Crohn's Flare with Normal Inflammatory Markers?

[newdiagnosis]

Hi All,

I have ileocecal Crohn's disease. REcently I have had what seems like a flare with increased urgency and mucous stools. However, my blood tests and calprotectin are normal, no signs of inflammation. What do you think of this? CAn the inflammatory markers be normal if it is just rectal inflammation? This does not seem like my initial crohn's symptoms. Also had stool sample submitted, normal, no signs of infection.

 

[Scipio]

Blood tests for inflammation such as CRP work in many Crohn's cases but also miss a fair number. For example even at the height of my Crohn's inflammation my CRP was always normal. Never budged. Also fecal calprotectin gets less and less accurate/useful the farther upstream the intestinal inflammation is located. So calprotectin should work well for detecting or assessing colonic or rectal inflammation but less well for ileal and other small bowel lesions.

So your results could still be consistent with an ileocecal flare but are less conssitent with a rectal flare.

 

[newdiagnosis]

Hmm. Interesting. Well if it's ileocecal I wonder why entocort is not working. Before it used to work like magic.

 

[Scipio]

If the inflammation is farther south in the gut your doc should consider trying Uceris. It's a formulation of budnesonide (same drug as Entocort) but designed to be released farther down well into the colon instead of the ileum.

 

[newdiagnosis]

Yes, unfortunately uceris is not under my insurance formulary

 

[my little penguin]

There are other rectal foam steroids that can be used if uceris is not covered
FWIW Ds had normal blood and fecal cal but has had rectal inflammation more than once
Uceris did help a lot with those symptoms in cluding temesus/rectal prolapse /abdominal pain /constipation
His body didn’t get the memo
Good luck

 

[newdiagnosis]

Just started my generic uceris today. I am praying this will work. I have a strong feeling this was incited by antibiotics that I took the month prior, but who knows. It's just weird that the entocort used to work so well before and now it has lost its effectiveness.

 

[newdiagnosis]

There are other rectal foam steroids that can be used if uceris is not covered
FWIW Ds had normal blood and fecal cal but has had rectal inflammation more than once
Uceris did help a lot with those symptoms in cluding temesus/rectal prolapse /abdominal pain /constipation
His body didn’t get the memo
Good luck

Symptoms have improved markedly on uceris, but still have bowel sounds and gas. Previously that has been a sign of active disease. Maybe adding oral prednisone would help? Definitely no longer having urgency and diarrhea like i did before.

 

[my little penguin]

We tend to not worry too much about gas or bowel sounds for ds.
Especially if his other symptoms improved
What did you Gi say ?