Methods of treatment of Crohn's disease in children, diagnosis, etiology, prevention and prognosis of the disease. What is the peculiarity of the course and treatment of Crohn's disease in children? Manifestations of the disease in childhood - obvious symptoms

Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract characterized by pathological changes in the intestinal mucosa. As a result of this kind of disturbance, specific granulomas grow over the surface of the intestine, followed by narrowing of its lumen.

Crohn's disease in children, in most cases, affects the terminal part of the small intestine, but the pathological process can affect any part of the digestive tract. In severe forms of the disease, ulcerative inflammation can spread throughout the entire digestive system. That is why it is so important to detect this disease in time.

Possible Causes of Crohn's Disease

The question of etiology and pathogenesis remains open to this day. Among the main causes of the disease, most modern scientists include factors such as genetic predisposition and functional disorders of the immune system. Many doctors also do not exclude the role of viruses and toxins in the development of acute inflammation.

Crohn's disease is not contagious and can be detected in a child at any age. Most often, the disease first makes itself felt in the period from 13 to 20 years.

The symptoms of Crohn's disease are gradual in nature. The main symptoms of this pathology include:

Diarrhea.

The first manifestation of Crohn's disease in children is persistent diarrhea (up to 10 times a day). The frequency of the urge to defecate and the amount of excreted feces depend on the degree of damage: the progression of the disease is characterized by an increase in the frequency and volume of stools, while the child's feces may contain impurities of blood, mucus or pus.

Stomach ache.

At the initial stage of the development of the pathology, the child may feel a slight pain in the abdomen, but in the future the pain intensifies, acquiring a paroxysmal spastic character when eating and defecation.

Common signs of Crohn's disease:

weakness;
weight loss;
bloating;
nausea and vomiting;
feeling of heaviness in the solar plexus;
increase in body temperature;
soreness in muscles and joints;
growth retardation and puberty.

Since the disease leads to a violation of the digestive processes, patients have a lack of nutrients in the body. In severe cases, Crohn's disease in children can lead to the development of abscesses, peritonitis, intestinal obstruction, intestinal perforation, internal bleeding, and acute toxic dilatation (expansion) of the colon.

Stages of development of the destructive process in Crohn's disease

Doctors distinguish three main phases of the disease:

phase of infiltration.

It is characterized by inflammation of the intestinal wall, which is accompanied by swelling of its mucous membrane with the formation of superficial ulcers and pseudopolyps.

Phase of cracks and ulcers.

It is caused by the appearance of extensive cracks with pus and necrotic films, which branch out and connect to each other. Pressure on the intestinal wall is accompanied by the release of purulent masses from the cracks. Most often, cracks spread over the entire surface of the affected segment of the intestine, but in some cases, instead of multiple cracks, one deep, wide ulcer is observed. At this phase of the disease, patients have a pronounced narrowing of the intestinal lumen, as well as the formation of internal and external fistulas.
The most severe form of the pathological process in Crohn's disease is accompanied by the formation of extensive ulcerations with loose, uneven edges surrounded by small inflammatory foci. Ulcers cover the entire thickness of the intestine and can penetrate the intestinal wall to the muscular layer or penetrate through all its layers.

scarring phase.

At this phase, ulceration heals, accompanied by the irreversible formation of cicatricial stenosis, which can lead to the development of intestinal obstruction. Despite the fact that the mucous membrane can be completely restored, the relief formed at the site of the cracks continues to be seen in the form of submucosal formations that deform the intestine and narrow its lumen. Mucosal healing may be incomplete in extensive lesions, so foci of ulceration are often present even at the stage of complete remission.

If you find your child showing signs of Crohn's disease, take them to a pediatrician or pediatric gastroenterologist immediately.

To identify the disease, the baby needs to undergo a series of examinations. To confirm or refute the presence of inflammation and malabsorption of nutrients, doctors do a laboratory blood test. Instrumental research methods usually include endoscopic (examination of the intestine by inserting a tube equipped with an optical device into it) and x-ray diagnostics.

Treatment of Crohn's disease in children is carried out through the use of medications (immunosuppressive agents, antibiotics, enzymes, etc.), surgery (if necessary, removal of the affected segment of the intestine or restoration of intestinal patency) and dietary adjustments.

During periods of exacerbations, patients are prescribed bed rest, therapeutic nutrition and medication. In case of ineffectiveness of such therapy, the child is transferred to inpatient treatment.

