Could it be something other than Crohn's?

I was diagnosed with mild Crohn's in 2003.  My symptoms were every 2-4 weeks fever, vomiting, and general malaise and myalgia--no diarrhea.  Colonoscopy showed no colon involvement (with clean biopsies), moderate inflammation at the ileum.  The pathology request was titled "R/O Crohn's disease" (does this bias the pathologist to look for IBD over other causes?)  The results of the ileocecal valve biopsy said:

"small bowel mucosa with moderate acute and chronic inflammation and ulceration.  There are gland regenerative changes.  The appearance is consistent with inflammatory bowel disease."

A follow-up with the Prometheus test for markers was negative.  A barium follow through showed "slight prominence of the mucosal folds of the ileum with several slightly elongated loops that could be in small longitudinal fissures, but no ulceration.  No significant mesenteric thickening or fulness."  I was put on a regime of Pentasa and Entacort, and the fevers/vomiting reduced in frequency to every six months.  Malaise/myalgia did not improve.

In 2006 I noticed short courses of Clindamycin (for a root canal) relieved the myalgia and malaise a lot.  In response, my GP put me on Xifaxin 200 mg bid.  It was very helpful, though not as much as the Clindamycin.

Because of money problems, I have been off all therapy for two months, with one attack that was brought on immediately following a veal marsala dinner and was limited to the time taken to pass the meal.  Following that, I tried a limited food diet (rice, apples, squash, turkey) for two weeks which was followed by markedly improved malaise, myalgia, and intestinal involvement, but increased asthma.

Since 2005, I have developed Reynaud's and increased asthma with the attacks.  I am wondering if Crohn's is not the right diagnosis.  Could the biopsy result have had other causes?  I have had asthma, allergy, eczema since I was 18 months old, and have received diagnoses of ADD.

[Kevin Pho, MD]

Difficult to say without examination.

The biopsy is normally pretty conclusive for inflammatory bowel disease.  I would also consider tests for celiac disease, which can cause similar symptoms, as well as a variety of autoimmune disorders.

Blood tests for an ANA and sedimentation rate can be considered to exclude the latter group of diseases.

That said, there can be an association between Crohn's and celiac disease with a variety of autoimmune symptoms, and this is what you may experiencing.

You can consider second opinion with another gastroenterologist, perhaps at an academic medical center.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd