What Causes Crohn's Remission?

Crohn's disease is an unexplained intestinal inflammatory disease that can occur anywhere in the gastrointestinal tract, but occurs in the terminal ileum and right hemicolon. Both the disease and chronic non-specific ulcerative colitis are collectively referred to as inflammatory bowel disease (IBD). The clinical manifestations of this disease are abdominal pain, diarrhea, intestinal obstruction, accompanied by extraintestinal manifestations such as fever and nutritional disorders. The course is prolonged, recurrent, and difficult to cure. This disease is also known as localized enteritis, localized ileitis, segmental enteritis, and granulomatous enteritis.

Basic Information

nickname

Localized ileitis

English name

Crohn's disease

Visiting department

Gastroenterology, abdominal surgery

Multiple groups

Young people

Common locations

Gastrointestinal tract

Common causes

Unknown, may be related to infection, heredity, and immunity

Common symptoms

Abdominal pain, diarrhea, intestinal obstruction, fever, nutrition disorders, etc.

Contagious

no

Causes of Crohn's disease

The etiology of this disease is unknown and may be related to infection, heredity, humoral immunity and cellular immunity.

Crohn's disease is a proliferative disease that penetrates all layers of the intestinal wall and can invade the mesentery and local lymph nodes. The disease is limited to the small intestine (mainly the terminal ileum) and the colon. Both can be affected at the same time, often ileum and right colon disease. The lesions of this disease are segmentally distributed, spaced apart from normal intestine segments, with well-defined boundaries, and are characterized by skip areas. The pathological changes were divided into acute inflammatory phase, ulcerative phase, stenotic phase and fistula formation phase (perforation phase). Intestinal wall edema and inflammation become the main part in the acute phase; intestinal wall thickening and stiffness in the chronic phase, the shape of the affected bowel is tubular, and the upper bowel is dilated. Typical lesions on the mucosal surface are:

Ulcer

Early superficial small ulcers, followed by vertical or horizontal ulcers, and vertical ulcers that penetrate deep into the intestinal wall form a more typical fissure, which is distributed along the mesenteric side, and there may be abscesses in the intestinal wall.

2. Pebble nodules

The small island protrusions formed by submucosal edema and cell infiltration, plus fibrosis and shrinkage of scars after ulcer healing, make the mucosal surface pebble-like.

3.Granuloma

No casein change, different from tuberculosis.

4. Fistula and abscess

The fissure in the intestinal wall is essentially a penetrating ulcer, which causes adhesions and abscesses between the intestine and intestine, intestines and organs or tissues (such as the bladder, vagina, mesentery or retroperitoneal tissue, etc.), and forms internal fistula. If the lesion penetrates the intestinal wall and passes through the abdominal wall or tissue around the anus to the outside, an external fistula is formed.

Crohn's disease clinical manifestations

The clinical manifestations are abdominal pain, diarrhea, abdominal mass, fistula formation and intestinal obstruction, which can be accompanied by fever, anemia, nutritional disorders and extraintestinal damage of joints, skin, eyes, oral mucosa, liver, and so on. The disease can recur and persist.

1. Digestive system performance

(1) Abdominal pain is located in the right lower abdomen or around the umbilical cord. It has spasmodic pain, intermittent seizures, accompanied by bowel sounds. If the abdominal pain persists and the tenderness is obvious, it suggests that the inflammation spreads to the peritoneum or abdominal cavity and forms an abscess. Abdominal pain and abdominal muscle tension may be caused by acute perforation of the diseased bowel.

(2) Diarrhea Caused by inflammatory exudation, increased peristalsis, and secondary malabsorption in the diseased bowel. It starts with intermittent attacks, and lasts with persistent mushy stools without pus or blood or mucus. Lesions involving the lower segment of the colon or rectum may have mucus, bloody stools, and severe aftermath.

(3) Abdominal masses are more common in the right lower abdomen and around the umbilicus, and are caused by intestinal adhesions, thickening of the intestinal wall and mesentery, enlargement of mesenteric lymph nodes, formation of internal fistula or local abscess.

(4) Fistula formation is one of the clinical features of Crohn's disease. A transmural inflammatory lesion penetrates the entire intestinal wall to extra-intestinal tissues or organs, forming a fistula. The internal fistula can lead to other intestinal segments, mesentery, bladder, ureter, and retrovaginal peritoneum. The external fistula leads to the abdominal wall or perianal skin.

(5) Lesions around the anus and rectum A small number of patients have lesions in the anus, around the rectum, fistulas, abscesses, and anal fissures.

2. Whole body performance

(1) Fever Fever is caused by intestinal inflammatory activity or secondary infection. It is usually intermittent low fever or moderate fever, and a few are relaxation fever, which can be associated with toxemia.

(2) Nutrition Disorders Weight loss due to loss of appetite, chronic diarrhea, and chronic wasting diseases, anemia, hypoproteinemia, vitamin deficiency, calcium deficiency, and osteoporosis.

(3) Water, electrolyte, acid-base balance disorder during acute attack.

3. Parenteral manifestations

Some patients have iridocyclitis, uveitis, clubbing fingers, arthritis, nodular erythema gangrenosum pyoderma, oral mucosa ulcers, chronic hepatitis, peritubular inflammation, sclerosing cholangitis, etc., occasionally Amyloidosis or thromboembolic disease.

Crohn's disease test

Blood test

It can be seen that an increase in white blood cell counts and a decrease in red blood cells and hemoglobin are related to blood loss, bone marrow suppression, and decreased absorption of iron, folic acid, and vitamin B ₁₂ . Hematocrit decreases and erythrocyte sedimentation increases. Mucin increases and albumin decreases. Serum potassium, sodium, calcium, magnesium, etc. can decrease.

