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Crohn's Disease Forum » General IBD Discussion » Can a small bowel resection can cause chronic inflammation?


 
12-01-2015, 05:45 PM   #1
ImDan
 
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Can a small bowel resection can cause chronic inflammation?

Hi guys,

I was recommended to throw up a post here to see if anyone has any ideas on my situation. My doctor doesn't seem too interested in discussing symptoms or my history but just wants to give me a load of medication.

Basically I'm trying to decipher whether I do infact have Crohns, or if this is just Chronic inflammation leftover after an injury.

To go through my history,
In January I took a big hit (trauma) to my stomach while training muay thai kickboxing - this perforated my small bowel resulting in a resection. Nothing was mentioned post-surgery that they noticed any type of inflammatory condition - however it's possible they weren't looking for it and focused purely on the injury. It was only in a check up a few months after they noticed my small bowel still had inflammation. I don't have any of the classic symptoms such as abdominal pain or diarrhea at all.

Since then I've undergone the following tests: (i've included links to results if needed)
- Discharge Summary after small bowel resection (https://gyazo.com/051f3d6325865578730c3699173db2d5)
- CT Scan (April) - (https://gyazo.com/5c4503f8ef242059d47ca475c05bf8f0)
- CT Scan (June) - (https://gyazo.com/3a22d5d1fd7d895a423acf1b5b6941c3)
- Colonoscopy (https://gyazo.com/43f34b0614ed01fb7118c342435d7c6d)
- Promethius Blood Test (https://gyazo.com/98625505b2be90db7aa3972d741d6e7c)
- CT Enterography (November) - https://gyazo.com/08f31218bcba8fed65404be02083c35a

Do you guys think it's still possible I have chronic inflammation from the injury back in January? Or do i need to just accept that these tests are accurate enough to say I have crohns and start medicating. (Even though I'm not medicating symptoms I guess I'm medicating to reduce future damage). Or are there anymore tests you think would be worthwhile?

Thank you.
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  • 24 Years old - United Kingdom.
  • Colonoscopy, CT Enterography and Prometheus blood test consistent with CD. No symptoms so far.
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12-01-2015, 06:18 PM   #2
ronroush7
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Have you had a fecal calprotectin?
12-01-2015, 09:33 PM   #3
Trysha
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Hello Dan
Do you have a regular gastroenterologist you can talk to?
Some of the features you mention could be consistent with Crohns diagnosis such as stricture and inflammation involving the crypts.
It may be your unfortunate accident and surgery following it has caused the lab investigations to show the kind of picture that can occur with crohns.
Your gastroenterologist is the best person to answer your questions definitively
On this site people are fellow sufferers with you and not qualified to give any diagnosis
but can give the benefit of their experiences.
Hope this helps you
Trysha
12-01-2015, 09:56 PM   #4
ImDan
 
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Hello Dan
Do you have a regular gastroenterologist you can talk to?
Some of the features you mention could be consistent with Crohns diagnosis such as stricture and inflammation involving the crypts.
It may be your unfortunate accident and surgery following it has caused the lab investigations to show the kind of picture that can occur with crohns.
Your gastroenterologist is the best person to answer your questions definitively
On this site people are fellow sufferers with you and not qualified to give any diagnosis
but can give the benefit of their experiences.
Hope this helps you
Trysha
Yes that's exactly my fear - that my injury (which was an accident) has been replicating Crohn's symptoms? However from what I've read so far on the forum - it looks quite common for misdiagnoses with IBD.

I've been seeing a specialist in LA - but he only seemed to want to give me medication and had little interest in actually discussing my history. I don't have insurance at the moment either so everything has been out of pocket for me.

I'll be heading back home to Scotland soon and will be looking to get a referral to a specialist there.
12-02-2015, 12:34 AM   #5
Clash
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In reference to the scope have you asked the doc about the biopsies and what granulomas signify?

A lot of times we contact the GI office and speak with the GI nurse to voice questions or concerns. Our GI nurse has been a lifesaver. Anything she can't answer on the spot she discusses with the GI and gets back to us.

