UC to Crohn’s

It's fairly rare but diagnoses can change between UC and Crohn's. Surprised this doc was willing to say that after only a visual examination. Typically you'd also need biopsy evidence to back it up.

Typical telltale crohn's findings would be findings like this:

1.) Deep tissue inflammation in a biopsy (UC is only shallow into the lamina propria layer of tissue).
2.) Skip lesions, which are areas of healed tissue between areas of inflamed tissue (UC starts at the rectum and is continuous in pattern).
3.) Aphthous ulcers (look like oral canker-sores, large and white) unique to crohn's and not found in UC.
4.) Small intestinal or ileum inflammation (with ileal-backwash ruled out). UC is limited to the large intestine, but ileal-backwash is possible and normal in UC-pancolitis patients.

I would ask this doctor what makes him/her believe you have crohn's.

Sounds like a possibility it's CD....hopefully once the antibiotics do their thing, you can have that doc do another look-see.

When was your last scope and when is yiur next one?

Do you have the pathology report of the biopsies?

What other meds are you on?

q

I agree with iPoop, I think it's odd to go so far as to say it's Crohn's just by looking, though I guess the 2 conditions look different. Did he do a sig scope? Did he take biopsies?

It will be interesting to see what your GI says. Are you going to start the antibiotics or wait until after you GI appt. Are the antibiotics cipro/flagyl?

beave said...

DBwithUC said...
it sounds like the ulcers in the rectum were deep as well as infected, and this might have prompted the preliminary speculation of CD instead of UC.

Until surgery, or critical choice between some biologic med options, CD vs UC does not matter so much because the initial treatment for each is the topical anti-inflammatory mesalamine - taken oral, rectal or both.

oral is not going to really reach into the rectum. Even after the ab handle the infection in the ulcerations, you still need to address the ulcers. this is best done with rectal meds.

good luck

As some of us Crohnies have said before, there is a difference in treatment between UC and Crohn's. The initial treatment for each is not topical anti-inflammatory mesalamine. Those are proven ineffective in Crohn's. They do not work for Crohn's. Yes, many GIs still prescribe them for Crohn's, but the data clearly show no benefit.

Having said that, I agree with the other posts questioning how the colorectal surgeon can determine it's Crohn's based on a look into your rectum only. The answer is, he can't.

I may have been out of date. I follow UC and only read about CD when it is in the same article. I did try to confirm this in the literature, and I do see in a 2018 review that mesalamine is currently mentioned only for maintence in CD and not for first-line induction of remission.

/www.ncbi.nlm.nih.gov/pubmed/28826742 said...
Management of Crohn's disease has been seen as an evolving challenge owing to its widely heterogeneous manifestations, overlapping characteristics with other inflammatory disorders, often elusive extraintestinal manifestations and uncertain etiology. Therapeutic interventions are tailored to address symptomatic response and subsequent tolerance of the intervention. Chronology of treatment should favor treatment dose acute disease or "induction therapy", followed by maintenance of adequate response or remission, i.e. "maintenance therapy". The medications which are highly effective in inducing remission include steroids and Tumor Necrosis Factor (TNF) inhibitors. Medications used to maintain remission include 5-aminosalicyclic acid products, immunomodulators (Azathioprine, 6-mercaptopurine, methotrexate) and TNF inhibitors (infliximab, adalimumab, certolizumab and golimumab). Surgical interventions like bowel resection, stricturoplasty or drainage of abscess is required in up to two thirds of CD patients during their lifetime.

What antibiotics do you have to take for 30 days? Hope it's not Flagyl, but guessing it is. Hate that medicine. Glad you liked this new doctor.