How to treat Crohn's disease and fistulas?

Question

Hello doctor,

I am a 28-year-old woman experiencing severe abdominal pain, non-bloody diarrhea, and perianal skin tags that have developed over the past year. My CT enterography showed thickening and inflammation in my terminal ileum with some stricturing, and my CRP is elevated at 45 mg/L with low vitamin B12 at 180 pg/mL.

I have developed painful mouth ulcers, and my calprotectin is very high at 800 μg/g, indicating significant intestinal inflammation. I have lost 12 pounds and have chronic fatigue that is affecting my work performance.

Could this Crohn's disease lead to bowel obstructions or fistulas, and am I at risk for malnutrition, osteoporosis, or developing kidney stones from malabsorption?

Please help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I understand your concern.

Your symptoms, CT (computerized tomography) findings, high calprotectin, and raised CRP (C-reactive protein) strongly suggest Crohn’s disease, particularly involving the terminal ileum. The perianal skin tags and mouth ulcers also fit with this diagnosis.

Crohn’s disease can cause bowel narrowing (strictures), which may lead to sub-acute or acute bowel obstruction if inflammation is not controlled. It can also form fistulas around the intestine or perianal area, especially with long-standing active disease.

Because the ileum is affected, there is a risk of malabsorption, especially of vitamin B12, iron, and vitamin D. This can cause weight loss, fatigue, anemia, and weak bones (osteoporosis) if not treated.

Patients with Crohn’s disease also have a higher risk of kidney stones, mainly due to fat malabsorption and dehydration during diarrhea episodes.

With early treatment using anti-inflammatory and immune-modifying medicines, along with nutritional correction, these complications can be largely prevented, and most patients are able to return to normal work and daily life.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.