A fistula (plural: fistulas or fistulae ; from Latin fistula, 'tube, pipe') is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs. Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation. Fistulas are generally a disease condition, but they may be surgically created for therapeutic reasons.

In botany, the term is most common in its adjectival forms, ...

fistula

What-is-Crohn's-disease?

What is Crohn's disease?

What-is-Crohn's-disease?_0_0

What-is-Crohn's-disease?_0_1

Crohn's disease, also called regional enteritis or ileitis, is a lifelong form of inflammatory bowel disease (IBD). The condition inflames and irritates the digestive tract - in particular, the small and large intestines. Crohn's disease can cause diarrhea and stomach cramps as the most common manifestations. It is customary to have periodic exacerbations of the disease with periods of lull in which there are no symptoms. &nbsp;<a href="https://medipro.bg/crohn-bolest/" target="_blank" data-ref="Болест на Crohn | Най-добрите лекари в България MediPro.bg" rel="noopener">[ref. 1]</a>&nbsp;

What-is-Crohn's-disease?_0_2

Crohn's disease gets its name from the American gastroenterologist Dr. Burrill Crohn (1884-1983). He was one of the first doctors to describe the disease in 1932. Ulcerative colitis is another commonly diagnosed inflammatory bowel disease.

Who-can-develop-Crohn's-disease?

Who can develop Crohn's disease? 

Who-can-develop-Crohn's-disease?_1_0

Crohn's disease usually occurs in younger people often in their late teens, 20s or early 30s. However, this condition can develop at any age. According to knowledge, it is equally common in men and women.&nbsp;

What-are-the-variations-of-Crohn's-disease?

What are the variations of Crohn's disease? 

What-are-the-variations-of-Crohn's-disease?_2_0

There are six varieties of Crohn's disease, all based on which part of the digestive system they affect. Here is the&nbsp; classification:

What-are-the-variations-of-Crohn's-disease?_2_1

<ul><li style="font-weight: 400;" aria-level="1">Gastroduodenal Crohn's disease. This unusual condition mainly affects the stomach and duodenum, which is the first part of the small intestine.</li><li style="font-weight: 400;" aria-level="1">Yeiunoileit. This type is found in the second part of the intestine, called the jejunum (empty intestine). Like gastroduodenal Crohn's disease, this variation is less frequent.</li><li style="font-weight: 400;" aria-level="1">Ileith. Ileitis involves inflammation in the latter part of the small intestine or ileum.</li><li style="font-weight: 400;" aria-level="1">Ileocolitis. This affects the ileum and colon and is the most common variation of Crohn's disease.</li><li style="font-weight: 400;" aria-level="1">Crohn's Colit. This species affects only the large intestine. Both ulcerative colitis and Crohn's colitis affect only the colon, but Crohn's colitis can affect the deeper layers of the intestinal mucosa.</li><li style="font-weight: 400;" aria-level="1">Perianal disease. This often includes the appearance of fistulas or abnormal connections between tissues, deep tissue infections, as well as wounds and ulcers on the outer skin around the anus.</li></ul>

What-causes-Crohn's-disease?

What causes Crohn's disease? 

What-causes-Crohn's-disease?_3_0

There is no specific known cause of Crohn's disease. However, some factors may increase the risk of developing the disease, including&nbsp;<a href="https://pubmed.ncbi.nlm.nih.gov/28601423/" target="_blank" data-ref="Crohn Disease: Epidemiology, Diagnosis, and Management - PubMed" rel="noopener">[ref. 2]</a>&nbsp;

What-causes-Crohn's-disease?_3_1

<ul><li style="font-weight: 400;" aria-level="1">Autoimmune disease: Bacteria in the digestive tract can cause your body's immune system to attack your healthy cells. This means triggering an autoimmune process and developing an autoimmune disease that gives rise to systemic inflammation in the body;</li><li style="font-weight: 400;" aria-level="1">Genes: Inflammatory bowel disease often occurs in families. If you have a parent, sibling, or other family member with Crohn's disease, you may be at increased risk of developing the disease. There are several specific mutations (changes) in genes that may predispose people to developing Crohn's disease.</li><li style="font-weight: 400;" aria-level="1">Smoking - Smokers may have a higher risk of Crohn's disease than non-smokers.&nbsp;</li></ul>

What-are-the-symptoms-of-Crohn's-disease?

