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


Crohn's disease is an inflammatory bowel disease, characterized by severe damage to the mucous membrane, accompanied by abdominal pain, diarrhea, malnutrition and weight loss.

The progression of the disease leads to the defeat of the deeper layers, leading to increased pain and an increase in exhaustion, sometimes ending with the development of serious complications that threaten the patient's life.

Although at the moment, Crohn's disease is incurable, the existing methods of maintenance therapy can significantly reduce the severity of its symptoms and even allow you to achieve a long lasting remission.

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 lesion is located in the rectum (large intestine). These are the most common sites of Crohn's disease.

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

A patient diagnosed with Crohn's disease symptoms include:

  • – наиболее распространенная проблема при данном заболевании. Diarrhea is the most common problem with this disease. Damage to the mucous membrane leads to disruption of the digestive processes, and frequent intestinal spasms contribute to bowel emptying with the appearance of loose stools;
  • — 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 the addition of infection in the affected area, the patient has a fever, usually moderate in nature - 37-38 0 C. Fatigue or fatigue are also caused by progressive inflammation;
  • — воспаление и изъязвление слизистой оболочки нарушает нормальное продвижение кишечного содержимого по пищеварительному тракту, вызывая болезненные ощущения. Abdominal pain and cramps - 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 the feces - patients may notice light blood streaks 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 mucous membrane of the mouth;
  • — постоянные болезненные ощущения в животе, а также появление воспалительных изменений стенки кишки снижают способность нормально переваривать пищу, что проявляется постепенной потерей аппетита у больного; Worsening of appetite and weight loss - 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 a patient;
  • из-за появления свища (сквозное поражение слизистой кишечника и окружающих тканей вплоть до кожных покровов больного). Pain in the anus area due to the appearance of a fistula (a through lesion of the intestinal mucosa and surrounding tissues up to the patient's skin).

Also, the symptoms of Crohn's disease in adults can occur:

  • Inflammatory diseases of the skin, eyes and joints;
  • Inflammation of the liver and bile ducts (see gallstones )

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

The reasons

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

  • Immunity - Symptoms of Crohn's Disease Crohn's disease trigger is believed to be viruses or bacteria. When the human immune system begins 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 sections of the digestive system;
  • — частота заболеваемости значительно возрастает в семьях, где один или несколько членов уже больны. Heredity - the incidence rate increases significantly in families where one or several members are already sick. This indicates the presence of a genetic predisposition to Crohn's disease. Every fifth patient has an aggravated hereditary history. However, in most patients, the disease develops on its own, and there is no family history of the disease.

Risk factors

Risk factors for developing 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 much 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 among Europeans;
  • — это самый важный контролируемый фактор риска развития болезни Крона. Tobacco smoking is the most important controlled risk factor for Crohn's disease. Bad habits not only increase the risk of disease, but also significantly aggravate its course. In smokers, there is an increase in the frequency of surgical interventions when 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 intake and abrupt cancellation of these drugs (ibufen, diclofenac , etc., see pain injections ) can lead to the development of inflammation in the intestine that worsens 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 - if they are taken for a long time (over 5 years), the risk of this disease increases 3 times (see contraceptives - pros and cons );
  • — жизнь в городе или в индустриальной зоне повышает риск развития болезни. Environment - life in the city or in the industrial zone increases the risk of developing the disease. Also, high risk is observed among residents of northern areas in harsh 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 - high in fat and refined foods (with a reduced amount of nutrients) leads to gradual damage to the intestinal mucosa and the development of inflammation.
  • лактозная недостаточность , целиакия (непереносимость глютена ), непереносимость любых продуктов питания. Food allergies - lactose deficiency , celiac disease (gluten intolerance ), intolerance to any food.
  • — известные всем факторы снижения иммунитета и как следствие пусковые механизмы для развития большинства заболеваний. Stress, mental overstrain are factors known to all that reduce immunity and, as a result, trigger mechanisms for the development of most diseases.

Complications

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

  • на большой участок слизистой оболочки, приводящее к возникновению рубцов и сужения просвета кишки (стеноз). The spread of inflammatory changes over a large area of ​​the mucous membrane, leading to scarring and narrowing of the intestinal lumen (stenosis). When all intestinal membranes are involved in the inflammatory process with the transition to the 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 swelling of the mucous membrane occurs intestinal obstruction due to the thickening of its own walls. Because of this, the intestinal contents accumulate in the initial parts of the digestive tract. Emergency surgery 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 damaged areas of the intestinal mucosa, as well as in other departments, including the mouth and anus region. Cases have been described in which patients had a spread of ulcers in 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 some cases, ulcers increase, capturing the deeper layers of the intestinal lining, leading to the development of a fistula - an abnormal canal connecting the intestinal cavity with the skin or other organs. In Crohn's disease, anal fistulas are most common.