Crohn's disease in children: preventive measures

Due to the fact that the causes of Crohn's disease remain unclear, it is not possible to prevent the development of this pathology today. Preventive measures are aimed at preventing relapses, exacerbations and further progression of the disease.

In order to minimize the risk of developing exacerbations and other negative consequences of Crohn's disease, the child should:

observe the diet (the frequency of meals is determined by the doctor, taking into account the severity of the disease and the individual characteristics of the child's body);
adhere to a special therapeutic diet;
timely treat infectious diseases;
limit physical activity;
normalize sleep.

Crohn's disease

If a child complains of pain in the abdomen, he has an elevated body temperature for a long time, the stool has changed and weight is decreasing, you should immediately contact a pediatrician. Maybe it's Crohn's disease.

What's this?

Crohn's disease is a chronic disease of the digestive system, in which the tissues of the intestines and other parts of the gastrointestinal tract become inflamed and destroyed. The name of this disease was given by one of the doctors who described it in 1932. The onset of the disease is possible at any age, but most often it is detected in people from 13 to 30 years old.

Although the pathology is quite severe and serious, many people who have Crohn's disease who receive adequate therapy live a long time and lead an almost normal life. Most often, the course of the disease passes with exacerbations (in most patients they occur every two years or less) and remissions.

The reasons

At the moment, scientists have not yet found the exact causes of Crohn's disease. At the same time, the role of heredity is noted, since in direct relatives of patients the incidence of the disease is 5-20 times higher. If parents have Crohn's disease, the child has a 5% chance of having the disease.

Other factors contributing to the development of this pathology include infection with viruses or mycobacteria, the ingestion of toxins, certain drugs, and the influence of food into the intestines.

Development of the disease

With this disease, foci of inflammation appear in the walls of the digestive tract. Most often they occur in the ileum and caecum, as well as in the rectum.

Due to the multiplicity of foci of inflammation, the work of the intestine is disturbed, which becomes a factor in the development of anemia and hypovitaminosis.

Complications

Sometimes inflammation affects the intestinal wall so deeply that it can cause perforation, adhesions, or fistulas. Other complications of Crohn's disease include bowel obstruction and internal bleeding. In rare cases, inflammation spreads from the digestive system to the skin (a rash appears, foci of peeling), joints (they can become inflamed and hurt), eyes (vision is impaired, pain is noted), kidneys and other organs.

Symptoms

During exacerbations of the disease, when the intestines become inflamed, the child is observed:

Long-term elevated body temperature up to 37.5-38 degrees.
Attacks of pain in the abdomen - they are localized at the bottom right or near the navel and are quite strong.
Diarrhea that lasts a long time or recurs may sometimes be bloody. The child defecates up to 10 times a day.
Fatigue and fatigue.
Weight loss or insufficient weight gain.
growth retardation.

When the stomach is affected, the disease is manifested by vomiting, heaviness in the abdomen, nausea. If the inflammatory process has swept the rectum, then there may be pain in the anus, constipation and spotting.

Treatment

In the selection of treatment for a child with Crohn's disease, factors such as the activity of the inflammatory process, the condition of the child, the severity of symptoms, and other factors are taken into account. So the approach to the treatment of this disease will be individual. Nutrition plays a big role.

Medications

If the disease has been diagnosed recently, the child is prescribed anti-inflammatory drugs, immunosuppressive drugs and hormones (prednisolone). In addition, antibiotics, antidiarrheals, sorbents and enzymes can be prescribed to them.

If the course of the disease is severe, intravenous administration of electrolytes, amino acids, plasma is prescribed. Sometimes, after a short course of drugs, a long-term remission occurs, but often the drugs need to be taken for quite a long time.

Surgical intervention

You can’t do without it if the intestinal tissues have collapsed and the result is an abscess, narrowing of the intestinal lumen, or the formation of a fistula. Such complications can only be eliminated surgically. During the operation, the damaged part of the intestine is removed. Unfortunately, such treatment does not help to get rid of Crohn's disease completely, so surgery is resorted to only when absolutely necessary.

- chronic nonspecific granulomatous inflammatory disease of the digestive tract with predominant localization of inflammation in the small intestine. The main symptoms are abdominal pain and diarrhea. During periods of exacerbation, there are general signs of inflammation (fever, weakness). Crohn's disease in children leads to developmental delays and other manifestations of malabsorption. Characterized by the formation of fistulas, fistulas, the development of intestinal obstruction. Diagnosed clinically, confirmed by the results of a comprehensive instrumental examination. Treatment is aimed at achieving and maintaining remission.

