Crohn's disease: symptoms, treatment, causes, prognosis


Crohn's disease is an inflammatory bowel disease characterized by severe mucosal damage, accompanied by abdominal pain, diarrhea, eating disorders and weight loss.

Progression of the disease leads to the defeat of deeper layers, leading to increased pain and increased exhaustion of the body, sometimes resulting in the development of serious complications that threaten the patient's life.

Although Crohn's disease is currently incurable, existing maintenance therapies can significantly reduce the severity of its symptoms and even allow a long-lasting remission to be achieved.

Symptoms

In different people, inflammation spreads to different parts of the intestine: in some (80%) only the final segment of the small intestine (ileum) is affected, in others (about 20%), the focus is located in the rectum (large intestine). These are the most common areas of development of Crohn's disease.

The severity of symptoms varies from moderate to severe. More often there is a gradual increase in the intensity of manifestations with intervals of remission (complete absence of symptoms of the disease).

The patient with a diagnosis of Crohn's disease symptoms include:

  • – наиболее распространенная проблема при данном заболевании. Diarrhea is the most common problem in this disease. The defeat of the mucous membrane leads to disruption of the digestive process, and frequent intestinal cramps contribute to the emptying of the intestine with the appearance of a liquid stool;
  • — из-за воспаления или присоединения инфекции в области поражения у больного отмечается повышение температуры, обычно умеренного характера – 37-38 0 C. Причиной усталости или быстрой утомляемости также является прогрессирующее воспаление; Fever and general malaise - due to inflammation or attachment of infection in the affected area, the patient has a fever, usually of a moderate nature, 37-38 0 C. The cause of fatigue or fast fatigue is also progressive inflammation;
  • — воспаление и изъязвление слизистой оболочки нарушает нормальное продвижение кишечного содержимого по пищеварительному тракту, вызывая болезненные ощущения. Pain and cramping in the abdomen - inflammation and ulceration of the mucous membrane disrupts the normal movement of intestinal contents through the digestive tract, causing painful sensations. The severity of symptoms varies in different patients from mild discomfort to unbearable pain, accompanied by nausea and vomiting;
  • — пациенты могут замечать светлые кровяные прожилки на стенке унитаза или темную кровь, смешанную с калом. Blood in stool - patients can notice light blood veins on the wall of the toilet bowl or dark blood mixed with feces. Bleeding can also go unnoticed ("hidden blood");
  • оболочки ротовой полости; Ulcers of the oral mucosa ;
  • — постоянные болезненные ощущения в животе, а также появление воспалительных изменений стенки кишки снижают способность нормально переваривать пищу, что проявляется постепенной потерей аппетита у больного; Deterioration of appetite and weight loss - the constant pain in the abdomen, as well as the appearance of inflammatory changes in the intestinal wall reduce the ability to normally digest food, which is manifested by a gradual loss of appetite in the patient;
  • из-за появления свища (сквозное поражение слизистой кишечника и окружающих тканей вплоть до кожных покровов больного). Pain in the anus due to the appearance of the fistula (a through lesion of the intestinal mucosa and surrounding tissues up to the skin of the patient).

Also, symptoms of Crohn's disease in adults can be manifested:

  • Inflammatory diseases of the skin, eyes and joints;
  • Inflammation of the liver and bile duct (see stones in the gallbladder )

Crohn's disease is more difficult in children, the symptoms of which are almost identical to those described above, but are more pronounced in connection with immaturity of the immune system. A characteristic feature in children is the retardation of growth and puberty.

Causes

The exact cause of the development of Crohn's disease remains unknown. Earlier it was suspected the influence of an improper diet and frequent stressful situations, but it is now established that these factors can only increase the risk of the disease, but are not its cause. A number of factors take part in the mechanism of the development of the disease, including heredity and impairment of the functions of the immune system:

  • Immunity - Symptoms of Crohn's Disease it is considered that the triggering mechanism of Crohn's disease is viruses or bacteria. When the human immune system starts to fight the pathogen, specific antibodies are produced that can cause damage to the body's own tissues. In this case - the mucous membrane of one of the digestive system;
  • — частота заболеваемости значительно возрастает в семьях, где один или несколько членов уже больны. Heredity - the incidence rate significantly increases in families where one or more members are already sick. This indicates a genetic predisposition to Crohn's disease. Every fifth patient has a hereditary hereditary history. Nevertheless, most patients develop the disease on their own, and there is no family history of the disease.

