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0«шиитеимм-лэишаи» ЖШ / MEDICAL sciences
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УДК 616.344-002-031.84-036.1 -07-08
Honcharuk L.M.,
PhD in Medical Sciences, Associate Professor Department of Internal Medicine;
Drohomyretskyi N. T., 6th year student of 14 group Buk ovinian State Medical University
Nazaryshyn O.V. 6th year student of 14 group Buk ovinian State Medical University Zhovtia O.S., 6th year student of 14 group Buk ovinian State Medical University
Lukashuk D.A. 6th year student of 14 group Buk ovinian State Medical University DOI: 10.24412/2520-6990-2023-34193-27-29 CROHN'S DISEASE: MODERN VIEWS ON DIAGNOSIS AND TREATMENT
Abstract.
Crohn's disease is a chronic, transmural, granulomatous inflammation that can affect any segment of the gastrointestinal tract. Typical for this condition are segmental inflammatory changes with demarcation by unaffected parts of the tissue. The etiology of this disease has not been fully elucidated, but there are assumptions about the influence of several provoking genetic factors and environmental factors that participate in the development of the disease. Modern knowledge about Crohn's disease has expanded significantly and helps improve the outcome of therapy. It is important to note that early and timely detection and treatment of the disease allow achieving clinical remission, reducing the number of complications and the volume of prescribed drugs for a larger number of patients. In this article, we want to shed light on the main modern methods of diagnosis and medical treatment of Crohn's disease.
Keywords: Crohn's disease, inflammatory bowel disease, diagnosis, treatment.
Crohn's disease is quite common in the developed countries of Western Europe and North America, including the UK, with an incidence of 3 to 20 per 100,000. In North America, the prevalence is 144 to 198 per 100,000. Most often, the manifestation of the disease occurs in patients aged 15 to 30 years, but there is a small number of people with late onset aged 60 to 80 years. The number of patients in Ukraine is not known for certain, because there is no corresponding registry, but according to experts, it is approximately 14,000 patients. The disease is thought to affect women more often, but this often varies by population. There is a gradual and steady increase in the incidence of Crohn's disease throughout the world. The greatest growth can be seen in Caucasians, African Americans, Hispanics, and Asians. Also, modern studies indicate an increase in the number of cases of damage to younger people.
The aim of the study. To analyze publicly available literature on current approaches to the diagnosis and treatment of Crohn's disease.
Results and discussion: Crohn's disease is a chronic, transmural, granulomatous inflammation and progressive disease of the gastrointestinal tract with various localization of lesions [1]. The most frequent segment of the gastrointestinal tract that is affected is the ileum - ileitis (about 30%) and the large intestine -granulomatous colitis (about 20%). Ileocolitis is an inflammatory lesion of the ileum and colon in approximately 40% of cases. Lesions of other segments of the
gastrointestinal tract are noted less often, but sometimes the stomach is affected, most often its antral part and especially in young patients.
The etiology is not fully established, but scientists believe that the development consists in the presence of several factors that contribute to the development of CD. These include genetic, immune and bacterial, intestinal microflora imbalance, smoking, medications. It is believed that the complex influence of these factors causes the occurrence of the disease in people prone to it [2]. This induces chronic inflammation with damage to the organ by the immune system The presence of relatives with this diagnosis increases the risk of the disease in other family members [3]. The main characteristic of Crohn's disease, which distinguishes it from ulcerative colitis, is the involvement of all layers. The disease begins with inflammation of the crypts and the formation of foci of inflammation. With an active process, neutrophilic inflammation occurs with the formation of microabscesses and aphthoid ulcers. These processes change the structure of the wall with alternating ulcers and foci of granulation inflammation - so-called granulomas, which are considered pathognomonic for Crohn's disease. Transmural inflammation leads to lymphedema and thickening of the intestinal wall and its mesentery. In addition to microabscesses, fistulas can form with penetration into neighboring structures [4].
The disease can be primary inflammatory, which over time turns into a stenotic or obstructive form, and can also have a penetrating or fistulizing nature. These
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forms will later determine the choice of patient treatment tactics. The course of the disease includes periods of exacerbation and remission. Exacerbations are manifested in the form of increased defecation, weight loss, painful or spasmodic nature, chronic diarrhea and, not infrequently, fever [5]. Stomach is sensitive. Weight loss is attributed to malabsorption syndrome due to transmural damage to the intestinal wall. Bleeding, fistulas, abscesses may occur. Extraintestinal symptoms include damage to the eyes (uveitis, iritis, conjunctivitis), joints (including arthritis, sacroiliitis, seronegative ankylosing spondylitis), cholelithiasis, urolithiasis, fingers in the form of "drum sticks". Dermatological manifestations are most frequent in the form of erythema, pyoderma, acute febrile neutrophilic dermatosis (Svit's syndrome). Extraintestinal manifestations (arthritis, anemia, growth retardation, etc.) occur more often in children without abdominal pain and diarrhea [6].
