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Crohn’s Disease

Crohn’s disease can affect any part of the gastrointestinal tract. It is a chronic inflammation that develops in the gastrointestinal tract which can involve all the layers of the bowel. The pathogenesis is associated with T-cell activations which lead to tissue injury. Complications of Crohn’s disease involve small bowel obstruction, intestinal strictures; free perforation, abscesses, toxic megacolon and fistulae.

Crohn’s Disease Treatment in Ernakulam

Causes

  • Diet and stress
  • Heredity
  • Genetics
  • Environmental factors
  • Immune system breakdowns

Signs and Symptoms

  • Rectal bleeding
  • Diarrhoea
  • Urgency to move bowels
  • Feeling of incomplete evacuation
  • Perianal fistulae and abscesses
  • Abdominal pain and cramps
  • Constipation which subsequently leads to bowel obstruction
  • Fever
  • Weight loss
  • Fatigue
  • Night sweats
  • Irregular menstrual cycles
  • Nausea and vomiting
  • Bone loss

Diagnosis

  • Physical examination: focus on temperature; weight; nutritional status; abdominal tenderness; palpable mass; findings on rectal examination; segments of the bowel reveal microperforation
  • Routine lab studies: CBC; chemistry panel; inflammatory markers; stool studies
  • Serologic tests: pANCA; ASCA
  • Barium contrast: study for pseudodiverticula
  • Small bowel follow-through: upper GI SBFT for the terminal ileum
  • CT scan: for extramural complications
  • Ileocolonoscopy: to take multiple biopsies
  • Upper GI endoscopy
  • MRI: magnetic resonance imaging can evaluate perianal and pelvic disease while investigating for perianal fistulae
  • Radionucleotide scanning: assesses the severity and extent of the disease

Treatment

Diarrhoea during Crohn’s disease is treated pharmacologically due to acute C.difficile infections. Anti-inflammatory and immunosuppressantmedications such as sulfasalazine are prescribed for small bowel and colon inflammation. Diet modifications and nutritional therapy are important modalities to facilitate bowel resting.

Indications for surgery: formation of intra-abdominal abscesses; fistulae that are medically intractable; symptoms persist in spite of high-dosage corticosteroid therapy; fibrotic strictures with obstruction; toxic megacolon; cancer; perforation; bleeding;

Recommended surgical procedures are: bowel resection; ileocolostomy; strictureplasty; total or segmental colectomy; proctectomy or total proctocolectomy

Dr. Deepak Varma is approached for several complications of IBD and Crohn’s disease all of which he has treated successfully for many years now.