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Crohn’s disease is a chronic, or long-term, condition that causes inflammation in the digestive tract. Crohn’s disease can be painful, debilitating, and sometimes life threatening. Crohn’s disease is an autoimmune-mediated inflammatory condition. It can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. The disease primarily involves the intestinal system, but it also has a variety of other manifestations and can affect the skin, joints, bones, eyes, kidney, and liver. Symptoms of Crohn’s disease can include intestinal ulcers, discomfort, and pain. Although it typically starts in childhood or early adulthood, it can develop at any age. Having a supportive network of people who understand life with Crohn’s disease is important. IBD Healthline is a free app for people with this condition. The app is available to download from the App Store and Google Play. In this article, we explain what Crohn’s disease is and how it manifests. We also discuss its causes, diagnosis, complications, and treatments, and we offer some dietary tips. Symptoms of Crohn’s disease vary, depending on which part of the gut the condition affects. They often include: - Pain: The level of pain varies from person to person and depends on where the inflammation is in the gut. People tend to experience pain in the lower right side of the abdomen. - Ulcers in the gut: These are raw areas that may bleed. If this happens, a person may find blood in their stools. - Mouth ulcers: These are a common symptom. - Diarrhea: This can range from mild to severe, and there may be mucus, blood, or pus. A person may also feel the urge to have a bowel movement but find that nothing comes out. - Fatigue: People with Crohn’s disease often feel very tired, and they may have a fever. - Altered appetite: At times, a person may experience appetite loss. - Weight loss: This can result from a loss of appetite. - Anemia: A loss of blood can lead to anemia. - Rectal bleeding and anal fissures: The skin of the anus becomes cracked, leading to pain and bleeding. During a flare of Crohn’s disease symptoms, a person may also develop: - arthritis - uveitis - skin rash and inflammation - liver or bile duct inflammation - delayed growth or sexual development, in children Symptoms in females Around - irregular menstruation, due to effects on hormone function - iron deficiency, as Crohn’s affects the absorption of nutrients and can lead to intestinal bleeding - pain during sex, if symptoms affect areas near the anus or vagina - discomfort about sex, as Crohn’s can affect a person’s libido and body image, as well as causing pain and other types of discomfort Crohn’s disease does not appear to affect fertility, but Having an inflammatory bowel disease (IBD), such as Crohn’s, does not keep a person from becoming pregnant. However, someone with this type of disease is - have a preterm delivery - need a cesarean delivery - give birth to an infant with a low birth weight Children with Crohn’s disease might need high calorie liquid formulas, especially if the condition affects their growth. Many people with Crohn’s say that the following foods can increase diarrhea and cramping: - bulky grains - dairy products - spicy foods - alcohol When a person’s appetite is very low, they may need to feed intravenously for a short period. A Crohn’s disease diet may help. It is not clear what causes Crohn’s disease. Factors that may increase the risk of inflammation include: - genetic factors - a person’s immune system - environmental factors A bacterium or virus may also play a role. For example, research suggests that there is a link between the bacterium Escherichia coli and Crohn’s disease. Smoking is another A doctor will ask a person about their symptoms. A physical examination may reveal a lump in the abdomen resulting from when loops of inflamed bowels became stuck together. How to test The following tests - stool and blood tests - biopsy - sigmoidoscopy, which involves using a short, flexible, tube-like tool, a sigmoidoscope, to investigate the lower bowel - colonoscopy, which involves using a flexible, tube-like tool, a colonoscope, to investigate the colon - endoscopy, which involves inserting a long, thin, flexible tool called an endoscope down through the esophagus and into the stomach to investigate the upper