Risk factors

The risk factors for the development of the disease include:

  • — заболевание может развиваться в любом возрасте, но частота значительно выше в молодом возрасте. Age - the disease can develop at any age, but the frequency is significantly higher at a young age. In most patients, the diagnosis of Crohn's disease was confirmed before the age of 30;
  • — более высокий риск заболеваемости отмечается у европейцев; Nationality - a higher risk of morbidity is noted in Europeans;
  • — это самый важный контролируемый фактор риска развития болезни Крона. Tobacco smoking is the most important controlled risk factor for developing Crohn's disease. Harmful habits not only increase the risk of the disease, but also significantly aggravate its course. Smoking people noted an increase in the frequency of surgical interventions in planning treatment. If you smoke, quit;
  • — неконтролируемый прием и резкая отмена этих препаратов (ибуфен, диклофенак и пр. см. уколы от боли ) может привести к развитию воспаления в кишечнике, ухудшающего течение болезни Крона; Non-steroidal anti-inflammatory drugs - uncontrolled reception and abrupt withdrawal of these drugs (ibufen, diclofenac , etc., see pricks from pain ) can lead to inflammation in the intestines, worsening the course of Crohn's disease;
  • — при длительном их приеме (свыше 5 лет) в 3 раза возрастает риск возникновения этого заболевания (см. противозачаточные средства — плюсы и минусы ); Oral contraceptives - long-term admission (more than 5 years) increases the risk of this disease 3 times (see contraceptives - pros and cons );
  • — жизнь в городе или в индустриальной зоне повышает риск развития болезни. Environment - living in a city or in an industrial zone increases the risk of developing the disease. Also, high risk is observed among residents of northern regions in severe and extreme climatic conditions;
  • — высокое содержание жиров и рафинированной пищи (с пониженным количеством питательных веществ) приводит к постепенному повреждению слизистой кишечника и развитию воспаления. Diet - a high content of fats and refined foods (with a reduced number of nutrients) leads to a gradual damage to the intestinal mucosa and the development of inflammation.
  • лактозная недостаточность , целиакия (непереносимость глютена ), непереносимость любых продуктов питания. Food allergy - lactose deficiency , celiac disease (intolerance to gluten ), intolerance of any food.
  • — известные всем факторы снижения иммунитета и как следствие пусковые механизмы для развития большинства заболеваний. Stresses, mental overstrain - known to all factors reduce immunity and, as a consequence, triggers for the development of most diseases.

Complications

Crohn's disease can be accompanied by complications such as:

  • на большой участок слизистой оболочки, приводящее к возникновению рубцов и сужения просвета кишки (стеноз). The spread of inflammatory changes to a large area of ​​the mucous membrane, leading to the appearance of scars and constriction of the lumen of the gut (stenosis). With the involvement of all shells of the intestine in the inflammatory process with the transition to surrounding tissues, a more serious complication arises, fistula;
  • — при прогрессировании воспаления с развитием выраженного отека слизистой оболочки происходит закупорка кишечника за счет утолщения собственных стенок. Intestinal obstruction - with the progression of inflammation with the development of pronounced edema of the mucous membrane, intestinal blockage occurs due to thickening of the walls. Because of this, the contents of the intestine accumulate in the initial parts of the digestive tract. An emergency operation may be required to treat this condition;
  • — хроническое воспаление приводит к развитию язв на поврежденных участках слизистой оболочки кишки, а также в других отделах, включая рот и область ануса. Ulcers - chronic inflammation leads to the development of ulcers in the damaged parts of the intestinal mucosa, as well as in other departments, including the mouth and anus. Cases have been described where patients had ulcers spread to the perineal region;
  • — в ряде случаев язвы увеличиваются, захватывая более глубокие слои кишечной оболочки, приводя к развитию свища – аномального канала, соединяющего полость кишки с кожей или другими органами. Fistulas - in a number of cases, ulcers increase, capturing deeper layers of the intestinal cage, leading to the development of a fistula - an abnormal canal that connects the gut cavity with the skin or other organs. With Crohn's disease, anal fistulas are the most common.

