CROHN'S DISEASE

Crohn's disease - a chronic nonspecific progressive trans-muralnoe granulomatous inflammation

of the digestive tract.

More often affects the terminal division of the small intestine, so there are synonyms of the
disease as "terminal ileitis", "granule-matous ileitis" and others in the pathological process may
be involved every department of the digestive tract from tongue to anus. The frequency of
lesions intestine decreases in the following sequence: terminal ileitis, colitis, ileokolit, rectal
form, etc. Provision has also been the focal, Multifocal and diffuse forms. The course of Crohn's
disease, fluctuating, with exacerbations and remissions.

Crohn's disease detected in children of all age groups. The peak incidence occurs in 13-20
years. Among the diseased ratio of boys and girls 1:1,1.

Etiology and pathogenesis

Etiology and pathogenesis of the disease are unknown. Discuss the role of infection
(mycobacteria, viruses), toxins, food, certain medications, considered as the starting point of
acute inflammation. Great importance attached immunological, dysbiotic, genetic factors. The
connection between the histocompatibility system, HLA and Crohn's disease, in which often
reveal the loci DR1 and DRw5.

Clinical picture

The clinical picture of disease is very varied. The disease onset is usually gradual, over many
years with periodic exacerbations. Possible and acute forms.

The main clinical symptom in children - a persistent diarrhea (up to 10 times a day). The
volume and frequency of stool depends on the level of destruction of the small intestine - than it
is higher, the more often a chair and, consequently, a serious disease. The defeat of the small
intestine is accompanied by a malabsorption syndrome. In the chair periodically appears
admixture of blood.

Abdominal pain - a symptom of a mandatory for all children. The intensity of pain varies from
minor (early disease) to intense cramping associated with food intake and defecation. Any
damage to the stomach, they are accompanied by a feeling of heaviness in the epigastric region,
nausea, vomiting. The later stages of pain is very intense, accompanied by abdominal distention.

Common symptoms: general weakness, weight loss, fever. When the lesion of the small
intestine violated the absorption and metabolism of proteins, carbohydrates, fats, vitamin B |
2, folic acid, electrolytes, iron, magnesium, zinc, etc. hypoproteinemia clinically evident edema
. Characteristic delay of growth and sexual development.
 The most common extraintestinal manifestations of Crohn's disease - arthralgia, monoartrity,
sacroiliac disease, Erythema nodosum, aphthous stomatitis, iridocyclitis, uveitis, episcleritis,
periangiocholitis, cholestasis, vascular disorders.

Complications in Crohn's disease most often associated with the formation of fistulas and
abscesses in various sites, ulcer perforation, peritonitis. Possible intestinal obstruction, acute
toxic dilata-tion of the colon.

Laboratory and instrumental investigations

In general, blood analysis reveal anemia (reduced red blood cells, hemoglobin, n-matokrita),
reticulocytosis, leukocytosis, increased ESR. For biochemical analysis of blood discovered
hypoproteinemia, hypoalbuminemia, hypokalemia, decreased the content of microelements,
increased alkaline phosphatase, os 2-globulin and C-reactive protein. The degree of biochemical
changes correlated with the severity of the disease.

Endoscopic picture in Crohn's disease differs a great polymorphism and depends on the stage
and extent of the inflammatory process. Endoscopically distinguish three phases of the disease:
infiltration, ulcers, fractures, scarring.

In the phase of infiltration (the process is localized in the submucosa), mucous membrane has a
kind of "quilt" with a matte surface,
18-3029

vascular pattern is not visible. In the future, there are erosion type the AFL with some superficial
ulceration and fibrinous overlay.

In the phase of ulcer-cracks reveal single or multiple deep longitudinal ulcer defect affecting
the muscular layer and the intestinal wall. The intersection of cracks attached mucosa form
"cobblestones".Because of significant submucosal edema, and destruction of deep layers of the
intestinal wall intestinal lumen narrows.

In the phase plots reveal an irreversible scarring of the bowel stenosis. The characteristic
radiographic features (research is usually conducted with a double staining) - segmental lesions,
wavy and irregular contours of the intestine. In the colon identify irregularities and ulcerations
on the upper edge of the segment with preservation haustration the bottom. In the stage of ulcers,
cracks - type "cobblestones".

Diagnosis and differential diagnosis

The diagnosis is established on the basis of clinical and anamnestic data and results of
laboratory, instrumental, morphological studies.
The differential diagnosis of Crohn's disease carried out with sharp and protracted intestinal
infections of bacterial and viral etiology, diseases caused by protozoa, worms, syndrome
malabsorb-tion, tumors, ulcerative colitis (Table 15-4), etc.

Table 15-4. Differential diagnosis of inflammatory bowel disease *

Clinical symptom Disease

Crohn's Disease
Ulcerative colitis
Stool with blood Often Rarely
'Pain in stomach Rarely Often
Tenesmus Often None
Stool volume Moderate Excess
The defeat of the rectum Always expressed Rarely
Perianal lesions Rarely Often
Fistulas Rarely Often
Recurrences after surgery No Often

* By Kanshinoy OA, 1999

Treatment

Treatment during acute bed rest, then - gentle. Therapeutic food (table number 4 to Pevsner). The
nature of the diet largely depends on the location and extent of intestinal lesions, the phase of the
disease.

The most effective medicines considered agents 5-aminosalicylic acid (mesalazin),

sulfasalazine. At the same time you should take folic acid and multivitamins with a dose trace
elements in age. In the acute phase of illness and severe complications (anemia, cachexia, lesions
of the joints, erythema, etc.) designate gluco-corticoids (hydrocortisone, prednisolone,
dexamethasone), rarely - immuno-depressants (azathioprine, cyclosporine).

In addition, for the treatment of patients with Crohn's disease used a broad spectrum antibiotic,
metronidazole, probiotics, enzymes (pancreatin), chelators [diosmektit (smectic)], Antidiarrheal
medication (eg loperamide), symptomatic agents. At serious disease with the development of
hypoproteinemia, electrolyte imbalance of intravenous infusion of solutions of amino acids,
albumin, plasma electrolytes.According to testimony spend surgical treatment - removal of the
affected departments ulcer, excision of fistulas, fistulization to restore patency.

Prevention

Prevention provides a rational, fully appropriate to the age and individual abilities
gastrointestinal nutrition, prevention and consistent treatment of acute intestinal disease,
parasites and other pathologies of all parts of the digestive system.
Forecast

Forecast for recovery is poor for life - depends on the severity of illness, the nature of its flow,
the presence of complications. Perhaps the achievement of long-term clinical remission.