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How to get housing with Crohn's disease. ITU commission for registration of disability Crohn's disease

Crohn's disease- chronic relapsing disease gastrointestinal tract, characterized by transmural segmental distribution inflammatory process, with the development of local and systemic complications, which is considered to be an AUTOIMMUNE disease. But a systemic cascade of disorders due to untreated or undertreated chronic viral infections- also a possible version of the development of BC. Everything is very individual, and therefore cause of system failure, Each patient has his own.

In economically developed countries, there is an increase in the incidence of Ulcerative Colitis and Crohn's Disease. The primary incidence of Crohn's disease is 2-4 people per 100,000 population per year, the prevalence is 30-50 cases per 100,000 population.
In many cases the disease affects the distal part ileum, colon. Sometimes other organs are affected digestive system: esophagus, stomach.
The international classification ICD-10 allows diagnosing Crohn's disease.

Based on the location of the disease, the disease has the following classification according to ICD-10:

K50 – regional Crohn's enteritis.

K50.0 – defeat small intestine Crown.

K50.1 – Crohn's lesion of the large intestine.

K50.8 – other types of Crohn's lesions.

K50.9 – Crohn's disease with an unknown diagnosis.

There can be many causes for this disease, as with any autoimmune disease. Many stories of IBD patients begin in childhood.

Hydro-MRI - very informative before surgery

Extract from 18.02.2016 - paragraph 14: 967 mcg/g, with a norm of up to 50 (ATTACK BC!)

During the first course of treatment: 05/20/2016 - 532.5 mcg/g

After a course of treatment with hormones, as of August 11, 2016 - 430.5 mcg/g

After removal of the ileocecal angle, as of 10/07/2016 - 75.1 mcg/g
5

3 months after resection of the inflamed part of the intestine:

As of December 13, 2016 - less than 10 mcg/g, at a rate of up to 50 mcg/g
6
6 months after surgery
As of March 2016 - 436.1 mcg/g

April 04, 2017

The term "Inflammatory Bowel Diseases" is usually used to refer to and, since they have much in common in etiopathogenesis and clinical picture. The etiology of both diseases is still unknown, and their natural history and response to treatment are unpredictable. This term is particularly useful in differentiating between the two diseases UC and other inflammatory bowel diseases with a well-known etiology, such as infectious, ischemic, or radiation.
Currently, there is no consensus on the etiology of inflammatory bowel diseases. The debate continues on whether ulcerative colitis is two independent nosological forms belonging to the group of inflammatory bowel diseases, or whether they are different clinical and morphological variants of the same disease.

Most experts believe that they are caused by various etiological factors, which, when exposed to the human body, trigger the same universal pathogenetic mechanisms . The main etiological role in Crohn's disease is assigned to the measles virus by supporters of the infectious theory. The commonality of the clinical picture of Crohn's disease and, as well as the presence of granulomas, makes us think about.

Proponents of the viral etiology of Crohn's disease believe that the measles virus can cause vascular disorders in the intestinal wall, which determine the uniqueness of the clinical picture. However, in Crohn's disease, modern virological studies cannot detect measles virus in intestinal tissues. However, HERPES IS!

Crohn's disease

Otherwise granulomatous colitis- a severe recurrent autoimmune inflammatory disease mainly of the colon with segmental damage to the entire intestinal wall by lymphocytic granulomas with subsequent formation of penetrating slit-like ulcers. The disease occurs with a frequency of 1:4000, young women are more often affected.
It is associated with an antigen and is caused by the formation of autoantibodies to the tissues of the intestinal mucosa with a decrease in the number and function nal activity of suppressor T-lymphocytes and to mimicking microbial antigens. An increased amount of IgG - containing lymphocytes specific to tuberculosis - was found in the colon. IN last years There have been encouraging reports about successful treatment of this disease with antibodies to TNF-β, which .

In this publication, you can see successful treatment, based on knowledge HLA-B27:

A disease that develops as diffuse chronic inflammation of the intestinal mucosa with the formation of extensive shallow ulcers. With this pathology, the formation of autoantibodies against the mucous membrane of the colon is noted. In 50-80% of patients, antibodies to cytoplasmic antigens of neutrophils are detected, and in the lymphoid-plasma cell infiltrate of the mucous and submucosal colon, 40-50% of cells synthesizing IgG are detected among immunoglobulin-containing cells (normally about 5-10%). Recently, increased numbers of lymphocytes expressing receptors for blood have been found in the colon and blood.

Theory of antigen formation

Antigens are molecular substances foreign to the body.. They arise in the body due to external or internal factors. The generated antigens remain in the intestine. The body begins to produce antibodies that combine with antigens. The immune response mechanism is launched. Everything in a healthy intestine epithelial cells protected by a specific mucous membrane. Various defects mucous membranes help increase the absorption of antigens, which can trigger an inflammatory process in the intestines. Characteristics of antigens: immunogenicity; antigenicity(structural features). The term "antigen" denote structures that induce an immune response, are responsible for the appearance of antibodies and react with them. Antigens are: internal ( endogenous, occurring within the body during natural metabolism or due to infection); external ( exogenous, entering the body from environment during breathing, feeding or after injections); autoantigenic (structures mistakenly recognized by the body as foreign). Antibody synthesis occurs in the blood. It is important to know that modern immunology is inseparably linked with the concept of antigen.

Infection theory

The infectious theory means pathological condition, which occurs when the body is attacked by harmful microorganisms. The development of the infection process depends on the etiology of the infection and the body’s ability to create favorable conditions for the proliferation of microorganisms. The infectious theory is the assertion that, under equal conditions, the disease affects organisms selectively. The reason for immunity to is the individual resistance of the body and a number of factors affecting it: genetic predisposition, the state of the immune system, living conditions, stress, lifestyle, nutrition, etc. When diagnosing Crohn's disease, The causes of the disease most often cannot be determined precisely. Proponents of the infectious theory are divided into two different groups: Some believe that there is an etiological role (and Crohn's disease is similar in its clinical picture). Others are confident in the involvement of the measles virus (the virus can provoke vascular disorders in the intestines, which determines the uniqueness of the clinical manifestations). Proof of the infectious theory is successful symptomatic treatment sick

Autoimmune theory

Normally functioning The immune system is activated when foreign “substances” enter the body. Special molecules called antibodies, instantly recognize antigens And tie them up, as a result of which a number of biochemical reactions occur in the body aimed at quickly eliminating the “danger”.