If the fistula develops inside the abdominal cavity, food entering the intestine can pass the departments responsible for absorbing nutrients, and also penetrate into organs such as the bladder or vagina. Fistula development is a formidable complication, as there is a high risk of suppuration and abscess formation. Left unattended, this condition can become a threat to the life of the patient;

  • — это небольшой разрыв, развивающийся в анусе или на коже вокруг анального отверстия и сопровождающийся развитием болезненных ощущений. Anal fissure is a small rupture that develops in the anus or on the skin around the anus and is accompanied by the development of painful sensations. The danger is a high risk of infection of the fissure and development of the fistula;
  • — диарея, боль в животе и болезненные спазмы могут привести к потере аппетита или недостаточной усвояемости питательных веществ в кишечнике. Insufficient nutrition - diarrhea, abdominal pain and painful spasms can lead to loss of appetite or insufficient digestibility of nutrients in the intestine. For Crohn's disease is characterized by the development of such concomitant diseases as B12-deficiency and iron deficiency anemia;
  • — развитие болезни Крона в прямой кишке значительно повышает риск развития злокачественных образований в области поражения. Cancer of the rectum - the development of Crohn's disease in the rectum significantly increases the risk of developing malignant lesions in the lesion. For timely detection of an undesirable complication, a screening examination should be performed regularly. For healthy people, colonoscopy is recommended every 10 years after the age of 50 years. In occasion of early appointment and more frequent examination it is necessary to consult with the attending physician. Read more about colorectal cancer .
  • — лекарственные препараты, назначаемые при болезни Крона, подавляют активность иммунной системы. Drug risk - drugs prescribed for Crohn's disease suppress the activity of the immune system. In connection with this, there is a small risk of developing certain cancers (lymphoma, skin cancer) with prolonged treatment. The susceptibility of the patient to various infectious diseases also increases.

Treatment

Treatment of Crohn's disease is usually carried out conservatively, using a variety of medications. Operative intervention is performed only if there are certain indications. At the moment the disease is considered incurable, and there is no special universal treatment method suitable for every patient. There are two different therapies of therapy: from the bottom up, from the use of light drugs to the appointment of more potent drugs, or "top-down", involving the use of potent drugs at the initial stage of treatment.

The purpose of drug therapy is to reduce the activity of the inflammatory process, which allows you to get rid of the symptoms and manifestations of the disease. In addition, it is necessary to plan treatment in such a way as to ensure the prevention of possible complications and to achieve persistent long-term remission. For a patient who developed symptoms characterizing Crohn's disease, treatment should be started as soon as possible. Timely conducted therapy can significantly reduce the severity of manifestations of the disease and shortens the duration of exacerbation.

Anti-inflammatory treatment

Anti-inflammatory drugs are usually the first on the list of prescriptions for Crohn's disease. These include:

Aminosalicylates for oral administration (sulfasalazine, mesalamine)

These drugs are effective in developing an inflammatory focus in the rectum. If the disease affects the small intestine, the drugs are useless. Earlier preparations of this group were widely used for the treatment of inflammatory diseases of the rectum, but at the moment it has been decided to limit their use due to insufficient efficiency and a large number of side effects.

Corticosteroids

Prednisolon and other drugs in this group can reduce the inflammatory response of the body, regardless of the location of the primary focus. Disadvantages of their use are a large number of side effects, including swelling, excessive facial hair growth, insomnia, hyperactivity, as well as increased blood pressure, diabetes, osteoporosis, cataracts, glaucoma and susceptibility to infectious diseases. These drugs are not the same for different patients. Doctors use their help only if other methods of treatment have no effect.

New generation corticosteroid Budesonide (Budenofalk) has a more rapid and pronounced effect and has fewer side effects. Nevertheless, its positive effect is fixed in the development of inflammation only in certain areas of the intestine. The duration of hormonal therapy with corticosteroids should not exceed 3-4 months. Continuation of treatment after remission does not lead to further improvement and increase the risk of side effects. It is more advisable to switch to maintenance therapy with immunosuppressors after reaching remission.

