Complications of Crohn's disease. Vitamin D is an essential substance for your immune system. Crohn's disease is divided by localization

Crohn's disease is a chronic inflammatory disease that affects the entire gastrointestinal tract, from the mouth to the anus. Unlike ulcerative colitis, in Crohn's disease all layers of the intestinal wall are involved in the inflammatory process. In most cases, inflammation first occurs in the ileum and then spreads to other parts of the intestine. At the same time, the symptoms of acute ileitis (inflammation of the ileum) are indistinguishable from the symptoms of acute appendicitis, so patients are often operated on and a true diagnosis is made during the operation.

Crohn's disease is a fairly rare pathology. The disease usually begins between the ages of 20 and 40, but can also occur at childhood. According to statistics, men get sick more often than women.

Causes of Crohn's disease

To date, the causative agent of Crohn's disease has not been identified. However, the infectious theory is the main version of the origin of the disease. This is explained by the positive effect of treatment with antibacterial drugs. In addition, in the development of the disease there is a lot important role Immune system disorders play a role. Autoimmune processes, in which antibodies are produced against one’s own intestinal tissues, and the insufficiency of the protective function of the immune system are an important link in the origin of the disease.

Predisposing factors for the development of the disease are:

Rescheduled viral infection(measles);
food allergies;
stress and mental strain;
smoking;
hereditary predisposition.

Symptoms of Crohn's disease

Considering that Crohn's disease can affect any part of the gastrointestinal tract, the picture of the disease is very multifaceted and depends on the location of the main source of inflammation. The clinical picture can distinguish local, general and extraintestinal manifestations of the disease.

General symptoms arise due to disorders of the immune system and the presence of intoxication. These include fever with chills, weight loss, weakness and malaise.

With fever, which can be caused by purulent complications of Crohn's disease, the temperature reaches 39 - 40°C.

Malabsorption nutrients, microelements, vitamins, bile acids due to extensive inflammation of the intestinal walls leads to metabolic disorders, weight loss, osteoporosis (loss of bone tissue strength), and the formation of cholesterol stones in the gall bladder.

The main local manifestations of the disease are abdominal pain, diarrhea with blood in the stool.

Abdominal pain may be mild, cramping in nature with a feeling of heaviness and bloating. Often the pain is localized in the right lower quadrant of the abdomen, sometimes it is impossible to distinguish it from that of appendicitis.

Loose stool mixed with blood is a constant symptom, its frequency ranges from 3 to 10 times a day. After stool, abdominal pain decreases.

Extraintestinal manifestations of the disease are associated with immunological disorders and include:

Arthropathy is an asymmetrical lesion of large joints, accompanied by pain and limited mobility;
sacroiliitis – inflammation of the sacroiliac joint with intense pain in the sacral area;
decreased vision;
skin rash(erythema nodosum, pyoderma gangrenosum);
ulcers in oral cavity.

Given the availability pain syndrome in the abdomen and stool upset, Crohn's disease is difficult to distinguish from an attack of acute appendicitis, inflammation of Meckel's diverticulum, ulcerative colitis, infectious enterocolitis, malignant lymphoma (tumor of blood cells) and intestinal tuberculosis. Therefore, if you have abdominal pain that does not go away within 6 hours, you should consult a surgeon.

If pain occurs, you can take antispasmodic drugs, such as no-spa, buscopan, no more than 2 tablets at a time. If diarrhea develops without signs of bleeding, you can take loperamide or imodium at an initial dose of 4 mg, then 2 mg after each bowel movement, a maximum of 16 mg per day, no more than 24 hours. If treatment is ineffective, you should consult a surgeon. Compresses and heating of the abdominal area should not be used.– this can increase inflammation. Painkillers should not be taken for abdominal pain.– they will distort the picture of the disease and prevent a correct diagnosis. Self-medication and delayed diagnosis can lead to the development of complications of the disease.

Screening for Crohn's disease

Specific laboratory diagnostics for Crohn's disease does not exist. When seeking medical help, you must undergo a standard examination, including a general blood and urine test, blood sugar, and a biochemical blood test.

CT scan allows you to assess the presence of complications - the formation of an abscess or infiltrate in abdominal cavity.

Treatment of Crohn's disease

Because Crohn's disease affects the entire gastrointestinal tract, treatment for Crohn's disease is primarily medication. Surgical treatment is used only in the presence of complications to correct them.

The diet for this disease should include high-calorie foods containing large amounts of protein and vitamins with limited fat and coarse fiber plant products that cause intestinal irritation. Alcohol consumption should be avoided. You can eat soups in weak fat-free meat and fish broth, boiled and pureed meat (chicken, beef, rabbit), oatmeal, buckwheat porridge in water, eggs (up to 2 per day) soft-boiled or in the form of a steam omelet, jelly, jelly from blueberries, ripe pears, unleavened cottage cheese, cottage cheese soufflé. All other dairy foods should be avoided as they may contribute to the development of diarrhea. Drinks include tea, cocoa in water, infusions of rosehip, bird cherry, and blueberry. Everything must be excluded fresh vegetables, sauces, spices.

During the period of exacerbation of the disease, antibacterial therapy is carried out. Ciprofloxacin and metronidazole are prescribed in doses of up to 1 g per day. In this case, their combination or sequential assignment is possible. The medications are taken for up to 6 weeks. The most effective use of antibiotics is for damage to the colon.

As an anti-relapse treatment, mesalazine is used in a daily dose of 3–4 g for up to 6 months, then a follow-up examination is carried out; if the dynamics are positive, the drug is discontinued; if there are no positive changes, treatment is continued.

Complications of Crohn's disease

With late diagnosis or prolonged course of the disease, the following complications may develop.

Intestinal obstruction is a specific symptom, especially when affected small intestine, consists in narrowing the intestinal lumen and disrupting the normal passage of food. Usually complete obstruction of the lumen does not develop, so wait-and-see is possible. conservative treatment with the prescription of antibacterial drugs, hormones (prednisolone), antispasmodic drugs (no-spa, papaverine). However, if conservative treatment is unsuccessful, an operation is performed - resection of a section of the intestine (the narrowed part of the intestine is removed).

The figure shows the x-ray appearance of intestinal obstruction with distended loops of small intestine filled with gas and fluid levels.

Perforation into the free abdominal cavity is a violation of the tightness of the intestinal wall due to deep ulcerative defects with spillage of contents into the abdominal cavity, accompanied by the development of peritonitis (inflammation of the peritoneum). IN in this case emergency surgery is indicated.

Infiltrate and abscess in the abdominal cavity - occur as a result of a previous complication. Due to activation protective properties the peritoneum is demarcated inflamed area with the formation of a conglomerate of inflamed tissue (infiltrate) with purulent contents (abscess). If these complications occur, the drug therapy indicated above is carried out; if it is ineffective, surgery is performed.