What are the symptoms of Crohn's disease? 

What-are-the-symptoms-of-Crohn's-disease?_4_0

People with Crohn's disease may experience periods of severe exacerbations followed by periods of absence or very mild symptoms (remission). Remission can last for weeks or even years. There is no way to predict when exacerbations will occur, except by controlling the intake of certain foods and medications. Of course, stress reduction and smoking are two more methods to avoid potential illnesses and protect against compromise of the immune system, in which Crohn's disease can develop.&nbsp;

What-are-the-symptoms-of-Crohn's-disease?_4_1

Symptoms of this health problem may include:

What-are-the-symptoms-of-Crohn's-disease?_4_2

<ul><li style="font-weight: 400;" aria-level="1">Pain in the abdomen</li><li style="font-weight: 400;" aria-level="1">Chronic diarrhea</li><li style="font-weight: 400;" aria-level="1">Feeling of heaviness in the stomach</li><li style="font-weight: 400;" aria-level="1">High temperature</li><li style="font-weight: 400;" aria-level="1">Loss of appetite</li><li style="font-weight: 400;" aria-level="1">Attenuation</li><li style="font-weight: 400;" aria-level="1">Unusual scars on the skin (usually on the buttocks)</li><li style="font-weight: 400;" aria-level="1">fissures</li><li style="font-weight: 400;" aria-level="1">fistulas</li><li style="font-weight: 400;" aria-level="1">Rectal bleeding</li></ul>

How-is-Crohn's-disease-managed-or-treated?

How is Crohn's disease managed or treated? 

How-is-Crohn's-disease-managed-or-treated?_5_0

Treatment for Crohn's disease varies depending on what causes the symptoms and how severe they are. In any case, the goal of treatment is to induce remission (the time between symptom exacerbations), maintain remission, and manage any complications of Crohn's disease over time. &nbsp;<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648997/" target="_blank" data-ref="Page not available - PMCTwitterFacebookLinkedInGitHubSM-TwitterSM-FacebookSM-Youtube" rel="noopener">[ref. 3]</a>&nbsp;

How-is-Crohn's-disease-managed-or-treated?_5_1

To this end, one or more of these treatments for Crohn's disease may be recommended by healthcare professionals:

How-is-Crohn's-disease-managed-or-treated?_5_2

<ul><li style="font-weight: 400;" aria-level="1">Antidiarrhea drugs</li><li style="font-weight: 400;" aria-level="1">Antibiotics&nbsp;</li><li style="font-weight: 400;" aria-level="1">Biologic drugs - include monoclonal antibodies to suppress the immune response</li><li style="font-weight: 400;" aria-level="1">Healing fasting&nbsp;</li><li style="font-weight: 400;" aria-level="1">Corticosteroids&nbsp;</li><li style="font-weight: 400;" aria-level="1">Immunomodulators and others</li></ul>

Natural-remedies-for-Crohn's-disease

Natural remedies for Crohn's disease

Natural-remedies-for-Crohn's-disease_6_0

Natural-remedies-for-Crohn's-disease_6_1

"For every pain there is an herb," said an unknown author. So do we, as well as many researchers who are looking at the use of phytotherapeutic and other alternative agents in various diseases, including Crohn's disease. &nbsp;<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367210/" target="_blank" data-ref="Page not available - PMCTwitterFacebookLinkedInGitHubSM-TwitterSM-FacebookSM-Youtube" rel="noopener">[ref. 4]</a>&nbsp;

Natural-remedies-for-Crohn's-disease_6_2

Some people use complementary and alternative medicine to achieve some relief from the symptoms of various conditions and ailments that are otherwise possible with medications, but at the cost of unpleasant side effects.

