Suffering from Chrohns Disease with Ulcers in Terminal Illium - #9858

Hi Jayesh Jii… By seeing your complaint Do You wanna to say all report are normal mean You have only symptom, in colonoscopy gut mucosa is normal ? Mostly like if symptom persist than mucosa surely doesn’t normal So If it’s doesn’t resolved by Steroid than Further consult to Your consultant . U have next step of treatment if Steroid resistant. Treatment Options 1. *Biologics*: Medications like infliximab, adalimumab, or ustekinumab can help reduce inflammation and manage symptoms. 2. *Immunomodulators*: Medications like azathioprine or mercaptopurine can help reduce inflammation and prevent flare-ups. 3. *Aminosalicylates*: Medications like mesalamine can help reduce inflammation in the digestive tract. 4. *JAK inhibitors*: Medications like tofacitinib can help reduce inflammation and manage symptoms. ## Lifestyle Changes 1. *Dietary changes*: Avoid trigger foods, eat smaller meals, and consider a low-FODMAP diet. 2. *Stress management*: Practice stress-reducing techniques like meditation, yoga, or deep breathing exercises. 3. *Exercise regularly*: Regular physical activity can help manage symptoms and improve overall health. ## Additional Support Mental health support*: Consider seeking support from a mental health professional to manage anxiety and stress. Regards Dr Bajrang Thank You

Jayesh, given the persistence of your symptoms despite steroid use, I recommend discussing the following treatment options with your doctor: 1. Immunosuppressive Medications (e.g., Azathioprine, Methotrexate) and Biologics (e.g., Infliximab, Adalimumab). 2. Nutritional Therapy (e.g., elemental diet) to help reduce inflammation and manage symptoms. 3. Pain management options and Stress relief through CBT, relaxation techniques, or SSRIs. 4. Consider Surgery if symptoms remain uncontrolled. Tests to consider: 1. CBC, CRP, ESR, Albumin to assess inflammation and nutritional status. 2. Stool Tests (Fecal Calprotectin, C. difficile) to rule out infection and inflammation. 3. Colonoscopy/Endoscopy to directly assess intestinal inflammation. 4. CT/MRI Enterography, Ultrasound for strictures, abscesses, or bowel thickening. 5. Capsule Endoscopy for small bowel evaluation.

Investigations needed before starting any treatment. Don’t take any treatment without knowing .

Hi, thank you for sharing this—I'm really sorry you're going through all of this. Crohn's Disease, especially with ulcers in the terminal ileum, can be incredibly painful and draining both physically and emotionally. While I’m not a doctor, I can share some detailed insights that may help you have a more productive conversation with your gastroenterologist, or possibly explore new directions for treatment. --- ### **Your Symptoms Recap:** - **Crohn’s Disease with terminal ileum ulcers** - **Persistent symptoms:** stomach pain (both sides), gas, constipation, back pain, anxiety - **Treatments tried:** Completed steroid course (possibly prednisone or budesonide), but with poor results --- ### **Step-by-Step Management Plan to Discuss with Your Doctor:** #### **1. Medication Review & Next Steps Beyond Steroids** Steroids are often for short-term flare control. If you haven’t responded, the next step is typically **immunosuppressants or biologics**: - **Immunomodulators:** - Azathioprine or 6-Mercaptopurine (6-MP) - Methotrexate (often once weekly) - **Biologics (more effective for many):** - **Anti-TNF:** Infliximab (Remicade), Adalimumab (Humira) - **Anti-integrin:** Vedolizumab (Entyvio) - **Anti-IL12/23:** Ustekinumab (Stelara) These treatments often take several weeks to show effects but can help maintain long-term remission and heal ulcers. --- #### **2. Imaging & Colonoscopy Follow-Up** Since your symptoms are worsening and back pain is new: - **Imaging (MRI or CT Enterography)** to check for: - Strictures (narrowing of intestines) - Fistulas or abscesses - Inflammation spread to spine (Sacroiliitis or Ankylosing Spondylitis can co-occur) - **Follow-up colonoscopy or capsule endoscopy** may be needed to assess whether ulcers are healing or worsening. --- #### **3. Nutritional & Lifestyle Support** Crohn’s can be aggravated by diet, stress, and gut imbalance. - **Low-residue diet** during flares (limits fiber) - **Elemental or semi-elemental diets** in severe inflammation - **Probiotics**: While evidence is mixed, some find relief using *VSL#3* or *Saccharomyces boulardii* - **Vitamin B12 & D3, Iron, Folate**: Get these checked—deficiencies are common with terminal ileum involvement --- #### **4. Mental Health & Pain Support** - **Anxiety & IBS-like symptoms** can coexist with Crohn’s - Low-dose **amitriptyline** or **SSRIs** sometimes help GI pain & mood - **CBT therapy** or **gut-directed hypnotherapy** shows benefits in IBS and IBD patients --- #### **5. Back Pain Consideration** This could be: - Related to inflammation (sacroiliitis, spondyloarthritis—common with Crohn’s) - Referred pain from gut inflammation - Muscle fatigue from chronic disease Ask your doctor about getting: - **MRI of the lower spine/SI joints** - **HLA-B27 test** (associated with IBD-related arthritis) --- ### **Final Tips:** - Find a **gastroenterologist experienced with IBD + a rheumatologist** - Consider consulting an **IBD specialist center** (e.g., AIIMS, Apollo, Fortis if in India) - Keep a **symptom-food diary** to spot triggers - **Avoid NSAIDs** (can worsen gut ulcers) --- Stay strong—this disease is hard, but with the right treatment combo, remission is very possible. You're not alone in this.

Investigations Advised: CBC, ESR, CRP Stool calprotectin Colonoscopy (if not done recently) MRI Enterography Vitamin B12, D3 levels Thyroid Profile Fecal occult blood test