What happens in the intestines
In people with a genetic predisposition, the immune system does not respond correctly to its own intestinal microflora. Chronic inflammation occurs, which penetrates all layers of the intestinal wall. The affected areas alternate with healthy ones, the wall thickens, and longitudinal ulcers form on the mucosa, giving it the appearance of a “cobblestone street.” Deep inflammation can “grow” outwards - this is how fistulas are formed between the loops of the intestine, with the bladder or skin, and abscesses.
- Ileitis - damage to the final section of the small intestine
- Ileocolitis - small and large intestine
- Crohn's colitis - colon only
- Perianal form - fistulas and abscesses near the anus
- Rarely - damage to the esophagus, stomach and oral cavity
Causes and risk factors
The exact reason is unknown. It is believed that the disease occurs due to a combination of hereditary predisposition, impaired immune response, changes in intestinal microflora and external factors. Most often, the disease begins at the age of 15–35 years, although it occurs in both children and the elderly.
- Smoking is one of the most significant factors that worsens the course of
- Inflammatory bowel disease in close relatives
- Frequent use of antibiotics in childhood
- Long-term use of NSAIDs can provoke exacerbations
Symptoms
Manifestations depend on the location of inflammation. The disease is often mistaken for a long time for irritable bowel syndrome, appendicitis or an intestinal infection. In addition to the intestines, Crohn's disease can cause damage to the joints, skin, eyes and liver.
- Recurrent abdominal pain, usually lower right
- Chronic diarrhea, sometimes bloody
- Weight loss, loss of appetite, weakness
- Low-grade fever
- Fissures, fistulas and abscesses in the anus
- Joint pain, erythema nodosum, eye inflammation
Diagnostics
The diagnosis is made based on a combination of data. The key method is ileocolonoscopy with examination of the final section of the small intestine and biopsy of several areas. MRI or CT enterography and capsule endoscopy are used to evaluate the small intestine where the colonoscope is insufficient. Fecal calprotectin helps distinguish inflammation from functional impairment and monitor disease activity. Be sure to exclude intestinal infections, including intestinal tuberculosis.
- Ileocolonoscopy with biopsy
- Fecal calprotectin
- MRI enterography, MRI of the pelvis for fistulas
- Complete blood count, CRP, albumin, iron, vitamin B12
- Stool tests for infections and Clostridioides difficile
Treatment and prevention of exacerbations
The goal of treatment is not only to remove symptoms, but also to achieve healing of the mucous membrane. Glucocorticoids are used to induce remission, and immunosuppressants and genetically engineered biological drugs are used to maintain it, the choice of which depends on the form and severity of the disease. In case of complications - narrowing of the intestine, fistulas, abscesses - surgical intervention may be required, while trying to maintain the maximum possible length of the intestine. Treatment is prescribed and monitored only by a gastroenterologist: independent withdrawal of drugs often leads to severe exacerbation.
- Complete smoking cessation
- Regular visits to a gastroenterologist and calprotectin monitoring
- Balanced diet, in case of contractions - a gentle diet
- Vaccination as recommended by a physician before immunosuppressive therapy
- Do not take NSAIDs without consulting your doctor