Crohn's disease attacks the intestines, stomach, esophagus and even the mouth and penetrates deep into the gastrointestinal wall. It manifests itself with diarrhea, abdominal pain, blood and mucus appear in the stools. Crohn's disease is a chronic and relapsing disease - the symptoms get worse and worse. What is life like with Crohn's disease and how is it treated?

Crohn's diseaseis just as common in both men and women. Most often it is diagnosed between the ages of 15 and 35. However, in recent years, the age of diagnosis has decreased and the disease is becoming more common among children.ChLCoccurs much more often in highly developed countries, i.e. in Western Europe and the United States. For about 30 years, however, there has been a steady increase in the incidence in Central and Eastern Europe and Asia. More people get sick in northern than southern countries, and the disease is least common in Africa. The incidence in Poland is approaching the typical incidence rate for Western Europe. In Poland, 10-15 thousand people suffer fromChLC , of which even half may go undiagnosed. The surest method to diagnose CD is endoscopy with taking a specimen for histopathological examination and evaluation of inflammatory changes.

What is Crohn's disease?

Crohn's diseaseis a chronic inflammatory disease classified as inflammatory bowel disease. Its symptoms and treatment can be very similar to ulcerative colitis, but they are two different entities.

The difference between CD and ulcerative colitis is that inflammatory changes in CD can be located in different sections of the gastrointestinal tract, pointwise, alternating with unchanged sections, and the inflammatory infiltrate affects the entire thickness of the gastrointestinal tract wall.

Inflammatory changes can occur from the mouth to the rectum, but most often appear in the terminal ileum and large intestine. CD is an incurable disease. It lasts for many years with alternating periods of severity and remission (periods of silence and asymptomatic disease).

Correctly selected treatment and lifestyle help in achieving andprolonging remission, however, it is observed that with increasing disease duration, asymptomatic periods become less frequent and shorter.

Crohn's disease causes

The etiology of Crohn's disease is not known so far. Its causes cannot be precisely determined, but there are known factors that potentially provoke or contribute to the disease. Such factors include:

  • the composition of the bacterial microbiota - in people with CD it is different than in he althy people, the disease may be associated with the frequent use of antibiotics,
  • stress - stress probably does not cause the disease, but it favors its manifestation and worsening of symptoms,
  • smoking,
  • industrial diet with low nutritional value - the risk of developing CLC is greater in people who consume a lot of sugar, hydrogenated vegetable fats, dyes, preservatives and red meat, i.e. pro-inflammatory foods,
  • genetic factors - CD is more common in families; the disease is favored by the presence of the NOD2 / CARD15 gene, the mutation of which increases the risk of developing the disease up to 40 times; if the parents suffer from CD or ulcerative colitis, the child has a 40% risk of developing the disease,
  • abnormal immune system response.

The increasing number of cases in the countries of Central and Eastern Europe and Asia is associated with increasing industrialization and urbanization, changing diets and increasing levels of hygiene.

Disease symptoms

Crohn's disease can manifest itself with varying severity and symptom complexity. The most common symptoms include:

  • frequent abdominal pain, mainly on the right side of the lower abdomen, near the navel,
  • cramps, gas and a feeling of splashing in the lower abdomen,
  • chronic diarrhea,
  • frequent urge to stool,
  • painful bowel movements (if the rectum is affected),
  • weight loss,
  • fever of unknown origin,
  • general symptoms: weakness, fatigue, general malaise, low appetite.

CHLC can have many symptoms unrelated to the gut, for example :

  • various eye inflammations,
  • autoimmune hepatitis,
  • pancreatitis,
  • erythema nodosum,
  • gangrenous dermatitis,
  • diseases of the nervous system,
  • venous congestion,
  • arthritis
  • and many more.

CDAI scale

Disease severity and remission status are assessed using theCDAIIndex of Crohn's Disease Activity Index. The scale takes into account both subjectivesensations related to the perceived pain and fatigue, etc., as well as objective data, e.g. weight deficiency or the amount of loose stools.

According to the CDAI, disease activity is divided into:

  • mild (150-220 points),
  • moderate (221-450pts)
  • and heavy (over 450).

If the disease activity is below 150 points in the study, it is considered to be in remission.

