Grohn’s disease

The disease is named after doctor Barril Bernard Crohn, who in 1932 published the description of disease, as chronic nonspecific granulomatous inflammation of gastro-intestinal tract, able in injure all its sections, starting from mouth cavity and finishing with rectum. But more often subilium is injured, what in 50% of cases it is accompanied by colitis. Inflammation is transmural, i.e. it touches all bowels layers, and that causes the appearance of plagues and scars on the paries of bowels.

Till present time the exact cause of Crohn’s disease remains unknown. Among causes there are inherited or genetic, infectious, immunologic factors. Genetic factors: frequent appearance of disease among enzygotic twins and among blood brothers. Approximately in 17% of cases patients have blood relatives also suffering from this disease.

 Infectious factors are not proved in full scale, but insertion of bowels elutions to laboratory rats sometimes can cause this disease among animals. Pathology of immune system is proved by systematic injuring of organs, accompanied by advance of numbers of T-lymphocytes, antibodies to colon bacillus, cow milk albumen, lipopolyssacharide. From blood of the sick in intensifying periods immune complexes are abstracted. The presence of unknown specific antigen in bowel lumen and blood of patient is acceptable, and it can cause activation of T-lymphocytes, cellular macrophages, fibroblasts, formation of antibodies, cytokines, prostaglandins, free atomic oxygen, which causes injuries of bowels tissues.

Cases of disease are described everywhere, but most often they can be met in the North Europe and North America (about 300000 of sick in the North America). Every year 2-3 cases among 100000 people are registered. Disease of most patients starts from between 15-35 years of life, but there is second peak of increased morbidity – after 60 years. Most often Crohn’s disease is met among Jews – approximately in 6 times more often, than among other nations.

Colitis                                                                        Colitis

Plague                                                                          cancer

Crohn’s disease is characterized by skip lesion of bowels, having distinct border with neighboring healthy sections. Wall is incrassated, hope is narrowed, bowel is extended before injured section. Mucous membrane with numerous lateral, fissured plagues and cross cracks, torous, looks like “pebble pavement” In some cases there can happen perforation of plagues with appearance of intraperitoneal abscess and cracks. Cracks can be connected with intestinal loops and surrounding organs (bladder, alvus and vagina for women, skin). As a result of chronic inflammation scar tissue can develop, and it can cause stenosis of bowel lumen.

Clinical examples are various and in most cases depend on localization, severity, duration and presence of palindromia. Common symptoms: weakness, fatigue, rise of temperature of undulating character. Symptoms, connected with bowels injury: stomach-ache, often simulating acute appendicitis, diarrhea, appetite loss, loathing, vomit, flatulence, loss in weight.

As far as Crohn’s disease is connected with dysfunction of immune system, pathological process involve many organs with development: eye - conjunctivitis, keratitis, uveitis; mouth cavity – mouth ulceration, joints – monoarthritis, ankylosing spondylitis, skin – nodal fever, angiitis, pyoderma gangrenosum; liver – hepatic steatosis, sclerosing cholangitis, cholelithiasis, cirrhosis, cholaiigiocarcinoma; kidneys – nephrolithiasis, pyelohephritis, cystitis, hydronephrosis, lardaceous kidney. In case of colitis there is a high possibility of large bowel carcinogenesis.

Tissue injury in case of Crohn’s disease

In the present time "golden standard" of Crohn’s disease diagnostics is carrying out of ileocolonoscopy (i.e. examination of large bowel and terminal portion of twisted intestine), as far as this disease injures not only large bowel, but also superposed sections. Complex therapy is carried out in accordance with protocol of European consensus on Crohn’s disease treatment. Surgical treatment is approved only in case of complications. In cannot result in final recovery and is aimed to remove complications.

Disease has recedivous course. Mortality is in 2 higher in comparison with mortality among healthy population. . Most reasons of death are connected with complications and surgical operations caused by them.

Transplantation of stem cells in case of Crohn’s disease has 2 aims. First – acceleration of regeneration process and renewal of infected tissues function. Second – main – influence on immune system of patient, which consists in elimination of immune aggression on self tissues by means of transplantation of greater amount of hemopoietic cell, and it renews cells of immune system and blocks autoimmune reactions.

Clinical example. Under our supervision there was patient С. (woman), 32 years old. Prior to admission to the Institute of cellular therapy this patient has repeatedly passes treatment courses in different clinics of Ukraine, but it was in vein. Course of a disease is characterized by high degree of severity. Patient was suffering because of constant stomach-ache, blooding during defecation. Her height was 165 cm, and her weight - 36 kg. As a result of chronic blood loss there has developed severe anemia (erythrocytes – 2,1 t/l, hemoglobin – 61 g/l). Patient was exhausted, she could barely move. After complex investigation diagnosis of Crohn’s disease was confirmed. Transplantation of hematopoietic stem cells was hold, after that patient received 10-day course of placenta extracts injections (original production of the Institute of cellular therapy). During 6 months after treatment patient did not receive medicamentous therapy (being under observation of personal doctor), put on standard weight and returned to work. Repeat transplantation of stem cells was no necessary.