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It is known that the disease often affects the last part of the small intestine (terminal ileum) and the beginning part of the large intestine (cecum or cecum). It is located in the last part of the small intestine and the beginning of the large intestine in 40-55% of the cases, only in the large intestine in 15-25%, and only in the last part of the small intestine in 25-40%.
The cause of Crohn’s disease is often unknown, but it is often thought to result from an imbalance of inflammatory chemical mediators in the body. Today, there are inherited (NOD2 gene), microbial (Mycobacterium paratuberculosis, Pseudomonas and Listeria), immune system related (interleukins and tumor necrotizing factor).
It has been suggested that it may occur with TNF), environmental factors (smoking), diet-related, vascular causes and stress.
Crohn’s disease symptoms vary according to age and gender. Some patients may have symptoms years before the diagnosis of CROHN Disease. people with CROHN disease,
Although they may develop more systemic symptoms, they often present to the doctor with abdominal pain and diarrhea. Intestinal obstructions often develop in patients with stricture disease. Small bowel obstruction most commonly occurs.
It is characterized by intestinal obstructions, gas and absence of bowel movements, hyperactive bowel sounds, and nausea and vomiting. Patients with penetrating Crohn’s disease may develop a fistula or abscess.
In the presence of abscess, in addition to abdominal pain, patients may have systemic symptoms such as fever and chills. Patients may also consult a doctor with symptoms of acute peritonitis. Penetrating disease can also cause symptoms related to the location of the fistula.
Anal fistula: In addition to intestinal fistulas, 15-30% of patients with Crohn’s have complicated rectal fistulas and abscesses. Makowiec et al. In the study, it was determined that in the presence of rectal fistula in Crohn’s patients, 35-60% relapse within two years.
In these patients, treatment with the seton method is often preferred and left in place for a long time. Whelan et al. They found that 90% of Crohn’s patients had at least one breech (anorectal region) surgery in their lifetime.
Bleeding from the rectum: In Crohn’s disease, severe rectal bleeding may occur due to the inflammatory event in the intestine, and in 40% of these patients, it may be necessary to remove the problematic part of the intestine (segmental resection).
Guard nipple: In 40-70% of cases, there is a guard nipple or other names, “duty nipple”, “sentinel pile” or “skin tag”.
Anus fissure: 20% of Crohn’s disease cases have breech fissures, and there is a possibility of rectal abscess in especially painful ones.
May increase kidney stone formation.
Skin diseases: 2-34% of the skin may cause swelling called erythema nodosum, pyoderma gangrenosum and psoriasis (psoriatic erythema).
Joint and bone diseases: 4-18%, especially in large joints, can cause arthritis, joint inflammation called ankylosing spondylitis. Similarly, bone resorption (osteoporosis) is observed in 10-15% of patients.
Aphthae may develop in the mouth.
Eye disorders: can cause eye problems called episcleritis, recurrent iritis and uveitis.
Vascular problems: It can cause occlusion in the veins (thrombo-embolism), such as portal vein thrombosis.
Liver and biliary tract problems: Bile duct stenosis called sclerosing cholangitis may develop in the bile ducts and the frequency of gallstones increases. It increases the tendency to liver inflammation (chronic active hepatitis) and liver cirrhosis.
The Montreal criteria are currently used in the classification of Crohn’s disease.
By disease region
L1: In the last part of the small intestine (terminal ileum) – 20-27%
L2: In the large intestine – 23-48%
L3: In both small intestine and large intestine – 23-43%
L4: Upper digestive tract (esophagus, stomach, duodenum) – 2%
Solberg et al. In their study in Norway, it was determined that 27% of Crohn’s patients were in the L1, 48% in the L2 group, 23% in the L3 and 2% in the L2 group. Jess et al. In the study they carried out in Denmark, the rate of patients in the L2 group was found to be between 30-43%.
Lakatos et al. In the study they carried out in Hungary, the L1 group was determined as 20%, the L2 group 35%, the L3 group 43% and the L4 group 2%. Ng et al. They found similar results in their studies in Asia and Australia.
According to the way of movement
B1: No stenosis or perforation (68-81%)
B2: There is stenosis (5%)
B3: Perforation present (14%)
Thia et al. In their study at the Mayo Clinic, they determined that 81% of Crohn’s disease cases were group B1, 5% group B2, and 14% group B3. In the ECCO-EpiCom study carried out in Europe, it was determined that 68-75% of the patients were in the B1 group and 10% had disease in the breech region.
