Crohn‘s disease is a chronic disease of the gastrointestinal tract. The disease owes its name to the American doctor Beryl Kron, who in 1932, together with colleagues, described 14 cases of the disease with similar symptoms. Despite the long-standing discovery, Crohn’s disease is still not fully understood. To date, it is known how Crohn’s disease develops and what symptoms it manifests. However, it is completely unclear why it suddenly occurs, sometimes even against the background of complete well-being. Naturally, the issue of therapy has not been resolved. There are supposedly effective treatment regimens for Crohn’s disease, but the disease is considered incurable.
How does Crohn’s disease develop?
There is an official definition of Crohn’s disease, copied from medical textbooks and massively replicated:
Crohn’s disease is an immune-mediated, transmural, predominantly granulomatous inflammatory disease that…
Okay, stop! There are doubts that someone can finish reading this definition at least to the middle. From the point of view of medicine-everything is competent and clear to the specialist. But what to do is not a doctor, because it is so important to get to the bottom of it. Especially if Crohn’s disease is your diagnosis. Let’s figure it out.
So. Crohn’s disease is directly related to our immunity. For unknown reasons, a malfunction occurs, and the cells of the immune system begin to behave aggressively towards the cells of the gastrointestinal tract. To be more precise, the immune cells try to destroy them and remove them from the body in every possible way. The way they usually do with foreign bacteria or viruses, for example.
Given that the disease lasts for years and decades, this behavior of the immune system can not but affect the health of both the digestive system and the body as a whole. By the way, the disease is often associated with the intestine. However, Crohn’s disease can affect the entire gastrointestinal tract from the mouth and esophagus, to the ampoule of the rectum. True, the intestines are hit much more often. And this is not surprising, because it is in the intestinal wall that about 80% of human immune cells are concentrated.
Thus, we have figured out why Crohn’s disease is considered an immune-mediated disease.
The term “transmural “ means that the lesion is not superficial, but penetrates deeply into the tissues, with the formation of ulcers, cracks, abscesses and fistulas. Therefore, the pain in Crohn’s disease is quite intense.
Granulomatous inflammation involves the formation of granulomas. This is the immune system’s way of limiting those cells that they are unable to completely destroy and recycle. Granulomas are formed in autoimmune diseases such as rheumatism, gout, and Crohn’s disease.
A few words about the localization of the process, that is, about its location. It is noted that most often, Crohn’s disease affects the ileocecal part of the intestine. This is a section of the ileum and cecum. And if it is even simpler, then this is the place of transition of the colon to the small intestine. This is where the appendix, commonly known as the appendix, is located. Therefore, the symptoms of Crohn’s disease (in the acute period) are often similar to appendicitis.
And another term that should be explained. In the literature, the defeat of the gastrointestinal tract in Crohn’s disease is described as “segmental”. This suggests that the lesion of the mucous membrane and deeper layers is intermittent. That is, the ulcerated areas are interspersed with islands of almost unchanged tissue. The combination of transverse and longitudinal ulcers with healthy areas in Crohn’s disease is called “cobblestone pavement” syndrome.
In Crohn’s disease, the villi of the intestine are affected, which leads to the so – called malabsorption-insufficient absorption of nutrients.
Causes of Crohn’s disease
There are several theories that, in some cases, can explain where Crohn’s disease comes from. But they are also theories that are at the level of assumptions. The most famous of them are:
- Hereditary. Crohn’s disease can be inherited. However, this does not always happen. But there is still a certain connection between the diagnosis of close relatives (brothers, sisters, parents) and the disease of their relatives. Scientists have found that the fault is a deficiency of one of the genes that is responsible for the development of immunity.
- Infectious. There are some similarities between the symptoms of intestinal tuberculosis and the signs of Crohn’s disease. This led to speculation about the likely influence of tuberculosis bacteria on the development of the disease. However, anti-tuberculosis drugs are effective for the treatment of Crohn’s disease only during remission, and even then not in every case. Similarly, it was assumed that the causative agents of the disease could be shigella and other bacteria with viruses. The fact is that with Crohn’s disease, the immune system suffers, which leads to the development of infection. The problem is that it is not always possible to determine what is primary. Microorganisms trigger Crohn’s disease, or vice versa, the disease itself contributes to their reproduction.
- Allergic reaction. Crohn’s disease is associated with allergies, as both the first and second cases involve the immune system. But allergies can not be considered the root cause of Crohn’s disease because, firstly, not all allergic people suffer from this disease, and secondly, Crohn’s disease is not always accompanied by allergies. This is nothing more than a risk factor.
As you can see, none of the existing theories have proven their validity.
Risk factors for Crohn’s disease are:
- Smoking. It is noted that the risk of getting sick in smokers is twice as high as in non-smokers. If a person with Crohn’s disease continues to smoke, the risk of surgery increases 7-8 times.