General information

Crohn's disease in children is often called terminal ileitis, since it is this localization of foci of inflammation that is most characteristic of this disease. The frequency of occurrence in the population does not exceed 0.1%. It is most often diagnosed in adolescence. The relevance of Crohn's disease in pediatrics is very high. This is due to the chronic course of the pathology, for this reason, all ongoing therapy is palliative. In addition, at present, the causes of the development of the disease remain unclear, so it is impossible to carry out preventive measures. The quality and duration of life are significantly reduced, Crohn's disease in children contributes to the structure of child mortality and disability.

Causes and classification of Crohn's disease in children

The etiology of the disease is currently being studied. A certain role is assigned to bacteria and viruses, drugs, structural features and functioning of the intestine. Along with a genetic predisposition, all of these factors can trigger acute inflammation in the intestine with the development of granulomas in the submucosal layer, characteristic of Crohn's disease in children and adults. Patients have an imbalance of cytokine regulation with a predominance of pro-inflammatory cytokines. The permeability of the intestinal wall is increased, which contributes to a significant increase in the antigenic load on the body.

Crohn's disease in children can affect all parts of the digestive tract. By localization, terminal ileitis is isolated (most common), colitis, ileocolitis, damage to the anorectal region, upper gastrointestinal tract. Mixed forms are also possible. Anatomically, fistula-forming, stricture-forming and inflammatory-infiltrative forms are distinguished. In the first case, clinical manifestations are associated with the formation of fistulas. In the second case, Crohn's disease in children is manifested by symptoms of intestinal obstruction and a condition close to it, caused by stenosis of the intestinal lumen. In the clinic of the inflammatory-infiltrative form of the disease, stool disorders, fever, malabsorption symptoms, associated developmental delay and weight loss predominate.

Symptoms of Crohn's disease in children

The disease is characterized by an undulating course with alternating periods of exacerbation and remission, often with few symptoms, less often there are periods of complete absence of clinical signs. There are typical intestinal and extraintestinal manifestations of Crohn's disease in children. The most common gastrointestinal symptoms that occur in almost all patients are diarrhea and abdominal pain. The pains are cramping, their intensity is usually insignificant. With the localization of foci of inflammation in the stomach and esophagus, there is a feeling of heaviness, nausea, and vomiting. As Crohn's disease progresses in children, bloating may be added to the pain. Tenesmus is rare.

Diarrhea is also one of the main symptoms. The disease can begin precisely with changes in the stool. The frequency of bowel movements is different, there is a connection with the location of foci of granulomatous inflammation - the higher the lesion of the gastrointestinal tract is localized, the more pronounced diarrhea. Rarely, small amounts of blood are found in the stool (usually in the acute phase with the formation of fissure ulcers). Prolonged diarrhea in Crohn's disease in children is accompanied by symptoms of malabsorption. The child is deficient in fat-soluble vitamins (A, D, E), calcium, iron and other micronutrients. This is due to the lag in physical development. Inflammation is manifested by fever, general weakness, weight loss. The most common extraintestinal manifestations are arthralgia, aphthous stomatitis, sacroiliitis, erythema nodosum, iridocyclitis, etc.

Diagnosis of Crohn's disease in children

Individual signs of the disease are characteristic of many other intestinal pathologies. In addition, Crohn's disease in children is rare, which, together with non-specific symptoms, causes difficulties in diagnosing the disease. A pediatrician can clinically suspect Crohn's disease by the presence of diarrhea and pain, for which there are no other explanations. Developmental delay, weight loss, and the presence of inflammatory bowel disease in relatives can also indicate the diagnosis. To exclude other nosologies, a complex of instrumental examination methods is carried out.

Plain radiography of the abdominal organs is performed with double contrast. This allows you to assess the intestinal lumen, its width and structure. So, it is often possible to visualize areas of inflammation in the form of a "cobblestone pavement". A similar pattern occurs only with this disease and is due to many intersecting cracks in the intestinal wall. Crohn's disease in children is often manifested by fistulas (external and internal), which can also be detected radiologically or noticed during examination if the fistula opens on the skin. With the disease, perianal localization of fistulas is often found, as well as other pathologies in this area: cracks, ulcers, pararectal infiltrates.

