Health education on Crohn’s disease Q&A
1. Can Crohn’s disease be prevented?
The cause of Crohn’s disease (CD) is not clear, and there are no preventive measures. However, the following aspects can reduce the severity of CD (1) quit smoking Current research shows that smoking can aggravate the activity of CD, so CD patients must quit smoking; (2) maintain a happy mood, adequate sleep, and a good state of mind. Overexertion, mental stress, and insomnia can trigger the aggravation of CD; (3) seek medical attention as soon as possible once symptoms are present, early treatment is beneficial to improve the prognosis of patients; (4) standardize treatment, follow the doctor’s treatment plan in a timely manner according to treatment norms, and step up communication with the doctor during the treatment process, who will develop an individualized treatment plan according to the patient’s efficacy and adverse reactions, and do not easily give up effective Do not give up the effective treatment easily.
2.What is Crohn’s disease?
Crohn’s disease (CD) is a chronic inflammatory disease that occurs in young adults and has an unknown cause.
It is called inflammatory bowel disease (IBD) together with ulcerative colitis. It can involve all segments of the digestive tract from the oral cavity to the anus, with a segmental or jumping distribution, and the distal small intestine and colon are most commonly involved, which can be combined with extraintestinal manifestations of rash, arthritis, iritis, and complications such as anal fistula, perianal abscess, and intestinal obstruction. The disease was first described by Crohn’s disease in 1932, which was translated into Chinese as Crohn’s disease and named as “clonorchiasis”, “granulomatous enteritis”, “segmental enteritis “etc. The current name is Crohn’s disease, abbreviated as CD.
3.What are the symptoms and manifestations or physical discomfort of Crohn’s disease?
Clinical manifestations of Crohn’s disease vary greatly among individuals. Patients commonly present with abdominal pain, diarrhea, wasting, and may have abdominal masses, fistula formation and intestinal obstruction, accompanied by fever, anemia, systemic manifestations of nutritional disorders, and extraintestinal damage to joints, skin, eyes, oral mucosa, liver, etc. The age of onset is usually between 18 and 35 years, with slightly more males than females (approximately 1.5:1 male:female) [1], and patients with severe disease have a poor prognosis of persistent disease. These symptoms can also be seen in other diseases, where mild cases are treated as enteritis and the diagnosis is delayed, and many patients do not receive a clear diagnosis for many years, often requiring surgery when the diagnosis is late. Therefore, it is important for young patients to pay enough attention to the above-mentioned symptoms and come to the hospital in time to obtain early diagnosis and treatment, to improve the quality of life of patients and to improve their prognosis.
3.What factors can cause Crohn’s disease?
Crohn’s and ulcerative colitis are collectively called inflammatory bowel disease, and their pathogenesis is similar.
The exact pathogenesis of Crohn’s disease is not clear, but may be due to the interaction of multiple factors, including environmental, genetic, infectious and immune factors [2]. (1) environmental factors: the incidence of IBD continues to increase, with a high prevalence in the economically developed West, and with the development of China’s economy, the incidence of the population in China is gradually increasing [3], which may be related to environmental factors such as changes in diet structure and smoking; (2) genetic factors: there is a family aggregation phenomenon in the development of IBD, suggesting that the disease is related to genetic factors, and hundreds of IBD susceptibility genes have been found in Western countries, commonly Hundreds of IBD susceptibility genes have been found in Western countries, commonly NOD2, IL-23R, ATG16L1, HLA, TNFSF15, etc. Chinese and Western IBD patients have the same or different genetic characteristics, the same ones are IL-23R, HLA, TNFSF15, etc., and the different ones are NOD2, CTLA4, MIC, etc. [4]; (3) Infectious factors: intestinal flora plays an important role in the pathogenesis of IBD, but no specific biological pathogens were found to have a constant relationship with IBD. Some studies have shown that Mycobacterium avium paratuberculosis and measles virus are associated with CD. It is currently believed that the development of IBD is related to an abnormal immune response of the patient against his or her own normal flora. (4) Immune factors: The intestinal immune system plays an important role in the occurrence, development and regression of IBD. Various inflammatory factors and mediators released in the immune response, including IL-2, IL-4, INF-γ, TNF-α, TNF-β, etc., are involved in the inflammatory response.
4.Why does Crohn’s disease occur?
It is currently believed that environmental factors act on genetically susceptible patients and, with the participation of intestinal flora, initiate the intestinal immune and non-immune systems, ultimately leading to the immune response and the inflammatory process [2], which ultimately leads to the onset and development of Crohn’s disease.
