Aphthous Ulcers, Early Crohn's?

[Madem]

After 2.5 years of lower abdominal cramping, diarrhea, and high frequency, I had a colonoscopy done.  Results were rather unremarkable except for the presence of multiple aphthous ulcers throughout colon.  Small bowel was not visualized.  GI doctor told me that I did not have IBD, but then put me on 9 mg of Entocort indefinitely.  Cramping and diarrhea resolved while taking Entocort.  I have read that aphthous ulcers can be indicative of early Crohn's, and other doctors (not GI doctors) have confirmed that.  I currently have other symptoms, and a family history, indicative of IBD.
1) My father has Ulcerative Colitis
2) I have rheumatoid arthritis with a positive RF
3) My joint patterns may be typical of enteropathic arthritis (i.e., hips, shoulders, hands)
4) My rheumatologist tells me that joint pains can precede active IBD by several years

My current GI is not inclined to do any further testing, but is content to leave me on Entocort.  Should I seek another opinion, or at least followup with an additional test?  If I don't have IBD, should I continue taking Entocort?

Thanks.

[Kevin Pho, MD]

You can consider another GI opinion if the diagnosis is in question.

A small bowel series can be considered - since a colonoscopy doesn't reach that far (a colonoscopy with intubation of the last part of the small bowel would be needed).  

You can consider antibody testing, such as antineutrophil cytoplasmic antibodies (P-ANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA), which are sometimes used in the diagnosis of Crohn's.

A biopsy would be helpful to determine if the ulcers are related to IBD.  

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.
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