An irrigoscopy is performed. To exclude pathologies of the large intestine, sigmoidoscopy with biopsy is performed. Even in the absence of granulomas, the signs of inflammation characteristic of Crohn's disease in children are often detected histologically. Colonoscopy, like sigmoidoscopy, allows you to visualize the intestinal mucosa, which can look like a "quilt" in the phase of infiltration and "cobblestone" in the phase of ulcers-cracks. You can see some erosion and areas of irreversible stenosis. General blood tests confirm the acceleration of ESR and other signs of inflammation. Be sure to examine the feces to identify other causes of diarrhea.

Treatment, prognosis and prevention of Crohn's disease in children

Therapeutic measures are aimed at achieving and maintaining remission. Shown a special diet. The goal is to increase the absorption of nutrients for the normal physical development of the child. Special high molecular weight mixtures are prescribed. Aminosalicylates are the main group of drugs in the medical treatment of Crohn's disease in children. Anti-inflammatory therapy is carried out using corticosteroids, including local agents in the small intestine. One of the relatively new methods is the use of biological drugs, in particular, TNFα inhibitors.

Cytostatics are sometimes used in the treatment of Crohn's disease in children. In the presence of intestinal complications, antibiotics are indicated. Surgical treatment is mandatory in case of development of intestinal obstruction, fistulas, intestinal abscesses. The indication for surgery is also the ineffectiveness of conservative therapy methods. Resection of a part of the intestine is carried out only in extreme cases and is performed as sparingly as possible. Often this leads to the retention of remission, but the inflammatory process inevitably resumes in another part of the gastrointestinal tract. In the postoperative period, course treatment with corticosteroids and antibiotics is carried out.

Crohn's disease in children is a severe and extremely unpleasant disease that is difficult to treat, especially in infants. It appears in a child at any age. Identifying the pathology is difficult because the symptoms are similar to other childhood diseases, such as ulcerative colitis. Treatment without an accurate diagnosis becomes difficult.

To determine this disease in a child and begin effective treatment, you need to see a doctor. A cause for concern can be a delay in growth and development - this is how the disease manifests itself in children. Doctors and parents confuse this pathology with ulcerative colitis. In fact, these are different diseases, although the symptoms are similar, and there are still discussions about the nature of these diseases.

Ulcerative colitis is characterized by a complex of signs and factors:

affects only the rectum and large intestine, while Crohn's disease extends to the digestive area, even affecting the tongue and throat. If ulcerative colitis inflicts a complex blow immediately on the colon, then the second disease is tricky - healthy areas alternate with infected foci;
Ulcerative colitis does not form fistulas, the patient suffers from diarrhea, blood in the stool, fever. In Crohn's disease, these symptoms are rare;
Crohn's disease torments its victims with constipation, severe pain, loss of appetite and weight, nausea and vomiting. Ulcerative colitis does not have the listed symptoms;
A sign of Crohn's disease - cracks, ulcers, sores in the anal canal, ulcerative colitis rarely causes such symptoms.

Thus, these are two different diseases and individual treatment is also necessary. Do not try to determine the disease yourself and prescribe treatment - hurry to the doctor.

The reasons

It is not fully understood what causes Crohn's disease, but there are suggestions. Each doctor has his own theories, but the exact reasons can not be found. As with other pathologies, heredity and immunity are considered the main causes. If there were similar diseases in the family, then the likelihood of a child developing this pathology increases dramatically.

Strong immunity is able to protect a person from viruses and bacteria, resistance to infection will be enhanced. Another reason, which, according to researchers, is the main one - if the parents are heavy smokers, then the child will have stomach problems.

Symptoms

The symptoms of the disease are numerous and similar to others, for example: hemorrhoids. Therefore, for effective treatment, you need to see a doctor in time. Crohn's disease is in remission - it subsides, disappears, then the symptoms disappear and there is a feeling that the child has recovered - this cunning disease will return with renewed vigor after a while.

Specific symptoms:

The whites of the eye become yellowish due to liver damage;
Wound healing is reduced;
Constipation and difficulty with bowel movements, severe pain, the appearance of blood;
Vision falls;
Intense pain in the abdomen, around the navel;
urinary disease;
Ulcers, inflammations appear on the gums and on the mucous membrane of the mouth;
Change in temperature by one or two degrees;
or vomiting, sometimes accompanied by bloody discharge;
Severe fatigue, loss of appetite and, as a result, weight loss;
Severe pain in the joints;
Fissures and ulcers in the anus.