Intestinal bleeding is less common than, for example, with ulcerative colitis, but is possible. In such cases, hemostatic drug therapy is prescribed, which is usually successful.

Toxic dilatation (marked enlargement of a section of the intestine) of the affected intestine occurs extremely rarely, unlike ulcerative colitis. Its development can be triggered by taking antidiarrheals, irrigoscopy and colonoscopy. In this case, anti-inflammatory drugs (prednisolone) and antibacterial drugs together with stopping food intake, they help eliminate this complication.

Anal fissures, fistulas and paraproctitis ( purulent inflammation fatty tissue around the rectum) is a common complication that can begin the disease. It consists of the formation of ulcers of the mucous membrane of the anal canal with transition to the surrounding skin; fistulous tracts are formed as a result of the breakthrough of ulcers of the peri-rectal fatty tissue. To correct these complications, an excision operation is performed against the background of drug therapy.

Prevention of Crohn's disease

Currently, no effective prevention of Crohn's disease has been developed. Therefore, the only way to protect yourself to some extent from the development of this disease is a healthy lifestyle and the elimination of predisposing factors.

To prevent the development of complications, early diagnosis of Crohn's disease and timely initiation of drug therapy are necessary. Therefore, self-medication when these symptoms appear is unacceptable.

As Seneca said: “One of the conditions for recovery is the desire to get well.” Therefore, take care of your health. It is better to overestimate the severity of your symptoms than to seek medical help late.

Surgeon Tevs D.S.

Video about Crohn's disease:

Crohn's disease is a very serious pathology, which is accompanied by intense abdominal pain, insufficient intake of nutrients by the body, and frequent complications. The disease has a chronic course. Treatment with modern methods is unable to completely eliminate the pathological focus, but can maintain a sufficient quality of human life, lengthening periods of remission and preventing the development of complications.

Drug therapy is the mainstay for Crohn's pathology

The main treatment for the disease is taking medications, to which, as an addition, various folk remedies are excellent. They are used as auxiliary methods in the treatment of the disease. latest developments scientists. However, in some cases there is still a need for surgical intervention.

Drug therapy

Drug treatment of the disease consists of basic therapy drugs, which are prescribed by a doctor taking into account the severity of the pathology, as well as drugs to eliminate individual symptoms both the disease itself and its complications. Therapy can also be divided into relief and maintenance: the first is designed to stop the process of intestinal destruction, while the second is to maintain the absence of inflammation and prolong remission.

Basic therapy

It consists of one or more medications, the purpose of which is to stop the autoimmune process in the intestines and reduce the level of inflammation in it.

Warning! The drugs for basic therapy are quite aggressive and have a range of side effects, therefore, they are prescribed only by a gastroenterologist. Stopping medications or continuing a course of therapy is also a medical decision, since the patient himself evaluates his own condition only from the point of view of the existing symptoms, while there are also objective assessment criteria.

How to treat Crohn's disease - medications such groups:

1. Preparations based on aminosalicylic acid. Are the most important means for the treatment of disease, having local antibacterial and anti-inflammatory effects; suppress the activity of the autoimmune process. Treatment of the disease begins with these drugs. They can be used in the form of tablets, as well as enemas and suppositories. Last two dosage forms used for lesions of the rectum and sigmoid colon to reduce systemic side effects.
2. Glucocorticoids. This synthetic analogues hormones produced by the adrenal glands of each person. They are very effective in reducing inflammation and blocking the autoimmune component of it, but have a significant number of side effects. Before prescribing them, the doctor must make sure that there is no bacterial infection in the human body.
3. Cytostatics. These are drugs that suppress inflammatory activity in the intestines, but at the same time have a significant effect on cell division throughout the body. Used in cases of severe Crohn's disease.
4. Monoclonal antibodies – relatively a new group drugs, which are prescribed both to relieve exacerbations and to maintain remission of inflammation in the intestines.

Symptomatic therapy

It includes:

• prescription of antidiarrheal drugs;
• dosage forms of calcium and vitamin D for the prevention of osteoporosis, especially if glucocorticoids are used in therapy;
• if the intestines are so severely affected that all food passes through it in “transit”, preparations of proteins, fats and carbohydrates can be prescribed for several days to feed the person through a vein;
• hemostatic drugs;
• antibiotics - during development purulent complications diseases.

Latest Treatment Methods

American scientists propose additional treatment for Crohn's disease:

• linolenic acid in conjugated form – it reduces the level of inflammation;
• stem cells, which are introduced during the main therapy: this is how the normal operation immunity, and also accelerates the healing process in the intestines.

Sage is often used to treat illness

A good addition to drug therapy is the treatment of Crohn's disease with folk remedies. The following recipes are used for this:

1. Mix chamomile flowers, sage and centaury leaves in equal parts, take 3 tbsp. spoons of the mixture, pour a glass of boiling water, leave for 40 minutes, strain. Take 1 tbsp. spoon often - 7-8 times a day. Course – 12 weeks.
2. Mix 20 g of mustard seeds and anise fruits, 10 g of yarrow herb and buckthorn bark with 30 g of licorice roots, pour 200 ml of boiling water over this mixture, boil for 10 minutes, strain. Take 100 ml twice a day.
3. In equal parts you need to mix cumin fruits, valerian roots, mint leaves and chamomile flowers, pour a tablespoon of the mixture with a glass of boiling water, leave for an hour. This glass of infusion should be taken a day, divided into 3 doses.
4. For traditional treatment For Crohn's disease, healers recommend using a decoction of sage. To do this, 100 g of dry raw materials are placed in an enamel bowl, poured with 3 cups of boiling water, and boiled for 10 minutes over low heat. Leave for 20 minutes, strain, take 150-200 ml three times a day.
5. Onion peels, which you need a whole glass for this recipe. The raw materials are placed in an enamel pan, poured with 8 glasses of water, and brought to a boil. The pan is kept on low heat with the lid half closed for an hour, without adding new water. Next, the broth is left to cool and filtered. Drink 100 ml 3-6 times a day.

Surgery

Surgery is performed to treat complications of Crohn's disease

Surgeries for Crohn's disease are performed according to strict indications, only in the presence of complications of the disease, such as:

• intestinal obstruction;
• abscesses in the intestines;
• perforation of the intestinal wall;
• intra-abdominal bleeding;
• fistulas;

This cautious attitude towards operations is due to the fact that after them within a year in 70% of cases (more than late dates– more often) a relapse of the disease develops, often requiring repeated surgical intervention. The frequency of relapse decreases when taking certain cytostatics and antibiotics,

Advice! Refusal of surgery in case of complications such as perforation, bleeding, fistulas or abscesses is not justified, since it leads to the death of the patient in very short time. It is better to protect yourself from relapse by taking medications, but agree to the help of a surgeon.

