Crohn’s disease: ulcerative colitis

Crohn’s disease got its name after a gastroenterologist from America, Barril Bernard Crohn, who first described it at a meeting of doctors. This happened as much as 85 years ago. Crohn’s disease is an inflammation of the wall of the entire digestive tract from the esophagus to the colon, although the lower parts of the small and large intestine are most often affected. Young women get sick more often.

Signs of Crohn’s disease: loose stools, ulcers, blood in the stool

What are the signs of Crohn’s disease? To begin with, we will describe the typical appearance of the patient — this is a thin, exhausted person. What makes it so is the poor digestibility of food, because with Crohn’s disease, the intestinal villi that we need to absorb food are destroyed, and there is constant diarrhea two or three times a day. There is blood in the feces. The patient also complains of severe abdominal pain, fever, weakness, and noticeably loses weight. In addition, Crohn’s disease can cause complications to the joints, eyes, skin, liver.

In healthy people, up to 9 liters of semi-liquid contents enter the large intestine from the upper parts of the digestive system. And feces contain only 150 ml per day. This means that all the rest of the water is absorbed by the large intestine back into the blood. A typical sign of Crohn’s disease is ulcers in the intestinal wall. The latter no longer performs its function of absorbing water, so the patient begins to have severe diarrhea. Blood enters the feces from open ulcers.

Ulcerative colitis has similar symptoms, but, unlike Crohn’s disease, in this case only the colon and only the superficial mucous layer suffer. In Crohn’s disease, the wall of the digestive tract is damaged to its full thickness. And, if we are talking about the intestine, then at the site of ulcers, its wall sometimes breaks through, which can lead to a serious complication — peritonitis, and sometimes through passages — fistulas form between the loops of the intestine.

Fistulas can go outside, to the skin in the anus, can lead to the bladder cavity. And women often form fistulas between the intestines and the vagina. Accordingly, the already mentioned signs of Crohn’s disease are supplemented by the release of intestinal contents onto the skin or from the vagina and bladder. This, in turn, leads to irritation of the skin and mucous membranes, pain. According to doctors, Crohn’s disease often exhausts a person so much that he becomes depressed.

Causes of Crohn’s disease: breakdown of immunity

We have described the signs of chronic intestinal inflammation that develops in Crohn’s disease, but so far we have not touched on the causes of this condition. Crohn’s disease is an autoimmune disease. That is, it occurs when the immune system ceases to recognize normal, healthy intestinal cells, considers them alien and seeks to destroy them.

For a person, this turns into the signs of Crohn’s disease described above. Nobody knows what makes the immune system turn against its own tissues. Infections, including chronic infectious foci such as tonsillitis or sinusitis, may play a role. The role of genetic predisposition is not excluded. One way or another, the therapy of Crohn’s disease will be based on the fight against antibodies against the cells of the digestive tract, which are produced by the “broken” immune system.

Treatment: fighting antibodies and diarrhea

Until recently, it was believed that Crohn’s disease was incurable, but today there are drugs that block antibodies against their own tissues. However, in the acute period of the disease, symptomatic agents are used, such as glucocorticoids (for example, prednisone). They help to relieve an acute attack of Crohn’s disease, but they cannot be taken for a long time because of pronounced side effects. Therefore, after the acute attack is eliminated, the patient is prescribed immunosuppressants, for example, 6-mercaptopurine or azathioprine.

If this treatment does not help, then resort to monoclonal antibody preparations, which were mentioned above. An example of such a drug is infliximab, although it is somewhat outdated — currently there are more modern and powerful drugs of this group that give fewer side effects. In mild cases, mesalazine is sufficient, which refers to non-specific anti-inflammatory drugs. Operations are performed for fistulas and abscesses.

When parasites are treated

We will also describe another — not yet approved, but actively studied method of treatment of Crohn’s disease. It all started with an observation: in African countries, where a significant part of the population is infected with parasitic worms, autoimmune intestinal diseases are almost not found. And then the doctors decided to try to give people eggs of whipworm pigs, which usually do not live in humans in the body, but are quite capable of “fooling” the immune system. When helminths settle in the intestines, the immune system is distracted by them and does not touch its own cells and tissues anymore. The method is very attractive, and its study is now continuing.

Diagnosis of Crohn’s disease: colonoscopy

The danger of Crohn’s disease, in addition to complications (and fistulas, especially between the loops of the intestine, are very difficult to treat), is that it predisposes to colon cancer. Therefore, if a person has been ill for 8-10 years, it is advisable to do colonoscopies regularly so as not to miss cancer in the early stages.

During a colonoscopy, you can do a biopsy — take a piece of the intestinal wall and send it for histological examination. As already mentioned, with Crohn’s disease, the villi of the intestine are damaged, the mucous membrane is exposed, which looks like a cobblestone pavement. This is a diagnostic sign of Crohn’s disease. By the way, the normal mucosa is smooth, shiny, pale pink in color.

By the way, about the research methods: nowadays, the so-called capsule colonoscopy is already used, when the patient swallows a capsule, inside which there is a miniature video camera. As you move along the digestive tract, this camera takes pictures, which allows doctors to then study in detail the mucosa of all departments — from the esophagus to the rectum.

Diet for Crohn’s disease: the opposite is true

A large role in the treatment belongs to a specific diet for Crohn’s disease. It is forbidden to eat food that irritates the intestines, namely food containing coarse fibers, fiber. And there is a lot of fiber in vegetables, fruits, legumes, greens, cereals — those products that are usually recommended for a healthy diet. Food should be easily digested and rich in vitamins and minerals, which the body loses with frequent diarrhea. You can also not eat pasta, spices, sauces and snacks, spicy food, drink alcoholic beverages.

The diet for Crohn’s disease determines the course and outcome of the disease. And just coarse, fibrous food injures the already damaged mucous membrane, which increases the pain. And what does the diet allow for Crohn’s disease? It is allowed to eat meat, fish, all flour and sweet, which, with the thinness of patients, is only good for them. In addition, red meat is rich in iron and vitamin B12. Well-boiled cereals, mashed soups, a little dairy products — cottage cheese, kefir, milk, sour cream, omelette and boiled eggs are also welcome, and tea and juices diluted with water are used as a drink.

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