Peptic Ulcer vs Crohn's Ulcer

[Brad P]

Back in 2010 I had a gastrojejunostomy (roux en y) to bypass a bad stricture in my duodenum. I was told I had to stay on PPIs for the rest of my life to keep stomach acid from irritating the surgical area. For almost 6 years I've been doing well and my Crohn's was under control which has been great given my 29 years with it now.

A few weeks ago I thought I was having a flareup as I was having cramps, dark stool, losing weight etc . I was given Prednisone but didn't seem to be working. A CT scan didn't show anything. It must have been bleeding asI neededa blood transfusion a week ago as myblood count bottomed out. An endoscopy last Thursday showed bad ulceration at that surgical site. She doubled my PPI from 40mg to 2x40mg a day. She said it is unlikely Crohn's was a factor here at all.

Question: I know Crohn's can cause ulcerations. So how does one distinguish between a regular peptic/gastric ulcer and a Crohn's ulcer?

Any recommendations on how to treat one? help it heal?

Thanks

 

[ronroush7]

You might need more testing.

 

[Trysha]

Wait and see how things go when you take the extra dosage of Ppi...........
If things settle down then you have your answer
Ppi,s don't cure Crohns.......
If symptoms continue regardless of ppi treatment then you need to seek further attention.
Hopefully you have further GI appointments for follow up and surveillance of symptoms.
Feel better soon
Trysha

 

[eleanor_rigby]

A regular peptic ulcer is usually caused by the bacteria Helicobacter pylori. During your endoscopy they should have taken biposies, which would subsequently be tested for this. You could also have a breath test, which could indicate whether you have it. If you have tested negative for this bacteria, and have a history of Crohn's Disease in this area, then I have no idea why your GI would jump to the conclusion that these ulcers aren't now being caused by Crohn's Disease. Are you on any medication for your Crohn's such as imuran / biologics etc?

 

[Brad P]

I'm on an Entocort tablet, Imuran, Pentasa. This started one evening mid-May with bad bloating/gas and eventually Cipro cleared up. So the bacteria theory is a possibility.

I also know there is no cure for Crohn's.

 

[eleanor_rigby]

I'm on an Entocort tablet, Imuran, Pentasa. This started one evening mid-May with bad bloating/gas and eventually Cipro cleared up. So the bacteria theory is a possibility.

I also know there is no cure for Crohn's.

OK, entocort and pentasa won't touch the dudeneum. The imuran may have lost some effectiveness? With the ulcers being at the surgical site and the fact that you say it was "bad ulceration", it does sound more like Crohn's to me but I am not a doctor.

 

[Brad P]

OK, entocort and pentasa won't touch the dudeneum. The imuran may have lost some effectiveness? With the ulcers being at the surgical site and the fact that you say it was "bad ulceration", it does sound more like Crohn's to me but I am not a doctor.

The Entocort I am taking is to treat the dudeneum. I don't take the capsule, I take the tablet that comes with the Entocort enema and dissolve it in a drink. It works right away.

I got the impression there is no inflammation there, just the ulceration. Does ulceration without inflammation mean likely not Crohn's?

I've been on Pred for weeks and it seems to not have improved any at all which my GI feels is another sign this is not a Crohn's problem.

 

[eleanor_rigby]

I got the impression there is no inflammation there, just the ulceration. Does ulceration without inflammation mean likely not Crohn's?

I have never heard of this. Even a standard peptic ulcer caused by H pylori would cause inflammation. I was under the impression inflammation precedes ulcers. Generally I would say if you have a diagnosis of Crohn's Disease, and have ulcers, what you are experiencing is likely going to be a flare of your Crohn's Disease. Biopsies should confirm the presence (or not) of h pylori.

I've been on Pred for weeks and it seems to not have improved any at all which my GI feels is another sign this is not a Crohn's problem.

Pred did not help me for the ulcers in my terminal ileum and duodenum (which also did not show up on a CT scan but did using colonoscopy/endoscopy) and does not help everyone every time they take it.