I am focusing my main efforts for the Year of the Tiger on Crohn’s disease!
After browsing through a large number of international Crohn’s websites on the evening of the first day of the year, the phrase that struck me most was: Living with Crohn’s disease. The direct translation means living with Crohn’s disease; the Italian translation means living with Crohn’s disease. I have not yet come up with an ideal sentence according to the translation in literature or movies and dramas. For the time being, I will use the phrase “dancing with Crohn’s disease” to make up for it. Crohn’s disease is not a good thing, and dancing with it is really painful. But according to all the literature and experts, the cause of Crohn’s disease is still unknown, and there is no complete cure. The only way is to control the symptoms and finish the journey of life with this disease. Ren Jianan, Department of General Surgery, Nanjing Military General Hospital
According to the Crohn’s and Colitis Foundation of America (CCFA) website, the goals of Crohn’s disease treatment should be to
1. Achieving remission (Achieving remission): defined as asymptomatic
2. Maintaining remission: defined as preventing symptom flare-ups
3. Improving quality of life: defined by the individual’s feelings
When these three objectives are met, it is considered to be a dance with Crohn’s. The next step is also clear.
1. Get remission
Recurrence of Crohn’s is divided into symptom recurrence, endoscopic recurrence and surgical complication recurrence. As surgeons, we will focus on the most effective and safe ways to treat surgical complications. Surgical complications of Crohn’s disease include stenosis, obstruction, perforation and fistula. These complications also entail malnutrition, infection and organ dysfunction. Malnutrition includes both macronutrient deficiencies and micronutrient deficiencies, the latter of which are more commonly overlooked, such as anemia and coagulation disorders. And these will increase the risk of surgical treatment. Micronutrient deficiencies require an early diagnostic approach.
The most common infection is abdominal infection. We have found that in the treatment of Crohn’s disease, people attribute the febrile symptoms caused by infection to Crohn’s disease and keep relying on hormones and immunosuppressive drugs to control the symptoms, thus aggravating the infection and eventually leading to worsening of the disease and treatment failure. Surgery also has no way to help.
Early recognition of infectious complications of Crohn’s disease in combination is a priority. The surgical consultation needs to address this same issue. The most common infections in Crohn’s disease are still predominantly abdominal infections, and the correct evaluation of the application of diagnostic imaging in the surgical complications of Crohn’s disease requires further study with a view to early and accurate treatment of infectious complications while reducing the cost of treatment. Systemic infections should be a further development of abdominal infections and should also be noted.
2. Maintenance of remission
Our study shows that without any preventive measures, the chance of recurrence of Crohn’s disease is significantly higher. How to maintain remission and prevent recurrence. After the recurrence of symptoms, it is an important task for surgeons to block its further recurrence to surgical complications. Based on the experience of digesting and applying traditional medicines of Western medicine, the role of the Chinese herbal medicine Regia in maintaining remission of Crohn’s disease should also be emphasized and elucidated.
Our experience in recent years has shown that enteral nutrition can prevent and control the recurrence of Crohn’s disease. Nutritional support for Crohn’s disease initially began by accident. It was when surgeons treated patients with Crohn’s disease who had comorbid malnutrition. A period of parenteral nutrition was given first, followed by surgery. As a result, it was discovered that the Crohn’s lesion could not be found during surgery. This opened up a new chapter in the nutritional treatment of Crohn’s disease. The main mechanism of parenteral nutrition for Crohn’s disease is based on an important pathogenesis of Crohn’s disease, which is the blocking of foreign antigens from stimulating the mucosa of the gastrointestinal tract. However, parenteral nutrition is too expensive and not easy to implement at home for a long period of time, and also involves certain risks. tPN can be used as a means to induce remission, but is not appropriate as a method to maintain remission.
In fact, in the field of clinical nutrition, the indications for total enteral nutrition are approaching infinitely to total parenteral nutrition. Therefore, there are experts who try to use enteral nutrition to induce remission. From the reports in the literature, some success has been achieved, and remission can be induced and maintained. We have applied this approach in the clinic and controlled the symptoms in some patients with acute attacks. Applying it to induce remission is also not a problem in China. However, the effect needs to be verified for long-term application. Factors such as cost and patient compliance must also be considered. Now it is to prove whether partial enteral nutrition to maintain remission is effective.
3. Improvement of quality of life
This should be the work of other physicians. However, Academician Lai suggested that the focus should be on specialized treatment. This is, not only treat the patient as a person, but also treat the disease as from a whole. We cannot treat surgical complications and send them to other doctors for treatment. You don’t care about yourself, so you may miss the best time for surgical treatment. But this task is controversial, we underwrite these things, the internal medicine doctors to do what. It is probably best to form a consortium of medical surgeons including imaging and pathologists (MDT) to find some like-minded doctors from various specialties to treat Crohn’s disease together. Surgeons are more likely to apply superb surgical procedures to address surgical complications.
However, there are some questions worth exploring, such as what should I eat in the future? Can a patient with Crohn’s disease have children? This is a topic on which we do not have much experience or which is very controversial. After all, Crohn’s disease has only started to be discovered more and more in China in the last decade. Today, there is a lot of experience from abroad, so I will try to take a good look at them and summarize them in one of these days.
Message
The firecrackers are going off again, I don’t know if they are inviting the God of Wealth or some other gods. I wish there was a custom of sending the god of plague to make people pay attention to our environment, to our food hygiene, to our living habits. Care for everyone who is sick, send the God of Plague away, and invite the God of Health to come. I think, as our economic life improves, we may one day, really have a this custom.
There is one habit that patients with Crohn’s disease must pay attention to, and that is: quitting smoking. This is a fact that has been affirmed by Western epidemiologists. Our question is: how to avoid second-hand smoke. I often hear the gloating conclusion of some smokers that so-and-so smoked and also got lung cancer. Trying to change some habits is really not easy.
This is tentatively my New Year’s message, and a New Year’s resolution of sorts. I hope it won’t be like an article in New Concept English about how New Year’s resolutions are getting smaller and smaller. So, I’m publishing it on for everyone to monitor.
We can definitely live each day with Crohn’s disease. With everyone’s efforts, of course!