part of the gut - CT scan or barium enema X-ray, which help reveal changes in the bowel While treatment can help manage Crohn’s disease, there is currently Meanwhile, the following information could one day help researchers develop a cure: - Microbacterium avium tuberculosis, or MAP, bacteria appear to be more commonin people with Crohn’s disease. Scientists are working to clarify the link. - One theoryis that Crohn’s disease results from changes in the gut microbiome. Learning more about this could reveal ways of rebalancing microbiota in the gut. - The immune responseplays a role in Crohn’s disease. As new methods of easing inflammation emerge, more effective ways of managing Crohn’s disease could result. - Genetic factors may play a role. Identifying genes that affect the risk of Crohn’s disease and learning how to adjust them could lead to a cure. - Implantable devices, regenerative medicine, and stem cells technology are also possible future options. However, more investigations are needed before any of these can lead to a cure. Learn more about research into possible cures and treatment options for Crohn’s disease. Treatment for Crohn’s disease may involve medication, surgery, and nutritional supplements. The aim is to control inflammation, resolve nutritional problems, relieve symptoms, and reduce the occurrence of flares. The course of treatment will depend on: - where the inflammation occurs - the severity of the issue - any complications - a person’s response to previous treatments Some people go for long periods, even years, without experiencing any symptoms. These are periods of “remission.” However, symptoms usually flare up again. As the duration of remission varies greatly, it can be hard to know how effective treatment is and how long remission will last. Medication There are many medications for Crohn’s disease, - Aminosalicylates: These are anti-inflammatory drugs and include balsalazide (Colazal) and mesalamine (Lialda). A doctor may prescribe these for a person with a new diagnosis and mild symptoms. - Steroids: These may include oral steroids, such as prednisone (Rayos) and budesonide (Entocort), or intravenous steroids, such as methylprednisolone (Solu-Medrol). They are for short-term use only, as they can have severe adverse effects. - Antibiotics: These can be useful during Crohn’s flare-ups if a person has an abscess or fistula. - Antidiarrheal drugs and fluid replacements: When the inflammation subsides, diarrhea usually becomes less severe. However, a person may still need something to address diarrhea and abdominal pain. It is important to have the choice of treatment guided by a doctor, because some antidiarrheal drugs can mask an infection that needs treating. Biologics Biologics are a type of drug that scientists have developed from living organisms. Biologics reduce the body’s immune response by targeting proteins that lead to inflammation. They appear to help people with Crohn’s disease. Below are some examples: - anti-tumor necrosis factor agents, such as infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia) - integrin receptor antagonists, such as vedolizumab (Entyvio) - anti-interleukin-12 and interleukin-23 therapy, which may include ustekinumab (Stelara) - anti-Janus kinase 1, such as tofacitinib (Xeljanz) Examples of biologics for Crohn’s disease include: - infliximab (Remicade) - adalimumab (Humira) - certolizumab pegol (Cimzia) Biologic treatments can have side effects, including vomiting, nausea, and weakened resistance to infection. Some studies suggest that using biologics can reduce the likelihood of needing abdominal surgery within 10 years to 30%. Before the introduction of biologics, researchers put this figure at 40–55%. Biologics also appear to reduce the risk of adverse effects of corticosteroids. There are different types of biologic drugs, and each person reacts to these differently. A doctor will recommend a suitable option and suggest alternatives or combinations of drugs if the first choice proves ineffective. Most people with Crohn’s disease Removing part of the intestine can help, but it does not cure Crohn’s disease. Inflammation often returns to an area next to the area that was removed. Some people require more than one procedure in their lifetimes. A person may need a colectomy, in which a surgeon removes the whole colon, or