Autoimmune diseases are a mistake of the immune system body systems, recognizing its molecules as antigens. In other words, there are histohematogenous barriers, which normally exclude the possibility of contact with lymphocytes. But, for example, barriers may be broken, and there is a risk of contact, which accordingly leads to self-aggression. Mechanisms autoimmune diseases, medicine, have not been fully studied. There is only a theory that activates. It can be difficult to immediately identify Crohn's disease; the diagnosis requires confirmation due to the similarity of symptoms with other diseases. Most often, the clinical picture of Crohn's disease is simple: diarrhea begins, weight loss occurs, and the person begins to experience constant painful sensations. Thus, damage occurs to the intestines, mucous membranes, possibly the liver, stomach, organs of vision and

Genetic factors

In 2001 it was identified CARD15 (NOD2) gene. Today, inflammatory processes in the intestines and CARD15 mutations are interconnected and this is confirmed by numerous scientific works. To understand the causes of the development of inflammatory processes in the intestines, it is necessary to turn to the sources of disruption of the normal functioning of the immune system, which are caused by genetic predisposition. Crohn's disease is often transmitted to blood relatives, including children. There is a theory that in a parent-child pair, the chance of inheriting the disease is about 70%. Clinical manifestations in this case they will coincide by about 80%.

At acute forms Crohn's disease causes are not necessarily genetic. The presence of a genetic predisposition determines the degree and speed of development of the disease. Development of therapeutic approaches and development effective methods treatment of CD often depends on the degree of knowledge of the genetic predisposition to the disease.

One of the arguments in favor of the infectious etiology of Crohn's disease is. In order for the patient to develop chronic inflammation, characteristic of this disease, is necessary, manifested in the intestines.

Crohn's disease differs from Ulcerative Colitis not only in its great morphological but also in clinical diversity. Clinical symptoms in Crohn's disease vary widely depending on the location and extent of the lesion, the stage of the disease, and the presence or absence of complications. This makes it difficult to create a classification based on an analysis of the clinical picture of the disease. Existing classifications mainly characterize the localization of the inflammatory process in the gastrointestinal tract, but do not reflect the diversity clinical course Crohn's disease. Foreign experts most often use the Bocus classification (1976), according to which they distinguish seven forms of Crohn's disease: 1st - jejunitis, 2nd - ileitis, 3rd - jejunoileitis, 4th - enterocolitis, 5th - granulomatous colitis, 6th - damage to the anal area, 7th - pan-regional intestinal damage involving the upper section gastrointestinal tract (stomach, duodenum).
Isolated lesion small intestine observed in 25-30% of cases of Crohn's disease, ileocolitis - in 40-50% and isolated damage to the colon - in 15-25%. Among patients with Crohn's disease who have small bowel disease, The terminal ileum is involved in the process in approximately 90%. Almost two-thirds of patients with this pathology have some degree of involvement of the colon in the process. Despite the fact that inflammation in the rectum is detected in Crohn's disease in 11-20% of patients, anorectal lesions ( anal fissures, fistulas, abscesses, etc.) are much more common - in 30-40% of cases. Rarely, this disease affects the esophagus, stomach and duodenum - only 3-5% of patients.
In the vast majority of cases pathology first occurs in the ileum and then spreads to other parts of the gastrointestinal tract. The ileocecal region is most often affected. The clinical picture of acute ileitis is very similar to acute appendicitis, and therefore patients usually undergo laparotomy.
Abdominal pain is a classic symptom of Crohn's disease and occurs in 85-90% of patients. Since most often inflammation in Crohn's disease is localized in the terminal segment of the ileum, this disease is characterized by recurrent pain in the lower right quadrant of the abdomen, and it can simulate the picture acute appendicitis or intestinal obstruction. At the same time, many patients may not have severe pain, and the main manifestations of the disease are a feeling of discomfort, heaviness in the abdomen, bloating and moderate intensity cramping pain, which intensifies with violation
“Diarrhea occurs in 90% of patients and is usually less severe than with Ulcerative Colitis» — the remaining 10% of patients suffer from periodic constipation.

When only the small intestine is involved in the process, stool frequency ranges from 2 to 5 times a day, and in cases of enterocolitis - from 3 to 10 times. The consistency of stool is often mushy than liquid. However, even in those patients in whom the damage is limited to the small intestine, the stool may be loose or watery. Severe diarrhea occurs in patients with widespread lesions, such as jejunoileitis.
Common symptoms of Crohn's disease occur due to an inflammatory process in the intestines or. These include fever, general weakness, and weight loss.

Increased body temperature is one of the main manifestations of Crohn's disease and is recorded during exacerbation of the disease in a third of patients. Fever is usually associated with the presence of purulent processes (fistulas, infiltrates, abscesses) or systemic complications toxic-allergic nature.

Weight loss in Crohn's disease, just like with Ulcerative Colitis, is associated with insufficient intake nutrients due to lack of appetite and abdominal pain, disruption of their absorption process and increased catabolism. Major metabolic disorders include anemia, steatorrhea, hypoproteinemia, vitamin deficiency, hypocalcemia, hypomagnesemia and other micronutrient deficiencies.

Damage to the small intestine leads to the development of malabsorption syndrome, which sometimes dominates the clinical picture of Crohn's disease. Impaired absorption of bile salts as a result of inflammation or resection of a segment of the small intestine, causes changes to the pool bile acids And the formation of cholesterol stones in the gallbladder. Gallstones are found in 15-30% of patients with localization of the process in the small intestine. Steatorrhea may promote increased intestinal absorption of oxalate and lead to the formation of oxalate stones in the kidneys. They are detected in 5-10% of patients with Crohn's disease of the small intestine.

In SSCC Treatment of patients with Crohn's disease is carried out jointly by gastroenterologists and coloproctologists. Thus, conservative and surgical methods treatment of this complex category of patients. Comprehensive intensive therapy patients with a severe form of the disease, carrying out multi-stage surgical intervention if necessary, creating a temporary regime of functional rest for the inflamed parts of the intestine made it possible to reduce the number postoperative complications from 34 to 13%, and mortality from 18 to 2%. Anti-relapse therapy and dynamic long-term observation of patients reduced the number of severe relapses of the disease from 55 to 24%, while repeated resections of the small and large intestines were avoided.

Indications for surgery for Crohn's disease are cicatricial stenosis. and formation of external intestinal fistulas. Due to inflammation of any segment of the intestine, its narrowing initially develops, which, when resistant to conservative therapy, transforms in cicatricial stenosis. An indicator of such a transition is the appearance of suprastenotic expansion of the proximal parts, which is a sign of decompensation contractility intestinal wall and a harbinger of the development of obstructive intestinal obstruction.

