Dr. Ertan Beyatlı

Current Approach to Crohn's Disease

(Update: ) - Digestive System Diseases

This disease, which is pronounced as Kron in Turkish, is called "in Latin".Crohn's diseaseThat is known as Crohn's Disease. It manifests itself with pain, especially in the lower right corner of the abdomen.

The name of this disease was first reported in 1932. Burrill Crohn and by friends chronic inflammatory ileum disease Announced with his published studies about him and passed to the medical literature.

What is CROHN Disease?

CROHN Disease (CH)digestive system from the lips to the anal ring It is a full-thickness chronic inflammatory disease that can affect any area. 

It is mostly seen in North America and Northern European countries. It occurs in 100.000 out of 5 people each year. Especially in the last 40 years, there has been an increase in the number of cases.

It is more common in women than in men, especially between the ages of 25-40. The second peak period of the disease is in the 70s. CROHN Disease specifically Ashkenazi Jew common in communities.

Causes

The reasons for CH are not yet fully although unknown The complex interplay of (ideopathic) genetic and environmental factors is thought to play a role. Although there are many similar features between CROHN Disease and chronic infection, no causative organism has been shown to date.

Mycobacterium paratuberculosis caused by infection and seen in cattle Johne disease It is thought that there are similar crops with. Consumption of refined foods, smoking, genetic predisposition (NOD2 / CARD15, identical twins)

Pathology and Pathogenesis

It is thought to be due to the stimulation of cell-mediated inflammatory response by the passage of luminal antigens as a result of increased mucosal permeability. This situation has been shown to be due to the release of proinflammatory cytokines (IL2 interleukin 2, TNF tumor necrotizing factor) that cause local and systemic inflammatory responses. This mechanism has been suggested to be due to a defect in suppressor T cells.

What is a terminal ileum?

The terminal ileum is the last part of the small intestine. Its length is 3-4 cm. The ileocecal sphincter is located at the tip of the terminal ileum. The small intestine is connected to the colon (cecum) via this sphincter.

What is terminal ileum?

Of cases At 60% terminal ileum involvement (alone or with other colon involvement) is present. Alone in 30% of cases colitisproximal small bowel involvement is seen in the rest.

Macroscopically, fibrotic thickening and lumen stenosis in the affected bowel wall and linear or snake-like ulcerative lesions are observed in the mucosa. Due to the edema of the mucosa between the ulcers cobblestone view (cobblestone appearance) attracts attention.

Transmural inflammation (full-thickness involvement) is the key feature of this disease and causes adhesions between the bowel and fistula formation. The unaffected parts of the intestines appear completely normal (skipping lesions = skip lesions)

Symptoms

Clinical findings vary according to the model of the disease. Very rarely Appendicitisor may be similar to small bowel perforation and peritonitis. Sometimes there are signs of colitis.

However, the most important situation in CROHN Disease chronic (chronic). For example, prolonged mild diarrhea (diarrhea), with occasional cramping abdominal painspain and fullness, especially felt in the lower right abdominal corner. Intermittent fever, secondary anemia, and weight loss are common symptoms. Painless ulcers and blue skin spots can be seen in the rectal area.

Growth retardation and sexual development disorder can be seen in children who have the disease before adolescence.

In advanced cases, complications due to the disease may occur, such as adhesions between the intestines, fissures, fistulas and abscess formation.

Other findings: Joint pain, arthritis, Eye inflammations (uveitis, iritis), Skin inflammations (Erythema nodosum, Pyoderma gangraenosum), mouth sores and abscess (aphthae), Amyloidosis, Gallstones, kidney stones, Bowel cancer risk, Intestinal bleeding, Osteoporosis or osteoclasis (osteopenia), Sacroiliitis.

Differences between CROHN Disease (CD) Ulcerative Colitis (UC)

CROHN Disease and Ulcerative Colitis
CROHN Disease and Ulcerative Colitis

Distinguishing CROHN Disease from ulcerative colitis can be quite difficult, and in some cases impossible.

  • Ulcerative colitis affects the colon; Crohn's disease can affect any part of the gastrointestinal tract, but especially the small and large intestine.
  • UC affects the intestinal mucosa, CH affects the full thickness of the intestinal wall.
  • UC creates ulcerative lesions that merge in the colon and rectum, while CH is characterized by skip lesions.
  • CH more commonly causes stricture and fistulization.
  • Granulomas can be seen in the histology of CH
  • CH is often associated with perianal disease
  • CH can affect the terminal ileum, causing symptoms similar to appendicitis.
  • Colon and rectum resection treats patients with UC, recurrence after resection is common in CD.

Diagnosis and Treatment

The following techniques can be used at the diagnosis stage in line with the clinical findings of the disease:

CROHN Disease - Cantor and the 'string' sign
CROHN Disease - Kantor and 'string' sign seen on the small bowel passage graph

Some other illnesses may also show Crohn's disease-like symptoms:

  • Appendicitis
  • Diverticulum
  • Yersinia Enterocolitica infections
  • Intestinal tuberculosis
  • Dysentery
  • Other infectious colitis such as salmonellosis
  • Food allergies and other allergies can, in extreme cases, cause chronic inflammation in different parts of the digestive system and cause symptoms similar to Crohn's disease.

Principles in the Treatment of CROHN Disease

  • Close contact between the physician (Internal Medicine Specialist, Gastroenterology) and the surgeon is very important.
  • Medical treatment should always be the first and long-term option. Of course, surgery can be applied when necessary, but there should be a clear justification for this, for example, complication.
  • Preoperative patients should be prepared very well and in an optimized way, preoperative total parenteral nutrition may be required.
  • CROHN Disease is a chronic and frequently recurring disease, the length of the intestine, its continuity and sphincter mechanisms should be preserved as much as possible in terms of the possibility of subsequent operations.

Since the causes of CROHN Disease are unknown, there is no complete cure yet. Minimizing the symptoms and complaints during the aggravation periods of the disease and treatment if possible; after this has been achieved of remission Extending it as much as possible is the current treatment method.

Usually a kind of persecution steroid hormone glucocorticoids or other cortisone, salicylazosulfapyridine or 5-aminosalicylic acid Used in conjunction with. Negligence of oral calcium supplements in long-term corticosteroid use can cause serious osteoporosis. If prolonging the remission Azathioprine It is provided with immunosuppressive drugs such as. Folic acid support should not be neglected during the use of Azathioprin.

These drugs may have unwanted side effects in some cases, and these need to be checked frequently by a doctor, especially at the beginning.

When should the surgery be done?

It should not be forgotten that surgical resection does not cure CROHN's disease, so surgical intervention should be performed and focused on the causes, that is, it should focus on the complications of the disease. An aggressive physician and a conservative surgeon are very important for ideal treatment.

The complications are:

  • Recurrent bowel obstruction
  • bleeding (haemorrhage)
  • perforation
  • Failure of medical treatment
  • Intestinal fistula
  • fulminant colitis
  • Malignant change (possibility of cancer)
  • Perianal disease (rectal ulcer, Anal Fistula, Anal abscess, etc.)
Stricturoplasty
Stricturoplasty

A wide range of surgical methods can be applied as open or closed (laparoscopic) in CROHN Disease.

The most common surgical operations are as follows:

  • ileocecal resection
  • segmental resection
  • Colectomy and ileorectal anastomosis
  • Subtotal colectomy and ileostomy
  • Temporary loop (loop) ileostomy
  • proctocolectomy
  • Stricturoplasty
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