Drugs in Crohn's disease

Treatment of CDC is based on minimizing symptoms and bringing the body into remission. As of today, the etiology of the disease is not known, so it is impossible to treat it causally. Drugs commonly used in the treatment of CD are:

  • aminosalicylates (sulfasalazine, mesalazine) - Sulfasalazine is used only when the large intestine is diseased, while mesalazine is used regardless of the part of the gastrointestinal tract where inflammation occurs. These drugs are not well-proven to be effective in inducing and maintaining remission, but they are safer and have far fewer side effects than other treatments. Hence, their use is very common.
  • glucocorticosteroids - Glucocorticosteroids are very effective in inducing remission of CD, but not in maintaining it. The goal of therapy should be to achieve remission with glucocorticosteroids and then reduce or completely eliminate them if it is possible to maintain remission. Chronic use of glucocorticosteroids leads to steroid resistance and steroid dependence, which results in the need to administer increasingly higher doses and shorten the remission time. Budesonide is the most significant drug in this class of drugs.
  • thiopurines - Tipourines are effective in inducing and maintaining remission, but their correct introduction and monitoring of the treatment course is essential. Possible side effects of their use include bone marrow suppression, hepatotoxicity and acute pancreatitis.
  • methotrexate - Methotrexate is mainly used in people for whom treatment with glucocorticosteroids or thiopurines does not bring the desired results. It is administered intramuscularly in the form of injections. Incorrectly conducted methotrexate therapy poses a risk of liver and bone marrow damage.
  • biological therapy - Drugs in this category, more specifically anti-TNF-α antibodies, are introduced in moderate to severe forms of CD, when other treatments do not work.

Diet in Crohn's disease

Nutrition is of great importance in CLC. While it is not possible to say that diet causes or reverses disease, many people find similar recommendations to help alleviate disease.symptoms. The basic rule of the diet in CD is to exclude foods that cause or worsen symptoms.

Special recommendations apply to periods of exacerbation of the disease. During this time, depending on the patient's condition, a special diet made of natural products or an industrial diet administered orally or enterally, less often intravenously, is introduced.

Diet with natural products in exacerbation of ChLC

A diet in exacerbation of CLC is an easily digestible diet with the restriction of insoluble fiber, fat and refined sugars. It is a high-calorie, high-protein diet, as an exacerbation is usually accompanied by malnutrition and weight loss.

You should eat small meals, even 5-6 a day, of moderate temperature, not too cold and not too hot.

Food should be prepared in such a way as to increase its digestibility - heat treated, finely chopped, free from hard and tough parts.

Recommended heat treatment methods are:

  • cooking,
  • steaming,
  • stewing without browning,
  • baking.

Avoid frying, especially deep-frying.

The diet should be rich in wholesome, low-fat protein sources:

  • poultry without skin,
  • young beef,
  • veal,
  • rabbit meat,
  • very high-quality cold cuts and sausages with a short composition without polyphosphates, nitrites, etc.,
  • fresh fish,
  • lactose-free dairy.

Highly digestible fat from lard, bacon and fatty meats should be excluded from meals, and easily digestible fats (butter, cream, vegetable oils) should be eaten in limited amounts and preferably added cold to ready-made meals.

In order to reduce the amount of fiber, vegetables and fruits should be peeled, shredded, mixed or rubbed.

It is better to choose small groats and pasta and white rice instead of thick groats, semolina pasta or brown rice, which have more fiber.

Soluble fiber is indicated in CLC, however, because fermented by the colon microbiome, it is a source of short-chain fatty acids essential for nourishing intestinal epithelial cells. For this reason, individual tolerance to fiber should be monitored and not ruled out hastily.

Patients with CD are often lactose intolerant - they do not produce the lactase enzyme responsible for digesting milk sugar. Therefore, they should avoid dairy products with lactose (milk, yoghurt, cottage cheese, buttermilk, kefir). Their consumption causes flatulence, abdominal pain,can cause diarrhea.

Lactose-free dairy products are now readily available and these should not cause digestive problems. Complete elimination of dairy products is necessary in the case of diagnosed intolerance to cow's milk proteins.

Omega-3 fatty acids, which reduce inflammatory processes, are of great importance in ChLC. Their source is oily sea fish:

  • wild salmon,
  • follow,
  • mackerel,
  • sardine,
  • anchovy,
  • or tuna.

Fish should be eaten at least twice a week. Otherwise, omega-3 fatty acid supplementation is necessary.