We can also email our GI office with our concerns or questions. So maybe that's an option.
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12-02-2015, 03:23 AM   #6
fuzzy butterfly
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Hi Dan on reading your reports it suggests to me that it is most likely crohns but im not a doc .. please get someone to ask about this . Can u get to see an IBD nurse they are usualy pretty good to go to for explainations.
Best wishes 💕
12-03-2015, 02:34 AM   #7
Jennifer
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I don't see how this could be caused by the old injury since it resulted in a resection which has since healed. Your resected portion should have automatically been sent off to pathology, did they find anything in that report?

No one knows what causes Crohn's and many have mentioned dealing with some type of stress before their diagnosis so I wonder if physical trauma may have kick started the disease. Your colonoscopy points to Crohn's because the inflammation is patchy and contains Granulomas which aren't found in UC. I'm going to tag David and see if he might have any suggestions or information.

If this is Crohn's then you have a unique opportunity to treat the disease before you experience any symptoms then again you may not have noticed that you've had symptoms for a while until they go away after treatment starts like fatigue, back or joint pain etc.
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Diagnosis: Crohn's in 1991 at age 9
Surgeries: 1 Small Bowel Resection in 1999; Central IV in 1991-92
Meds for CD: 6MP 50mg
Things I take: Tenormin 25mg (PVCs and Tachycardia), Junel, Tylenol 3, Omeprazole 20mg 2/day, Klonopin 1mg 2/day (anxiety), Restoril 15mg (insomnia), Claritin 20mg
Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
12-05-2015, 12:17 AM   #8
ImDan
 
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I don't see how this could be caused by the old injury since it resulted in a resection which has since healed. Your resected portion should have automatically been sent off to pathology, did they find anything in that report?

No one knows what causes Crohn's and many have mentioned dealing with some type of stress before their diagnosis so I wonder if physical trauma may have kick started the disease. Your colonoscopy points to Crohn's because the inflammation is patchy and contains Granulomas which aren't found in UC. I'm going to tag David and see if he might have any suggestions or information.

If this is Crohn's then you have a unique opportunity to treat the disease before you experience any symptoms then again you may not have noticed that you've had symptoms for a while until they go away after treatment starts like fatigue, back or joint pain etc.
That's a great point about my resection being sent to pathology. But I didn't hear anything about this. Maybe they didn't bother because it was an injury and they didn't assume anything was underlying?

I guess it's a difficult decision in how hard i want to treat it at this stage. I feel like biologics just delay the inevitable and maybe I should save them for when I have symptoms and need them to be really effective?
12-05-2015, 12:20 AM   #9
ronroush7
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Maybe you can stop the symptoms or put them in remission.

12-05-2015, 04:17 PM   #10
buttER
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Where are you near to when you are back in Scotland? There are a few Scots on the site, perhaps they can give you recommendations about who to see.
12-15-2015, 04:47 PM   #11
Jennifer
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That's a great point about my resection being sent to pathology. But I didn't hear anything about this. Maybe they didn't bother because it was an injury and they didn't assume anything was underlying?

I guess it's a difficult decision in how hard i want to treat it at this stage. I feel like biologics just delay the inevitable and maybe I should save them for when I have symptoms and need them to be really effective?
Maybe you could contact the hospital and ask if there's a pathology report or just get all of your records from there.

Without any treatment you're likely bound to run into the inevitable but there's no way of knowing when that would be. Taking maintenance medication helps to get people in remission and keep them in remission. It's a lot easier to keep the disease under control this way then to treat it only when symptoms become unbearable. There are many other medications out there if you feel you aren't comfortable with biologics just yet.

The choice is definitely up to you. I hope you're able to find a good GI when you get back home. I believe Grumbletum is out in Scotland so maybe they will know other members who may know of a good GI out there as mentioned above.
12-27-2015, 09:46 PM   #12
David
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Hi Dan.

As you train Muay Thai, might I suspect that you regularly take blunt force trauma to the abdominal region and have been for years now?

Do you have ANY other weird symptoms? Rashes, eye issues, tingling anywhere, constipation, etc etc. ANYTHING?

Do you regularly take ibuprofen such as advil, motrin, etc?
12-28-2015, 11:32 AM   #13
ImDan
 
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Hi Dan.

As you train Muay Thai, might I suspect that you regularly take blunt force trauma to the abdominal region and have been for years now?

Do you have ANY other weird symptoms? Rashes, eye issues, tingling anywhere, constipation, etc etc. ANYTHING?

