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Crohn’s Disease

A chronic inflammatory disease that can affect any section of the gastrointestinal tract is Crohn’s disease. Tissue injury occurs with inflammation due to T-cell activation. Cytokines stimulate inflammatory responses, and these cells release inflammatory material like proteases and platelet activating factors. Ulcerations of the superficial mucosa occur after the first lesion develops around the crypts. Deep mucosal layers are also invaded by the inflammatory cells causing granulomas, which extend into the intestinal wall and regional lymph nodes. Crohn’s disease can develop anywhere from the mouth up to the anus.

Causes

The contributing factor to Crohn’s disease is usually attributed to diet and stress but is not deemed as a predominant cause. Though the exact cause is yet unknown, it is related to microbial, immunologic, dietary, environmental and hereditary factors. Smoking, ingestion of NSAIDs, oral contraceptives usage has implications towards Crohn’s disease.

Signs and Symptoms

  • Abdominal pain

  • Incomplete evacuation

  • Prolonged diarrhoea

  • Constipation

  • Urgent need to move bowels

  • Fever (low grade)

  • Weight loss or anorexia

  • Rectal bleeding

  • Malnutrition

  • Vitamin deficiency

  • Nausea

  • Bone loss

  • Depression

  • Anxiety

  • Difficulty coping

  • Fatigue

  • Imbalance of normal menstrual cycle

  • Night sweating

Diagnosis

  • Physical examination will focus on the weight, body temperature, and patient nutrition. Abdominal tenderness is noted. Intermittent fever and tachycardia are present. Perianal examination, rectal examination and extraintestinal manifestations are also analyzed.

  • Routine blood tests such as CBC to detect anaemia, chemistry panel and inflammatory markers such as C-reactive protein levels and ESR are taken

  • Faecal calprotectin studies are noninvasive markers of IBD

  • Barium contrast study evaluates fistulization, intensity of strictures and pseudodiverticula

  • Abdominal radiographs will indicate small bowel abnormalities, mural thickening and dilatation

  • CT scan for hepatobiliary and renal complications are done

  • MRI is conducted to determine pelvic and perianal diseases

  • Ultrasound for evaluation of IBD and its complications

  • Ileocolonoscopy for the management of patients who have been diagnosed with IBD to evaluate mass lesions and cancer

  • Radionucleotide scanning helps to assess the severity of the disease

Treatment and medication

Treatment may include pharmacological therapy for acute C difficile infection and bacterial overgrowth, which causes diarrhoea. Anti-diarrhoeal agents such as bile acid binders, loperamide and tincture of opium are prescribed. Antibiotics such as sulfasalazine are prescribed to manage colon and small bowel inflammation. Corticosteroid therapy is recommended for patients with acute systemic symptoms.

Crohn’s disease requires expert advice and treatment. Consult with Dr. Deepak in Chennai, India for a disciplinary approach to the treatment of the disease.

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