Expert: Odette Yuhas - 3/6/2005

Question
Basically, I want to know if it is possible to have Crohn's without obvious bowel lesions?

I am a 30 yr old female, history of 10+ yrs diarrhea and abdominal pain, occasional blood in stool.

Over the past 3 months the abdominal pain has increased dramatically, to the point where I had gone into the ER several times and was on morphine for nearly a month. I have just discontinued the morphine as I didn't want to become dependant on it. So I am back in a very high level of pain and find my activities greatly curtailed. I had a colonoscopy done about 2 weeks ago, which didn't show any gross lesions in the colon or distal ilium.

I have also in this 3 month period developed erythema nodusum, iritis and joint pain. The morphine masked the majority of the joint pain while I was on it, but since weaning off it I am having extreme difficulties with it (I will have to stop typing after this brief blurb as my fingers are too sore) I cannot pick up my children or anything slightly heavy. I cannot walk more than 200 meters before having to alter my walking pattern to accomidate the pain in my hips/knees/ankles. Even each individual toe joint hurts. Some swelling and mild redness of joints that are complaining the loudest. Basically every joint in my body hurts, to varying degrees, at varying times. Activity increases the pain if continued over a short period of time.

I have been on treatment for the iritis for a bit over a month now, and have been attempting to cut back on the eye drops from 4 to 3 x a day as recommended by the opthamologist. However within 3 days of cutting down it is flaring again. The first time I called and they said to go back up to 4 for another week, this is the second attempt and I will obviously have to go back up because my eye is not happy.

Basically I am trying to figure out if this is not something digestive related (as per scope being a little too "good" to say - bingo: must be an inflammatory bowel disease). I feel that this must be an autoimmune response of some type (though I am open to the thought that it may not be - so feel free to disagree). I am seeking any input on how to deal with symptoms, or questions to ask of my Dr. I cannot do 90% of the daily activities that I was accustomed to doing before this, which with 2 children 5 and 3 yrs of age, really stinks.

Any thoughts or advise would be great. I am going in for a small bowel study (swallow) in a couple of weeks (had one 7 yrs ago that showed suspicous areas). I am having great difficulty managing the pain and disability that has been going along with this.

Answer
Hi Michelle,

It sounds exactly the same symtpoms I had when I 1st got diagnosed.  Please see the doctor, ask for a CT scan.  Blood in stools is very dangerous.  If this is Crohn's disease, it is nothing to fool around with.  It can be very serious if not treated!  Joint pain is also a sign of CD,  the eye problem I have had as well.  They called it Herpies of the eye which is not uncommon again, with CD. Could be IBS, IBS, but with the blood in the stools, it sounds more than that.  Ask your doctor for a CT scan. If you are not seeing a GI, then please do so.  It may be something that is not major but could also be the other way.  If you do have CD, don't worry, with the right meds, you can lead a normal life and be as energetic as you have to be with those sweet babies.

If there is anything else I can do, let me know.

Best of health,
Odette