Biopsy Results?

"cobblestoning" - your bowel walls look like cobblestones. Typical Crohn's feature.

I'm not surprised by your doctor's hesitation in giving you a firm diagnosis with negative biopsies. It's usually the biopsies which clinch the diagnosis - the tissues have features that are specific to Crohn's. I'm not a pathologist, so I can't say what most of them are off hand, but it includes things like granulomas, crypt distortion, etc. - the tissues show evidence of both chronic (past) and acute (current) inflammation.

That said, I have heard of folks with negative biopsies getting a Crohn's diagnosis; I don't know how often it happens though. But I'm pretty sure your doctor is taking the right approach in assuming it's Crohn's for now. I would go ahead with the other tests. For a start if you have any narrowing it's important to know that.

Can you get a copy of your biopsy results (pathology report) and tell us exactly what it says?

Crohn's is often diagnosed by exclusion - everything points to it, other things are ruled out, biopsies are "consistent" with Crohn's, but even biopsies don't have any specific feature that says "THIS IS CROHN'S DISEASE." The biopsies may show features that say "THIS IS ALMOST CERTAINLY CROHN'S DISEASE," but even then the doctor should always make sure that other things are considered - ie, infections ruled out, symptoms are consistent with Crohn's, macroscopic colonoscopy or capsule endoscopy or MRI shows things consistent with Crohn's, etc.

Your doctor being just a little hesitant is not unreasonable. He's right that it's almost certainly Crohn's (probably 98% sure), but it's impossible to say 100% until you've had it for a few years and chronicity is established (ie, it doesn't go away and never come back).

The MR Enterography next is a good idea. But I think the capsule endoscopy for you at this point is not needed. It's useful for diagnosing in cases where it's not clear and the colonoscopy doesn't find anything, but your's did. The results of the pillcam won't change your diagnosis, or your prognosis, or your medication plan, so why bother with the time and expense?

Beave: yes I am going to pick up a copy of my biopsy report tomorrow, then I will post what it says.

Alright that makes sense to me, he said that all of my symptoms are consistent with crohns but I do understand him being a little hesitant without the other tests. When I was 17 I had an MR Enterography that showed narrowing, structured and inflammation of the TI as well, so it will be interesting to see what it shows this time. I'm going in for the test Monday, I'll keep you guys posted on that. Yea I'm not sure why he wants to do the pillcam! Maybe he wants to see if there are other spots in the small intestine that are inflamed, but wouldn't the MR Enterography show that anyway?

As for the cobblestonning, that gives me better insight on why this is so painful!! Ouch

Yeah, if the ulcers are shallow an MRI scan can miss them. But an MRI scan can show stuff like thickening of the bowel walls, creeping fat, enlarged lymph nodes and even fistulas, all of which a pillcam can't show.