Crohn's disease

Crohn's disease
Crohn's Disease ! Diarrhea , abdominal pain and intestinal cramps , blood in the stool , ulcers , weight loss and decreased food ... There may be fever , fatigue , arthritis , eye inflammation , skin disorders , inflammation of the bile duct , slow development .

definition



Crohn's disease is an inflammatory bowel disease ( IBD ) . It causes inflammation of the lining of the digestive tract , which can lead to abdominal pain , diarrhea and even severe malnutrition .

The inflammation caused by Crohn's disease often spreads deep into the layers of affected bowel tissue . Like ulcerative colitis , a common IBD , Crohn's disease can be both painful and debilitating and sometimes may lead to life-threatening complications .

While there is no known medical cure for Crohn's disease , therapies can greatly reduce the signs and symptoms of Crohn's disease and even bring about long-term remission . With treatment , many people with Crohn's disease may work well .

Symptoms

The signs and symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly without warning . There may also be a period when there are no signs or symptoms ( remission ) . When the disease is active , signs and symptoms may include :

Diarrhea . The inflammation occurs in Crohn's disease causes the cells in the affected area of the gut to secrete large amounts of water and salt . Because the colon can not completely absorb this excess fluid , developed diarrhea . Enhanced intestinal spasms can also contribute to loose stools . Diarrhea is the most common problem for people with Crohn's .

Abdominal pain and intestinal spasms . Inflammation and ulceration may cause a portion of the intestines to swell and eventually thicken with scar tissue . This affects the normal movement of components through the digestive tract and can lead to pain and spasm . Crohn's disease usually causes mild intestinal discomfort mild to moderate , but in many more cases - severe pain can be severe and include nausea and vomiting .

Blood in the stool . Food moves through the digestive tract can cause inflamed tissue to bleed , or intestinal bleeding can . There may notice bright red blood in the toilet bowl or darker blood mixed with the stool. There may be no visible bleeding .

Ulcers . Crohn's can cause sores on the surface of the small intestine that eventually become large ulcers penetrate deep and sometimes perforation of the intestinal tract . There may also be similar sores in the mouth .

Reduced appetite and weight loss . Abdominal pain and cramping and the inflammatory response in the walls of the gut can influence both appetite and digestion and absorption of food .

Signs and symptoms

People with severe Crohn's disease may also experience :

Fever .

Tired .

Arthritis .

Inflammation of the eye .

Skin disorders .

Inflammation of the liver or bile ducts .

Or retarded sexual development in children .

See your doctor if you have a habit of constant change in bowel or if there are any signs and symptoms of Crohn's disease , such as :

Abdominal pain .

Blood in the stool .

Being bouts of diarrhea that do not respond to prescription drugs ( OTC ) .

Unexplained fever lasting more than a day or two .

cause

The exact cause of Crohn's disease is still unknown . Previously, diet and stress have doubts , but doctors now know that although these factors may aggravate existing Crohn's disease , but does not cause it . Now, researchers believe that a number of factors , such as heredity and a malfunctioning immune system , play a role in the development of Crohn's disease .

The immune system . It could be a virus or bacteria may cause Crohn's disease . When the immune system tries to fight the invading microorganism , the digestive tract becomes inflamed . Currently, many investigators believe that some people with the disease develop because of an abnormal immune response to bacteria normally live in the intestines .

Heredity . Mutations in a gene called NOD2 tend to occur frequently in people with Crohn's disease and apparently associated with a higher likelihood for surgical patients . Scientists continue to search for other gene mutations may play a role in Crohn's disease .

Risk Factors

The risk factors for Crohn's disease may include :

Age . Crohn's disease can occur at any age , but are likely to develop the condition at a young age . Most people are diagnosed Crohn aged 20 and 30 .

Ethnicity . Although whites have the highest risk of the disease, it can affect any nation . If the Jewish people , the risk is even higher .

