Yes, you should see a doctor for blood in your stools — whether or not you have Crohn’s disease. In patients with Crohn’s, bleeding usually signifies active disease in the large bowel or the perianal area. Perianal problems in patients with Crohn’s disease include fissures, fistulas, hemorrhoidal skin tags, and perianal ulcerations. Fortunately, many of these problems can be resolved if you and your doctor initiate the proper treatment in a timely fashion. Waiting to see your doctor is not a good idea. To give you some background, perianal fissures are tears or cracks in the skin of the anus that can cause bleeding. Fistulas are abnormal tunnel-like passages, lined with epithelial cells, between two organs; they are also a potential cause of bleeding. Hemorrhoids are lumps of tissue in the anus that contain enlarged blood vessels; they can bleed when a person is straining to have a bowel movement. Q2. What is the possible clinical significance of the colon appearing red upon both capsule endoscopy and colonoscopy? Prior biopsies showed mild to moderate acute chronic inflammation. Active inflammation in the intestines may result in a red appearance of the mucosa (or lining) of the intestine. There are other characteristic findings associated with active inflammation including ulceration and friability of the mucosa, which are typically seen in conjunction with red discoloration (also referred to as erythema). Mild redness without other characteristic findings of inflammation may be a non-specific finding not representative of inflammation at all. Biopsies are usually taken to confirm the presence of inflammation. Q3. Recently I had a bout of green feces. I have only had this one time before, when I was 13 and had my first Crohn’s attack. What does this mean? What causes it? Should I be a little concerned, concerned, or very concerned? Green stool color is no reason for concern. Most likely there is something in your diet — spinach, leafy green vegetables, or even food coloring — that is making the stool green. Green stool color is not an indication that your Crohn’s disease is active. Q4. What is Crohn’s colitis with granulomas? I have granulomas all over inside my colon. Do I need to be worried about this? About 10 percent of Crohn’s disease patients have granulomas (small inflamed bumps or nodules) on biopsy. Granulomas also can be seen in other diseases of the bowel like tuberculosis and sarcoidosis. As far as I know, granulomas in Crohn’s disease carry no adverse consequences in terms of complications or response to treatment. Q5. I’ve had Crohn’s for over 30 years. I recently had a polyp removed. And after much review, it was said to be a DALM or adinoma. My doctor now wants to remove my entire colon due to the risk of colon cancer. Is this really necessary? My Crohn’s has been very inactive, but I do have scarring throughout the entire colon. But to wear a bag for the rest of my life (I’m almost 50) just seems a little extreme because I might get cancer. Patients with inflammatory bowel disease have an increased risk of developing colon cancer compared to the general population. A DALM (dysplasia-associated lesion or mass) is a pre-malignant lesion sometimes found in patients with Crohn’s disease or ulcerative colitis. When these lesions are found on colonoscopy, removal of the colon is generally recommended because there is a high risk for additional pre-malignant or malignant lesions in the colon. Unfortunately, our ability to detect pre-malignant changes in patients with inflammatory bowel disease is imperfect. Therefore, it is important to understand and consider the risk of an undetected pre-malignant or malignant lesion if you choose not to have your colon removed. Q6. I have had Crohn’s for seven years now, and it has been that long since my last colonoscopy. I have been taking sulfa drugs to keep it in remission (and they’ve been effective thus far). Recently, my blood work showed my vitamin D was low, so I was placed on a supplement. My doctor wants me to undergo another colonoscopy, but my last one was extremely irritating. It was like a flare-up that lasted a good week-and-a-half. If the disease is in remission, what is the purpose of going through the pain of a colonoscopy? Patients with either ulcerative colitis or Crohn’s disease are at increased risk of developing colorectal cancer. Periodic cancer surveillance colonoscopy is recommended to minimize this risk. In the last seven years, colonoscopy preparation regimens have improved greatly and should not be as irritating as before. Also, our conscious sedation practice has improved in the last seven years, and there is less pain associated with colonoscopy. Q7. How frequently should a Crohn’s patient have a colonoscopy to evaluate the condition of the diseased area in the colon? Are other methods effective for this purpose? Not all Crohn’s disease patients need periodic colonoscopy. In patients who have a large portion of the large bowel (colon) affected with disease, cancer surveillance colonoscopy every one to three years is beneficial. Otherwise, I would consider colonoscopy only if there are symptoms that do not respond to Crohn’s disease therapy. This might indicate some other diagnosis, such as infection colitis or pseudomembranous colitis, which are both conditions that cause inflammation of the large intestine. Q8. What’s your opinion on the theory that Crohn’s is an infectious disease caused by Mycobacterium avium paratuberculosis? I’ve seen testimonies from many patients on different Crohn’s message boards who have not had symptoms for years now and feel they are cured. Mycobacterium avium paratuberculosis (MAP) has been purported to be a cause of Crohn’s disease. Unfortunately, research has not found this to be true. Only a few patients have had MAP cultured from intestinal tissue specimens and even fewer have responded to appropriate antibiotics. Still, there are some anecdotal reports of success with antibiotics aimed at these bacteria, such as rifabutin and clarithromycin. We need more research in this area. Learn more in the Everyday Health Crohn’s Disease Center.
