What is Crohn’s Disease?
What is Crohn’s Disease? Crohn’s disease is one of the chronic intestinal inflammatory diseases that cause inflammation of all the walls of the digestive system, from the mouth to the anus. However, Crohn’s disease generally appears in the small intestine precisely on the ileum and colon (colon).
This condition can be painful, make the body feel weak, and can sometimes cause life-threatening complications of the sufferer. Complications that occur are generally the narrowing of the intestinal space and the formation of channels (fistulas) that connect the end of the intestine with the skin surface near the anus or vagina.
Patients with Crohn’s disease have a remission period that is either no symptoms or only mild symptoms. This remission period will be followed by a period of recurrence and sometimes complicate the sufferer.
Symptoms on Crohn’s Disease
The symptoms that occur in Crohn’s disease patients vary, ranging from mild to very severe, and can affect any part of the body’s digestive system sufferers.
The following are common symptoms that can arise from Crohn’s disease:
- Feeling very tired.
- Abdominal pain and cramps that feel worse after eating.
- Diarrhea that appears many times.
- Stool mixed with mucus and blood.
- Decreased appetite.
- Extreme weight loss is undesirable.
Some of the symptoms that may appear in Crohn’s disease patients but do not always appear are:
- Fever above 38 o
- Pain and swelling joints.
- Inflammation and irritation of the eyes (uveitis).
- Appears pain in the skin that cause redness, often on the feet.
Inflammation that occurs in the digestive system of children can inhibit the absorption of nutrients from the food they consume. Crohn’s disease cases that occur in children will lead to their growth slower than healthy children.
The following are some of the conditions and symptoms that should immediately get treatment from doctors, namely:
- The appearance of blood mixed with feces.
- Diarrhea that does not heal.
- Weight loss for no apparent reason.
- Abdominal pain and abdominal cramps that do not heal.
Things That May Increase The Risk Of Crohn’s Disease
The true cause of Crohn’s disease is still unknown. However, there are a number of risk factors that can be associated with this disease, namely:
- Heredity. There is evidence that Crohn’s disease is a hereditary disease in the family. Moreover, Crohn’s disease tends to occur only in some ethnicities. It also proves that this disease is a condition inherited from generation to generation.
- Immune system disorders. Disorders in the immune system cause immune cells that are supposed to protect the intestines from harmful bacteria entering the digestive system, also attack the good bacteria (probiotics) that aid in the digestive process. This condition causes inflammation of the gastrointestinal tract associated with Crohn’s disease.
- Smoke. People who smoke have twice the risk of getting Crohn’s disease compared to people who do not smoke. The symptoms of Crohn’s disease in people who smoke are usually more severe and tend to require surgery for treatment.
- History of Infection. Infection that occurs in childhood can lead to the emergence of abnormal reactions of the immune system. This condition can eventually lead to the emergence of symptoms of Crohn’s disease.
Steps in Diagnosis of Crohn’s Disease
The following are some types of checks that may be performed by a doctor, either to diagnose Crohn’s disease directly, or to eliminate a number of conditions that also cause symptoms similar to Crohn’s disease.
- Initial check. The doctor will inquire about the pattern of symptoms experienced by the patient. In addition, the doctor will check whether there are any specific causes for the symptoms. For example food, history of drug use, family health history, and recent trips that may cause diarrhea symptoms. Examination of pulse rate, body temperature, blood pressure, and abdominal examination will also be performed by the physician to check the patient’s general health.
- Blood examination. This check is necessary to determine the level of inflammation that occurs in the patient’s body. In addition, with a blood test, the doctor will know if an infection occurs. If the results of blood tests obtained anemia, then the patient may be malnourished or bleeding in the digestive tract.
- Fecal examination. Fecal samples will be checked for blood and mucus. From this procedure, the doctor can tell whether the symptoms of a natural patient are caused by a parasitic roundworm or other condition.
- Colonoscopy. This is a procedure performed to examine the inside of the colon. This procedure is done by inserting a flexible hose equipped with a camera and light into the colon through the anus and rectum (the end of the gastrointestinal tract). Doctors can see the severity and extent of inflammation that occurs in the colon. In this procedure can also be done biopsy (tissue sampling) in the digestive tract, for later examined under a microscope. The examination is useful to see changes in microscopic gastrointestinal wall cells, which are characteristic of Crohn’s disease.
- Wireless endoscopic capsule. In this examination procedure, patients are required to swallow capsules that will enter the small intestine. The capsule will send the image to the tape recorder. After a few days, the capsule will come out of the body through the dirt. This is a disposable capsule. Not all hospitals have this very new procedure.
- CTE (computerised tomography enterography / enteroclysis) and MRE (computerised tomography enterography / enteroclysis). Both of these scanning methods can be used to diagnose Crohn’s disease in the small intestine. On examination, the patient will be asked to drink contrast fluids (enterografi). The contrast fluid can also be inserted into the tube which is then inserted through the nose and reaches the small intestine (enterocyclic). After the patient is given a contrast fluid, the small intestine is then scanned using magnetic resonance method (MRE) or using X-ray (CTE).
Treatment of Crohn’s Disease
Treatment performed on Crohn’s disease only aims to relieve the symptoms experienced and maintain the remission period. Until now, there has been no treatment or medication that can cure Crohn’s disease completely. In patients with children, Crohn’s disease treatment also aims to improve the growth and development of children.
Here are some treatments that are done to relieve the symptoms that appear, namely:
- Antiinflammatory Drugs. Antiinflammatory drugs are often used as the first treatment given to Crohn’s patients. Some types of anti-inflammatory drugs include:
- 5-Aminosalisilat oral. This type of drug is given to people with Crohn’s disease in the colon but can not treat Crohn’s disease in the small intestine. Examples of these drugs are sulfasalazine and mesalamine.