Prognosis and disability

The prognosis for Crohn's disease is as follows. This disease is almost never cured. With her mild flow 90% of relapses respond well to treatment; in 10%, exacerbations develop 1-3 times a year, which can have varying degrees of severity. The factor that influences the risk of developing complications, even life-threatening ones, has not been clarified. The 20-year survival rate for Crohn's disease is believed to be no different from that of other people.

Disability due to Crohn's disease is a controversial issue. It is given if.

Crohn's disease is a chronic, relapsing disease unknown etiology, characterized by granulomatous inflammation with segmental damage to different parts of the digestive tract. Unlike ulcerative colitis, in Crohn's disease all layers of the intestinal wall are involved in the inflammatory process. In most cases, inflammation first occurs in the ileum and then spreads to other parts of the intestine.

We will look in more detail about what this disease is, what its symptoms are, as well as treatment methods in this article.

What is Crohn's disease?

Crohn's disease is a severe chronic inflammatory bowel disease. Progression leads to damage to deeper layers, leading to increased pain and increasing exhaustion of the body, sometimes ending in the development serious complications threatening the patient's life.

The inflammatory process involves absolutely any part of the gastrointestinal tract, from the anus to the oral cavity, but the most common lesion is the large intestine (rectum or colon) and/or the final part of the small intestine (ileum).

Systemic manifestations include fever, weight loss, damage to the musculoskeletal system (arthropathy, sacroiliitis), eyes (episcleritis,), skin ( erythema nodosum, pyoderma gangrenosum).

• The disease is chronic, with alternating acute attacks and remissions. The first signs of the disease (first attack) usually occur in at a young age– in persons 15–35 years old.
• Revealed genetic predisposition Crohn's disease - if direct line relatives suffer from this disease, the risk of developing it increases 10 times.
• Women are less susceptible to such diseases. This is more likely due to the characteristics of nutrition and lifestyle.
• According to ICD 10 it has code K90.

At the moment, the disease is considered incurable; the goal of treatment for Crohn's disease is to maintain the intestines in a state of long-term remission and relieve symptoms during exacerbation, as well as prevent complications.

Causes

There is still no exact answer to what causes the development of the disease. In some cases acute illness Crohn's may be mistaken for inflammation of appendicitis or.

The following are distinguished: possible reasons development of pathology:

• Hereditary predisposition. It is known that people with Crohn's disease often have relatives suffering from chronic inflammatory bowel diseases, for example -;
• In addition, immune system disorders also play an important role. The fact is that autoimmune processes, accompanied by the production of antibodies acting against their own tissues of the affected area (intestines), as well as an insufficiently effective protective function on the part of the immune system - all this serves as a serious background for the appearance and development of Crohn's disease.
• Damaging effects of external factors: unhealthy diet, bad habits, unhealthy lifestyle, infection.

Predisposing factors for the development of the disease are:

• Past viral infection ();
• food allergies;
• stress and mental strain;
• smoking;
• hereditary predisposition.

It is noted that Crohn's disease occurs with equal frequency in both sexes, and the prevalence is 50-95 people per 100,000 population.

Degrees

The disease tends to spread to healthy intestines. It occurs with exacerbations and incomplete remissions. Among patients in remission, approximately 30% of patients experience an exacerbation within a year and approximately 50% of patients experience an exacerbation within 2 years. Gradually, remissions become short, and symptoms intensify during exacerbations.

Symptoms of Crohn's disease

U different people inflammation spreads to various parts of the intestine: in some (80%) only the final segment is affected small intestine(ileum), in others (about 20%) the focus is located in the rectum (part of the large intestine). These are the most common sites for Crohn's disease to develop.

Symptoms:

• The main local manifestations of the disease are abdominal pain, diarrhea with blood in the stool.
• Abdominal pain may be mild, cramping in nature with a feeling of heaviness and bloating. Often the pain is localized in the right lower quadrant of the abdomen, sometimes it is impossible to distinguish it from that of appendicitis.
• Loose stool mixed with blood is a constant symptom, its frequency ranges from 3 to 10 times a day. After stool, abdominal pain decreases.
• With Crohn's disease, appetite is often reduced, but even if it is not changed, weight loss is still observed, and often quite significant.

Signs of Crohn's disease by form:

1. Spicy. The disease has a clear onset: diarrhea (diarrhea), body temperature rises, and pain appears in the lower right segment of the abdomen. These symptoms are often misdiagnosed as inflammation, ovarian apoplexy, which leads to surgery. The diagnostic error is detected during surgery.
2. Subacute. The patient develops exhaustion (weight decreases quickly), mild diarrhea, and cramping pain of any localization are present.

The disease is also characterized by extraintestinal manifestations, which are determined by specific immunological disorders. Such manifestations include in particular:

• sacroiliitis - an inflammatory process in the sacroiliac joint, accompanied by severe pain concentrated in the sacral area;
• arthropathy – in this case we are talking about an asymmetrical lesion affecting large types of joints, which, in turn, leads to the appearance of pain with a forced limitation of the patient’s mobility;
• skin rash (in particular, this includes pyoderma gangrenosum, erythema nodosum);
• the appearance of ulcerative formations in the oral cavity;
• loss of vision;
• hepatitis;
• dermatitis;
• gallstone disease, kidney stone disease;
• arthrosis, arthritis;
• inflammatory processes in the mucous membranes of the mouth, eyes, etc.

With a long course, the formation of abscesses in the intestinal wall and fistulous tracts into the abdominal cavity and neighboring organs is possible ( bladder, vagina), on the surface of the skin (in the anus area). The acute phase of the disease is usually accompanied by fever and general weakness.

During periods of exacerbation, the symptoms of Crohn's disease are most pronounced. Patients complain of cramping, rather severe pain in the abdomen, diarrhea is observed five to six times a day, and due to digestive disorders, the patient significantly loses body weight.

Complications

Crohn's disease is dangerous not only for its unpleasant manifestations, but also for its severe complications that can only be eliminated surgically. These include:

• Perforation of the intestinal wall, with the addition of peritonitis
• Intestinal obstruction
• Heavy bleeding
• External and internal fistulas, ulcers
• Inflammatory infiltrates and strictures (narrowing of the lumen) of the intestine
• Risk of adenocarcinoma
• Weeping fissures and maceration of the rectum
• Foci of suppuration (abscesses)

Disability due to Crohn's disease can only be diagnosed in some cases. The basis for this pathology are the following conditions:

• complications arose;
• loss of ability to work due to pathology;
• the disease is severe even with treatment;
• it is not possible to select a therapy.

Diagnostics

Primary diagnosis consists of:

• taking an anamnesis (taking into account symptoms, age, seasonality of exacerbation, family diseases, presence of other pathologies, etc.);
• visual examination of the patient (palpation of the abdominal cavity, examination of the skin and mucous membranes, palpation lymph nodes, for example, on the neck, etc.);

During diagnostic tests, the doctor must exclude diseases similar in symptoms to Crohn's disease. Thus, it is necessary to differentiate diseases such as irritable bowel syndrome, acute appendicitis, ischemic and ulcerative colitis.

