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Colonoscopy/Biopsy Reports (Finally)

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Crohn's Disease
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Posted 7/21/2018 3:26 AM (GMT 0)
After a long wait, finally got these today. Here's the colonoscopy:

Anus, rectum: Normal
Sigmoid colon, descending colon, splenic flexure, transverse colon, hepatic flexure, ascending colon: Moderate to severe colitis with ulcerations, segmental involvement (skip areas of more normal appearing tissue)
Cecum, ileocecal valve: Normal

He didn't go in the terminal ileum "due to the severe nature of colitis" in the colon. Not sure what that means.

Assessment was "Pancolitis with segmental involvement grossly consistent with possible Crohn's disease."

Biopsies returned diagnosis of "Chronic active colitis with mucosal ulceration." No dysplasia, which is good.

So I wonder--if this is Crohn's, could this be granulomatous colitis, since that usually only affects the colon? Going off of the CCFA website there.

Have at it, folks.
Posted 7/21/2018 3:51 AM (GMT 0)
Remind me - did you have stool cultures to rule out infections?

That certainly reads like Crohn's disease, specifically Crohn's of the colon, which is called Crohn's colitis or sometimes granulomatous colitis.

But again, there is around 20 feet of small intestine that hasn't been checked for anything - that's why you need an MRI or CT scan of the small bowel too. You might have disease only in the colon, but you might find you have problems in the small intestine too. The only way to know is to test.

"Moderate to severe" colitis is certainly way, way too strong for something like Asacol or Pentasa or other mesalamines. I'd argue it's too severe to even bother with monotherapy with imuran.

I'd strongly suggest biologics be considered sooner rather than later.
Posted 7/21/2018 4:08 AM (GMT 0)
Not yet. The stool culture was another thing the hospital "forgot," so I'm getting that done next week. Luckily, that can be done locally.

I have another follow-up in two weeks, and will definitely ask about the CT scan. That's a pretty easy one to get, so I can get that done locally too.
Posted 7/21/2018 4:24 AM (GMT 0)
If your facility can do it, you'll want either a CT Enterography or an MR Enterography. That's a CT or MRI of the small intestine and surrounding tissue with IV contrast AND with oral contrast (meaning you drink a about a half gallon of liquid). Not all facilities can do it, but many can. Most can now at least do a CT or MRI of abdomen and pelvis with contrast. Good enough.

The CT is probably a little cheaper, and faster (less time in the tube), but you get exposed to more radiation. The MRI version costs more and takes longer but has no radiation exposure.
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