large intestine. This procedure may also involve making a small opening in the front of the abdominal wall and bringing the tip of the end of the small intestine into this opening, forming a stoma, through which feces exits the body. A pouch then collects the fecal matter. Experts confirm that people with stomas can lead typical, active lives. If the surgeon can remove the diseased section of the intestine and reconnect the healthy areas, no stoma is necessary. Surgery is not an option for everyone, however. It is also important to know that the disease will recur after the operation. There is no known cure for Crohn’s disease. People can help manage their symptoms using natural treatments that are complementary to prescription medications. Some natural approaches to Crohn’s disease symptoms include: - Dietary changes: During a flare-up, avoid high fiber foods, dairy, sugar, high fat foods, and spicy foods. Between flare-ups, drink more water, eat small meals, boil or steam food instead of frying it, and keep a food diary to track the effects of different foods. - Behavioral changes: Consider quitting smoking, if this applies. And try relaxation practices and techniques, such as meditation, mindfulness, and yoga. Exercise and mental health counseling could be helpful, as well. - Supplements: Certain supplements, including curcumin, probiotics, bromelain, and wormwood, may prove effective. - Essential oils: Some essential oils, such as patchouli, peppermint, and fish oil, may help reduce inflammation. There is not enough scientific evidence to confirm that any of these approaches are safe and effective. However, experts say that quitting smoking can help reduce the severity of symptoms and the frequency of flareups. People with Crohn’s who continue to smoke are more likely to have intestinal strictures and other complications. There is currently no cure for Crohn’s disease, but treatments and various care strategies can help manage it. Still, the disease is Some people with Crohn’s need surgery and possibly more than one procedure over time. Experts do not know exactly why Crohn’s disease develops, but one In someone with Crohn’s disease, bacteria in the digestive tract may trigger an immune response that continues to occur, resulting in ongoing intestinal damage. Learn more about immune system involvement in Crohn’s disease. Crohn’s disease and ulcerative colitis are both types of IBD. But they are different conditions. Crohn’s disease can affect any part of the digestive tract, including the esophagus, stomach, small intestine, and large intestine, which is called the colon. Ulcerative colitis, on the other hand, only affects the colon. Another major difference is the depth of inflammation in the intestinal wall. In Crohn’s disease, the inflammation affects all layers of the intestinal wall. In ulcerative colitis, the inflammation mainly affects the top layer, known as the mucosal layer. Moreover, in Crohn’s disease, there can be healthy areas between diseased parts of the bowels. In ulcerative colitis, the damage appears in a continuous pattern. In addition, the pain of Crohn’s disease pain may be different from the typical pain of other GI diseases, such as irritable bowel syndrome (IBS). In a person with IBS, there will also be no signs of colon inflammation. There are five types of Crohn’s disease. Each affects a different part of the GI tract: - Ileocolitis: This is the most common type, and it affects the small and large intestines. Symptoms include diarrhea, unexplained weight loss, and pain in the lower and middle abdomen. - Ileitis: This only affects the small intestine. The symptoms are the same as those of ileocolitis, but a person with a severe case could develop fistulas or an inflammatory abscess. - Gastroduodenal Crohn’s disease: This affects the stomach and the beginning of the small intestine. Symptoms may include nausea, vomiting, loss of appetite, and unexplained weight loss. - Jejunoileitis: This causes spots of inflammation in the upper area of the small intestine, called the jejunum. Symptoms include abdominal cramping after meals, diarrhea, and in severe cases, fistulas. - Crohn’s colitis: This only affects the large intestine, or colon. Symptoms may include diarrhea, rectal bleeding, and damage around the anus, such as ulcers, fistulas, and abscesses. It can