Crohn's disease - symptoms and treatment
Crohn's disease in adults is a chronic disease that most often affects the large and small intestines, in which inflammation of all layers of the digestive tube occurs with the development of various, sometimes severe complications.
Causes of Crohn's disease
Unfortunately, modern medicine does not know the reasons for the development of this pathology. It is believed that many factors play a role in its appearance:
- genetic predisposition;
- disruption of immune system functions;
- changes in the composition of intestinal microflora;
- environmental factors.
In the presence of even one of the first three factors, the risk of CK increases many times over - 3 people out of a thousand in the population get sick. The probability of the appearance of pathology increases with smoking, chronic stress, hypovitaminosis D, a diet with mainly animal food and a lack of dietary fiber, intestinal infections, especially clostridial.
Symptoms of Crohn's disease in adults
This pathology is often diagnosed in two age periods: 20-30 years and 60-70 years. This means that Crohn's disease is relatively rare in children. Its usual symptoms are prolonged diarrhea lasting more than one and a half months (the most important diagnostic criterion!), during which there are often no blood impurities in the stool, abdominal pain, increased body temperature, and anemia for no apparent reason. Along with the symptoms described above, detection of complications in the anus is considered important for diagnosis:
- chronic cracks, especially in cases of their recurrent course;
- paraproctitis;
- fistula of the rectum.
The presence of diseases of an autoimmune nature, but located outside the intestines, is often noted in patients with HC:
- arthropathy;
- nodular erythema and gangrenous pyoderma;
- aphthous stomatitis;
- inflammatory eye diseases;
- Bekhterev's disease;
- osteoporosis and osteomalacia;
- psoriasis;
- amyloidosis of different localization;
- hepatic steatosis (fatty dystrophy);
- gallstone disease, etc.
At the beginning of the disease, its diagnosis is very difficult due to the fact that Crohn's disease often resembles other types of intestinal pathology. Sometimes there are even unnecessary operations for appendicitis, for example, and only on the operating table is the true cause of abdominal pain revealed. However, in the event of complications and a thoughtful study of already existing symptoms, an experienced doctor will be able to suspect the presence of this pathology.
Among the complications of HC, the following are distinguished:
- intestinal-cutaneous, interintestinal, entero-vaginal and entero-bladder fistulas;
- infiltrates localized in the abdominal cavity;
- abscesses;
- strictures (persistent narrowing) in various parts of the gastrointestinal tract, which sometimes lead to intestinal obstruction;
- toxic dilatation of the colon;
- anal fissures;
- purulent inflammation of the perirectal tissue (paraproctitis);
- intestinal bleeding.
Treatment of Crohn's disease: clinical recommendations
The goal pursued by the doctor is to suppress the aggravation of the disease, put it into remission and prevent a new aggravation. The second goal is to prevent complications and prevent the occurrence of such situations in which the operation will become inevitable. The third goal is to recognize the occurrence of these cases in a timely manner and to prescribe surgical treatment in a timely manner. This does not mean that the doctor will first perform one task, then the second and only then the third - therapy is carried out taking into account the entire set of tasks.
At the initial stage and in the absence of complications, exclusively conservative treatment is carried out with glucocorticoids (prednisolone drugs), immunosuppressants (azathioprine, methotrexate), biological drugs of the antibody group (infliximab, adalimumab, certolizumab, vedolizumab), vedolizumab.
At the same time, symptomatic agents are used that do not directly affect the disease, but eliminate its adverse effects on the body:
- intravenous iron preparations fight anemia;
- saline solutions restore the water-electrolyte balance;
- calcium preparations prevent osteoporosis, etc.
Surgical treatment begins only when complications arise, some of which are very dangerous. But even in this case, they try to preserve the affected organ as much as possible - this is the difference between Crohn's disease and ulcerative colitis, in which doctors are forced to completely remove the ulcerated part of the intestine.
In the case of perforation of the small intestine, the affected part is removed (resection) and the remaining part of the intestine is sutured, or it is removed to the skin of the abdomen, that is, a stoma is placed. The operation for intestinal bleeding looks the same.
Perforation of the large intestine forces surgeons to resort to its complete removal and imposition of a stoma. This is a debilitating operation, but luckily such perforation is extremely rare. It is also performed with toxic dilatation of the colon.
In case of diseases of the perianal zone (that is, around the rectum and anus), urgent surgical intervention is performed to remove the purulent focus. Fissures and most fistulas are treated conservatively, as they usually close under the influence of medication. Only sometimes it is necessary to resort to their drainage to improve the outflow from them. The exception is recto-vaginal and recto-bladder fistulas, which require plastic surgery to close them.
Crohn's disease is a chronic, long-term disease that is constantly progressing. Complications inevitably occur in most patients, but the sooner treatment is started, the longer this "bright time interval" will be. It is recommended to strictly follow the doctor's recommendations, and then the chance to avoid surgery and disability can be quite high.
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