Disease Crohn

the disease Crohn (synonyms: M. Crohn, Enteritis regionalis Crohn, Ileitis terminalis, Enterocolitis regionalis, sklerosierende chronic Enteritis; English: Crohn's disease, regionally enteritis) belongs to the group of the chronic-inflammatory intestine illnesses. This concerns a probably auto+aggressive, chronic granulomatöse inflammation, those in the entire gastro-intestinal tract ofthe oral cavity up to the after to arise can. Are preferentially stricken the lower small intestine (terminal Ileum, infestation in zirka 40%) and Grimmdarm, rare esophagus (Ösophagus) and mouth. Characterizing for disease Crohn is the intermittent, segmentale infestation (so-called. „skip lesions“) the intestinal mucosa, D. h. can do at the same time several intestine sections gets sick to be, which are by healthy sections from each other separated.

The name „Crohn “refers not to the chronic process of the illness, but to the stomach and intestine specialist Dr. Burrill Berne pool of broadcasting corporations Crohn, that the disease picture1932 described for the first time.

Table of contents

frequency

the Inzidenz of M. Crohn (D. h. the annualNumber of new illnesses) amounts to about 2 to 4 to 100.000 inhabitants; the Prävalenz (D. h. the existence got sick on) lies with approximately 250 to 500 to 100.000. The number of the illnesses increases in the last 20 years. Both sexes are equivalent, usually frequently concernedget sick „young adults “between that to 16. and 35. Lebensjahr as well as older humans starting from an age of 60. One observes both a family amassment and an ethnical. Lightmembranous humans about twice as often get sick like dark-membranous.

emergence of disease Crohn (etiology andPathogenesis)

the causes of the emergence of the disease Crohn are not clearly clarified.

autoimmune illness

at most at present opinion see in the disease Crohn an autoimmune illness of the intestinal mucosa represent. The main argument for this opinion is good responding of the illness on immune-restraining medicines how Cortison and Azathioprin and the missing proof of a specific exciter.

The trip for the autoimmune reaction is not so far well-known. So far also no specific autoanti-bodies are like this with other autoimmune illnesses the case are proven. After present realizations both a weakened, and one could diseasedincreased immune reaction against the Darmflora in a genetically prädisponierten landlord a cause chronic-inflammatory intestine illnesses its.

Newer studies (February 2006) support rather the thesis of a weakened immune reaction in connection with a diseased decreased blood circulation of wounds. This leads to a long lasting bacterial mucous membrane infestation, that from the immune systemonly with means to be fought can, which damage the intestinal mucosa.

a increased risk at disease Crohn have to get sick to smoking smoker.

genetics

it exists a hereditary assessment for the illness. Meanwhile several hereditary factors were discovered, their proofthe risk for the illness increase.

barrier disturbance

much interprets thereupon that at least with a part the disease Crohn patient is defective the barrier between the intestine lumen and the organism. Concrete referring to this barrier defect show up z. B. in the lack on anti- infektiveffective Peptiden (Defensinen) in the Mucus (Schleim), which is supported the intestinal mucosa. Besides frequently the sealing connections between the epithelium cells the intestinal mucosa are „leaky “, D. h. no longer functionally and in its number decreases. Whether the controlled cell death (Apoptose) of many epithelium cells a primary orsecondary phenomenon is, and thus for the disease picture causally is the basis or only to the Chronifizierung of the inflammation contributes, is unclear. By the defect to the barrier function - contrary to the situation when recovering - bacteria of the normal Darmflora in large number arrive to that directly at the epitheliumAnd penetrates intestinal mucosa partly also into the intestine wall, where they actually release then proper inflammations, which continue to damage the barrier still, so that in the sense of a vicious circle further bacteria of the Darmflora penetrate the inflammation of far anfachen into the intestine wall and. The primary defect thatBarrier disturbance can be partly genetically conditioned at least. So the production of certain Defensine is with disease Crohn patient also for disease Crohn characteristic mutations in a gene (NOD2/CARD15), which a intrazellulären sensor for bacterial structures codes, in relation to disease Crohn patient without this gene defect still more strongly decreased, although thoseDefensinproduktion also with disease Crohn patient without this gene defect is already drastically in relation to recovering decreased.

further ones possible causes

excessive hygiene

which factors of the environment for the common development of the disease Crohn in societies with high hygenic standard lead are stillunclearly. Possibly an infestation with parasite (z bends. B. Worms), by a specific modulation of the immune answer of the Chronifizierung of the inflammation reaction forwards. Also like soaps, softeners or emulsifying agents, to it, the barrier function could contribute different hypotheses, like the damage of the intestine barrier by the increasing exposition opposite Detergentien,to damage and so for the penetration of bacteria of the normal Darmflora feed motion carry out the intestine wall. The shift is probably secondary in the composition of the Darmflora with disease Crohn patient. Compared with recovering one finds a clear reduction of the number of different bacteria species.

