Crohn disease
About a disease
I have ulcers on small intestine and large intestine when I say briefly and am the disease that abdominal pain and diarrhea occur with it. I can suppress the condition by medical therapy and nourishment therapy, but unfortunately do not understand the treatment to completely cure a disease currently.
It is a disease reported as "regional enteritis" for the first time in 1932 by physician Bril B clone and others of the New York mount rhinoceros Ney Hospital. I came to be called "Crohn disease" after the name of this reporter. A concept, diagnostic criteria were paid off by a European and American way of thinking, and a national-scale study was started based on a common standard in Japan in 1975 by a Japanese digestive organ society and the Ministry of Health and Welfare. The study group of the Ministry of Health and Welfare in particular is succeeded from generation to generation, and a study aiming at the elucidation of the cause and establishment of the radical cure treatment is pushed forward.
When the Crohn disease is diagnostic criteria of the specific disease study group of the Ministry of Health and Welfare and is authorized, an identification of specific disease treatment study medical care recipient is issued, and the some public money burden on medical expenses is performed. The number of grants was 128 cases in 1976, but after that I continue increasing year by year and become 16,891 cases at 1,998 degrees.
In addition, the age to suffer from Crohn disease for the first time is concentrated in Japan for early 20s from late teens, and about half of patients become sick at the time. A man: The difference of the incidence in women becomes 1.8:1.0.
It is a disease reported as "regional enteritis" for the first time in 1932 by physician Bril B clone and others of the New York mount rhinoceros Ney Hospital. I came to be called "Crohn disease" after the name of this reporter. A concept, diagnostic criteria were paid off by a European and American way of thinking, and a national-scale study was started based on a common standard in Japan in 1975 by a Japanese digestive organ society and the Ministry of Health and Welfare. The study group of the Ministry of Health and Welfare in particular is succeeded from generation to generation, and a study aiming at the elucidation of the cause and establishment of the radical cure treatment is pushed forward.
When the Crohn disease is diagnostic criteria of the specific disease study group of the Ministry of Health and Welfare and is authorized, an identification of specific disease treatment study medical care recipient is issued, and the some public money burden on medical expenses is performed. The number of grants was 128 cases in 1976, but after that I continue increasing year by year and become 16,891 cases at 1,998 degrees.
In addition, the age to suffer from Crohn disease for the first time is concentrated in Japan for early 20s from late teens, and about half of patients become sick at the time. A man: The difference of the incidence in women becomes 1.8:1.0.
Symptom
The clinical manifestations of the Crohn disease diverge into many branches very much, and the onset of condition pattern varies every patient, too. It is abdominal pain, diarrhea, fever, weight loss, abdominal mass, hemorrhoids rounadoga characteristic-like symptom particularly in that. Abdominal pain, diarrhea, the symptom such as the weight loss may only pass through 1-3 years before they have a diagnosis of Crohn disease to emerge in jo々. Most of these symptoms are included in the item of the IOIBD score to evaluate the number of the activities of the Crohn disease and are important in knowing the state of the current disease.
Inspection, diagnosis
| Inspection, diagnosis I interview a diagnosis of the Crohn disease, and there are X-ray check, endoscopy in addition to a general blood test. However, abdominal pain, fever, the bowel movement number of times, the change of the everyday state such as the weight loss become the important clue because it is a chronic disease in usually knowing the condition. I will usually pay interest to one's state. It is asked about the symptom with property of feces, bowel movement state and them other than a general symptom by the interview chiefly. What I think of as these become the important point for treatment early in the attack in particular will tell enough. In addition, let's keep it in mind as abdominal pain and the bowel movement are the indexes that I can observe myself, and it is a matter important at all in knowing one's state in a remission to usually observe the state of the bowel movements such as diarrhea, the bloody bowel discharge. I perform the blood test to know the inflammatory degree and nourishment state of the whole body. For an index of inflammation, serum protein is measured as sedimentation of blood, CRP, α 2 globulin, a monitor of the nourishment state. The biopsy makes Crohn disease and a diagnosis in the cases that cannot be settled only by results such as an interview and a blood test, the X-ray check. After dyeing a specimen provided by endoscopy or an excision operation, under a microscope, I see having granuloma or not. I insert a tube to the duodenum than a nasal cavity and inject barium and air, and, as for the small intestine X-ray check, X-rays photograph having small intestinal lesion or not, narrow fence, rou hole. The infusion X-ray check injects barium and air than anus to know a part, the distribution of the lesion, a state of inflammation, the states such as having rou hole or not and performs the radiography of the large intestine. |
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| The large intestine endoscopy inserts an endoscope in the bowels than anus to observe a lesion of large intestine and the terminal ileum and performs it. The right figure 2 piece is the image which I saw with a real endoscope. |
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Treatment of the Crohn disease
Cure
Nourishment therapy
For the purpose of nourishment management of the Crohn disease patient whom a condition moved, ingredient nourishment (Element Diet:ED) law was used than before. And I knew what not only the nourishment state of the patient and the general state but also the symptoms derived from Crohn disease such as abdominal pain or the diarrhea improved by the ED method. It is almost established about the effectiveness of the nourishment therapy for the Crohn disease, and, as for approximately 100% of remission introduction, it is thought with a possibility except the bad patient who is extremely in a state and the patient of the intestinal tract narrow fence now. Because the serious side effect does not cause it, I examine the treatment finger of the Ministry of Health and Welfare study group and but do nourishment therapy with the cure that primarily you should choose.
