When your doctor tells you that you have a disease called “Crohn’s disease,” maybe you and your family have never heard of it. Maybe your doctor tells you that the disease may not be curable at this time, that it may last a lifetime, and that you may need long-term medication.
Doubting your doctor’s diagnosis, bouncing around for confirmation, overwhelm, anxiety, worry, and fear are all natural reactions at first, and the next thing you know, you have a bunch of questions: What is Crohn’s disease? How is Crohn’s disease treated? Can it be cured? What is the prognosis? Why did I get this disease? Is it related to what I eat? What can I eat in the future? Can I work and live normally? Do I need surgery? Will it become cancerous?
I. What is Crohn’s disease?
Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) with symptoms such as abdominal pain, diarrhea, fever, poor appetite, and weight loss. These symptoms may not occur simultaneously, or may be asymptomatic in remission. Crohn’s disease can involve any part of the entire GI tract from the oral cavity to the anus, but most often involves the terminal segment of the ileum.
No one can say exactly what causes Crohn’s disease or predict how the disease will affect a particular individual. Perhaps some patients remain asymptomatic for many years, while others have frequent relapses. In short, Crohn’s disease is a chronic, recurrent intestinal disease that can be managed with treatment and is not yet curable. This means that the disease is long-term, but not fatal. Most people with Crohn’s disease are able to live peacefully with the disease and can live, study and work normally.
II. Epidemiological characteristics of Crohn’s disease
In the United States there are probably about 15,000 new diagnoses of Crohn’s disease each year, and the exact number in China is not known at this time, but there are more and more patients being diagnosed. Crohn’s disease can develop at any age, but tends to occur around 15-25 years of age, and can also develop at any age, including in elderly people or children over 70 years of age. Crohn’s disease affects more people in developed countries and more in urban than rural areas. About 20% of people with Crohn’s disease have a first-degree relative with inflammatory bowel disease. Children of people with Crohn’s disease may have a higher risk of developing the disease than the general population, but it is not necessarily passed on to the next generation.
III. Causes of Crohn’s disease
The exact cause of the disease is still unknown. Most experts believe it is the result of multiple factors involved. Three possible factors are included: genetic factors, transitional immune response and certain factors in the environment.
The patient may have a single or multiple genes causing susceptibility to Crohn’s disease, while some factor in the environment triggers an abnormal immune response in the body, rejecting and attacking the foreign invaders, which at the same time damages its own intestinal tract, and this is where the inflammation begins. Then the body’s immune system continues to attack and the inflammation continues to develop destroying the intestinal mucosa thus causing the symptoms associated with Crohn’s disease.
Fourth, the symptoms of Crohn’s disease
1, in general, is divided into gastrointestinal symptoms and extraintestinal symptoms, gastrointestinal symptoms include.
Abdominal pain, diarrhea, blood in the stool, etc. Symptoms vary from person to person, and performance varies at different stages. It can also cause weakness, anemia, weight loss, etc. In pediatric patients, it can also lead to growth retardation. Inflammation may form fistulas between the intestines or between the intestines and other organs such as the bladder, vagina or skin. Intestinal fistulas usually occur in the perianal area and you may notice mucus, pus or stool coming out of the fistula. Some patients also present with intestinal strictures, anal fissures, and perianal abscesses. Symptoms can be mild or severe, sometimes mild or severe, and there are acute episodes of activity with obvious symptoms, as well as periods of remission without symptoms.
2. Extra-intestinal manifestations include.
Red and itchy eyes, mouth ulcers, joint edema and pain, skin lesions, osteoporosis, urinary tract stones, and liver lesions. In some patients, extraintestinal manifestations may be the earliest manifestation of Crohn’s disease, even before the GI symptoms. In other patients, they may appear at the time of disease onset.
V. Classification of Crohn’s disease
Symptoms and complications vary depending on the site of digestive tract involvement, and the following are some of the subtypes of Crohn’s disease.
1, Crohn’s disease (granulomatous) colitis: only the colon is involved.
