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Diagnosis, or NOT?

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Crohn's Disease
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Posted 10/6/2009 1:59 PM (GMT 0)
So, the doctor called today after my husband's ct scan and biopsises from his colonoscopy.

The ct scan was negetive for what they were looking for- tumor, mass, etc.. in the appendix, because the appendix is swollen, along the cecal area.

Anyways... the doctor wants to put him on creon 10- because of the high fat content that he has in his bowel- from his 24 hour sample.

Also.. the pathology report from the biopsies said this:

the differntial indicates crohn's colitis or damage from drug use.

Okay, so my husband doesn't use drugs- except for ones for his GERD, and blood pressure medicine- 10 mg... she said those drugs wouldn't cause that.

So, are we back to crohn's? She said she didnt'know.. she was just the nurse- but it does point to crohn's of more then a likely picture... but she doesn't know for sure, because the pathologist said the differential points to crohn's colitis or damage from drug use--- so either way, I guess they still don't know?


On another note, since my husband's colonoscopy last Tuesday, today was the first time he had a bowel movement- which is good. No pain, no cramps.

His last flare up was over 2 months long, and he lost about 10 pounds in those 8 days of diarrhea that lasted 8 days long- 20 movements or so each day. Hasn't had a flare up since.

We would just like to know what this is.

THe doctor wants to do the egd tomorrow- to see if they can get a better picture of anything--- since he was diagnosed with gerd 11 years ago, it could be crohn's there- she said.  Hmm, they never said anything about that 11 years ago. They just put him on meds, and kept him there all these years, because the gerd comes back as soon as he tries to wean off the meds. 40mg of omeprazole a day along with 150 mg of zantac- he wants to j ust not do the egd tomorrow, as he doesn't see that it will make a difference, and if nothing is conclusive, why bother....

I'm frustrated, as well.

What the heck!! sad

Posted 10/6/2009 6:10 PM (GMT 0)
Crohn's colitis is the term used for crohn's affecting the colon...what is the pattern of inflammation they found like? If it's skipped/patchy (with healthy tissues in between inflamed)  then that indicates crohn's, if the entire area was inflamed with no patches then that would indicate along thelines of ulcerative colitis or C-Diff induced colitis (I believe).

:)
Posted 10/6/2009 8:48 PM (GMT 0)
Since you still don't know what is going on, I don't see why you would want to cancel a diagnostic test. Some of us spend years not knowing what is going on and end up going from test to test, doctor to doctor just trying to figure things out. I was one of the lucky ones in that my Mom had CD so when the S*&t really hit the fan I was diagnosed fairly quickly, but others aren't so lucky. There are some people here whose doctors can't 'prove' they have an IBD but treat them for it anyway and they respond accordingly. Obviously, you and your husband know that something isn't right, you just need to find out what it is and find the appropriate treatment.

As far as GERD, many of us have GERD along with our IBD, or if in fact your husband has Crohn's it could be manifesting itself higher up in the digestive track. That is one of the differences in Crohn's, it can be anywhere in the digestive track, mouth to anus, where as Colitis is limited to large intestine.

I do hope you can figure things out so that he can start feeling better soon.
Posted 10/7/2009 5:31 AM (GMT 0)
Creon 10, as you know is a pancreatic enzyme supplement. There is a common condition called SIBO (Small Intestinal Bacterial Overgrowth) that can contribute to pancreatic problems. The difficulty may have its origin in the omeprazole used to treat his GERDs. Omeprazole is a Proton Pump Inhibitor (PPI) and acts by reducing the acid produced by the stomach. This has the unfortunate effect of changing the pH of the gastric juices so that the stomach enzymes don't work. This results in food passing undigested into the small intestine where sensors detect the undigested food and slow down the passage of the food through the SI to allow for digestion of the food. This allows bacteria to multiply and causes gas/bloating and diarrhea. The overgrowth of bacteria is then able to filter into the duct linking the pancreas and the gall bladder to the gut. Bacteria in the pancreas can cause inflammation which results in improper production of enzymes and damage to the pancreas via trypsin activation.

Ordinarily, PPI's don't cause "clinically significant" SIBO. I would guess that there are other contributing factors such as diet, stress or illness/allergies. The return of reflux on stopping meds is a common effect called rebound. To determine whether you are able to stop reflux meds, you would have to endure reflux for a couple of weeks to see if it eventually fades. If possible, stopping omeprazole and continuing zantac would be preferable - if that gives reflux control.
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