- Corticosteroids. Corticosteroids are given if the patient does not respond to various treatments given to overcome Crohn’s disease. Corticosteroids can decrease inflammatory reactions in different parts of the body. But keep in mind that corticosteroids have various side effects such as facial swelling, diabetes, hypertension, night sweats, insomnia, and hyperactivity. Corticosteroids are not recommended for use in long-term treatment. The maximum administration time of corticosteroids in Crohn’s penyakt sufferer is 3-4 months.
- Immunosuppressants. In treating Crohn’s disease, immunosuppressant works by suppressing the immune system’s work so that the inflammatory reaction of the digestive tract can be alleviated. Immunosuppressant group drugs will work optimally when combined with several other immunosuppressant types.
Some combinations of immunosuppressant drugs for Crohn’s disease are:
- Azathioprine and mercatopurine. The combination of these two drugs is the most commonly used to treat gastrointestinal inflammation. Routine monitoring of the physician should be performed on the side effects of both drugs during the consumption of the drug.
- Infliximab, adalimumab, and pegol certolizumab. These three drugs are used as inhibitors of tumor necrosis factor (TNF), which is thought to be the main cause of Crohn’s disease. These medicines can be used for adults and children suffering from moderate and severe Crohn’s disease. These drugs can be used directly for the patient after diagnosis confirms Crohn’s disease in the patient, especially if the patient has a fistula. Patients with TB infection should not take all three drugs.
- Methotraxate. Methotraxate is an alternative if immunosuppressant, if other drugs can not be used. Side effects of this drug include nausea, fatigue, diarrhea and pneumonia. This drug can cause disability to the fetus. To that end, both women and their partners should stop taking this drug at least 6 weeks before planning a pregnancy.
- Cyclosporine and tacrolimus. Both of these drugs can be used to treat fistulas caused by Crohn’s disease. Side effects of cyclosporine are quite harmful so it is not recommended for long-term use.
- Natalizumab and vedolizumab. In treating Crohn’s disease, both drugs work by stopping the immune cell response to integrins. By administering natalizumab and vedolizumab, immune cells can be prevented from sticking to the intestinal wall thus reducing inflammation. It should be noted that natalizumab and vedolizumab are only used in severe Crohn’s disease that can not be overcome with other drugs.
- Antibiotics. Antibiotics can reduce fluid secretion in the fistulas and treat abscesses caused by Crohn’s disease. Antibiotics are also thought to help lighten Crohn’s disease by reducing the population of bad bacteria that stimulate the immune system’s response to the gut. Keep in mind that the purpose of antibiotics is to prevent the occurrence of infection in patients with Crohn disease if the perceived sufferers have the risk. Two types of antibiotics commonly used in Crohn’s disease patients are metrodinazole and ciprofloxacin.
To relieve symptoms of Crohn’s disease and reduce the risk of complications from the disease, doctors may also recommend some medications such as:
- Antidiarrheal, eg psyllium or methylcellulose. For more severe diarrhea may be given loperamide.
- Painkiller. For mild pain, doctors will usually suggest paracetamol. While ibuprofen and sodium naproxen are not allowed because they can aggravate the symptoms of Crohn’s disease.
- Iron supplements and vitamin B12. Both supplements can reduce the appearance of anemia due to iron absorption and vitamin B12 is not good due to Crohn’s disease.
- Supplements of vitamin D and calcium, to reduce the risk of osteoporosis.
Remission periods can be undertaken by taking certain drugs or not. If the patient chooses to continue taking the drug, corticosteroids are not recommended for use in remission.
Some foods may allegedly improve symptoms experienced by Crohn’s disease patients, although to date there is no clear evidence of a link to food with this disease.
If any food is suspected to aggravate the symptoms experienced, the patient is required to avoid the food. But it is not advisable to completely eliminate certain types of foods with certain nutrients, such as whole grains or sugar-containing foods.
For people who smoke, quitting these bad habits will alleviate the symptoms experienced and help keep the condition in remission.
Complications Due to Crohn’s Disease
The following are some of the possible complications of Crohn’s disease, including:
- Fistula. Fistula is a channel formed from ulcers on the walls of the gastrointestinal tract, which permeate other parts of the gastrointestinal tract or even penetrate the bladder, vagina, anus, or skin. As a result can cause constant pain, fever, dirt containing blood or pus, even leakage of dirt in underwear.
- Blockage of the gastrointestinal tract. Crohn’s disease can thicken the walls of the small intestine and trigger blockage of food flow. To eliminate these complications can be performed surgery.
- Ulcers. Chronic inflammation of the intestines can cause ulcers or ulcers in various digestive organs, including the mouth, intestines, anus, and also genital organs.
- Malnutrition. Diarrhea, abdominal pain, and abdominal cramps can cause people to have difficulty eating and digesting food. This condition can interfere with the absorption of nutrients that cause people with nutritional deficiencies.
- Osteoporosis. This is a condition when the quality of bone density decreases due to the intestines that can not absorb nutrients well. In addition, this condition is also at risk due to the use of corticosteroid drugs.
- Iron deficiency anemia. Bleeding that occurs in the digestive tract due to Crohn disease can lead to iron deficiency anemia. Symptoms can include fatigue, shortness of breath, and face
- Anemia deficiency of vitamin B12 or folate. Patients who experience these complications will look tired and lack of energy. Failure absorption of vitamins and minerals by the body can also trigger a mala
- Colon Cancer. Crohn’s disease that attacks the large intestine increases the risk of colon cancer.