Ask a doctor on the topic of Internal medicine

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October 26, 2016 | 20,00 EUR | answered by Dr. med. Ralf Berg

Good day, is there a gastroenterologist here with experience in treating patients with inflammatory bowel disease (IBD)? I have been suffering from Crohn's disease since 2011. I experience recurrent diarrhea, fatigue, and joint pain. Pentasa was ineffective for me. My diarrhea improved with Imurek, but I experienced extreme fatigue, malaise, and abscesses in the genital area. During flare-ups, I have been prescribed cortisone, which has led to osteopenia. Puri Nethol was better tolerated than Imurek. Additionally, for the past year, I have been treating myself with probiotics, vitamins, and Boswellia serrata with good results. However, conventional medicine is the only one recognized in the hospital, and it is difficult to have a confidential conversation as everything is documented and sometimes misrepresented. For example, in my medical records, it is stated that I stopped taking Imurek on my own, but the reason (extreme fatigue that prevented me from doing my job) is not mentioned. During my last colonoscopy in May 2016, everything appeared normal, with Crohn's disease in remission. However, two weeks later, the histology report indicated collagenous colitis, leading to an immediate recommendation for Entocort therapy. I chose not to start this therapy since I was having formed stool at that time. I have also stopped taking Purinethol for the past month, and I am still feeling well. Why take strong medications when there are other options? However, I have noticed an increase in abscess formation in the genital area. My questions now are: Is it possible to have two chronic bowel diseases simultaneously? And are the abscesses due to discontinuing immunosuppressants or just a coincidence? Thank you in advance for your response.

Dr. med. Ralf Berg

Good day,

Let's go through the questions one by one:
1. Yes, it is possible to have multiple bowel diseases. However, in your case it is unlikely, as many biopsies have been taken and other groups would have been noticed in the histological examination. Collagenous colitis is one of these subgroups.
2. Regarding the abscesses, in inflammatory bowel diseases such as Crohn's disease, abscesses are part of the clinical picture when inflammation becomes encapsulated. Fistulas can also form in Crohn's disease. It is known that any form of immunosuppression, including Immurek, can lead to more abscesses (as can cortisone shots). In my opinion, the abscesses are unlikely to have resulted from discontinuing Immurek. They could also be precursors of a new Crohn's disease flare-up.
One problem is that the disease progresses in flare-ups, with no reliable early warning signs for when a new flare-up might occur. As you described, the gastroenterologists wanted to start treatment immediately based on the histology results (as a preventive measure), while you did not want to participate because you did not feel any clinical signs of deterioration. It is uncertain whether you or your treating doctors are correct, as these inflammatory flare-ups can also subside on their own. The goal is to reduce the occurrence of such disease flare-ups with Immurek or Purimethol, but unfortunately they cannot be completely prevented.

This is a very unsatisfactory situation for you. I am sorry that I cannot provide better news.

Kind regards,
R. C. Berg