2. stool test

Visible red and white blood cells, occult blood test was positive.

3. Intestinal absorption function test

Extensive bowel resection or malabsorption due to small bowel disease can be tested for intestinal absorption to further understand the function of the small intestine.

4. Colonoscopy

It is the most sensitive test for diagnosing Crohn's disease. The main risks are bowel perforation and bleeding.

5. Barium enema inspection

Barium shadow showed signs of jumping. For those who are not suitable for colonoscopy.

6.X-ray small bowel angiography

By observing the lesions of the small intestine, the narrow part of the intestinal cavity was determined.

7.CT inspection

The lesions of the entire intestine and surrounding tissues can be observed at the same time, which has important diagnostic value for complications such as abdominal abscess.

Crohn's disease differential diagnosis

This disease should be distinguished from the following diseases: acute appendicitis, intestinal tuberculosis, small bowel lymphoma, duodenal retroampullary ulcer, non-granulomatous ulcerative jejunal ileum, ulcerative colitis, ischemic colitis, colon Tuberculosis, amoeba enteritis, colon lymphoma, radiation colitis, etc.

Crohn's disease complications

Complications of this disease are common intestinal obstruction, occasional intra-abdominal abscesses, malabsorption syndromes, acute perforation in large amounts of blood in the stool, and rarely toxic colonic dilatation.

Crohn's disease treatment

Principle

There is no special treatment for this disease. When there are no complications, supportive and symptomatic treatments are important to relieve the symptoms. During the activity period, it is advisable to rest in bed and eat with high nutrition and low residue. In severe cases, fasting should be temporarily suspended, water, electrolyte, acid-base balance disorders should be corrected, and enteral or parenteral nutrition support should be used. Anemia can be supplemented with vitamin B ₁₂ , folic acid or blood transfusion. Hypoproteinemia can be transfused with albumin or plasma. Drugs such as salicylazosulfapyridine, adrenocortical hormone, or 6-mercaptopurine are effective in controlling active symptoms. Antispasmodic, analgesic, antidiarrheal, and control of secondary infections can also help relieve symptoms. Supplementing a variety of vitamins and minerals can promote the synthesis of enzymes and proteins in the body, while protecting the cell membrane.

2. Drug treatment

(1) Salicylic acid Salsalazine and 5-aminosalicylic acid (5-ASA) are suitable for patients with chronic and mild to moderately active periods. SASP is generally not considered to prevent the recurrence of Crohn's disease. For those who cannot tolerate SASP or allergies, 5-ASA can be used instead. For rectal and sigmoid, descending colon lesions, SASP or 5-ASA preparations can be used for enema, and anal medication. SASP and 5-ASA preparations should not be used for severe liver and kidney diseases, infants and young children, hemorrhagic constitution, and those allergic to salicylic acid preparations.

(2) Adrenal corticosteroids are commonly used in patients with moderate, severe or fulminant symptoms. For those who cannot tolerate oral administration, hydrocortisone or methylprednisolone or ACTH can be given intravenously. After 14 days, oral prednisone can be maintained. It is usually discontinued as soon as possible after the control of the acute attack. Oral prednisone or combined with SASP or s-ASa can be used as maintenance treatment every other day. For straight, diabetic, and descending colon lesions, drug retention enema can be used, such as hydrocortisone flavone salt, 0.5% procaine, normal saline, slow rectal drip, or with SASP, s-ASA or Xi class powder and other drugs used in combination, can also be used during pregnancy.

(3) Other drugs For those who do not respond to treatment with adrenal corticosteroids or sulfa drugs, other immunosuppressive agents such as azathioprine, 6-leurone (6MP), cyclosporine, FK506, etc. may be used instead, or levamisole may be used in combination. , Interferon, transfer factor, BCG and immunoglobulin and other immune enhancers. In addition, metronidazole (metronidazole), broad-spectrum antibiotics, and monoclonal antibodies can also be used.

3. Surgery

Surgical treatment is used in patients with complete intestinal obstruction, intestinal fistula and abscess formation, acute perforation or uncontrollable bleeding, and patients who have difficulty ruling out cancer. For intestinal obstruction, it is necessary to distinguish between functional spasm caused by inflammatory activity and mechanical obstruction caused by fibrous stenosis. The former can be alleviated without fasting and active medical treatment without surgery. For fistulas without combined abscess formation, active medical conservative treatment is sometimes used. Fistulas that can be closed, combined with abscess formation, or failed medical treatment are the indications of surgery. The surgical method is mainly the removal of the intestinal segment of the lesion, and the surgical resection includes the lesion and the intestinal segment 10 cm away from the lesion, proximal 10 cm, and its mesentery and lymph nodes. If the local adhesion is severe or the abscess is formed and cannot be removed, it can be short-circuited or left out, and a second-stage diseased bowel resection may be performed according to the situation. For abdominal abscesses, incision and drainage are performed. For cases with multiple lesions, only the intestinal lesions with complications are removed to avoid the occurrence of short bowel syndrome due to excessive resection. If the disease is found during surgery due to misdiagnosis of appendicitis, there is no need for bowel resection if there are no complications such as intestinal obstruction and perforation. The disease often recurs near the intestinal anastomosis after surgical treatment. The recommended preventive medication starts at 2 weeks and lasts for at least 3 years. The postoperative recurrence rate is high and should be followed up.