Immunosuppressors

Drugs of this group also relieve inflammation, but due to the impact on the immune system. In some cases, a combination of two immunosuppressors is used to achieve a more pronounced effect. Among the drugs used are:

  • Azathioprine (Imuran) and Mercaptopurine (Purinethol ). These are the most commonly used immunosuppressors in the treatment of inflammatory bowel diseases. Side effects from a short reception include suppression of bone marrow activity, the development of hepatitis and pancreatitis. Long-term use increases the susceptibility to infections, and increases the risk of skin and lymphoma cancer;
  • Infliximab (Remicade), Adalimumab (Humira), and Certolizumab Pegol (Symphony) . The mechanism of action of these drugs is to suppress the activity of the plasma protein - tumor necrosis factor (TNF). The use of TNF inhibitors effectively curable the symptoms of Crohn's disease and achieve remission of the disease. This is one of the most promising directions for improving the methods of treatment of this disease.

Preparations of this group are recommended to be used immediately after diagnosis, especially if there is a suspicion of a complicated course of the disease and fistula development.

Contraindications to the use of TNF inhibitors are tuberculosis, chronic viral hepatitis (B, C, etc.) and other serious infectious diseases.

  • Methotrexate (Rheumatrex). It is a drug used in the treatment of cancer, psoriasis and rheumatoid arthritis. But his appointment to patients with Crohn's disease had a definite positive effect. Usually it is used as an alternative means for ineffectiveness of other methods of treatment.
  • Ciclosporin (Sandimmun Neoral, Panimun Bioral, Ecoral) and Tacrolimus (Astagraf XL , Advagraf, Prograf, Tacrosel). Usually used in Crohn's disease, complicated by the development of fistulas, these drugs can be used in uncomplicated course of the disease in the absence of improvement from standard therapy. The use of cyclosporine is associated with some severe side effects (kidney and liver damage, seizures, infectious diseases). Prolonged reception is contraindicated;
  • Natalizumab (Tizabry) and Vedolizumab (Envivivo) . The mechanism of action is to prevent the binding of integrins (cellular molecules of leukocytes) with surface molecules on the intestinal mucosa. The rupture of communication prevents the development of autoimmune inflammation, thereby removing the symptoms of the disease. Natalizumab is recommended for use in patients with moderate or severe course of the disease, not responding to treatment with other medications.

The use of the drug is associated with some risk of developing multi-cell leukoencephalopathy - a brain disease that can lead to death or disability. Therefore, before starting treatment, a patient must become a participant in a special program with limited distribution of the drug.

Vedolizumab also underwent clinical trials and was approved for use in Crohn's disease. The mechanism of action of the drug is identical to that described above, but the advantage is that there is no risk of developing leukoencephalopathy;

  • Ustekinumab (Stelara). This medicine was used to treat psoriasis. Due to the conducted studies, the effectiveness of the drug in relation to Crohn's disease was noted.

Antibiotics

Antibiotics are prescribed in the development of fistulas or abscesses to combat infectious complications. Some researchers also suggest that antibiotics can reduce the degree of adverse effects of opportunistic bacteria on the damaged intestinal wall. Nevertheless, the confirmed effectiveness of antibacterial therapy regarding the outcome of Crohn's disease has not yet been revealed.

The most frequently prescribed antibacterial drugs for Crohn's disease are:

  • Metronidazole (Flagil, Trichopol, Clion) . Once metronidazole was the most common antibiotic in the treatment of this disease. Although, its use is associated with the risk of developing side effects such as weakness and pain in the muscles, numbness and tingling in the hands and feet;
  • Ciprofloxacin . This drug, the use of which in some patients reduces the severity of symptoms of Crohn's disease. Currently, it is more preferable than metronidazole.