The patient is directed to undergo the following examination:

• Endoscopic examination is mandatory. This study is necessary both for visual confirmation of the diagnosis and for taking a biopsy (a piece of tissue) for examination under a microscope. Moreover, it is done in various parts of the digestive tract
• Colonoscopy. Allows you to get the most full picture condition of the large intestine. It helps to identify the presence of ulcers, areas of inflammation and bleeding. Probing of the colon allows you to examine it completely - from the cecum to the rectum.
• Ultrasound examination of the abdominal organs makes it possible to assess the diameter of the intestinal loops and the presence of free fluid in the abdominal cavity, which helps in diagnosing complications (perforation of the intestinal wall with the development).
• X-ray. The implementation of the techniques is carried out in combination with the use of a contrast agent, on the basis of which it is possible to detect areas of narrowing, granulomas and other types of neoplasms in the small intestine.
• Laboratory research methods. Conduct general and biochemical tests blood, urine, stool analysis and culture, as well as a comprehensive immunological blood test.

Treatment of Crohn's disease in adults

The main methods of treatment for Crohn's disease should be aimed at reducing inflammatory process, stabilization of the patient’s condition and prevention of complications. The drugs are selected individually, their effectiveness and tolerability by the patient are assessed over time.

Therapy depends primarily on the severity of the disease. It is impossible to assess it by any one indicator; it is necessary to take into account the nature of the damage to the gastrointestinal tract, systemic manifestations, the presence of exhaustion and general state.

The treatment plan includes:

• diet, proper nutrition;
• medications;
• surgery.

It is extremely important for the patient, regardless of the stage of progression of the disease, to maintain physical and mental rest. In many ways, the final result of recovery depends on the emotional background of the patient.

Medications

The goal of drug therapy for Crohn's disease is to:

• relieve symptoms (so that the disease goes into remission);
• prevent disease outbreaks (maintain remission). The main drugs used for this are Azathioprine, Methotrexate, Infliximab and Adalimumab.

If the patient encounters the disease at a later stage, complex treatment is used:

• immunosuppressants (suppress defense mechanisms the immune system that attacks the intestines; may cause brain dysfunction and other problems);
• There is a group of drugs with anti-inflammatory effects that are designed specifically for the treatment of Crohn's disease (Sulfasalazine, Mesalazine, Pentasa). The dosage of drugs is prescribed only by a doctor, depending on the severity of the disease, the age of the patient and the stage of the disease.
• hormonal drugs;
• antibacterial drugs (in rare cases);
• leukotriene receptor antagonists (reduce antibody activity);
• homeopathy (some doctors consider homeopathy ineffective);
• articular syndromes can be additionally treated with injections of corticosteroids into the joints (contraindications - gold preparations);
• analgesics;
• vitamins.

Drug therapy for Crohn's disease is considered successful if it can push the disease into remission and keep it in remission without causing significant side effects.

Operation

The positive effect of surgical treatment for Crohn's disease is usually temporary. The disease often recurs, causing inflammation near the previous site. The best policy is to continue supportive drug therapy after surgery.

Surgical treatment is indicated for:

• development of fistulas and abscesses (opening of abscesses and their sanitation, elimination of fistulas);
• development of deep wall defects with prolonged heavy bleeding or refractory to conservative therapy severe course diseases (resection of the affected area of ​​the intestine).

Diet

In combination with drug therapy, doctors pay great attention special diet, which is very important for reducing mechanical, thermal and chemical irritation of the intestines. The diet for Crohn's disease is not very strict, the main thing in it is careful attitude to the intestines.

• You need to eat at least 5 times a day;
• Proteins per day – up to 150 g, fats – 70-80 g, carbohydrates – 250 g;
• Energy value – about 2100 kcal;
• Salts – no more than 8 g per day;
• Must be consumed more products containing potassium and calcium;
• Liquids – 1.7-2 liters per day;
• Food should be prepared by baking, boiling, steaming;

The patient's diet should consist of the following products:

• stale wheat bread;
• skinless poultry, lean varieties of rabbit, veal, beef;
• lean fish;
• scrambled eggs;
• cracker;
• vegetable pilaf;
• porridge on water;
• pudding;
• dry biscuit.

Food must be processed according to means steam bath, it should be boiled or stewed.

But the diet for exacerbation of Crohn's disease is preventive fasting, which lasts for 1-2 days. The patient is only allowed to consume liquid in volumes of 1.7 to 2 liters per day.

During an exacerbation, the diet includes:

• liquid and pureed porridges (rice, semolina) in water, since milk and broths are excluded.
• It is convenient to use porridge for baby food, but they need to be diluted with water.
• It should be taken into account that buckwheat porridge enhances motor skills, so it is not recommended during an exacerbation.

Menu

Traditional methods

Before using any folk remedies during Crohn's disease, consult a gastroenterologist.

1. Should be added regularly dietary dishes flax or pumpkin seed oil, which will support the immune system and have a beneficial effect on digestive processes.
2. 40 g ground seeds caraway seeds are infused in a thermos, 400 ml of water, at an initial temperature of 70-80⁰C. Drink 60-80 ml before meals.
3. Rosehip oil is prepared at home and taken one tablespoon at a time according to the following schedule: an hour before breakfast, 30 minutes before lunch and 2 hours after dinner. You need to take crushed fruits (a full liter jar) and fill with 1.5 liters olive oil. Leave for 2 weeks in a warm place.

Prevention

Due to the unclear etiology of Crohn's disease, it is possible to definitely prevent the disease. That is why all preventive measures come down to timely detection of the problem and prevention of relapses.

Methods of secondary prevention:

• cessation of smoking and alcohol abuse;
• limiting physical and emotional stress;
• strict adherence to the recommended diet;
• compliance with the optimal work and rest regime;
• prevention of exacerbations and progression of symptoms of Crohn's disease;
• taking medications only as prescribed by a doctor;
• examination by a gastroenterologist at least once a year.

Forecast for life

Prognosis for adults with proper treatment good. The question of how long people live with Crohn's disease is of interest to all patients, but the initial stage does not affect life expectancy. Late diagnosis may cause difficulties.

Doctor must constantly watch monitor the patient’s condition and timely prescribe examinations aimed at identifying complications. This helps improve forecasts.

It is worth noting that the quality and length of life will be influenced by several factors:

• time of onset of first symptoms and initiation of treatment;
• frequency of exacerbations;
• the body's reaction to treatment and susceptibility to it;
• the level of responsibility of a person towards his health and doctors’ recommendations.

Watch your lifestyle, eat right and avoid stressful situations. We wish you good health, thank you for your visit!

Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the digestive tract, from the mouth to the anus. In most cases, the ileum is affected.