Diagnosis and treatment

The first stage of the fight against the disease is an accurate diagnosis of the location, nature and phase of development. Further treatment will depend on these three points.

The peculiarity of the disease is that it is easy to confuse it with other gastric pathologies.

First you need to pass a general and biochemical analysis of blood and urine - this will determine the specifics of the disease, distinguish it from nonspecific ulcerative colitis, cancer. Then you will need an x-ray of the stomach, intestines, throat to determine the location of the disease. There may be several inflamed foci, then the treatment will be complex.

The modern method of diagnosing this specific disease is colonoscopy. With its help, it is possible to determine the location of the inflammation and its stage. Colonoscopy will allow you to distinguish Crohn's disease from others, to identify its features and specifics. Sometimes, in addition to these operations, doctors prescribe an ultrasound or computed tomography to find out what the condition of other organs is.

Treatment depends on the degree of development of the disease. Different stages require special attention, a specific approach to the patient's condition.

1 stage. Little activity. The patient needs rest, both physical and mental. Sulfasalazine is usually prescribed for inflammatory processes. This medicine is mandatory in the treatment of this disease. Patients need to follow a diet. Avoid fatty meats, smoked foods, eggs, milk, everything spicy and salty, highly carbonated drinks. It is also worth giving up cabbage, cucumbers, radishes, radishes, horseradish and turnips.
2 stage. The disease is progressing. Doctors prescribe potent drugs: hormonal drugs to slow down the process of inflammation. Immunosuppressants - will not allow the disease to develop, and antibacterial pills - which will not allow new infections.
3 stage. More and more new areas are affected, there are more foci of inflammation. The necessary drugs are administered intravenously for rapid absorption and immediate effect. The diet is being tightened, flour, sausages and sweets are prohibited.
4 stage. The patient's condition is grave, the clinical picture is gloomy, urgent measures are required. In this condition, surgical intervention is necessary. The doctor removes the inflamed area, and the patient is prescribed vitamin complexes and anti-inflammatory drugs.

If you do not pay due attention to the disease, then it will develop rapidly, affecting more and more new sections of the gastrointestinal tract.

The sooner you pay attention to the child's condition and the sooner you go to the doctor, the easier it is to eliminate the disease itself and its possible consequences.

Prevention

Almost any disease can be prevented if you pay increased attention to your own health and the health of your child. Those who plan to become parents should take care of their health as much as possible, because they are responsible for the life and condition of a new person. It is forbidden:

Eat spicy and fatty foods;
experience severe stress;
Overstress.

Eat nutrients and nutrients;
Fruit;
Vegetables;
vitamins;
Fresh juices;
To walk alot;
To breathe fresh air;
To enjoy life;
Take care of your health and future baby.

Comprehensive prevention includes maintaining a healthy lifestyle, then treatment is not needed. Make sure that your child observes the regime of work and rest, eats properly.

Treat infectious stomach diseases in time. Do not forget to be examined by a doctor once a year.

The patient should be required to see a doctor when symptoms of Crohn's disease are detected. The doctor will give recommendations and prescribe treatment.

Crohn's disease is a chronic (lasting more than 6 months) disease of the gastrointestinal tract that can affect any part of the digestive system, most often the final part of the small and/or large intestine.

It is characterized by chronic inflammation, stenosis (narrowing) of the affected areas of the intestine, the formation of fistulas (pathological (normally absent) channels between the intestine and internal organs) and extraintestinal manifestations (not associated with the gastrointestinal tract).

The reasons

The exact causes of Crohn's disease are unknown. Most patients are adolescents (most often the disease can occur from 10 to 17 years).

Predisposing factors that contribute to the onset of Crohn's disease include:

hereditary predisposition (the disease is more likely to occur in those children whose parents suffered from various diseases of the gastrointestinal tract, including Crohn's disease) - observed in approximately 20% of patients;
viral and bacterial infections;
decreased immunity against the background of serious diseases (for example, oncological (tumor));
smoking (in teenagers).

Forms

Depending on the localization (location) of the inflammatory process distinguish 2 types of Crohn's disease.

Type 1:
- the lesion is limited to one area of the small intestine (for example, only the 12-colon);
- damage to the ileocecal region (the place where the small intestine passes into the large intestine);
- the lesion is limited to any segment (section) of the colon.
Type 2:
- damage to several segments of the large and small intestine;
- a combination of intestinal damage with damage to the stomach, esophagus and / or oral mucosa.