Other medicines

In addition to fighting inflammation, other drugs can be used to improve the condition. Depending on the severity of the disease, doctors can recommend:

  • — для легкого течения подойдет метилцеллюлоза (Цитрусел). Antidiarrhoeal preparations - for light flow, methylcellulose (Citrusel) is suitable. In more severe cases it is recommended to use Loperamide (Imodium). Begin the treatment with these drugs only on the advice of a doctor;
  • — умеренную болезненность может снять Ацетаминофен (Тайленол). Analgesics - moderate pain can remove acetaminophen (Tylenol). Учтите, что в данном случае противопоказаны распространенные анальгетики ( Ибупрофен , Напроксен). Их применение может ухудшить течение заболевания и привести к развитию более выраженных симптомов;
  • Препараты железа при анемии — при хронической кишечной кровоточивости может развиваться железодефицитная анемия, для лечения которой назначаются данные препараты;
  • Инъекции Витамина B12 — болезнь Крона может приводить к развитию B-12 дефицитной анемии. Для предупреждения дальнейшего ее прогрессирования назначаются витаминные препараты;
  • Препараты кальция и витамина D — само заболевание и применяемые для его лечения гормоны увеличивают риск развития остеопороза. Описанные препараты назначаются с целью профилактики данного осложнения.

Operation

Если диета, перемена образа жизни, лекарственная терапия и другие методы оказались неэффективными, больному рекомендуется оперативное лечение. Около половины всех больных болезнью Крона в процессе лечения переносят как минимум одно хирургическое вмешательство. Тем не менее, это не обеспечивает излечение от заболевания.

Оперативное лечение заключается в удалении поврежденного отдела кишечника с последующим наложением анастомоза между здоровыми участками. Хирургическое вмешательство также необходимо для лечения свищей и дренирования абсцессов, а также при развитии кишечной непроходимости.

Положительный эффект от оперативного лечения при болезни Крона обычно имеет временный характер. Заболевание часто рецидивирует, вызывая воспаление вблизи от прежнего очага. Наилучшая тактика – продолжать поддерживающую медикаментозную терапию после операции.

Diet

Не существует обоснованных доказательств того, что определенные продукты являются причиной развития болезни Крона. Но отказ от употребления некоторых видов пищи может значительно уменьшить выраженность симптомов заболевания.

Многие врачи рекомендуют пациентам завести дневник для контроля над своей диетой. Если после употребления какого-либо продукта больной отмечает ухудшение состояния, в будущем он сможет избежать обострения, просто скорректировав диету.

Рекомендации касательно питания:

  • Ограничить употребление мучного и выпечки;
  • Отдать предпочтение продуктам с низким содержанием жиров;
  • Отказаться от употребления острых блюд, алкоголя;
  • Питаться малыми порциями 5-6 раз в день;
  • Пить достаточно жидкости;
  • Принимать мультивитаминные комплексы.

Примеры знаменитостей, страдающих болезнью Крона

Только в США насчитывается около 700 тысяч больных болезнью Крона. Хотя симптомы заболевания могут значительно ухудшать качество жизни больного, правильно подобранный план лечения позволяет пациентам оставаться на ногах. К примеру, многие знаменитые спортсмены сумели бросить вызов этому тяжелому заболеванию и, несмотря ни на что, достичь пика своей карьеры. Ниже приведены их истории о том, как им удалось справиться со своим состоянием и достичь превосходства на игровом поле.

Дэвид Гаррард: Американский футбол. Defender

About 30 centimeters of the intestine is removed due to Crohn's disease. Fighting the disease for David, the 35-year-old former player of the Jacksonville Jaguars, began in 2004 when he began to suffer unbearable pain in his stomach after eating. In 2005, in an interview for The New York The Times, he said that, in his opinion, he picked up the intestinal infection and did not hurry to see a doctor for three months. Garrard began to lose weight, which is not very good for a football player, until the supporting therapy and surgery has not returned everything to its proper place. Despite his age and Crohn's disease, David continues to perform on a lined field: for 2017-2014 he signed a contract with the New York Jet team.

Cynthia McFadden

ABC News correspondent, McFadden felt for the first time the excruciating pain caused by Crohn's disease, which her friends imaginatively dubbed "George", at the age of 2 in college. "They did not ask how many bouts of diarrhea I had during the day. Instead, they said: "How is George?" - says Cynthia in an interview for People magazine in 1994.

