IBS/Crohns - bad abdominal pain, can't eat

I will give some backstory before I ask my question...

I have Crohns in the small intestine. As of May 2019 it was still in remission (verified with scope). I started having issues with right-side abdominal pain and lots of bloating/gas in the past month. My GI thinks I have IBS on top of my Crohn's so she ordered a breath test to find out what was causing the bloating.

However in the past four days the pain suddenly spiked (it happened after eating fried food, I normally don't have problems from it). The pain doesn't go away now though it is only excruciating right after I eat. I couldn't eat or drink anything without horrible crampy pain on my right side and the feeling I needed to vomit. I went to the ER and the ultrasound was negative for stones but the ER suggested a HIDA scan; they think it is still my gallbladder. They had me take Bently and Zoftan regularly and that has taken the pain and nausea down but I still cant eat without a ton of pressure and stabbing pain. Right now all I can eat comfortably (with meds) is a slice of cheese. Aside from the pain and nausea, I have a low grade fever.

Is it possible this is all still just IBS? I'm worried that's what the doctor will say and I cant imagine living like this long term. I cant even eat soup without feeling like I am going to throw up.

My Crohns pain was never quite like this pain even when I was actively flaring and losing weight.

Post Edited (artemis111) : 9/18/2019 3:25:02 PM (GMT-6)

From my understanding, the Crohns was around the terminal illeum. I dont understand the diagnosis of remission either from the scope. I was initially diagnosed with Crohn's from a pill endoscopy and from inflammation in my terminal illeum. The terminal illeum definitely looked much better in recent exams. I hadn't been having any symptoms either and had returned to normal eating patterns.

My last MRI was several years ago. It does hurt more after applying pressure (the ultrasound hurt quite a bit). The pain happens with any food now, and even with liquid if I have more than sips. The reaction occurs with 5 to 30 minutes. I haven't tried rice yet. I tried eating peaches yesterday and still had pain. It seems like the quantity of food or liquid is what changes the instensity of the pain rather than the type of food or liquid.

Gall bladder problems are more likely to cause pain a while (a few minutes to an hour) after eating a meal with fat. Something like a peach, which has no fat, shouldn't cause much gall bladder pain.

When I say to poke/probe around the right ribs, I mean to really probe as much as you reasonably can *under* the right ribs, like curl your fingers under the lowest bone.

A colonoscopy can say you're in remission if your Crohn's is only at the terminal ileum, and the scope was able to reach there and visualize it well. But it leaves out entirely the possibility that you have Crohn's somewhere upstream/proximal from there that is well beyond the reach of the scope.

You should probably have an MR enterography. To me, you symptoms sound like it could be a blockage/stricture of the small bowel.

I hadn't taken my breath test yet, I just got the test so I am waiting to see if my doctor wants me to hold off until after the HIDA scan. I can pass gas and stool without difficulty but my stool has been either super dark or oddly light (like I'm not digesting things right). I checked my labs from the ER and they did not run a C Reactive Protein or ESR test. I know I will be due soon anyway so I imagine I can get my GI to run those labs. The last test I had (about two months ago) already had high levels but not crazy high.

I like the idea of a CT or MR enterography. Hopefully that is something my GI would do next if the HIDA doesn't reveal anything. My abdominal pain does seem to be wrapping around to my back now. When I had pain from Crohns before, it was always more centralized in my abdomen or lower when on the right side, so this seems odd compared to previous experiences.

Straydog, did you have an ultrasound done as well. Was the HIDA scan the only thing that showed issues?

I got my breath test my doctor orginally sent me. It says it is testing for SIBO. Can that cause abdominal pain in the upper right quadrant? I have never had SIBO before and am not sure if this could mimic the symptoms of gallbladder issues. My pain is a bit calmer with very small meals and Bentyl but my nausea is 24/7 unless I am constantly medicated with Zofran. It is there even with Zofran, just bearable. It is pretty hard to eat, I have lost 7 pounds in the last week.

Post Edited (artemis111) : 9/23/2019 12:40:48 PM (GMT-6)

Poor you, I can relate, been there many a time. It could be IBS along with the crohn's? I get spasms of painful and uncomfortable gas, and that keeps me nauseous a great deal of time. When I go, I will pass some fluid stool, then some gas, then some stool and release pockets of gas in between. I still don't have answers, but I had a FFT and told I do have malabsorption not only from the crohn's but from the pancreas as well, so guess it can hurt when food and fat isn't absorbed properly? Hope you feel better soon and get the answers you need.