Family history . Are at higher risk if a close relative , like a parent, sibling or child with the disease . Up to 1 in 5 people with Crohn's disease have a family member with the disease .

Smokers . Smoking is an important risk factor for developing most control Crohn's disease . Smoking also leads to more severe disease and greater risk of surgery . If you stop smoking . Discuss this with your doctor and get help. There are many smoking cessation programs available if you can not quit on my own .

Habitat . If you live in an urban area or in an industrialized country , are more likely to develop Crohn's disease . Because Crohn's disease occurs more frequently among those who live in cities and industrialized countries , it could be environmental factors , including a diet rich in fat or refined foods plays role in Crohn's disease . People who live in northern climates also seem to have a greater risk of disease .

Using Isotretinoin . Isotretinoin ( Accutane ) is a powerful medication sometimes used to treat scarring cystic acne or acne that does not respond to other treatment . Although cause and effect has not been proven , studies have reported the development of inflammatory bowel disease with the use of isotretinoin .

Nonsteroidal anti-inflammatory drugs ( NSAIDs ) . Although these drugs - ibuprofen , naproxen , diclofenac , piroxicam and other drugs have not been shown to cause Crohn's disease , it can cause signs and symptoms similar . In addition, drugs can make Crohn's disease worse now .

Complications

Crohn's can lead to one or more of the following complications :

Intestinal obstruction . Crohn's affects the entire thickness of the bowel . Over time , parts of the bowel can thicken and narrow , can block the digestive flow through the affected part of the bowel . Some cases require surgery to remove part of the bowel disease .

Ulcers . Chronic inflammation can lead to ulcers anywhere in the gastrointestinal tract , including the mouth and anus and genital area .

Red line ( fistulas ) . Sometimes ulcers can extend completely through the gut into creating a fistula - an abnormal connection between different parts of the intestinal tract , between the intestines and skin , or between the intestine and other organs , such as bladder or vagina . When internal fistulas develop , food may be through areas of the intestine . An external leak can cause the drainage system to the skin constantly , and in some cases , a fistula can become inflamed and infected forming abscesses, a problem that could threaten life if left untreated .

Anal fissure . This is a crack or opening in the anus or the skin around the anus where infection can occur . It is usually accompanied by painful bowel movements .

Malnutrition . Diarrhea , abdominal pain and spasms can cause difficult to eat or intestines absorb enough nutrients to keep nourished . In addition, anemia is common in people with Crohn's disease .

Other health problems . In addition to inflammation and ulcers in the gastrointestinal tract , Crohn's can cause problems in other parts of the body , such as arthritis, inflammation of the eyes or skin , formation of access nails , kidney stones , gallstones and sometimes inflammation of the bile duct . The long with Crohn's disease may also develop osteoporosis .

IBD and colon cancer . Crohn's disease increases the risk of colon cancer . Despite this increased risk , more than 90 percent of people with inflammatory bowel disease never develop cancer .

The biggest risk is if you have inflammatory bowel disease for at least eight years and if it has spread through the entire colon . Had the disease and the affected area is greater than , the bigger the risk of colon cancer . The risk of cancer is increased in other cancers including anal .

Medications and cancer risk . It inhibits the immune system is associated with a risk of developing cancer . These include azathioprine , mercaptopurine , methotrexate , infliximab and others. The risk may be due to the suppression of the immune system these drugs cause . While these drugs increase the risk, it may be necessary for people with Crohn's disease to improve their quality of life and avoid surgery or hospitalization . Work with your doctor to determine which medication is right for .

Tests and diagnosis

Your doctor will be able to diagnose Crohn's disease only after exclusion of other possible causes signs and symptoms , including irritable bowel syndrome ( IBS ) , diverticulitis and colon cancer . To help confirm the diagnosis of Crohn's disease can have one or more tests and procedures the following :

Blood tests . Your doctor may recommend a blood test to check for anemia - a condition in which there are not enough red blood cells carry oxygen to the full size or to check for signs of infection . Two tests for the presence of certain antibodies can sometimes help diagnose the type of inflammatory bowel disease , but not all people with Crohn's disease or ulcerative colitis also have antibodies . While doctors can order these tests , a positive detection does not mean that there are Crohn's disease and a negative search does not mean that there is no disease .

