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Crohn's disease (granulomatous colitis, terminal ileitis) is a chronic disease associated with inflammation of the mucous membrane of the digestive system.
Crohn's disease is relatively rare in Russia. 3.5 people out of 100,000 get sick with this pathology per year. Crohn's disease is much more common in residents of Northern Europe and America, reaching 100 or more cases per year per 100,000 population. White-skinned peoples are more susceptible to the disease than dark-skinned and Asians. In addition, the risk of getting sick is somewhat higher for Jews of European origin.
Most often, people aged 16-30 years become victims of this disease. The second peak of morbidity occurs in the age group from 60 to 80 years, although it is possible to develop the disease at another age. Women are slightly more susceptible to Crohn's disease than men, but among children, the disease is more common in boys than in girls.
Inflammation can occur in any part of the digestive system: from the mouth to the anus. However, the favorite place of Crohn's disease are: the terminal part of the small intestine and the large intestine.
Characteristic signs of Crohn's disease: frequent loose stools with mucus and blood, poor general health and weight loss. The disease proceeds with alternating remissions and exacerbations. During remission, symptoms are mild or may be absent altogether. The exacerbation of the disease brings the greatest anxiety.
The exact cause of Crohn's disease is unknown, but research suggests that several factors influence the development of the disease:
Currently, there is no way to completely get rid of Crohn's disease, so treatment is aimed at suppressing inflammation in the intestine and relieving symptoms. Thanks to modern medicines, it is possible to transfer the disease to a state of remission, prolong it as much as possible and, if possible, avoid surgery. In some cases, an operation is performed to remove an inflamed part of the intestine.
Over time, inflammation can cause damage to certain areas of the digestive system, which leads to various additional complications, such as narrowing (stenosis) of the intestine or the appearance of a fistula - a channel connecting the intestine to the surface of the skin near the anus or vagina. Usually, with such complications, surgical intervention is required.
The symptoms of Crohn's disease depend on the location of the foci of inflammation in the digestive system.
The most common symptoms are:
You may have one symptom or all at once. The severity of the manifestations can be different: from intense to moderate.
Symptoms may be mild or absent for several weeks or months (this is called remission), after which an exacerbation (relapse) occurs.
Less common symptoms of Crohn's disease:
Children with Crohn's disease may have a growth lag, because due to inflammation, the body does not receive enough nutrients from food.
Consult your doctor if the following symptoms occur:
If you suspect Crohn's disease, you need to contact a gastroenterologist. This specialist will be engaged in in-depth diagnosis of the disease, its treatment, and will also refer you to other doctors for consultation, if necessary.
There is no reason to believe that eating certain foods can cause Crohn's disease, but changing the diet can alleviate certain symptoms. Therefore, doctors and nutritionists recommend a special diet for patients with inflammatory bowel diseases.
The exact cause of Crohn's disease is unknown. Most researchers believe that it is caused by a combination of factors.
Genetic predisposition. There is evidence that genetics plays a role in the appearance of Crohn's disease. Researchers have identified over 200 different genes that are more common in people with Crohn's disease than in others. There is also evidence that Crohn's disease can be inherited. Approximately 3 out of 20 people with Crohn's disease have a close relative (mother, father, sister or brother) with the same disease. And if you have an identical twin with this disease, the probability that you will also get sick is 70%.
The fact that some nationalities have Crohn's disease more common than others also indicates the important role played by genetics.
The immune system protects the body from harmful bacteria that can enter the digestive system. At the same time, a large number of various beneficial bacteria live in the intestine, which are involved in the digestion of food. The immune system usually recognizes these bacteria and does not touch them, but in Crohn's disease something disrupts its work, and the body secretes a special protein called "tumor necrosis factor-alpha". This protein leads to the destruction of all bacteria, beneficial and harmful, which causes intestinal inflammation, characteristic of Crohn's disease.
A transferred infectious disease. In some genetically predisposed people, infectious diseases suffered in childhood can cause a disorder of the immune system, which leads to the appearance of symptoms of Crohn's disease. One of the causes of such disorders is considered to be paratuberculosis, an infectious disease that is usually found in cows, sheep and goats. The causative agent of paratuberculosis is Mycobacterium avium. Studies show that in people with Crohn's disease, this mycobacterium is detected seven times more often in a blood test than in other people.
It is known that Mycobacterium survives during pasteurization (heat treatment), so it can be infected through the milk of sick animals. At the same time, the exact role of paratuberculosis in the development of Crohn's disease has not been fully studied, and some researchers refute the above theory.