Do you regularly take ibuprofen such as advil, motrin, etc?
Hi David, thank you for your reply.

I have trained for several years, the trauma to my stomach hasn't been anywhere too excessive. I have not had a professional fight so never had 100% power contact. I've also been hit alot harder than the injury that put me in hospital. I felt dizzy at one point after a take-down onto a mat and sat down for 10 minutes. I felt fine after that and carried on with the session. It was only hours later that night I started having stomach cramps. It was the next day I went to a local DR who told me it was fine and later that day I started vomiting and getting such bad pain I was rushed to emergency hospital.

I haven't taken much of any of those tablets. I'm lucky enough to not get headaches very often and I usually let them pass themselves as I don't like taking medication unless I really have to. The only medication I have taken much of was hayfever (allergy) medicine as a kid, usually 1 per day of cetirizine.

As for weird issues this is everything I can think of:
- Since surgery sometimes a weird sensation in my lower right quadrant (NOT pain - just sometimes a weird feeling that doesn't last long). I believe this is where the resection was and where the inflammation is. However I wouldn't be surprised it was all in my head...sometimes worrying about symptoms can make them happen lol.
- Swollen lymph nodes in groin area. These have been swollen for years and I even had a blood test when it first happened that showed my red/white cells are normal so I was assured it was OK. I also had a weird one come up on my left cheek near my ear recently.
- My eyes are fine, I've always had a slight focus issue in my right eye but nothing I need glasses for
- Occasionally I sweat quite alot in my sleep
- I usually need to go to the toilet shortly after eating breakfast and dinner, I always assumed this was my metabolism as I have always been quite thin (not quite underweight though).
- Usually after training with hard exercise, I will get quite shakey afterwards. This might last an hour or so and I have always wondered but could never quite pin-point why it is. I always assumed it was a come-down of adrenaline or something?

That's all I can think of for now. Thanks for your time!
12-28-2015, 10:24 PM   #14
ronroush7
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Hi David, thank you for your reply.

I have trained for several years, the trauma to my stomach hasn't been anywhere too excessive. I have not had a professional fight so never had 100% power contact. I've also been hit alot harder than the injury that put me in hospital. I felt dizzy at one point after a take-down onto a mat and sat down for 10 minutes. I felt fine after that and carried on with the session. It was only hours later that night I started having stomach cramps. It was the next day I went to a local DR who told me it was fine and later that day I started vomiting and getting such bad pain I was rushed to emergency hospital.

I haven't taken much of any of those tablets. I'm lucky enough to not get headaches very often and I usually let them pass themselves as I don't like taking medication unless I really have to. The only medication I have taken much of was hayfever (allergy) medicine as a kid, usually 1 per day of cetiri

As for weird issues this is everything I can think of:
- Since surgery sometimes a weird sensation in my lower right quadrant (NOT pain - just sometimes a weird feeling that doesn't last long). I believe this is where the resection was and where the inflammation is. However I wouldn't be surprised it was all in my head...sometimes worrying about symptoms can make them happen lol.
- Swollen lymph nodes in groin area. These have been swollen for years and I even had a blood test when it first happened that showed my red/white cells are normal so I was assured it was OK. I also had a weird one come up on my left cheek near my ear recently.
- My eyes are fine, I've always had a slight focus issue in my right eye but nothing I need glasses for
- Occasionally I sweat quite alot in my sleep
- I usually need to go to the toilet shortly after eating breakfast and dinner, I always assumed this was my metabolism as I have always been quite thin (not quite underweight though).
- Usually after training with hard exercise, I will get quite shakey afterwards. This might last an hour or so and I have always wondered but could never quite pin-point why it is. I always assumed it was a come-down of adrenaline or something?

That's all I can think of for now. Thanks for your time!
Maybe ,from repeated punching, it built up and caused stress.
12-29-2015, 08:53 PM   #15
David
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Hi Dan,

Based upon all the test results and everything you've described, I suspect you do indeed have Crohn's. I personally advocate a top down approach to treatment meaning I'd use the big guns first.
12-30-2015, 10:23 AM   #16
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Hi Dan,

Based upon all the test results and everything you've described, I suspect you do indeed have Crohn's. I personally advocate a top down approach to treatment meaning I'd use the big guns first.
So I just managed to visit a GI back in Scotland. He agreed he thinks I have Crohn's, especially given the granulas result from my Colonoscopy.


