Crohn's or UC?

Hi. I am a long-time IBD patient. First diagnosed as UC, but Prometheus bio marker study indicates Crohn's. Most of my disease has been recto-sigmoid chronic inflammation. Although not diagnosed, I believe I've had peri-rectal/ano fistulas in the past.

After a couple of years of not taking maintenance medication, I recently had a flare treated with rectal meds and prednisone. The urgency/diarrhea/blood has resolved. But, I've since had more pronounced constipation, bloating, and abodominal distention after eating.

A recent CAT scan showed rectal wall thickening and perirectal fat infiltration consistent with proctitis. There was also dilatation of mesenteric veins and slightly thickened and hyperemic jejunal loops.

This is looking more and more like a Crohn's colitis (rather than UC).

Has anyone else have similar CT scan findings? The abdominal bloating and distention is a new symptom to this point. Could prednisone, mesalamine enema, and steroid suppository (taking all three) help at this point? I don't think there's much active inflammation. I'm most interested in the best long-term meds to reduce the rectal/sigmoid scarring and narrowing.

Any perspectives or opinions would be appreciated.

I started my Diagnosis Saga as Crohns (finally after my 3rd colonoscopy while in the hospital for 3 months). Main symptom were unknown location of frank blood (very red) hemorrhaging with 30 units of blood needed to replace, diahrrea thought to be caused by ampecillin.

In 1992 I switched GI's and he said since nothing had ever been found in the small bowel, I had UC, possibly crossover UC and Crohns. Most of my symptoms by that time were thought to be proctitis (the last 30 cm down to the rectum). He also told me I have IBS.

In 2010 I switched to another GI within the same practice (long story), and he revealed that he disagreed with his colleague, and I definitely have Crohns. My latest bowel resection in April was of the small intestine, where I had about 2 feet of inflamed bowel removed.

The only one I haven't been diagnosed with is microscopic Crohns. Hey I could have that and not even know it.

So... you decide It doesn't really matter to me (although I did like having UC because it has a lower chance of colon cancer (I think). I guess my point is, they really don't know enough about this disease to confidently categorize it. Either that, or I am a medical rarity - haha. (I actually have been written up several times by different doctors because I am so weird!)

Sudsmom

I've had a similar battle with the uc vs crohns battle
my first diagnosis was at age 12 when I was diagnosed after a major flare leaving me in the hospital for a few months (colonoscopy/endoscopy w/biopsies) as ibd undetermined. At the time I was told my Ibd showed signs of both uc and crohns so a definitive diagnosis could not be given. At the time it didnt much matter. What mattered was getting me well as it got to a point I was severely underweight and couldn't keep anything down as my intestines were so inflammed my food was backing up in my stomach causin me to instantly throw anything I ate up. After a few years, switching to homeschoiling to minimize stress and focus on getting well...I went through a large time period my symptoms went in remission. A main factor during this time was I developed anorexia nervosa as a result of not eating from ibd...losing weight and liking it and them spiraling downward into full blown anorexia. Once recovered from my eating disorder I began to manage my ibd symptoms (urgancy, diahrrea w/blood and or mucus, fevers, joint pain, etc) myself. I didnt know anything differently as my upset stomach and pain has been for as long as I can remember. My parents say I was born this was and as a overly anxious over achiever child, my symptoms were exacerbated. I found myself in the midst of a flare 3 times during my 20s. All of which I've taken Prednisone and Reglan and then felt better and able to go back to living with the diarrhea. The closest I got to a Uc vs crohns diagnosis was at 11 I had a appendectomy which showed crohns in my appendix. THEN I go to a gi at the army hospital who did a blood test which he said would he if I had uc or crohns. I was told it came back negative for both. He seemed to hold this blood test at very high esteem and wasn't convinced I had ibd. (Although he never himself actually preformed a scope). I started feeling better so went on with my business of trying to manage things on my own. Now I find myself in a flare in a disease I may or may not have :) im being referred to a gi while beinon prednisone tapering dose for the meantime. I find the doctors now feeling as though I should be able to have a definitive diagnosis. Im not sure whether its because in the past 11 yrs since my original diagnosis a lot has changed or if maybe im just weird and really do have signs of both. All the research I have down leads me to believe I have crohns due to the location (my whole tract is effected esophagus down to colon) and during the last scope (2008) the surgeon informed me I had patches of inflammation. Although im sad that there r others with similar dx stories as mine I find it comforting that im not alone.