For Crohn's disease of the small intestine, either resection of the affected part is performed, or stricturoplasty. The choice of surgical method is determined by the extent of intestinal damage. Stricturoplasty is possible only for small strictures up to 4-5 cm.

For extensive infiltrates, bypass interintestinal anastomoses are used; the same intervention is also performed for duodenal stenosis. After small bowel resection, end-to-end anastomoses are preferred, and the resection line should be no closer than 2 cm from the macroscopically defined border of the lesion. Stricturoplasty of limited (up to 3-4 cm), scar lesions is performed without opening the lumen of the small intestine - dissection of the scar to the mucous membrane is carried out in longitudinal direction, and suturing of the resulting defect is done transversely. For more extensive strictures, all layers are dissected along one of the intestinal walls, followed by the application of a two-row suture like a three-quarter anastomosis.

The most common form of Crohn's disease is terminal ileitis, which often develops under the guise of acute appendicitis and is quite common in the practice of surgeons emergency assistance. In case of a pronounced inflammatory component, local peritonitis, threat of perforation, as well as the possibility of developing intestinal obstruction, resection of the affected segment of the small intestine is performed, and if the lesion spreads to the bauginian valve, resection of the ileocecal part of the intestine is performed. The decision on the possibility of forming an anastomosis is made individually based on criteria such as the degree of perifocal inflammation, severity metabolic disorders at the patient. Doubts should sway the surgeon in favor of stoma formation - ileostomy and ascendostomy- followed by reconstructive surgery on time from 2 to 6 months.
With limited narrowing of the colon, intraoperative DISABILITY is required, the patient is tormented constant pain, diarrhea, fistulas have formed, severe anemia. There is a disturbance in the normal functioning of the intestines and weight loss.

Group I disability: assigned if your weight drops by 30% or more, the development of endocrinological problems, heart failure and hypovitaminosis. If the entire intestine is completely affected by Crohn's disease, disability may be assigned. The commission will take into account damage to the endocrine glands, as well as the degree of decrease in the ability to self-care.

Be prepared to face difficulties when receiving disability:

Former head of the Main Bureau branch medical and social examination together with his accomplices, he was caught taking a bribe, the press service of the Investigative Committee for Moscow reported.
As investigators established, the former head of Bureau No. 73, a branch of the State Budgetary Institution MSE in Moscow, Natalya Vladimirova, received a bribe from Ravili Khusainova in October last year in the amount of 50 thousand rubles for issuing a certificate establishing disability group 3 without a medical examination.
Guardians order, criminal cases were opened under three articles on receiving a bribe, giving a bribe and mediation in bribery. The crime was stopped by employees of the capital's Economic Security and Commissariat of the Main Directorate of the Ministry of Internal Affairs of Russia. The police searched the residences of the suspects and the premises of Bureau No. 73. The attackers are under recognizance not to leave the place.
—————

In turn, the Minister of Labor and social protection acknowledged the existence of corruption and the growth of fraud associated with the assignment of disability based on fictitious medical certificates. The minister also promised to take a number of organizational measures to combat corruption in the bureau of medical and social examination (MSE) when establishing disability. “We are trying to solve this [problem of corruption in the assignment of disability. – Vademecum] eradicate. It is very clear to define with documents what decision the expert should make. So that he can’t correct anything, so that he puts it all into electronic forms so that we can check it all.” As previously reported, the purchase of domestic wheelchairs for the disabled often costs the Russian budget more than the purchase of foreign ones. Read more: Russian wheelchairs cost the treasury more than imported ones

Criteria for determining disability in Crohn's disease in children

Crohn's disease is a chronic inflammatory disease of the digestive tract, mainly the colon, characterized by steady progression of the process and the development of severe complications.
The frequency is 3.5 per 100,000 population, of which in 20-25% the onset of the disease is attributed to childhood.

Etiology unknown. The disease is considered multifactorial. polygenic; Genetic markers of predisposition were identified - HLA DR1, Drw5 antigens. As a result of exposure to various antigens (antigens of cow's milk and other food ingredients, infectious agents, of which Lately note the role of clostridia, drugs, etc.) an immunopathological process (immune complex) occurs in the form of a regional wave-like current primary vasculitis, developing predominantly at the microcirculatory level. accompanied by hypercoagulation, ischemia up to the development of multifocal microinfarctions, necrobiological and dystrophic changes in the intestinal wall, leading to disruption of its permeability, penetration of infection and catabolic products.

Crohn's disease affects different parts of the digestive tract: most often the cecum and distal ileum, but the left parts of the colon, small intestine and even the esophagus, stomach and duodenum can be affected. The main morphological criterion for diagnosing Crohn's disease in adult patients is sarcoid-like granulomas with giant multinucleated cells found in the biopsy specimen.

In children, a complex of signs is more common: perifocal fibrosis around lymphoid follicles and dystrophic changes in the epithelium above them, adhesion of lymphoid tissue to the surface of the epithelial layer, vascular structures in the lamina propria of the mucous membrane similar to the tissue of amputation neuroma.
The disease is characterized by a strict limitation of the affected area from healthy tissues, alternation of pathological and healthy tissues (“kangaroo jumping”, “cobblestone pavement” relief).
Inflammation affects the entire thickness of the intestine down to the serous layer, accompanied by local lymphostasis and occlusion of arterioles. The process spreads from the inside, from the thickness of the intestine, so the ulcers are always deep, aphthous or silky (fissures), and the development of external adhesions and fistulas is typical.

Clinical picture: the disease develops gradually, there may be a latent course for a long time - melena, diarrhea, weight loss, growth retardation, abdominal pain, often in the right iliac region, damage to the anal and perianal area (chronic deep fissures, fistulas, paraproctitis). The disease is characterized by a slow but steadily progressive course and is difficult to treat.

Complications: intestinal bleeding, perforation, fistula formation, paraproctitis and others infectious complications up to sepsis; intestinal obstruction as a result of intestinal stenosis.

Laboratory and instrumental methods necessary to confirm the diagnosis:

X-ray examination (segmental lesion with narrowing of the intestine up to stenosis);
endoscopic signs;
biopsy and histological examination.

Treatment: diet (table No. 4), basic therapy with non-hormonal anti-inflammatory drugs (sulfasalazine), immunomodulators (interferon drugs), eubiotics, angioprotectors.
In severe cases - prescription hormonal drugs and cygostatics.