5.How to diagnose Crohn’s disease?
The clinical manifestations of Crohn’s disease are often confused with other diseases, especially with intestinal tuberculosis, which is more difficult to differentiate.
The diagnosis depends mainly on clinical manifestations, colonoscopy or small intestine microscopy, CT/MR intestinal imaging (CTE/MRE) and pathological findings, and exclusion of various intestinal infectious or non-infectious inflammatory diseases and intestinal tumors. The diagnosis is generally made according to the following points: those with clinical manifestations are considered suspicious, and further examinations including colonoscopy or small bowel microscopy and CTE/MRE are arranged; the above-mentioned manifestations are consistent with the characteristics of Crohn’s disease and can be diagnosed, and the above-mentioned patients with pathological confirmation are confirmed patients. The diagnosis will be clarified based on the effect of treatment and changes in the disease. If there is confusion with intestinal tuberculosis but a tendency to intestinal tuberculosis, anti-tuberculosis treatment should be given for 8-12 weeks to further clarify the diagnosis based on the efficacy of the treatment [1].
6. Which diseases are easily confused with Crohn’s disease or which diseases need to be differentiated?
Crohn’s disease needs to be differentiated from infectious or non-infectious inflammatory diseases of the intestine and intestinal tumors, especially from intestinal nodules, intestinal lymphomas, intestinal tumors, and intestinal tumors.
In particular, it needs to be differentiated from intestinal nodules, intestinal lymphoma, intestinal leukoaraiosis, ischemic enteritis, drug-induced enteropathy, eosinophilic enteritis, and infectious enteritis such as acute bacterial dysentery, amebic enteropathy, schistosomiasis, and Clostridium difficile infection. The above differentiation mainly relies on epidemiological history, stool culture, mucosal manifestations under colonoscopy and pathological changes.
7.What tests can help to confirm the diagnosis of Crohn’s disease?
In order to clearly diagnose Crohn’s disease, in addition to clinical symptoms and signs, the following auxiliary tests are often required for diagnosis.
(1) Laboratory tests: anemia, increased sedimentation and C-reactive protein, positive fecal occult blood, decreased serum albumin; negative stool culture; (2) Endoscopy: including colonoscopy, small intestine microscopy, small intestine capsule endoscopy and gastroscopy, CD manifests as segmental lesions, longitudinal ulcers and cobblestone-like appearance. (3) Imaging examinations: including CTE/MRE, barium enema and small intestine barium angiography and abdominal ultrasonography. Intestinal lumen narrowing, intestinal wall thickening, intestinal fistula, abdominal abscess, enlarged mesenteric lymph nodes, and increased, dilated, and tortuous mesenteric vessels can be seen. (4) Histopathological examination: histologically, Crohn’s disease is characterized by A non-caseous necrotizing granuloma, which can occur in all layers of the intestinal wall and local lymph nodes; B fissure-like ulcer, the depth of the ulcer can reach the submucosa or even the muscle layer; C total inflammation of the intestinal wall Inflammation can spread to the whole layer of the mucosa, accompanied by lymphoid tissue hyperplasia and fibrous tissue hyperplasia.
8.How to treat Crohn’s disease?
The goals of treatment for Crohn’s disease are to induce remission and maintain remission, to prevent and control complications (including gastrointestinal bleeding, obstruction,
perforation and carcinoma), and to improve the quality of survival. Treatment is divided into two phases: treatment in the active phase and maintenance treatment in remission. Pharmacological treatment must be accompanied by smoking cessation because smoking significantly reduces the efficacy of drugs, increases the risk of surgery and the recurrence rate after surgery [5], and enhances nutritional support for patients with CD. Commonly used drugs include aminosalicylic acid agents, glucocorticoids, immunosuppressive agents including azathioprine or methotrexate, and biological agents including infliximab. Salicylic acid agents, including salazosulfapyridine, balsalazide, and mesalazine, are mostly used for the treatment of mild CD. Moderate to severe CD often requires treatment with glucocorticoids, immunosuppressive agents, and even biologic agents. When the disease is controlled, drug maintenance therapy is still needed. Glucocorticoids cannot be used as a long-term drug to maintain remission, other classes of drugs can be used, and the course of treatment salicylates is 3-5 years or even longer, and the course of immunosuppressive agents and biological agents has not yet reached a consensus. Patients with gastrointestinal hemorrhage, perforation, intestinal obstruction or cancer need to be treated surgically. Postoperative patients are still at high risk of recurrence, so maintenance therapy is still needed after surgery, and the choice of drugs is the same as for non-surgical patients.