Antibiotics

antibiotics could to a shift of the Darmflorabeitragen. On the other hand antibiotics bend possibly an acute inflammation thrust forwards. Controlled ones clinical studies with antibiotics showed however so far no clear value of these substances in the therapy of the disease Crohn.

nutrition

in former times assumed connections alsoa specific nutrition, like z. B. increased use of refined sugar varieties with MC-patients, today as secondary are judged, since due to the inflammations in the small intestine a generally decreased absorption and thus a worse food utilization exhibit many disease Crohn patients.

Psychosomatik

psychological remarkablenesses are likewiseConsequence, a less cause of the illness, although stress can lead with disease Crohn patient to the occurrence of renewed inflammations.

Mykobakterien

the proof that Mykobakterien (Mycobacterium paratuberculosis) cause the illness, did not succeed so far convincingly.

symptomatology

disease Crohn begins usually withyoung adults with tiredness, decrease in weight, pain in the right hypogastric region and (usually unblutigen) falling through. Likewise fever , strong decrease in weight, nausea and vomiting can develop. A Manifestation of the illness without failure is also possible. Thrust way also with fever, a rise of the white blood corpuscles and an anemia(Acceptance of the red blood coloring material). With many patients however the kind and feeling of the symptoms are different. For example the entire hypogastric region and Oberbauch can come at the beginning and in the process of one „inflammation phase “(so mentioned „a thrust “) to loss of appetite, pain or cramps into. Also becomes ofConcerned ones „butterfly-like Kribbeln “described that after a toilet course disappears, and/or. the symptomatology occasionally improves. With up to 50 per cent the disease Crohn patient also extraintestinale Manifestationen so mentioned, features of the disease Crohn arise outside of the gastro-intestinal tract. The joints, the skin are very frequent orthe eyes concerned. The extraintestinalen Manifestationen can occur also before the intestinalen symptomatology. (Mainly these symptoms step however as side effect of many medicines such as z. B. Kortison up.)

in Europe and North America concerns this illness mostly white humans and mostly begins between 15 and 30 years. Disease Crohn is an illness despite treatment comes again and again, thus a lifelong illness.

complications

  • of mechanical Ileus: At first frequently by restricting the intestine segment concerned during the inflammatory process causes, in the later stage by fibröse structures. A Ileus joinszirka 20% to 30% of the patients in the process of the illness up.
  • Fistel: Fisteln arise in the chronic process quite frequently and can be quite different: cutaneously, enteroenteritisch, enterovesikal, enterovaginal, peranal, rektal. More rarely however Fisteln are into the free abdominal cavity inside, there thoseEnvironment of the intestine grew together usually strongly.
  • Enteropathi Arthritis or Sakroiliitis
  • Uveitis at the eye
  • abscess: intra and retroperitoneale abscesses occur.
  • intestinale bleedings
  • toxic Megakolon: (= through „poison “caused abnorme far position of the large intestine) rather rarely with disease Crohn, but more frequently with Colitis joke-pink
  • Karzinom: Particularly for Dünndarmkarzinome a increased risk exists.

diagnostics

pathology /Morphologie

macroscopic are characteristic the following changes:

  • Hose phenomenon:By Fibrosierung Segmentstenosen caused
  • paving-stone phenomenon: It alternates inflamed mucous membrane with deep ulcerations whereby a paving-stone-like appearance develops.
  • Inflammatory conglomerate tumor: Different intestine sections stick together with one another.

Histologically (feingeweblich) one recognizes above all an amassment of Lymphozyten, (eosinophilen) Granulozyten and Histiozyten in the Biopsie of the ignited intestine fabric.Adjacent lymph nodes are usually increased. Frequently form Granulome, which can be differentiated with respect to two types: Epitheloidzellgranulome and Mikrogranulome (smaller and without central necrosis).

differential diagnostics

for the differential diagnostics is a detailed ultrasonic investigation with good equipment and an experienced examiner muchhelpfully. Thus a Divertikulitis or a Appendizitis can be usually defined. The CT is a good investigation possibility. With the usually young patients one uses it however because of the radiation dose only rarely.

differential diagnostics to chronic-inflammatory intestine illnesses

disease Crohn is to be sometimes differentiated heavily from another chronic-inflammatory intestine illness to: the Colitis joke-pink.

The main differences between disease Crohn and Colitis joke-pink are under in a table chronic-inflammatory intestine illnesses in summary.

to determine

activity index over whether it itself around an acute thrust in need of treatment , becomes a score acts after the Crohn's Disease Activity index (CDAI) nach Best errechnet. Bei einem CDAI > 150 concerns it an acute thrust in need of treatment.

therapy

a goal of the therapy is primarily the Linderung of the symptoms and the decrease of the number of acute thrusts. One operates only for avoidance or when being present dangerous complications.

acute thrust

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Long-term therapy

  • Immunsuppressiva (z. B. Imurek, Remicade)
  • surgical therapy (Resektion of intestine sections concerned): Leads to no definite healing, is however with heavier cases perhaps essential, in order to avoid heavy complications such as Stenosen, Fisteln, abscesses or perforations.

therapy resistance

  • with therapy resistanceunder Immunsuppressiva or with heavy Fistelbildungen Infliximab can be given as repeated infusions.

