Crohn’s disease

Summary

Crohn’s disease (CD) is an inflammatory disease of the digestive tract. She is an IBD (inflammatory bowel disease), as well as hemorrhagic colitis (ulcerative colitis). These two diseases have very similar symptoms (diarrhea and abdominal cramps) but are distinguished by their location, as ulcerative colitis is limited to the rectum and colon, while Crohn’s disease can affect the entire digestive tract.

The disease is characterized by irregularities and ulcerations in the intestinal wall, which cause bleeding and pain (usually in the form of abdominal cramps).

Of unknown cause, it is difficult to be diagnosed, as its symptoms are not specific (weight loss, fever, diarrhea…) and can be associated with other diseases.

The doctor should first exclude other diseases, such as:

– parasitic or bacterial infections

– sexually transmitted diseases that can affect the rectum (herpes, chlamydia)

– possible cancer of the colon or rectum, which can cause bleeding

– an extrauterine pregnancy

For this, the doctor will examine the patient (through stool analysis and blood tests), and perform a rectoscopy, colonoscopy or even an X-ray, to diagnose Crohn’s disease.

Many treatments can be prescribed to relieve the symptoms caused by Crohn’s disease, such as: anti-inflammatories, analgesics, antidiarrheals and immunomodulators. However, there are no medications that act on the causes of Crohn’s disease.

In severe cases, surgery (removal of parts of the bowel) may be performed by a doctor.

In recent years, in very advanced cases of Crohn’s disease, especially when conventional medications are ineffective, a new surgical technique has been used mainly in Europe and North America, which is a surgical method of cell-transplantation. hematopoietic stem cells (cells that give rise to all other blood cells).

Definition

Crohn’s disease is an IBD (inflammatory bowel disease) that can affect the entire digestive tract, from mouth to anus, most frequently in the ileum (final part of the small intestine).

Crohn’s disease can manifest at any age, with a higher incidence in adolescents and people over 60 years of age. Most patients will develop the disease before age 35. It affects both women and men.

The disease evolves by outbreaks, and attacks the segments of the intestines. Lesions are characterized by thickening of the bowel wall and ulcerations that cause bleeding and abdominal pain. In patients, it is possible to find healthy intestinal segments and diseased, inflamed segments.

Before making a diagnosis of Crohn’s disease, a doctor must rule out all other causes of bowel inflammation through numerous tests.

Epidemiology

In the United States it is estimated that in 2016 around 700,000 Americans suffered from Crohn’s disease. The Mayo Clinic in Arizona estimates that about 3 people per 1000 population are affected by Crohn’s disease. Of those affected, 1 in 5 are hospitalized each year due to this disease.

Causes

To date, the causes of Crohn’s disease remain unknown, as noted in a press release from the Mayo Clinic in Arizona published in March 2017.

The immune system would attack the intestines after the appearance of an environmental, food or infectious element, as in the case of seasonal allergies, when the body reacts very strongly to pollen and causes sneezing, runny nose and burning eyes.

The researchers believe in a genetic predisposition, which causes this dysfunction of the immune system, because, in fact, it can be observed in several members of the same family.

Apparently, smoking can also act in triggering the disease, as well as in the appearance of inflammatory outbreaks.

Crohn’s disease and the birth control pill
A large study of 230,000 women published in March 2015 showed that taking the birth control pill for at least 5 years tripled the risk of developing Crohn’s disease, an incurable disease of the digestive system. The researchers noted that the pill could weaken the intestine and create conditions conducive to the development of Crohn’s disease. The Doctor. Hamed Khalili, a gastroenterologist at Massachusetts General Hospital in Boston who conducted the study, noted along with his team that the number of people suffering from Crohn’s disease has increased by a factor of 2 to 3 over the last 50 years, i.e. the from the almost universal use of birth control pills among Western women.

However, Dr. Khalili noted that the pill is probably not the direct cause of Crohn’s disease, but the development of this disease depends primarily on each individual’s genetic heritage. In other words, the pill can be a trigger, but not the source of the disease. For a woman with Crohn’s disease in her family, it would be advisable not to use the pill as a contraceptive method. The study is published in the specialized journal Gut.

Mycoses
According to a study carried out by the Case Western Reserve University School of Medicine in the United States, fungi can contribute to the development of Crohn’s Disease. In patients with this disease, researchers have mainly found the presence of the Candida tropicalis fungus .
This study was published in September 2016 in the specialist journal mBio .

Risk Factors
Stress and diet are possible risk factors for Crohn’s disease, but they are not causes, according to the Mayo Clinic .