Prognosis: unfavorable with regard to recovery.

It is advisable to refer children to MSE no earlier than 6 months after the onset, as well as for UC. The disease is primarily chronic from the moment of its debut; however, the severity of the disease can be determined as chronic only after assessing the effectiveness of basic therapy.

At mild form remission of the disease is achieved during therapy with non-steroidal anti-inflammatory drugs, which indicates persistent minor disturbances of digestive function that do not lead to limitation of the life activity of patients in any category.

For moderate and severe cases in basic therapy include corticosteroids.
The prevalence and activity of the process, as well as aggressive therapy, lead to persistent moderate, severe and significantly pronounced disorders of both digestive and immune functions, metabolic disorders, multiple organ failure in total colitis, which limits the child, respectively, in the categories of movement, self-care, training.

Benefits of Disability and Crohn's Disease

The damage and tissue damage associated with Crohn's disease require long-term management. In fact, the condition itself is considered chronic or lifelong. This form of inflammatory bowel disease (IBD) varies widely in severity among people. Some people may only experience mild and occasional symptoms, while others experience debilitating and frequent symptoms. pain, diarrhea and fatigue. The symptoms may be severe enough to affect your quality of life. They may also increase your risk of additional health problems.

Given the long-term nature of Crohn's disease, it may be worth looking into disability benefits, which can help offset management costs and help pay for unexpected expenses associated with potential complications of the disease.

Qualifications: Non-Crohn's disease qualifies for disability benefits

Th e Social Security Administration (SSA) includes Crohn's disease under the IBD category. This section can be found in the SSA Digestive System - Adult criteria for disability assessment. Crohn's disease primarily affects the gastrointestinal (GI) tract. Important symptoms include:

abdominal pain and cramps
diarrhea
loss of appetite
nausea

Crohn's disease can affect other organ systems and cause additional symptoms, including:

malnutrition > weight loss
fever
fatigue
anemia
neurological symptoms
inflammatory arthritis
skin rash
oral ulcers
vision problems

Complications associated with progressive forms of the disease may interfere with your Everyday life and even make it difficult to work. These problems may make you eligible for disability benefits. You may be eligible to receive disability benefits through social security(SSDI) if:

Do you have mental or physical disorder related to medical condition(you will need an official diagnosis from a doctor).

Your condition has interfered with work-related activities for at least 12 months.
You earn less than $800 per month.
Your condition has progressed to a level where you expect to be impaired in your work-related activities for at least 12 months.
Your prognosis is bad.
In addition to providing basic evidence of your condition and possible limitations, you may also be required to show detailed documentation of your medical history. According to the SSDI Resource Center, you may need one or more of following conditions to receive disability benefits:

hospitalization or surgery to remove a blockage in the small intestine or colon

chronic abdominal pain that is severe enough to require narcotic drugs for anemia management
associated with hemoglobin readings below 10.0 gm/dL
severe weight loss of 10 percent or more, or extremely low BMI (less than 180)
proof of malnutrition from a doctor or registered dietitian
It is also important to note that you may need to prove that these effects occurred at least twice (60 days apart) within a six month period.

Benefits Disability Benefits You Can Receive

Benefits received from SSA are monetary. This is intended to cover the costs associated with lost wages, increased level of treatment and operations. The exact amount you receive varies as it depends in part on average earnings. You can get an estimate of this amount directly from the SSA before you apply for disability benefits.

Once you receive your benefits, the SSA will review your progress. You may be required to provide additional documentation to demonstrate your disability, if required. Generally, the SSA wants recipients to be able to return to work. Once you resume work, you will no longer be able to receive SSDI benefits. If your condition makes it impossible for you to continue working, you may receive benefits indefinitely.

The Application Process for Disability Benefits

SSDI is provided through the SSA. You can apply by phone, online, or in person at your local SSA office. Regardless of how you choose to apply, you will need to bring the following items with you:

confirmation of diagnosis, including documentation from your doctor, imaging results, and endoscopy results, if applicable > results of medical and laboratory tests that were done within the past year

proof prescription drugs necessary for your condition
information about all doctors and other health care professionals with whom you consult.
most recent W-2 forms from the previous year (if you are self-employed, you will need to provide all tax return documentation)
financial records, including bank statements, mortgage or rental statements, and insurance policies
birth certificate or other proof of US citizenship
Once you are approved, you will begin receiving benefits on the first day of the sixth month in which the SSA determines you are disabled.
TakeawayThe Takeaway

Disability Benefits are a great help for those struggling with severe forms of Crohn's disease. As the disease progresses, treatment becomes more and more expensive. Disruptive, uncomfortable symptoms may also affect your ability to function as well as before.

Keep in mind that even if you are not eligible for standard standard benefits for IBD, the SSA may still allow you to receive medical benefits to help offset the cost of treatment. You also have the right to pursue an appeal of your claim if you feel you are still eligible for SSDI even though it was denied.

For getting additional information You can contact SSA SSDI Services at 1-800-772-1213.

Editor's Choice

Crohn's disease- a chronic recurrent disease of the gastrointestinal tract, characterized by transmural segmental spread of the inflammatory process, with the development of local and systemic complications, which is considered to be an AUTOIMMUNE disease. But a systemic cascade of disorders due to untreated or undertreated chronic viral infections is also a possible version of the development of CD. Everything is very individual, and therefore cause of system failure, Each patient has his own.

In economically developed countries, there is an increase in the incidence of Ulcerative Colitis and Crohn's Disease. The primary incidence of Crohn's disease is 2-4 people per 100,000 population per year, the prevalence is 30-50 cases per 100,000 population.
In many cases, the disease affects the distal ileum, the large intestine. Sometimes other organs of the digestive system are affected: the esophagus, stomach.
The international classification ICD-10 allows diagnosing Crohn's disease.

Based on the location of the disease, the disease has the following classification according to ICD-10:

K50 – regional Crohn's enteritis.

K50.0 – Crohn's lesion of the small intestine.

K50.1 – Crohn's lesion of the large intestine.

K50.8 – other types of Crohn's lesions.

K50.9 – Crohn's disease with an unknown diagnosis.

There can be many causes for this disease, as with any autoimmune disease. Many stories of IBD patients begin in childhood.

Hydro-MRI - very informative before surgery

Discharge 09.09.2016 laparoscopic surgery Morozov Children's City Clinical Hospital

Extract from 18.02.2016 - paragraph 14: 967 mcg/g, with a norm of up to 50 (ATTACK BC!)

