The disease of Crohn is a inflammatory affection chronic being able to touch all the digestive Tract with a predilection for the Iléon, the colon and the anal area.
Its diagnosis rests on a whole of the clinical data, radiological, and/or endoscopic and histological.
It can be accompanied by extra-intestinal demonstrations (articular, cutaneous, ocular…). The principal clinical demonstrations observed during the evolutionary pushes of the disease depend on the seat (hail, Côlon, another digestive segment) and on extended from the lesions. It is especially about the Diarrhée with or without Syndrome dysenteric, of the abdominal pains sometimes of subocclusif type, of the demonstrations anopérinéales, the deterioration of the general state with or without Fièvre, of the extra-intestinal demonstrations. The evolutionary pushes can be enamelled of complication S, of which some can require a surgical intervention : Occlusion, Perforation, Colectasie, Abscess, Dent, demonstrations hépato-biliary.
Disease described precisely in the Years 1930 with the the United States by the Doctor B. Crohn (1884 - 1983), surgeon with New York in Mount the Sinai Hospital.
Symptom S
Mainly a Diarrhea chronic (several weeks in several months), especially hydrous and frequently accompanied by abdominal pains. A weight loss is often observed (by malabsorbtion). It is not rare that the pushes are accompanied by a little Fièvre. It can exist demonstrations extra-intestinal, mainly ostéo-articular but suchbiliary, ocular or cutaneous. One uses an index of activity to know if the disease is into thorough or not, it is the Indice of BEST (CDAI for the Anglo-Saxons), if the latter is lower than 150, the patient is in remission.
Incidence
Several thousands of new cases per annum (probably about 3.000 to 4.000). The disease of Crohn remains a Rare disease. It preferentially concerns the teenagers and adult young. One estimates at 60.000 the number of patients touched in France in 2005.
Etiology
Still mainly unknown. The last assumptions evoke a genetic predisposition (several identified genes), environmental factor starting (bacterium?) and occurred of a not controlled inflammatory cascade. One is thus in the presence of a multifactorielle disease as well as the hemorrhagic Rectocolite or the Polyarthrite rhumatoïde, other close diseases.
Endoscopy
The direct visualization of the lesions is capital to affirm the diagnosis. The attacks are in general diffuse and discontinuous, vague contours. The affected areas are typically the colonist and the last centimetres of the iléon. The lesions met are a type of ulcerations, often aphtoïdes or deep, they can be presented in the form of true cracks in the mucous membrane.
Histology
In the Biopsie S of digestive mucous membrane one seeks a epithelioid Granulome. Its discovery is a strong argument in favor of the diagnosis of the disease.
Vidéocapsule
It is a small video camera which the patients avalent and who records the images of the digestive tract. Its principal asset is to be able to visualize the small intestine, indeed this last is inaccessible to the endoscopy.
Entéroscopie
One can also explore the small intestine using a entéroscope (double balloon or simple balloon). It is about an endoscope longer than a coloscope whose progression is facilitated by a surtube with inflatable balloon. Its interest compared to the vidéocapsule lies in the possibility of intervening in situ and especially to locate the lesions perfectly.
Radiology
Useful to observe the nonvisible zones by endoscopy (in particular small intestine). It makes it possible to detect possible Sténose S (contractings).
Scanner
More sophisticated than the simple radio, this last can help with the diagnosis, particularly if there exist Fistule S.
Complication S
in the short run
One fears especially the Sténose S, cracks, Fistule S or perforations, a colectasy (dilation toxic of the colon) or a serious colitis (very severe push from the start).
long-term risks
There exists, after 10 years of evolution, an increase of the colo-rectal cancer risk. This risk is especially important in the event of wide attack and requires a regular monitoring (Coloscopie S).
Treatment
The Traitement of attack rests especially on the corticoid S for the average pushes and anti-TNF alpha for the severe or refractory pushes. Preventive medication is divided between salicylated (sulfasalazine or mésalazine) and the Immunosuppresseur S.
Treatment of the pushes
-
Salicylated S for the tiny pushes.
- Corticoids for the pushes moderated with severe.
- Infliximab (Immunomodulateur, anti-TNF alpha) or Surgery for the serious pushes or in the event of failure of the preceding treatments.
Treatment of maintenance (preventive)
Azathioprine (Immunosuppresseur), Méthotrexate or Infliximab (Remicade).
Surgery
Sometimes necessary, generally as a last resort, after failure of the medical care:
- on the level of the small intestine: in the event of sténose (generally Iléal E) or of dent
- on the level of the colonist: in the event of acute colitis engraves not answering the medical care or complicated of perforation, hemorrhage or major dilation (toxic Mégacôlon)
- in the event of attack serious Anopérinéal E.
Mode
Of a very discussed interest, especially for the resumption of the standard weight and to avoid the denutritions. Some Probiotique S could have an interest. More and more of nutritionnists a mode known as hypotoxic or recommends ancestral |July 3rd, 2007 with 21:14 (CEST) (for example the Nutrition Seignalet). It consists, mainly, has to eliminate the Gluten, the dairy products and refined sugars of the food of the patient reached of these chronic intestinal disorders. This last was however not validated by the clinical trials and can even present a danger to the patient.
The disease and tobacco
The final adoption of any cigarette smoking is very strongly advised. ,
differential Diagnosis
The differential diagnosis is difficult to make because the disease can, wrongly, be labelled like a digestive, intestinal functional disorder (TFD, functional TFI or Colopathie).
One can confuse hemorrhagic Rectocolite easily (touching only the colon) and disease of Crohn (being able to touch all the digestive Tract), both of the forms of Mici (intestinal chronic inflammatory disease).
The diagnosis can not be carried with certainty between these two entities at the time of first pushed, one speaks then about unspecified colitis. In the majority of the cases, the evolution of pathology and its clinical signs makes it possible, after several months or years, to end up determining with precision the disease concerned and thus to adapt the therapeutic strategy as well as possible. It happens however that the colitis remains unspecified, the current debate being to know if it is not a third entity of the MICI!
Certain infectious colites can also present a misleading table.
See too
External bonds
- general Information
- AFA the disease of Cröhn
- the disease of Crohn, Site Health-AZ
- Disease of Crohn
- Discussion forum in connection with the diseases of the intestine
- Crohnique, a site different on the disease from Crohn
- Crohn' S Disease - US Institute National off Diabetes and Digestive and Kidney Diseases
- Crohn' S Disease - WebMed
- Crohn' S Disease: Alternate Clinical and Treatment
- Crohn' S Disease - HealthAtoZ
- How the disease cam to Be known ace Crohn' S disease
- Organizations
- Association François Aupetit
- National Association off Colitis and Crohn' S Disease
- CrohnsZone.org - Coil-help Group
- Crohn' S and Colitis Foundation off America
-
To control the disease of Crohn, the General practitioner n°2147, October 23rd 2001
- Thermal Company of Plombières: treatment of the Disease of Crohn
Simple: Crohn' S disease
| Random links: | Decline | The Answer | Nuclear plant of Higashidori | Insurance construction | New Philadelphia (Ohio) |