also cause joint pain and skin lesions. IBDs, such as Crohn’s disease, are - unexplained weight loss - bloody diarrhea - abdominal pain Children with Crohn’s disease may also experience poor growth and anemia. When a doctor is looking at the treatment options, they must consider the possible effects of the disease on a child’s growth, development, bone health, and psychosocial functioning. The same review notes that 48–88% of the children had received at least one corticosteroid course, and up to one-third had become dependent on steroids. The authors of the review also point to a trend toward lower rates of surgery as the use of immunomodulators and biologicals increases. If symptoms are severe and frequent, the risk of complications is higher. A person with any of the following complications - internal bleeding - a stricture, which involves part of the gut narrowing, causing a buildup of scar tissue and a partial or complete blockage of the intestine - a perforation, a small hole in the wall of the gut, which can lead to leakage, infections, and abscesses - fistulas, which involves a channel forming between two parts of the gut In addition, a person may have: - a persistent iron deficiency - food absorption problems - a slightly higher risk of bowel cancer Can Crohn’s disease be fatal? Typically Crohn’s disease is not life threatening, but it can cause fatal complications, such as colorectal cancer or severe infections. The life expectancy of someone with Crohn’s disease is usually the same as that of someone without it. Experts determine whether Crohn’s disease constitutes a disability on a case-by-case basis, because each person with the condition has a different experience. A person with Crohn’s disease could qualify for disability insurance if it prevents the person from working. Many people with IBD have to go through a series of appeals before the authorities approve their disability claims. Crohn’s disease is a chronic, or long-term, condition that causes inflammation in the digestive tract. It can be painful, reduce the quality of life, and cause complications that can be fatal. A person with Crohn’s disease can manage the symptoms with medication, stress reduction, and other approaches. Some people need surgery, as well.
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Bol u zglobovima zaustavljanje razloga Sadržaj - Prirodno Le・enje Reumatoidnog Artritisa | Prirodni Lekovi za Artritis - Juvenilni idiopatski artritis - Faktori rizika i simptomi・artritisa: - ・ta su reumatske bolesti? - Pregled najčešćih uzroka bolova u mišićima - Crohnova bolest - Hrvatsko udruženje za Crohnovu bolest i ulcerozni kolitis - Dijagnostika bola - FIZIKALNI PREGLED Uzrok Crohnove bol u zglobovima zaustavljanje razloga nije poznat, ali se sumnja na kombinaciju genetske sklonosti i okolišnih čimbenika uzimanje antibiotika, pretjerana higijena u modernim društvima. Simptomi Crohnove bolesti su obično rane u ustima, umor, proljev, bol u trbuhu, gubitak tjelesne mase te vrućica. Prirodno Le・enje Reumatoidnog Artritisa | Prirodni Lekovi za Artritis Pacijenti mogu imati i simptome izvan probavnog sustava: kožni osip, bolove u zglobovima, crvenilo očiju te rjeđe probleme s jetrom. Bolest se dijagnosticira temeljem simptoma i testova. Iako je Crohnova bolest dugotrajna, kronična, liječenjem bol u zglobovima zaustavljanje razloga može držati pod kontrolom te postići duga razdoblja bez simptoma remisije. Mnogi pacijenti s Crohnovom bolešću vode kvalitetan i ispunjen život bez obzira na simptome. Liječenje se prilagođuje svakom pacijentu ponaosob te ovisi o pogođenom dijelu probavnog sustava, tipu simptoma te aktivnosti bolesti. Brojna istraživanja se provode kako bi se bol u zglobovima zaustavljanje razloga uzrok bolesti te pronašli novi oblici liječenja. Osoba oboljela od Crohnove bolesti treba imati aktivnu ulogu u medicinskim odlukama, naučiti što više o svojoj bolesti, pridržavati se liječnikovih savjeta te odmah obavijestiti liječnika kad dođe do promjene stanja. To, međutim, nije bio prvi opis bolesti. Izvješća o simptomima koje uzrokuje ova bolest postoje još od I u medicinskoj literaturi je bolest ranije opisana; Bol u zglobovima zaustavljanje razloga Daziel u British Medical Journal objavio izvješće o liječenju ćđ pacijenata s tipičnim simptomima. Između ih i ih sve veći broj mladih odraslih osoba