During the first course of treatment: 05/20/2016 - 532.5 mcg/g

After a course of treatment with hormones, as of August 11, 2016 - 430.5 mcg/g

After removal of the ileocecal angle, as of 10/07/2016 - 75.1 mcg/g
5

3 months after resection of the inflamed part of the intestine:

As of December 13, 2016 - less than 10 mcg/g, at a rate of up to 50 mcg/g
6
6 months after surgery
As of March 2016 - 436.1 mcg/g

April 04, 2017

The term "Inflammatory Bowel Disease" (IBD) is usually used to refer to Ulcerative Colitis (UC) And Crohn's disease (CD), since they have much in common in etiopathogenesis and clinical picture. The etiology of both diseases is still unknown, and their natural history and response to treatment are unpredictable. This term is particularly useful in differentiating between the two diseases UC and CD and other inflammatory bowel diseases with a well-known etiology, such as infectious, ischemic, or radiation.
Currently, there is no consensus on the etiology of inflammatory bowel diseases. The debate continues on whether ulcerative colitis and Crohn's disease are two independent nosological forms belonging to the group of inflammatory bowel diseases, or whether they are different clinical and morphological variants of the same disease.

Most experts believe that Ulcerative colitis and Crohn's disease are caused by various etiological factors, which, when exposed to the human body, trigger the same universal pathogenetic mechanisms autoimmune inflammation. The main etiological role in Crohn's disease is assigned by supporters of the infectious theory to Mycobacterium paratuberculosis and the measles virus. The commonality of the clinical picture of Crohn's disease and intestinal tuberculosis, as well as the presence of granulomas make one think about tuberculous etiology Crohn's disease.

Proponents of the viral etiology of Crohn's disease believe that the measles virus is capable of causing vascular disorders in the intestinal wall, which determine the uniqueness of the clinical picture. However, in Crohn's disease, modern virological studies cannot detect measles virus in intestinal tissues. However, HERPES IS!

Crohn's disease

Otherwise granulomatous colitis- a severe recurrent autoimmune inflammatory disease mainly of the colon with segmental damage to the entire intestinal wall by lymphocytic granulomas with subsequent formation of penetrating slit-like ulcers. The disease occurs with a frequency of 1:4000, young women are more often affected.
It is associated with an antigen HLA-B27 and is caused by the formation of autoantibodies to the tissues of the intestinal mucosa with a decrease in the number and function nal activity of suppressor T-lymphocytes and to mimicking microbial antigens. An increased amount of IgG - containing lymphocytes specific to tuberculosis - was found in the colon. In recent years, there have been encouraging reports about successful treatment of this disease with antibodies to TNF-β, which suppress the activity of autoreactive T lymphocytes.

In this publication, you can see successful treatment based on knowledge HLA-B27: “Short ESSAY...”

Theory of antigen formation

Antigens are molecular substances foreign to the body.. They arise in the body due to external or internal factors. The generated antigens remain in the intestine. The body begins to produce antibodies that combine with antigens. The immune response mechanism is launched. In a healthy intestine, all epithelial cells are protected by a specific mucous membrane. Various defects in the mucous membrane contribute to an increase in the absorption of antigens, which can provoke an inflammatory process in the intestines. Characteristics of antigens: immunogenicity; antigenicity(structural features). The term "antigen" denote structures that induce an immune response, are responsible for the appearance of antibodies and react with them. Antigens are: internal ( endogenous, occurring within the body during natural metabolism or due to infection); external ( exogenous, entering the body from the environment during breathing, feeding or after injections); autoantigenic (structures mistakenly recognized by the body as foreign). Antibody synthesis occurs in the blood. It is important to know that modern immunology is inseparably linked with the concept of antigen.

Infection theory

The infectious theory refers to a pathological condition that occurs when the body is attacked by harmful microorganisms. The development of the infection process depends on the etiology of the infection and the body’s ability to create favorable conditions for the proliferation of microorganisms. The infectious theory is the assertion that, under equal conditions, the disease affects organisms selectively. The reason for immunity to viruses, fungi and bacteria is the individual resistance of the body and a number of factors affecting it: genetic predisposition, the state of the immune system, living conditions, stress, lifestyle, nutrition, etc. When diagnosed with Crohn's disease, The causes of the disease most often cannot be determined precisely. Proponents of the infection theory are divided into two different groups: Some believe that the etiological role belongs to mycobacteria paratuberculosis (intestinal tuberculosis and Crohn's disease are similar in their clinical picture). Others are confident in the involvement of the measles virus (the virus can provoke vascular disorders in the intestines, which determines the uniqueness of the clinical manifestations). Proof of the infectious theory is successful symptomatic treatment of the patient with antibacterial drugs.

Autoimmune theory

Autoimmune diseases are a failure of the body's immune system. recognizing its molecules as antigens. In other words, there are histohematogenous barriers, which normally exclude the possibility of contact with lymphocytes. But, for example, barriers may be compromised due to infection, and there is a risk of contact, which accordingly leads to self-aggression. The mechanisms of autoimmune diseases are not fully understood by medicine. There is only a theory of the appearance of an infection that activates immune cells. It can be difficult to immediately identify Crohn's disease; the diagnosis requires confirmation due to the similarity of symptoms with other diseases. Most often, the clinical picture of Crohn's disease is simple: diarrhea begins, weight loss occurs, and the person begins to experience constant pain. Thus, damage occurs to the intestines, mucous membranes, possibly the liver, stomach, organs of vision and skin.

Genetic factors

In acute forms of Crohn's disease, the causes are not necessarily genetic. The presence of a genetic predisposition determines the degree and speed of development of the disease. The development of therapeutic approaches and the development of effective methods for treating CD often depends on the degree of knowledge of the genetic predisposition to the disease.

One of the arguments in favor of the infectious etiology of Crohn's disease is the positive clinical effect of antibiotic therapy. In order for a patient to develop chronic inflammation characteristic of this disease, it is necessary genetic predisposition, manifested by defects in the intestinal immune system.

