What Is Crohn's Disease?

Crohn's Disease is a chronic inflammatory bowel disease that causes inflammation of the entire lining of the digestive system, from the mouth to the anus. However, Crohn's disease generally appears in the small intestine, especially in the ileum and large intestine ( colon ). This condition can be painful, makes the body feel weak, and can sometimes cause complications that threaten the lives of sufferers. Complications that occur generally are narrowing of the intestinal space and the formation of a channel (fistula) that connects the tip of the intestine with the surface of the skin near the anus or vagina.

People with Crohn's disease have a period of remission which is a period of no symptoms or just experiencing mild symptoms. This remission period will be followed by a period of recurrence and sometimes makes it difficult for the sufferer.

Symptom-g e mesh in Crohn's Disease
Symptoms that appear in patients with Crohn's disease vary, ranging from mild to very severe, and can affect any part of the body's digestive system.

The following are common symptoms that can arise due to Crohn's disease:

• Feeling very tired.
• Abdominal pain and cramps that feel worse after eating.
• Diarrhea that appears many times.
• Stool mixed with mucus and blood.
• Decreasing appetite.
• Extreme weight loss without being desired.

Some symptoms that may appear in patients with Crohn's disease but do not always appear are:

• Fever above 38 o
• Nausea
• Gag
• Joint pain and swelling.
• Inflammation and irritation of the eyes (uveitis).
• Pain appears on the skin which causes redness, often on the feet.
• Sprue

Inflammation that occurs in the digestive system of children can inhibit the absorption of nutrients from the food they consume. Cases of Crohn's disease that occur in children will result in their growth slower than healthy children.

The following are some of the conditions and symptoms that should be treated immediately by a doctor, namely:

• The appearance of blood mixed with feces.
• Diarrhea that does not heal.
• Weight loss for no apparent reason.
• Abdominal pain and abdominal cramps that do not heal.

Things That Can Increase the Risk of Crohn's Disease
The real cause of Crohn's disease is still unknown. However, there are a number of risk factors that can be associated with this disease, namely:

• Descent. There is evidence that Crohn's disease is a hereditary disease in the family. What's more, Crohn's disease tends to occur only in some ethnic groups. This also proves that this disease is a hereditary condition.
• Immune system disorders. Disorders in the immune system cause immune cells that are supposed to protect the intestine from harmful bacteria that enter the digestive system, also attack good bacteria (probiotics) which help in the digestive process. This situation causes inflammation of the gastrointestinal tract associated with Crohn's disease.
• Smoke. People who smoke have twice the risk of developing Crohn's disease than people who don't smoke. Symptoms of Crohn's disease in people who smoke are usually more severe and tend to require surgery to treat them.
• Infection History. Infection that occurs in childhood can result in abnormal reactions from the immune system. This condition can eventually trigger the appearance of symptoms of Crohn's disease.

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Steps in Diagnosing Crohn's Disease
The following are some types of examinations that may be done by a doctor, either to diagnose Crohn's disease directly, or to eliminate a number of conditions that also cause symptoms similar to Crohn's disease.

• Inspection . The doctor will ask about the pattern of symptoms experienced by the patient. In addition, the doctor will check whether there are certain causes for these symptoms. For example food, history of drug use, family health history, as well as new trips that can cause symptoms of diarrhea. Examination of the pulse, body temperature, blood pressure, and abdominal examination will also be performed by a doctor to check the patient's health in general.
• Blood test . This examination needs to be done to determine the level of inflammation that occurs in the patient's body. In addition, with a blood test, the doctor will find out if an infection occurs. If the results of blood tests show signs of anemia, the patient may be malnourished or bleeding in the digestive tract.
• Stool examination . Stool samples will be examined for blood and mucus. From this procedure, the doctor can find out whether the symptoms that the patient experiences are caused by roundworm parasites or other conditions.
• Colonoscopy . This is a procedure performed to examine the inside of the large intestine. This procedure is done by inserting a flexible hose equipped with a camera and lights into the large intestine through the anus and rectum (the final part of the digestive tract). The doctor can see the severity and extent of inflammation that occurs in the large intestine. In this procedure you can also do a biopsy (taking a tissue sample) in the digestive tract, and then examine it under a microscope. The examination is useful to see changes in cells of the gastrointestinal wall microscopically, which is characteristic of Crohn's disease.
• Wireless endoscopic capsules . In this examination procedure, patients are required to swallow capsules that will enter the small intestine. The capsule will send the image to the recorder. After a few days, the capsule will come out of the body through dirt. This is a disposable capsule. Not all hospitals have this very new procedure.
• CTE (computerized tomography enterography / enteroc lysis ) and MRE ( computerized tomography enterography / enteroc lysis ). Both of these scanning methods can be used to diagnose Crohn's disease in the small intestine. On examination, patients will be asked to take contrast (enterographic) fluids. Contrast fluid can also be inserted into a hose which is then inserted through the nose and reaches the small intestine (enterosiclis). After the patient is given contrast fluid, the small intestine is then scanned using the magnetic resonance method (MRE) or using X-rays (CTE).

Treating Crohn's Disease
Treatment for Crohn's disease is only intended to relieve the symptoms experienced and maintain a period of remission. Until now, there has been no treatment or medication that can cure Crohn's disease completely. In pediatric patients, treatment of Crohn's disease also aims to improve the child's growth and development.

