Advice needed

Hi - l have crohns - have had it for 25 years - no symptoms except some days I get the runs worse than others. 16 months ago I had my first small intestine mri and a colonoscopy. The results said a foot of small intestine was grossly abnormal with thickening. I also have some fistulas and odd ulcers throughout. However I am well and have always been. The consultant says I should be on azathiaprine - I am fighting it - it’s a powerful drug and my life is normal. He says he should treat the scans not the symptoms - I have asked for another mri scan to see if there is any worsening but advice gratefully received. Thanks

You might be required to try azathioprine before you're allowed to try a biologic, but, yes, you're long past due to be on a biologic if you have a foot of thickened intestine and fistulas. I don't want to alarm you too much, but even though you feel well, there is significant damage done to your instestines. Biologics may or may not be able to reverse that. But you're heading toward eventual surgeries if you don't give them a try.

Your doctor is right to treat the scans and not the symptoms in this case, because while you may be asymptomatic right now, sooner or later you're going to find yourself having lots of trouble if you can't get it under control sooner rather than later.