The following should be excluded from the diet:

  • products containing added sugar - sweets, confectionery, carbonated and non-carbonated drinks, fruit syrups, high-sweetened jams, sweetened dairy products,
  • flatulent products - legume seeds, green peas, green beans, cabbage, Brussels sprouts, cauliflower, broccoli, kohlrabi, radish, swede, onion, leek, fresh cucumbers, pears, plums, cherries,
  • beer,
  • sparkling water,
  • fermentable sugars (limit or exclude temporarily) - lactose from dairy products, fructose from honey, grapes, pears, plums, apples, figs, cherries, dried fruits, bloating vegetables,
  • fluids that relax and increase intestinal peristalsis - large amounts of coffee, very cold and hot drinks.

Products that may exacerbate discomfort in CD include:

  • spicy food,
  • beetroot,
  • peppers,
  • spinach,
  • wheat,
  • tomatoes,
  • eggs,
  • wine,
  • bananas,
  • corn,
  • yeast.

There is no strong scientific confirmation of the relationship between the consumption of these products and the exacerbation of the disease, however, interviewed patients often refer to these products as poorly tolerated.

Nutrition for acute diarrhea

In the period of increased occurrence of diarrhea, it is advisable to use foods that constrict and reduce intestinal peristalsis:

  • rice dishes, with potato flour, gelatin, jelly, fruit and meat jellies,
  • carrots, pumpkin, apples, bananas,
  • dry blueberry infusion, water with dry red wine, strong bitter tea,
  • dark chocolate,
  • drinks that protect the gastrointestinal mucosa: chamomile, mint, infusion or decoction of linseed.

Nutrition with industrial diets in exacerbation of ChLC

When the symptoms of the disease do not allow for natural nutrition, necessaryis the use of industrial diets - ready-made mixtures for oral nutrition (non-residue polymer diets) or enteral nutrition (elemental or semi-elementary diets).

In situations where even enteral nutrition is poorly tolerated by the patient, intravenous parenteral nutrition is required.

Industrial diets are fully digestible, they are aimed at feeding the patient, who is often debilitated and loses weight during the exacerbation of the disease. They are also used as a means of bringing a patient with CD into remission.

Diet in remission of Crohn's disease

The diet in remission should be a normal he althy diet without any specific recommendations. Of course, apart from the elimination of poorly tolerated products.

New nutritional trends in the treatment of CD pay more and more attention to the effectiveness of the FODMAP diet. It is a diet with the restriction or complete exclusion of fermentable, poorly absorbable carbohydrates, such as:

  • lactose,
  • fructose,
  • fructans,
  • sorbitol,
  • xylitol,
  • mannitol,

referred to as fermentable oligo-, di-, monosaccharides and polyols. In maintaining remission, however, this issue requires more careful research.

Another proposed nutritional intervention is the IBD-AID anti-inflammatory diet, which consists of:

  • restriction or complete exclusion of certain carbohydrates (lactose, refined sugars, complex carbohydrates) and the consumption of simple carbohydrates, the supply of pre- and probiotics,
  • modification of fatty acid composition in food,
  • meeting the demand for minerals and vitamins and observing the body to identify possible food intolerances,
  • changing the texture of food (e.g. blending, cooking) to improve the absorption of nutrients and reduce the irritating effect of fiber.

Bioactive phytochemicals and supplementation in Crohn's disease

  • Polyphenols present in plants have antioxidant and anti-inflammatory properties. Scientific studies have confirmed the beneficial effect of anthocyanins, turmeric, EGCG, naringenin, ellagic acid, quercetin, resveratrol, apple polyphenols or blueberry on the suppression of inflammatory reactions in inflammatory bowel diseases by reducing the concentration of pro-inflammatory cytokines and increased activity of antioxidant enzymes. For this reason, the diet of people suffering from CD should be rich in vegetables and fruits, especially dark berries.
  • According to available datasupplementation with probiotics does not bring improvement in patients with CD.
  • The ratio of omega-6 to omega-3 fatty acids in the diet most beneficial in the treatment of CD is 2: 1. It is virtually impossible to obtain it without eating oily sea fish on a regular basis, which is why supplementation with anti-inflammatory omega-3 fatty acids is so important.
  • Crohn's disease in children
  • Intestinal diseases
  • Intestinal inflammation: causes. What causes intestinal inflammation?

Category:

Gastrology