Patients with Crohn's disease may experience various unpleasant symptoms, including abdominal pain and discomfort, diarrhea, fatigue. This condition is slightly more common in women and usually develops between the ages of 15 and 40.

Causes

The exact causes of Crohn's disease are unknown. Most doctors and scientists believe it is caused by a combination various factors.

• Genetic reasons. There is scientific evidence that genetic reasons play an important role in the development of CD. Scientists have discovered more than 200 genes that are more common in patients with this disease than in the general population. There is also evidence that the tendency to CD is inherited. Approximately 15% of patients with this disease have a close relative who also suffers from Crohn's disease. For example, people who have identical twins with CD develop the disease themselves in 70% of cases. In addition, the role of genetic factors in the development of Crohn's disease is confirmed by its high prevalence in some ethnic groups.
• The immune system. The immune system provides protection against harmful microorganisms that can potentially harm the digestive system. The gastrointestinal tract is also home to many different “friendly” microorganisms that help the body absorb nutrients. The immune system usually recognizes these microorganisms and does not attack them. However, with Crohn's disease, something disrupts the functioning of the immune system, and it begins to destroy all bacteria - both pathogenic and “friendly”. This causes the inflammation associated with Crohn's disease.
• Past infections. In some genetically susceptible people, childhood infections can cause the immune system to react abnormally, causing symptoms of Crohn's disease.
• Smoking. Besides heredity and ethnicity, smoking is the most important risk factor for developing Crohn's disease. Smokers are twice as likely to get the disease compared to non-smokers. Moreover, their Crohn's disease is more severe, which increases the likelihood of needing surgical treatment.
• Factors environment. Many scientists have come to the idea that environmental factors may play an important role in the development of Crohn's disease, prompted by two phenomena - the high prevalence of this disease in economically developed countries (USA, UK) and the wider spread of the disease after the 1950s. These phenomena confirm that some factors associated with modern lifestyle in Western countries increase the risk of developing CD. One theory (hygiene) says that since children grow up in an environment with a low number of microorganisms, their immune system does not fully develop due to the lack of childhood infections. Another theory says that the increase in the prevalence of Crohn's disease may be due to the increased use of refrigerators after World War II.

Symptoms

The main symptoms and signs of Crohn's disease are abdominal pain, diarrhea and weight loss. Less common are loss of appetite, fever, night sweats, intestinal bleeding. The clinical picture depends on the location, size and severity of the inflammatory process.

Classification of Crohn's disease includes:

• Crohn's disease of the colon(). This is inflammation limited to the large intestine. The most common symptoms of this form of CD are abdominal pain and bloody diarrhea. Anal fistulas and perirectal abscesses may also develop.
• Enteritis in Crohn's disease. Inflammation limited to the small intestine. Most often it manifests itself as abdominal pain and diarrhea, and small intestinal obstruction can sometimes occur.
• Terminal ileitis in Crohn's disease. Inflammation of the terminal ileum, most often manifested by abdominal pain and diarrhea.
• Enterocolitis in Crohn's disease. Inflammation of the small and large intestines, which causes abdominal pain and bloody diarrhea.

The most common forms of Crohn's disease are terminal ileitis and.

About a third of patients with CD may have the following anal conditions:

• Swelling of the tissues of the anal sphincter, the muscle that controls bowel movements.
• Development of ulcers inside the anal sphincter, which can cause bleeding and pain during bowel movements.
• Development of fistulas between the anus or rectum and the surrounding skin anus, from which mucus and pus may be released.
• Development of perirectal abscesses causing fever, pain and increased sensitivity in the rectal area.

• Joints. Arthritis may develop, causing painful swelling and fluid accumulation within the joint cavity. CD usually affects large joints in the legs and arms, such as the elbows or knees.
• Eyes. With CD, the outer layer of the sclera can become inflamed, causing the eyes to become red and painful.
• Liver. With CD, inflammation of the liver (hepatitis) and bile ducts (cholangitis) sometimes develops, which can lead to recurrent infectious diseases and.

Crohn's disease manifests itself in children frequent diarrhea, pain or cramps in the abdomen, blood in the stool, fever, weight loss, slower growth and sexual development, and decreased appetite. Parents who notice symptoms of Crohn's disease in their child should immediately consult a doctor.

Diagnostics

Diagnosis of Crohn's disease is carried out in patients with fever, abdominal pain, diarrhea with or without bleeding.

Laboratory blood tests can detect an increase in the white blood cell count and an increase in the erythrocyte sedimentation rate, which indicate the presence of an inflammatory process in the body. Other changes include anemia (decreased levels of hemoglobin and red blood cells), hypoproteinemia (decreased levels of plasma proteins), and decreased levels of various micronutrients in the blood.

A stool test for CD may show mucus and blood. The fecal calprotectin test can differentiate Crohn's disease from.

• Colonoscopy. This is the main test for Crohn's disease of the large intestine. It allows you to examine the mucous membrane of the entire colon using a flexible endoscope with a camera and a light source. During a colonoscopy, a biopsy of the affected area of ​​the mucosa may also be performed.
• Video capsule endoscopy. This new method examination, which consists of swallowing a small capsule, which wirelessly transmits an image of the internal structure of the small and large intestines to a special recording device.
• Computer or magnetic resonance enterography. Before these examinations, the patient needs to drink a harmless contrast agent, which allows you to increase the diagnostic value of the test. These methods are increasingly replacing X-ray contrast examinations, as they allow a more detailed examination of the small intestine.
• X-ray contrast examination of the intestine with barium. To study the condition of the stomach and small intestine, barium must be drunk, and to study the colon, it must be administered using an enema. Doctors then helped x-ray radiation images of the corresponding section of the intestine are obtained.

What are the limitations of people with Crohn's disease?

Patients diagnosed with Crohn's disease know that it is a disease that can limit their diet, physical activity, ability to work and other aspects of a full life.

Constant diarrhea strong pain in the abdomen, fever, chronic fatigue, nutritional deficiencies, weight loss, anemia - all of these consequences of Crohn's disease can negatively affect daily activities, the ability to spend time in society, quality of life, and the ability to concentrate.

Because of this, in severe Crohn's disease, patients are assigned a disability group.

Do I need a special diet?

A proper diet, aimed at providing the body with the necessary nutrients, is very important, so drawing up a diet menu is one of important aspects improving the condition of patients with Crohn's disease.

There is no evidence that any foods cause Crohn's disease, but some foods may increase symptoms. It is very important to find out which foods make the condition worse and avoid them.

Patients with CD should be aware that poor intestinal absorption of nutrients and decreased appetite, often seen with this disease, can lead to malnutrition.