9.What are the precautions for Crohn’s disease drug treatment and prevention?
The choice of medication for Crohn’s disease requires a reasonable selection of the patient’s condition and close observation of adverse reactions during medication. During the course of medication
The liver and kidney function should be tested during the course of medication. Glucocorticoids are the mainstay of treatment for IBD and may inhibit the inflammatory response of the body through various pathways including inhibition of inflammatory factor production and suppression of leukocyte function. It is mainly used to induce remission of CD. In the process of applying hormones, it is important that the dose should not be reduced too quickly to prevent rebound, and the hormones should be gradually reduced and discontinued within 3-4 months, and it should not be used as maintenance medication. Pay attention to the adverse effects of hormones, mainly metabolic disorders including hyperglycemia, hyperlipidemia, hypokalemia, sodium and water retention, opportunistic infections and osteoporosis, etc. Especially for patients with diabetes, hypertension, hyperlipidemia and osteoporosis, the condition may be aggravated and needs to be monitored and the corresponding treatment measures for the primary disease should be adjusted if necessary. Budesonide oral formulation has little intestinal absorption and high first-pass metabolism, with fewer systemic adverse effects, but its efficacy is slightly inferior to that of traditional glucocorticoids. Immunosuppressive agents are available for hormone-dependent or resistant patients. Immunosuppressants are administered in small doses, and peripheral blood leukocytes and their classification, liver and kidney function are closely monitored for timely therapeutic measures. The drug has a slow onset of action and takes 2-4 months to achieve satisfactory efficacy and control of disease activity. If the drug is ineffective for 3 months, consider the drug resistance. Before applying the biological agent infliximab, it is necessary to exclude tuberculosis infection, lymphoma and other malignant tumors, exclude hepatitis B virus, cytomegalovirus infection, patients should not be combined with severe cardiac insufficiency, because infliximab can induce the spread of nodules, easy to combine infection, aggravate cardiac insufficiency, increased risk of developing lymphoma, allergic reactions, infusion reactions and other adverse reactions can occur during the use of the drug, it is necessary to observe Adverse reactions should be observed and dealt with in a timely manner. The treatment plan should be adjusted according to the efficacy of the patient and the severity of the adverse reactions.
It should be emphasized that if there are no serious adverse reactions, it is especially important to adhere to the efficacy of the drug treatment, do not easily change or stop the effective treatment plan, and strengthen the communication with the doctor is very important for the patient’s treatment.
10.What should be the nutritional support and dietary management during the prevention and treatment of Crohn’s disease?
Patients with Crohn’s disease are often malnourished due to insufficient intake, malabsorption, increased energy consumption and loss.
Nutritional support therapy can not only improve the nutritional needs of the body, improve the nutritional status of patients, but also regulate their inflammatory response, so nutritional support has the same important role as drug and surgical treatment, and is an important treatment tool for CD. First of all, enteral nutrition can play an important role in maintaining the immune barrier of intestinal mucosa and stabilizing the intestinal flora. Enteral nutrition has a role in inducing remission in patients with Crohn’s disease and also in maintaining remission, while improving the nutritional status of patients, which is an advantage that no other drug has, especially for adolescent and pediatric patients, and in European countries such as the United Kingdom, enteral nutrition is the first-line treatment option for new cases of Crohn’s in children [6]. (1) elemental meals composed of crystalline amino acids as nitrogen source (VIVO, ELENDO), which can be absorbed without digestive process; (2) protein hydrolysis products (Bepril); (3) non-elemental meals composed of intact proteins as nitrogen source (Energizer, Energizer). Enteral nutrition can be considered for patients who are not suitable for enteral nutrition in the following conditions. It mainly includes those who cannot have enteral nutrition for gastrointestinal bleeding, obstruction, perforation and toxic megacolon, in addition, it can be used for those who have deteriorated or severe disease, short bowel syndrome and preoperative correction of malnutrition can be given parenteral nutrition. Regarding the dietary regulation of patients: emphasize dietary regulation and nutritional supplementation, generally give a highly nutritious and low residue diet, appropriate multivitamins such as folic acid, vitamin B12 and trace elements [2]. Spicy and excessively cold foods are prohibited, and for lactose intolerant people dairy products are prohibited. For those with diarrhea reduce the intake of fiber.