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Pain in the abdomen and chronic diarrhea: These are typical complaints that suffer patients with Crohn's disease and ulcerative colitis. Your bowel is chronically inflamed. So where does it come from and what helps then, says Professor Brigitte Mayinger.
MORBUS CROHN AND COLITIS ULCEROSA
BY ANDREA EPPNER
Progress can have a huge impact on the stomach and intestines: everywhere in China, Russia or India As the modern lifestyle in between, the number of patients with inflammatory bowel disease also increases. In Germany, about 400,000 people suffer from Crohn's disease or ulcerative colitis – the once rare fire in the intestine has long since become a wildfire.
Experts still wonder why. But one thing seems certain: "It has something to do with industrialization," says Professor Brigitte Mayinger, Chief Medical Officer of Helios Klinikum München West in Pasing. But is it due to excessive hygiene, is there something in the food or is it environmental pollutants? All is not clear. The only certainty is that some people are more vulnerable. And: The people involved are more interested in how they get their complaints under control anyway. Together with our expert we clarify the most important questions.
-What symptoms may indicate chronic inflammatory bowel disease?
"Affected typically suffer from chronic diarrhea," says gastroenterologist Mayinger. Chronic means that patients have diarrhea for more than four weeks – and that with three or more chairs a day. The symptoms often provide the first clues about the presence of an inflammatory bowel disease (IBD). The two most common are Crohn's disease and ulcerative colitis. The latter suggests, for example, if the stool is pulpy and has added blood. Unilateral abdominal pain is more common in Crohn's disease. If they affect the lower right abdomen, they can even be mistaken for appendicitis, says Mayinger.
Is the stool problem limited?
First, but not only. Frequent diarrhea often causes patients to lose weight. Very severe inflammation may also trigger a fever. But common complaints can also occur. The knee, ankle, elbow, wrist and ilio-sacral joint are particularly affected. The latter is located between the coccyx and the large iliac shovel. In addition, red and nodular skin lesions, especially at the edge of shinbone attack, may occur, says Mayinger. "It's an indication that something is wrong with the immune system," says the expert. Very rarely, ulcerative colitis can cause ocular inflammation and constrictions in the bile ducts. Patients are therefore regularly monitored for liver function.
– Diarrhea can have many causes …
Indeed. First and foremost, it must be excluded that bacteria or viruses are the cause, says Mayinger. A viral infection is usually complete after a few days. However, bacteria and parasites can also cause chronic diarrhea. For example, "lamblias" – small parasites that nest in the lining of the small intestine – cause very violent and partially watery diarrhea. "Cause can also be drugs," says the expert. Sometimes antibiotic therapy causes the spread of the germ "Clostridium difficile" in the intestine – also causing severe diarrhea
– how do you explain it?
This is a sample of bacteria, viruses and, most importantly, also examined parasites. In addition, the blood is collected, which is tested in the laboratory for signs of inflammation, so that the "CRP value" and an increase in white blood cells. If the number of red blood cells is too low, it may also indicate a loss of blood hidden in the intestine. This is followed by an ultrasound of the abdomen: This often makes it clear already if the intestinal wall is thickened in places – a sign of inflammation. Or if other causes, such as adhesions or "ileus", ie intestinal obstruction, are present. If the diarrhea lasts for four weeks, an endoscopic examination follows, that is to say a colonoscopy. In this case, the doctor can see if and where the intestine is inflamed – and what part of the intestinal wall is affected: Here, Crohn's disease and ulcerative colitis differs.
-What is typical of ulcerative colitis?
The inflammation concerns only the large intestine, from the rectum. "The strongest infestation is still down," says Mayinger. "One can see a mbadive mbad of phlegm especially in the first ten inches of the sphincter." The inflammation then rises continuously upward and weakens. If we looked at the microscope part of the affected mucosa, we could see that only the upper layer was inflamed.
– And what is different in Crohn's disease?
This is typically another section of the affected intestine. that is, the area where the small intestine empties into the large intestine, the "ileocecal region". In Crohn's disease, the bowel is also not affected, but discontinuously. It can be found here and there inflamed areas – not just in the colon. In Crohn's disease, the entire gastrointestinal tract can be affected, such as the small intestine, sometimes even the esophagus and stomach. "The inflammation can also cross the entire intestinal wall," says Mayinger. Sometimes, this has bad consequences: fistulas, that is to say, connecting ways to neighboring organs, for example between the large intestine and the bladder, are formed. Fistulas are particularly common in the rectum. Other complications may be inflammatory or scarring constrictions of the intestine, or even encapsulated inflammation sites
Should we operate in such cases?
In fact, fistulas sometimes require surgery. In very serious cases, so-called conglomerate tumors appear. Then parts of the intestine are really stuck together, says Mayinger. Under certain circumstances, the chyme barely pbades. So sometimes parts of the intestine must be removed. But: "Fortunately, we rarely see such serious cases today," says Mayinger. The therapy has improved considerably in recent decades.
– What is being treated?
Usually, inflammation can be controlled by immunosuppressive therapy. Various drugs are used that dampen the immune system's response. Depending on the severity of the complaints, the choice is made. So, you try it in ulcerative colitis first with enemas with mesalazine or cortisone. If the inflammation is stronger or there is an increase in the disease, you should also rely on cortisone tablets or infusions. In order to avoid cortisone-related side effects with a longer duration of treatment, you will then need, depending on the course of the disease, to switch quickly to immunosuppressive preparations. This includes, for example, "azathioprine", which only develops its full effect after two to three months. Or biological immunomodulatory drugs such as anti-TNF-alpha antibodies. These are administered in the form of a short infusion or in the form of an injection under the skin. The treatment of Crohn's disease follows a similar pattern. Before using immunosuppressive drugs, it is important to exclude chronic infections and to check beforehand their immunization status.
-What should patients know?
When they eat, patients should be well balanced and healthy at the inflammatory interval feed. We recommend a Mediterranean diet with lots of vegetables and fat and sugar in moderation. Deficiency states are rare today because of improved therapy, Mayinger says. If part of the small intestine has been cleared in Crohn's disease, it may be necessary to add Vitamin B12. Important to know: Due to immunosuppressive therapy, patients are more susceptible to infection. Frequent inflammations in the intestine also increase the risk of colorectal cancer. Fortunately, as the best therapy reduces inflammation, it is less of a problem today.
Back to overview: Weltspiegel
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