Helpful for some people with CD:

• Limit consumption of dairy products. Many patients with inflammatory bowel disease find that their symptoms improve when limiting or eliminating dairy products from their diet. This is due to lactose intolerance, which often develops in these people.
• Try eating low-fat foods. If CD affects the small intestine, the digestive tract cannot digest fats properly. In this case, they make the diarrhea worse.
• Reduce the amount of fiber in your diet. For inflammatory bowel disease, fiber-rich foods may worsen symptoms.
• Avoid consuming foods and drinks that contribute to the formation of gases in the intestines.
• You need to eat in small portions, but often (5-6 times a day).
• It is necessary to drink enough fluids, with the exception of alcoholic and caffeinated drinks, which stimulate the intestines and worsen diarrhea.
• You need to take multivitamins. Because Crohn's disease can impair the body's ability to absorb nutrients from food, patients often need to take special medications.

If Crohn's disease in children is accompanied by delays in growth, physical and sexual development, doctors recommend a special liquid diet that can reduce inflammation and allow the digestive system to recover, while providing the body with essential nutrients.

Treatment

Many patients and their loved ones are interested in how and how to treat Crohn's disease. Unfortunately, there is no medicine that can cure this disease. Typically, people with Crohn's disease experience alternating periods of remission and exacerbation. During an exacerbation, the symptoms of the disease worsen; during remission, they improve or disappear.

Remission can occur as a result of drug or surgical treatment of Crohn's disease, but sometimes develops without any therapy.

Since CD cannot be completely eliminated, treatment goals include:

• Induction of remission.
• Maintaining remission.
• Minimizing side effects of treatment.
• Improving quality of life.

Medicines used to treat Crohn's disease:

1. Anti-inflammatory drugs.
2. Local antibiotics.
3. Immunomodulators.

The choice of treatment regimen depends on the severity of the disease, localization pathological process and the presence of complications. Various clinical guidelines for Crohn's disease say that therapy should be sequential - first inducing remission, then maintaining it. It is advisable to achieve the first signs of improvement at 2-4 weeks of treatment, maximum improvement should be observed at 12-16 weeks.

Currently, “de-escalation” therapy (more aggressive treatment) is becoming increasingly popular, which can reduce the effects of anti-inflammatory drugs and increase the effect of agents that promote mucosal repair and prevent future complications.

In most cases, the first line of treatment for Crohn's disease is corticosteroids, which reduce inflammation. Examples of these drugs are prednisolone and hydrocortisone.

These medications are effective in relieving symptoms, but have serious side effects, including weight gain, facial swelling, increased susceptibility to infection, and osteoporosis (weakening bone tissue). Because of these side effects, the dose of corticosteroids is gradually reduced after the patient's condition improves.

Sometimes a drug with a milder effect is prescribed - Budesonide.

Some patients are recommended to take 5-aminosalicylates (sulfasalazine, mesalamine) instead of corticosteroids. They have fewer side effects, but are also less effective.

If the disease worsens 2 times a year or more often, if its symptoms return when the dose of corticosteroids is reduced, it may be necessary to prescribe immunomodulatory drugs. The most commonly used drugs are Azathioprine, Mercaptopurine or Methotrexate.

Side effects of these drugs include nausea and vomiting, increased susceptibility to infections, feeling tired and weak, and liver problems. During treatment with immunosuppressants, blood tests should be done regularly to detect serious side effects.

Azathioprine and Mercaptopurine are considered safe drugs for the treatment of Crohn's disease during pregnancy and breastfeeding.

In patients with severe Crohn's disease, corticosteroids and immunosuppressants may be used if they are ineffective. biological drugs(Infliximab and Adalimumab). These drugs are powerful immune suppressants made from antibodies and enzymes. They act on tumor necrosis factor, which is considered responsible for the inflammatory process in CD.

Complications

Many people do not know why Crohn's disease is dangerous, and at first they consider it a simple diarrhea, which can be cured with the help of folk remedies.

However, it can cause serious complications, including:

• Intestinal stricture. Inflammation of the intestinal wall can cause scar formation that narrows the intestinal lumen. This narrowing is called a stricture. This increases the risk of developing intestinal obstruction and perforation. To treat intestinal stricture, surgery is usually necessary.
• Fistulas (fistulas). When the intestines become inflamed, ulcers can form on its mucosa, which over time turn into canals connecting the digestive tract with other organs - for example, the bladder, vagina, rectum. These channels are called fistulas or fistulas. Biological drugs are used to treat them, but if they are ineffective, surgery is needed.
• Osteoporosis. Weakening of bone tissue caused by impaired absorption of nutrients in the intestines and the use of corticosteroids.
• Iron deficiency anemia. A disease that develops with bleeding in the gastrointestinal tract.
• Folate deficiency or B 12 deficiency anemia. Caused by impaired absorption of these substances in the intestines.

In what cases is conservative treatment not enough?

If diet, lifestyle changes, and drug therapy do not relieve the symptoms of Crohn's disease, if complications (such as strictures or fistulas) develop, your doctor may recommend surgery. About half of patients with this disease will have to have surgery at some point.

During the operation, surgeons remove the damaged part of the intestine and form an interintestinal anastomosis. However, the effectiveness of surgical treatment is often temporary, and the disease can recur. It is best to continue drug therapy after surgery, as this reduces the risk of exacerbation of CD.

Forecast

Crohn's disease is a chronic disease for which there is no cure. It is characterized by alternating periods of exacerbation and remission. With treatment, most people can keep the disease under control and the mortality rate is relatively low. With Crohn's disease, the prognosis for most patients is relatively benign; normal duration life. However, this disease is associated with a small increase in the risk of developing cancer of the small intestine and colon.

Crohn's disease is inflammatory disease, affecting mainly the thin and colon. Its symptoms may subside or worsen. Although Crohn's disease currently has no cure, there are many medications available to help control the severity of symptoms and prevent flare-ups. This disease can be accompanied by the development of serious complications, which sometimes require surgical treatment.

Which doctor treats Crohn's disease?

In the process of diagnosing and treating Crohn's disease, consultation may be necessary:

• Immunologist– to determine the nature and degree of dysfunction of the immune system.
• Hepatologist– with liver damage and the development of cholelithiasis.
• Nephrologist– in case of kidney damage and the development of urolithiasis.
• Hematologist– with the development of anemia, when there is a need to transfuse the patient with red blood cells or other blood products.
• infectious disease specialist– when identifying signs of intestinal infection or when pathogenic microorganisms are isolated from feces.
• Surgeon– with the development of complications requiring surgical treatment (for example, perforation of the intestinal wall, massive intestinal bleeding).
• Dermatologist– in the presence of complications from the skin.

Drug therapy for Crohn's disease

Treatment of Crohn's disease with medications

Diet for Crohn's disease

• Eat small meals 5-6 times a day. This regimen prevents overstretching of the stomach and intestines, promotes better interaction food products with digestive enzymes and ensures optimal absorption of nutrients.
• Eat food no later than 3 hours before bedtime. Overeating at night leads to retention of eaten foods upper sections digestive tube, which can cause belching and heartburn.
• Take food only when it is warm. Eating cold foods can cause muscle spasms at the stomach level, which can cause increased pain. If the oral cavity, esophagus or stomach is affected, hot food can injure the already inflamed mucous membrane, which will cause complications.
• Drink enough liquid. Patients with Crohn's disease are recommended to drink at least 2 - 2.5 liters of fluid per day, and in the presence of diarrhea or vomiting - up to 3 - 3.5 liters (to compensate for body losses and maintain the volume of circulating blood at the desired level).

