Crohn's disease (terminal ileitis) - causes, signs, treatment. appropriate methods of treatment. How does Crohn's disease affect pregnancy?

(terminal ileitis) belongs to the group of idiopathic inflammatory diseases of the colon and is a complex chronic autoimmune disease of unknown etiology, characterized by recurrent and intermittent inflammation in all parts of the gastrointestinal tract from oral cavity to the perianal region.

Pathogenesis is a reflection complex interaction between genetic predisposition, environmental triggers (diet, infections, etc.) and the immune system: triggering factors cause an increase in mucosal permeability, which facilitates sensitization to antigens. Consolidation and strengthening of the immune response subsequently leads to self-destructive processes.

Since the specific cause of disease absent, the treatment is also non-specific. In contrast to ulcerative colitis (UC), surgical intervention in Crohn's disease does not lead to a cure and is therefore only indicated for complications of the disease.

Paradoxically, but > 50% of patients need surgery within the first 10 years of disease, > 70-90% have this risk for life. Repeated interventions significantly increase the risk of secondary complications (stoma, short bowel syndrome).

a) Epidemiology:
The annual incidence in Western countries: 6-8 new cases per 100,000; the prevalence of the disease is 50-100 cases per 100,000. Bimodal age peak: 15-30 and 60-80 years. North-south gradient: higher incidence among residents of industrialized countries, urban population > rural population. The severity of the disease in different ethnic groups does not differ.
The presence of a family history in 15-25% of patients. Concordance of the disease among twin pairs: 30-67% among monozygotic, 4% among dizygotic. Smoking increases primary risk and relapse risk (as opposed to UC, where nicotine has the opposite effect). Among patients with Crohn's disease, mortality is higher than in the general population. Crohn's disease is associated with an increased risk of developing small bowel cancer and colorectal cancer in areas of chronic inflammation.

b) Symptoms of Crohn's disease. The severity of the disease, the frequency of exacerbations and remissions are variable:
General symptoms(particularly at the onset of illness in childhood): anorexia, weight loss, malnutrition, anemia (blood loss, vitamin B12 deficiency), growth retardation.
Abdominal symptoms: diarrhea (due to damage to the epithelium combined with reduced absorption of bile acids, causing a laxative effect), bleeding, abdominal pain and cramps, inflammatory infiltrates, fever, sepsis, symptoms of obstruction (stricture).
Perianal manifestations: swollen anal fimbriae, suppuration / abscesses, fistulas, non-healing cracks / ulcers, anal stenosis.
Extraintestinal manifestations: cholelithiasis (reduced absorption of fatty acids in the small intestine), urolithiasis ( bile acids bind calcium => increased oxalate absorption => increased urinary oxalate concentration), sclerosing cholangitis, skin changes (nodular erythema, pyoderma gangrenosum), ophthalmopathy (uveitis, conjunctivitis, iritis), rheumatological diseases (polyarthritis nodosa, arthralgia, rheumatoid spondylitis), bronchopulmonary diseases.
Complications: massive bleeding, sepsis, retroperitoneal abscess, toxic megacolon, malignant transformation.

in) Differential Diagnosis:
UC, indeterminate colitis (7-15%), ischemic colitis, appendicitis, diverticulitis ( sigmoid colon, right side of the colon), drug-induced colitis (eg, NSAIDs), infectious colitis (including pseudomembranous C. difficile colitis), proctitis in STPH (eg, lymphogranuloma venereum, gonorrhea), radiation proctitis, IBS, celiac disease, Whipple's disease , Behçet's disease.

G) Pathomorphology of Crohn's disease:
Distribution throughout the gastrointestinal tract: small and large intestine - 40-50%, only the small intestine - 30%, only the large intestine - 20% (Fig. 4-14 A), perianal lesions - 15-40% (in 3-5% cases, only perianal manifestations of the disease are noted).

Macroscopic examination:
- "Patchwork" discrete inflammation (alternation of affected and unaffected segments), longitudinal slit-like ulcers ("a trace of bear claws, rake"), cobblestone appearance, aphthoid ulcers, deep ulcers and fissures that can form fistulas, mesenteric tissue envelopment of the intestine, mesenteric thickening, and lymphadenopathy.
- Perianal lesions: anal fissures, hemorrhoids, fissures, anal canal ulcers, fistulas, rectovaginal fistulas. Perinatal abscesses. Anorectal strictures, anal cancer.
- Warning: Crohn's disease often does not have the form of a tumor!

microscopic examination:
- Transmural acute and chronic inflammation (neutrophils, lymphocytes), ulceration, formation of non-caseating granulomas ( common frequency detection 50-60%, but rarely with superficial biopsy!), penetrating cracks => fistulas, abscesses; chronic inflammation => fibrosis, strictures.
- Attention: partial coincidence with morphological features in 7-15% of patients (non-deterministic colitis).

e) Examination for Crohn's disease

Required minimum standard:
History: Family history of IBD? Colon function, perianal changes (current, past), course of symptoms, extraintestinal manifestations, fecal incontinence, smoking? Risk factors for differential diagnosis with other diseases?
Clinical examination: stigmas of Crohn's disease (perianal deformity, fistulas, etc.), strictures?
Endoscopy:
- Rigid sigmoidoscopy or fibrosigmoidoscopy: rectal involvement, biopsy?
- Colonoscopy: the "gold standard" for determining the prevalence and activity of the disease in the colon.
Stool culture, worm eggs, C. difficile toxins => identification of a specific infectious etiology.
Laboratory tests: Reactive protein (CRP), blood count, liver function tests, nutritional parameters.
Examination of the small intestine: passage of contrast through the small intestine, CT enterography or capsule endoscopy (attention: the presence of strictures!).
Emergency hospitalization: plain radiography of organs abdominal cavity=> detection of perforation or dilatation of the colon.