Crohn's disease differs from Ulcerative Colitis not only in its great morphological but also in clinical diversity. Clinical symptoms in Crohn's disease vary widely depending on the location and extent of the lesion, the stage of the disease, and the presence or absence of complications. This makes it difficult to create a classification based on an analysis of the clinical picture of the disease. Existing classifications mainly characterize the localization of the inflammatory process in the gastrointestinal tract, but do not reflect the diversity of the clinical course of Crohn's disease. Foreign experts most often use the Bocus classification (1976), according to which they distinguish seven forms of Crohn's disease: 1st - jejunitis, 2nd - ileitis, 3rd - jejunoileitis, 4th - enterocolitis, 5th - granulomatous colitis, 6th - damage to the anal area, 7th - pan-regional intestinal damage involving the upper section gastrointestinal tract (stomach, duodenum).
Isolated damage to the small intestine is observed in 25-30% of cases of Crohn's disease, ileocolitis - in 40-50% and isolated damage to the large intestine - in 15-25%. Among patients with Crohn's disease who have small bowel disease, The terminal ileum is involved in the process in approximately 90%. Almost two-thirds of patients with this pathology have some degree of involvement of the colon in the process. Despite the fact that inflammation in the rectum is detected in Crohn's disease in 11-20% of patients, anorectal lesions (anal fissures, fistulas, abscesses, etc.) are much more common - in 30-40% of cases. Rarely, this disease affects the esophagus, stomach and duodenum - only 3-5% of patients.
In the vast majority of cases pathology first occurs in the ileum and then spreads to other parts of the gastrointestinal tract. The ileocecal region is most often affected. The clinical picture of acute ileitis is very similar to acute appendicitis, and therefore patients usually undergo laparotomy.
Abdominal pain is a classic symptom of Crohn's disease and occurs in 85-90% of patients. Since inflammation in Crohn's disease is most often localized in the terminal ileum, this disease is characterized by recurrent pain in the lower right quadrant of the abdomen, and it can simulate a picture of acute appendicitis or intestinal obstruction. At the same time, many patients may not experience severe pain, and the main manifestations of the disease are a feeling of discomfort, heaviness in the abdomen, bloating and moderate intensity cramping pain, which intensifies when the diet is violated.
“Diarrhea occurs in 90% of patients and is usually less severe than with Ulcerative Colitis.” — the remaining 10% of patients suffer from periodic constipation.

When only the small intestine is involved in the process, stool frequency ranges from 2 to 5 times a day, and in cases of enterocolitis - from 3 to 10 times. The consistency of stool is often mushy than liquid. However, even in those patients in whom the damage is limited to the small intestine, the stool may be loose or watery. Severe diarrhea occurs in patients with widespread lesions, such as jejunoileitis.
Common symptoms of Crohn's disease occur due to inflammation in the intestines or immunopathological reactions . These include fever, general weakness, and weight loss.

Weight loss in Crohn's disease, as with Ulcerative Colitis, is associated with an insufficient supply of nutrients due to lack of appetite and abdominal pain, impaired absorption and increased catabolism. Major metabolic disorders include anemia, steatorrhea, hypoproteinemia, vitamin deficiency, hypocalcemia, hypomagnesemia and other micronutrient deficiencies.

Damage to the small intestine leads to the development of malabsorption syndrome, which sometimes dominates the clinical picture of Crohn's disease. Impaired absorption of bile salts as a result of inflammation or resection of a segment of the small intestine, leads to changes in the bile acid pool and the formation of cholesterol stones in the gallbladder. Gallstones are found in 15-30% of patients with localization of the process in the small intestine. Steatorrhea may promote increased intestinal absorption of oxalate and lead to the formation of oxalate stones in the kidneys. They are detected in 5-10% of patients with Crohn's disease of the small intestine.

In SSCC Treatment of patients with Crohn's disease is carried out jointly by gastroenterologists and coloproctologists. Thus, conservative and surgical methods of treating this complex category of patients are combined and complemented. Complex intensive therapy for patients with a severe form of the disease, multi-stage surgical intervention if necessary, and the creation of a temporary regime of functional rest for the inflamed intestines made it possible to reduce the number of postoperative complications from 34 to 13%, and mortality from 18 to 2%. Anti-relapse therapy and dynamic long-term observation of patients reduced the number of severe relapses of the disease from 55 to 24%, while repeated resections of the small and large intestines were avoided.

Indications for surgery for Crohn's disease are cicatricial stenosis. and the formation of external intestinal fistulas. Due to inflammation of any segment of the intestine, its narrowing initially develops, which, when resistant to conservative therapy, transforms in cicatricial stenosis. An indicator of such a transition is the appearance of suprastenotic expansion of the proximal sections, which is a sign of decompensation of the contractility of the intestinal wall and a harbinger of the development of obstructive intestinal obstruction.

For extensive infiltrates, bypass interintestinal anastomoses are used; the same intervention is also performed for duodenal stenosis. After small bowel resection, end-to-end anastomoses are preferred, and the resection line should be no closer than 2 cm from the macroscopically defined border of the lesion. Stricturoplasty of limited (up to 3-4 cm) scar lesions is performed without opening the lumen of the small intestine - dissection of the scar to the mucous membrane is carried out in the longitudinal direction, and suturing of the resulting defect - in the transverse direction. For more extensive strictures, all layers are dissected along one of the intestinal walls, followed by the application of a two-row suture like a three-quarter anastomosis.

The most common form of Crohn's disease is terminal ileitis, which often develops under the guise of acute appendicitis and is quite common in the practice of emergency surgeons. In case of a pronounced inflammatory component, local peritonitis, threat of perforation, as well as the possibility of developing intestinal obstruction, resection of the affected segment of the small intestine is performed, and if the lesion spreads to the bauginian valve, resection of the ileocecal part of the intestine is performed. The decision on the possibility of forming an anastomosis is made individually based on criteria such as the degree of perifocal inflammation and the severity of metabolic disorders in the patient. Doubts should sway the surgeon in favor of stoma formation - ileostomy and ascendostomy- followed by reconstructive surgery on time from 2 to 6 months.
With limited narrowing of the colon, intraoperative DISABILITY is required, the patient is tormented constant pain, diarrhea, fistulas have formed, severe anemia. There is a disturbance in the normal functioning of the intestines and weight loss.

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In turn, the Minister of Labor and Social Protection acknowledged the existence of corruption and the growth of fraud associated with the assignment of disability based on fictitious medical certificates. The minister also promised to take a number of organizational measures to combat corruption in the bureau of medical and social examination (MSE) when establishing disability. “We are trying to solve this [problem of corruption in the assignment of disability. – Vademecum] eradicate. It is very clear to define with documents what decision the expert should make. So that he can’t correct anything, so that he puts it all into electronic forms so that we can check it all.” As previously reported, the purchase of domestic wheelchairs for the disabled often costs the Russian budget more than the purchase of foreign ones. Read more: Russian wheelchairs cost the treasury more than imported ones

Crohn's disease is a chronic pathology with an incompletely studied etiology. It cannot be completely cured.

