Crohn's complications

[lizziecee]

I have been having symptoms of a Crohn's flare, severe nausea, loss of appetite, weight loss of 18 lbs in last 6 weeks,steatorrhea, pain in mid chest and right upper quadrant. Had CT scan 2 weeks ago which showed significant inflammation in terminal ileum and old pancreatitis with calcification. Gastroscopy last week showed oesphagitis.Biopsies taken. MRI scan Nov 2007 showed two strictures in small intestine. Gastro has advised following until I see him in clinic 23 July:
Double my mtx injections to 25 mg weekly.
Add budesonide 9 mg daily
Start elemental diet of Fortijuice today.
Eat low residue diet if I can manage it.
Have another MRI scan asap.

I am concerned about taking mtx and budesonide concurrently as I had steroid induced psychosis when dx with breast cancer Jan 2003. He said I have some serious decisions to make about resection of strictures but need to put on some weight beforehand. Do you think this treatment plan is correct? Was dx with Crohn's 1970, now PanCrohn's Colitis. I am also taking Aromasin for bc.  Stopped alendronate (I am osteopenic due to 30 yrs of prednisolone and Arimidex) in case this caused the oesophagitis. Would appreciate your advice.

[Kevin Pho, MD]

The treatment plan suggested is reasonable.  During an acute Crohn's flare, antibiotics can also be considered as well.  

If the symptoms continue, I agree that surgical options need to be considered.

Another GI opinion can be sought if the treatment plan continues be in question.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[lizziecee]

I forgot to mention that I am also taking omeprazole and domperidone but they have made no difference to the nausea and pain.