Surgery for Crohn's disease

The absolute indications for surgery are:

• Perforation of the intestinal wall, accompanied by the release of feces into the abdominal cavity and the development of peritonitis (inflammation of the peritoneum).
• Massive intestinal bleeding.
• Transition of the inflammatory process to the urinary tract (formation of fistulas).

In the postoperative period, the entire range of therapeutic and preventive measures indicated for patients with Crohn's disease.

Treatment of Crohn's disease with folk remedies

The following may be used to treat Crohn's disease:

• Enema with a decoction of marshmallow root. To prepare the decoction, add 4 tablespoons of crushed raw materials to 1 liter of water, bring to a boil and boil for 3 to 5 minutes, then cool for 2 hours. Use warm to wash the intestines 1 – 2 times a day. It has a local anti-inflammatory effect, which is effective for Crohn's disease of the large intestine.
• Infusion of yarrow. The essential oils contained in this plant and tannins determine its anti-inflammatory, anti-allergic, wound-healing and antibacterial effect, which determines the effectiveness of the drug both during exacerbation of the disease and during remission. To prepare the infusion, 5 tablespoons of crushed raw materials need to be poured with 500 milliliters of warm boiled water and heat in a water bath (without boiling) for 15 - 20 minutes. Strain and take 2-3 tablespoons warm 30 minutes before each meal.
• Infusion of chamomile flowers. This plant has antispasmodic (eliminates spasm of the intestinal muscles), anti-inflammatory, antibacterial and wound-healing effects. The infusion should be prepared directly on the day of use. To do this, pour 2 tablespoons of raw material into 1 glass of hot boiled water and heat in a water bath for 20 minutes. After cooling, take 1-2 tablespoons orally 3-4 times a day 30 minutes before meals. Also, the resulting infusion can be used for intestinal lavage (in the form of an enema).
• Infusion of celandine herb. When used orally, it has an anti-inflammatory and antibacterial effect at the level of the mucous membrane of the stomach and intestines. It also has a pronounced immunosuppressive and cytostatic effect (that is, it inhibits the formation of leukocytes and their destruction at the site of inflammation, which reduces the activity of the inflammatory process). In addition, it has a certain antispasmodic effect at the level of the muscular layer of the gastrointestinal tract, biliary and urinary tract. To prepare the infusion, add 4 tablespoons of crushed raw materials to 400 ml of boiled water and heat in a water bath for 15 minutes. After this, cool to room temperature, strain and add another 100 ml of warm boiled water. Take 2 tablespoons orally 3-4 times a day before meals.

Complications and consequences of Crohn's disease

Crohn's disease can be complicated by:

• perforation of the intestinal wall;
• fistula formation;
• the formation of abscesses;
• massive intestinal bleeding;
• intestinal obstruction;

• toxic expansion of the colon (toxic megacolon);
• malignancy;

Fistula formation
Fistulas are pathological channels between the affected part of the intestine and another organ or tissue. This happens due to the fact that the inflammatory process destroys all layers of the intestinal wall and spreads to the organ that is directly adjacent to the affected area of ​​the intestine (this could be the bladder, abdominal wall, another loop of intestine, and so on). The result of such a pathological message may be the transfer of feces from the intestinal cavity to other organs and tissues, which is an indication for surgical treatment (removal of the fistula and cleaning of the organ contaminated with feces).

Abscess formation
An abscess is a limited cavity filled with purulent masses. In Crohn's disease, abscesses usually form in the perianal area and are a consequence of the development of a pyogenic infection. Thanks to the activity of the immune system, the source of infection is limited (many leukocytes accumulate around it, which form a kind of capsule that prevents further dissemination infections). Next, neutrophils (a type of immune system cell) begin to migrate to the site of infection and absorb (destroy) pyogenic microorganisms, which leads to the formation of pus.

If an abscess is detected, it is indicated to open it (in a sterile operating room), remove purulent masses and wash the resulting cavity with antiseptic solutions (for example, a solution of furatsilin in a concentration of 1:5000).

Massive intestinal bleeding
Damage to a large blood vessel can lead to profuse intestinal bleeding. This condition requires emergency surgery to save the patient's life. After an incision in the anterior abdominal wall, the bleeding vessel is first located and compressed, after which the damaged section of the intestine is removed.

Intestinal obstruction
The cause of intestinal obstruction can be adhesions characteristic of Crohn's disease (the growth of scar tissue in the intestinal cavity). The clinical picture of intestinal obstruction is determined by the level of blockage of the intestinal lumen. If the small intestine is affected, stool and gas will be produced for some time. When the final sections of the large intestine are affected, feces and gases are not released at all, the patient’s abdomen swells and becomes sharply painful. Upon examination and palpation (palpation), it is possible to determine excessively strong peristaltic waves up to the site of obstruction (blocking the lumen) and a complete absence of peristalsis after it. Lack of effectiveness from conservative measures (intestinal lavages) is an indication for urgent surgery.

Toxic expansion of the colon
This condition characterized by inflammatory damage to all layers of the intestinal wall in a certain area of ​​the large intestine, which leads to disruption of the regulation of its tone, excessive relaxation muscle fibers and expansion of the affected department. The peristaltic activity of the intestine completely disappears, as a result of which feces accumulate in stretched loops. A few hours after the onset of the disease, the barrier function overstretched intestinal wall, as a result of which toxic substances from the intestinal lumen begin to be absorbed into the bloodstream. This causes the appearance of symptoms of severe intoxication (increased body temperature more than 38 degrees, increased heart rate more than 120 per minute, muscle and headaches, and so on).

At clinical examination pronounced flatulence (bloating, developing due to the accumulation of gases in distended intestinal loops), protective tension of the abdominal muscles and a complete absence of peristalsis noise are detected. The diagnosis can be confirmed by a survey radiography of the abdominal cavity, which reveals dilated loops of the large intestine filled with gases.

If within 24 hours after establishing this diagnosis, conservative treatment (including the use of antibiotics, hormonal anti-inflammatory and detoxifying drugs) does not give positive results– surgical treatment is indicated (removal of the affected area of ​​the colon).

Malignancy
Impaired activity of the immune system in combination with a long-term progressive inflammatory process at the level of the intestinal wall creates favorable conditions for the formation of malignant (tumor) cells. The process of malignancy is characterized by a decrease in the severity of pain, digestive disorders (frequent diarrhea and constipation) even during remission of the underlying disease. An X-ray examination of the abdominal cavity may reveal a tumor-like formation blocking the intestinal lumen. Invasive research methods (biopsy - intravital removal of a piece of tissue in order to study its cellular structure) are contraindicated, since during the collection of material, tumor cells can enter damaged blood vessels and spread throughout the body.

