Polyps on the intestinal walls seldom express themselves as symptoms, but with time they can turn into malignant neoplasms. Therefore, when detecting polyps, it is better to get rid of them.
What are intestinal polyps?
Intestinal polyps are small benign neoplasms that grow asymptomatically on its inner (mucous) membrane. The most common polyps of the large intestine. This is a fairly common disease, affecting 15-20% of people. The size of polyps is usually less than 1 cm, but can reach several centimeters. They grow alone or in groups. Some outwardly look like small bumps, others have a thick or thin leg with a seal in the shape of a mushroom or a bunch of grapes.
Polyps themselves are benign growths that rarely worsen a person’s well-being. But they can transform into malignant, poorly treatable tumors. Therefore, when detecting polyps, they are recommended to be removed.
The diagnosis of intestinal polyps can be given to people of any age, gender, race. A little more often found in men, and the most characteristic age of patients - 50 years and older. People of the Negroid race are more prone to the formation of polyps and their malignant transformations than Caucasians.
Types of polyps
1. Adenomatous - the most common, approximately 2/3 of all tumors belong to this group. In some cases, these polyps are reborn into cancerous tumors or malignized, as doctors say. Not all of them are capable of malignancy, but if colon cancer originates from a polyp, then an adenomatous polyp is responsible for 2 cases out of three;
2. Serrated - depending on the size and location, they have different chances of being malignant. Small polyps located in the lower part of the colon (hyperplastic polyps) rarely turn into cancerous tumors. But the large, flat (sessile), located in the upper part of the intestine, most often transformed;
3. Inflammatory occur after suffering inflammatory bowel disease (ulcerative colitis, Crohn's disease). Prone to malignant degeneration.
Causes of colon polyp formation
Why cells begin to suddenly turn into atypical and form tumors is still not known exactly. An analysis of the incidence helped to identify factors that increase the risk of polyp growth:
- age over 50 years
- inflammatory bowel disease (Crohn's disease, ulcerative colitis)
- alcohol consumption
- excess weight
- sedentary lifestyle
- type II diabetes that is difficult to treat
- heredity is the most significant factor.
The probability of illness is higher if blood relatives (parents, children, brothers and sisters) were diagnosed with colon polyps. The number of relatives with this disease also matters. Although sometimes multiple cases of polyposis in the family are not associated with genetic factors.
There is a whole group of genetic diseases that increase the likelihood of developing certain types of tumors (malignant and benign), including intestinal polyps:
- Lynch syndrome is the most common variant of hereditary colon cancer. The disease begins with the formation of polyps, which malignize very quickly;
- Familial adenomatous polyposis (FAP) is a rare pathology, the formation of hundreds and sometimes thousands of polyps in adolescence. Without treatment, the probability of malignant degeneration is 100%;
- Gardner syndrome (a special case of SAP);
- MYH polyposis is a rare cause of multiple polyps in children;
- in Peutz-Jeghers syndrome, dark pigment spots appear all over the body, including on the lips, gums and feet; further, multiple polyps grow throughout the gastrointestinal tract;
- toothed polypous syndrome.
Polyps rarely signal their presence with symptoms. In most patients, they are found by chance during a bowel examination.
But for some people, polyps can manifest themselves:
- bleeding from the rectum (rectal bleeding);
- a change in the color of the stool (black or red veined);
- constipation or diarrhea lasting more than a week;
- abdominal pain, nausea, vomiting - with a partial overlap of a large intestinal lumen polyp;
- iron deficiency anemia, which occurs due to persistent intestinal bleeding.
Any of the above symptoms is a sign of a serious problem and the reason to immediately see a doctor.
Most polyps are detected during a routine examination of the large intestine. This is due to the fact that the symptoms are not observed or are characteristic of many pathologies: hemorrhoids, inflammatory bowel diseases, peptic ulcer. A stool test can show blood, a blood test can show low red blood cell count. But these figures are also non-specific. Large polyps are detected by MRI or CT. Both methods are painless, convenient, but do not reveal small (less than 1 cm) neoplasms.
