The most common IBD are:
• Ulcerative colitis (YAK) - affects the large intestine, usually starting from the rectum;
• Crohn's disease - can affect any part of the gastrointestinal tract: from the oral cavity to the anus. In the inflammatory process, the entire thickness of the intestinal wall is often involved.
Causes and morbidity
Despite the large number of scientific studies, the reasons for the development of the VZK have not been fully clarified. According to one theory, the pathogens of IBD are viruses or bacteria that enter the intestine from the environment and provoke a pathological aggressive reaction from the normal intestinal microflora. Ulcerative colitis is registered in all countries of the world, its prevalence is 50-80 cases per 100 thousand population. The disease affects people of any age, but the age group of 15 to 40 years is most vulnerable to it. The incidence rate among men and women is practically the same. In about 15% of patients, close relatives (parents, brother or sister) also suffered from this disease. According to the research, two-thirds of patients with Crohn's disease smoke. Smoking is the only reliably established factor of the external environment that affects the incidence of IBD. In developed countries, the prevalence of Crohn's disease is 30-4-0 cases per 100 thousand of the population. Crohn's disease and ulcerative colitis are characterized by a recurrent course (episodes of exacerbation of the disease followed by periods of asymptomatic flow). Stress and viral infections are the most frequent triggers of relapse.
Typical symptoms of ulcerative colitis are:
• frequent urge to defecate with an abundant stool;
• an admixture of blood or mucus in the feces;
• intense abdominal pain, decreasing after defecation;
• general malaise and fatigue;
• fever and loss of appetite.
Symptoms of Crohn's disease are somewhat different. This is partly due to the fact that any part of the gastrointestinal tract can be affected in this disease. When Crohn's disease can be observed:
• a loose stool with an admixture of blood;
• cramping pain in the abdomen;
• weight loss;
• Stenosis of the intestine, sometimes leading to intestinal obstruction;
• formation of fistulas (abnormal joints between organs through which intestinal contents enter adjacent cavities, for example, in the bladder or vagina).
In addition, Crohn's disease can affect the mucous membrane of the mouth, joints, lower limbs. Some patients associate the exacerbation of the disease with the use of certain foods, but there is no specific diet recommended for patients with IBD. The diagnosis of any disease of the IBD group is usually based on laboratory data and examination of the patient. After careful collection of anamnesis and general physical examination, including a finger examination of the rectum, a renumeroscopy is usually given, allowing to examine the inner surface of the rectum and the lower part of the large intestine. In carrying out this test, a special instrument (sigmoidoscope) is inserted through the anus, allowing you to examine the intestinal mucosa and take a tissue sample for microscopic examination.
Survey plan
Regardless of the results of sigmoidoscopy, the following studies are usually conducted:
• blood tests (including the presence of markers of the inflammatory process);
• Radiography of the intestines using a barium enema. On the eve the intestine is emptied with a laxative. On the day of the study, a barium solution is introduced through the rectum, which is an X-ray contrast material, which allows to identify areas of inflammation or narrowing of the intestine. When suspected of Crohn's disease, the upper intestinal tract is likewise examined. In this case, the patient takes a barium suspension inside, which makes it possible to visualize the small intestine;
• Colonoscopy. In this study, a wide flexible endoscopic instrument with a light source is introduced through the anus and allows examination of the mucosa of the large intestine and rectum. With its help, you can not only examine areas of the intestine that are inaccessible with sigmoidoscopy, but also if necessary, conduct tissue biopsy. If you suspect a defeat in the upper intestine, another type of endoscopic examination is prescribed: gastroduodenoscopy. In carrying out this procedure, a special endoscope, called a gastroscopy, is inserted through the esophagus into the stomach and duodenum. Gastroscope is a flexible fiber optic tube that allows you to inspect all parts of the stomach. The image is transferred to the monitor screen. This method is used for both diagnosis of IBD and for minimally invasive surgical procedures. The methods of treatment of IBD vary from oral taking of steroid preparations to surgical intervention, which is used in severe cases. Despite the impossibility of complete cure, most patients are able to lead an active lifestyle. After the diagnosis of IBD, the patient is observed with a gastroenterologist, usually at the place of residence.