Natural-remedies-for-Crohn's-disease_6_3

Some alternative forms of treatment that can be used for Crohn's disease include:

Natural-remedies-for-Crohn's-disease_6_4

<ul><li style="font-weight: 400;" aria-level="1">Probiotics. These are living and beneficial bacteria that help restore balance in the intestinal tract. Probiotics can also help prevent microorganisms from disrupting the gut's natural balance and causing a Crohn's attack. Scientific data on the effectiveness of specific probiotic strains are still limited, with purported benefits of Lactobacillus rhamnosus and Bifidobacterium longum. &nbsp;<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7389339/" target="_blank" data-ref="Page not available - PMCTwitterFacebookLinkedInGitHubSM-TwitterSM-FacebookSM-Youtube" rel="noopener">[ref. 5]</a>&nbsp;</li><li style="font-weight: 400;" aria-level="1">Prebiotics. These are potentially beneficial substances found in plants, such as asparagus, bananas, artichokes, and leeks, which are actually the food of the good bacteria in the gut.</li><li style="font-weight: 400;" aria-level="1">Fish oil. Fish oil is rich in omega-3 fats, which have anti-inflammatory effects. According to a 2017 study, research is ongoing regarding the possible treatment of Crohn's disease using omega-3. 6 Fatty fish such as salmon and mackerel are rich in omega-3s, and another meto provide these beneficial fats is through fish oil supplements. It is important that it has the most pure and unprocessed composition, as well as that it is of certified origin, so that it is not subject to rancidity.&nbsp;</li><li style="font-weight: 400;" aria-level="1">Acupuncture. This is the practice of precisely inserting needles into the skin to stimulate different points on the body. A 2014 study found that acupuncture combined with moxibustion a type of traditional Chinese medicine that involves burning dried medicinal herbs on or near your skin improved symptoms of Crohn's disease. More research is needed in this direction to confirm the effects.</li></ul>

Natural-remedies-for-Crohn's-disease_6_5

Although an unpleasant disease, a person can live with Crohn's disease by adapting their diet and habits to triggers, that is, the factors that cause exacerbation. Achieving remission is possible through a special diet, hydration, medicinal medications, as well as natural remedies. Studies are still ongoing to find more effective treatments and potentially a possible cure for Crohn's disease. But the condition can be successfully managed, and remission is possible.

Crohn's disease: Types, symptoms and treatment options with natural remedies

Crohn's disease: Types, symptoms, and treatment options with natural 

Бетина Цветкова

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Author: Silvia Marinova, PhD student in the Genomic Stability Laboratory at BAS

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Crohn's disease is a chronic recurrent inflammation of the gastrointestinal tract. It belongs to a group of conditions called inflammatory bowel diseases. The disease can affect the entire digestive system and cause symptoms such as diarrhea, serious weight loss, abdominal pain, general fatigue and others.

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The clinical picture is very similar to ulcerative colitis, and this makes it difficult to differentiate them.

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Both conditions can lead to serious consequences if not treated appropriately, and therefore their timely diagnosis is very important. In addition, for making a correct diagnosis, other disturbances of the gastrointestinal tract such as bacterial infections must first be distinguished and excluded.

Who-is-at-higher-risk-of-Crohn's-disease

Who is at higher risk of Crohn's disease

Who-is-at-higher-risk-of-Crohn's-disease_0_0

The disease develops with the same frequency in men and women, most often in late adolescence or early adulthood, usually between the ages of 15 and 30 years of age [<a href="https://www.medscape.com/answers/172940-14889/at-what-age-does-the-onset-of-crohn-disease-typically-occur" target="_blank" rel="noopener">ref.1</a>]. However, there is also a second age peak of disease: between the ages of 55 and 59 years of age [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518904/" target="_blank" rel="noopener">ref.2</a>]. Crohn's disease also has a genetic burden and therefore there is an increased risk of developing the disease if your relatives suffer from it.