javljao se liječnicima sa simptomima koji su naličili upali crvuljka: grčevitim bolovima, vrućicom, proljevima, gubitkom tjelesne mase. Sinai Hospital u New Yorku, imali dvanaest pacijenata s ovakvim simptomima te su prikazali njihove slučajeve s tvrdnjom kako to nije posljedica nijedne dotada poznate bolesti. Burril Crohn je Crohn bol u zglobovima zaustavljanje razloga povezao s kirurzima te su zajedno objavili rezultate JAMA članak objavljen je u doba kad je javnost bila mnogo prijemčivija za nova otkrića i njihov članak je prezentiran širokoj medicinskoj publici. Stoga je rad koji su objavili Crohn i suradnici dobio mnogo priznanja i publiciteta, za razliku od Dazielovog iz U vrijeme kad su Crohn i suradnici opisali bolest smatralo se kako su ova bolest i ulcerozni kolitis dvije različite bolesti. Poznato je kako se bolest češće javlja u određenim obiteljima, što ukazuje na genetsku ulogu. Ipak, mutacija ovog gena se nalazi kod svega trećine oboljelih. Još najmanje sedam podložnih gena se trenutno istražuje. Proučavanjem gentike bolesti dovest će do boljeg razumijevanja njena nastanka i uloge okolišnih čimbenika te olakšati terapijske napore. Iako su brojna istraživanja pokušala otkriti okolišne čimbenike te infekcije koji bi je mogli uzrokovati, nijedan od potencijalnih uzroka nije potvrđen. Trenutno se vjeruje kako neka vrsta okidača kod genetski podložne osobe dovodi do promjene u imunološkom sustavu tijela te nastanka upale u probavnom sustavu. Bakterije te tvari iz hrane koje se nalaze u probavnom sustavu vjerojatno imaju ulogu u nastanku bolesti. Juvenilni idiopatski artritis Upala oštećuje crijeva te dovodi do pojave simptoma. Znakovi i simptomi Kliničke manifestacije Bol u svim zglobovima tijela bolesti su mnogo raznolikije nego kod ulceroznog kolitisa zbog zahvaćanja cijele stjenke crijeva te različitog zahvaćanja crijeva. Pacijenti mogu imati simptome mnogo godina prije postavljanja dijagnoze. Zbog nespecifičnih simptoma često se sumnja na sindrom iritabilnog crijeva. Ileitis i kolitis upala tankog i debelog crijeva uzrokuje proljev, bol u trbuhu, gubitak tjelesne mase, vrućicu. Proljev može imati više uzroka: pretjerano izlučivanje tekućine, poremećaj upijanja tekućine iz crijeva, poremećaj upijanja žučnih soli iz crijeva, povećan gubitak masnoća steatoreja zbog upale i gubitka žučnih soli. Bakterijsko umnožavanje u suženjima tankog crijeva, fistule između tankog i debelog crijeva te opsežno zahvaćanje gornjeg dijela tankog crijeva jejunum također dovodi do steatoreje. Može biti teško razlučiti ileitis od kolitisa, osim ako je bolest ograničena na lijevi dio debelog crijeva. Tada pacijenti mogu imati veća krvarenja koja imitiraju ulcerozni kolitis. Nalazi koji ukazuju na upalu tankog crijeva su suženja u njemu te pipanje mase u desnom donjem kvadrantu trbuha. Faktori rizika i simptomi・artritisa: Bol u trbuhu grčevitog tipa, najčešći je simptom bolesti, bez obzira koji dio crijeva zahvaća. Budući upalni proces zahvaća cijelu debljinu zida crijeva, nastaju vezivna suženja koja dovode do čestih epizoda začepljenja crijeva opstrukcija. Ponekad pacijent kod kojeg je bolešću zahvaćen donji dio tankog crijeva nema simptoma bolesti sve dok suženje crijeva ne uzrokuje zatvor konstipaciju i rane znakove začepljenja crijeva s boli u trbuhu. Krvarenje — laboratorijskim pretragama se kod ove bolesti često nalaze mikroskopski tragovi krvi u stolici, ali vidljiva makroskopska krv je rijetka, mnogo rjeđa nego kod ulceroznog kolitisa. To je jedan od razloga zašto se dijagnoza postavlja relativno kasno u tijeku bolesti. Kod osoba s produženim proljevom bez vidljive krvi u stolici, ali s problemima od strane kože, očiju ili zglobova, osobito ako postoji upalna bolest crijeva u obitelji, treba posumnjati na ovu dijagnozu. Perforacije i fistule — perforacija je stvaranja otvora pukotina u zidu crijeva; fistule su neprirodne komunikacije spojevi između organa koji su inače odvojeni. ・ta su reumatske bolesti? Upala zahvaća cijelu debljinu zida crijeva. U sklopu obnavljanja uništenih stanica stvara se vezivno tkivo koje je manje elastično, uzrokuje sile trakcije koje mogu stvoriti otvore u crijevu. Crijevni sadržaj izlazi u trbušnu šupljinu, uzrokuje upalu. Ova komplikacija je potencijalno smrtonosna. Može imati akutnu prezentaciju zbog lokalizirane upale potrbušnice sa simptomima vrućice, boli u