Treatment with steroids
To remove inflammation with exacerbation of IBD prescribe steroid drugs in the form of tablets, enemas or suppositories. Patients often fear the appointment of steroids, believing that these are potent agents that can cause unwanted effects, especially with prolonged admission. Side effects of these drugs include the formation of the moonlike face, weight gain, weakness of skeletal muscles and increased blood pressure. The side effects of the new generation of steroids may be less pronounced, however, in any case, it is undesirable to abruptly stop taking them, as the body takes time to restore its own rhythm of production of steroid hormones.
Removal of inflammation
After elimination of the initial acute symptoms of the disease, 5-aminosalicylic acid derivative preparations (in the form of monotherapy or in combination with steroids) form the basis of treatment of IBD. They include sulfasalazine, mesalazine and olsalazine. Their administration prevents relapse of the disease, thus providing a stable remission. These drugs can be used in the form of tablets, enemas or candles and do not have such aggressive action as steroids. Common side effects of this group include nausea, rash, headache and anemia. To identify their individual intolerance, the patient is regularly examined by blood. Another drug with a powerful anti-inflammatory effect is azathioprine. It is used for poor tolerability of dose reduction of steroids, as well as for patients with difficultly controlled IBD. When taking this drug, you also need regular monitoring of blood counts. A small percentage of patients with IBD require surgical treatment. If the adequate therapy scheme is not adhered to, the probability of the need for surgical intervention increases.
Heavy forms
With untreated ulcerative colitis, indications for surgical treatment occur in about 30% of patients. Surgical treatment is necessary when it is impossible to quench a severe exacerbation with the help of high doses of medications, as well as with a significant decrease in the patient's quality of life. In addition, the operation is required if early signs of a malignant process in the intestine are detected.
Types of operations
In Crohn's disease, surgical treatment is mainly aimed at eliminating complications by removing the affected areas of the intestine. For most patients with ulcerative colitis, the operation of choice is the so-called reconstructive proctocollectomy, which consists in removing part of the large intestine and then forming a "pocket" from the intestinal gut connected by the anastomosis to the anus. The operation is performed in two stages, in contrast to the colectomy, in which the large intestine and rectum are removed simultaneously, and the excretion of stool is carried out through the ileostoma in a special sac. Adequate treatment makes it possible to successfully control the course of IBD in most patients, but these diseases are incurable. In such patients, under certain conditions, the risk of developing malignant tumors of the intestine increases.
The risk of developing cancer of the colon or rectum increases with the involvement of the entire intestine (or a large part of it) in the inflammatory process, as well as with an increase in the duration of the disease. The risk of a malignant process can be reduced by regularly passing a colonoscopy, which allows detecting precancerous changes at an early stage. It is important to note that in patients with mild IBD, it is significantly lower. Very rarely, malignant changes occur against the background of Crohn's disease, which proceeds without the defeat of the large intestine.
Forecast
IBDs are characterized by a chronic course, and their manifestations in each patient are individual. In the active phase, the disease can cause considerable discomfort, but with the right selection of drug therapy, taking into account the regularities of the course of the disease, most patients retain the ability to fully active, despite the impossibility of complete cure. During the remission period, a patient with an IBD can lead a normal life. Among the patients there is an opinion that the exacerbations of IBD appear "on the nerves", which is absolutely wrong. In fact, a relapse of the disease can lead to considerable nervous tension and even depression, especially when the patient is forced to frequently visit the toilet. Therefore, during the period of exacerbation, sympathy and understanding on the part of both the patient's family members and colleagues are very important. For a woman planning a pregnancy, the chance to become pregnant is higher during remission. During pregnancy, there may be exacerbations of the disease, but they usually occur in a non-severe form and respond well to drug treatment. The ratio of benefit and risk of taking steroids during pregnancy is estimated as favorable, since the probability of developing side effects during this period is low enough.