Who-is-at-higher-risk-of-Crohn's-disease_0_1

Besides genetic predisposition, other risk factors [<a href="https://www.mayoclinicproceedings.org/article/S0025-6196(17)30313-0/fulltext" target="_blank" rel="noopener">ref.3</a>] predisposing to the development of the disease are considered disorders in the intestinal flora (dysbiosis), infections of the digestive system, the use of antibiotics at an early age, smoking, etc.

Symptoms-of-Crohn's-disease

Symptoms of Crohn's disease

Symptoms-of-Crohn's-disease_1_0

Crohn's disease is a chronic inflammatory disease, which means that periods of remission alternate with periods of exacerbation, characterized by a pronounced symptomatology. Unlike ulcerative colitis, it can affect different parts of the entire digestive tract.

Symptoms-of-Crohn's-disease_1_1

Symptoms-of-Crohn's-disease_1_2

Most often it is the small or large intestine, but sometimes the duodenum or stomach may be affected. For this reason, the clinical picture may have personal differences, but nevertheless there are some common symptoms of gastrointestinal inflammation, which can also be caused by Crohn's disease. These are:

Symptoms-of-Crohn's-disease_1_3

<ul>
<li style="font-weight: 400;">
abdominal pain
</li>
<li style="font-weight: 400;">
diarrhoea or constipation
</li>
<li style="font-weight: 400;">
unexplained increase in temperature
</li>
<li style="font-weight: 400;">
general tiredness and fatigue
</li>
<li style="font-weight: 400;">
weight loss
</li>
<li style="font-weight: 400;">
frequent occurrence of sores
</li>
<li style="font-weight: 400;">
delayed development and growth in children
</li>
<li style="font-weight: 400;">
skin irritations, etc.
</li>
</ul>

Symptoms-of-Crohn's-disease_1_4

In case of suspected Crohn's disease or manifestation of some of the above symptoms, consultation with a doctor is necessary, since the disease has a serious prognosis and can lead to dangerous complications.

What-are-the-complications-of-Crohn's-disease

What are the complications of Crohn's  disease

What-are-the-complications-of-Crohn's-disease_2_0

If it remains undiagnosed or is not treated promptly and adequately, Crohn's disease can have serious consequences. [<a href="https://www.bioseek.eu/en/eng/research/search?q=complications%2C%20Crohn&amp;p=1&amp;st=1&amp;tp=9&amp;as=ARTICLE%3APUBMED%3A16702444" target="_blank" rel="noopener">ref.4</a>]

What-are-the-complications-of-Crohn's-disease_2_1

An example of such complications are:

What-are-the-complications-of-Crohn's-disease_2_2

<ul>
<li style="font-weight: 400;">
Obstruction of the intestine - this term means narrowing of the opening of the intestine caused by thickening of its wall. It can lead to blockage.
</li>
<li style="font-weight: 400;">
Fistula - is an abnormal duct that can form between one part of the intestine and another as a result of inflammation. It is removed operationally.
</li>
<li style="font-weight: 400;">
Fissure - rupture of the most superficial layer (mucous membrane) of the anus, which is highly painful and often leads to bleeding or leakage of another secretion, imbling with pus.
</li>
</ul>

What-are-the-complications-of-Crohn's-disease_2_3

What-are-the-complications-of-Crohn's-disease_2_4

Patients suffering from Crohn's disease have an increased risk of developing cancer and frequent monitoring by a doctor is necessary.

How-is-Crohn's-disease-diagnosed

How is Crohn's disease diagnosed

How-is-Crohn's-disease-diagnosed_3_0

As already mentioned, the disease is difficult to diagnose, since the symptoms vary from person to person and are also very similar to those of a number of other diseases of the digestive system.