trbuhu, osjetljivosti trbuha na dodir, a često se može opipati masa u trbuhu. Proširena upala potrbušnice difuzni peritonitis je rijetka, ali moguća. Stvaranje otvora u zidu crijeva često ne uzrokuje alarmantne simptome te dovodi do stvaranja fistula. Simptomi fistule oise o mjestu na kojem je nastala. Fistule između dva dijela tankog crijeva enteroenterične fistule ne moraju uzrokovati simptome ili se pipaju bol u zglobovima zaustavljanje razloga masa u trbuhu. Pregled najčešćih uzroka bolova u mišićima Fistule između tankog crijeva i mokraćnog mjehura enterovezikalne fistule dovode do čestih upala mokraćnih organa s različitim mikroorganizmima te mjehurima zraka u mokraći pneumaturija. Fistule s kožom enterokutane uzrokuju očite kozmetičke probleme jer se crijevni sadržaj cijedi kroz njih na površinu tijela. Perianalna bolest — bolest može zahvatiti područje oko otvora debelog crijeva te može dominirati u kliničkoj slici. Simptomi i znakovi su: bol, iscjedak, fisure napuklinenakupine gnoja, fistule. Druga mjesta probavnog sustava također mogu biti zahvaćena. Pacijenti kod kojih je zahvaćena usna šupljina imaju aftozne rane ili druga oštećenja te bol usta i zubnog mesa. Vaša težina utječe i na visinu vašeg tlaka! Besplatno ga pravilno izmjerite i izračunajte indeks tjelesne mase Svjetska zdravstvena organizacija proglasila je razdoblje od Cilj obilježavanja Svjetskog dana borbe protiv artritisa je osvještavanje javnosti o važnosti ranog prepoznavanja upalnih reumatskih bolesti te promoviranje troškovno učinkovitih načina prevencije i liječenja tih bolesti. Važno je omogućavanje što zdravijeg starenja te poboljšanje kvalitete života za oboljele koji zbog posljedica bolesti doživljavaju fizičke i psihičke promjene. U Hrvatskoj od reumatoidnog artritisa boluje oko Oko pet posto bolesnika će imati kliničku sliku čira na želucu sa simptomima gornjeg probavnog sustava te ponekad začepljenjem opstrukcijom izlaza iz želuca. Sustavni simptomi — gubitak tjelesne mase i vrućica su glavni opći simptomi. Mršavljenje je obično povezano s izbjegavanjem hrane jer se pacijenti znaju osjećati bolje ako ne jedu. Vrućica može biti uzrokovana upalnim procesom ili rezultat perforacije crijeva i naknadne infekcije. Sulfasalazin i ciklosporin Za druge nebiološke lekove, kao što je sulfasalazin, takođe je potvrđeno da su efikasni u JIA, ali se obično lošije podnose. Iskustvo sa primenom sulfasalazina je znatno manje u poređenju sa metotreksatom. Do sada nije sprovedena studija u JIA koja je ispitivala efikasnost drugih potebncijalno efikasnih lekova kao što je ciklosporin. Sulfasalazin i ciklosporin se trenutno ređe koriste u zemljama gde je dostupnost bioloških lekova rasprostranjena. Tipičan uzorak Crohnove bolesti Crohnova bolest obično teče kroz pogoršanja i smirenja egzacerbacije i remisije. Deset do dvadeset posto pacijenata će ući u remisiju nakon prve pojave simptoma bolesti. Kod drugih pacijenata bolest je varijabilna te može imati povremene duge periode tjedni, mjeseci s blažim simptomima blagi proljev, grčevi ili, rjeđe, teške i onesposobljavajuće simptome jaka trbušna bol, obilni proljevi, začepljenje crijeva. Liječenje pomaže usmjeravanju bolesti u remisiju te produžuje njeno trajanje. Većinom Crohnova bolest pogađa završni dio tankog crijeva terminalni ileum — bol u zglobovima zaustavljanje razloga čega se bolest često naziva terminalni ileitis i debelo crijevo te uzrokuje njihovu upalu. Upala crijeva može dovesti do nastanka abnormalnih prolaza i komunikacija fistulestvaranja otvora u stjenkama crijeva perforacijeuzrokovati suženje probavnog sustava strikture te njegovo začepljenje. Crohnova bolest - Hrvatsko udruženje za Crohnovu bolest i ulcerozni kolitis Crohnova bolest može zahvatiti područje oko otvora debelog crijeva perianalno područje gdje također uzrokuje fistule, čireve, gnojne nakupine te napukline fisure. Može li bolest zahvatiti druge dijelove tijela Crohnova bolest može uzrokovati upalu izvan probavnog sustava ekstraintestinalna bolest. - Kada vam je potreban odmor, uzmite ga. - Liječenje osteoartritisa aloe vera Mogući simptomi su crvenilo i oticanje kože, bol očiju, problemi s vidom, kašljanje, zvižduci pri disanju te otežano disanje. Upala kože nastaje kod manje od petnaest posto pacijenata. Obično se povlači kad se počnu liječiti probavni simptomi, ali ponekad su potrebni