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Small bowel wall thickening

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Crohn's Disease
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Posted 11/30/2010 4:17 PM (GMT 0)
Hi i am new on this and am just looking for a bit of advice.  I have been having sever abdominal pains and diarehea for the past 5 months.  I have been to a GI specialist who has sent me for upper and lower scopes which came back fine.  I have had ultrasounds done on liver pancreas kidneys etc fine.  On my x-ray the last part of my small bowel looks slightly inflamed so he has reccomended i have a capsule endoscope to check this out.  Can any one advise what this could be?  He says if this is normal then it is most likely irratble bowel syndrome but would this really cause so much pain?  The diarehea stopped 2 weeks ago after having it each day and has not resulted in constipation
Posted 11/30/2010 4:28 PM (GMT 0)
Hi Shaun! Welcome to the forum.

A capsule endoscopy is a camera that you swallow. There is really no other way to visualize the small bowel. You should talk to your DR about the risks of this procedure. I've heard that some people first swallow a dissolving capsule to make sure that there's enough room in your bowel to pass the camera. If the capsule passes, then the camera will, too. If the capsule doesn't pass, then you cannot swallow the camera without being at risk for surgery to remove it.

I would love to swallow the camera to answer my own questions about the state of my small bowel, but no one's suggested it to me! There are some on this forum who have done this test. You can post another question with 'capsule endoscopy" in the title and get specific advice.
Posted 11/30/2010 5:17 PM (GMT 0)
I think the pill cam is one of the best test to diagnose Crohns in the small bowel. The colonoscopy can only go so far. The pill cam will take pictures all the way thru your digestive system and will show Crohns where other tests might miss. Good luck!
Posted 11/30/2010 7:20 PM (GMT 0)
You referred to having an Xray of your small bowel - is that what you had, a regular x-ray?
Or some other test like a CT Scan or MRI or series of xrays after you drank contrast medium?

The pill cam is a great diagnostic tool but, like everything, it has it's strengths and weaknesses.

It does let the doctors see actual pics of the inside of your small bowel where there is no other way to see. This can be very helpful.

The main problem with the pill cam is that it has to be pointed at a problem for it to take a picture of the problem. Since the docs can't control the speed or direction of it's progress through your bowel it may under or over represent the degree of inflammaiton/problems in your small bowel. If it happens to be pointed at an ulceration for a long time then you get lots of pics of an ulcer. If it happens to pointed away from the ulcer, then you may get lots of pics of perfectly fine bowel.

It can get stuck and require surgical removal but this is a very rare problem and is unlikely if other imaging like xrays or ultrasound have not shown extensive inflammation and swelling or narrowing (stricturing) of the bowel.

You may want to ask your doctor about having an MRI-Enterography instead of or in addition to the pill cam. You drink some contrast and then they take an MRI of your abdomen. Many places like Mayo now use this procedure a lot for imaging the gut because it is so effective (provided you have a trained radiologist) and safe. No radiation exposure and nothing that could get stuck like the pill cam.

Post Edited (rlsnights) : 11/30/2010 12:23:21 PM (GMT-7)

Posted 11/30/2010 8:23 PM (GMT 0)
Since Crohn's tends to focus on the terminal ileum in most, but not all, Crohn's patients, then a colonoscopy can at least see this far into the small bowel. Based upon what the X-ray revealed,  which sounds like classic Crohn's (inflammation of the terminal ileum) your doc was probably unable to get into the terminal ileum during the colonoscopy because it was too inflamed. You can ask him how far he was able to see.

Now, here's the problem. If the area was so inflamed and narrowed that he couldn't get into it, then why the heck would he chance using a camera pill? These can and do get stuck in Crohn's patients.  Seems the title of your post indicates there IS narrowing because "small bowel wall thickening" does lead to narrowing. More than one poster on this forum has had to have surgery because of a stuck pillcam. My own daughter's docs, knowing she could have a stricture if inflammation returns, have not recommended the pill cam for her. 

Do you have any symptoms right now?

Post Edited (njmom) : 11/30/2010 6:50:05 PM (GMT-7)

Posted 11/30/2010 9:40 PM (GMT 0)
The pill cam test is probably the easiest test that you will ever do. Make sure that you insurance will cover it because some insurances require that you do other tests prior to it because it is not cheap. I have done this test several times and it is the only way to really see the inside of the small bowel. CT scan, MRIs, and CT enterography will show inflammation and are great tests but they do not give the visual that the pill cam does. The likelihood of it getting stuck is extremely low and I would not hesitate do the test. Risnight, have you ever done the test or seen the actual dvd of it? It is very good at capturing the whole bowel and the doctor can pause it if he needs to slow it down to look at an area more. It will see the whole bowel reguardless of how it is pointing and they can still zoom in on an area if needed on the computer. I am seen a couple parts of my tests and it was amazing how clear the pictures were and would compare them to a colonoscopy. The most important thing is to make sure that you follow the instructions the night before so that you do not have any solid food in you. You will probably not have to prep like a scope but may have to do a clear liquid diet the day or 2 before. I have done both depending on the doctor.
Posted 11/30/2010 11:08 PM (GMT 0)
Yes, my son has done the pill cam twice and I have seen the pics and dvd films.

Each time we got less than good info.

The first time it transited so quickly that it went through his whole small bowel in an hour - at least that was their estimate. They got almost nothing out of it - one good shot of one bleeding ulcer.

The second time it shot through the duodenum and then stuck in the upper jejunum for about 7 hours. Then the camera shut off while it was starting through the rest so - again no helpful results.

Thus my comments about the pros and cons.

However, his were done about 4 years ago and the technology may have improved making it more helpful. Don't know. Just know it was pretty much a bust for us. He now has multiple strictures up to 12 cm long so he won't be doing the pill cam again in the foreseeable future.
Posted 12/1/2010 10:17 AM (GMT 0)
Hi

Yes i have had botha CT scan and also a normal xray and a barium meal which showed slight thickening which he said could be normal. My colonscopy came back normal and biopsy done at end of erminal illeum showed no inflamation. I have been put on meberline for spasm of small bowel but surely i would not have small bowel inflamation?

Just really stressed about it now, and if it is IBS then me stressing is not going to help!

I have my capsule endoscopy monday so hopefully it will be sorted by then
Posted 12/1/2010 5:05 PM (GMT 0)
Good luck with the capsule endoscopy - just make sure they use the one that disintegrates...this will help protect against issues of getting stuck. I think one of the moderators had this done, and might be able to tell you which one it is. 
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