Additional studies (optional):
Markers: detection of antibodies to Saccharomyces cerevisae (ASCA) in Crohn's disease gives a positive result in 60% of cases; test for perinuclear antineutrophil cytoplasmic antibodies (pANCA) - negative positive in 60-80% of cases in UC) => the combination of ASCA-positive/pANCA-negative in Crohn's disease has 80% predictive value, the final role of markers remains unclear.
CT: for changes specific to Crohn's disease, > 70% sensitivity and > 90% accuracy.
MRI: study in complex pelvic and pararectal fistulas.
X-ray contrast studies (irrigoscopy with barium or gastrografin): mucosal condition, bowel configuration, strictures, fissures and fistulas; study is contraindicated in patients with acute illness(may aggravate the situation with toxic dilatation).
Virtual colonoscopy: role undefined, risk of perforation.
PET PET-CT role is currently undefined, investigations may be useful to identify fistulas and characteristic picture alternation of affected and unaffected segments, evaluation of process activity, differential diagnosis between Crohn's disease and UC.

e) Classification of Crohn's disease:
By the nature of the disease: with and without the formation of strictures, with and without the formation of penetrations.
By anatomical localization: terminal ileum (distal third of the small intestine), large intestine (without involvement of the small intestine), ileocolitis (small and large intestine), upper divisions Gastrointestinal tract (proximal to the detailed third of the small intestine), perianal form.
By severity (reflected in the Crohn's disease activity index): moderate, moderate, severe, fulminant, remission.

and) Treatment of Crohn's disease without surgery:
- Conservative treatment= treatment of choice; ultimate goal: achieving remission (control of symptoms, suppression of disease activity), maintenance of remission, prevention of relapse after surgery; in severe cases full parenteral nutrition to ensure "rest of the intestine." - Groups of drugs:
Salicylates: mild to moderate form.
Corticosteroids: moderate to severe forms, rapid suppression activity in 70-80% of cases.
Antibiotics: moderate to severe forms with suppuration and abscess formation.
Conventional immunosuppressants (azathioprine, 6-mercaptopurine (6-MP), methotrexate, cyclosporine, tacrolimus, mycophenolate mofetil): maintenance of long-term suppression of activity in order to prevent chronic steroid dependence, it may take 3-6 months to achieve a visible effect.
Biological immunosuppressants (infliximab, natalizumab, adalimumab): rapid suppression of steroid-resistant disease activity (20-30%).

h) Surgery for Crohn's disease

Indications:
Symptomatic subacute / chronic complications of the disease: recurrent / persistent abscess (if percutaneous drainage is impossible), fistulas, strictures.
Acute life-threatening complications: fulminant colitis, toxic megacolon, perforation, sepsis, massive bleeding. No response or deterioration within 3-5 days of conservative therapy.
Malignancy: identified cancer, dysplasia of any (low, high) degree, stricture, inaccessible to inspection (risk of malignancy - 5-10%).
Refractory course of the disease of limited extent: failure or side effects of conservative therapy, the risk of developing dependence on steroids.

Surgical approach. Principles:
Goal: Optimize symptom control and reconstruction with low morbidity/fatality and high quality of life (eg, no stoma formation).
Non-renewable small bowel resource => need for bowel preservation: no benefit of radical surgery => no difference in recurrence rates after limited vs. wide resections.
Laparoscopic approach (if possible) => reduced risk of developing adhesive SBO in the long term.

Spring in Ukraine turned out to be politically turbulent. Even the outburst of "patriotism" in connection with the dispatch of Savchenko to Ukraine speaks of an increase in political instability and a deepening crisis at the top, political ferment in the regions of present-day Ukraine.

It remained in the shadow of Transcarpathia, where the regional council in April adopted an appeal to the president, the Verkhovna Rada and the prime minister demanding that the region be recognized as a “special self-governing territory” in accordance with the results of the referendum on December 30, 1991, when 78.6% of the voters of Transcarpathia voted for autonomy . The deputies of the regional council also reminded the central government that in January 1992 the Transcarpathian Regional Council adopted an appeal to the Verkhovna Rada on making appropriate changes and additions to the Constitution of Ukraine, the essence of which is that Transcarpathia, while remaining " integral part Ukraine”, “independently resolves issues within its competence” within the framework of autonomy.

If a quarter of a century has passed since Ukraine gained independence, and Transcarpathians again and again turn to the topic of autonomy, then there are good reasons for that. The fact is that the Rusyns living today in Transcarpathia, Eastern Slovakia, Serbian Vojvodina, southeastern Poland, Hungary and northwestern Romania are not Ukrainians, as Kyiv seems to be, but a special East Slavic people. In Poland, Russia, Slovakia, the Czech Republic, Serbia and Croatia, they are recognized as an ethnic minority.