Nourishment therapy with the infusion
Nourishment management with the infusion is usually performed when the intestinal tract has narrow sakuyarou hole, and there is not enteral nourishment management. Because food does not pass in intestinal tract at all when I transfuse it, rest is completely kept, and the lesion is improved. However, the atrophy of the intestinal mucosa happens when it takes effect too for a long term. It may be said that it is desirable to shift to the ingredient nourishment method immediately if a lesion part is improved, and enteral nourishment is enabled.
Medical therapy
A steroid, antiinflammatory, an immunosuppressive drug, antibiotic are used in medical therapy well. I can expect all the effect. It recurs when I cancel use and might cause a side effect when I use it for a long term.
Operative treatment
It was performed well before, but I begin to know that it often recurs within several years as I pass through many cases and am used only for a symptom (when there are narrow sakuyarou holes) that I cannot manage by a nourishment therapy and medical therapy now. It is a current basic way of thinking to minimize the operation.
For the purpose of nourishment management of the Crohn disease patient whom a condition moved, ingredient nourishment (Element Diet:ED) law was used than before. And I knew what not only the nourishment state of the patient and the general state but also the symptoms derived from Crohn disease such as abdominal pain or the diarrhea improved by the ED method. It is almost established about the effectiveness of the nourishment therapy for the Crohn disease, and, as for approximately 100% of remission introduction, it is thought with a possibility except the bad patient who is extremely in a state and the patient of the intestinal tract narrow fence now. Because the serious side effect does not cause it, I examine the treatment finger of the Ministry of Health and Welfare study group and but do nourishment therapy with the cure that primarily you should choose.
Nourishment therapy with the infusion
Nourishment management with the infusion is usually performed when the intestinal tract has narrow sakuyarou hole, and there is not enteral nourishment management. Because food does not pass in intestinal tract at all when I transfuse it, rest is completely kept, and the lesion is improved. However, the atrophy of the intestinal mucosa happens when it takes effect too for a long term. It may be said that it is desirable to shift to the ingredient nourishment method immediately if a lesion part is improved, and enteral nourishment is enabled.
Medical therapy
A steroid, antiinflammatory, an immunosuppressive drug, antibiotic are used in medical therapy well. I can expect all the effect. It recurs when I cancel use and might cause a side effect when I use it for a long term.
Operative treatment
It was performed well before, but I begin to know that it often recurs within several years as I pass through many cases and am used only for a symptom (when there are narrow sakuyarou holes) that I cannot manage by a nourishment therapy and medical therapy now. It is a current basic way of thinking to minimize the operation.
Diet cure
Generally, the nourishment from intestinal tract is disturbed when a symptom is a season, and it is a basic boiled rice, I stew it, and to supply udon, bread, high energy food such as the rice porridge, high quality protein (soybean food such as white-fleshed fish, chicken except the skin, a beef red meat, tofu or the dried bean curd eggs), good food of the digestion as it may cause consumption of the physical strength. It prevents you from taking the thing with many dietary fiber (a burdock, a shiitake, a bamboo shoot, edible wild plants come, and there are no jellyfish, myoga, celery persimmons) stimulating large intestine and fat which is easy to have loose bowels, but the diet cure that I put together is necessary for each by degree and a range of inflammation. It is not necessary to become such nervous in a remission, but please avoid overeating and overdrinking and the intake of the excessive alcohol. In addition, you should wait as coffee or spice, the soda do enteric peristalsis lively. In addition, I do not mind it in the normal eating habits if the cold things of the heat potato usually extremely avoid intakes of the food considered not to be good for a stomach. The self-control that a stimulant and alcohol, the thing with much fat content avoid is important if I feel that I am ill-conditioned for the revival period.