Therefore, if you suspect colon polyps or during routine checks, the patient is prescribed one of two examinations:
- colonoscopy - the most sensitive test, during which the doctor has the opportunity to examine the inner surface of the intestine with a flexible tube with a video camera at the end - an endoscope. It is introduced into the rectum through the anus, and on the big screen you can see the entire surface of the colon. In addition to the video camera, the endoscope is equipped with micro tools. Therefore, polyps are often removed directly during the procedure. Also, the doctor can select a small piece of the intestine from the suspicious area and send it for histological diagnosis;
- flexible sigmoidoscopy is an abbreviated version of a colonoscopy, during which only the rectum and partially sigmoid are examined with a flexible tube of 35-60 cm in length with a video camera — a sigmoidoscope.
Preparation for the procedure
Before colono or sigmoidoscopy it is necessary to carry out preparatory procedures. They cleanse the intestines of fecal masses, making it available for a thorough examination. For this you need:
1. Discuss with the doctor and adjust the intake of any medications that the patient usually takes no less than a week before the procedure. The doctor should be informed about the existing diseases, especially diabetes mellitus, high blood pressure or heart problems.
2. On the eve of the day of the study can not eat solid food. You can drink water, tea and coffee without milk or cream, broth. You should refrain from red drinks, the remnants of which may be mistaken for a bleeding by a doctor. At night before the study can not eat or drink.
3. Taking a laxative (pills or liquid) according to the scheme proposed by the doctor. As a rule, the medication is taken on the evening before the test, and sometimes even in the morning on the day of the procedure.
4. Cleansing enemas. Best for the night before and a few hours before the procedure.
The only effective way to get rid of polyps is their surgical removal. In the vast majority of patients, this procedure (polypectomy) is carried out during the examination of the colon. She is very fast and painless. When a polyp is detected, the doctor sends a tool to it, inserts a little liquid under the polyp into the intestinal wall, so that the borders of the neoplasm are clearly visible. Then a special nozzle-loop captures the polyp, tightens its leg and cuts off the intestinal wall, passing an electric current through the loop.
Large polyps may require surgery. Whenever possible, doctors try to do with techniques with minimal intervention — microinvasive laparoscopic surgery. At the same time, endoscopes equipped with all the necessary tool attachments are inserted through small holes in the abdominal wall.
In very rare cases when there are too many polyps, they are removed along with the affected part of the intestine. This is a complex operation that requires preparation and long-term recovery.
If the appearance of a polyp (size, shape) causes a suspicion of a possible malignant degeneration in a doctor, then a small “tattoo” is made at the site of its former attachment. These tags help in subsequent screening studies to find suspicious areas in the past and carefully examine them.
All removed tissue is sent for histological examination. According to the structure of tissue, the histologist can determine the type of polyp, identify the initial signs of malignancy. This information will allow the attending physician to determine the prognosis and scheme of preventive examinations.
The most dangerous complication of polyps is the malignant degeneration of polyp cells. The likelihood of colon cancer depends on: size (the larger the polyp - the greater the risk); type of neoplasm (adenomatous and jagged polyps are more often reborn); detection time (the earlier the polyps are detected, the less the threat).
Fortunately, polyps grow slowly. In most cases, colon cancer begins to develop 10 years after the formation of a small polyp. The exception is hereditary diseases in which malignancy occurs much faster.
Early detection is an excellent guarantee of a favorable outcome of treatment and the absence of future complications. Since most often there are no complaints or signs of these tumors, all people over 50 are recommended to undergo regular examinations (once every 3-5 years). Representatives of the Negroid race should begin screening somewhat earlier because of the greater likelihood of malignant transformation. People with an established diagnosis of a genetic variant of polyps or with suspicion of them are checked more often (every 1-2 years) and from an earlier age.
Avoiding overeating, smoking, alcohol abuse, sedentary lifestyle - a reasonable step, which somewhat reduces the likelihood of polyps. According to some reports, a healthy balanced diet rich in calcium and plant fiber also reduces the risk of disease.
People with close relatives with colon polyps are recommended to be tested for genetic diseases.
Early polyps can be easily treated, and the risk of malignancy is minimal. They can grow back, so after removal, patients should be examined regularly.
Cautious and poor projections are people with multiple polyps.
Crohn's disease is an inflammatory disease of the gastrointestinal tract that can affect any part of it, although it most often affects the final fragment of the small and large intestine, deeply affecting their walls.
Definition, causes, pathogenesis
People get sick at any age, but most often young (from 15 to 35 years). Among the inhabitants of Northern Europe, the disease is somewhat more common than in the south, and whites suffer more often than representatives of the Negroid or Asian races ..