2. gastroduodenal Crohn’s disease: involving the stomach and duodenum (the first part of the small intestine)
3, ileitis: involves the ileum; ileocolitis, the most common type of Crohn’s disease, involves the ileum (the last part of the small intestine) and the colon; jejuno-ileitis: involves the jejunum (the upper part of the small intestine).
VI. Diagnosis of Crohn’s disease
Through clinical manifestations and physical examination by the physician, followed by laboratory tests: stool routine can exclude diarrhea caused by bacteria, viruses and parasites, and also reflects intestinal bleeding; nowadays, tests for Clostridium difficile are also done to exclude co-infection. Blood tests such as routine blood tests can clarify the presence of anemia, which in turn can reflect intestinal bleeding. In addition, routine blood tests can detect the presence of elevated white blood cells, which can also reflect the inflammatory status of the body. Blood sedimentation and C-reactive protein are also used to assess inflammation, and cytomegalovirus and tuberculosis infections are also examined.
Colonoscopy (and small bowel microscopy if necessary) is very important for the diagnosis of Crohn’s. The colonoscope allows the doctor to clearly visualize the specific inflammatory lesions in the intestine, including inflammation, bleeding, ulcers, and the extent of the lesions. During the examination, the doctor will also take a biopsy of the intestinal mucosa and refer it to a pathologist for a pathological diagnosis to differentiate it from other diseases and to clarify the diagnosis. For Crohn’s disease, the doctor will also perform a gastroscopy to determine the involvement of the upper gastrointestinal tract. CT or MRI of the small intestine is also routinely performed to assess the extent of disease involvement, fistulas, abscesses, etc. If there is an anal lesion, the doctor will also examine it by pelvic MRI, perianal ultrasound, etc.
VII. Treatment of Crohn’s disease
The current treatment for Crohn’s disease is mainly to control the development of the disease through drugs, and surgery can be considered if it cannot be controlled. These treatments can make the intestinal mucosal inflammation improve and the lesions heal, while relieving symptoms such as abdominal pain, diarrhea and blood in the stool. The basic goal of treatment is to eliminate symptoms and maintain asymptomatic remission, reducing the rate of surgery and hospitalization.
Patients are very different and no two people have the same disease, so treatment needs to be “tailored”. Therefore, his treatment may not be suitable for her, and you should seek professional advice to develop an optimal treatment plan for you.
VIII. Medication
The following five types of medications are most commonly used.
1. Aminosalicylic acid
These drugs include salazosulfapyridine, mesalazine, olsalazine, balsalazide, etc. They can be taken orally or by anal plugs or enemas and can relieve inflammation, and may be effective in the treatment of mild to moderate Crohn’s disease. However, there is growing evidence that these drugs have limited efficacy in the disease.
2. Glucocorticoids
These include prednisone and prednisolone, which can affect the process of inflammation and maintenance of the body, and suppress the body’s immune system. Commonly used in moderate to severe Crohn’s disease. They can be administered orally, by anal plug, enema or intravenously. Generally used for short-term induction of remission in acute attacks, not recommended for long-term maintenance treatment.
3. Immunomodulators
Including azathioprine, 6-mercaptopurine, methotrexate, etc.. These drugs control the development of inflammation by suppressing the immune system of the body. They are generally administered orally and start to take effect after about 3 months of administration. They are indicated for patients in whom aminosalicylic acid and hormone therapy have failed, and also reduce or eliminate dependence on glucocorticoids. Other drugs can be used to maintain remission when they are ineffective.
4. Biological agents
is a new class of drugs for the treatment of inflammatory bowel disease, including infliximab, which is indicated for patients with moderate to severe Crohn’s disease who are not sensitive to conventional drugs, patients with active anal fistula, patients with high-risk factors, etc. By blocking specific biological pathways thus reducing the inflammatory response, while keeping side effects to a minimum.
5. Antibiotics
Methotrexate, ciprofloxacin and other antibiotics may be effective when Crohn’s disease is complicated by infection (e.g., abscess formation).
