Disease Overlap, Best Treatment Strategy?

Hi, Dr. Pho.

Last week, I had a capsule endoscope revealing multiple ulcers throughout the small bowel, (thus explaining pain I've felt over the ileum for over a year). I'm also producing a high number of antibodies for Crohn's.

Three years ago, my GI doc performed a colonoscopy, taking a biopsy which revealed microscopic colitis. (I was having severe diarrhea). If I had to estimate, I

[Kevin Pho, MD]

Typically, a GI specialist would be appropriate to manage Crohn's disease.  If there is concern about the management, another opinion can be considered - preferably at a major academic medical center.  If there is further concern about the autoimmune aspects of the disease, a rheumatologist can be considered.

If prednisone or mesalamine isn't controlling the disease, one can consider medications that affect the immune system.  This can include azathiorine and 6-MP.  Methotrexate can also be considered.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

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, M.D.
kevinmd_b

[myproblem]

If I were you, I would definately see a rheumatologist and get a full panel of autoimmune tests. Because Crohn's is an autoimmune disease, and they often overlap with each other, you are at risk for complications. There are better drugs available for most autoimmune disorders. These are in a class referred to as DMARD's (Disease Modifying Anti-rheumatic Drugs). If you visit RISG.org, and sign up for their newsletter, they send out news links every week on autoimmune diseases including Crohn's.