After she developed internal bleeding in 1979, she was removed 4.5 meters of the intestine. Since then, McFadden has been persistent remission, and she continues to work for the American Foundation for the Fight against Crohn's Disease and Colitis.

Kerry Johnson: participant of the Olympic Games on kayaking

Kerry Johnson performed at the three Summer Olympics despite the diagnosis - Crohn's disease. In 2003, anemia, weight loss and exhaustion forced her to stop training. After conducting a variety of tests, she was diagnosed with Crohn's disease, but with medical help she was able to cope with the disease. A year later she qualified for her first Olympic Games in Athens. At the recent Games in London in 2012, Johnson went to the semi-finals in two categories. Now, having left the sport, Kerry has directed efforts to support people with Crohn's disease, urging others not to be afraid of their condition.

Frank Fritz

Fritz, one of the stars of the reality show American Pickers on the History Channel, an antiquarian treasure hunter who fought Crohn's disease for almost a quarter of a century.

"Crohn's disease is like a duck," he tells the correspondent of Crohn's Advocate magazine. "The ducks seem calm, quietly floating on the water surface, but they are flailing like crazy under the water. Similarly, for people with Crohn's disease, you can not see anything from the side, but I have to make great efforts to control my condition. "

George "Animal" Steel - fight without rules

His real name is Jim Myers, but fans of the fight know this athlete as George "Animal" Steele from World Wrestling Entertainment. Crohn's disease was diagnosed in Steele in 1988. At that time, the doctors said that the defeat of the rectum was progressing so quickly that it needed to be removed, but he refused. After many years of drug treatment, which led to the development of a number of concomitant diseases, doctors still had to remove his rectum in 2002. Steele says that he finally regained his former health, and now travels around the US as a motivational speaker.

Mike McCredy

Rocker McCredy, the guitarist, the head of the band Pearl Jam, considers himself lucky, despite Crohn's disease. In 2007, in an interview for BigButtRadio.com, he said that he was happy that he could do what he really likes. "I tried to show people that despite the illness, we still have life and a career."

James Morrison - Golf

British golfer James Morrison learned that he had Crohn's disease more than 10 years ago. During the French Open 2011 season, the attack caused him to go to the hospital, but Morrison met with strength and completed the tournament. The disease was not accurately determined.

Kevin Dining. Hockey.

Former professional ice hockey player Kevin Dinin experienced hard times, having entered the fight against Crohn's disease. "It was a really instructive lesson, because a quick solution is not a suitable word for this state," Dinin said in an interview for the USA magazine Hockey Magazine in 2010. "This is a chronic, debilitating disease that is present with you throughout life." Like many other professional athletes, Crohn's disease arose just on the path of a hockey player's hugely promising career. But he managed to take the disease under control and continued to play in the NHL for 16 more years. Now Dinin trains the NHL team Florida Panthers.

Matt Light - Football

Former midfielder of the New England Patriots Matt Light learned about his diagnosis in 2001, during his debut season, after which for 10 years led his illness with a quiet struggle. Over the course of his football career, Light could not take most of the prescribed drugs and skipped games due to exacerbation of symptoms. Three times the champion of the Super Cup has undergone surgery, during which more than 30 cm of his intestines were removed. Now retired athlete shares his story with others in order to increase literacy and self-confidence to fight Crohn's disease.

Dwight D. Eisenhower

In 34 of the United States President, Crohn's disease was diagnosed in 1956. Due to the severity of the condition, he was soon operated on. Commander of Allied forces in Europe during the Second World War, Eisenhower was able to win a repeat election despite heart problems and severe inflammation of the intestine.

Forecast

The prognosis of the disease varies considerably and is determined individually. The course of Crohn's disease may be asymptomatic (if the focus is located only in the anus in the elderly) or proceed in extremely severe form.

In 13-20% of patients, the chronic course of the disease is noted. With properly administered treatment, the duration of the remission periods reaches several tens of years. As an independent disease, Crohn's disease is very rarely a cause of death of patients, and the percentage of deaths remains extremely low. Usually patients receiving maintenance therapy live to a very old age.

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