Suggest Management Of Crohn S Disease With IBS

Hi this is Dr. Subhadeep.I can understand your concern. There are lot of aetiologies for crohn s disease like infections due to M.Paratuberculosis Atypical Mycobacteria,Immunologic,Genetic,Enveronmental,Ethnic background and Smoking,food allergy.if u r a smoker quit smoking it will help in reducing your BP and your symptoms. Kindly get your blood urea,sr.creat and sr.albumin and urine albumin levels as crohn s disease can cause Nephrotic syndrome and it can attribute to hypertension. You have already undergone ileocaecal valve resection but still the symptoms are persisting so let me guide you:- USG,Contrast CT(better),Barium meal follow through or Small bowel enema,Colonoscopy to see colon invovement,Blood tests for anaemia,protien loss,mineral,trace element loss,raised CRP and Orsomucoid in active disease. Capsule endoscopy or MRI will be more helpful. Medical treatement 1)Protein and Vitamin supplementation. 2)Steroids for remission 20-40mg/day of prednisolone for 3-6 weeks.Methylprednisolone infusion iv 60mg/day for 5-7 days combination of Budesonide and Mesalamine combination can be suggested as alternate first line therapy under strict guidance of treating surgical gastroenterologist. 3)Azathioprine or Tacrolimus,Cyclosporine,IL2 for maintenance. 4)Metronidazole to suppress cell mediated immunity and antibacterial. 6)In severe refractory cases Monoclonal antibody like Infliximab single dose for induction later on 2nd week,6th week and then once in 8 weeks at a dose of 5mg/kg. This options to be implemented only after consulting your treating surgical gastroenterologist. If all these options fell and CT or Colonoscopy or Capsule endoscopy or MRI shows colonic involvement then surgery to be done to treat complications.as you have already told that you underwent Ileocaecal resection and still symptoms are persisting so if medical therapy fails then options are 1)Segmental resection conservative resection better 2)Total colectomy and Ileorectal anastomosis. 3)Right hemicolectomy occasionally or emergency Colectomy in extensive severe colitis but with rectal sparing 4)Laparoscopic resection is a better option. So my advise is to get CT/MRI/Capsule endoscopy/Colonoscopy and discuss with your treating Surgical Gastroenterologist and to implement as per his advise.Hypertension medications as per physician. Regards Dr.Subhadeep Tripathy