Colonoscopy results: Remission, polyps, IBS

Is your Crohn's only in the colon or do you have it in the small intestine as well?

Crohn's tends to skip UP the GI tract rather than down the GI tract so I would NEVER accept a Dx of remission based on a colonoscopy. Nor would I accept a Dx of IBS as the excuse for continuing symptoms or the colon's reaction to the scope. My gastro tried the same excuse after a clear colonoscopy. Her reasoning for the colon spasms during the scope was IBS. One month later a CTE at Mayo Clinic proved continued disease activity in the small intestine. Their Dx of the continued disease activity resulted in an increase in meds and that eventually resulted in symptomatic remission and remission.

Bacterial overgrowth can be the cause of gas, bloating and pain. I've had that too and it responded very well to treatment.

 

Chronie I was just wondering (i'm here from the UC forum) what treatment did you get for the bacteria overgrowth and how did they find it?

Thanks and please let me know.

Linda

I was also told I have IBS after my upper endoscopy and colonoscopy in October.  But, he didn't say that it was based on any spasms or pain during the procedure (he didn't even say anything about it, just noticed it on the reports).  Once before, I woke up part-way during a colonoscopy and they had to give me more meds (Demerol) which I had a very bad reaction to and can't have again.  I think it was because they didn't give me enough of or the right meds to start with.  I've been told several times that I'm in remission based on the colonoscopy and a lack of symptoms.  CrohnieToo, you said you'd never accept that dx from a colonoscopy...what do you use to determine whether you're in remission?

I understand what you are saying Prof! I'm feeling the same way right now. The GI said that since I can't tell if I am flaring by the pain, that if I feel like I am flaring they will do some blood tests..Creactive protien is one I think he said. In not on any kind of meds for guts right now but nexium for my GERD. I guess I will just have to wait and see what happens. He told me to come back in 6 months unless I get sick.

No I wasnt on meds. I was on asacol and colocort a 2 years ago but I lost my GI doc because he no longer wanted to take my insurance ( Low income california Medi-Cal) It was two years till I got a new GI doc but he is supposed to be one of the best at UC Davis medical center. Since the scope was clean Im not on any meds except nexium. I don't know...feeling confused about it all right now. I guess I will just wait and see for now. I go back in 6 months.

Thank you!

My last colonoscopy put me into a Crohn's flare. I agree with CrohnieToo, I would never take the "you have IBS also" from my GI. A colonoscopy cannot see beyond the terminal ileum. Pain during a scope seems like a reasonable reaction, otherwise why would they sedate everyone!

For the bacterial overgrowth I was put on amoxicillin for 10 days, then at the beginning of the next month I was put on tetracycline for 10 days, next month back to amoxicillin until symptoms no longer occurred. Symptoms were bloating, nausea, queasies.

Once I've been Dx'd w/Crohn's disease (including one resection at Mayo Clinic) I would no more accept an IBS Dx than I would accept that my symptoms were "all in my head".

The pain from the scope was more likely the lack of patience and/or skill of your gastroenterologist. I don't care how many scopes they have done thru the years that doesn't mean they've learned patience and to take their time.

I've posted these two abstracts before but it has been awhile:

Endoscopy 2002 Jun;34(6):435-40

Patient pain during colonoscopy: an analysis using real-time magnetic
endoscope imaging.
Shah SG, Brooker JC, Thapar C, Williams CB, Saunders BP.
Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, London, United Kingdom.

BACKGROUND AND STUDY AIMS: Colonoscopy is generally perceived as being a painful procedure. Contributory factors are: stretching of the colonic wall and mesenteric attachments from looping of the instrument shaft, overinsufflation, the degree of torque or force applied to the colonoscope shaft, and patient pain threshold. The aim of this study was to determine the frequency of pain episodes experienced during diagnostic colonoscopy and the corresponding colonoscope configuration, utilizing real-time magnetic endoscope imaging (MEI).

