Does my son at 22 need biologics for Crohn’s disease?

Question

Hello doctor,

My 22-year-old son has Crohn’s disease and keeps losing weight despite eating well. He gets abdominal pain and diarrhea at least three to four times a week. He is on Azathioprine and steroids, but symptoms persist. Please tell me,

Could this mean the disease is not under control?
What are the next treatment steps, do we need to consider biologics or surgery?
Is there a risk of long-term complications like colon cancer?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

If he is still losing weight and having frequent pain and diarrhea despite Azathioprine and steroids, it usually means the inflammation is not fully under control. Crohn’s can smolder silently between flares, so symptoms persisting like this suggest ongoing disease activity. The probable causes of this include active Crohn’s inflammation in the bowel.

Investigations that you can do are;

Fecal calprotectin (to gauge inflammation)
Colonoscopy and imaging to assess the extent and severity
Blood tests like complete blood count (CBC), CRP (C-reactive protein), and ESR (erythrocyte sedimentation rate)
Liver and kidney function tests.
Nutritional profile (vitamin B12, vitamin D, iron studies)

Your treatment plan includes;

If tests confirm ongoing inflammation, a gastroenterologist may escalate therapy to biologics, such as infliximab and Adalimumab.
Surgery is considered if there are localized strictures, fistulas, or sections, or any other issue in your gastrointestinal tract.
Meanwhile, he should keep your diet soft and nutrient-dense; supplement with protein shakes and vitamins as advised.
He should avoid NSAIDs (non-steroidal anti-inflammatory drugs) and smoking.
Continue your current medications until specialist review.

I hope this information helps you.

Feel free to ask further queries.

Thank you.