Crohn's disease is a disease of the digestive tract, which was first described in 1932 in a trade journal, named after one of the authors. Together with ulcerative colitis, Crohn's disease is a chronic inflammatory bowel disease. The patients - mostly young people between 15 and 30 - suffer primarily from abdominal pain, diarrhea and general side effects such as fever and inefficiency. In Germany, approximately 150,000 people are affected by Crohn's disease.Crohn's disease is often diagnosed only after years
In the course of the disease, which is also known as Crohn's disease known to alternate with periods of high complaints from largely symptom-free intervals. At the same time, many patients also occur in diseases outside the colon, such as arthritis and reddish-nodular changes on the lower legs (erythema nodosum). The symptoms are so very complex. Be between the first appearance of symptoms and the diagnosis Crohn's disease for several years. For the patient this is a time visits to the doctor more frequently and research . Often suffers from his psyche. Effective drugs for a new life Although the cause of Crohn's disease to date is not known, there are now very effective medications with less side effects than cortisone and patients often live a normal life permit.
Healthy lifestyle slows Crohn's disease relapses A balanced life contributes to the well-being and can reduce the number of relapses. Diet also plays a role: It is helpful to-eat vitamin, mineral and protein-rich to avoid malnutrition. It is very important also not to smoke. Smoking harms not only - as already known - vessels and airways: In Crohn's patients appeared to smoking aggravates the pain and increases the number of relapses.
Crohn's Disease: Causes
In Crohn's disease, it is difficult to identify the causes. Are you are still not sure.However, the disease mechanism is now widely known: intestinal specialists assume that it is a genetically determined disease. This means there is a predisposition to Crohn's disease. The lifestyle, nutrition and psychological factors as the cause of the disease is not an object. In many diseases are often specific factors that best promote their development. For example, is known to promote obesity, diabetes, fatty foods and lack of exercise.
The immune system is disturbed
In Crohn's disease is a morbidly excessive response of the immune system. The barrier function of the intestinal wall is disturbed: enabling bacteria of the normalintestinal flora enter the body and cause an inflammatory reaction. A turn genetic dysregulation of the immune system leads to the fact that this immune response persists and the inflammation becomes chronic.
The intestinal flora and bacteria play a role
This genetic component may be a decisive factor, but not the sole trigger for Crohn's disease. Thus, in identical twins only 58 percent of cases, both affected siblings. Obviously, the nature of the intestinal flora also plays a significant role. It has been found that regressing the inflammation in animals as soon as the intestinal lumen of germfree holds, then kill any bacteria. This is of course only possible in humans. Good results are possible, for example with a colostomy (stoma), because the underlying bowel comes to rest. Also, broad-spectrum antibiotics show good results, but they are not suitable for long-term therapy.Maybe even in Crohn's disease probiotics helpful.
Crohn's disease: complications
Patients with Crohn's disease are often not provided with sufficient essential nutrients. Because of the diarrhea and inflamed sections of the digestive tract, the nutrients in the gut are not absorbed as well. In addition: Chronic inflammation consume energy - they rob the body of calories and nutrients.
Other causes of poor nutritional status of Crohn's disease patients are:
- Anorexia
- any bottlenecks in the gut
- or the surgical removal of intestinal segments
The consequences range from weight loss, the loss of fat and muscle mass to symptoms of vitamin deficiency. So there may be a lack of calcium come, bone metabolism affects. Often patients have Crohn's also a lack of vitamin B12 of blood disorders leading to.
More than every second patient has osteoporosis
A common and dreaded consequence of Crohn's disease is osteoporosis . In this disease decreases bone density, which is why falls can easily lead to breakage. In advanced stages, are already possible with the smallest impact fractures. About 60% percent of all Crohn's patients are probably affected by osteoporosis.
The causes are many:
- the poor nutrient absorption through the gut
- the bone-depleting effect of the inflammation itself
- the corticosteroid therapy
- a milk intolerance, which is in Crohn's disease patients quite often.
In children and adolescents can lead to osteoporosis, growth retardation, and a delayed onset of puberty is discussed.
Dieticians recommend the
For Crohn's disease patients and doctors, it is important to look for possible nutritional deficiencies and to balance them. A dietitian and a special nutritional therapy is useful in any case, especially if your body mass index below 18. If more than 10 percent of your weight within 6 months or have lost your serum albumin level is too low, the nutrition education is a must.
Crohn's Disease: Complications
Crohn's disease - unlike ulcerative colitis - in all regions of the digestive tract occur in principle. The infection is typically not limited to a section, that is, healthy and inflamed sections alternate. Another difference with ulcerative colitis: In Crohn's disease suffer all the wall layers of the digestive tract. It is therefore often a narrowing of the digestive tract (stricture). In about 10-15 percent of patients make transitions into the adjacent tissue (fistulas). Also a collection of pus (abscess) is possible.
Stenosis: Often, surgery is necessary
If heal Crohn's disease, the mucosal inflammation, often left scars. In severe cases, these scars are so severe that it restricts the cavity. This can hinder the transport of the chyme. In the worst case, the bowel is completely blocked, there is an intestinal blockage ( ileus ). In most cases, only an operation for spinal stenosis creates lasting remedy.