Symptoms

Since Crohn’s disease is a disease that attacks the intestines, its repercussions will reach the digestive sphere, having the following symptoms:

–  chronic diarrhoea , sometimes with blood

– abdominal pain due to intestinal cramps

–  fever

– decreased appetite

– weight loss

– anemia

– tiredness

– blood in the stool

Symptoms can last for several days and even weeks, and they can also disappear and reappear at irregular and unpredictable time intervals. The intensity, severity, as well as frequency of symptoms are completely random. However, severe outbreaks, which can seriously affect bowel functions, can cause dehydration, severe pain and blood loss.

Crohn’s disease can attack the same area(s) of the digestive tract more than once, as well as other places and leave some parts intact. Therefore, even if the patient removes a diseased part through surgery, the disease can start again in other places.

Although Crohn’s disease essentially manifests itself in teenagers and people over 60 years of age, it can also affect children and cause the following symptoms, explained by the malfunction of the digestive tract:- growth retardation

– an inflammation of the joints (certainly due to the growth problem)

– asthenia

–  fever

Diagnosis

To diagnose Crohn’s disease, the doctor will use a clinical examination, biological tests (not specific to the disease), as well as an intestinal x-ray.

Before carrying out these exams, the doctor will carry out an anamnesis of the patient, analyzing the following pains and discomforts:

– Cramps and repetitive abdominal pain, accompanied by diarrhea

– presence of lesions in the anal area

– existence of similar cases in the family

– inflammation of the joints, eyes or skin, individually or simultaneously

A first clinical examination in the form of an abdominal palpation will show a distention or a mass, usually in the lower right part of the abdomen.

Then the doctor will perform biological (blood) tests to look for signs that confirm inflammation. In case of inflammation, biological tests may show an increase in the number of white blood cells, a reduction in the level of albumin or anemia.

After that, a colonoscopy will be performed to examine the condition of the colon through a rectal probe. When only the small intestine is affected (in most cases), a normal colonoscopy will be performed, on the other hand, when the colon is affected, Crohn’s disease will be diagnosed from X-rays, after ingestion of barium, which allows to highlight the characteristic features of the disease: thickening and ulcerations of the intestinal wall.

Disease-specific biomarkers
Researchers primarily from the Mayo Clinic in Arizona have identified several molecules called biomarkers, which are unique indicators found only in patients with Crohn’s disease. In their widespread press release in March 2017, the scientists estimated that a set of biomarkers may be able to successfully diagnose this disease and not a single biomarker.

Complications

Crohn’s disease is an inflammation of the digestive tract, therefore, its main complications are intestinal occlusion and the appearance of abscess and digestive fistulas.

In principle, in a healthy person, the intestinal organs are well defined. In the case of Crohn’s disease, when fistulas appear, they can connect different organs of the abdomen, thus, two distant parts of the intestine can communicate, or the intestine and the bladder, or even the intestine and the skin, with a greater frequency in the perianal region. Fistulas can be found frequently and much more rarely can perforations be found, which are more serious. One third of the complications occur in the perianal region, such as the appearance of fistulas and fissures that increase pain during defecation.

Rectal bleeding can occur when the disease attacks the colon and this can increase the risk of colon cancer.

Although Crohn’s disease reduces patients’ quality of life, it only gets in the way while it is occurring. We talk about side effects because it increases the risk of cancer in the digestive region, which can cause the death of the patient.

In case of crises it is possible to find inflammation in other parts of the body:

– inflammation of the white of the eye

– joint inflammation

– canker sores (ulcerations of the oral mucosa)

– erythema nodosum, skin inflammation of the arms and legs

Even when there are no crises, inflammatory complications can appear with the following possible consequences:

– a uveitis (inflammation of the eye)

– a sacroiliitis (inflammation of the pelvic joints)

– an inflammation of the bile ducts

We also note that the disease can be aggravated by the malfunction of certain organs such as:

– the renal pathways (urinary infections, renal lithiasis)

– the digestive tract (in case of poor absorption of food and in the presence of gallstones)

Treatments

Treatment of Crohn’s disease is essentially aimed at relieving symptoms (diarrhea, cramps, abdominal pain) and decreasing inflammation. The doctor will then prescribe corticosteroids and salazosulfapyridine derivatives. To avoid complications he may also eventually prescribe antibiotics.

When this is not enough, immunosuppressants will be administered.

If any complication occurs, such as bleeding, severe fistulas or intestinal obstruction and in case of lack of response to drug treatment, surgery will be performed.

To reduce symptoms, the following medications will be prescribed:

– antidiarrheals such as loperamide, which relieve abdominal pain

– nervous system anticholinergics, which reduce abdominal cramps and therefore pain.

– codeine and tincture of opium, which relieve severe pain and have an anti-diarrheal effect

– methylcellulose and psyllium preparations, which harden the stool and help prevent anal irritation.