For further medication it is recommended that you consult a specialist inflammatory bowel disease doctor. You will need to discuss with your doctor the efficacy and safety of various medications, the doses to be used, ways to monitor efficacy and side effects, etc.
Surgical treatment
Two-thirds to three-quarters of people with Crohn’s disease will require surgery during their lifetime.
Surgery becomes necessary when symptoms are not controlled by conservative drug therapy. Surgery may also be considered when other complications such as intestinal obstruction or intestinal abscesses occur. Typically, the diseased bowel and any associated abscesses are surgically removed, and the remaining two ends of the normal bowel section are then anastomosed. This procedure can result in the elimination of symptoms for several years, but Crohn’s disease can often recur at or near the anastomosis, making surgery difficult to cure the disease.
Ileostomy is used for colonic Crohn’s disease. When the surgeon removes the colon, the small intestine is pulled to the skin and stomaed so that stool can be emptied into a bag that hangs outside the abdomen. This stoma is often used for patients who cannot be anastomosed because of lesions in the rectum. The overall goal of the surgery is to preserve the bowel and improve the patient’s quality of life. Unlike surgery for ulcerative colitis, surgery for Crohn’s disease does not imply a cure. Treatment is to eliminate symptoms and maintain remission, and surgery can help.
X. Diet and nutrition for people with Crohn’s disease
You may think that you yourself ate any particular food that caused Crohn’s disease, but this may not be the case, and no exact food has been found to cause the disease. Once you have the disease, however, you can ease your symptoms, replace lost nutrients and promote recovery by paying attention to your diet. Smoking is strongly associated with Crohn’s disease, so it is important for people with Crohn’s disease to quit!
Ensuring a healthy diet with proper nutrition is very important to the treatment of ulcerative colitis. A healthy diet should include a wide variety of dietary components, protein-rich meat, fish, poultry and dairy products (if tolerated), etc., and carbohydrate-rich bread, cereals, starches, fruits and vegetables. Also, multivitamin supplementation can fill in the gaps in food intake. Limit the intake of dairy products in lactose intolerant patients and caffeine in patients with severe diarrhea. Patients also need to observe their tolerance to food and choose the right food for them.
Eleven, Crohn’s disease patients stress and emotions
Some people believe that people with a particular personality type are prone to Crohn’s disease or other inflammatory bowel disease. This is a wrong view. However, the organism and the mind are closely related, and emotional stress can affect the symptoms of Crohn’s disease as well as any other chronic disease. Although some patients may experience a relapse of Crohn’s disease after a traumatic experience, there is still no evidence that mental stress can cause Crohn’s disease.
Mental stress is likely a symptomatic response to the disease itself, so patients with Crohn’s disease should have the understanding and emotional support of their families and physicians. Although formal psychotherapy may not be necessary, some patients can be helped by talking to a specialist with knowledge of inflammatory bowel disease or general chronic disease.
Twelve, small life help
To make your life easier. There are a number of different ways to cope with the disease. For example, because you have abdominal pain or diarrhea, you may be afraid to appear in public. In fact, this is unnecessary. These situations can be handled as long as you make arrangements beforehand. For example, find out where the restrooms are located in restaurants, malls, theaters and transportation, and carry extra underwear or toilet paper with you. If you are traveling or going on business, you should tell your doctor in advance to prepare adequate medication.
Surviving Crohn’s disease
Dancing with Crohn’s disease is perhaps the most difficult time for patients when they first learn they have Crohn’s disease. This slowly changes over time. You can seek help from family, co-workers, friends, doctors and fellow patients to discuss your disease and your life together. There is no reason to give up the life you used to enjoy and aspire to. Keep a positive outlook. Learn all the ways to deal with your illness and share your knowledge with others. Persevere with treatment even when the disease is in remission. Dancing with the disease is a challenge, but we believe that with everyone’s efforts we can overcome the challenge, and we believe that medicine is evolving and a cure for Crohn’s disease will eventually be found.