A distinctive feature of the disease is that inflammatory bowel disease entails a rapid spread of the process to all organs of the gastrointestinal tract.

After achieving remission during treatment, a new exacerbation occurs over time. Surgery only temporarily improves the situation, after which it is necessary to undergo a therapeutic course again.

Causes

In medicine, there are a number of theories, based on which, the factors that provoke the disease can be divided into 3 categories. Main causes of the disease:

Infectious carriers. Bacteria and viruses infect the body when they enter the intestines.
Antigen production. They can appear both to a specific food product and to any representative of non-pathogenic flora. The body activates immune protection. When antigens and antibodies interact, an inflammatory process occurs.
Autoimmune reaction. When the body's immune response directs destructive force against its own cells. The body kills itself, recognizing its native cells as pathogenic.

People at risk include:

With a genetic predisposition.
Having a habit of unhealthy eating and snacking. This is most often observed among young people, which determines this category as the most susceptible to the disease.
European nationality.
Those who are addicted to smoking.
Taking NSAIDs.
Those enjoying long time oral contraceptives.
Having allergic reactions for food products for lactose intolerant people suffering from celiac disease.
With reduced immunity.
Subject to constant stressful situations due to their work specialty.

Classification

The disease can have either an isolated form or a combined form. Its classification is based on the localization of the inflammatory process. The isolated type includes esophagitis, gastritis, duodenitis, jeunitis, ileitis, colitis, proctitis. The most common representative of the mixed course is ileocolitis.

Based on these data, a number of pathologies of different localization are identified:

Ileitis when the ileum is affected.
Ileocolitis, in which the colon and ileum are involved in the process.
Gastroduodenitis, with which the focus is localized in the duodenum and stomach.
Colitis that affects the large intestine without affecting other organs of the gastrointestinal tract.
Jejunoileitis, in which the small intestine and ileal region are affected.

According to the clinical picture there are:

A disease with signs of inflammation. Pathogenesis can manifest itself in both acute and chronic forms.
Segmental narrowing of the intestine.
Presence of fistula tracts.

According to the form of the disease, the disease is classified into:

Acute phase.
Chronic stage.

Chronicity of the disease

The chronic form is most often manifested by a number of symptoms caused by the process of intoxication of the body. This is weakness, fatigue, decreased appetite, fever, joint pain. Gradually, the situation is aggravated by bloating, pain in the abdominal area, and diarrhea. The patient is rapidly losing weight.

In this form, phases of remission alternate with exacerbation of the disease. The consequences of the disease are ulcers, anal fissures, the formation of fistulas, bleeding during bowel movements, and intestinal obstruction.

Symptoms

The nature of the severity of signs of the disease can vary significantly in intensity. This depends on the location of the lesion and the degree of damage to the organ. All symptoms are conventionally divided into general, extraintestinal and local.

The latter include:

Pain syndrome in the abdominal area. There may be bloating and heaviness. Often the symptoms resemble an exacerbation of appendicitis.
Diarrhea. In this case, blood is often present in the stool. During defecation, increased pain is observed. The frequency of bowel movements reaches 15-20 times a day.
Nausea, vomiting, loss of appetite.
Weight loss, the appearance of stones in the gall bladder. This is due to a disruption in the absorption of nutrients.

Extraintestinal signs are expressed in:

Eye diseases, for example, conjunctivitis, keratitis.
Skin lesions, in particular erythema nodosum.
Joint diseases.
Damage to the mucous membranes of the oral cavity.
Impaired functionality of the gallbladder and its ducts.
Kidney damage.
Development of cancer formations.

TO general symptoms include:

Decreased performance, increased fatigue.
Fever, chills.
Temperature increase.
Anemia, decreased blood clotting.

Features of manifestation in children

The disease tends to manifest itself in childhood, the most dangerous age range is considered to be from 13 to 20 years. Wherein gender does not affect the risk of disease.

The manifestation of the disease in children is:

The presence of diarrhea with the number of bowel movements up to 10-12 times a day. Blood streaks may be present.
The presence of pain of varying intensity in the abdominal area, especially in the lower part.
Late onset of puberty. In this case, the child lags behind in growth compared to his peers.
Joint diseases, impaired vision, the presence of erythema nodosum or aphthous stomatitis.

Diagnosis of the disease in children occurs in the same way as in adults.

Manifestation of the disease during pregnancy

During pregnancy this pathology can cause a number of complications:

Premature onset of labor.
Miscarriage.
Fetal hypotrophy.
Delivery by caesarean section.

Previously, there was a widespread theory that the disease makes a woman infertile, but studies have proven that this is not so. The main problem is that chronic course in the first trimester and after childbirth it can develop into an acute form.

However, in 70% of women the disease remains at the same stage it was in before the child was conceived.

To avoid complications, you must adhere to the recommended treatment and diet. Unauthorized cessation of taking medications is fraught with exacerbation of the process.

Detection methods

At initial stage illness, it is quite difficult to understand what it is, since the symptoms may have a blurry picture, which significantly complicates the process differential diagnosis. After collecting anamnesis and a preliminary examination by palpation, the doctor prescribes laboratory and instrumental examinations to the patient.

Laboratory ones include:

Submission of material for immunological, general, biochemical blood tests. This helps determine the presence of anemia, inflammation, and various dysfunctions of the gastrointestinal tract.
Analysis of urine. With its help, infectious carriers and kidney pathologies are identified.
Study of feces. Necessary to rule out other diseases.
Tests for antibodies of a specific spectrum. Used for differential diagnosis from ulcerative colitis.

The most informative instrumental examinations are:

Colonoscopy. This method gives a complete picture of the condition of the entire large intestine. If necessary, a biopsy is performed during the procedure.
Irrigoscopy. Used to determine the affected areas of the mucosa, the presence of ulcers, fistulas, and neoplasms.
Survey radiograph. With its help, you can see swollen intestinal loops and the presence of air collected in their lumen.
FGDS. The examination is necessary to examine the esophagus, stomach, and duodenum.
CT. Used to identify abscesses.
MRI. With its help, you can detect damage to the mucous membranes of the organ, the presence of fistulas, strictures, and enlarged lymph nodes.

