How can a 29-year-old handle Crohn's disease with high CRP?

Question

Hello doctor,

I am 29 years old and was recently told that I might have Crohn’s disease after months of abdominal pain and diarrhea. My colonoscopy showed patchy inflammation in the terminal ileum and ascending colon. Biopsy revealed non-caseating granulomas. My fecal calprotectin returned at 740 µg/g, and CRP (c-reactive protein) is 21 mg/L. I also had anemia, Hb (hemoglobin) of 10.2 g/dL, and low iron. I am still waiting on the ASCA (anti-saccharomyces cerevisiae antibody) and pANCA (perinuclear anti-neutrophil cytoplasmic antibody) results.

Could you please help me understand what these values mean and if they suggest moderate or severe disease?
What treatment should I ask about at this point?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Your fecal calprotectin and CRP (c-reactive protein) suggest that there is significant inflammation in your gut. In normal individuals, calprotectin is between 50 and 120, but you have multiple-fold increased levels, which points towards inflammatory bowel diseases. In a colonoscopy, you mentioned the involvement of the terminal ileum, which suggests Crohn's disease.

Laboratory values alone cannot suggest the severity of the disease; instead, they indicate active disease. Along with laboratory values, imaging and colonoscopy findings, and clinical symptoms, decide the severity of the disease. Preventive measures to be followed are lifestyle modifications, diet control, stress and control, gut hygiene, and probiotics.

The probable cause is gut inflammation due to antigenic response, pro-inflammation, and genetic and environmental factors. Do CBC (complete blood count), vitamins and micronutrient profile, colonoscopy, endoscopy, MR (magnetic resonance) enteroclysis, and CECT (contrast-enhanced computed tomography) in case of abscess. The treatment needed is a multidisciplinary approach along with supplementary nutrition for anemia, hypoproteinemia, metabolites, and electrolyte maintenance.

Take steroids and topical agents for rectal inflammation and oral steroids with reduced systemic moiety for active diseases. Immunomodulators like 6-Mercaptopurine and Azathioprine can be taken. Take Ciprofloxacin 500 mg two times a day for four weeks or Metronidazole 400 mg three times a day for three weeks or 5-ASA (5-aminosalicylic acid) either rectally or systemically. Monoclonal antibodies are targeted against tumor necrosis factors.

All therapy is based on clinical and individual assessments and titrations. Surgery should be advised according to the imaging and clinical findings, and steroids are the mainstay of treatment for active flare-ups and remission. Kindly review the reports and feedback on treatment after a month.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.