Enfermedad de Crohn

¿QUÉ ES LA ENFERMEDAD DE CROHN?

La enfermedad de Crohn es un proceso inflamatorio crónico del tracto intestinal principalmente. Aunque puede afectar cualquier parte del tracto digestivo desde la boca hasta el ano, más comúnmente afecta la porción más baja del intestino delgado (íleon) o el intestino grueso (colon y recto).

La enfermedad de Crohn es una afección crónica y puede recurrir varias veces durante la vida. Algunas personas tienen períodos prolongados de remisión, a veces durante años, en los que no presentan síntomas. No hay manera de predecir cuándo puede ocurrir una remisión o los síntomas volverán a aparecer.

¿CUÁLES SON LOS SINTOMAS DE LA ENFERMEDAD DE CROHN?

Debido a que la enfermedad de Crohn puede afectar cualquier parte del intestino, los síntomas pueden ser muy distintos entre un paciente y otro. Los síntomas comunes incluyen cólicos, dolor abdominal, diarrea, fiebre, pérdida de peso e hinchazón. No todos los pacientes presentan todos estos síntomas, y algunos no tienen ninguno de ellos. Otros síntomas pueden incluir dolor anal o secreción, lesiones de la piel, abscesos rectales, fisuras y dolor de articulaciones (artritis).

SINTOMAS COMUNES DE LA ENFERMEDAD DE CROHN:

  • Cólicos: dolor abdominal
  • Diarrea
  • Fiebre
  • Pérdida de peso
  • Hinchazón
  • Dolor o secreción anal
  • Lesiones cutáneas
  • Absceso rectal
  • Fisura
  • Dolor de articulaciones

¿A QUIÉN AFECTA ESTA ENFERMEDAD?

Puede afectar a personas de cualquier edad, pero la mayoría de los pacientes son adultos jóvenes entre los 16 y los 40 años. La enfermedad de Crohn se presenta más comúnmente en las personas que viven en los climas septentrionales. Afecta a hombres y mujeres por igual y parece ser más común en algunas familias. Un 20 por ciento de las personas que padecen la enfermedad de Crohn tienen un pariente, un hermano o hermana más frecuentemente y, a veces, el padre, la madre o un hijo que tiene algún tipo de enfermedad inflamatoria intestinal.

La enfermedad de Crohn y otra similar llamada colitis ulcerosa se agrupan con frecuencia como enfermedad inflamatoria intestinal. Se estima que ambas enfermedades afectan a dos millones de personas en los Estados Unidos.

¿CUÁLES SON LAS CAUSES DE LA ENFERMEDAD DE CROHN?

Se desconoce la causa exacta. Sin embargo, las teorías actuales se concentran en una causa inmunológica (el sistema de defensa del cuerpo) o en una causa bacterial. La enfermedad de Crohn no es contagiosa, pero tiene una ligera tendencia genética (hereditaria). Se puede usar un estudio radiológico del intestino delgado para diagnosticar la enfermedad de Crohn.

¿CÓMO SE TRATA LA ENFERMEDAD DE CROHN?

El tratamiento inicial es casi siempre con medicamentos. No existe una “cura” para la enfermedad de Crohn; sin embargo, la terapia médica con uno o más fármacos proporciona un medio para tratar la enfermedad en su etapa temprana y aliviar los síntomas. Los fármacos que se recetan más comúnmente son corticoesteroides, como prednisona y metilprednisolona y varios agentes antiinflamatorios.

Otros fármacos usados en ocasiones incluyen 6-mercaptopurina y azatioprina, que son inmunodepresores. El metronidazol, un antibiótico con efectos en el sistema inmunitario, suele ser de utilidad para las personas que tienen una enfermedad anal.

En los casos más avanzados o complicados de la enfermedad de Crohn, puede recomendarse la cirugía. La cirugía de emergencia es necesaria a veces cuando se presentan complicaciones con la enfermedad de Crohn, tales como una perforación del intestino, obstrucción (bloqueo) del intestino o hemorragia considerable. Otras señales menos urgentes de la necesidad de cirugía pueden incluir la formación de abscesos, fístulas (comunicaciones anormales del intestino), enfermedad anal grave o persistencia de la enfermedad a pesar del tratamiento adecuado con fármacos.

No todos los pacientes que tienen estas u otras complicaciones necesitan cirugía. La consulta con el gastroenterólogo y el cirujano de colon y recto ayuda a tomar una mejor decisión.

¿NO DEBERIA EVITARSE POR COMPLETO LA CIRUGIA PARA TRATAR LA ENFERMEDAD DE CROHN?

Aunque es cierto que el tratamiento inicial de preferencia es la terapia médica, es importante señalar que, tarde o temprano, hasta el 75 por ciento de los pacientes con enfermedad de Crohn requieren cirugía. Muchos pacientes sufren de manera innecesaria debido a la creencia errónea de que la cirugía como tratamiento de la enfermedad de Crohn es peligrosa o que causa complicaciones inevitables.

La cirugía no es “curativa”, aunque muchos pacientes no necesitan operaciones adicionales. Con frecuencia, se sigue un procedimiento conservador, de los cuales el más común es la resección limitada del intestino (extirpación de la parte enferma del intestino).

En ocasiones, la cirugía proporciona alivio eficaz y duradero de los síntomas y limita o elimina con frecuencia la necesidad del uso continuo de medicamentos con receta. Lo mejor es que un médico con conocimientos y experiencia en el tratamiento de la enfermedad de Crohn realice la cirugía.

AVISO LEGAL

La Asociación Americana de Cirujanos de Colon y Recto está dedicada a asegurar la atención al paciente de alta calidad, al avance de la ciencia, la prevención y el tratamiento de los trastornos y enfermedades del colon, recto y ano.  El propósito de estos folletos es proporcionar información sobre los procesos de enfermedades, y no la de indicar una forma específica de tratamiento. Están diseñados para el uso de  los médicos, trabajadores sanitarios y pacientes que deseen información sobre la gestión de las condiciones tratadas. Estos folletos no incluyen o excluyen otros métodos apropiados de atención médica de estas enfermedades. La última palabra sobre el tratamiento a seguir le corresponde al médico basándose en las circunstancias  de cada paciente.



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