The UN Committee on the Elimination of Racial Discrimination in 2008 recommended that Ukraine consider recognizing the Rusyns as a national minority. But Kyiv, which is busy building the Ukrainian nation “with fire and sword” “from the Xiang to the Pamirs”, has no time to consider the recommendations of the UN and the appeals of the Transcarpathian Regional Council.

In May, in Budapest, and in Ukraine, the question of the autonomy of the Hungarians in Transcarpathia was raised.

Collected more than 25 thousand signatures a petition to the president on the creation of a special development region "Slobozhanshchina" in the Kharkiv region. It is this number that is necessary for the head of state to consider the appeal. Kharkiv residents propose to adopt a law providing for the transfer to the region of a number of powers of the center, including the right to independent foreign economic activity. The goal is to resume the former cooperation of Kharkov industrial giants with Russian partners. A “special status” of the region is proposed, which in essence means its autonomy, although in a primary form. On May 26, a march of supporters of this idea took place in the center of Kyiv.

The reunification of Crimea with Russia, the emergence of the proclaimed republics of Donbass, strangled by force of arms, the fires of the Inquisition and arrests, but the unbroken movement for the federalization of the country in Odessa, Nikolaev, Kherson, Dnepropetrovsk and Zaporozhye, and now the initiatives of Transcarpathia and Kharkiv region, make us once again look at how viable or on the contrary, Ukraine is a doomed state entity.

The territory of modern Ukraine consists of several regions that are seriously different from each other in terms of ethnic, socio-cultural and civilizational features. Eastern Ukraine, that is, everything that lies east of the Dnieper, from Chernigov to the Sea of ​​Azov, is a territory dominated by the Russian ethnic group and the Orthodox Ukrainian population (after Ukrainization). This region is historically, culturally, ethnically and religiously closely connected with Russia and is an organic part of the Russian world. Here, in the fire of the national liberation struggle, the independent Donbass was born, and in Kharkov, seized by the noose of the Kyiv punishers, the grapes of anger ripen again.

The central part of Ukraine from Chernihiv towards Odessa, which includes Kyiv, is a region where Ukrainians are ethnically dominated and Ukrainian language with the simultaneous advantage of Orthodoxy. But Orthodoxy itself became heterogeneous. The activities of schismatics from the "Kyiv Patriarchate" who turned their shoulders ruling regime influences the mindset of the population. Nevertheless, this part of Ukraine still remains culturally close to Eastern Ukraine.

The south of Ukraine, or Novorossiya, stretches from the Donbass in the east to the Danube Delta in the west. The region is inhabited by Ukrainians and Russians, interspersed with Bulgarians, Greeks, Armenians and other peoples. Novorossiya is almost entirely Orthodox. However, in recent times the factor of Islam, moreover, with elements of fundamentalism, is asserting itself more and more loudly.

The Majlis, dug in in Genichesk, with the good will of Kyiv and with the money of Ankara, resettles the extremist-minded part here Crimean Tatars. The joint plans of Kyiv, Ankara and the Mejlis include the creation of a Crimean Tatar autonomy on the territory of the Kherson region. Kyiv is counting on a "special relationship" with Ankara, while Erdogan's regime still cherishes illusions about turning the Black Sea into a "Turkish puddle", as in the days of the greatness of the Porte.

Western Ukraine is notable for its heterogeneity. Volhynia with a predominance of Uniates in socio-cultural terms belongs to the Catholic sector of Central Europe. Similar situation in Galicia and Transcarpathia, although there are differences: Volyn is historically connected with Poland, Galicia and Transcarpathia - with the Austro-Hungarian Empire. The Rusyns of Transcarpathia showed amazing stubbornness in the struggle for the preservation of Orthodoxy. In the Bessarabia, Ukrainians and Russians mix with Moldavians and Romanians.

Even a cursory glance at the religious, cultural and ethnic situation in Ukraine allows us to see that at least three civilizations have met here - Orthodox Slavic (Eurasian), which is increasingly called the Russian World, Western (Euro-Atlantic) and Islamic.

The question arises: how viable is a state formation, cobbled together not only on a multinational, but also on a polycivilizational basis? In Switzerland, for example, five peoples live, two confessions met here, but the state turned out to be prosperous.

The federal structure, three official and one partially official languages ​​help out. Although everyday friction is probably nowhere to be avoided, they do not define the Swiss example of achieving unity through diversity.

In Ukraine, the opposite is true - an aggressive nationalist minority, living by the standards of wild nationalism, growing into Nazism, is trying to dress the whole country in the OUN-UPA “one-building”, relying on bayonets. The obvious truth, discovered by Napoleon, has been forgotten: a bayonet is convenient for everyone, except for one thing - you can’t sit on it for a long time.

It can be seen that, at the level of intuition, still guessing about the precariousness of the created structure of power, the regime from time to time tries to invent additional "clamps" for it. The latest "achievement" in this field is the policy of "decommunization". The idea was to rally the heterogeneous elements of a loose society in the "fight against the communist legacy." Several months of "titanic efforts" by the Verkhovna Rada and local authorities to rename everything "red" led to the fact that the law of negation of negation began to operate.

