent cells are returned to their positions, the inflammation gradually subsides, and begin the process of regeneration and recovery.

In Crohn's disease the immune system for unknown reasons, while paradoxically behaving wrongly directing his aggression on a completely harmless, and sometimes vital (bacteria simbionity) microorganisms.In some cases, an unknown and therefore not stop the inflammatory response, so over time the chronic inflammation leads to ulcerations and other damage to the intestine

Risk factors for Crohn's disease: smoking, severe emotional and physical stress, hormonal changes, infections, certain medications,family history, the origin of the countries of northern Africa and the Middle East

Crohn's Disease - Symptoms

Symptoms of Crohn's disease, depending on the localization of the pathological process and form of the disease vary.There are two clinical forms of the disease - acute and chronic.

acute form of Crohn's disease is developing at lightning speed.Increased body temperature, increased blood sedimentation rate and leukocyte count.In the right iliac fossa, pain (due to the fact that in this area is the appendix, patients often mistakenly operate, as suspected acute appendicitis).Obtained in step morphological data clarify the diagnosis.In more than 95% of the acute form of Crohn's disease, even without the treatment ends with a full recovery.In other cases, the disease takes a chronic nature.

chronic form of Crohn's disease is determined by the slow development and a gradual increase in symptoms.Patients usually seek specialized assistance only after the first complications of the disease.

Patients complain of abdominal pain (usually after meals), bloating, two or three times a day, they observed transient diarrhea.There may be a slight increase in body temperature.A characteristic symptom of Crohn's disease is a significant weight loss.If in the process involves the rectum, the anus, and a crack may occur fistulas.

during the exacerbation of symptoms of the disease is most pronounced.Patients complain of cramping quite severe abdominal pain, five or six times a day, there is diarrhea, due to digestive disorders the patient loses much of its weight.The most frequent complication in acute include perforation of the intestinal wall, internal bleeding, against bowel stenosis develops intestinal obstruction, ulcer penetration into adjacent organs, toxic-allergic damage of joints and eyes, fistulas.During periods of remission (which may take several years), symptoms of the disease subsides

Crohn's Disease - Diagnosis

diagnosis of Crohn's disease almost always causes some difficulty, it is partly because its symptoms are not always obvious and often the patient simply ignored.In addition, there are many diseases which have the same symptoms and pain of the same location.

Diagnosis begins with a general examination and medical history data collection.The doctor should note the presence of classic symptoms of Crohn's disease: weight loss, digestive disorders, anemia, fistula formation of the outer, long-lasting pain in the right iliac area.During the examination focuses on the state of the mucous membranes and skin (a bundle of nails, brittle hair, dry and pale skin).Palpation right iliac fossa often detected morbid formation, which consists of small bowel loops soldered.

In order to clarify the diagnosis by conducting the following diagnostic tests:

• Colonoscopy.With this endoscopy into the colon of the patient inserted fiber-optic visualization system, which allows to identify the characteristic of the disease bowel lesion that looks like a deep ulcers, with thick rough edges, which are located along the longitudinal axis of the intestine.Absolutely the whole intestinal mucosa becomes kind of the so-called "cobblestone pavement".While colonoscopy is extracted biopsy for histological examination.This histological analysis allows to differentiate Crohn's disease from other diseases with similar symptoms (malignant tumors, ulcerative colitis, intestinal tuberculosis) and to establish a definitive diagnosis

• Radiological study using barium sulfate suspension allows to specify the presence of narrowing of the lumen of the intestine.At the beginning of the disease, almost narrowing the lumen, but the mucosal folds are already beginning to acquire the wrong direction.As the progression of Crohn's disease, the narrowing (stenosis) of the lumen of the intestine is increased to such an extent that in the X-ray data portions of the intestine take the form of a hose or cord, with healthy portions alternate with affected

• Complete blood count shows increased erythrocyte sedimentation rate (indicates the presence of inflammationprocess) and the presence of leukocytosis (in the blood increased number of white blood cells)

Crohn's Disease - Treatment

treatment of Crohn's disease presents certain difficulties, because even with adequate timely treatment of the disease tends to the progression and development of complications and the formation of continuous relapsing forms.It uses two treatment option - conservative and surgical.It should be noted that surgical treatment is a difficult non-standard tasks that surgery carried out in stages, and the treatment itself can take several years.However, there are a number of specific indications for surgical treatment mandatory - is the formation of internal and external fistulas (interintestinal, vaginal or perianal) and the development of stenosis (impaired intestinal motility and develops intestinal obstruction).

In order to reduce the frequency of exacerbations in the treatment of Crohn's disease, the main focus is on anti-relapse therapy, which includes imunosupressory, glucocorticoids, chimeric monoclonal antibodies, drugs 5-amino salicylic acid (sulfasalazine and mesalazine).In today's time it is mesalazine and sulfasalazine provide the longest good effect and are prevalent drugs of choice.

In case of insufficient effect in the treatment of Crohn's disease aminosalicylates, in the course of treatment administered drugs ciprofloxacin and metronidazole.If in this case there is no adequate therapeutic effect of systemic glucocorticoids are assigned values.In the case of long-term treatment of Crohn's disease are applied immunomodulatory agents (azathioprine), which action is directed at reducing the activity of cells of the immune system (thereby extending lockup occurs in the gut inflammation).

Surgical treatment of Crohn's disease is shown in the absence of conservative treatment and the positive dynamics in the development of complications.The goal of surgery - removing develop complications (abscess, stenosis, fistulas), or the affected area of ​​the intestine.

Diet Crohn's disease not too strict, but some restrictions are still present.It should be remembered that in this disease is of vital importance to the cautious attitude of the digestive tract.Diet for Crohn's disease allows to use almost the entire range of products to which the patient is accustomed.It should be reduced to a minimum consumption of carbohydrates and fats, and proteins, on the other hand share significantly increase.To use is strictly prohibited pickles, canned food, spices, smoked and fried peas, kvass, eggs, alcohol and fatty meats.All products before use must be heat treated.To achieve long-term remission, diet, supervision and treatment of Crohn's disease must necessarily control the treating physician.

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