To reduce inflammation, derivatives of salazosulfapyridine, such as sulfasalazine, mesalamine, olsalazine and balsalazide, will be indicated. These drugs act on inflammation and control symptoms, especially in the colon region, but they are ineffective in case of crises (severe outbreaks of the disease).
Corticosteroids will be effective against diarrhea, fever and abdominal pain. They will be used orally in high doses to control inflammation. As always in corticosteroid therapy, doses are gradually reduced until treatment is discontinued. The medicine that will be prescribed is prednisone. In the long term, corticosteroid therapy can have side effects, so a new type of cortisone may be indicated, budenoside ., which causes fewer side effects but is less effective than prednisone.

The disease progresses through outbreaks and when these are severe, it will be necessary to hospitalize the patient so that he can receive corticosteroids intravenously. The patient may experience serious rectal bleeding that will warrant some blood transfusions. A large loss of blood can trigger anemia, which should be treated with iron supplementation, orally.

The use of immunosuppressants (azathioprine and mercaptopurine) is justified when the different drugs mentioned above do not have an effect on the disease. They act on the immune system, allowing longer periods of remission and therefore improving the general condition of patients. However, its effectiveness takes time to happen, it will take two to four months to see the first benefits. Furthermore, they can cause serious side effects such as allergies. therefore, in case of treatment with immunosuppressants, it will be necessary to control:

– the level of pancreatic enzymes

– white blood cell count

Other immunomodulatory drugs will be used in case of intolerance to corticoids, azathioprine or mercaptopurine, such as injectable methotrexate or infliximab. We note that the infusions are effective but the effect is brief and this implies maintaining other treatments between injections.

Complementary treatments such as antibiotics will often be prescribed to treat bacterial complications. In general, the doctor will prescribe metronidazole to treat abscesses and fistulas, reduce diarrhea and intestinal cramps. Metronidazole can, however, have side effects if used for a long time. It can cause tingling in the region of the limbs, injuring the nerve fibers. However, there are alternatives to this antibiotic, such as ciprofloxacin or levofloxacin, associated or not with metronidazole.

conventional surgery

Surgery may be used, but only when other treatments have failed or in case of complications, especially during a bowel obstruction, fistulas or major abscesses. The surgery involves removing part of the digestive system, including the intestines. Ask your doctor for up-to-date information.

Remember that removing diseased parts of the intestine does not prevent Crohn’s disease from returning in other parts of the digestive tract. However, surgery improves the condition of patients as the symptoms are greatly reduced. A second procedure is often necessary.

According to the Mayo Clinic , up to about 50% of patients with Crohn’s disease need at least one surgery. In the long run, the benefits of surgery tend not to last.

Peripheral stem cell transplantation for severe Crohn’s disease

In recent years, in very advanced cases of Crohn’s disease, especially when conventional medications are ineffective, a new surgical technique has been used mainly in Europe and North America, which is a surgical method of cell-transplantation. hematopoietic stem cells (cells that give rise to all other blood cells).

This technique involves removing hematopoietic stem cells from the patient’s own bone marrow. These cells are then exposed to immunosuppressive drugs, in high doses, to be “cleaned”. These cells are then reimplanted in the body. The idea is to act on the immune system.

In Brazil, this surgery was performed by doctors from the Beneficência Portuguesa Hospital of São José do Rio Preto (SP) on a patient with Crohn’s disease in an advanced stage and with no satisfactory response to conventional treatments, as reported by the newspaper Folha de S. Paulo on 15 of May 2014.

Herbal medicine

Turmeric , consumed in the form of curcumin powder in a serving of 1 to 2 g per day, appears to reduce the symptoms of Crohn’s Disease and reduce inflammation in general.

Tips

– Doctors recommend that patients adopt diets before or as a complement to a surgical intervention. These diets are interesting in cases of intestinal occlusion or fistulas in children, as they allow their growth to be maintained. In adults, parenteral nutrition will be prescribed in case of poor absorption of food.

– As the contraceptive pill can be a triggering factor for the disease (see below under Causes) in women with a family history of Crohn’s disease, it would be advisable not to use the pill as a contraceptive method.

Prevention

– In general, during chronic inflammatory bowel disease (CIBD) such as Crohn’s disease, experts recommend limiting the consumption of dairy products. Dairy products can cause diarrhea and abdominal pain.

– In case of Crohn’s disease of the small intestine, avoid eating certain foods high in fat, such as butter, margarine and fried foods.

– Drink lots of water if possible. Avoid gaseous products that lead to bloating.

– Eat in small portions, for example, 5 to 6 meals a day instead of 2 or 3.

– Avoid some caffeine-rich foods and spicy foods.

– Limit alcohol.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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