Disease of Crohn

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disease of Crohn is one chronicle being able to touch all it with a predilection for the iléon, the colonist and the anal area.

Its rests on a whole of the clinical data, radiological, and/or endoscopic and .

It can be accompanied by extra-intestinal demonstrations (, , ...) and sometimes even of extra-digestive localizations. The principal clinical demonstrations observed during evolutionary pushes of the disease depend on the seat (, colon, another digestive segment) and of extended from the lesions. It acts especially of with or without syndrome dysenteric, of abdominal pains sometimes of subocclusif type, of the demonstrations anopérinéales, the deterioration of the general state with or without , of the extra-intestinal demonstrations. The evolutionary pushes can be enamelled of complications, some can require an intervention : , perforation, colectasy, , , hépato-biliary demonstrations.

Mainly one chronic (several weeks in several months), especially hydrous and frequently accompanied by abdominal pains. A loss of weight is often observed (by malabsorbtion). It is not rare that the pushes are accompanied by a little . 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 index of BEST (CDAI for the Anglo-Saxons), if the latter is < 150 the patient is in remission.

Several thousands of new cases per annum (probably about 3000 to 4000). 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.

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 or polyarthite 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 touched zones are typically the colonist and the last centimetres of the iléon. The lesions met are has standard ulcerations, often aphtoïdes or deep, they can be presented in the form of true cracks in the mucous membrane.

In of digestive mucous membrane one seeks one granulome epithélioïde. Its discovery is a strong argument in favour 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 coloscopy.

Radiology

Useful to observe the nonvisible zones by endoscopy (in particular the small intestine). It makes it possible to detect the possible ones sténoses (contractings).

More sophisticated than the simple radio, this last can help with the diagnosis, particularly if there exists .

Complications

in the short run

One fears especially the sténoses, cracks, dents or perforations, a colectasy (dilation toxic of the colonist) or a serious colitis (very severe push of start).

long-term risks

There exists, after 10 years of evolution, an increase of the risk of colo-rectal cancer. This risk is especially important in the event of wide attack and requires a regular monitoring (coloscopies).

Treatment

The treatment of attack rests especially on . The preventive treatment is divided between salicylated (5ASA or mésalazine) and them immunosuppresseurs.

Treatment of the pushes

Salicylated for the tiny pushes.
Corticoids for the pushes moderated with severe.
Infliximab (immunomodulator, anti-TNF alpha) or for the serious pushes or in the event of failure of the preceding treatments.

Treatment of maintenance (preventive)

Salicylated (5ASA or mésalazine) or azathioprine (immunosuppressor) or a combination of both.

Surgery

As a last resort or in the event of sténose iléale or in the event of attack anopérinéale answering the medical treatment badly (antibiotic, immunosuppressor).

Mode

Of a discussed interest. Certain probiotic could be useful.

Differential diagnosis

Difficult to make because the disease can, wrongly, be labelled like a digestive, intestinal functional disorder (TFD, TFI or functional colopathy). One can easily confuse RCH (touching only the colonist) and disease of CROHN (being able to touch all the digestive tract), both intestinal chronic inflammatory diseases. Certain infectious colites can also present a misleading table.