Intestinal Abscess and Inflammation

[iamaaron]

Hi there,

I have had been diagnosed with Crohn's Disease around a decade ago. I have had two major flares in that time frame. Currently, I believe I am going through my third. It seems like the pattern is around every four to five years that I get a bad flare and typically have to try new medications. Currently the past four years I have taken Humira alone and that has always helped.

About three months ago I was working out, and started getting very painful pains in my abdomen. I had thought I had pulled a muscle. Went to the ER, they said I strained my abdominal muscles. For a month I struggled with the strain, but the pain didn't go away, and my GI wanted me to come in for a CT scan. I had a CT scan and they found an intestinal abscess in my Terminal Ileum, coupled with inflammation which was narrowing my passageway.

Per that discovery, my doctor put me on CIPRO and FLAGYL to treat the abscess. Those two medications destroyed me. Told me to go off of them, had another CT scan done, found that the abscess was healing if not almost gone, and that inflammation has gone down a substantial amount. He also did an endoscopy to see if I had an ulcers in the top of my GI tract, and also did a biopsy for H. Pylori, they found nothing. The GI said that he believes the Humira isn't working and wants to get me started on Entyvio. I start that in the next few days.

I sat down and really thought about things, and my symptoms haven't been typical to what I know. Usually, I have diarrhea, severe weight loss, general sickness, and lack of energy. But they are different this time. This time, I noticed that when I eat food, within ten minutes I am having severe abdominal pain, and I seem to burp a lot. From what I feel, it's like when I eat, I have an insane amount of gas that just doesn't escape. I have bowel movements that can be comparable to that of a person without Crohn's Disease. All of which is so different and odd.

I am curious. Does this sound like stricturing, inflammation, or an abscess/fistula to anyone here? I am taking a low dose of Prednisone at 10MG for the past two weeks or so. But I don't feel like it's doing too much.

Has anyone experienced this? What are your thoughts?
Thank you so much!

 

[24601]

Just some quick thoughts:

Symptoms vary between patients and over time and don't correlate as well as would be useful with disease activity OR even the presence of complications. You can have strictures, fistulas and abscesses and not know it from your symptoms. You can have active disease and have no symptoms at all. Bottom line is we have to go on imaging.

My main concern would be that it sounds like you will be tapering off prednisone well before Entyvio has a chance to work and for that time you will be effectively untreated. Has you GI talked about enteral nutrition in the meantime or perhaps methotrexate which takes about 6 weeks to get to therapeutic levels?

You mention having an insane amount of gas - which is something that I have a lot of experience with! And you've just been on two broad spectrum antibiotics. So that makes me think that you could be dealing with SIBO (Small Intestinal Bacterial Overgrowth). Treatments include diet (removing carbohydrates), taking probiotics or (ironically) more antibiotics.

How did the narrowing look in the last CT scan? Was it causing any dilatation of the bowel upstream of the narrowing?

Are your inflammatory markers in your blood decent indicators of disease activity for you? How have they been looking?

When did you stop Humira? What's the plan for making sure the abscess has gone entirely?

Sorry for all the questions!

Good luck!

 

[iamaaron]

Hi 24601,

Symptoms vary between patients and over time and don't correlate as well as would be useful with disease activity OR even the presence of complications. You can have strictures, fistulas and abscesses and not know it from your symptoms. You can have active disease and have no symptoms at all. Bottom line is we have to go on imaging.

I figured that symptoms over time may change. Mine seems to be a buildup of painful gas, of which is still passable, along with a non-IBD patients bowel movements.

My main concern would be that it sounds like you will be tapering off prednisone well before Entyvio has a chance to work and for that time you will be effectively untreated. Has you GI talked about enteral nutrition in the meantime or perhaps methotrexate which takes about 6 weeks to get to therapeutic levels?

He hasn't. My doctor and his office have been anything but helpful these past three months lol. I have three refills for my prednisone until well into 2016. So, I think I am going to take 30 - 50 MG daily until I get at least 3 infusions of the Entyvio in me. But nothing else. Taking me off the Humira, and starting me on the Entyvio.

You mention having an insane amount of gas - which is something that I have a lot of experience with! And you've just been on two broad spectrum antibiotics. So that makes me think that you could be dealing with SIBO (Small Intestinal Bacterial Overgrowth). Treatments include diet (removing carbohydrates), taking probiotics or (ironically) more antibiotics.

SIBO, I have never heard of this before and I have been Googling things left and right. I should probably be proactive with probiotics. To see if that will do the trick.

How did the narrowing look in the last CT scan? Was it causing any dilatation of the bowel upstream of the narrowing?

The last scan showed that the inflammation had reduced greatly and that the abscess was near-healed. So, I don't know if my little bit of inflammation is still causing the pain and gas issues.

Are your inflammatory markers in your blood decent indicators of disease activity for you? How have they been looking?

The hospital did blood work for my first CT scan and said everything came back fine.

When did you stop Humira? What's the plan for making sure the abscess has gone entirely?

I haven't had a shot of Humira in a little over a month. So, I am pretty sure it is out of my system by now. Currently there is no plan, the plan is to bring down the inflammation according to the doctor.

Sorry for all the questions!

By all means! :-D

Good luck!

Thank you so much! Especially for the help and contributions!