Find fecal occult blood ( FOBT ) . It may be necessary to provide a stool sample to the doctor can test blood in the stool .

Colonoscopy . This test allows the doctor to view the entire colon using a tube with a camera attached. During the procedure , your doctor may take a small tissue sample ( biopsy ) for laboratory analysis , which can help confirm the diagnosis . Some people have clusters of inflammatory cells called granulomas , which helps to confirm the diagnosis of Crohn's disease because granulomas do not occur with ulcerative colitis . In the majority of those who are not present and Crohn's granulomatosis is diagnosed through a biopsy done and the location of the disease . The risk of colonoscopy include perforation and bleeding colon .

Sigmoid colonoscopy ( sigmoidoscopy ) . In this procedure , the doctor uses a tube to examine the sigmoid morning , the last section of the large intestine .

Barium enema . This test allows the doctor to diagnose colon evaluation with X - ray . Before the test , getting a enema with a contrast dye containing barium . Sometimes , the air is also added . The barium dye Ruo lining , creating a silhouette of the rectum , colon and small intestine partially displayed on a X - ray .

Image intestine . This test looks at a part of the small intestine that can not be seen by endoscopy . After drinking a liquid containing barium , image collection X - ray , CT or MRI of the small intestine . The test can help locate areas of narrowing or inflammation in the small intestine seen in Crohn's disease . The test can also help your doctor determine what type of inflammatory bowel disease .

Computerized tomography ( CT ) . Sometimes there may be a CT scan , a technique of X - ray special offer more details an X - ray standard . This test looks at the entire intestine as well as in tissues outside the intestine can not be seen by other tests . Your doctor may order this scan to better understand the location and extent of disease or to check for complications such as partial obstruction , abscess or red line . Although non-invasive , a CT scan showed multiple radiation than a conventional X-ray .

Capsule endoscopy . If signs and symptoms suggestive of Crohn's disease , but other diagnostic tests are negative , the doctor may perform capsule endoscopy . For this test to swallow a capsule has a camera in it . The camera images are transferred to a computer on the belt . The images are then downloaded, displayed on the screen and check for signs of Crohn's disease . Having made ​​the trip through the digestive system , and exits through the camera body painlessly in the stool . Capsule endoscopy is generally very safe , but if there is a partial blockage in the intestine , there is a little chance may become lodged in the intestines .

Treatments and drugs

The goal of treatment is to reduce inflammation that causes signs and symptoms . In the best cases , this can lead not only to symptom relief but also to long-term remission . Treatment for Crohn's disease usually involves drug therapy or , in some cases surgery .

Doctors use several drugs to control inflammation . But drugs that work well for some people may not work for others , so it may take time to find a drug . In addition, because some drugs have serious side effects , will need to weigh the benefits and risks of treatment .

Anti-inflammatory medications

Anti-inflammatory medications are often the first step in the treatment of inflammatory bowel disease . These include :

Sulfasalazine . Although these drugs are not always effective for treating Crohn's disease , it may be of some help for the treatment of colon related diseases . It has some side effects including nausea, vomiting , heartburn and headache . Do not use this medication if you are allergic to sulfa drugs .

Mesalamine . This medication tends to have fewer side effects than sulfasalazine , but can cause nausea , vomiting , heartburn , diarrhea , and headache . Use it in tablet form or use it in the form of an enema or suppository depending on the part of the large intestine is affected . It is not often effective for diseases involving the small intestine .

Corticosteroids . Corticosteroids can help reduce inflammation anywhere in the body , but it has many side effects , including a puffy face , excessive hair , night sweats , insomnia and hyperactivity . More serious side effects include high blood pressure , type 2 diabetes , osteoporosis , bone fractures , cataracts and increased susceptibility to infection . Long-term use of corticosteroids in children can lead to stunted growth .