Depending on the course of the disease There are 3 forms of Crohn's disease.

The first attack of the disease (first-time acute symptoms):
- acute course (with a duration of the disease up to 6 months) - the symptoms are moderately pronounced;
- with a gradual onset - characterized by the absence of clear manifestations of the disease, prolonged development of symptoms (more than 6 months).
Chronic (continuous) - continuous, remission (period of absence of symptoms) is absent, or its duration is less than 6 months.
Recurrent - frequent recurrence of symptoms with remission periods of more than 6 months.

Depending on the clinical picture There are 5 forms of Crohn's disease.

acute ileitis - inflammation of the ileum
jejunoileitis with small bowel obstruction syndrome - inflammation of the ileum and jejunum with impaired passage of feces through the intestines
chronic jejunoileitis with malabsorption of nutrients - inflammation of the jejunum with malabsorption of nutrients into the body
granulomatous colitis - the formation of many small tumor-like formations (granulomas) in the wall of the large intestine
granulomatous proctitis - the formation of many small tumor-like formations in the wall of the rectum.

Symptoms

The formation of the symptoms of the disease is decisively influenced by the localization (location) and the time of the development of the disease (gradual, acute, fulminant onset).

General symptoms are divided into intestinal and extraintestinal (not associated with the gastrointestinal tract), and in children, unlike adults, extraintestinal predominate and occur more often than intestinal.

Intestinal:
- diarrhea - may be rare and profuse or frequent and scanty, mixed with blood and mucus;
- abdominal pain - can be dull and prolonged or sharp and short-term;
- inflammation of the perianal region (anus area).
Extraintestinal:
- increased body temperature (may range from 37 to 39º C)
- insufficient weight gain, (weight loss in adolescents)
- weakness, fatigue
- anemia
- cholelithiasis.
- defeat:
  - joints (periodic pain, inflammation of the joint)
  - skin (formation of poorly healing wounds)
  - liver (appearance of jaundice - staining of the skin and whites of the eyes in yellow)
  - kidneys (discoloration of urine, increased or decreased frequency of urination)
  - eye (decreased visual acuity)
  - gums (formation of ulcers (deep defects of the mucous membrane)).

Some affected children often go into remission (reduction of symptoms), sometimes lasting for years. It is impossible to predict when and for what reasons the disease will again take an acute form. Stay close to us on facebook:

Diagnostics

Analysis of the anamnesis of the disease and complaints: when (how long ago) abdominal pain appeared, is there a seasonality of exacerbations (in autumn and spring), with what the child or his parents attribute the occurrence of these symptoms.
Analysis of the history of life: did the child have intestinal infections, poisoning, operations on the intestines, other diseases of the gastrointestinal tract, which ones, what is the nature of the stool (color, texture, smell).
Analysis of a family history (the presence of diseases of the gastrointestinal tract in parents or relatives: gastritis, peptic ulcer of the stomach and duodenum 12, cholelithiasis).
Examination of the child. On palpation (palpation) of the abdomen, its soreness is determined, more often in the lower abdomen, under the navel (slightly to the right).
Laboratory research methods.
- Clinical and biochemical blood tests (diagnosis of possible anemia, the presence of inflammation, diseases of the liver, pancreas, kidneys, the content of the main blood electrolytes - potassium, calcium, magnesium, sodium, chlorine).
- General urinalysis - is carried out to monitor the urinary system. The doctor pays attention to the color, density and composition of urine, which are indicators that determine how well the kidneys cope with their function - the excretion of urine.
- Analysis of feces for occult blood (performed if bleeding from the gastrointestinal tract is suspected).
- Coprogram - analysis of feces (you can detect undigested food fragments, a large amount of undigested fat, coarse dietary fiber).
- Analysis of feces for fecal calprotectin (a biological substance - an indicator of the inflammatory process in the intestine). The concentration of the substance in the feces is higher if the inflammatory process progresses.
Instrumental research methods.
- Ultrasound examination (ultrasound) of the abdominal organs is performed to assess the condition of the gallbladder, biliary tract, pancreas, kidneys, intestines (to search for possible damage to these organs and the small intestine).
- Esophagogastroduodenoscopy (EGD) is a diagnostic procedure during which the doctor examines and evaluates the condition of the inner surface of the esophagus, stomach and duodenum using a special optical instrument (endoscope) with a mandatory biopsy (taking a fragment of an organ to determine the structure of its tissue and cells). It is performed to detect Crohn's disease of the upper digestive tract.
- Colonoscopy - examination of the mucous membrane of the large intestine using a special apparatus of the colonoscope. Allows you to identify characteristic changes in the intestines in Crohn's disease. The examination should be accompanied by a biopsy.
- Chromoendoscopy using special dyes. The method is very similar to colonoscopy, the difference is the staining of the mucosa with special substances that react with the damaged intestinal wall, thereby confirming the presence of an inflammatory process in Crohn's disease.
- Video capsule endoscopy is a method that allows you to visually assess the intestinal mucosa. To do this, the child needs to swallow a special capsule with a video camera, which for several hours in the gastrointestinal tract will record the state of the intestine.
- Double-balloon enteroscopy is a method similar to colonoscopy, but allows you to examine the small intestine in more detail using a special small-sized enteroscope device and establish the presence of possible damage to the intestinal mucosa.
- Irrigoscopy is an x-ray examination of the colon, which allows to identify lesions of the colon. Irrigoscopy is performed in the presence of intestinal stenosis (narrowing of the lumen), when it is impossible to perform a colonoscopy.
- Computed tomography (CT) of the abdominal organs is performed for a more detailed assessment of the condition of internal organs, including the stomach, duodenum and small intestine.
- Computer colonography (CT - colonography) - selective (only a certain organ is examined) examination of the colon to detect damage to it.