How-is-Crohn's-disease-diagnosed_3_1

There are different approaches to the detection of the disease, and it will most likely be necessary to carry out a combination of tests to confirm its presence. This usually involves combining a general physical examination with laboratory tests, endoscopy and / or imaging techniques at the discretion of the gastroenterologist.

Laboratory-tests

Laboratory tests

Laboratory-tests_3_0

<ul>
<li style="font-weight: 400;">
Blood test - usually checked whether the patient is anemic or has inflammation. It is good to know that if the results are negative, this does not exclude Crohn's disease as a possible diagnosis.
</li>
<li style="font-weight: 400;">
Fecal test to detect the presence of blood.
</li>
</ul>

Endoscopic-research

Endoscopic research

Endoscopic-research_3_0

They are the gold standard in the diagnosis of Crohn's disease, because they allow the detailed looking of parts of the gastrointestinal tract for pathological changes. For this purpose, a small camera is used, which is inserted on top of a thin hose. Endoscopic studies are:

Endoscopic-research_3_1

<ul>
<li style="font-weight: 400;">
Gastroscopy - allows a view of the upper part of the digestive system - esophagus, stomach and duodenum.
</li>
<li style="font-weight: 400;">
Colonoscopy - allows a view of the large and lower end of the small intestine.
</li>
<li style="font-weight: 400;">
Capsule endoscopy&nbsp;- allows a view of the small intestine. The patient swallows a capsule in which there is a small chamber and naturally it reaches the small intestine, which is not accessible by the other two described endoscopic methods.
</li>
</ul>

Endoscopic-research_3_2

Sometimes in endoscopic examination, a biopsy is taken from some parts of the digestive tract at the discretion of the doctor. The aim is histological examination of the tissues taken for pathologies.

Endoscopic-research_3_3

Imaging

Imaging_3_0

In more severe cases where there are complications, it is often necessary to use diagnostic imaging methods. Such are MRI, computed tomography (CT), <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353827/" target="_blank" rel="noopener"></a> as well as ultrasound. MRI and CT scans may show the severity of complications such as fistulas. In contrast, ultrasound is used mainly in emergencies [<a href="https://link.springer.com/article/10.1007%2Fs40477-015-0159-0" target="_blank" rel="noopener">ref. 5</a>], when rapid diagnosis is required.

Conventional-treatment-of-Crohn's-disease

Conventional treatment of Crohn's disease

Conventional-treatment-of-Crohn's-disease_4_0

Treatment of the disease depends on its severity, as well as which part of the digestive system it affects. There are various medical therapies that relieve symptoms and allow patients to control the disease, but unfortunately no treatment <a href="https://www.bioseek.eu/en/eng/research/pubmed/Hospitalisations_and_surgery_in_Crohn_s_disease_22267595" target="_blank" rel="noopener"></a> is available that leads to complete recovery. Surgery is often required to remove the damaged parts. Some patients require more than one operation [<a href="https://www.bioseek.eu/en/eng/research/pubmed/Hospitalisations_and_surgery_in_Crohn_s_disease_22267595" target="_blank" rel="noopener">ref. 6</a>].

Conventional-treatment-of-Crohn's-disease_4_1

Treatment with pills aims to suppress inflammation. This not only leads to relief of symptoms, but also allows the affected tissues to recover. Proper therapy aims to increase the periods of remission of the disease at the expense of reducing acute phases.

Conventional-treatment-of-Crohn's-disease_4_2

As with all diseases of the digestive system, an important part of controlling the disease is also compliance with an appropriate diet. It is good to avoid irritating foods that cause increased symptoms and discomfort. Such are foods rich in fiber, flavored with strong spices or chillies. The diet to be followed is also individual and it is good to be prepared by a specialist.