In addition, these drugs do not work for everyone with Crohn's disease . Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that does not respond to other treatment . A newer type of corticosteroid , budesonide , works much faster than traditional steroids and appears to fewer side effects . Entocort EC is effective only in Crohn's disease as related to the first part of the small intestine and colon .

Corticosteroids should not be used long term . But it can be used for short -term ( 3-4 months ) and to improve the symptoms relieved. Corticosteroids can also be used with an inhibited immune system - the corticosteroids can cause remission while inhibiting the immune system may help maintain remission .

Sometimes your doctor may prescribe steroids if rectal disease in low rectal colon . This is only for short term use .

Inhibition of the immune system

These drugs also reduce inflammation , but target the immune system rather than directly treating arthritis . By suppressing the immune response , inflammation is reduced . Immunosuppressive drugs include:

Azathioprine and mercaptopurine . These are immune widely used to treat inflammatory bowel disease . Although it may take 2-4 months for the drug to start working , it helps reduce the signs and symptoms of IBD in general and that road can heal from Crohn's disease in particular . If you are taking one of these drugs , will need to track closely with your doctor and have regular blood tests to look for side effects .

Infliximab . This medicine is for adults and children with moderate to severe Crohn's disease do not respond or can not tolerate other treatments . It works by disabling a protein produced by the immune system known as tumor necrosis factor ( TNF ) . TNF infliximab found in the blood and remove it before it causes inflammation in the gut .

Some people with heart failure , those with multiple sclerosis , and those with a history of cancer or cancer can not using infliximab or other types of classes ( adalimumab and certolizumab pegol ) . Talk to your doctor about the potential risks of infliximab . Tuberculosis and other serious infections have been associated with the use of these drugs . If you have an active infection , do not use these drugs . Need to have a skin test for tuberculosis before infliximab and X - ray if living or traveling extensively in the areas of tuberculosis was found . In addition, the Food and Drug Administration issued a warning that children and young people using TNF blockers infliximab increased cancer risk .

Adalimumab . Adalimumab , like infliximab by blocking TNF for people with moderate to severe Crohn's disease . Rules for those who have not been helped by infliximab or other treatments . Supposedly adalimumab subcutaneously every week . Adalimumab may reduce the signs and symptoms of Crohn's disease and can cause disease in remission .

However, adalimumab , infliximab carries a small risk of infection , including tuberculosis and serious fungal infections . Your doctor will run a skin test for tuberculosis before starting adalimumab treatment . The most common side effects of adalimumab are skin irritation and pain at the injection site , nausea , runny nose and upper respiratory infections .

Certolizumab pegol . Approval by the Food and Drug Administration ( FDA ) for the treatment of Crohn's disease , works by certolizumab pegol TNF inhibitors . Certolizumab Pegol prescribed for moderate to severe Crohn people , who have not been helped by other treatments . Initially received certolizumab pegol is an injection every two weeks . After a few times , doctors determine progress and get a dose of a month . Common side effects include headache , upper respiratory infections , abdominal pain , nausea and local reactions . Like other TNF inhibitors , because these drugs affect the immune system , there is also the risk of becoming ill with certain infections , such as tuberculosis .

Methotrexate . This medication is used to treat cancer , psoriasis and rheumatoid arthritis , is sometimes used for people with Crohn's disease who do not respond well to other medicines . It starts to work in about eight weeks or more . Short -term side effects include nausea , fatigue and diarrhea , and rarely it can cause pneumonia likely life threatening . Long-term use can lead to scarring of the liver and sometimes to cancer . Avoid pregnancy while taking methotrexate . If you are taking this medication , track closely with your doctor and have regular blood tests to look for side effects .

Cyclosporin . This powerful drugs , often used to help heal the red line , is usually reserved for those who do not respond well to other medicines . Although effective , cyclosporine has the potential for serious side effects , such as kidney and liver damage , high blood pressure , seizures , fatal infections and increased risk of lymphoma .