kortikosteroidi. Bol u zglobovima zaustavljanje razloga oka javlja se kod pet posto bolesnika. Primjena oralnih inhibitora Janus kinaza tofacitiniba u održavanju remisije ulceroznog kolitisa Što je ulcerozni kolitis? Ulcerozni kolitis je kronična dugotrajna upalna bolest crijeva koja zahvaća debelo crijevo. Najčešći simptomi ulceroznog kolitisa uključuju krvavi proljev, bolove u trbuhu i iznenadni, gotovo nekontrolirani nagon za ispuštanjem stolice. Neki ljudi imaju simptome izvan crijeva, uključujući bolne zglobove, rane u ustima i upalu očiju. Kad netko ima simptome ulceroznog kolitisa, kaže se da ima 'aktivnu' bolest. Obično se povlači tijekom liječenja osnovne bolesti, ali je potrebno pozorno praćenje kako bi se spriječile komplikacije, primjerice glaukom. Upala pluća i dišnih puteva nastaje rijetko, ali je moguća. Dijagnostika bola Kad je potreban kirurški zahvat? Konzervativnim liječenjem mogu se kontrolirati simptomi te odgoditi potreba za operacijom. Kirurgija se koristi za zaustavljanje krvarenja, zatvaranje fistula te zaobilaženje zažepljenja,a ponekad jednostavno za uklanjanje zahvaćenog dijela crijeva. Što očekivati nakon operacije Važno je imati realna očekivanja od kirurškog zahvata. Zahvat može poboljšati bolesnikovo zdravstveno stanje te čak spasiti život. Operacija, međutim, neće izliječiti bolest te je vrlo vjerojatno kako će se simptomi bolesti opet pojaviti. Ako je bolest ograničena na debelo crijevo te se ono odstrani, svega desetina pacijenata će razviti simptome tijekom slijedećih deset godina. Odmah započeta dugotrajna terapija lijekovima nakon operacije smanjuje rizik od ponovne pojave bolesti. Ponekad je tijekom operacije potrebno napraviti otvor na trbušnom zidu kroz koji će se prazniti crijevni sadržaj stoma. Nakon prilagodbe sa stomom se obično može voditi potpun život. Rizici za rani kirurški zahvat Rani kirurški bol u zglobovima zaustavljanje razloga se definira kao veliki kirurški zahvat u svrhu liječenja Crohnove bolesti koji se poduzima unutar tri godine nakon postavljanja dijagnoze. Proučavanjem slučajeva pacijenata koji su podvrgnuti takvom ranom kirurškom zahvatu uočeno je ponavljanje određenih čimbenika rizika. Rizični čimbenici koji su značajno povezani s rizikom od ranog kirurškog zahvata su: pušenje cigareta, bolest tankog crijeva bez zahvaćanja debelog crijeva, mučnina i povraćanje ili trbušna bol u vrijeme dijagnoze, broj neutrofilnih leukocita te liječenje steroidima u prvih šest mjeseci. Kako se bolest liječi kad se opet javi nakon remisije ili kirurškog zahvata? Rekurentna Crohnova bolest liječi se po istim principima kao i njene početne epizode. U nekim slučajevima je potrebno koristiti jače lijekove ili uvesti novu grupu lijekova. Crohnova bolest kod djece i adolescenata Petina oboljelih razvije bolest prije osamnaeste godine. Ukoliko se bolest ne liječi, polovina zahvaćene djece će imati nizak rast ili odgođen razvoj. Agresivna nutricionistička terapija može omogućiti uredan rast i razvoj. Terapija može uključivati prehrambene nadomjeske, visoko-kaloričnu dijetu te ponekad infuzije. FIZIKALNI PREGLED Budući steroidi mogu usporiti rast te dovesti do osteoporoze, upotrebljavaju se kod djece jedino u krajnjoj nuždi. Visina, težina i mineralna gustoća kostiju trebaju se pomno nadzirati kod djece koja se liječe kortikosteroidima. Djeca mogu imati značajne psihosocijalne probleme ako stanje utječe na svakodnevno funkcioniranje te onemogućuje druženje s vršnjacima. Ukoliko dijete izgleda povučeno, tužno, nezainteresirano za aktivnosti ili ima teškoća u školi, preporučljivo je to naglasiti liječniku te se posavjetovati s psihologom ili dječjim psihijatrom. Novi oblici liječenja Veliki broj istraživanja bavi se Crohnovom bolešću. Većina novih lijekova pomaže stišavanju upale. Mnogi lijekovi prolaze kroz klinička istraživanja. Ukoliko je bolesnik zainteresiran za sudjelovanje u istraživanju novih lijekova treba razgovarati sa specijalistom koji ga vodi. Mogu li oboljeli od Crohnove bolesti imati djecu? Muškarci i žene oboljeli od Crohnove bolesti mogu imati djecu. S liječnikom je prethodno preporučljivo razgovarati o sigurnosti lijekova u trudnoći. Djeca roditelja s Crohnovom bolesti imaju tri do dvadeset puta veću vjerojatnost nego opća populacija za razvijanje iste bolesti. Međutim, trenutno ne postoji način za predviđanje individualnog rizika za dijete.