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Crohn's Disease
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Posted 12/8/2009 1:59 PM (GMT 0)
Hi All! I've only posted a few times but you all have been very helpful so I thought I'd toss another question out there.  I haven't been formally diagnosed with Crohn's (I am having a colonoscopy next week) but I have had blood work done and I was wondering if anyone else has had these results (or close to them) and then been diagnosed with Crohn's following a colonoscopy, small bowel series, pillcam, etc.  Please let me know what you think - I'm currently going through a bout of diarrhea that is not too fun!  I know the sed rate is inflammation and the others are Crohn's markers but I also know that typically doctors don't put too much stock in these results.  Just thought I'd try to get a little clarification from some experts!  Thanks again! Erythrocyte Sedimentation Rate     Latest value registered: 30.0 mm/hr. Normal: 0-20.0 mm/hr Saccharomyces Cerevisiae Ab.iga Latest value registered: 31.3 units. Normal: 0-24.9 units Saccharomyces Cerevisiae Ab.igg Latest value registered: 33.7 units. Normal: 0-24.9 units
Posted 12/8/2009 2:27 PM (GMT 0)
I don't have an answer for you, but you can go to labtestsonline.org and put in these tests and see what it says. Good luck!
Posted 12/8/2009 5:50 PM (GMT 0)
The latter two sound like they might be Prometheus lab results, don't you think?
Posted 12/8/2009 7:42 PM (GMT 0)
The sed rate looks like it is either at the upper limit, or over, the normal range. The upper limit varies depending on gender and age:

http://www.aafp.org/afp/991001ap/1443.html

Sed rate is useful for detecting inflammation, and is used by doctors everywhere. However, it is useful to have a CRP test because CPR levels tend to rise faster (detecting inflammation sooner) than sed rate, and also fall faster (in response to declining inflammation) than sed rate. My daughter usually gets both tests. 

The two Saccharomyces Cerevisiae tests are mainly used to help confirm Crohn's (elevated levels indicate it is Crohn's), but also todistinguish Crohn's from Ulcerative Colitis. According to the following link, they don't seem to be useful for identifying the extent of Crohn's, nor are they any help in determining response to therapy.  Therefore, there is no need to have the cerevisiae tests done, again:

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/83022

 

Posted 12/9/2009 12:11 PM (GMT 0)

Thank you all for your insight.  I'm 29 so it seems the Sed rate is high for my age.  And since I tested positive for both antibodies, maybe that means I have it somewhere? I don't know - it's all so confusing!  This will be my 2nd colonscopy this year (had one in January) and it was clear except internal hemmies.  I know one thing - this round of diarrhea is unrelenting!  I just hope to have some clear cut answers after the procedure.

Thanks again!

Posted 12/9/2009 1:31 PM (GMT 0)
Remember it is entirely possible to have active Crohns in your small bowel even with a normal colonoscopy, since the scope can only visualize a small segment of the terminal ileum under the best conditions. If your next scope does not show colonic involvement, given the lab results you posted, I would suggest asking your GI about a small bowel follow through series of xrays or a pill camera test to see what is going in in the ileum. I think the figures are 40% of Crohns patients have ileal and cecal involvement, with the rest about evenly divided between primarily colon or primarily small bowel. You could very well be one of those with disease primarily above the terminal ileum. One thing, a clean colonoscopy probably rules out ulcerative colititis!

Posted 12/9/2009 3:27 PM (GMT 0)
Thanks MikeB.  I think it is very interesting you mentioning those specific areas.  Those are close to the appendix, right?  The reason I ask is that 2 years ago (Nov 2007) I had an appendectomy.  I went to the ER and they said acute appendicitis and removed it.  I remember clearly the doctor mentioning I had one of the longest ones he had ever seen!  I read somewhere there may be a link between appendectomies and Crohn's Disease/UC.  I will definitely bring all this up to my GI after my colonoscopy.  She mentioned the next step would be the pillcam if the colonoscopy came out clean so I'm hoping that really soon I'll have an answer.   Thanks again!
Posted 12/9/2009 7:01 PM (GMT 0)
I have heard speculation about a link between appendectomies and Crohns in the past, and on one occasion a thread here explored it. The consensus seemed to be no clear connection. I myself still have my appy at 62 after developing Crohns at age 19 . . . and since the general scientific consensus remains that Crohns is very likely caused by a genetic susceptibility to experiencing a runaway autoimmune reaction to some external stimuli (bacteria probably), an inflamed appendix (not the surgery) could well be a triggering event for some people who are already genetically set up to develop the full blown disease. Yes the appendix dangles off the lower end of the cecum, a few inches below the ileosecal valve where the small bowel empties into the colon, but an appendix connection would not explain CD located higher up in the small bowel, and certainly not in the rectum. Overall your GI seems to be proceeding wisely and I hope you get a defiintive diagnosis soon.
Posted 12/10/2009 12:31 AM (GMT 0)
I think that being diagnosed is largely clinical - for example, I have Crohn's Colitis, they can't determine which. I had the Prometheus lab work done and $550 later (not covered by insurance) they said I was in the small percentage where they just don't know.

It's trial and error, they treat the symptoms and try to look at your overall picture, where your inflammation is, what medications you are responding to, your past medical history, etc.
Posted 12/10/2009 12:49 AM (GMT 0)
Your prometheus lab tests seem positive but just barely. Mine ASCA IgG was 129 and my docs still poo-poo the test. lol... Sometimes tests don't reveal what is going on clinically. Have they done stool testing yet? Your doctor needs to rule out other reasons for diarrhea. Have they checked you for celiac? Have you lost weight? Do you think you are lactose intolerant? Many people go on a low residue diet if they have diarrhea and are very careful about what they eat.
Posted 12/10/2009 1:03 PM (GMT 0)

I know my test scores aren't off the charts - and like you said even if they were it probably wouldn't amount to a hill of beans as far as the doctor is concerned.  I'm not lactose intolerant, I have had stool tests done and I tested positive for shigella.  I went through 2 rounds of antibiotics to kill it.  In fact, that's what they thought was causing my issues initially.  But here I am - back at square one!  I've only lost about 5-10 lbs and that fluctuates.  I have also been checked for celiac - negative.  This is my 3rd GI doctor in a year.  The first one did my initial colonoscopy back in January (with no biopsies) announced it clean and sent me on my way.  The 2nd one ended up doing the stool tests, small bowel series and a upper endoscopy (with biopsies).  Again, all clear except for the shigella.  He ended up trying to put me on anti-depressants and made me feel like I was crazy!  So, now I'm on to the 3rd (and hopefully) last GI.  She actually had colon cancer herself and while I'm sorry she went through that, I am thankful that I'm working with someone who has kinda been through the process (although her situation is way different!) and understands the ups and downs of diagnosis.  She tells me we'll get to the bottom of it and I hope she's right!  I just have a gut feeling (no pun intended!) that I have Crohn's but really think the only way they will see something is with the pillcam which is the next step.

Thanks everyone for your feedback - it is much appreciated!

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