The following are some of the treatments taken to ease the symptoms that arise, namely:

• Anti-inflammatory drugs. Anti-inflammatory drugs are often used as the first treatment given to patients with Crohn's disease. Some types of anti-inflammatory drugs include:
• 5-Aminosalicylate orally. This type of medication is given to patients with Crohn's disease in the large intestine but cannot treat Crohn's disease in the small intestine. Examples of these drugs are sulfasalazine and mesalamine.
• Corticosteroids. Corticosteroids are given if the patient does not respond to various treatments given to treat Crohn's disease. Corticosteroids can reduce inflammatory reactions in various parts of the body. But keep in mind that corticosteroids have various side effects such as facial swelling, diabetes, hypertension, night sweats, insomnia , and hyperactivity. Corticosteroids are not recommended for long-term treatment. The maximum time for corticosteroid administration in patients with Crohn's disease is 3-4 months.
• Immunosuppressants. In treating Crohn's disease, immunosuppressants work by suppressing the workings of the immune system so that inflammatory reactions in the digestive tract can be reduced. Immunosuppressant drugs will work optimally when combined with several other types of immunosuppressants. Some immunosuppressant drug combinations for patients with Crohn's disease are:
• Azathioprine and mercatopurine . The combination of these two drugs is most often used to treat inflammation of the digestive tract. It is necessary to carry out routine monitoring by doctors of patients regarding the side effects of the two drugs during drug consumption.
• Infliximab, adalimumab, and certolizumab pegol. These three drugs are used as tumor inhibitors ne rosis factor (TNF) which is thought to be the main cause of Crohn's disease. These medicines can be used for adults and children who suffer from moderate and severe Crohn's disease. These drugs can be used directly for sufferers after diagnosis confirming the presence of Crohn's disease in patients, especially if the patient has a fistula. Patients who have TB infection cannot take the three drugs.
• Methotraxate. Methotraxate is an alternative if immunosuppressants, if other drugs cannot be used. Side effects of this drug include nausea, fatigue, diarrhea and pneumonia. This drug can cause disability in the fetus. For that, both women and their partners must stop using this drug at least 6 weeks before planning a pregnancy.
• Cyclosporine and tacrolimus . Both of these drugs can be used to treat fistula caused by Crohn's disease. Side effects of cyclosporine are quite dangerous so they are not recommended for long-term use.
• Natalizumab and vedolizumab. In treating Crohn's disease, these two drugs work by stopping the immune cell response to integrins. With the administration of natalizumab and vedolizumab, immune cells can be prevented from attaching to the intestinal wall thereby reducing inflammation. It should be noted that natalizumab and vedolizumab are only used in severe Crohn's disease which cannot be treated with other drugs.
• Antibiotics. Antibiotics can reduce fluid secretion in the fistula and treat abscesses caused by Crohn's disease. Antibiotics are also thought to be able to relieve Crohn's disease by reducing the population of bad bacteria that stimulates the immune system's response to the intestine. Keep in mind that the purpose of antibiotics is to prevent infection in patients with Crohn's disease if they feel that the patient has this risk. Two types of antibiotics commonly used in patients with Crohn's disease are metrodinazole and ciprofloxacin .

To relieve symptoms of Crohn's disease and reduce the risk of complications due to the disease, doctors can also recommend several medications such as:

• Antidiarrhea, for example psyllium or methylcellulose . For more severe diarrhea, loperamide can be given .
• Painkiller. For mild pain, the doctor will usually recommend paracetamol . Whereas ibuprofen and naproxen sodium are not allowed because they can aggravate the symptoms of Crohn's disease.
• Iron and vitamin B12 supplements. both supplements can reduce the appearance of anemia due to poor absorption of iron and vitamin B12 due to Crohn's disease.
• Vitamin D and calcium supplements, to reduce the risk of osteoporosis.
• Remission can be done by taking certain drugs or not. If the patient chooses to continue taking the drug, corticosteroids are not recommended for remission.

Some foods are thought to improve the symptoms experienced by people with Crohn's disease, although until now there is no clear evidence of the link between food and this disease.

If food is suspected to worsen the symptoms experienced, patients are required to avoid these foods. But it is not recommended to completely eliminate foods with certain nutrients, such as grains or foods that contain sugar.

For people who smoke, quitting these bad habits will relieve the symptoms experienced and help keep the condition in remission.


Complications due to Crohn's Disease
The following are some of the complications that may occur due to Crohn's disease, including:

• Fistula. A fistula is a channel formed from ulcers in the digestive tract wall, which penetrates other parts of the gastrointestinal tract or even penetrates the bladder, vagina, anus, or skin. As a result it can cause constant pain, fever, dirt containing blood or pus, even leakage of dirt in underwear.
• Blockage of the digestive tract. Crohn's disease can thicken the small intestinal wall and trigger blockage of food flow. To eliminate this complication, surgery can be done.
• Ulcer. Chronic inflammation of the intestine can cause ulcers or ulcers in various digestive organs, including in the mouth, intestines, anus, and also the genital organs.
• Malnutrition. Diarrhea, abdominal pain, and stomach cramps can cause sufferers to experience difficulty eating and digesting food. This condition can interfere with the absorption of nutrients, causing malnutrition.
• Osteoporosis. This is a condition when the quality of bone density decreases due to intestines which cannot absorb food nutrients properly. In addition, this condition is also at risk of occurring due to the use of corticosteroid drugs.
• Iron deficiency anemia . Bleeding in the digestive tract due to Crohn's disease can lead to iron deficiency anemia. Symptoms can include fatigue, shortness of breath, and face
• Anemic vitamin B12 or folate deficiency . Patients who experience this complication will appear tired and lack energy. The failure of absorption of vitamins and minerals by the body can also trigger mala
• Colon Cancer. Crohn's disease that attacks the large intestine will increase the risk of colon cancer .

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