Treatment

Therapeutic tactics in Crohn's disease should be determined by the degree of disease activity. Stay close to us on facebook:

During the period of exacerbation, the patient must be provided with complete physical and mental rest.
With a small activity of the disease - the appointment of sulfasalazine (combined anti-inflammatory drug, which forms the basis of the treatment of Crohn's disease).
With a more pronounced course of the disease - the appointment:
- hormonal drugs (reducing the activity of inflammation in the body);
- leukotriene receptor antagonists (reducing the activity of biologically active inflammatory substances of the body's immune system);
- immunosuppressants (drugs that suppress the immune system involved in the development of Crohn's disease due to a genetic (passed from parents to children) defect);
- antibiotics (sometimes).
In an extremely severe course of the disease, surgical treatment is performed (resection - removal of the affected intestine) followed by the appointment of antibacterial and anti-inflammatory drugs.
Great attention is paid to nutrition.
Patients with low disease activity are prescribed diet No. 4c according to Pevzner.
- Allowed:
  - yesterday's baked wheat bread, dry biscuits, dry biscuits, lean buns;
  - lean beef, veal, rabbit, skinless poultry, dietary, doctoral, dairy sausages;
  - lean fish in boiled, aspic, steam form;
  - scrambled eggs;
  - all cereals, pasta, cereals on the water, meat broth, puddings, pilaf, zrazy.
- It is forbidden:
  - fatty meat, fish, poultry, smoked meats;
  - raw, fried, hard-boiled eggs;
  - milk in its natural form, spicy, smoked, salty cheese;
  - white cabbage, cucumbers, radishes, turnips, radishes;
  - spicy and fatty sauces, pepper, mustard, horseradish;
  - grape juice, kvass, carbonated drinks.
Patients with a high degree of disease activity are prescribed partial intravenous nutrition with solutions of amino acids (substances necessary for building protein in the body), as well as a reduced (in addition to the usual diet, pasta, fish, doctor's, milk sausages, cookies and biscuits) 4c with the introduction of slag-free products (containing easily digestible fats and proteins). The transition to the usual diet No. 4 is carried out after the elimination of high body temperature, abdominal pain and loose stools.
All patients are prescribed vitamin complexes rich in vitamins A, E, K, D, as well as B12 and folic acid, since due to damage to the intestines, these substances do not enter the body with food.

Course of the disease

Complications and consequences

the formation of fistulas (normally absent channels) and strictures (narrowings) of the intestine
the occurrence of abscesses (abscesses) in the intestines
intestinal bleeding
development of intestinal obstruction (disturbances in the movement of intestinal contents through the intestines)
perforation (violation of the integrity of the intestinal wall)
anemia
urolithiasis disease
cholelithiasis.

Prevention

compliance with the regime of work, rest and nutrition
Early detection of Crohn's disease
prevention of exacerbations and further progression of Crohn's disease
limiting excessive psycho-emotional and physical stress
regular (at least once a year) examination by a pediatric gastroenterologist.