- Allergies. Above, we have already determined why allergies can lead to Crohn’s disease.
- Age. The onset of Crohn’s disease is more often observed at the age of 15-30 years.
- Infections. Past illnesses, especially in childhood, can provoke the development of the disease.
- Social status. Strange, but true. Residents of civilized countries with a high level of economy suffer from Crohn’s disease 3-4 times more often than the population of less prosperous countries.
In general, we can say that in the search for cause-and-effect relationships regarding the causes of Crohn’s disease, humanity has not yet succeeded. There are more questions than answers.
Symptoms of Crohn’s disease
Crohn’s disease proceeds according to the same scenario – periods of remission are replaced by exacerbation. At the same time, everything is very individual. Some people with Crohn’s disease in remission report a complete absence of symptoms. As if the disease never happened. Others complain of discomfort, indigestion, and other symptoms. Someone in remission lasts for years and even decades, and someone experiences constant severe pain with small respites in a day or two. The severity of symptoms depends on the severity of Crohn’s disease
Symptoms of Crohn’s disease can be divided into intestinal and extra-intestinal.
Let’s list the intestinal symptoms of Crohn’s disease:
- Frequent long-term abdominal pain;
- Symptoms of intoxication – nausea, vomiting, weakness, headache;
- Weight loss – due to a violation of the absorption of nutrients in the intestine;
- Frequent stools – from 3 to 10 times a day;
- There may be blood in the stool;
- Abdominal muscle tension;
- At least a third of patients have anal fissures and rectal fistulas;
- In more severe cases, the seal – infiltrate-is clearly palpated.
Infiltrate-accumulation in the tissues of immune cells, destroyed intestinal cells, bacteria, viruses with an admixture of blood and lymph.
Extra-intestinal symptoms of Crohn’s disease:
- Skin lesions – erythema, pyoderma;
- Eye lesions – uveitis, conjunctivitis;
- Diseases of the oral cavity-aphthous stomatitis;
- Joint pain – arthritis. The appearance of painful nodules on the hands and shins;
- Bone lesions;
- Temperature increase in the acute period. The temperature in Crohn’s disease can be subfebrile, but it can be higher than 38 C.
- Liver diseases;
- Venous thrombosis.
Signs of Crohn’s disease are similar to a number of diseases – non-specific ulcerative colitis, appendicitis, dysentery, salmonellosis, intestinal tuberculosis, irritable bowel syndrome, etc.And extra-intestinal manifestations of Crohn’s disease, at first glance, have nothing to do with the intestine at all. That is why it is important to treat the diagnosis of Crohn’s disease very responsibly.
A gastroenterologist treats Crohn’s disease, but if surgery is necessary, the patient is treated by a surgeon.
Complications of Crohn’s disease
- Stenosis, intestinal obstruction
In Crohn’s disease, a chronic inflammatory process occurs, as a result of which the intestinal tissues are replaced by connective tissue, while losing their function. Connective tissue is much less elastic than muscle, and it is unable to stretch. The result of chronic inflammation is stenosis, or narrowing of the intestinal wall. Gradually, the lumen of the intestine narrows more and more, which can result in intestinal obstruction.
Malignancy is a degeneration into an oncological process. Unfortunately, long-term untreated Crohn’s disease can lead to cancer. With this, not only the intestines, but also the lungs, and the chest. There is a misconception that Crohn’s disease is cancer. These are two completely different diseases, and not always the inflammatory process passes into oncology.
Perforation – perforation of the intestine. In Crohn’s disease, the intestinal wall is thinned, breaks through and the contents of the intestine go out into the abdominal cavity, causing inflammation – peritonitis.
An abscess is a limited purulent inflammation. Simply put, an abscess resembles a pouch filled with pus. This is also the result of inflammation in Crohn’s disease.
Diagnosis of Crohn’s disease
There are several methods for diagnosing Crohn’s disease. At the reception, first of all, a survey and examination are conducted, and then, based on these data, those tests and diagnostic methods are selected that will help clarify the diagnosis.
— Blood test. In the acute period, ESR will increase, the level of hemoglobin and protein decreases, and the leukocyte formula has signs of inflammation. Also, the level of C-reactive protein is important for determining inflammation in Crohn’s disease.
C-reactive protein – blood plasma protein, which is an indicator of acute inflammation. It is the first to react to the inflammatory process and increases several dozen times.
— Fecal analysis for occult blood and fecal calprotectin.
Calprotectin is a protein found in the cells of the immune system. There is a pattern-the more intense the immune response, in Crohn’s disease, the more calprotectin in the feces.