Natalizumab . This drug works by inhibiting the molecule certain immune cells - integrins from binding to other cells in the intestinal lining . Blocking these molecules is believed to reduce chronic inflammation occurs when it binds to intestinal cells . Natalizumab is approved for people with moderate to severe Crohn's disease with evidence of inflammation and those who do not respond well to treatments other common Crohn's disease . Rare but dangerous , because the drug is associated with serious multifocal leukoencephalopathy - a brain disease that usually leads to death or severe disability , must be enrolled in a special program distribution limited its use .

New drugs are being developed and clinical trials . If Crohn's disease is not controlled with current medications , ask your doctor if there are clinical trials available .

antibiotics

Antibiotics can heal abscesses that road and in people with Crohn's disease . The researchers believe that antibiotics reduce harmful bacteria in the intestines and prevent the immune system of the gut can cause symptoms . Antibiotics are prescribed include:

Metronidazole . Are the most commonly used antibiotic for Crohn's disease , metronidazole can sometimes cause serious side effects , including numbness and tingling in hands and feet and sometimes painful muscle weakness . If these effects occur , stop medication and call your doctor . Other side effects include nausea , a metallic taste in mouth , headache and loss of appetite . Avoid drinking alcohol while taking this medication .

Ciprofloxacin . This drug improves symptoms in some people with Crohn's disease , now generally preferred to that of metronidazole . Ciprofloxacin can cause nausea , vomiting , headache and rarely tendon problems .

Other drugs

In addition to controlling inflammation , some medications can help reduce the signs and symptoms . Depending on the severity of Crohn's disease , your doctor may recommend one or more of the following :

Anti- diarrhea . Fiber supplements , such as psyllium or methylcellulose powder can help reduce mild to moderate diarrhea . For more severe diarrhea , loperamide can be effective . Use caution to prevent diarrhea and only after consultation with your doctor , because they increase the risk of toxic megacolon , a life-threatening inflammation of the colon .

Laxatives . In some cases, the swelling can cause intestinal narrowing leading to constipation . Talk to your doctor before taking any laxatives , because even the -counter medications - may be too harsh for your system.

Analgesics . For mild pain , your doctor may recommend acetaminophen . Avoid nonsteroidal anti-inflammatory drugs ( NSAIDs ) such as aspirin , ibuprofen or naproxen . This is the ability to make the symptoms worse.

Iron supplements . If you have chronic intestinal bleeding , can develop iron deficiency anemia . The iron supplements can help restore normal iron levels and reduce anemia .

Nutrition . Your doctor may recommend a special diet through a feeding tube or nutrients intravenously for the treatment of Crohn's disease . This can improve overall nutrition and allows the intestines to rest. The remaining intestine can reduce inflammation in the short term . However, when eaten regularly reboot , signs and symptoms may return . Your doctor may use short -term nutritional therapy and combine it with other drugs , such as inhibition of the immune system . Tube feeding is often used to get healthy for surgery or when other drugs do not control symptoms .

Vitamin B - 12 . Vitamin B - 12 to help prevent anemia and promote normal growth and development and is essential for proper nerve function . It is absorbed in the ileum , part of the small intestine often affected by Crohn's disease . If inflamed ileum interference in the ability to absorb this vitamin , may need monthly B - 12 injections . Also need lifelong B - 12 injections if the ileum was removed during surgery .

Calcium and vitamin D supplements . Most people with Crohn's disease need extra calcium supplement with vitamin D. This is due to Crohn's disease and steroid used to treat it can increase the risk of osteoporosis . Ask your doctor if a calcium supplement .

surgery

If diet and lifestyle changes , drug therapy or other treatments to reduce the signs and symptoms , your doctor may recommend surgery to remove the damaged part of the digestive tract or to close the road detector or remove the scar tissue .

In Crohn's disease , surgery may provide the best relief .