Could this be something else than Crohn's?

[mamason]

My 16 year old son was diagnosed with Crohn's 2 months ago.  His symptoms are rectal bleeding and mucous discharge with constipation.  Blood work with CBC, sed rate was 1, IBD panel, C retic, C diff, A and B were all normal except Globulins were slightly out of range.  Stool cultures were negative.  Colonoscopy revealed an ulcer about the size of your thumbnail in the large intestine near the terminal ileus.  Biopsy results concluded Crohn's.  My son has no diarrhea only aagets a blocked feeling.

My son has been on 60 mg prednisone for 2 months.  Initially he stopped bleeding and reduced to 20 mg biut started bleeding again even back up to 60 mg.  Doctor prescribed 6-mp but I am concerned since it causes bleeding and my son drips blood with every bowel movement already.

Should my son have any other diagnostic tests done?  Is it safe to go ahead with 6-mp for 2 months and then Remicade?  How Dangerous is this ulcer and is he in danger of perforating or bleeding excessively with 6-mp?  Why can't antibiotics be tried as a therapy.  The doctor says he does not use antibioticsfor Crohn's.

[Kevin Pho, MD]

If the biopsy shows Crohn's disease, then this is the most likely possibility.  Other possible tests to consider would be antibody tests such as antineutrophil cytoplasmic antibodies (P-ANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) which can differentiate between ulcerative colitis and Crohn's.

Treatment typically involves 5-ASA medications such as Pentasa and Asacol.  Antibiotics can be considered if there is no response to this option.  The use of 6-MP is used for refractory disease.  The response rate is between 60 and 70 percent.  The fact that this medication is considered suggests that the Crohn's has progressed to a point past where antibiotics can be useful.  

I cannot comment on the excessive bleeding without being more familiar with the case.  

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.

Thanks,
Kevin, M.D.

[kwag]

How have you addressed your son's diet?  What changes have you made so that it can heal?  Please read the Makers Diet.  It is about a person that had Crohns and it is healed.  Yes, I said healed.  It can be but the person's lifestyle has to change.  Please don't believe that meds are the only way to go and that there is no cure.  That is simply not true.  Look into that matter and you will see.

[kimbacat]

you might want to check out www.ccfa.org
lots of good info on Crohn's there including treatment options.  Crohn's doesn't always result in diarrhea, constipation is also seen.  there is a risk of perforation with CD but that is usually with extensive and severe disease.  with a lone, smallish ulcer, I don't think your son's disease is anywhere near that stage.    

to my knowledge, 6mp doesn't cause bleeding.  are you thinking of NSAIDs and those risks?  6mp and azathioprine are immune modulating meds and aren't like NSAIDs at all.  they take anywhere from 3-9 months to thoroughly work (starts to work sooner, but not fully), so most docs start you out on steroids to cover you until the 6mp kicks starts to kick in.  

please note, he would have to take either 6mp, azathioprine or methotrexate while taking Remicade.  immunomodulators have been shown to reduce the development of antibodies to Remicade, making it work more effectively with fewer side effects.  

unless there is an abscess or fistula present, antibiotics aren't that effective for CD.  check out the CCFA sight for more info on antibiotics and IBD.