Rezidivprophylaxe

  • 5-Aminosalicylsäure

accompanying therapy possibilities

  • nourishing therapy, z. B. with modules (drinking food nutrient-balanced for sufficient supply of macro and micro nutrients)
  • Psychotherapie: the Psychotherapie in most cases offersa large assistance during the stress accomplishment and contributes thereby to the reduction of the psychosomatischen factors of influence. Likewise relaxation exercises are, z. B. after Feldenkrais, progressive muscle relaxation or autogenous training advisable.
  • Income of pig whip worm preparations

prognosis

it concerns usually a chronic illness alsohigh Rezidivrate. Complications make in most cases an operational therapy necessary, which leads in addition, to no definite healing. Whether the illness affects the life expectancy, is disputed. Both investigations, with which no significance could be determined, exist and such,to the conclusion it came that the life expectancy sinks by the illness slightly. Here always an adequate therapy is presupposed.

see also

to Phytotherapie with gastro-intestinal diseases

literature

  • Monika Stoll, Stefan writer: Disease Crohn: Second illness-associated gene discovers. Biology inour time 34 (4), S. 208 - 209 (2004), ISSN 0045-205X
  • Korzenik JR, Dieckgraefe UC Is Crohn s disease on immunodeficiency? A hypothesis suggesting possible early events into the pathogenesis OF Crohn s disease. Dig this Sci 2000 June; 45 (6): DC
  • , Wiedenmann B, Dignass A tree-refines 1121-9: Biological one Therapy of chronic-inflammatory intestine illnesses. Z Gastroenterol 2003; 41: 1017-1032.
  • Castle village W: Cutaneous manifestations OF Crohn´s disease. J at the Acad Dermatol 1981; 5: 689.
    • Hautmanifestationen of the disease Crohn
  • Cheifetz A, Smedley M, Martin S, rider M, Leone G, Mayer L, Plevy S: The incidence and management OFinfusion reactions tons infliximab: A large centers experience. At the J Gastroenterol 2003; 98: 1315-1324.
  • D'Haens G, Van Deventer S, Van Hogezand R, Chalmers D, Kothe C, Baert F, Braakman T, Schaible T, Geboes K, Rutgeerts P: Endoscopic and histological healing with Infliximab of antibodies in Crohn´sdisease: A European multi-center trial. Gastroenterology 1999; 116: 1029-1034.
  • Ghosh S, Goldin E, Gordon FH et al.: Natalizumab for active Crohn´s disease. N Engl J Med 2003; 348: 24–32.
  • Grange F, Djialali Bouzina F, white TO, Polette A, Guillaume JC: pyoderma gangraenosum associated with Crohn Corticosteroid resistant `sdisease: rapidly cure with infliximab. Dermatology 2002; 205: 278–280.
  • Herfarth H, upper Meier F, Andus T, Rogler G, Nikolaus S, Kuehbacher T, writer S: Improvement OF arthritis and arthralgia after treatment with infliximab (Remicade) in A German prospective, open label, multi-center trial in refractory Crohn´s disease. ToJ Gastroenterol 2002; 97: 2688-2690.
  • Petrelli, I/O, McKInley M, Troncale FJ: Ocular manifestations OF inflammatory bowel disease. Ann Ophthalmol 1982; 14: 356.
  • Podolsky DC: Inflammatory Bowel Disease. N Engl J Med 2002; 347: 417–429.
  • Present DH, Rutgeerts P, Targan S, Hanauer SELF-SERVICE, Mayer L, vanHogezand RA, Podolsky DC, sand, Braakman T, DeWoody KL, Schaible TF, van Deventer SJ: Infliximab for the treatment OF fistulas in patients with Crohn's disease. N Engl J Med 1999; 340: 1398-1405.
  • Sand, Anderson one FH, amber CN, Chey WY, Feagan BG, Fedorak RN,Comb mA, Korzenik JR, Lashner BA, Onken EVER, Rachmilewitz D, Rutgeerts P, game G, wolf DC, Marsters Pa, Travers SELF-SERVICE, blank mA, van Deventer SJ: Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 2004; 350: 876–885.
  • Targan SR, Hanauer SELF-SERVICE, van DeventerSJ, Mayer L, Present DH, Braakman T, DeWoody KL, Schaible TF, Rutgeerts PJ: A short term study OF chimeric monoclonal antibody cA2 ton tumor necrosis factor alpha for Crohn´s disease. Crohn´s Disease cA2 Study Group. N Engl J Med 1997; 337: 1029-1035.
  • Wehkamp, J., J.Harder et al.,…,Schroeder, J., bar, E.F. 2004. NOD2 (CARD15) mutation in Crohn´s disease acres associated with diminished mucosal A-defensin expression. Well 53: 1658-1664.
  • Wehkamp, J., N.H.Salzman et al.,…, bar, E.F., Bevins, C.L. 2005. Reduced Paneth cell {alpha} - defensins in ileal Crohn's disease. PNAS 102: 18129-18134.
  • Weiner SR, Clarke J,Day-refines N, Utsinger PD: Rheumatism TIC manifestations OF inflammatory bowel disease. Semin Arthritis Rheum 1991; 20: 353.

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