Smoking. Along with heredity and ethnic origin, smoking is the most important risk factor for Crohn's disease. Smokers are twice as likely to develop the disease. Moreover, smokers with Crohn's disease have more pronounced symptoms than non-smokers. Read more about how to quit smoking.
Environmental factors. There are two unusual aspects of Crohn's disease, because of which many experts believe that environmental factors may play a role in the development of the disease. They are described below.
Crohn's disease is a "disease of the rich." Residents of developed countries of the world, for example, the USA and the UK, are most susceptible to the disease, and residents of developing countries in Asia and Africa are least affected.
Crohn's disease has been spreading since the 1950s. This suggests that something in the lifestyle of modern residents of Western countries increases the likelihood of the disease.
Thus, according to the hygiene hypothesis, modern urban children grow up in an increasingly "clean" environment, without contact with bacteria, and their immune system remains underdeveloped, since the child does not suffer from childhood infectious diseases, but there is no convincing evidence of this.
Another assumption is based on the cold chain hypothesis, according to which the spread of Crohn's disease may be associated with the spread of refrigerators after World War II.
The manifestations of Crohn's disease are similar to many other diseases, so a serious examination will be required for its diagnosis. Crohn's disease is usually diagnosed by a gastroenterologist. With the help of our service, you can easily find a good gastroenterologist in your city.
A gastroenterologist conducts a general examination, prescribes laboratory and instrumental studies, and can also involve doctors of other specialties in complex diagnostic cases. For example, you may need to consult an infectious disease doctor, since the initial symptoms of Crohn's disease are similar to infectious bowel diseases. Use our service to quickly find a good infectious disease specialist. In some cases, you may need to consult a surgeon or a coloproctologist. You can find these doctors using our service.
General inspection. During the general examination, the doctor will interview you about the nature of the symptoms and check what they may be related to. These can be:
Your doctor may also conduct a number of standard examinations to assess your overall health. For example, it can perform the following actions:
Blood and stool tests. The doctor may also prescribe a number of blood tests to assess the following indicators:
The doctor may ask you to take feces for a blood and mucus test, as well as to determine whether the symptoms are related to a parasite, for example, a roundworm.
After receiving the results of laboratory diagnostics, a gastroenterologist can refer you to additional instrumental studies.
Colonoscopy is a procedure in which the inner surface of the colon is examined. To do this, a long flexible tube (endoscope) is inserted through the anus into the colon. The endoscope has a light bulb at the end and a camera that transmits images to the screen (see image). With the help of a colonoscopy, the doctor will be able to assess the degree and scale of inflammation in the colon.
The endoscope is also equipped with surgical instruments for taking tissue samples from various parts of the digestive system. This is called a biopsy. This procedure may be a little unpleasant, but it does not cause pain. The resulting tissue samples are then examined under a microscope for cellular changes characteristic of Crohn's disease and other diseases.
Wireless capsule endoscopy is a type of examination in which you swallow a small capsule (about the size of a large vitamin tablet). It passes through the entire digestive tract, including the small and large intestines, and transmits images from there to a recording device that you wear on your belt or in a small bag over your shoulder. After a few days, the capsule leaves the body with feces. It's disposable, so you won't need to get it out.
This is a relatively new method, and it is not available everywhere. Sometimes an MRI of the intestine or a CT of the intestine is used instead.
MRI and CT of the intestine. If Crohn's disease is suspected, small intestine scanning methods are used, which are called MRI magnetic resonance imaging and CT computed tomography of the intestine (CT enterography or CT enteroclysis).
Before computed tomography, a contrast agent is injected into the body (through the mouth with CT-enterography, or through a nasal catheter with CT-enteroclysis). These contrast agents will allow you to see the small intestine better when scanning. Next, a series of X-rays are taken, which are then assembled on a computer into one detailed image. With MRI using magnetic fields and radio waves, a detailed image of the internal structure of the small intestine is created.
These methods are increasingly being used instead of enteroclysms and barium passage through the small intestine, as they allow for a more detailed examination of the small intestine. In addition, with an MRI of the intestine, you are not exposed to X-rays.
Intestinal enteroclysm X-ray and barium passage through the small intestine are two similar research methods that are traditionally used to examine the entire inner surface of the small intestine, usually at the place where it passes into the colon. Intestinal X-rays are also used because colonoscopy usually examines only the last 20 cm of the small intestine.