The GI I saw in California strongly suggested a top-down approach using biologics, however the doctor here said there is not enough evidence to prove that top-down is more effective than bottom-up. He also added that the NHS will only give you those here as a last chance resort if symptoms aren't treated by any other drugs, whereas in America health insurance covers it.

He has given me lower dose of the budesonide to come off it over 2 months, and said It's up to me if i want to stop the pentasa as it's overall not very useful. (Since I have no symptoms it's impossible for me to tell what is working either).

So I've been given the option to either take Azathioprine and deal with the long-term side effects of it. Or stay unmedicated to avoid the side-effects and just get regular check-ups to keep track on the disease.

I feel really frustrated and confused what the best course of action should be?

Also as a side note. I asked about the original injury and he reckons Crohn's caused a weekness in my small bowel, resulting in the injury happening. But he said he's happy for me to live my life as normal and keep training muay thai, and even compete, and said I'm not at any higher risk of injury (even with a stricture). Does this sound right?
12-30-2015, 11:26 AM   #17
ronroush7
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I'm no expert but I would be cautious about the training. It is a shame the health care.

12-30-2015, 01:11 PM   #18
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Stricturing from scar tissue is usually a more inflexible area of intestine that the build up of scar tissue has narrowed. I don't see any reason this would affect training.

Inflammation can also cause swelling which causes narrowing or stricture. When my son had narrowing from inflammation he was on the varsity football and wrestling teams and found that a lot of physical activity drained him and made the area of his abdomen where the active inflammation was tender.

For the last 2 years my son has had active CD with no symptoms. Being asymptomatic is hard because though he isn't experiencing symptoms the disease was progressing. He finally required surgery and now is on new meds yet the disease is still active and he is still asymptomatic.

Because even simmering inflammation can cause permanent damage I would be hard pressed to for go meds. The goal isn't to have no symptoms of active disease but to reach, deep stable remission(which includes clinical, endoscopic and histological) with mucosal healing. This promotes long periods of inactive disease and lowers the risk of permanent damage which of course lends itself to being able to perform at higher levels physically in all activities.
12-31-2015, 04:38 PM   #19
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Stricturing from scar tissue is usually a more inflexible area of intestine that the build up of scar tissue has narrowed. I don't see any reason this would affect training.

Inflammation can also cause swelling which causes narrowing or stricture. When my son had narrowing from inflammation he was on the varsity football and wrestling teams and found that a lot of physical activity drained him and made the area of his abdomen where the active inflammation was tender.

For the last 2 years my son has had active CD with no symptoms. Being asymptomatic is hard because though he isn't experiencing symptoms the disease was progressing. He finally required surgery and now is on new meds yet the disease is still active and he is still asymptomatic.

Because even simmering inflammation can cause permanent damage I would be hard pressed to for go meds. The goal isn't to have no symptoms of active disease but to reach, deep stable remission(which includes clinical, endoscopic and histological) with mucosal healing. This promotes long periods of inactive disease and lowers the risk of permanent damage which of course lends itself to being able to perform at higher levels physically in all activities.
Thanks for the information. Maybe I am too asymptomatic. Is this caused by where the inflammation is located? I believe mine is located in the terminal ileum at the join from the small bowel.

What tests do you use for keeping track when asymptomatic? I asked about a fecal calprotectin that Ron mentioned, however they said it's not something they do here.

What drugs is your son currently on if you don't mind me asking? Do you also believe a top-down approach is best - so going straight to the hard stuff (biologic injections) even at this early of a stage?
12-31-2015, 04:51 PM   #20
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When my son was dxed (his was located at terminal ileum and the ileocecal valve so same place as yours) his was severe and at that time he was symptomatic. No D but mouth ulcers, joint pain, night fevers and abdominal pain.

Since he was pediatric we opted for top down because studies have shown starting biologics within 2 years of dx decreases the risk for permanent damage leading to surgery. So he was started on remicade. All of his symptoms were gone after the first dose.

C, my son, may not respond well to tnf blockers (unfortunately this is the case for some). So after 2 years of being asymptomatic it was determined his disease was progressing and surgery was warranted.