It is still not clear what provokes the development of the disease. Improper diet and stress can exacerbate the disease, but are not the root cause. In some cases, the appearance of the first symptoms is associated with the intake of nonsteroidal anti-inflammatory drugs: ibuprofen, diclofenac, and others.
Most doctors believe that several factors should coincide for the development of Crohn's disease:
Genetic. More than 200 different genes have been identified that are more characteristic of people with Crohn's disease than other groups. 3 out of 20 patients have close relatives suffering from this disease. If one of the twins is diagnosed with Crohn's disease, then the chances of developing it in the second are 70%. The fact that this violation is more characteristic of certain ethnic groups (in particular, it occurs 3-4 times more often in Jews than in other nationalities) also indirectly confirms the role of genetics in the development of inflammation.
The state of the immune system. According to the available data, in Crohn's disease, failure of the immune system leads to the formation of a specific protein (tumor necrosis factor alpha, TNF-alpha). This protein destroys all the bacteria that live in the intestines and damages the cells of the digestive organs.
Postponed diseases, in particular, childhood infections, can disrupt the immune system, which increases the likelihood of Crohn's disease.
Smoking is considered a major risk factor. Smokers are twice as likely to get sick than non-smokers. According to the supervision of doctors, patients with Crohn's disease who continue to smoke, the manifestations of inflammation is much more serious and they often require surgery.
Lifestyle. Crohn's disease is more common in developed countries, and less often in poor countries. An increase in the incidence rate has been observed since 1950, which coincides with an increase in welfare in Europe and North America. These facts formed the basis of some theories about the connection of Crohn's disease with lifestyle, but none of them have been convincingly confirmed.
The pathogenesis of Crohn's disease (developmental mechanism) is now being actively studied, with various assumptions being made, the essence of which boils down to the following. The impact of one of the factors (microorganisms, toxins, food components) causes an immune response, which, in turn, causes damage to the cells of the digestive tract and the development of inflammation, and it causes an additional immune response, aggravating pathological processes.
Differences between ulcerative colitis and Crohn's disease
Because of the great similarity, Crohn's disease and ulcerative colitis were grouped together in the “inflammatory bowel disease” (IBD) group, which also includes collagen and lymphocytic colitis.
There are 3 key differences between Crohn's disease and ulcerative colitis:
1. Localization process. Ulcerative colitis affects only the colon, and Crohn's disease affects any part of the digestive tract (mouth, esophagus, stomach, thin or large intestine, anus). In this case, ulcerative colitis affects only the inner layer of the intestinal wall (mucous membrane), and Crohn's disease - everything.
2. The prevalence of inflammation. In people with Crohn's disease, the affected areas alternate with healthy ones, with ulcerative colitis, a certain part of the intestine that does not contain healthy tissue is affected.
3. Symptoms. As a rule, the main manifestations coincide, although blood in the feces is more characteristic of ulcerative colitis. The difference in the localization of the inflammatory process also leads to differences in symptoms, for example, in patients with Crohn's disease, there are ulcers in the tongue or between the gums and upper lip, and in inflammation of the anus, cracks, ulcers, fistulas, narrowings or infectious lesions.
Classification of Crohn's disease (form of Crohn's disease, ICD-10 code)
There are several approaches to the classification of Crohn's disease, most based on the localization of the inflammatory process. But there are more detailed approaches that take into account the age of the patient, the location of inflammation, the form of Crohn's disease (inflammatory, stenotic, fistulous) and the severity of the disease.
According to the International Classification of Diseases of the 10th revision (ICD-10), the code for Crohn's disease is K50. Depending on the location and characteristics of the course, there are 4 subgroups: Crohn's disease of the small intestine, Crohn's disease of the colon, other types of Crohn's disease and Crohn's disease, unspecified.
Symptoms and signs of Crohn's disease
The signs of Crohn's disease depend on the location and stage of the inflammatory process. The severity of the disease in different people varies. In some, the symptoms are not pronounced or develop gradually, arising one after another and growing with time, in others, the disease is very difficult from the very beginning. Crohn's disease is a chronic disease characterized by alternating exacerbations and quiet periods (remissions).
Symptoms may include:
- diarrhea (diarrhea) is the most common symptom;
- slight increase in temperature;
- abdominal pain and cramps;
- blood in feces (red or dark);
- mouth ulcers;
- lack of appetite and weight loss;
- pain and itching in the anus.
