CROHN'S DISEASE AND CURRENT TREATMENTS

Inflammatory bowel disease (IBD), common, similar in some aspects but different from each other in many aspects, ulcerative colitis (UC) and Crohn's disease ( It covers two chronic forms called CH). Although these two diseases are collected under the same title, they are named differently in terms of their clinical characteristics.

Western societies (USA, Canada, France, England, Germany. . etc.) Incidence of UC (number of new cases seen in a year),2-10/ 100 000, prevalence (number of cases found in the entire population at any time period) It is reported as 35-100 / 100 000. . The incidence of CH varies between 1-6/100 000 and the prevalence varies between 10-100/100 000. UC occurs more frequently. Although there are no reliable statistics regarding the frequency of occurrence in Turkey, it is thought that cases very close to these figures are encountered.

It is known that both diseases are frequently encountered geographically in Northern Europe, racially in the Caucasians, and ethnically in Jews. It is suggested that IBD is more common in societies that are closed to population movements and frequent consanguineous marriages.

Crohn's disease (CH) and ulcerative colitis (UC)

strong> Chronic, remission (calming) and exacerbation, which causes many systemic involvements that are thought to originate from the small and large intestines, which are collected under the title of inflammatory bowel diseases (IBD) of unknown cause. These are diseases characterized by periods of (exacerbation).

Etiology (cause of occurrence), clinical presentation (appearance), complications Although the two diseases have many similarities in terms of clinical course, there are points where they differ sharply or relatively from each other. Some cases may start like UC and progress to CD symptoms and behaviors in the following years, or vice versa.

Although IBD is a group of diseases that are moderately common in the society and rarely result in fatal disease, it generally 3-4. in the decade (in the 30s and 40s ), that is, the economy It usually occurs in a productive period and can progress as an active disease for many years. It constitutes a serious disease group in terms of medical and socioeconomic aspects as it may require intensive medical or surgical treatment. Because it can deeply affect the person's quality of life, the lives of both the patient and the patient's first-degree relatives can be affected.

Etiopathogenesis:

IBD(assumptions) have been put forward regarding the emergence mechanism of > . When we think about the digestive system, the differences and different antigenic properties of many foods we consume as food are subject to change in an environment where many bacteria are taken in with these foods and settle in the digestive system. In this system, the digestive system works in an important balance during the process of breaking down food, taking on different structures and properties, creating compounds with different chemical properties, absorbing some of them and excreting some of them. It is not clearly understood which factor or factors disrupt this balance in IBD. For more than seventy years, efforts to elucidate the etiopathogenesis have focused on the immune system.

Ethiopapathogenesis

  • In the etiology of Crohn's disease and ulcerative colitis
  • In addition to genetic factors
  • Environment and climate,
  • Socioeconomic status,
  • Infections (such as tuberculosis, measles)
  • Immunity,
  • Various factors such as smoking,
  • Oral contraceptives and

Nutrition have been held responsible.

CH and UC. Predisposition has been identified in some families. Geographical and racial differences naturally affect the genetic structure. Presence of susceptibility loci on chromosome 16 in CH, and on chromosomes 3, 7 and 12 in bothCH hCHem and UC, and HLA< in some individuals. The detection of polymorphism in /strong> genes and cytokine genes (TNF-α, IL-1RA) as well as the identification of nearly 100 susceptibility genes reveal the importance of genetic factors.

Although the exact cause of Crohn's disease is not understood to date, a certain progress has been made with studies on genetic, microbial, immunological, environmental, dietary, vascular and physiological factors. Findings have been obtained that it develops with one or more stimulating factors in immunosensitive people. .;

In genetically predisposed individuals, it is thought that the first damage begins microscopically as a small infiltrative focal lesion around the crypts (located in the small intestine). This is followed by ulceration in the superficial mucosa. Then, it is determined that ulceration progresses and non-caseating granulomas (caseating in tuberculosis) granulomas are formed. Granulomas spread to all layers of the intestinal wall and progress to the regional lymph nodes and mesentery. Neutrophil infiltration into the crypts causes crypt abscesses, crypt destruction, and atrophy in the colon. Granuloma formation is important for Crohn's. It is extremely important to distinguish it from tuberculosis, which causes granulomatous inflammation. The absence of granulomas detected in the tissue taken does not exclude the diagnosis.

Macroscopically, the initial lesion in the small or large intestines is edema and hyperemia in the mucosa. Afterwards, superficial ulcers form on the lymphoid aggregates. They appear as mucosal depressions.

