Crohn's AND Cirrhosis?

Does anyone know anyone who has both Crohn's Disease and Cirrhosis?

My Mom contracted Hep-C 30 years ago through blood transfusion. The Hep-C has been eradicated, but not before doing irreversible damage to the liver. She's been a great patient but now the disease seems to be rapidly progressing.

She also has had Crohn's Disease under treatment for probably 15 to 20 years. Through medication and diet she is usually able to keep it in check.

The problem now is that one of the few treatments for the hepatic encephalopathy "HE" (confusion etc. due to build-up of ammonia in the system due to failure of liver and kidneys to process it) is a drug called lactalose. As the name implies, it is a laxative. This laxative attracts the ammonia in the body and helps eliminate it through the bowels.

As you might suspect, laxatives are very difficult for an individual with severe digestive problems (like Crohn's) to handle. My Mom's first treatment with lactalose worked wonders on the HE but was accompanied by the onset of persistent and uncontrollable diarrhea. She ended up in the hospital for nearly 2 weeks during which time they discovered ruptured vessels in the lower digestive tract responsible for the bleeding. During this visit she also contracted (or was diagnosed with) c-diff (some nasty spore or bacteria) that had to be treated with heavy duty antibiotics.

Long story short -- Mom is convinced that the lactalose irritated Crohn's which caused diarrhea which ruptured the vessels which caused bloody diarrhea which caused hospitalization which caused c-diff. Therefore, she says that she will NEVER take the lactalose again.

Unfortunately, there is only one other treatment (that I'm aware of) for the HE and that's an antibiotic called rifaximin. No one has told me this, but I am beginning to believe that there are some undesirable properties for this drug as well. She was just hospitalized again for complications involving renal insufficiency. When she was released from hospital, they sent her home without either treatment for HE. I think this is probably because long term treatment with the rifaximin leads to complications (including creating an environment for c-diff to flare and also difficulty with kidney processing).

Long story short (again) -- without treatment for the ammonia, eventually she will go into a hepatic coma (currently BP is running 100/40).

I just want to know whether anyone knows anyone who has both Crohn's and Cirrhosis so that we might understand how best to manage a patient with both. I don't want her to continue refusing the HE treatment just because the last lactalose treatment coincided with (was not caused by) other issues.

Thanks for giving me a place to formulate thoughts.

TB

Caregiver25 -- Glad to hear from you, though I am sorry to hear of your mom's condition. My Mom is still hanging in there with more bad days than good, however, her attitude is getting better. Since she was hospitalized back in October when C-diff was diagnosed, she has been almost constantly treated with Vacamycin. Though it is not prescribed or intended to address the HE and diarrhea, she is almost always better on it than not. I'm sure there are some side effects and complications that will result from this, but it seems when it gets to this point you have to choose which is the worst complication -- nausea, vomiting, diarrhea, HE, and now she has developed a serious and persistent skin rash that is miserably itchy. The doctors tried to treat the rash as unrelated to the liver disease. The steroidal med that they put her on REALLY exaccerbated the HE. So, now it appears to be just one of those things she's got to live with.

Not really the question you asked, but it is what's on my mind right now. I wonder if anyone else out there has developed the itchy, persistent rash in course of liver disease progression.