After surgery he was started on humira, still no symptoms but at 3 months scope his inflammation was active at surgical site. 6 months later it has spread from small bowel throughout large bowel to rectum. Still no symptoms.

He has used fecal calprotectin as Ron had mentioned because for him blood work inflammatory markers stay fairly normal. But for most blood work that includes checking the CRP (inflammation marker for whole body) is a good indicator.

I've seen great results for members on here that started with top down. But I think most important no matter the treatment is to not become complacent. Kick the med to the curb and move on if symptoms persist or tests are consistently out of range.
12-31-2015, 09:02 PM   #21
Catherine
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ImDan

I am from Australia, we have a similar system to Scotland. My daughter also doesn't have anything in the way of symptoms until she is really sick. No bowel symptoms at all.

Faecal calprotecton testing is becoming more common. Things to look out for low iron (ferritin) And hemoglobin. Try and work out what your normal levels are. These will usually decrease when the Crohn's is active. They don't alway go out of range at first but they will trend down.

There are new studies showing keeping vitamin D levels at the high end of normal are a good idea.
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Currently no supplements.

Has previously taken Multi B, Caltrate, B12 & Iron

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Last edited by Catherine; 01-01-2016 at 08:08 PM.
01-01-2016, 11:59 AM   #22
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Hi Dan!

Maybe you're just asymptomatic? I do have loose stool, extended bathroom visits, intermittent cramps and a fistula, but since I don't have outright diarrhea and pain, and can generally have a bit of a life, my doctor says that I'm pretty asymptomatic.
Either way, good luck!
01-15-2016, 06:08 PM   #23
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My GI has taken me off Budesonide and Pentasa and given me 2 options, either unmedicated or Azathioprine.

Since I'm still symptom free after being off the steroid medication, do you guys think Azathioprine is an appropriate one for me to be on? Some of the side effects look pretty unfavourable. Is Azathioprine the best you can get to top-down treatment without having access to biologics?
01-15-2016, 06:17 PM   #24
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The immune modulators include imuran(azathioprine) 6mp (sister drug to imuran) and methotrexate. Some GIs prefer to try mtx in young adult male population due to certain risk profiles with the thioprines. But azathioprine is a long standing med and is a step under biologics.
01-15-2016, 06:37 PM   #25
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I have been on azathioprine for years now. Just make sure your doctor checks your blood regularly.

01-16-2016, 06:45 AM   #26
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I have been on azathioprine for years now. Just make sure your doctor checks your blood regularly.
Do the blood tests check for pancytopenia or to see if they're keeping away the inflammation?
01-16-2016, 09:35 AM   #27
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After one of the blood tests they cut the amount of Imuran in half .

01-17-2016, 10:56 PM   #28
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Untreated Crohn's is far scarier than the potential side effects of azathioprine in my opinion.

With that said, in my opinion, he should have left you on those meds while waiting for the aza to reach optimal levels in your system.
01-18-2016, 04:17 AM   #29
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My GI has taken me off Budesonide and Pentasa and given me 2 options, either unmedicated or Azathioprine.

Since I'm still symptom free after being off the steroid medication, do you guys think Azathioprine is an appropriate one for me to be on? Some of the side effects look pretty unfavourable. Is Azathioprine the best you can get to top-down treatment without having access to biologics?
This is pretty much where I am too. The colonoscopy last year showed some active inflammation returning, and I was expecting to start Aza but my symptoms remain mild and a course of Budesonide did seem to improve things. The consultant said it wasn't clear if I needed the treatment or not, so I opted to wait and see.
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01-18-2016, 01:45 PM   #30
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My goal is to avoid medication for as long as possible, diagnosed in 1990 with mild symptoms until recently. Have SBO with scar tissue, surgery in February. I may be naive but I feel that letting my own body do as much of the healing as it can is important. I don't eat anything processed, only locally grown and sourced foods. I feel like a hypocrite feeding my body medications with strong chemicals that appear to cause many adverse side affects-some worse than the original disease. I feel so fortunate to be relatively healthy-2 surgeries and a couple blockages. I certainly don't judge those who need medications to feel better-just my own personal opinion at this stage of my journey with Crohn's.
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