I posted before about my 18 year old daughter whose colonoscopy showed possible Crohn’s due to inflammation seen in the terminal ilium. She had her MRE today and the results are as follows:
impression: Possible subtle inflammation at the terminal ilium, with mild diffusion restriction in this region. No other areas of involvement are identified, no evidence of stricture.
Everything else was all normal.
She hasn’t received any communication from the doctor’s office yet and has an appointment I think on the 10th. Any idea what treatments would be suggested in this case?
48 F
Diagnosed UC 2010
Entyvio every 8 weeks since 2018, Lialda, curcumin, vitamin D, probiotic
That's relatively good news. That means they didn't see any inflammation in other areas of the small bowel, just in the terminal ileum - as was previously seen in the colonoscopy.
So the colonoscopy biopsy results for that area are key to the diagnosis.
As for treatment,she could try entocort, which is targeted to help that very area and should help symptoms, but it isn't a long-term solution.
In the longer term, there are two approaches depending on how aggressive her disease is (assuming it's Crohn's, which it likely is). Ufortunately it's not easy to decide which is the right path because it's hard to predict how aggressive hers will be. Research is being done to help predict which patients will have milder disease courses and which will have it more severe, but right now it's not easy to determine.
Hers seems fairly mild now, but only time will tell if it remains that way.
1) People with mild Crohn's often can go years with no treatment. But she would need to watch it closely, with a follow up scope every six months or year to see if it's getting worse.
2) Go ahead and start a biologic to get it under control as quickly as possible and prevent any further damage.
A thorough discussion should be had with her and her doctor to go over the options and make a decision on how to procede.
So the colonoscopy biopsy results for that area are key to the diagnosis.
As for treatment,she could try entocort, which is targeted to help that very area and should help symptoms, but it isn't a long-term solution.
In the longer term, there are two approaches depending on how aggressive her disease is (assuming it's Crohn's, which it likely is). Ufortunately it's not easy to decide which is the right path because it's hard to predict how aggressive hers will be. Research is being done to help predict which patients will have milder disease courses and which will have it more severe, but right now it's not easy to determine.
Hers seems fairly mild now, but only time will tell if it remains that way.
1) People with mild Crohn's often can go years with no treatment. But she would need to watch it closely, with a follow up scope every six months or year to see if it's getting worse.
2) Go ahead and start a biologic to get it under control as quickly as possible and prevent any further damage.
A thorough discussion should be had with her and her doctor to go over the options and make a decision on how to procede.
@beave has left you an excellent and concise reply. I could only echo her sentiments. Only emphasis I would put on is be very careful if opting for more conservative treatments. Most particularly when newly diagnosed are afraid of the more serious meds we have now, but if undertreated the disease can do serious harm. If you do decide on a mild treatment plan, then be sure to monitor her very closely, even scheduling regular diagnostics. Hopefully she does well, and stays on the milder side of things.
Well, I had been feeling better about all this until now. I guess CD is more different than UC than I thought. So there is nothing between not treating and biologics? If she’d had UC classified as mild, it would be a clear choice about where to start. I don’t like the idea of jumping straight to biologics for mild inflammation in an 18 year old. For one thing, I know the reality of biologics is that even if the one you choose works, it probably won’t work for you forever. Starting at 18 you could run through them all and be left with no more options. But obviously I don’t want her to end up with serious problems due to under treating either. Sigh. I wish I could just take her CD, too. I’m already diseased and more than halfway through my life. It’s so crappy.
48 F
Diagnosed UC 2010
Entyvio every 8 weeks since 2018, Lialda, curcumin, vitamin D, probiotic
48 F
Diagnosed UC 2010
Entyvio every 8 weeks since 2018, Lialda, curcumin, vitamin D, probiotic
Yeah, mild Crohn's (assuming that's what it is) can be tricky in its own way because treatment options are limited. There's Entocort, as mentioned. There's the mesalamines that some doctors use for mild Crohn's, but data shows they don't do much of any good. So people with Crohn's who do well on them would probably be doing just as well not on anything. There's also imuran, 6mp, and methotrexate, but their use is debatable too. Their risks might outweigh benefits for mild Crohn's.
Again, this is all assuming that hers is mild. We don't yet know. Only time will tell.
I wouldn't worry too much about running through all the biologics so quickly. More and more are approved and more still in the pipeline.
Again, this is all assuming that hers is mild. We don't yet know. Only time will tell.
I wouldn't worry too much about running through all the biologics so quickly. More and more are approved and more still in the pipeline.