Genetic-factors-contributing-to-Crohn's-disease

Genetic factors contributing to Crohn's disease

Genetic-factors-contributing-to-Crohn's-disease_5_0

The causes of Crohn's disease are complex. This condition is the result of a combination of genetic factors, environmental factors and lifestyle, many of which are unknown.

Genetic-factors-contributing-to-Crohn's-disease_5_1

Many of the main <a href="/p/kak_ghienitie_opriedieliat_prilikata_s_roditielitie_ni_2256bb0a_9ee8_4d00_8f3e_7ca44b90aa45" target="_blank" rel="noreferrer">genes</a> associated with Crohn's disease, including NOD2, ATG16L1, IL23R and IRGM, are involved in the function of the immune system. Proteins produced by these genes help the immune system to adequately recognize and respond to bacteria on the lining of the digestive tract. Many of the proteins play a role in autophagy, a process that cells use to destroy bacteria and viruses. Variations in these genes can disrupt autophagy or otherwise alter the immune system's response to bacteria in the digestive system. In combination with other genetic and environmental factors, these changes can lead to chronic inflammation and lead to digestive problems characteristic of Crohn's disease.

Genetic-factors-contributing-to-Crohn's-disease_5_2

Researchers have identified at least 200 genetic variations that affect the risk of Crohn's disease. Most of these variants are thought to work by fine-tuning the amount, timing and location of gene activity (expression). The mechanism by which many variants affect disease risk is unknown - although they probably alter the function of the immune system in some way. Taken together, the known genetic variations represent only a small percentage of the overall risk of Crohn's disease due to genetic factors.

Genetic-factors-contributing-to-Crohn's-disease_5_3

Other genes known to be relevant for the development of Crohn's disease are: HLA-DRB1, IL10, IL12B, JAK2, LRRK2, MUC2, SLC22A4, SLC22A5, STAT3, TYK2. [<a href="https://ghr.nlm.nih.gov/condition/crohn-disease" target="_blank" rel="noopener">ref. 7</a>]

Herbs-that-may-help-Crohn's-disease-sufferers

Herbs that may help Crohn's disease sufferers

Herbs-that-may-help-Crohn's-disease-sufferers_6_0

There are few studies on the effects of herbs on improving symptoms of Crohn's disease. However, several stand out, which can bring relief to both sufferers in the active stage of the disease and help retain at the stage of remission. [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367210/" target="_blank" rel="noopener">ref.8</a>]

Herbs-that-may-help-Crohn's-disease-sufferers_6_1

For patients in an active form of the disease, those herbs are promising:

Herbs-that-may-help-Crohn's-disease-sufferers_6_2

<ul>
<li style="font-weight: 400;">Boswellia serrata H5 extract (Indian incense is made of it);</li>
<li style="font-weight: 400;">mastic resin from the Mastic tree (Pistacia lentiscus);</li>
<li style="font-weight: 400;">wormwood (Artemisia absinthium) - also known as grand wormwood, absinthe, absinthium, absinthe wormwood, mugwort, wermout, wermud, wormit, wormod;</li>
<li style="font-weight: 400;">Tripterygium wilfordii - a herb used in Chinese traditional medicine.</li>
</ul>

Herbs-that-may-help-Crohn's-disease-sufferers_6_3

To maintain remission:

Herbs-that-may-help-Crohn's-disease-sufferers_6_4

<ul>
<li style="font-weight: 400;">Boswellia plant extract (Boswellia serrata);</li>
<li style="font-weight: 400;">léi gōng téng (Tripterygium wilfordii) also known as thunder god vine but more properly translated as thunder duke vine.</li>
</ul>

Herbs-that-may-help-Crohn's-disease-sufferers_6_5

Of course, before taking any of these herbs, be sure to consult your attending physician - each case is individual and should be considered by a specialist!

fistula

What is Crohn's disease - diagnosis, conventional and herbal treatment