When a tumor is detected on early stages Surgical treatment is indicated - removal of the malignant neoplasm and normal intestinal tissue at a distance of several centimeters on both sides of it, as well as removal of regional lymph nodes (into which tumor cells could penetrate). With the development of metastases (spread of tumor cells to other organs and tissues), chemotherapy and symptomatic treatment are indicated.

Osteoporosis
This term refers to a chronic disease characterized by a violation metabolic processes in the bones, which leads to a decrease in their strength. The cause of osteoporosis in Crohn's disease is a violation of the intestinal absorption of microelements (calcium, magnesium, phosphorus, fluorine) and vitamins (D, A, C, E), necessary for the normal growth, development and functioning of bone tissue.

Main clinical manifestations Osteoporosis is a pathological fracture of bones that occurs when exposed to minor loads (which normally do not cause any damage). Treatment of the disease is based on complete and balanced diet(containing all the necessary microelements and vitamins). If this is not possible (for example, if primary departments small intestine), these substances must be administered into the body parenterally (intravenously or intramuscularly, bypassing the gastrointestinal tract).

Crohn's disease and pregnancy

However, we should not forget that Crohn's disease is a chronic disease. autoimmune diseases, occurring with damage not only to the gastrointestinal tract, but also to other organs and systems. That is why it is extremely important for both spouses, at the stage of pregnancy planning, to undergo a thorough examination, identify all kinds of organ disorders and carry out their early correction.

The effect of Crohn's disease on conception
During the period of remission, a woman’s ability to conceive is practically not impaired. Difficulties may occur due to the development of complications of the disease itself or as a result of previous treatment. For example, the development of adhesions in the abdominal cavity (often observed after surgical treatment of Crohn's disease) can lead to compression of the fallopian tubes, which will make the process of conception impossible. In this case, it is recommended to first treat the existing complications and then try to conceive a child again.

The effect of Crohn's disease on the male body
The presence of this disease usually does not affect a man’s ability to conceive a child (even during an exacerbation period). However, when planning a pregnancy, a man should consult a doctor to review and possible change ongoing treatment. The fact is that sulfasalazine (an anti-inflammatory drug often used to treat and prevent relapses of Crohn's disease) has an inhibitory effect on the process of synthesis of male germ cells in the testicles, which can cause oligospermia (reduced amount of ejaculate) and male infertility.

The solution to this problem is to replace sulfasalazine with another anti-inflammatory drug at least a month before the expected conception. Also, three months before conception, both partners should stop taking immunosuppressants and cytostatics (methotrexate, azathioprine and other drugs from this group), as they have a toxic effect on the germ cells and make pregnancy impossible.

What difficulties may arise during pregnancy?
Many studies conducted in this area have established that if conception occurred during the period of remission of the disease, the probability of its exacerbation during gestation does not exceed 30%. The cause of exacerbation in this case may be the impact of predisposing factors on the female body (due to poor diet, development of intestinal infectious diseases, smoking, etc.) or refusal to take preventive treatment (many women, fearing harm to the child, refuse to take any medications). It's important to note that possible consequences when the disease worsens during pregnancy, they are much more dangerous than the consequences of taking prophylactic doses anti-inflammatory drugs.

Exacerbation of the disease during pregnancy is an unfavorable prognostic sign. In addition to a lack of nutrients (due to impaired absorption in the intestines) and anemia (resulting from frequent intestinal bleeding), immune complexes, which can damage blood vessels in various organs, including the placenta. This condition is further worsened by the fact that a pregnant woman cannot be prescribed the full range of anti-inflammatory drugs (including cytostatics and immunosuppressants). That's why when active form Crohn's disease increases the risk of spontaneous abortion or stillbirth.

Is it possible to give birth with Crohn's disease?

If in the third trimester of pregnancy there is increased activity inflammatory process, this is also an indication for cesarean section. If during this period complications develop that pose a danger to the mother’s life (intestinal bleeding, intestinal perforation), the issue of their surgical treatment is resolved medical commission and by the patient herself individually in each specific case.

Prevention of Crohn's disease

Secondary prevention of Crohn's disease includes:

• Elimination of risk factors. The patient should follow a diet throughout his life (in particular, he should avoid foods that irritate the intestinal mucosa and often causing development allergic reactions). Also, such patients are recommended to stop smoking and promptly and fully treat infectious intestinal diseases.

• Prophylactic use of drugs. WITH for preventive purposes the same medications are prescribed that are used to treat exacerbations of the disease, but in smaller doses (mesalazine 2 grams per day, methotrexate 25 mg, used daily for 3 to 4 months, and so on). Preventive treatment is prescribed in repeated courses at certain intervals, which should ensure stable remission diseases throughout the patient's life.
• Regular consultations with a gastroenterologist. Even if the patient has developed complete remission of the disease, he is recommended to visit a doctor and undergo necessary examinations at least once a year (in order to promptly identify signs of possible activation of the pathological process). When symptoms of the disease appear, as well as during the first year after surgical treatment of Crohn's disease, you should visit a gastroenterologist every 3 to 6 months.
• Timely treatment of relapses of the disease. When the first signs of Crohn's disease appear (even while taking prophylactic doses of anti-inflammatory drugs), you should consult a doctor as soon as possible, who will conduct the necessary examinations and prescribe a course of treatment in order to promptly prevent the progression of the inflammatory process and damage to the tissues of the intestinal wall.

Prognosis for Crohn's disease

The quality of life of people with Crohn's disease is determined by:

• Time of onset of the disease. The earlier the first clinical symptoms appeared, the greater the likelihood of an aggressive course of the disease and an unfavorable outcome.
• The severity of clinical manifestations. Frequent exacerbations of the disease, accompanied by severe damage to the intestines and other organs, are an unfavorable prognostic sign.

• Time to start treatment. The sooner the patient starts taking medications, the less tissue will be damaged by the inflammatory process and the more favorable the prognosis will be.
• The effectiveness of the treatment. If, while taking the entire spectrum of medications (anti-inflammatory drugs, immunosuppressants, etc.), the activity of the inflammatory process does not decrease (or decreases slightly), the prognosis is unfavorable.
• The degree of patient cooperation. This point is extremely important, since if the patient does not strictly follow the doctor’s instructions, interrupts treatment and exposes himself to risk factors (continues to smoke, does not follow a diet), the prognosis for him can be very sad (even death due to for developed complications).

• profuse (massive) intestinal bleeding;
• toxic megacolon;
• acute intestinal obstruction;
• development of a malignant tumor;
• intestinal perforation and development of peritonitis;
• postoperative complications (bleeding, infections, etc.).