With the help of a spray, anesthesia of the nasopharyngeal mucosa is performed. A probe (tube) is passed through the nose into the throat, and then into the small intestine. At first it may cause unpleasant sensations, but most likely, after a few minutes you will get used to it.
A harmless liquid containing a radiopaque substance containing barium is fed through the tube. Thanks to the barium suspension, the intestine becomes clearly visible on the X-ray. Often, the images show areas of narrowing and inflammation that causes Crohn's disease.
After an intestinal X-ray, you will be recommended to drink more liquid to wash the barium suspension from the body. In the first few days after the procedure, the feces may turn white. This is completely normal.
Currently, there is no way to completely get rid of Crohn's disease, so treatment is aimed at suppressing inflammation in the intestine and relieving symptoms.
The main goals of treatment:
In children, treatment is also aimed at ensuring normal growth and development.
In the active stage of Crohn's disease (when the symptoms are moderate and severe), medication is recommended, which is sometimes supplemented with surgical intervention.
Treatment of severe forms of Crohn's disease usually with the appointment of hormones of the adrenal cortex - corticosteroids (for example, prednisone) in the form of tablets or injections. This is necessary to relieve inflammation in the intestine.
Corticosteroids quickly relieve severe manifestations of Crohn's disease, but can have serious side effects, namely:
Therefore, as soon as your condition improves, the dosage of hormones is reduced.
With moderate activity of the disease, the doctor may prescribe treatment with more "mild" medications that have less pronounced side effects. This is the hormone budesonide or preparations of 5-aminosalicylic acid (5-ASA), for example, mesalazine.
In children and adolescents who are particularly in need of adequate nutrition for growth and proper development, a special liquid diet - enteral nutrition can be prescribed as an initial treatment. It helps to relieve inflammation in the intestines and allows the digestive system to recover due to the fact that the body receives all the necessary nutrients. Mixtures for enteral nutrition can contain only amino acids (elementary nutrition), oligopeptides - short sequences of amino acids (semi-elementary nutrition) and whole protein (polymer nutrition).
If you have two or more exacerbations per year or they return with a decrease in the dosage of corticosteroids, additional treatment may be required. In such cases, drugs that suppress the immune system (immunosuppressants) may be added to the initial treatment. The most commonly used immunosuppressants are azathioprine and mercaptopurine.
They are not suitable for everyone, and therefore you first need to do a blood test to determine whether you can take them. If they don't suit you, your doctor may prescribe you another immunosuppressant called methotrexate.
Side effects of immunosuppressants:
Blood tests will be performed regularly during medication intake to monitor the development of side effects.
The immunosuppressants azathioprine and mercaptopurine are considered safe to take during pregnancy and lactation. Women can take these drugs while trying to have a baby and during pregnancy, but methotrexate should not be taken at least six months before trying to conceive, as it causes malformations of the child. This applies to both men and women. It is also not recommended to take it while breastfeeding.
If you are planning to have a baby or if you become pregnant during treatment for Crohn's disease, talk to your doctor.
If the symptoms of Crohn's disease persist despite treatment with hormones (corticosteroids), as well as in severe forms of the disease, drugs of biological origin (biological therapy) are prescribed.
Biologics are a type of powerful immunosuppressants that use natural biological substances such as antibodies and enzymes. Infliximab is the most common among biological products in Russia. This remedy is officially recommended for the treatment of Crohn's disease in our country. There are other biological products: adalimumab, certolizumab and others. But their use in Russia for Crohn's disease is still limited.
Biopreparations block tumor necrosis factor-alpha (TNF-alpha), which is believed to be involved in the development of Crohn's disease. Infliximab can be given to children over the age of six and adults, but adalimumab can only be given to adults. If the medications are effective, the treatment is continued for at least 12 months. After that, the doctor will assess your condition to determine further tactics.
Infliximab and other biologics can cause an allergic reaction that manifests itself:
You should immediately consult a doctor if you have these symptoms. Negative reactions of this type can occur immediately after the start of treatment, after several months of taking the drug and even after the end of therapy.
Surgical treatment does not lead to a cure for Crohn's disease, but it may be necessary with the development of certain complications (fistulas, strictures, perforations - see complications of Crohn's disease), which cannot be cured without surgery. The issue of surgical intervention is usually solved by a gastroenterologist and a coloproctologist together.