In severe disease, inflammation of the skin, eyes, joints, as well as hepatitis and cholangitis develop.
With Crohn's disease in children, growth and puberty can be delayed
Diagnosis of Crohn's disease, analyzes
The gastroenterologist deals with the diagnosis and treatment of diseases of the digestive tract. Be prepared during the first visit to answer the questions:
- When did the first symptoms appear?
- Do symptoms persist or disappear and reappear?
- Have you noticed patterns associated with exacerbations (after stress, taking pills, full meals, etc.)
- How serious are health problems?
- What medications do you take or take when the first symptoms appear (do I need to prepare a list)?
Based on the information collected and the general clinical study (palpation of the abdomen, examination of the oral cavity), the doctor forms a further comprehensive examination plan, which in most cases includes:
- a blood test to detect anemia and indirect signs of infection;
- general analysis of feces - shows the digestibility of food, the presence of overt or covert blood, the presence of inflammatory cells;
- colonoscopy or flexible sigmoidoscopy for examining the inner surface of the intestine using a flexible tube with a video camera (endoscope and sigmoidoscope, respectively). In addition to the video camera, these devices are equipped with tools for taking a biopsy, removal of foreign bodies, cauterization of blood vessels;
- capsule endoscopy - a subspecies of endoscopy, in which the patient swallows a capsule-camera that takes pictures while moving along the digestive tract. The images are transferred to a computer, and then the doctor examines them to identify signs of Crohn's disease.
- double-ball enteroscopy - a method of visualization of the small intestine developed in 2001 (which is not available during colonoscopy). The long and thin endoscope is advanced along the intestine by alternately blowing off the cylinders fixed on it. As with the endoscope, the doctor can biopsy the altered portions of the intestines or burn the bleeding vessels. Such a study is carried out in cases when the images obtained using capsule endoscopy show pathological areas in the small intestine, but these data are not sufficiently informative.
- visual diagnostics (MRI, CT, X-ray) (including with the introduction of a contrast agent).
To date, there is no evidence that any malnutrition can provoke the development of Crohn's disease. But it is known that the diet facilitates the patient's condition and reduces the severity of complaints, which is especially important during exacerbations. There are general nutritional guidelines. But each patient can have his own list of products that should be avoided. To compile such a list, it is recommended to keep a food diary and record all the food eaten and its effect on well-being. Analysis of the records allows you to prepare an individual diet.
General dietary guidelines for Crohn's disease:
- reduce the amount of dairy products;
- choose foods low in fat;
- reduce high fiber intake (fresh vegetables, fruits, whole grains);
- give up alcohol, strong tea, coffee, spices;
- switch to fractional meals (5-6 times in small portions);
- drink enough water.
Complications of Crohn's Disease
Uncontrolled Crohn's disease can lead to a number of complications:
- scarring or narrowing of the intestinal lumen, which are fraught with obstruction (obstruction);
- an intestinal fistula (a hole connecting the intestinal lumen to the skin, other organs (vagina, bladder) or the abdominal cavity);
- insufficient intake of blood nutrients, vitamins, minerals;
- colon cancer;
- complications associated with taking drugs (diabetes, glaucoma, cataracts, high blood pressure, osteoporosis, fractures, lymphoma, skin cancer).
Crohn's disease prognosis and prevention
Crohn's disease is a serious disease that requires regular medical monitoring and medication. However, usually this pathology does not significantly affect the life expectancy. In the first year after the diagnosis, half of the patients relapse, whereas in the chronic course of the disease (if appropriate treatment is carried out), only 10% of patients experience exacerbation. Most patients will have surgery sooner or later. According to statistics, in the first five years after diagnosis, at least one operation is performed by 37% of patients, two or more - 12%; and 51% receive only drug therapy. In the first 10 years, 39% do 1 operation, 23% - 2 or more, 39% do without operations. In 34% of patients, the first 15 years after diagnosis are performed with 1 operation, with two or more - in 36%, without - in 30%.
In patients with lesions of the upper small intestine, the risk of mortality is slightly higher than in any other site.
Since the exact causes of the disease are currently unknown, preventive measures have not been developed.
Crohn's disease and pregnancy
Women with Crohn's disease need to carefully plan a pregnancy in order to carry the child during the remission of the disease. It is necessary to review the list of drugs taken with the doctor.