Treatment

The goal of therapy is to stop the process and eliminate complications. For this, doctors recommend:

Taking medications.
Dieting.
Folk remedies to eliminate the inflammatory process.
Surgical intervention.

Drug therapy

Treatment consists of eliminating symptoms and maintaining stable remission. For this purpose they prescribe:

Anti-inflammatory drugs.
1. Aminosalicylates: Sulfasalazine, Mesalamine. They eliminate inflammation in the rectum, but are ineffective when affecting the small intestine.
2. Corticosteroids: Prednisolone, Budesonide. They eliminate inflammation well, but have a number of contraindications, which leads to their use only as a last resort when other therapy does not help.

Immunosuppressants. Eliminate inflammation by affecting immune system. The most common are: Azathioprine, Mercaptopurine, Infliximab, Adalimumab, Certolizumab Pegol, Methotrexate, Cyclosporine, Natalizumab.
Antibiotics. Medicines in this group are needed to eliminate fistulas, abscesses and infectious carriers. The most popular are Metronidazole and Ciprofloxacin.

Adjuvant therapy consists of drugs to eliminate the symptoms of the disease:

Antidiarrheals: Methylcellulose, Loperamide.
Analgesics: Acetaminophen, Tylenol.
Vitamin complexes containing B12, calcium, vitamin D, iron.

Treatment with traditional methods

When taken simultaneously medicines at home you can improve your condition using:

Marshmallow infusion. It envelops the mucous membrane and promotes cell regeneration. To prepare tea, you need to pour 5 g of dried leaves or roots of the plant with a glass of boiling water. After the product has infused, take it 3 times a day.
An infusion of dried slippery elm bark. The plant helps restore damaged tissue, heals erosions and ulcers, and normalizes the functionality of the gastrointestinal tract. 60 mg of powder is poured into a glass of water and taken 3 times a day.
Turmeric. The spice has anti-inflammatory and antibacterial properties. In the daily menu, its amount should be 1-2 g per day.

Treatment folk remedies helps relieve inflammation and accelerate tissue regeneration, but to achieve the desired effect you must follow a diet and take prescribed medications.

Surgical intervention

Surgery is prescribed only as a last resort, when drug and dietary therapy is ineffective or there is a threat to the patient’s life.

During the procedure, the affected area of the intestine is removed and an anastomosis is performed between areas not affected by the disease.

Besides, surgery allows you to get rid of fistulas, intestinal obstruction and drain abscesses. The operation does not provide 100% protection against relapses.. Most often, the appearance of new lesions occurs next to the previous lesion. To avoid complications, drug therapy should continue after surgery until stable remission is achieved.

Proper nutrition

Flour products and baked goods.
Spicy, fatty, salty and fried foods.
Spices and seasonings.
Fish and meat of fatty varieties.
Millet and pearl barley porridge.
Canned food.
Legumes.
Radish, pepper, garlic.
Mushrooms.
Pasta.
Alcoholic drinks.
Chocolate, coffee, black tea.

In addition, you should also avoid those products, after taking which the patient individually feels negative impact on the body.

IN daily diet useful to add:

Dishes containing low amounts of fat.
Drinks made from herbs, jelly and fruit compotes, green tea with a total daily volume of at least 2 liters.
Soups with vegetable, low-fat meat or fish broth.
Eggs, soft-boiled or steamed.
Ground boiled meat and fish from low-fat varieties.
Low-fat cottage cheese, fermented milk products.
Well-cooked and mashed porridge.
Vitamin complexes.

Food is consumed warm in small portions 5-6 times a day. It is better to cook food by steaming or baking in the oven.

The daily amount of fat should be within 70 g, and carbohydrates - up to 250 g. The diet for Crohn's disease excludes the consumption of salt. The menu should be expanded to include protein products.

Complications of the disease

At untimely application see a doctor, pathological processes spread to other human organs and systems, causing serious complications. The main danger of the disease is:

The formation of ulcers on the walls of the intestinal mucosa with subsequent perforation.
Penetration of feces into the abdominal cavity.
Damage to the walls of the mucous membranes, which causes internal bleeding.
Stenosis of the walls of the organ mucosa, intestinal obstruction.
Anal fissures.
Duodenal cancer.
Formation of fistula tracts penetrating internal organs abdominal cavity and external skin, the appearance of abscesses in these areas.
Metabolic disorders and decreased supply of nutrients to the body. Over time, this condition leads to exhaustion, sudden weight loss, dysbacteriosis, vitamin deficiency, and anemia.

Forecast

The disease is one of the pathologies that are incurable, so the prognosis for life with frequent exacerbations is disappointing. If you follow all the recommendations of specialists, it is possible to achieve stable remission for many years.

Death in the presence of the disease can occur during surgery or with significant damage to the organ after the onset of complications. It all depends on the location and degree of pathology.

After treatment, the risk of relapse is quite high; on average, exacerbation occurs once every 15-20 years. Most people diagnosed with Crohn's disease have at least 1 surgical intervention throughout life.

Who is eligible for disability?

Disability assigned to a certain group is recognized by a decision of the commission after passing a medical examination.

III group assigned to persons with damage to only one segment of the large or small intestine, when exacerbations are observed no more than 3 times a year with a slight impairment of intestinal functionality with a feeling of mild discomfort. This condition must be confirmed by tests showing a slight deterioration in health (up to 15% deviation from the norm) and weight loss within 10%.
Group II indicated for persons whose small and large intestines are affected simultaneously, when lab tests confirm deviations from the norm up to 30% with a weight loss of up to 20%. There is severe pain with significant impairment of intestinal functionality and diarrhea up to 10 times a day. The patient has perforation, fistula, anemia, bowel dilation, stricture, internal bleeding, or early signs of cancer.
Group I is given when there is significant damage to the large and small intestines, when when taken necessary medications no positive effect is observed. In this case, the patient’s weight decreases to 30%, hypovitaminosis, signs of exhaustion, edema, and severe anemia appear. The endocrine glands and other organs of the body are affected: the brain, the cardiovascular system.

Preventive actions

To avoid serious problems health, you need to:

Spend a lot of time outdoors.
Play sports, jogging, swimming.
Review your diet by removing junk food from your diet and diversifying it with vegetables, fruits and dairy products.
Stop smoking and drinking alcohol.
Avoid stressful situations, provide the body with proper rest.

Crohn's disease - quite serious illness which may endanger human life.

When the disease appears, it is assumed long-term treatment, available high risk relapses. To avoid complications, you should reconsider your diet, lifestyle and focus all your efforts on strengthening your immune system.