Diagnosis of the disease includes a set of measures aimed at its confirmation. These include radiography and CTscan of the abdominal organs with barium contrast, FGDS with biopsy, colonoscopy or video capsule endoscopy. A classic endoscopic symptom is the alternation of a zone of ulceration, swelling and healthy tissue - the "cobblestone" symptom Microscopic examination of the biopsy reveals infiltration by cells of the immune system in combination with epithelioid cells. Among them are lymphocytes, plasma cells in the submucosal layer and giant multinucleated cells of the Pi-rogov-Langhans type in granulomas [7]. It is worth noting that non-caseoid granulomas are not found in all cases, which forces a careful approach to the further plan of diagnosis of the disease. Patients with acute abdominal symptoms are recommended to undergo abdominal CT scan to detect abscesses, fistulas, etc. Ultrasound better describes the disease of the gynecological profile in women with pain in the lower abdomen [8]. Laboratory indicators are not a basis for confirming Crohn's disease due to their non-specificity. However, they are used to monitor the course and activity of the disease. Research is conducted to detect anemia, deficiency of vitamins B12 and D, hypoalbuminemia. Liver tests to detect lesions of the liver or bile ducts [9].
Complications include intestinal obstruction due to strictures or narrowing of the intestinal lumen, anemia, osteoporosis, and osteopenia due to the development of malabsorption, fistula formation, carcinoma of the small or large intestine, gallstone disease, urolithiasis, and bleeding, etc. [10].
To date, there is no complete cure for Crohn's disease, but there are drugs to maintain long-term remis -sion of the disease. The choice of therapy will depend on the activity, complexity and localization of the lesion [11]. Therapy of an uncomplicated course consists of induction of remission and maintenance of remission. Glucocorticoids (budesonide, prednisone), salicylates (5-ASA)(sulfasalazine, mesalazine), immunosuppressants (azathioprine, methotrexate, 6-mercaptopu-rine), antibiotics (metronidazole) are used for induction. In the last 20 years, anti-TNFa biologics (infliximab, ustekinumab, adalimumab, certolizumab pegol, golimumab), anti-integrin drugs (natalizumab
and vedolizumab) and ustekinumab, which acts on cytokines (IL-12 and IL-23) and is approved for the treatment of Crohn's disease in the United States [12]. Glucocorticoids are prescribed today on a short-term basis and in case of exacerbations due to the presence of a large number of side effects. Antibiotics are part of the first line of drugs purely for empiric therapy. Also, monotherapy and combined therapy with the addition of a biological drug to an immunomodulator are distinguished in the treatment. Each of them has both positive qualities (reduced inflammation) and negative qualities (increased number of side effects, liver damage, nausea, bone marrow suppression, etc.). To maintain remission, it is recommended to use azathioprine or 6-mercaptopurine after induction of remission [13]. The drug of choice is methotrexate in patients with intolerance or contraindications to the use of azathioprine and 6-mercaptopurine (low thiopurine methyltransferase activity). Glucocorticoids are not prescribed to maintain remission in Crohn's disease [14]. In patients with a complicated course or lack of a positive response to drug therapy, the option of surgical treatment is considered. It consists in the resection of the affected segment of the intestine. To avoid relapses, immunosuppressants, antibiotics or biological drugs are used. With compliance with all treatment recommendations and removal of factors that can cause relapses, the quality of life improves in most patients. Given the impaired absorption process, diarrhea and decreased appetite during the disease, patients are recommended to maintain a proper diet rich in vitamins and minerals. There is no special diet and it should be as varied as a healthy person, excluding dishes and products that cause discomfort. In case of exacerbations of the disease or intestinal stenoses, preference should be given to the consumption of products with a low fiber content [15].
Conclusion: In this article, we shed new light on the diagnosis and treatment of Crohn's disease, which is a severe, chronic disease with multiple etiological factors and diverse clinical manifestations. The disease requires a complex and individual approach to identifying and building a treatment plan. Modern diagnostic methods are becoming more and more accurate and effective in determining the condition of patients. Taking into account the traditional medical therapy, surgical treatment is still the main factor in stabilizing the condition in this disease. However, the continuous development of medicine and technology allow to increase the chances of discovering new methods of treatment with greater effectiveness, and further scientific research will ensure the improvement of the quality of life of people with this disease.
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«@®ii®@yjum-j®urnaL» 2023 /
Adults". The American Journal of Gastroenterology. 113 (4): 481-517.
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