The logic of the development of events turned out to be such that it is necessary to move from the erasure of the past to the destruction of the present, created in the past. It's about first of all, in fact, about Ukraine as we know it. Ukraine is the brainchild of two of the greatest figures of the Soviet period in our history - Lenin and Stalin. Thanks to the first, it gained statehood and became the second most important federal republic of the USSR, while receiving the current South-East, which never belonged to it. Thanks to the second, Ukraine entered the international arena, becoming a founder of the UN, and again grew territorially - Galicia, Northern Bukovina and Transcarpathia.

If we have abandoned the names of Lenin and his associates, we must go to the end and abandon their heritage - modern Ukraine. Consequently, the slogan of the moment should be Kyiv's demand for the entry of Ukraine in parts into the composition of those states where they were before Lenin and Stalin. If there are none today, then you need to turn to their successors. It seems that in this case, the peoples of Ukraine would support "decommunization" with both soul and heart. And without this, instead of a “clip”, it turned out, like that non-commissioned officer's widow, who flogged herself. The society, and indeed the whole world, once again became convinced of the dense cavernousness and obscurantism of the Kyiv regime.

Deprived of the slightest signs of rationality and common sense, Kyiv's policy has become the main subjective cause of the disintegration of the state taking place before our eyes, the objective prerequisites for which were laid in its organizational and structural foundations. If nothing changes in the Kyiv regime’s policy of “decommunization” and rejection of the past as part of historical Russia, the disintegration of Ukraine will only accelerate, and the point of no return will soon be passed. Moreover, and it is difficult to doubt this, knowing the history of the country and its peoples, most of Ukraine will turn towards the Russian world - to his home. The crown will finally take root.

Crohn's disease nonspecific disease inflammatory nature, which affects the entire gastrointestinal tract. The disease is characterized by the instant development of inflammation, which has a detrimental effect on the intestinal wall. This causes the formation of ulcers and inflammatory foci.

Crohn's disease occurs with remissions or exacerbations. Most often affects the final section of the small intestine or the large intestine. On the this moment statistics show 60 per 100 thousand people with an autoimmune disease.

Pathology acquired its name in honor of the discoverer of a gastroenterologist from America, Barril Kron. He first reported the discovery of a new type of disease in 1932 at a scientific meeting.

The disease develops in a place where water is absorbed and feces are formed. Segmental inflammation captures mainly the distal intestine. Crohn's disease is common in the age range of 13 to 37 years. Signs can appear even in the most seemingly healthy person.

Sometimes it is difficult to determine the inflammatory process, since it is similar to such pathologies as non-ulcerative colitis, salmonellosis and others. At any age, starting from the age of 13, both boys and girls are prone to inflammatory processes. Diagnosis in children is carried out in the same way as in adults.

Symptoms

The clinical signs of Crohn's disease can vary. It depends on the stage and location of the inflammation. The defeat of the gastrointestinal tract always comes to the fore.

And here is a violation in the activity immune system can provoke the development of inflammation of other systems and organs. The following signs are distinguished:

• bleeding;
• constipation;
• diarrhea;
• vomit;
• colic in the abdomen;
• extraintestinal manifestations of the disease.

The severity of all symptoms depends on the location of the inflammatory process and its neglect.

Characteristics of bleeding in Crohn's disease

Statistics show that in 95% of patients, the inflammatory process occurs in the large and small intestines. The appearance of blood in the feces can be explained by the fact that the ulcerative process progresses and spreads to the deep layers of the intestinal walls, where the blood vessels are damaged.

The nature and amount of blood released depends on the depth, size and level of the inflammatory process, which can be:

1. Scarlet. Bleeding occurred in the region of the final sections of the colon or rectum. Here are almost ready stool, so the blood does not mix with them, but is located on them.
2. Dark scarlet. Bleeding is in primary departments large intestine, where feces have not yet formed. So, the blood mixes with the feces, which gives a dark color.
3. Black with a smell. Bleeding originates in the small intestine, where normal environment and conditions incoming food is absorbed and digested. Blood cells are destroyed by digestive enzymes. The content mixes with the remaining food, which is the reason for the black color.

On the initial stage damage blood vessels insignificant. The presence of blood in the feces in some cases cannot be noticed on its own, only with additional study. In other cases, the patient may observe small blood streaks, which will be the first signal to see a doctor.

Abundant bleeding in this disease can occur only in advanced cases. It must be remembered that the presence of blood in the stool is not the norm, therefore, if abnormalities are found, you should immediately go to the doctor.

Characteristics of diarrhea

Most people with Crohn's disease suffer from diarrhea. This process occurs due to the presence of inflammation in the area of ​​the intestinal wall. Inflammations that are released in this area irritate the nerve endings. This speeds up the passage of food through digestive tract, thereby reducing the level of absorption and digestion, which causes diarrhea.

The chair can appear up to 10 times a day. Between bowel movements, false urges may appear, accompanied by colic in the abdomen. The urge may be accompanied by the release of mucus and blood in a small amount, and the feces may be almost completely absent.

constipation

Constipation - rare symptom as opposed to diarrhea. It occurs in about 20 patients out of 100, and, as a rule, alternates with diarrhea. Constipation is due to irritation of nerve endings, which leads to spasm. Feces accumulate in front of the spasmodic area, stretching and overflowing the bowel loops. The walls of the intestine tense, which can be seen with the naked eye, when feeling the abdomen.