The most common in Crohn's disease is the operation of resection (excision) of a part of the intestine. In this case, the damaged part of the intestine is removed, and the healthy parts are stitched together.
In more complex cases, part of the intestine is temporarily turned off from digestion in order to create ideal conditions for healing in it. To do this, the end of the small intestine is cut off from the large intestine and removed to the front wall of the abdomen, forming an opening - ileostomy. A colostomy bag is attached to the hole, into which the contents of the intestine will flow.
The colon turns out to be free of its contents, which contributes to its healing. A few months later, a reconstructive (reconstructive) operation is performed: the ileostomy is removed from the surface of the abdomen, and the ends of the intestines are sewn back together.
Remission is a period of time when you have no symptoms, or they are poorly expressed. Despite the improvement, as a rule, it is necessary to continue taking certain medications in reduced doses. Without treatment, Crohn's disease symptoms return quickly.
As an anti-relapse (supportive) therapy is usually prescribed drugs of 5-aminosalicylic acid, azathioprine or mercaptopurine. Infliximab is sometimes used. Corticosteroids are not usually prescribed. If you decide to stop taking medications, you should carefully monitor the appearance of symptoms such as weight loss, abdominal pain and diarrhea, as well as regularly visit a gastroenterologist.
Information about the effect of diet on the development and course of Crohn's disease is contradictory. Some people note that a number of products worsen their condition, although there is no scientific evidence of a link between the disease and nutrition yet. However, according to the national recommendations of Russian gastroenterologists, people with Crohn's disease should limit dairy products, vegetable and animal broths, as well as alcohol in their diet.
It can be beneficial to keep a food diary, in which you can record the body's reaction to various foods.
If you notice that certain foods exacerbate your symptoms, try limiting their use. However, it is not recommended to completely exclude food groups (for example, cereals or sugar) from the diet. For some, it helps to eat a little six times a day instead of three large meals.
If you smoke, quitting smoking can also relieve your symptoms and prolong periods of remission.
With prolonged inflammation, scars form in the intestine, which over time can lead to stenosis (narrowing, stricture) of the intestine. Another cause of narrowing of the intestinal lumen may be inflammatory swelling of the mucous membrane.
A narrow section of the intestine makes it difficult for the passage of solid intestinal contents, which is manifested by watery stools or its complete absence. This condition is called intestinal obstruction or intestinal obstruction.
Other symptoms of intestinal obstruction:
In the absence of treatment, it is possible to rupture the intestine and get its contents into the abdominal cavity. If you suspect an intestinal obstruction, contact a general practitioner (therapist, family doctor) as soon as possible. The doctor will help you assess your condition and, if necessary, will refer you to an urgent consultation with a specialist (gastroenterologist or coloproctologist) or to a hospital.
If possible, you can immediately contact a gastroenterologist or a coloproctologist. Our mednavigator will help you choose the right specialist.
If intestinal stenosis is caused by mucosal edema, treatment with medications is possible. Cicatricial strictures of the intestine are usually treated surgically by excising the affected area. In some cases, a procedure called balloon dilation can be used. It is performed during a colonoscopy.
If balloon dilation of the intestine did not help or is contraindicated, the intestinal lumen is expanded using stricturoplasty. In this case, only the scar tissue or the entire intestinal wall is dissected at the site of narrowing, its original shape is restored, after which it is stitched.
A prolonged process of inflammation and scarring in the digestive system can lead to the formation of ulcers, which eventually turn into channels leading from one area of the digestive system to another. Sometimes these channels - fistulas (fistulas) connect the digestive tube with the skin, bladder, vagina, anus, etc.
With small fistulas, there may be no symptoms, while large fistulas can become inflamed and cause:
If a fistula appears on the skin (usually in the area of the anus), a discharge with an unpleasant odor leaves it.
As a rule, treatment of fistulas begins with drug therapy (taking antibiotics, 5-ASA drugs, immunosuppressants). If the fistula does not heal as a result of taking medications, surgical treatment is prescribed — excision of the fistula or other methods of surgical correction.
Other intestinal complications of Crohn's disease are:
People with Crohn's disease also have an increased risk of complications from other organs:
Children with Crohn's disease may also experience a lag in growth and development due to the fact that the body does not receive enough nutrients.
Some people with Crohn's disease have a slightly increased risk of colorectal cancer (colon and rectal cancer) later in life. If your doctor believes that you may have an increased risk of colorectal cancer, he will recommend that you have a regular checkup, which usually consists of a colonoscopy and a biopsy.