If a fistula develops inside the abdominal cavity, food that enters the intestine may bypass the departments responsible for the absorption of nutrients, as well as penetrate organs such as the bladder or vagina. The development of a fistula is a terrible complication, as there is a high risk of suppuration and abscess formation. Left without attention, this condition can be 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. An anal fissure is a small tear that develops in the anus or on the skin around the anus and is accompanied by the development of painful sensations. The danger lies in the high risk of fracture infection and fistula development;
  • — диарея, боль в животе и болезненные спазмы могут привести к потере аппетита или недостаточной усвояемости питательных веществ в кишечнике. Malnutrition - diarrhea, abdominal pain and painful cramps can lead to loss of appetite or inadequate digestion of nutrients in the intestines. Crohn 's disease is characterized by the development of such comorbidities as B12-deficiency and iron deficiency anemia;
  • — развитие болезни Крона в прямой кишке значительно повышает риск развития злокачественных образований в области поражения. Colorectal cancer - the development of Crohn's disease in the rectum significantly increases the risk of developing malignant tumors in the affected area. For timely detection of undesirable complications, it is necessary to undergo a regular screening examination. For healthy people, a colonoscopy is recommended every 10 years after the age of 50. For early appointments and more frequent examinations, you should consult with your doctor. Read more about rectal 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 this regard, there is a small risk of developing certain cancers (lymphoma, skin cancer) with long-term treatment. Also increases the susceptibility of the patient to various infectious diseases.

Treatment

The treatment of Crohn's disease is usually carried out conservatively, using various drugs. Operative intervention is carried out only if there are certain indications. At the moment, the disease is considered incurable, and there is no special universal treatment method suitable for each patient. There are two different methods of treatment: “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 goal of drug therapy is to reduce the activity of the inflammatory process, which allows 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 stable long-term remission. For a patient who has developed symptoms that characterize Crohn's disease, treatment should be started as soon as possible. Timely therapy can significantly reduce the severity of manifestations of the disease and reduces 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 the development of an inflammatory focus in the rectum. If the disease affects the small intestine, the drugs are useless. Previously, drugs 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 effectiveness and a large number of side effects.

Corticosteroids

Prednisiolone and other drugs in this group can reduce the inflammatory response of the body, regardless of the location of the primary focus. The disadvantages of their use are a large number of side effects, including edema, excessive growth of facial hair, insomnia, hyperactivity, as well as increased blood pressure, diabetes, osteoporosis, cataracts, glaucoma and susceptibility to infectious diseases. These drugs do not work equally in different patients. Doctors resort to their help only if other methods of treatment had no result.

The new-generation corticosteroid Budesonide (Budenofalk) has a faster and more pronounced effect and has fewer side effects. However, its positive effect was recorded with the development of inflammation only in certain parts of the intestine. The duration of hormone therapy with corticosteroids should not exceed 3-4 months. Continuing treatment after achieving remission will not entail further improvement and increase the risk of side effects. It is more expedient to switch to supportive therapy with immunosuppressants after achieving remission.

Immunosuppressants

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

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

Preparations of this group are recommended to be used immediately after diagnosis, especially in cases of suspected complicated course of the disease and the development of fistula.

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 prescribing it to patients with Crohn's disease had a definite positive effect. It is usually used as an alternative remedy for the failure of other treatments.
  • Cyclosporin (Sandimmun Neoral, Panimun Bioral, Ecoral) and Tacrolimus (Astagraf XL , Advagraf, Prograf, Takrosel). Usually used for Crohn's disease, complicated by the development of fistulas, these drugs can also be used for uncomplicated disease in the absence of improvement from the standard therapy. The use of cyclosporine is associated with some severe side effects (kidney and liver damage, seizures, infectious diseases). Long-term use is contraindicated;
  • Natalizumab (Tizabri) and Vedolizumab (Entivivo) . The mechanism of action is to prevent the binding of integrins (cellular molecules of leukocytes) with surface molecules on the intestinal mucosa. A 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 disease who do not respond to treatment with other drugs.

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

Vedolizumab also passed clinical trials and received approval 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 has been used to treat psoriasis. Thanks to the research, the effectiveness of the drug in relation to Crohn's disease was noted.

Antibiotics

Antibiotics are prescribed for 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. However, the proven efficacy of antibiotic therapy in relation to the outcome of Crohn's disease has not yet been identified.

The most commonly prescribed antibacterial drugs for Crohn's disease include:

  • Metronidazole (Flagyl, Trichopol, Klion) . Once metronidazole was the most common antibiotic in the treatment of this disease. Although, its use is associated with the risk of 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. It is currently preferred over metronidazole.

