Q: My 17 years old daughter weighs 49 kg. She has been suffering from oral aphthous ulcers for the past six years. Four years back, she had urticaria (rashes 3-4 times a day) for eight months. Urticaria has resolved with homeopathy but ulcers are unrelenting and becoming more painful with age. She has been passing motion 4-6 times a day for over six months. She has also lost over 10 kg in the past two years. A recent colonoscopy showed ulceration in her small intestine. Crohn's and IBS have been ruled out. She has been on Normaxin (TDS), folic acid and other vitamin supplements for over a month with no respite. I am suffering from Takayasu's arthritis and am concerned that she should not have any autoimmune problem.

A:Aphthous ulcers can be associated with coeliac disease, Crohn's disease, Behcet's syndrome and some skin conditions. With associated diarrhoea, coeliac and Crohn's diseases should be considered. I see the patient had colonoscopy and this showed ulcerations in small intestine. Was it in terminal Ileum? What did the biopsies show? Exclude coeliac disease by doing blood test (TTG) or Jejunal biopsy. It is important to establish correct diagnosis before starting specific treatment.