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Best treatment for ileitis

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Crohn's Disease
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Posted 9/12/2014 4:33 PM (GMT 0)
Just a quick question to this group. My 11 y.o. son had his MRE recently which showed the last 15cm (5.9in) of his small intestine was inflamed.

He's currently on Pentasa (after having endoscopy/colonoscopy with biopsy, bone scan, bloodwork, stool test, etc.) and doing great--feeling well, gaining weight, no pain, increased energy, etc. However, based on the MRE results, the doctor would like to use more aggressive therapy at this point.

While we're not ready to go to the Remicade level at this time, we would like to explore other options (herbal, diet, etc.) or other medications (sulfa, steroid, etc.) both in general as well as specifically that get to the end of the ileum (right before the terminal ileum) better than Pentasa does and that people have had success with. Any suggestions?
Posted 9/12/2014 4:47 PM (GMT 0)
Entocort is a relatively low risk approach to treating the ileum, but it is a steroid and should be used on a time-limited basis.

Prednisone will not be something anyone will recommend for a pediatric patient who is growing and having little pain etc.

The other oral meds like sulfazine are not better than Pentasa.

I can't tell you anything about alternative methods that would focus on the ileum, but I can say that the home made yogurt that's part of the specific carbohydrate diet is chock full of excellent probiotics and could really help him establish good gut flora. People with Crohn's have a skewed gut flora and one of the reasons the SCD might be successful is most likely this yogurt.
Posted 9/12/2014 5:54 PM (GMT 0)
Kazbern
Thanks for the input. I will research Entocort v. Prednisone as I definitely don't want to stunt his growth. The bone scan came back normal which is good and the doctor says that shows he still has the potential to grow to his full height--whatever that may be. I'm fine with going to a steroid for short-term use (she suggested 8 weeks--4 at full dose, 4 at weaned dosage) so that we can see if that works and then go from there.

Great suggestion about the yogurt--I need to get that book and read it asap as I've heard so much about it.

I'm hoping a combo of diet and low dose meds will keep this at the mild level it's been diagnosed at.

Thanks!
Posted 9/12/2014 8:00 PM (GMT 0)
If you really want to repopulate the colon with good bacteria, a faecal transplant must surely be the best option by miles (I don't know if it would reach as far as the ileum; the vast majority of gut bacteria are contained in the colon).

The SCD yoghurt may contain a lot of bacteria, but it only contains 2 species; 3 at most.

www.breakingtheviciouscycle.info/knowledge_base/detail/yoghurt-what-kind-of-yoghurt-starter-to-use/

But the human gut contains anything up to 1000 species of bacteria.

en.wikipedia.org/wiki/Human_microbiome#Bacteria

Now the thing is, while a faecal transplant should in theory provide the full array of bacterial diversity, its use as a treatment in Crohn's disease has not been proven to be effective. (It's somewhat more effective in UC, but where faecal transplants really shine as a treatment is in treating resistant c. diff infections).

My point is I don't personally believe the gut flora has a lot to do with Crohn's. I'm quite prepared to believe the flora is disordered; it's just that treating it doesn't seem to have any effect on Crohn's.

If I had an 11-year-old kid with Crohn's, I'd consider an enteral nutrition diet or Entocort as a short-term stop gap, and 6MP or Imuran as a longer-term solution. (Or, possibly, Remicade but not with 6MP or Imuran.)

I'm sorry I cannot be more helpful. This disease just sucks, in all honesty.
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