Mild/Moderate Crohn's, Medicine or Natural Approach?

[alwaystraveling]

Hi everyone!

I am a 27 year old male of Eastern European background living in Thailand and diagnosed with Crohn’s Disease about 4 months ago. At first I was put on 2gms of Pentasa twice a day along with budenofalk 9gm once a day in the morning. Now just Mesacol 2gms twice a day (I think it maybe does nothing...).

After starting the medicine, I quickly felt much better than I had in the last 5 years. I wouldn’t say I was always 100% but I went from 4-9 bowel movements a day to only twice a day and almost never having diarrhea. Still it’s not perfect, I do feel I really need to go to the bathroom in the morning and its usually not very solid but other than that pretty good.

Last week I did another colonoscopy to see if I had really healed. Unfortunately, the findings show that its pretty similar to before, not worse but not better. Still multiple lesions and ulcers around the ileum. The doctor said it can be considered a mild-moderate case based on the colonoscopy and clinical remission based on my lack of strong symptoms (for the most part).

Now, the doctor gave me two choices:

1. Do not take any new medicine except maybe continue the Mesacol for a little while and wait until I have a flare up and deal with it from there.
2. Start taking 50mg of Imuran (azathioprine) everyday for at least 9 months if not a year or two. At the beginning I might also take prednisone for a short period of time.

I would really love to hear what people think is the best choice. On one hand, I have heard so many great stories on this website on how diet and lifestyle changes have really worked. So part of me wants to try no drugs and see if I can heal that way. I’m also pretty worried about the idea of taking any medicine for a long time, especially an immunosuppressant. On the other hand, I don’t want to risk getting much worse by not taking Azathioprine.

One of my big questions is, how common is it for my bowels to be getting worse and not experience any symptoms? To me it seems if I really did start to get worse internally I would also feel it, in which case I could start taking the immunosuppressant. What does everyone think? Is there such thing as asymptomatic worsening Crohn’s Disease?

Also, how long does it normally take for the ulcers to go away? Is it strange that after not having many symptoms for 3-4 months the ulcers haven’t gotten better?

Thank for you very very much for any and all thoughts and feedback!

 

[aypues]

there are more than the 2 options your doctor gave you. #1 prob won't do much, it's a very weak drug. #2 may work somewhat, in many months. The other options are biologics (remicade, humira, sterlara, etc), or a combination of a biologic and an immunomodulator like 6MP/AZA. Diet hasn't been shown to change the course of disease, only help control the symptoms. I would search out an IBD specialist if possible and get a 2nd opinion. Being in Thailand it may be challenging. Not to mention all these drugs are immunosuppressants and it may be more risky being in a developing country near the equator.

 

[ronroush7]

I would go for option 2. It would bother me not being on any medication.

 

[Guerrero]

I agree with Ron and aypues.
choice 1 is very weak... and had not much effect on you as colonscopy shown similar results than before. Also there is no clear proofs a diet can improve the course of the disease (except enteral nutrition for kids).
choice 2 is still not a strong medication but it's better than nothing.

Regarding the absence of symptoms, disease in the ileum can be silent while when in the colon there is much more symptoms (increase of bowel movements and diarrhea).

The problem with ulcers is that they could either evolve in strictures (narrowing of your small bowel) or loss of blood. So it's better to address it sooner rather than later to kick down the disease and avoid it spread up. Make sure to have regular blood work to monitor hemoglobin and iron.

 

[Catherine]

I would go with option 2. Imuran takes at least for 4 months.

Silent Crohn's disease is very dangerous. My daughter has a no bowel symptoms. She went unable treated for 4 years. Her was swimming 8 x 2 hrs times a week only 2 months before dx. Had long standing mild anemia


At dx she had lost 14 kg in 2 months and her hemoglobin was 9. She was in constant pain and sleep up to 20 hours a day.

 

[Bufford]

I would go with #2 and use the medications to get into remmission and to form a baseline for your condition. Once the condition is managed then one can tinker and try #1 and see if one can manage with less medication, and perhaps no medication. But first thing is to knock down the flare.

 

[alwaystraveling]

Thank you everyone! I agree, I really need to get into total remission both in terms of symptoms and mucosal healing. Will try and take the medicine for at least 6-12 months and combine it with diet and lifestyle change and see if I can get to a better state. I really appreciate everyone's input!!! This forum really makes me feel much better