Saturday, July 21, 2012

Crohn's disease


Crohn's disease is a non-specific inflammatory disease of the digestive tract. This disease can affect any part of it, in most cases the ileum (part of the small intestine) and colon (large intestine). Crohn's disease is very similar to ulcerative colitis, so that in about 10% of patients the two diseases are indistinguishable.


Frequency

In developed countries of Western Europe the incidence of Crohn's disease is 2-6 cases in a population of 100 thousand inhabitants. Prevalence is 10-20 times higher. Gender representation is about the same.Crohn's disease can manifest at any age, usually between 15 and 35 year.

The cause of

Various clinical studies have shown that genetic factor plays an essential role in the development of this disease. There is a high incidence of monozygotic twins konkordantnosti. Numerous infectious, bacterial and viral agents were proposed as the cause, but without evidence definitnih. M. causes paratuberculosis in ruminants Johneovu disease, a chronic inflammatory disease of the ileum, similar Crohnovoj disease.As Crohn's disease predisposing factors mentioned diet with plenty of refined sugar and use of contraceptives. Smoking is also one of the possible sinergetičkih trigger in the onset of the disease.

Description of disease

Crohn's disease is usually localized to the final part of the ileum, part of the ascending colon, the entire colon or ileum and jejunum (part of the small intestine). Bowel wall as a whole is swollen and thickened.There are deep sores (ulcers), usually in the form of grooves. Deep ulcers can penetrate the intestinal wall and cause abscesses or fistulas. Fistulas can occur between adjacent lines or curves of affected segments of bowel and bladder, vagina, or perineal skin.

The clinical picture

Ulcerative colitis is a chronic disease with unpredictable ups and improvements in clinical course. The manner of expression and the symptoms depend on the affected region of the intestine and the extensiveness of the disease. Clinical characteristics of Crohn's disease is usually diarrhea, usually without blood, and abdominal pain (> 75%), followed by fever (> 50%), as well as general weakness, and a possible loss in weight. Sometimes, especially in children and the elderly only symptoms include fever and weight loss.

Diagnosis

The diagnosis should be considered in all patients with diarrhea, with or without blood, and abdominal pain. Are possible atypical manifestations, fever of unexplained origin without intestinal symptoms or vancrevna expression, such as arthritis or liver disease. As Crohn's disease may be to grasp and small intestine, it should be taken into account in all forms malapsorpcionih syndrome, intermittent bowel obstruction and of abdominal fistulas. Blood tests are nonspecific. Can you show a moderate anemia (normochromic, normocytic or hypochromic), elevated sedimentation rate, leuko and thrombocytosis, hipoproteinemiju. Diarrhea can lead to electrolyte disturbances, a malabsorption disease in Crohnovoj to steatorrhea. Disease extent, determined by X-ray examination of the small bowel barium and barium enema. These changes may seem to show mucosal ulceration and deep pathognomonic, sign of cord or wire. "Changes often affect ileum and colon in continuity. In chronic cases may arise stricture. Intestinal lesions are usually discontinuous.

Treatment

The most effective medications for the treatment of Crohn's disease have anti-inflammatory drugs (corticosteroids, aminosalicylates and immunosuppressive agents) and, if necessary, also apply to other drugs. Corticosteroids are effective in treating acute phases. Long-term use is limited by side effects, and acute treatment does not reduce the risk of recurrence. Steroid drugs that act primarily as local development. Aminosalicylates are effective in treating Crohn's disease and small bowel. Not recommended for use with aminosalicylates corticosteroids in the acute phase, because there is no evidence that increasing the effectiveness of treatment. Side effects with sulfasalazine - nausea, headaches, skin rashes, reversible sterility in men and, very rarely, Hemolytic anemia and agranulocytosis is attributed to-sulfapiridinu. In these cases, the use or mesalazine preparations olsalazina. Immunosuppressive drugs, and 6-azotioprin merkaptropin have the same active metabolite, their main application in the treatment of perianal fistulas.


Can the disease affect other body parts?
Crohn's disease can cause inflammation of the digestive system outside 9ekstraintestinalna disease).Possible symptoms include redness and swelling of skin, eye pain, vision problems, coughing, breathing whistles and difficulty breathing.
Inflammation of the skin occurs in less than fifteen percent of patients. Usually when you start withdrawing treat gastrointestinal symptoms, but sometimes needed corticosteroids.
Inflammation of the eye occurs in five percent of patients. Usually retreats during the treatment of disease, but need careful monitoring to prevent complications such as glaucoma.
Inflammation of the lungs and airways occurs rarely, but possible.

When you need surgery?
Conservative treatment can be controlled symptoms and delay the need for surgery. The surgery was "the last line of defense" because it will not cure the disease, although in some patients the fastest improving health. About 80% of patients will at some point during the disease need surgery, usually due to serious health problems. Surgery is used to stop bleeding, fistula closure and bypass zažepljenja, and sometimes simply to remove the affected part of the intestine.

What to expect after surgery?
It is important to have realistic expectations of surgery. The procedure can improve the patient's health and even save lives. The operation, however, will not cure the disease and it is very unlikely to produce the symptoms reappear. 85-90% of patients have no symptoms for one year after surgery, and even up to 20% have no symptoms through fifteen years. If the disease is confined to the colon and remove it, only a dozen patients will develop symptoms over the next ten years. Immediately began long-term drug therapy after surgery reduces the risk of recurrence.
Sometimes it is necessary during surgery to make an opening in the abdominal wall through which the intestinal contents are discharged (stoma). After adjusting to the stoma can usually lead a complete life.

The risks of early surgery
Early surgical intervention is defined as a surgical procedure to treat Crohn's disease who are taking within three years after diagnosis. By studying the cases of patients who undergo this surgery early noticed the repetition of certain risk factors.
Risk factors that were significantly povezanis the risk of early surgery as smoking cigarettes, a disease of the small intestine without grasping the colon, nausea and vomiting, or abdominal pain at diagnosis, the number of neutrophils and steroid treatment within the first six months.

How is it treated if it occurs again after remission or surgery?
Recurrent Crohn's disease treated with the same principles as its initial episode. In some cases it is necessary to use stronger drugs or introduce a new group of drugs.

Crohn's disease in children and adolescents
A fifth of patients develop the disease before the age of eighteen years. If the disease is left untreated, half of affected children will have a short stature and delayed development. Aggressive nutritional therapy can facilitate orderly growth and development. Treatment may include nutritional supplements, high-calorie diet and sometimes infusion.
Because steroids can stunt growth and lead to osteoporosis, are used in children only as a last resort.Height, weight and bone mineral density should be carefully monitored in children who are treated with corticosteroids.
Children can have significant psychosocial problems if the condition affects daily functioning and prevents socializing with peers. If a child seems withdrawn, sad, uninterested in activities or having difficulty in school, it is advisable to naglsiti doctor and consult with a psychologist or child psychiatrist.

New forms of treatment
Numerous studies dealing with Crohn's disease. Most new drugs help decrease the inflammation. Many drugs undergoing clinical trials. If the patient is interested in participating in the research of new drugs should be discussed with a specialist to guide him.

Can people with Crohn's disease have children?
Men and women suffering from Crohn's disease can have children. With the doctor had previously advised to talk about drug safety in pregnancy.
Children of parents with Crohn's disease have three to twenty times more likely than the general population to develop the same disease. However, there is currently no way to predict the individual risk for a child.

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