Treatment of Crohn`s disease (Chronic cicatrizing enteritis) abroad
Crohn’s disease is a chronic one which is characterized by granulomatous (with the formation of nodules) transmural (affecting all layers of the wall) inflammation of the intestine. The pathology is often accompanied by complications. Crohn’s disease can lead to death if not treated with surgery.
Causes of Crohn’s disease
Etiology of Crohn’s disease remains unclear. It is assumed that this is an autoimmune illness.
Risk factors are:
- Genetic predisposition. 17% of patients have relatives also suffering from this disease. Gene mutations are detected associated with the increased risk of Crohn’s disease.
- Infectious factors mean the estimated impact of some viruses and bacteria on the likelihood of developing Crohn's disease.
- Age. Most often, pathology is diagnosed for the first time in young people under 35 years old. The second peak of incidence is after 60 years.
- Place of residence. Residents of Scandinavian countries are more often ill. High disease incidence is noted in Israel.
- Race. Europeans are more likely to get sick from this disease than Asians and Africans.
- Sex. More males ( 70-80% ) have this illness than females.
Symptoms of Crohn’s disease
Clinical manifestations of Crohn’s disease mainly depend on the location of the inflammatory process. Pathology can affect different parts of the small and large intestine. The most frequent location is the end section of the small intestine and the cecum of the large intestine (45% of patients).
The nature of the disease is chronic and recurrent. In most cases, symptoms are present or manifest themselves during periods beyond acute conditions.
The main intestinal symptoms of Crohn's disease are:
- Abdominal pain increasing after the meal
- Painful sensations when palpating the abdomen
- Presence of volumetric formation in the abdomen
- Blood in the stool
- Presence of undigested food, mainly fat in the stool
Extraintestinal symptoms of Crohn's disease are:
- Weight loss due to malabsorption of nutrients
- Anemia is a consequence of blood loss and impaired absorption of cyanocobalamin (vitamin B12)
- Inflammatory processes in the mucosa of the oral cavity, conjunctiva
- Arthritis (inflammation of the joints)
- Women can have irregular periods
The exchange of uric acid is broken. Therefore, patients often suffer with kidney stones. Oxalate stones are usually formed.
Disruption of bile salts reabsorption in the small intestine is also possible, which provokes the appearance of concrements in the gallbladder.
Diagnostics of the Crohn’s disease
Main laboratory diagnostics techniques to detect Crohn’s disease are:
- Coprogram (general stool analysis).
- Immunological blood test.
- Clinical and biochemical blood test.
Instrumental techniques help to confirm the diagnosis. Ultrasound gives rise to the suspicion of Crohn’s disease and its possible complications. Ultrasound shows bowel’s thickened walls, presence of the volumetric education, and an abscess in the abdominal cavity.
X-ray methods are used. Irrigoscopy involves retrograde introduction of a contrast agent into the intestines, after which the doctor takes a few pictures and determines the radiographic signs of Crohn's disease.
Endoscopic methods form the basis of diagnostics. Most patients undergo colonoscopy, which allows them to examine the intestines from the inside. Endoscopic diagnosis allows the doctor to study the mucous tissue, which enables a biopsy for histological examination.
Laparoscopy as a diagnostic method is used to settle doubts based on previous studies, in order to exclude other pathologies and diagnosis verification.
Additional research techniques are:
- 75SeHCAT test (specific absorption of bile acids in the small intestine is determined)
- Gordon test (for protein loss)
- Schilling test (for absorption of vitamin B12)
The activity of Crohn's disease is determined by the Best's index. It includes the presence and severity of the following symptoms:
- Frequency of liquid stools per week
- The intensity of abdominal pain (in points)
- General well-being (in points)
- Presence of signs of systemic inflammatory process
- Inflammation of other organs
- Effectiveness of symptomatic treatment of diarrhea
- Resistance of the anterior abdominal wall
- Patient’s weight
All points are summed and multiplied by the coefficients. The process is considered active if the Best’s index exceeds 150 points.
Stages of severity of Crohn's disease are:
- Light stage is diagnosed if an abdomen doesn’t hurt, there is no intoxication, and weight loss is not higher than 10% from the norm. C-reactive protein level in the blood is normal.
- Mild stage is diagnosed if Best's index is between 220-450, the body temperature is increased. There is pain in the abdomen, which increases with palpation; anaemia, increase of the C-reactive protein is higher than normal. Weight loss is more than 10% of normal body weight.
- Severe stage is diagnosed if Best's index is above 450. A patient experiences extreme exhaustion. The body mass index is below 18 kg / m2. A patient has severe fever. C-reactive protein is much higher than normal. Symptoms of irritation of the peritoneum are determined.
Treatment of Crohn’s disease abroad
A patient receives conservative therapy for acute attacks that are aimed at:
- Reduction of inflammation
- Elimination of symptoms
- Prevention or elimination of complications
Surgery is done in two cases:
- No effect from drug therapy
- Presence of Crohn's disease complications
The main indications for the operation are:
- Intestinal obstruction
- Perforation of the intestine (appearance of a hole in it)
- Toxic increase in the large intestine
- Fistula of the intestine
Extent of the surgery depends on the clinical case nature. Sometimes, it is enough to perform an endoscopic surgery.
Kidney stone disease is considered to be a complication of Crohn’s disease. It can lead to the obstruction of the ureter and hydronephrosis. In this case, an emergency surgical procedure is performed.
Prognosis for the Crohn’s disease
Prognosis is negative for Crohn’s disease. Pathology leads to a chronic suffering and is not treated completely. Death is possible on the basis of related complications.
60% of patients require surgery within 10 years after the diagnosis is confirmed. 45% of those, who had a surgery, will be operated again within the next 5 years.
Conservative and surgical therapy result largely depends on the doctor’s experience and quality of the medical equipment. Therefore it is highly recommended to undergo treatment in German hospitals. Medical travel to medically advanced countries help a patient satisfy his mind that he receives only the best possible advice and treatment.