Constipation is often accompanied by painful and frequent false calls to defecation. Violation of defecation processes can lead to serious complications, so going to the hospital is inevitable.

Vomiting and nausea

If inflammation develops in the stomach or intestines, then nausea and even vomiting may occur.

In this case, there is a violation of the enzymatic and mechanical processing of the incoming food, the digestion process slows down.

Vomiting attacks can occur due to blood entering the intestines or damage to blood vessels. This provokes the overflow of intestinal loops and the launch of some reflex mechanisms.

Pathological conditions may occur in which the direction of food advancement changes. The contents of the stomach come out due to a sharp contraction of the muscles abdominal wall and respiratory tract. Vomiting in the presence of this disease is rare, as a rule, due to malnutrition.

Colic in the stomach

Colic is paroxysmal in nature, they can be both pulling and stabbing. The pain varies from mild to unbearable. If the stomach is affected, then the pain will be felt at the top of the abdomen. With the defeat of the transition from thin to large intestine the pain is located in the lower right corner.

If inflammation has formed in the small intestine, spasms will be near the navel. Pain in the lower abdomen indicates inflammation in the large intestine.

Extraintestinal signs

The disease also manifests itself outside the intestines, usually this is due to untimely treatment.

The following symptoms are distinguished:

• heat;
• joint damage;
• skin rashes;
• eye diseases;
• damage to the kidneys and liver;
• severe weight loss and anemia.

In addition, the patient may become irritated, his appetite worsens and sleep is disturbed. The quality of life is severely impaired.

How to diagnose an ailment

Due to the nonspecificity and variety of symptoms, it can be difficult to make a diagnosis. That is why doctors prescribe whole complex laboratory research.

An important role in the calculation of the disease is played by:

• blood test (general and biochemical);
• research in the laboratory;
• analysis of feces for the presence of occult blood;
• tomography;
• histological examination;
• pathology activity index.

The doctor carefully listens to the patient's complaints and examines him. On palpation of the abdomen, intestinal tension can be noted.

Complications

With a long course of the disease or its untimely detection, the following complications may develop:

1. Intestinal obstruction. The intestinal lumen narrows, due to which food cannot pass freely from the small intestine to the large intestine. If conservative therapy is unsuccessful, only surgery will help - removal of the narrowed part.
2. Abscess. It occurs due to perforation of the intestine, and the ingress of pus into the abdominal cavity. In this case, only surgery can help.
3. Bleeding. This complication is less common than with an ulcer. In this case, hemostatic therapy is effective.
4. Significant expansion of the intestine. It happens less often than with ulcerative calitis. It develops due to the use of antidiarrheal drugs and colonoscopy.
5. Cracks in the anus, paraproctitis. These complications can only be removed by surgery. No mucosal treatment anal passage ulcers form.

Crohn's disease needs to be treated as soon as possible. A constant inflammatory process in the intestine is a predisposing factor for the onset of cancer.

Crohn's disease treatment

This disease affects the stomach and intestines, so it is mainly used drug therapy. Surgical intervention is necessary for complications.

Medical treatment

During the progression of the disease, use antibacterial agents. Patients take 1 g daily Ciprofloxacin and Metronidazole. They can be alternated or combined.

Mesalizin is also prescribed - 4 g per day for six months. Further examination is carried out, and in the case positive results the drug is cancelled.

Diet

Food should be high-calorie, contain a lot of protein and vitamins. Fatty foods should be limited, as well as those with coarse fibers. Such food strongly irritates the mucous membrane of the stomach and intestines. You also need to avoid alcohol.

You can eat soups on a low-fat broth of fish or meat, buckwheat and oatmeal. It is allowed to eat up to 2 soft-boiled eggs, jelly, pears, cottage cheese and soufflé from it.

Avoid dairy products that can cause diarrhea. As for drinks, you can tea, compote, decoctions of herbs, cocoa on the water. Limit the amount of vegetables, spices and sauces.

Is it possible to treat Crohn's disease with folk methods

Crohn's disease is highly treatable folk ways especially if they complement medical treatment.

In addition, you can drink an infusion of chamomile, which has an anti-inflammatory and wound-healing effect.

Prognosis of Crohn's disease

With a single attack, a complete recovery is possible. However, a syndrome that resolves on its own is usually not related to Crohn's disease, but is associated with infectious disease. The chronic form of Crohn's disease worsens throughout life. If the disease began to develop in early age the child's development slows down.

cases lethal outcome from complications are rare. A common cause of death is gastrointestinal cancer. Children with Crohn's disease lead an active lifestyle, with exceptions only during exacerbation. Surgical intervention rarely helps, so it should be carried out only in extreme cases.

We bring to your attention a video that explains the symptoms of Crohn's disease and gives recommendations for its treatment:

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Crohn's disease - is an inflammatory bowel disease whose cause is still unknown. Due to some factors, the cells of the immune system begin to attack and destroy their own organs. Any part of the digestive tract from the oral cavity to the anus can be involved in the inflammatory process.