Fistula: Gears from the intestine to the bladder or vagina possible
When the inflammation in Crohn's disease eats deeper and deeper into the tissue, may cause transitions. Does such a transition to another loop of intestine or a hollow organ such as the bladder or the vagina, so a connection between these two areas. Doctors refer to this connection as a fistula. About these compounds can pass stool or pus into adjacent hollow organs such as bladder or vagina.
Fistulas are rejected
Fistulae is therefore also make a stool through the vagina or the urine noticeable.Sometimes fistulas, can carry out to the body surface. Doctors try of purging of pus in the fistula drainage threads and to heal the fistula. Sometimes, however, sustained only by surgery.
Abscess: drainage as therapy
An abscess occurs when dying cells leave pus-filled cavities. They are formed mainly in Crohn's disease in the anal region and can be very painful. The pus may be discharged through a drainage. In some cases, the abscess, however, occurs again and again, so that the doctor consider an operation.
Crohn's Disease: Symptoms
Crohn's disease often begins with general symptoms such as:
- Flatulence
- Abdominal pain, typically lasting
- Diarrhea, often bloody and
- Fatigue, tiredness
- Fever
- Weight loss
In about every second Patient's symptoms also occur outside the digestive tract, mainly eye inflammation, joints or skin. These symptoms are probably just as Crohn's disease itself caused by a dysregulation of the immune system.
Typical are:
- Inflammation at the knees, ankles and elbows and on the joint ligaments and muscle sheaths. Frequently, the bowel and sacral vertebrae and the joints are affected.
- Inflammation at the middle coat of the eye (uveitis) and the dermis (iritis)
- erythema nodosum, Gangrenosum a reddish nodular change on the legs and the pyoderma, a non-infectious chronic ulcer.
Can continue to occur in Crohn's disease patients, disturbances in the liver, bile ducts and other internal organs. The overall result is usually not a picture that immediately suggest a Crohn's disease.
Crohn's Disease: Diagnosis
It usually takes a while until the doctor can make the diagnosis Crohn's disease.First, he must rule out other diseases with similar symptoms. Therefore often fall longer observation periods with many studies that must bring together the doctor a mosaic. Patients should not rashly condemn their doctor if he can time of diagnosis.
The first part of the mosaic are the medical history ( history ), the exact analysis of symptoms and physical examination. It scans the doctor, for example, hardened after intestinal loops and inspected after the region to any fistula can be seen.
Gastro-intestinal endoscopy: Endoscopy is the focus
In a further step, the physician collects certain blood tests that provides information on the inflammatory activity in the body give others. Also an ultrasound scan can provide information about over thickened bowel wall, abscess or fistula supply further. The main method of examination in diseases of the digestive tract is, however, colonoscopy and gastroscopy (endoscopy). Only in this way, the physician receives direct view of the wall of the esophagus, stomach, duodenum and the colon and rectum and may remove tissue samples. There is no endoscope in a position, however, until the middle regions of the small intestine, penetrate, also supplies X-ray examination , especially the MRI Sellink an important contribution to diagnosis.
Crohn's disease diagnosis: laboratory values
The symptoms of Crohn's disease are relatively nonspecific: The patients suffer from diarrhea, abdominal pain, fever and fatigue, it also usually comes to weight loss. The doctor must first determine whether the diarrhea is not caused by bacteria such as salmonella. An examination of the stool is in the laboratory diagnosis so first.
Inflammation, and protein deficiency can be identified
Pathogens are excluded as a cause, a blood test can be revealing. This can be stated as an inflammation or a protein deficiency. Both would speak for Crohn's disease.
The following table provides an overview of key laboratory values and changes in Crohn's disease:
Laboratory values | Sample collection | Value change in Crohn's disease | Statement |
Erythrocyte sedimentation rate (ESR) | Blood | increased | Inflammation present |
Leukocytes (white blood cells) | Blood | increased | Inflammation present |
Hemoglobin (red blood pigment) | Blood | decreased | Blood loss, for example, bloody diarrhea, blood Education disorders |
Platelet | Blood | increased | Colon infection |
C-reactive protein (CRP) | Blood | increased | Inflammation present |
Albumin (serum albumin) | Blood | decreased | Protein loss through wounds in the intestines |
Alpha-1 Antitrypsin | Chair | increased | Protein loss through wounds in the intestines |
Schilling Test (resorption Capacity for vitamin B12) | Urine | decreased | Recording deficits in the small intestine |
A blood test is in the course of Crohn's disease therapy important: The laboratory values provide information about the severity of inflammation and the success of therapy. On the basis of laboratory parameters can also be complications identified: For example, a low calcium levels in the blood indicative of osteoporosis, many E. coli bacteria in the urine indicate a fistula between the bowel and bladder out.
A distinction between Crohn's disease and ulcerative colitis is not by blood, stool or urine examination, however, possible. They lead to almost identical changes in laboratory parameters.