Although there are many theories about what causes Crohn’s disease, many of them remain unproven. Still, it is crucial to understand the possible causes of CROHN disease and how they interact. Doing so can help a person better understand the symptoms, diagnosis, and treatment of Crohn’s disease. Causes of CROHN disease
People with Crohn’s disease have an immune system that reacts inappropriately. The immune system may mistakenly protect the body against beneficial microbes. Or it would not be wrong to show another cause, inflammatory, as an example. Either way, over time, this chronic inflammation in the digestive tract can cause ulcers and other injuries to the intestines.
After a correct diagnosis, treatment decisions should be made based on firm clinical judgment. There are variable clinical features during the course of the disease, so each case should be considered individually.
Physicians for people with Crohn’s disease should be prepared for treatment options in the different states of the disease and possible complications of both the disease and medications. Crohn’s disease does not respond to treatment (antibiotics, drainage). drug therapy is administered.
The first treatment for people with Crohn’s disease is steroid drugs applied to reduce the rate of inflammation. It is recommended as a treatment option with immunosuppressant and biologic drugs for people with intolerance or contraindications to treatment. It should be tried for 12 months until the treatment fails, and then it can be operated if needed.
It would not be correct to say that the cause of Crohn’s disease is this. Inflammation of the digestive system is a chronic disease and people who come with symptoms such as vomiting, fever, diarrhea are undergoing pre-treatment diagnostic research.
However, when the history of the disease was examined, it was determined that some of the patients were caused by genetic (from relatives and family) and some of them were caused by environmental reasons.
Reasons such as insufficient breast milk intake, smoking and alcohol consumption are important factors in the risk of developing the disease.
Crohn’s disease does not heal completely. By applying drug treatments, the severity of the disease is spread over time and intervened to overcome it more mildly.
While small intestine localization is found together in approximately 50% of the patients, the colon is the only localization in the other half.
The rectum is involved in approximately 40% of patients. At least 30% of patients with Crohn’s disease will require surgery in their lifetime.
Crohn’s disease is usually not life-threatening, but it can cause serious and even fatal complications. Crohn’s is a long-term inflammatory bowel disease.
The disease, which starts from the digestive canal and continues to the anus, requires surgical intervention. It most commonly affects the ileum, the last part of the small intestine, and the first part of the large intestine or colon.
The first place it affects is the immune system. It has been determined that the patient with inflammatory bowel disease activates suppressor t cells and instead of responding normally to an offending antigen, an exaggerated helper lymphocyte response is generated and this response is not physiologically down-regulated.
Crohn’s disease most commonly affects the colon and the last part of the small intestine. Ulceratitis colitis only affects the colon. In Crohn’s disease, any part of your small or large intestine may be involved and may be continuous or contain multiple segments.
Patients treated early with thiopurines may be less likely to have surgery. Treatment with anti-TNF reduces the risk of surgery. Ileocolonoscopy is the best method for diagnosing the return of disease after surgery. Whether the disease recurs, how severe it is, and
It helps to predict the clinical course. this should be done within the first year after surgery when treatment decisions may be affected. Patients diagnosed or treated should pay attention to nutrition first.
A diet enriched with protein and energy-containing foods should be applied. They should avoid dairy and lactose. They should also stay away from smoking and stress.
Crohn’s disease gets worse without treatment. Left untreated, crohn’s disease spreads to the intestinal tract, making severe symptoms and treatment more dismal.
People with untreated Crohn’s disease of the large intestine are more likely to develop colon cancer.
Crohn’s disease is characterized by abscesses and fistulas. Fistulas usually pass through the mesocolon and may enter the small intestine or vagina. It may reflect carcinoma in chronically diseased intestinal segments.
Medical management of Crohn’s patients begins with dietary modification to eliminate trigger foods. Initially, drug therapy is prescribed for the disease, which stimulates intestinal activity (dairy products and very spicy foods). This disease, whose digestive system starts from the mouth, mostly affects the large intestine.
Nutrition after treatment or surgery is very important. Related to this, a diet program must be applied.
It is recommended to stay away from acidic spicy foods and dietary fiber is recommended. White bread, pasta, gluten-containing foods should be avoided.
Dairy products should be avoided as milky desserts can exacerbate the disease. For patients who do not remove nut, popcorn, french fries, alcohol and cigarette consumption from their lives, Crohn’s disease will be a recurrent disease.
The Crohn’s disease exacerbation can last several days or even months, depending on its severity. It is important to notify your doctor of any changes in your symptoms, especially if symptoms worsen.
Crohn’s disease lasts a lifetime and will always be in an exacerbation unless attention is paid.
It is important to know that Crohn’s disease can be fatal if left untreated. This is because the chronic inflammation associated with this intestinal condition can lead to many serious and fatal complications.