These ulcers deepen and widen, resulting in the typical cobblestone appearance. The lesions are often separated from each other by normal mucosa. The lesion, which continues for a few centimeters, may leave a solid area and then involve another area with the involvement of another pathological segment. This feature is an important feature that distinguishes Crohn's disease from ulcerative colitis. In ulcerative colitis, the diseased area continues uninterrupted.

Pathophysiology and clinic:

Transmural (involvement of all layers of the intestine) i Inflammation causes thickening of the intestinal wall, narrowing of the lumen and fistulas. Fistula (hole opening) can occur as wounds opening internally between organs or externally towards the abdominal skin. This opening opens the small intestine to another small intestine (entero-enteral), the small intestine to the large intestine, the bladder (entero-vesical) and the vag. It may be divided into different parts, such as ina (enterovaginal), incision into the abdominal skin (entero-cutaneous). This is a sign that the severity of the disease is advanced. Such developments change the course and clinical findings of the disease.

In some cases, Crohn's disease may cause obstructions in parallel with the severity of inflammation in the disease. Obstruction is initially associated with mucosal edema and spasm and is temporary. As the disease progresses and its severity increases, permanent obstructions occur as a result of scarring (scar tissue remaining after wound healing).

The segment that the disease involves in the small intestine and is included in the disease. Depending on the length and the role of food in the absorption function, malabsorption develops as a result of a decrease in the mucosal absorbent surface. As it is known, the absorption of proteins, fats, carbohydrates, vitamins and minerals is extremely important in the digestive system. The main segment where these are absorbed is the terminal ileum, that is, the last 60-70 cm, which is the transition point of the small intestine to the large intestine. Especially due to malabsorption

Protein calorie malnutrition

  • Dehydration
  • Steatorrhea

Increased kidney stone formation is observed secondary to calcium loss due to fat malabsorption and increased oxalate secretion.

In individuals with a genetic predisposition to Crohn's disease, idiopathic chronic transmural (all layers of the intestines) occur following the abnormal immune response to intestinal-derived antigens. It occurs in an inflammatory process. It can affect the entire gastrointestinal system (GIS) from the mouth to the anus. It occurs due to the imbalance between pro-inflammatory and anti-inflammatory mediators secreted in the body in the chain of events following an exaggerated immune response. It is frequently located in the small intestines, especially in the terminal ileum, which is the transition section of the small intestines to the large intestines.

Of the cases

The most common involvement is both small and small intestines, with a rate of 40-55%. It is both involvement of the large intestine.

Of all involvements

Oral in 8-9%,

Esophagus in 1%,

Gastroduodenu in 0.5-5% m,

The perianal region is involved in the disease in 3-36%

Crohn's disease can be very insidious and can also be seen as acute abdominal pain that requires emergency surgery. Abdominal pain may come with diarrhea or complications. Postprandial diarrhea, a sudden need to defecate with the feeling of having to go to the toilet, or even incontinence may occur. Let's review the clinical types of CH, which can be accompanied by abdominal pain, weakness, fever, and weight loss.

Let's review the clinical types of CH.

  • Inflammatory (inflammatory) ,
  • Ostructive-stenosing (occlusive) and
  • There are three types: fistulizing-penetrating (opening holes extending to the adjacent organ or skin).
  • Diarrhea, abdominal pain and fever are the prominent findings in the inflammatory form.
  • In the stenosing form, intestinal obstruction findings dominate the picture and are usually recurrent. (Due to strictures)

Symptoms of ulcerative colitis (UC) and Crohn's disease (CD) There are significant differences between the results and findings. The typical symptom of UC, which is one of the most important differences between ulcerative colitis and Crohn's disease, is diarrhea with bloody mucus. Diarrhea is frequently observed in 90-95% of cases. There is frequent defecation, day and night, in small amounts at a time, and a feeling of tenesmus (the feeling of still being present after defecation is over). It can reach up to 30-35 times a day. In Crohn's disease, diarrhea with bloody mucus may sometimes occur, but most often this complaint belongs to UC. As is known in CD, the location of involvement determines the symptoms. Abdominal pain is the typical symptom of the disease. In UC, if it only affects the rectum, the blood is on the surface of the stool. However, if the inflammation has spread more distally, the blood is mixed with the stool.

The symptoms and findings of CD will vary depending on the location of involvement.

When abdominal pain occurs after a meal, it may occur 1-2 hours after the meal. This pain may be evident in the right lower quadrant or suprapubic region if the disease is clearly located in the terminal ileum.

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