The disease is named after Dr. Burrill Krohn, who described it in 1932. Symptoms vary from mild redness to pronounced changes when the intestinal wall becomes thickened and deformed, covered with deep ulcers. Statistics show that Crohn's disease is equally common in both men and women. Almost one in five patients with Crohn's disease has a close relative in the family with the same diagnosis, most often a brother or sister, sometimes a parent or child. The disease usually occurs in young age between 15 and 30 years old.

Recently, people around the world have become more likely to suffer from Crohn's disease. It is also noted that Crohn's disease is more common in Western countries, in northern regions, and usually occurs in people with a high socioeconomic level.

To explain all these data, perhaps, not every doctor faced with this disease, which has not yet been studied, will undertake. And since there is no clear answer to many questions, it is considered incurable even in the modern world of high technologies and discoveries. This is the most important and, perhaps, the most difficult myth of Crohn's disease.

On the one hand, the disease is indeed considered incurable. On the other hand, there are treatment methods that allow you to stop the process, and temporarily return the patient to normal health and lifestyle. Crohn's disease is a chronic disease with periods of exacerbations and remissions. Sometimes the patient feels so good that he is able to do whatever he wants in his life. And sometimes it is so bad that it immediately needs surgical treatment.

Myth 1 - Periods of remissions and exacerbations are unpredictable

Predicting their frequency is sometimes really difficult. But at proper treatment and medical supervision can even be prevented. Crohn's disease can go away for decades, but its symptoms usually do return. Especially under the influence of various stimulating factors. Quitting smoking, diet, a positive emotional attitude, no doubt, will help to avoid exacerbations.

The point is that smokers have big risk development of abscesses or fistulas. The more you smoke, the more likely the symptoms of the disease will return again, and more powerful therapy will be required. In addition, patients who smoke increased risk surgical intervention, it almost doubles. There is also an increase in the risk of recurrence of the disease after surgery, at least two to three, or even six times.

Myth 2 - Diagnosis is extremely difficult

The symptoms of Crohn's disease are similar to a number of other diseases - irritable bowel syndrome, ulcerative colitis, peptic ulcer, etc. Its acute manifestations are generally more often mistaken for appendicitis. Extraintestinal inflammation of the eyes is also characteristic of the disease: the mucous membrane, the middle layer of the eye wall, the white shell, the iris, joint pain, most often peripheral arthritis, skin rashes - painful red nodules on the arms or legs. Patients, and many doctors, do not always associate such manifestations with the underlying disease. Therefore, they are treated by rheumatologists, dermatologists, ophthalmologists and other specialists.

It is not difficult to make a diagnosis, for this the doctor has the possibilities: clinical and biological research, confirming the presence of signs of inflammation in the blood, endoscopic, radiological and histological examinations. Endoscopy provides the highest evidence of disease. Applies to relatively new method research that allows you to clearly see the walls of the small intestine without radiation exposure - hydro-magnetic resonance imaging. And, of course, the latest technique is capsule endoscopy, a modern method of examination using a video capsule. A small device more pills swallowed, washed down with water and then freely moves through the digestive tract. Thanks to sensors on the patient's body, it transmits an image of the small intestine mucosa to a computer monitor. The only method, which could identify all cases of Crohn's disease, no, but a combination of different studies allows us to draw unambiguous conclusions.

Myth 3 - Surgery is unavoidable

- Unfortunately, there are patients in whom conservative therapy was unsuccessful or the development of complications is observed. Only in this case, surgery is necessary. In most cases, you can try to stop the process with medication. Approximately half of patients with Crohn's disease have a mild course and are successful with minimal or intermittent therapy. For patients with moderate (30%) or severe (20%) disease, permanent treatment individually selected medicines.

Myth 4 - The operation is not radical

- Surgery to remove the affected area of ​​the bowel cannot cure Crohn's disease, but it can improve a person's condition. We are accustomed to the fact that surgery cures the disease: appendicitis inflamed - it was removed, and the person was cured, there is inflammation of the gallbladder - removed gallbladder and cured. As for Crohn's disease, things are different here. The basis of the disease is excessive activity immune system against intestinal cells. And after the operation, such a reaction of the body to the intestine is preserved. Therefore, relapses occur often, but not in 100% of cases. In some patients, after removal of the pathological site and with subsequent proper treatment, relapses do not occur at all. It all depends on how you treat. If not treated at all, there will be more relapses than remissions. If treated correctly, there will be more remissions than relapses.

When competent is used A complex approach to treatment, relapses after surgery occur in less than half of the cases. The fact is that this specific disease, on the one hand, is traditionally treated by gastroenterologists, but patients may experience complications that gastroenterologists are unable to remove. Then the treatment is continued by the surgeon and completed again by the gastroenterologist. Great importance has a choice of the right approach to treatment at each stage. During the operation, which are performed by a gentle laparoscopic method, new technologies for tissue separation, high-quality suture material. And the most common complication of Crohn's disease - narrowing of the intestine, is removed using the balloon expansion technique without removing the affected areas.

Myth 5 - Drug treatment only produces side effects.

