Definition
Regional Enteritis, Crohn's disease is defimed as chronic,
granulomatous inflammation of the entire bowel wall and surrounding
mesentery. The terminal ileum and the proximal colon are the most
frequently involved areas. Its incidence ranges from 1 to 5 cases
per 100,000 population. Like in UC, Crohn's disease is more common
in the developed countries of Europe and North America, involving
more frequently whites than other races and without sexual
predominance. It has a bimodal age distribution with peak incidences
between 15 and 25 years and 50 and 80 years. It is more commonly
seen in urban populations and is associated with smoking.
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Radiographic Appearance
Using a barium enarma and or small bowel meal / barium
follow through the radiologisy may demonstrate strictures,
fistula, mucosal cobblestoning, or ulceration of the bowel depending
on the phase, acute or resting of the disease.CTscan,
being used more now than previously, shows changes in the wall of
the entire intestine and can identify complications such as
intestinal obstruction, abscesses, and fistula formation.T he
transmural thickening and ultimate fibrosis of the gut will produce
findings by ultrasound such as the "target sign"; or by CT
the "string sign".
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Pathology
Crohn's disease causes inflammation in the small
intestine. Crohn's disease usually occurs in the lower part of the
small intestine, called the ileum, but it can affect any part of the
digestive tract, from the mouth to the anus. The inflammation
extends deep into the lining of the affected organ. The inflammation
can cause pain and can make the intestines empty frequently,
resulting in diarrhea.
Crohn's disease is an inflammatory bowel disease (IBD), the
general name for diseases that cause inflammation in the intestines.
Crohn's disease can be difficult to diagnose because its symptoms
are similar to other intestinal disorders such as irritable bowel
syndrome and to another type of IBD called ulcerative colitis.
Ulcerative colitis causes inflammation and ulcers in the top layer
of the lining of the large intestine.
Crohn's disease affects men and women equally and seems to run in
some families. About 20 percent of people with Crohn's disease have
a blood relative with some form of IBD, most often a brother or
sister and sometimes a parent or child.
What Causes Crohn's Disease? Theories about what causes
Crohn's disease abound, but none has been proven. The most popular
theory is that the body's immune system reacts to a virus or a
bacterium by causing ongoing inflammation in the intestine.
People with Crohn's disease tend to have abnormalities of the immune
system, but doctors do not know whether these abnormalities are a
cause or result of the disease. Crohn's disease is not caused by
emotional distress.
What Are the Symptoms? The most common symptoms of Crohn's
disease are abdominal pain, often in the lower right area, and
diarrhea. Rectal bleeding, weight loss, and fever may also occur.
Bleeding may be serious and persistent, leading to anemia. Children
with Crohn's disease may suffer delayed development and stunted
growth.
What Are the Complications of Crohn's Disease? The most
common complication is blockage of the intestine. Blockage occurs
because the disease tends to thicken the intestinal wall with
swelling and scar tissue, narrowing the passage. Crohn's disease may
also cause sores, or ulcers, that tunnel through the affected area
into surrounding tissues such as the bladder, vagina, or skin. The
areas around the anus and rectum are often involved. The tunnels,
called fistulas, are a common complication and often become
infected. Sometimes fistulas can be treated with medicine, but in
some cases they may require surgery.
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Treatment:
What Is the Treatment for Crohn's Disease? Treatment for
Crohn's disease depends on the location and severity of disease,
complications, and response to previous treatment. The goals of
treatment are to control inflammation, correct nutritional
deficiencies, and relieve symptoms like abdominal pain, diarrhea,
and rectal bleeding. Treatment may include drugs, nutrition
supplements, surgery, or a combination of these options. At this
time, treatment can help control the disease, but there is no cure.
Some people have long periods of remission, sometimes years, when
they are free of symptoms. However, the disease usually recurs at
various times over a person's lifetime. This changing pattern of the
disease means one cannot always tell when a treatment has helped.
Predicting when a remission may occur or when symptoms will return
is not possible.
Someone with Crohn's disease may need medical care for a long time,
with regular doctor visits to monitor the condition.
Drug Therapy
Most people are first treated with drugs containing mesalamine, a
substance that helps control inflammation. Sulfasalazine is the most
commonly used of these drugs. Patients who do not benefit from it or
who cannot tolerate it may be put on other mesalamine-containing
drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or
Pentasa. Possible side effects of mesalamine preparations include
nausea, vomiting, heartburn, diarrhea, and headache.
Some patients take corticosteroids to control inflammation. These
drugs are the most effective for active Crohn's disease, but they
can cause serious side effects, including greater susceptibility to
infection.
Drugs that suppress the immune system are also used to treat Crohn's
disease. Most commonly prescribed are 6-mercaptopurine and a related
drug, azathioprine. Immunosuppressive agents work by blocking the
immune reaction that contributes to inflammation. These drugs may
cause side effects like nausea, vomiting, and diarrhea and may lower
a person's resistance to infection. When patients are treated with a
combination of corticosteroids and immunosuppressive drugs, the dose
of corticosteriods can eventually be lowered. Some studies suggest
that immunosuppressive drugs may enhance the effectiveness of
corticosteroids.Surgery
Surgery to remove part of the intestine can help Crohn's disease but
cannot cure it. The inflammation tends to return next to the area of
intestine that has been removed. Many Crohn's disease patients
require surgery, either to relieve symptoms that do not respond to
medical therapy or to correct complications such as blockage,
perforation, abscess, or bleeding in the intestine.
Some people who have Crohn's disease in the large intestine need
to have their entire colon removed in an operation called colectomy.
A small opening is made in the front of the abdominal wall, and the
tip of the ileum is brought to the skin's surface. This opening,
called a stoma, is where waste exits the body. The stoma is about
the size of a quarter and is usually located in the right lower part
of the abdomen near the beltline. A pouch is worn over the opening
to collect waste, and the patient empties the pouch as needed. The
majority of colectomy patients go on to live normal, active
lives.Sometimes only the diseased section of intestine is removed
and no stoma is needed. In this operation, the intestine is cut
above and below the diseased area and reconnected.
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