PATIENTS AND METHODS: Consecutive outpatients undergoing colonoscopy were studied. Patients with previous colonic resections were excluded. Procedures were commenced with antispasmodics only, and patient sedation was self-administered whenever significant discomfort was experienced, using a patient-controlled analgesia (PCA) syringe pump. All "demands" were correlated with the MEI record, which was subsequently analysed.

RESULTS: A total of 650 demands were recorded in 102 patients. Seventy-seven percent of all demands occurred with the colonoscope tip in the sigmoid colon, 7 % in the descending colon, 6 % at the splenic flexure, 5 % in the transverse colon, and 4 % in the proximal colon. Ninety percent of all pain episodes coincided with either looping (79 %) or straightening of the colonoscope shaft (11 %); presumed overinsufflation being an infrequent cause of pain (9 %). Of the loops encountered during colonoscopy, the N-sigmoid spiral loop was associated with the majority of pain episodes (56 %). Looping was both more frequent ( P = 0.0002) and less well tolerated in women than in men ( P = 0.0140).

CONCLUSIONS: This study is the first to document pain at colonoscopy accurately. Looping, particularly in the variable anatomy of the sigmoid colon, is the major cause of pain, especially in women. Use of MEI may improve pain control by facilitating the straightening of loops within the sigmoid colon, and by enabling the endoscopist to target patient analgesia.

PMID: 12048623 [PubMed - indexed for MEDLINE]
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Gastrointest Endosc 1996 Feb;43(2 Pt 1):124-6

Why is colonoscopy more difficult in women?

Saunders BP, Fukumoto M, Halligan S, Jobling C, Moussa ME, Bartram CI, Williams
CB.
Department of Endoscopy, St. Mark's Hospital, London, England.

BACKGROUND: In our experience colonoscopy in women is more difficult than in men. A retrospective review of 2194 colonoscopies performed by a single experienced endoscopist (CBW) showed that 31% of examinations in women were considered technically difficult compared with 16% in men.

METHODS: To investigate a possible anatomic basis for this finding, normal barium enema series from 183 female and 162 male patients were identified. From these barium enemas, measurements of colonic length and mobility were independently taken by two physicians who were unaware of each patient's gender.

RESULTS: Total colonic length was greater in women (median, 155 cm) compared to men (median, 145 cm), p = 0.005, despite women's smaller stature (p < 0.0001). Although there were no significant differences in rectum plus sigmoid, descending, or ascending plus cecum segmental lengths, women had longer transverse colons (female median length, 48 cm; male median length, 40 cm), p < 0.0001. There were no differences in mobility of the descending colon and transverse colon between the sexes, but the transverse colon reached the true pelvis more often in women (62%) than in men (26%), p < 0.001.

CONCLUSIONS: Colonoscopy appears to be a technically more difficult procedure in women. The reason for this may be due in part to an inherently longer colon.

PMID: 8635705 [PubMed - indexed for MEDLINE]

My gastro is slicker than snot on a doorknob w/the colonoscope. She usually takes her time - of course, I usually don't leave her much choice by insisting we do my colonoscopy w/o sedation, just demerol for discomfort.

I don't feel anything at the sigmoid except an awareness of where the scope is. In fact I have absolutely no discomfort until we get about 1/2 thru the transverse colon approaching the hepatic flexure. It can get quite uncomfortable getting thru this area (I think my transverse colon takes off and heads for my knees). Once we get around the hepatic flexure its a piece of cake the short distance down the ascending colon. Which takes us to the next uncomfortable area - the ileocecal valve and first part of the terminal ileum. These two mentioned areas can be a challenge and require some time to maneuver thru. My unsedated scopes take considerably longer than the usual colonoscopy which is the main reason most gastros insist on or routinely use sedation.

It amazes me that so many actually remember their scopes. I'm so sedated for them that I don't remember a thing. Doc even said he would have to use heavier sedation this time because they used the big guns last time and it wasn't enough.