Traditional drug therapy for Crohn's disease includes drugs that reduce inflammation in the colon, hormonal drugs that quickly relieve flare-ups, and drugs that block the activity of the immune system. You have to pay for this side effects- Nausea, headache or abdominal pain.

A certain breakthrough in treatment has occurred in the last few years with the introduction of the so-called biological preparations.

Biological drugs are protein molecules that act more selectively and target cytokines released during inflammation. Selective action makes biological preparations not only more effective, but also the safest for the patient. In addition, they are indicated in cases where traditional drug therapy is ineffective. In some patients, already within a day after the administration of the drug, the state of health improves - abdominal pain, diarrhea, bleeding and discomfort decrease, physical activity is restored, appetite increases. For some patients, hormone withdrawal becomes possible, for others even surgery. The great success of biologics is that they quickly relieve the symptoms of Crohn's disease. According to fibrocolonoscopy, they even have the ability to heal the affected mucous membrane.

New drugs offer a more gentle treatment regimen. The first 1.5 months the drug is administered only 3 times, with a positive effect - once every two months. And surgery is no longer mandatory for every patient.

Myth 6 - About normal life you can forget

Even if you are forced to constantly take medications, your life can be quite fulfilling. Despite the need for long-term treatment and periodic hospitalizations, most patients can keep their jobs, provide for their families, be successful at home and in society, enjoy sports and entertainment. There are many examples of this.

Anna Vasilevskaya

Dr. Peter

“Society is already accustomed to helping children with cancer. And the fact that there are diseases in gastroenterology that can end in tragedy and require serious financial investments is not yet obvious to everyone?

– Many charitable foundations today help children with hematological and oncological diseases. But in gastroenterology, I compare Crohn's disease with hematology and oncology. This is a terrible disease - it gradually progresses, may require surgical intervention, gives inflammation of the entire intestinal wall, holes in the intestine, adhesive disease, fistulas, can affect the esophagus, duodenum, lead to death.

And children, teenagers are my big pain. It is much more difficult for adolescents to cope and accept the disease than adults. They are maximalists. Imagine that you went in for sports, were the captain of a basketball team, and suddenly this trouble ... Psychological assistance is poorly developed in our country. The child is frightened, the parents are shocked - that is impossible, that is impossible. And despair sets in - life is over.

Or the girl was friends, talked with boys, and now she is inflated on prednisolone, she has acne ... The child is completely lost.

– At the same time, parents, apparently, can miss the symptoms of both Crohn's disease and other serious gastroenterological diseases, because "The stomach got sick - who does not have it." What symptoms should alert them?

– Diarrhea lasting more than 6 weeks. Blood in the stool. Weight loss. Stomach ache.

But Crohn's diseasecan occur without diarrheaso if the patient loses weight and eats pain syndrome you need to see a doctor.

Patients do arrive at the hospital very late.The median time to diagnosis for Crohn's disease is 2-3 years.

- That is, even when contacting doctors, the diagnosis is not made immediately?

- Yes, for some reason, intestinal dysbacteriosis is most often mistakenly diagnosed, sometimes - chronic gastroduodenitis.

Who is at risk for inflammatory bowel disease? Children?

- As for Russia, there are no data on the prevalence of the disease. But in general, the world is now experiencing a sharp increase and a sharp rejuvenation of these diseases. The number of children who fell ill before the age of 6 is increasing. If earlier to us indepartment of gastroenterology a maximum of 4 children under the age of 3 were admitted per year, but now in one September we received 5 children.

Natalia Shchigoleva

The operation is still a disability

- Speaking of inflammatory bowel diseases (IBD), we primarily mean Crohn's disease and ulcerative colitis?

– Yes, mainly these two diseases. Still undifferentiated colitis stands out - a disease that has features of both ulcerative colitis and Crohn's disease. But there is no provision of drug therapy for undifferentiated colitis, so we distribute patients according to these two nosological forms.

Ulcerative colitis is an inflammatory bowel disease that affects the lining of the colon. Therefore, it is believed that ulcerative colitis can be cured by colectomy - removal of the colon.Although UC patients actually have many problems, some have to leave a permanent ostomy. An operation is still a disability.

Crohn's disease affects the entire gastrointestinal tract from mouth to anus. Surgical intervention is performed only in extreme cases, because after the operation the disease recurs rather quickly.

I would compare Crohn's disease in terms of danger and complexity of management with hematological and oncological diseases. Unfortunately, this disease, from which today it is impossible to recover, you can only go into remission.

Unlike ulcerative colitis, Crohn's diseasethe entire intestinal wall is affected, which leads to the development of stenosis (narrowing of the intestine), the formation of fistulas both between the intestines and other organs, abscesses (abscesses) in the abdominal cavity, severe lesions of the area around the anus: ulcers, cracks, fistulas. Many patients have multiple surgeries.

This disease leads to severe disability. Therefore, the sooner we make a diagnosis and begin to treat, the fewer complications the patient will have.

In children, unlike adults, both ulcerative colitis and Crohn's disease are more aggressive. But with children wemore limited in drugs.

– What do we know today about the causes of Crohn's disease and ulcerative colitis?

- Primarily, predisposing genetic factors . IBD belongs to polygenic diseasesat which more than a hundred sensitive loci are found that increase the risk of the disease. To date, about 200 loci have been discovered where these genes can be.

