Most diseases of the gastrointestinal tract respond well to treatment and do not cause dangerous complications. The main threat is chronic inflammation, the group of which includes terminal or transmural ileitis (granulomatous, regional enteritis).
Crohn's disease - causes
Doctors have not yet figured out exactly why this pathology arises, there are only a few theories of its origin. Proposed causes of terminal ileitis:
- genetic mutations;
- autoimmune disorders;
- viral or bacterial infections.
Crohn's disease - classification
There are many forms of the described disease, which are divided into several groups depending on the localization of the inflammatory process, its severity, nature and other factors. According to modern international standards, terminal ileitis (Crohn's disease) is classified according to 4 criteria:
- age of the patient;
- phenotype of the disease;
- localization of inflammation;
- severity of pathology.
Groups by age:
- up to 16 years (A1);
- from 17 to 40 years old (A2);
- after 41 years (A3).
Crohn's disease depends on the phenotype:
- inflammatory (B1) - the pathology is not complicated, sometimes the perianal lesion joins;
- Stricturing or stenosing (B2) - the walls of the intestine are narrowed, there is a pre-stenotic enlargement or obstruction;
- Penetrating (B3) - there are fistulas, inflammatory masses and abscesses.
Types of pathology by localization:
- ileitis (L1) - ileum;
- colitis (L2) - the large intestine between the blind and straight;
- ileocolitis (L3) - any place between the rectum and the ascending part of the large intestine;
- organs of the upper gastrointestinal tract (L4).
Forms of the disease by severity:
- light;
- moderate;
- high;
- remission;
- exacerbating;
- postoperative recurrent.
Crohn's disease - symptoms
Clinical manifestations of the presented pathology correspond to its degree, localization and duration of the inflammatory process, the frequency of relapses and other factors. There are some nonspecific signs accompanying terminal ileitis - symptoms of a general nature:
- fever or undulation;
- weakness;
- constant fatigue;
- decreased body weight;
- stomach ache;
- lack of appetite;
- Diarrhea lasting more than 6 weeks.
Terminal catarrhal ileitis
This type of disease is characterized by inflammation of only the mucous membranes of the organs of the gastrointestinal tract. Crohn's disease of the catarrhal form may be accompanied by intestinal and extraintestinal symptoms. The first group of clinical manifestations includes:
- pain, imitating acute appendicitis ;
- nausea;
- anorexia;
- vomiting;
- bloating;
- chronic diarrhea.
Extraintestinal signs of Crohn's disease:
- conjunctivitis, uveitis or keratitis;
- aphthous stomatitis;
- sclerosing cholangitis ;
- cirrhosis;
- pyelonephritis;
- fatty degeneration of the liver;
- cholelithiasis;
- cystitis;
- hydronephrosis;
- cholangiocarcinoma;
- amyloidosis of the kidneys;
- nephrolithiasis.
Terminal follicular ileitis
In the submucosa of the thin and ileum, a large number of Peyer's plaques are located. These are special lymphoid follicles, designed for the production of immunoglobulins. Terminal ileitis often affects such structures, resulting in the already listed symptoms and additional clinical manifestations:
- susceptibility to frequent infections, especially viral infections;
- ankylosing spondylitis;
- nodal erythema;
- gangrenous pyoderma;
- angiitis;
- adhesive processes;
- monoarthritis;
- peritonitis;
- fistulous courses;
- intra-abdominal abscesses;
- narrowing of the lumen and intestinal obstruction;
- steady increase in body temperature.
Erosive terminal ileitis
This Crohn's disease is characterized by the formation of deep ulcers on the mucous membranes of the organs of the gastrointestinal tract. Inflammation in combination with erosive processes is considered one of the most dangerous forms of terminal ileitis, leading to dangerous and life-threatening consequences. Ulcerous Crohn's disease - manifestations:
- perforation of intestinal walls;
- internal bleeding;
- toxic megacolon;
- abscesses due to secondary infection.
Crohn's disease - diagnosis
The clinical picture of terminal ileitis is non-specific, therefore at first the gastroenterologist has to exclude many other diseases with similar signs. It is important to distinguish digestive pathologies, accompanied by diarrhea, and Crohn's disease - differential diagnosis is performed with such ailments:
- mesenteritis;
- appendicitis;
- salmonellosis;
- enteritis;
- shigellosis;
- colitis;
- intestinal tuberculosis;
- angiitis;
- gonorrheal or chlamydial proctitis;
- amebiasis;
- lymphoma of the intestine.
Instrumental and hardware methods are used to confirm the terminal ileit:
- colonoscopy;
- endoscopy and biopsy;
- radiograph of abdominal cavity;
- magnetic resonance or computed tomography of the intestine with contrast.
Crohn's disease - tests
Laboratory research also helps to establish the correct diagnosis. The main way to detect Crohn's disease is a blood test:
- for antibodies to Saccharomyces cerevisae (referred to as ASCA);
- common;
- biochemical;
- immunological.
Additionally, stool analysis is performed:
- bacteriological;
- to the level of calprotectin;
- parasitic.
Crohn's disease - treatment
Because of the absence of well-known causes of the described chronic pathology, special therapy for its elimination has not yet been developed. All options, how to treat Crohn's disease, boil down to stopping the inflammatory process, preventing complications and relapses. The main methods of therapy are medication and diet. In the presence of severe consequences of terminal ileitis, surgical intervention is performed.
