Crohn's in pouch without granulomas?

While granulomas are diagnostic for Crohn's, they are not found very often. In those cases, the diagnosis is based on which way the scales are tipped, with UC on one side and Crohn's on the other. There is newer thinking that IBD is a spectrum of diseases, not just UC and CD. Realistically, it does not really matter (once you have a j-pouch), as you pretty much go through the same treatment protocols. It mostly is important if you are considering initial j-pouch surgery.

If it were me, I would be relieved to be just treating this as Crohn's as long as it was effective. The big question will be if Humira is effective once the steroids are stopped. You may need methotrexate in addition. For me, my pouch function and endoscopic results improved greatly since starting Humira, and I never had a Crohn's diagnosis (at least not yet).

Oh, snd yes, chronic active IBD can cause an elevated neutraphil count. Doesn't matter which type. Actually, any chronic inflammation can.

Jan

Thanks Jan, If there is a chance it's chronic pouchitis will the prednisone and humira help or hurt it? Would chronic pouchitis make my neutrophil count high as well? I've been being treated for chronic fissures, he didn't say but I'm wondering if that's also making him lean toward the crohn's dx?

Yes, any chronic inflammation can cause an elevated neutraphyl count. And, yes, perianal disease is another indication this might be Crohn's. You have to remember that pouchitis can be caused by several different things, but mostly boils down to IBD response (pouchitis seldom occurs in those without IBD). So, just like colitis, any particular treatment may or may not be effective. You've already noticed improvement with the prednisone, but you can't stay on it long term. That is the reason for the Humira.

Jan