But in order for the genetic factors to be realized, some kind of triggering factor is needed, these are:

1. Environmental factors.The higher the urbanization, the higher the level of development of the country, the higher the level of development of the VZK.

2. Improper nutrition:eating food with the addition of emulsifiers, food E-supplements, fast food. There is an interesting statistic that in Asian countries, where the so-called oriental diet is widespread - rice, seafood, - for a long time there was no inflammatory bowel disease. But as soon as the inhabitants began to switch to a European diet, a sharp increase in diseases began.

3. Smoking.

4. Stress.After all, what is stress? This is a breakdown of all our adaptive mechanisms. We become exposed to various factors: infectious, viral, etc. Chronic stress leads to a weakening of our immunity.

How are Crohn's disease and ulcerative colitis diagnosed?

– A specific marker of IBD is fecal calprotectin. Its increase above 150 mcg / g should alert in terms of ulcerative colitis and Crohn's disease.

In UC, antibodies to neutrophils can be detected, in CD - to saccharomycetes.

IBD can also be suspected by such routine tests as general analysis blood and scatology. These patients may present with anemia, increase in ESR, leukocytes, erythrocytes in the analysis of feces.

- Is it always needed? genetic research?

- When the patient does not fit into any particular clinical picture and does not respond to therapy. This is no longer ulcerative colitis or Crohn's disease, but monogenic diseases that are very difficult to detect and have completely different therapy - up to transplantation bone marrow.

Unfortunately, in my practice there were two children who were diagnosed too late and died.

As for the commercial tests that people go to in order to identify a predisposition to the disease, I believe that they are not informative. IBD can be identified by a number of signs.

Two severe patients and one good remedy

– What are the modern possibilities in drug therapy for Crohn's disease and ulcerative colitis?

– Drug therapy for Crohn's disease and ulcerative colitis is aminosalicylates, cytostatics and anticytokine drugs that block a certain link inflammatory response and give healing to the mucosa. In this way we can prevent the recurrence of the disease.

Last autumn, a new drug was registered in RussiaVedolizumab (Entivio). It is used when our patients do not respond to antibodies to tumor necrosis factor - neither to Remicade nor to Humira.

Vedolizumab blocks the migration of T-lymphocytes that cause chronic inflammation.This is targeted therapy.

So far, it has not been registered for the treatment of children, but a huge multicenter study is underway on its use. But, nevertheless, all over the world there is already experience with the use of Vedolizumab in children - in Canada and Norway, for example. The results are very good.

Sveta is 14 years old, she is from Irkutsk. Bleeding, purulent discharge, fever, stomatitis, mouth ulcers, skin rash. Then Sveta was in the hospital for a long time, she lost weight dramatically. The worst thing was that no one knew what happened to the child - gastritis, ulcerative colitis? A year later, she was diagnosed with Crohn's disease. By that time, Sveta became completely transparent and completely weakened.

– Do you have children in the department who need this drug?

– We have two seriously ill patients whose diagnosis is not completely clear today – A girl with severe damage to the intestines, oral cavity, operated on, as she had severe fistulas. Boy with frequent exacerbations of the disease, severe damage to the oral cavity and high inflammatory activity in blood tests.

We see them with Crohn's disease, but their course of the disease is not typical.

What are we afraid of? So that the disease does not lead to stenosis - narrowing of the intestine, since then surgery will be needed, the child will become disabled and then the disease will begin to progress much faster. For these two children, the situation is now such that we will either try Vedolizumab, a drug that gives nice results and we can get on it positive effect, or let's talk about bone marrow transplantation.

Alyosha is 13 years old, he lives in the Amur region, the village of Progress. Alyosha fell ill at the age of six. Swollen gums, blood test showed high inflammatory activity. And the trips to the doctors began - herpes? No. Chickenpox? No. Primary immunodeficiency? Unspecified. Crohn's disease? Not a typical flow. And so six years.

Alyosha is tired, he seems to be sick all his life, but the illness does not go away and does not go away. He is very tired.

- And what decision do you tend to?

- Of course, if you weigh on the scales conservative therapy and bone marrow transplantation with its dangers and complications, then with a new drug there are more chances.

The Moscow Department purchases the drug only for adults. For children, until the drug is registered, it is possible to use it off label , that is, according to vital indications.

We will be able to bring children into remission and prevent the development of complications.

And another very important point is that if we initiate therapy now and get a positive effect, the regions will get involved and find opportunities in the local budget to allocate money for the purchase of this drug. Children will be able to continue to receive medicine at their place of residence free of charge.

– The state of remission in children with inflammatory bowel diseases – as far as possible in such a situation full life?

- I have pictures of patients - how they saw their lives before and after anti-cytokine therapy. Before is all gray and black. After - the sun, joy, red, yellow, green colors.

When you see these pictures, you understand how their life changes. Of course, the emergence of new drugs is just a hope for salvation for our patients.

And in the future, our task is to teach the child to live with ulcerative colitis and with Crohn's disease. Because sometimes the disease can return, aggravate. We recommend that children in the future look for professions with a free schedule, so as not to depend on sick leave. There are also restrictions on physical activity, food. But in general, having gone into remission, children can live a full life.