Q. Do I have Crohn’s disease or ulcerative colitis?
Hello doctor,
Doctors are switching between whether I have Crohn’s or ulcerative colitis, based on the response to the treatment and medicine. I started Humira last month, but it has come in for my second round, and it is already a month late. I do not know if that worked or not since I am off schedule. The last week the area around my rectum, which is very raw, has swelled up. It is around where I have the seton in from a fistula. Last week, I had nothing but liquids. Every time I go to the bathroom, the area expands, causing excruciating pain. I am currently on Imodium and Flagyl. I have taken Advil and Tylenol. Nothing has reduced the pain.
Hello,
Welcome you to icliniq.com.
I know you must be very upset about your ongoing condition.
Your symptoms suggest that you have Crohn's disease, not ulcerative colitis. Humira and biological medications like this work for a while before losing effect until the next dose. So yes, if the interval between two doses is extended, the patient can develop flare in the interval period. The symptoms you mention may be of a mild to moderate intensity flare but can be secondary to infections, the Clostridium difficile infection, which is common. Did you not mention that the pain in the area of where you have seton is new or occurring before as well? And when did you have seton for fistula? The swelling you mention can be an evolving perianal abscess due to active luminal disease. The abscess formation is the first step in the formation of the fistula, which is an end result due to rupture of abscess from both side-lumen on one side and skin on another side. So I am afraid you may have this. Flagyl is good if taken for a long time to treat perianal disease, but you did not mention for how long you have been using this. For now, you can continue this and get yourself examined by your physician to look for evolving abscesses.
Adalimumab (Humira) works well for the perianal disease but make sure you need to increase the frequency and do not disturb the schedule.
I hope this will help.
Take care.
The Probable causes:
Crohn's disease with perianal disease.
Investigations to be done:Stool for c.difficle antigen and stool for calprotectin.
Stool detail report.
Stool culture.
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