Emom, You mention the doc told you about patchiness, is that what they look for and base treatment on? The doc told us depending on what she saw, would determine the treatment plan. Why are some on oral med and some on remicade?
I don't know that I would say the patchiness is what they base treatment on, but I guess there are certain things they can conclude from the patchiness--like 95% sure it IS Crohn's. I believe they have to wait on the biopsies for further info. Maybe someone will jump in here with more knowledge on the subject than me as to what *exactly* the biopsies tell the doctors....
I was surprised that my son's biopsies did not check for E. coli infection. If anyone has the answer to that, I'd love some insight. I have read multiple studies that implicate a possible E. coli infection in CD (along with MAP, which I understand is extremely difficult to test for).
As for treatment, this seems to vary from doctor to doctor and individual case to case. Our doctor definitely takes the "bottom/up" approach, while I've read here that others take the "top/down" approach to treatment. By this, I mean our doc starts with "entry level" drugs (like Asacol) and if he doesn't get results, moves on to the more powerful ones (Imuran, Humira, Remicade, etc.) (That said, my son did initially take an 8 week course of prednisone. Some doctors choose not to use this drug, but nearly all admit it usually does the trick.) I would think, though, that doctors also take into consideration how severe the current symptoms are, and that may dictate where they start with treatment.
I am thankful our doctor chooses to use the bottom/up approach because I definitely did not want to jump to the big guns at the start, and thankfully things have been under control with the least aggressive drug. That said, we did make drastic dietary changes and added supplements (something our doctor did not encourage and nearly DIScouraged).
Not much help here... As you can see, we're still very new to this whole thing and I still have much to learn.... Best wishes to you and your son!
Mother to 16 year old boy diagnosed in June, 2007.
Currently taking Asacol, omega 3s, digestive enzymes, probiotics, iron, vit. C, calcium w/D3 and a good multivitamin.
Started The Maker's Diet in early September.