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Kronova bolest (Morbus Crohn) PDF Štampaj E-pošta
Autor UKUKS   
Tuesday, 02 June 2009

Učestalost


 U razvijenim zemljama zapadne Evrope učestalost Crohnove bolesti je 2-6 slučajeva u populaciji od 100 hiljada stanovnika. Prevalencija je 10-20 puta veća. Zastupljenost polova je približno ista. Crohnova bolest može da se ispolji u bilo kom životnom dobu, najčešće između 15. i 35. godine.

Uzrok nastanka

  

Različita klinička istraživanja su pokazala da genetski faktor ima veoma bitnu ulogu u nastanku ove bolesti. Postoji visok stepen konkordantnosti obolevanja monozigotnih blizanaca. Mnogobrojni infektivni, bakterijski i virusni agensi predlagani su kao uzrok, ali bez definitnih dokaza. M. paratuberculosis izaziva kod preživara Johneovu bolest, hronično zapaljenjsko oboljenje ileuma, slično Crohnovoj bolesti. Kao predisponirajući faktori Crohnove bolesti pominju se dijeta sa dosta rafiniranih šećera i upotreba kontraceptiva. Pušenje je, takođe, jedan od mogućih sinergetičkih okidača u nastanku ove bolesti.

Opis bolesti

 

 
 
Crohnova bolest je najčešće lokalizovana na završnom delu ileuma, uzlaznom delu debelog creva, čitavom debelom crevu ili ileumu i jejunumu(delovi tankog creva). Zid creva je u celini otečen i zadebljan. Postoje duboke ranice(ulkusi), obično su u vidu žlebova. Duboki ulkusi mogu da prodru kroz zid creva i uzrokuju apscese ili fistule. Fistule mogu da nastanu izmedu susednih vijuga creva ili zahvaćenih segmenata creva i mokraćne bešike, vagine ili kože perineuma

Klinička slika

Crohnova bolest je hronično oboljenje sa nepredvidljivim pojačanjima i poboljšanjima kliničkog toka. Način ispoljavanja i simptomi zavise od zahvaćenog regiona creva i opsežnosti bolesti. Kliničke osobenosti Crohnove bolesti su najčešće proliv, obično bez krvi, i bol u trbuhu (> 75%), zatim povišena telesna temperatura (>50%), kao i opšta slabost, a moguć je i gubitak u težini. Ponekad, posebno kod dece i starih jedini simptomi mogu da budu povišena telesna temperatura i gubitak u težini.

Dijagnoza

 Dijagnozu treba uzeti u obzir kod svih bolesnika s prolivom, sa ili bez krvi, i bolom u trbuhu. Moguća su atipična ispoljavanja, povišena telesna temperatura neobjašnjenog porekla bez crevnih simptoma ili vancrevna ispoljavanja, recimo artritis ili oboljenje jetre. Kako Crohnova bolest može da zahvati i tanko crevo, treba je uzeti u obzir u svim oblicima malapsorpcionih sindroma, intermitentnoj crevnoj opstrukciji i abdomenskim fistulama. Analize krvi su nespecifične. Mogu da pokažu umerenu anemiju (normohromnu, normocitnu ili hipohromnu), povišenu sedimentaciju, leuko i trombocitozu, hipoproteinemiju. Proliv može da dovede do poremećaja elektrolita, a malapsorpcija u Crohnovoj bolesti do steatoreje. Proširenost bolesti utvrđuje se rendgenskim pregledom tankog creva barijumom i irigografijom. Ovi mogu da pokažu promene izgleda sluznice, duboke ulceracije i patognomični ,,znak vrpce ili žice ". Promene često zahvataju ileum i kolon u kontinuitetu. U hroničnim slučajevima mogu da nastanu strikture. Lezije creva su obično diskontinuirane.

 

Lečenje

Najefikasniji medikamenti u lečenju Crohnove bolesti su antiinflamatorni lekovi (kortikosteroidi, aminosalicilati i imunosupresivi) a, po potrebi, primenjuju se i drugi lekovi. Kortikosteroidi su efikasni u lečenju akutne faze. Dugotrajna primena ograničena je neželjenim dejstvima, a akutno lečenje ne smanjuje rizik recidiva. Steroidni lekovi koji deluju pretežno lokalno su u razvoju. Aminosalicilati su efikasni u lečenju Crohnove bolesti tankog i debelog creva. Ne preporučuje se primena aminosalicilata uz kortikosteroide, u akutnoj fazi, jer nema dokaza da povećavaju uspešnost lečenja. Neželjena dejstva pri primeni sulfasalazina - mučnina, glavobolja, kožni osipi, reverzibilni sterilitet kod muškarca i, vrlo retko, hemolitična anemija i agranulocitoza -pripisuju se sulfapiridinu. U tim slučajevima koriste se preparati mesalazina ili olsalazina. Imunosupresivni lekovi, azotioprin i 6-merkaptropin, imaju isti aktivni metabolit; osnovna im je primena u lečenju perianalnih fistula.

 

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