Other medicines

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

  • — для легкого течения подойдет метилцеллюлоза (Цитрусел). Antidiarrheal drugs - methylcellulose (Citrusel) is suitable for an easy course. In more severe cases, it is recommended to use Loperamide (Imodium). To begin treatment with these drugs is possible only on the recommendation of the attending physician;
  • — умеренную болезненность может снять Ацетаминофен (Тайленол). Analgesics - Acetaminophen (Tylenol) can relieve moderate pain. 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.

Операция

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.

Диета

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 bowel removed due to Crohn's disease. The fight against the disease for David, a 35-year-old former player of the Jacksonville Jaguars team, began back in 2004, when he was tormented by intolerable stomach pains after eating. In 2005, in an interview for The New York Times, he said that, in his opinion, he caught an intestinal infection and was in no hurry to see a doctor for three months. Garrard began to lose weight heavily, which is not very good for a football player, until supportive therapy and surgery did not return everything to its 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

The correspondent of the channel ABC News, McFadden for the first time felt the excruciating pain caused by Crohn's disease, which her friends figuratively dubbed "George", in her 2 year of college. “They did not ask how many bouts of diarrhea I had during the day. Instead, they said, “How is George doing?”, Says 1994 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 experienced a stable remission, and she continues to work at the American Foundation for the Control of Crohn's Disease and Colitis.

Kerry Johnson: Participant in the Kayak Olympics

Kerry Johnson has performed in three Summer Olympics despite the diagnosis of Crohn's disease. In 2003, anemia, weight loss and exhaustion forced her to stop training. After many 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 London Games in 2012, Johnson reached the semi-finals in two categories. Now, after leaving 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 American reality show The Pickers on the History Channel, an antique treasure hunter who fought Crohn's disease for nearly a quarter of a century.

“Crohn's disease is like a duck,” he tells a Crohn's Advocate magazine reporter, “Ducks seem to be calm, quietly swimming on the water surface, but under the water they hit the flippers like crazy. Similarly, for people with Crohn's disease, nothing is visible from the outside, but I have to make great efforts to control my condition. ”

George "The Beast" Steele - a fight without rules

His real name is Jim Myers, but wrestling fans know this athlete as George “The Animal” Steele from World Wrestling Entertainment. Crohn's disease was diagnosed in Steele in 1988. At that time, doctors said that the lesion of the rectum was progressing so quickly that it needed to be removed, but he refused. After many years of medical treatment, which led to the development of a number of associated diseases, doctors still had to remove his rectum in 2002. Steele says he finally regained his former health, and is now traveling the United States as a motivational speaker.

Mike McCredy

Rocker McCready, guitarist, head of the Pearl Jam group, considers himself lucky, despite Crohn's disease. In 2007, in an interview with BigButtRadio.com, he said that he was happy that he could do what he really loved. “I tried to show people that despite the disease, we still have life and career.”

James Morrison - Golf

British golfer James Morrison found out that he has Crohn's disease more than 10 years ago. During the 2011 French Open Championship, an attack made him go to the hospital, but Morrison braced himself and finished the tournament. The cause of the disease has not been clarified.

Kevin Dinin. Hockey.

Former professional hockey player Kevin Dinin survived hard times, joining the fight against Crohn's disease. “It was a really instructive lesson, because a quick decision is not an appropriate word for this state,” Dinin told the USA magazine. Hockey Magazine in 2010. "This is a chronic, debilitating disease that lasts with you throughout life." Like many other professional athletes, Crohn's disease arose in the path of a hockey player’s only promising career. But he managed to take the disease under control and continued to play in the NHL for another 16 years. Now Dinin coached the team of the NHL Florida Panthers.

Matt Light - Football

Former New England Patriots midfielder Matt Light learned about his diagnosis in 2001, during his debut season, after which for 10 years he waged a quiet fight with his illness. Throughout his football career, Light could not take most of the prescribed drugs and missed the game due to exacerbations of symptoms. Three times the champion of the Super Bowl underwent an operation in which more than 30 cm of its intestines were removed. The retired athlete now shares his story with others to increase literacy and self-confidence to fight Crohn's disease.

Dwight D. Eisenhower

34 President of the United States was diagnosed with Crohn’s disease in 1956. Due to the severity of the condition, he was soon operated on. Commanded by Allied forces in Europe during the Second World War, Eisenhower managed to win a repeat election despite heart problems and severe intestinal inflammation.

Forecast

The prognosis of the disease varies considerably and is determined individually. The course of Crohn's disease may be asymptomatic (with localization of the lesion only in the anus in the elderly) or to proceed in a very severe form.

In 13-20% of patients there is a chronic course of the disease. With the right treatment, the duration of remission periods reaches several decades. As an independent disease, Crohn's disease is very rarely the cause of death of patients, and the percentage of mortality remains extremely low. Typically, patients receiving maintenance therapy, live to a ripe old age.

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