— Endoscopy. Depending on the localization of the process – either FGDS (esophagus, stomach, duodenum), or colonoscopy, sigmoscopy (intestine). The endoscopic picture of Crohn’s disease is very specific. Longitudinal and transverse rather deep ulcers with relatively healthy areas of the mucous membrane. The “cobblestone pavement” that we talked about earlier. During endoscopy, a biopsy must be taken in order to examine the tissue under a microscope. To date, this is the most informative and accurate diagnostic method.
One of the modern options for endoscopy in Crohn’s disease is capsule endoscopy. The patient needs to swallow a small capsule. It’s no bigger than a regular pill. Throughout the entire length from the oral cavity to the rectum, the capsule takes pictures of the intestinal mucosa and transmits this data to the monitor screen. This method is a good alternative to standard endoscopy, but when the intestine is narrowed, there have been cases of stopping this camera. Therefore, before conducting the study, you need to make sure that the normal patency of the intestine.
– X-ray of the large and small intestine. In this case, the intestine is filled with an X-ray contrast agent. The method allows you to assess the patency of the intestine and mark the places of narrowing of its lumen due to infiltration or stenosis.
–MRI SCAN (magnetic resonance imaging),CT (computed tomography) – diagnosis of fistulas, abscesses, and infiltrates.
–Ultrasound of the internal organs allows you to exclude other pathologies.
Treatment of Crohn’s disease
Treatment of Crohn’s disease is complex and quite long. At the same time, it should be noted that even the newest methods of treating Crohn’s disease are not able to get rid of this disease forever. But this does not mean that you need to refuse medical care. The main goal of therapy is to lead to long-term remission. And in most cases, it succeeds.
First of all, you need to remove the inflammation. To do this, use:
1. Hormonal drugs-glucocorticosteroids, for example, prednisone.
2. 5-aminosalicylates, for example, sulfasalazine.
3. Immunosuppressors-drugs that depress the immune system. This is a whole group of drugs that act on different parts of the immune system. As a rule, it is quite difficult to choose these drugs, since it is obviously unknown how the body of a particular patient will react.
4. Antibiotics-prescribed if the disease is complicated by a bacterial infection.
Symptomatic medications for Crohn’s disease are used to relieve symptoms. These can be iron supplements and vitamin B12 for the treatment of anemia, antidiarrheal medications to eliminate diarrhea, painkillers, antispasmodics, and so on. For the prevention of osteoporosis, a complex of vitamin D + calcium is prescribed.
Relatively recently, a new treatment method has appeared-biological therapy for Crohn’s disease. It involves taking cytokine blockers (inflammatory mediators). These include infliximab and adalimumab. These drugs have good tolerability and effectiveness. However, it is noted that with long-term treatment, about 40% have the so-called eluding effect. That is, for unknown reasons, the drug ceases to work and the symptoms of Crohn’s disease return again.
There are different treatment regimens for Crohn’s disease. One treatment strategy involves starting treatment with hormones and 5-aminosalicylates, followed by switching to biological therapy. Another – on the contrary, start with cytokine blockers. At the same time, no one knows exactly what tactics will work in each individual case. Moreover, the mechanism of action of cytokine blockers is still not fully understood. And this is not to mention the nature of the disease itself.
Approximately half of the patients with Crohn’s disease are mild, and conservative treatment is sufficient for them. But there are situations where you can not do without surgery. And there is one nuance here – the operation is not radical. That is, it will not lead to a complete cure. The purpose of surgical treatment of Crohn’s disease is the excision (removal) of a pathologically altered part of the intestine and the prevention of complications. In most cases, after surgery, the patient really becomes much easier, and properly selected conservative therapy can significantly prolong remission.
As for the prevention of Crohn’s disease, for obvious reasons, it has not yet been developed.
Diet for Crohn’s disease
When Crohn’s disease is recommended to adhere to the classic diet number 4, which is reduced to:
- Reduce the consumption of fat and fatty meats;
- Restriction of products containing fiber;
- Exclusion of fried, spicy, spicy food, tonic drinks, tea, coffee and alcohol;
- Reduce the consumption of milk and dairy products.
- Fractional food 5-6 times a day in small portions.
These are general recommendations. Each patient should be attentive to their well-being after taking certain products. Depending on individual portability, this list may be adjusted accordingly.
In general, we can say that Crohn’s disease is a fairly serious disease that requires medical attention. There is no universal treatment, the drugs are selected individually depending on the severity of the disease, concomitant diseases and the body’s response to the prescribed treatment. Long-term therapy. The first success of the treatment of Crohn’s disease can be said no earlier than 2-4 weeks.
Crohn’s disease continues to be studied, and new clinical studies of drugs and treatment regimens are emerging. Let’s hope that soon scientists will be able to solve the mystery of this disease and find an effective method of its treatment.