Crohn's disease: treatment - drugs
The main direction in the treatment of the disease is the removal of inflammation and the restoration of the normal digestive process. Terminal Ileitis - treatment involves the following pharmacological agents:
- glucocorticoids - Prednisolone, Methylprednisolone;
- salicylates - Mesazalin, Sulfasazalin;
- immunosuppressants - Methotrexate, Azathioprine;
- topical hormones - Budesonide, Beklazone;
- antibiotics - Rifaximin, Ciprofloxacin ;
- biological preparations of genetic engineering - Etanercept, Infliximab and others.
Crohn's disease continues to be investigated, so scientists are constantly looking for new ways to deal with terminal ileitis. Prospective options are:
- blockers of integrin receptors - Vedolizumab;
- live donor or genetically modified bacteria;
- sorbents;
- conjugated linoleic acid;
- DNA sequencing;
- nanotechnological preparations;
- enzymes;
- plasmapheresis;
- stem cells - polychrome;
- placing in a hyperbaric chamber;
- means of marijuana - Naltrexone;
- plasmabsorption;
- vaccines against inflammatory bowel pathologies;
- preparations based on eggs of porcine worms (TSO) and others.
With Crohn's Disease
All patients with a gastroenterologist with the indicated diagnosis must be assigned a special diet. Diet for terminal ileitis is selected taking into account the nature of the course of the disease and the presence of complications. The easier the degree of pathology, the more foods are allowed to be consumed. Nutrition for Crohn's disease involves an exception:
- fresh flour and bakery products;
- snacks;
- rich broths;
- vegetable and cereal soups;
- smoked products;
- milk and dairy products;
- fatty meat, fish;
- canned food;
- barley, millet, pearl barley;
- beans;
- any sweets;
- vegetables;
- cold and carbonated drinks;
- cocoa or coffee with milk.
Recommended food:
- dishes from low-fat fish or minced meat, steamed or boiled (soufflé, cutlets and others);
- rusks from the highest grade flour;
- calcined or grated fresh cottage cheese;
- weak or fat-free broths with the addition of egg flakes, meatballs, mucous cereal broths (from mango, rice);
- eggs (boiled soft-boiled, steam omelet);
- butter, like the filling of dishes;
- grated raw apples;
- oatmeal, rice, semolina porridge on water in the garbled form;
- green tea;
- coffee or cocoa on water;
- berry fruit drinks;
- diluted fruit juices;
- kissel;
- broth of dogrose.
It is important to eat often and in small portions, additionally take minerals and vitamins, especially groups B, A, D, E and K. If necessary, the doctor can correct the given variant of the diet (table 4 according to Pevzner) according to the following parameters:
- features of the pathology;
- severity of clinical manifestations;
- severity of symptoms;
- presence of concomitant ailments and complications;
- well-being of a person;
- side effects of drug therapy.
Crohn's disease - treatment with folk remedies
Many alternative recipes help to quickly stop the inflammatory process and restore proper digestion. Folk advice how to treat terminal ileitis should be combined with drug therapy. Separately, natural remedies have too little effect, so they are used as additional health measures.
Anti-inflammatory tea
Ingredients:
- flowers of chamomile pharmacy - 30-35 g;
- boiling water - 200-210 ml.
Preparation, use:
- Pour vegetable raw materials with hot water.
- Insist 1-3 hours.
- Drink the whole dose of medicine before eating.
- Repeat up to 5-6 times a day.
Decoction against diarrhea
Ingredients:
- Bilberry fruits - 100-140 g;
- water - 1 liter.
Preparation, use:
- Boil the berries in boiling water for 10 minutes.
- Filter the resulting compote.
- Drink remedy during the day.
Spasmolytic infusion
Ingredients:
- the roots of the marshmallow are 100-150 g;
- water - 50-80 ml.
Preparation, use:
- Rinse and cut into small pieces of raw materials.
- Pour it with cold water in a deep dish, so that the liquid only covers the roots.
- Insist 6-10 hours.
- Drain the resulting mucus into a separate container.
- Drink 2 tsp 2-4 times a day, adding the medicine to a glass of water.
Antiulcer decoction
Ingredients:
- Purified licorice roots - 2-3 g;
- water - 150-200 ml.
Preparation, use:
- Boil vegetable raw materials in boiling water (10-15 minutes).
- Insist half an hour.
- Filter the solution.
- Drink a remedy between meals three times a day.
- Heal not longer than a month, then take a break and continue.
Crohn's disease - consequences
The ailment examined has a chronic course, therefore it constantly progresses and often leads to dangerous conditions. Crohn's disease - complications:
- the exit of feces into the abdominal space;
- anal fissures ;
- ulceration of mucous membranes;
- dysbiosis;
- colon cancer;
- abscesses;
- fistulas .
Because of a violation of absorption of nutrients, Barill's disease is accompanied by:
- exhaustion with a strong weight loss;
- hypovitaminosis;
- a dysbacteriosis.
Crohn's disease - prognosis
Completely cure terminal ileitis can not, a person will have to adhere to a diet all the time, engage in therapy and prevent pathology. While one can only control Crohn's disease - the prognosis of life is favorable, provided:
- compliance with recommendations for the formulation of the diet;
- abandonment of addictions;
- regular visits to the gastroenterologist;
- timely treatment and prevention of complications.