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Crohn's Disease
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Posted 6/4/2018 11:46 AM (GMT 0)
Hi

I am a 57 year old male with no prior history of GI issues.

Around mid-March of this year, I started having loose stools, and some constipation. The loose stools were no more than once a day, and I really wouldn't characterize it as diarrhea. I did try some Pepto-Bismol, which didn't have any effect.

After 6 weeks of these symptoms, and no others, I had a colonoscopy, which showed "congested, erythematous, eroded and vascular-pattern decreased mucosa in the recto-sigmoid colon and in the sigmoid colon". This was biopsied. I also had diverticulum in the sigmoid colon, with no evidence of bleeding. No other pertinent findings in the rest of the colon, including the terminal ileum.

Based on the biopsy, I was diagnosed with Focal Active Colitis, and I was referred for serology testing, which I guess is antibodies. At least one of the levels came back at 26.5, when the "normal" cut-off is 25. Even so, the doctor told me she didn't think this was Crohn's, and I was then referred for a stool sample to test for some infectious diseases and also for Calprotectin and Lactoferrin. This was sent off to the lab last week, and I am waiting for results.

I was also advised to use Probiotics which has firmed up BM's pretty well, though I wouldn't quite say they are back to normal.

As mentioned, I have had no other symptoms at all other than a change in Bowel habits.

Any advise/comments/observations would be appreciated.

Thanks!

Mike
Posted 6/4/2018 7:10 PM (GMT 0)
Hi Mike & welcome to the forum. Once your dr gets the biopsy report back you will know the actual diagnosis. When you look up FAC sometimes it's an infection or could be either crohns or UC. Did your dr start you on antibiotics by chance? I think you mentioned she did some labs but I am not clear on what you showed a slight elevation in the numbers.

Hang in there until you see what the biopsy report says. Be sure to ask for a copy of all of your testing. Any time tests are done you should get a copy for your own personal file.

Take care.
Posted 6/4/2018 9:05 PM (GMT 0)
That could be Crohn's, or it could be UC, or it could be infection-related. The stool tests will tell more.

Can you find out more details about your blood work? Get copies of the tests that were run and the results. That will be a piece of the puzzle too.

Are you on any medications for other conditions? Sometimes medications for other things can cause bowel inflammation.
Posted 6/4/2018 9:17 PM (GMT 0)
Thanks Susie

I don't have the actual records yet - I have requested them and I am then going to another GI - I have some issues with this facility.

I did get a call from the office today advising lactoferrin was normal and calprotectin was 90, and that the doctor still does not think I have IBD. The tests for infectious diseases could not be done for some reason.

The doctor seemed unconcerned after the colonoscopy when she told me the findings, and no, she did not start me on any antibiotics. I think the lab level I mentioned was either IGA or IGG but that is just from googling around.
Posted 6/4/2018 9:23 PM (GMT 0)
Thanks Beave

No, i am not on any meds at all.

I'll have all the tests results in my possession soon, hopefully, and I'll be able to review them. I get straight answers on some questions from this doctor but on others she is not real clear.
Posted 6/4/2018 9:26 PM (GMT 0)
I did have routine blood work done at my primary doctor a few days before the colonoscopy - it was all normal.
Posted 6/9/2018 6:39 PM (GMT 0)
Got copies of all my test results today

The biopsy of the sigmoid colon "shows focal active colitis with neutrophilic inflammation involving the lamina propia, surface epithelium, and crypts (cryptitis). No crypt architecture distortion, granuloma, intraepitelial lymphocytosis or thickening of subepithelial collagen table is seen. Differential diagnosis includes infection, drug injury (especially NSAIDS) and early IBD. Bowel preparation may cause FAC as well. Clinical correlation with follow-up is suggested." Colonoscopy was 5/3/18

The blood work showed :

ANCA Screen - negative

SACCHAROMYCES CEREVISIAE
AB (ASCA) (IGG) 69.5
AB (ASCA) (IGA 26.7

Blood work was done 5/10/18


The Stool Test, done 5/31/18, showed:

Calprotectin 0.00
Lactoferrin 1.79
Occult Blood negative
Pancreatic Elastase 90.1 - <100 = Severe exocrine pancreatic insufficiency

So naturally I am concerned about the last result especially.

I have a follow up with my GI next week and am still looking for a second opinion doc.

Mike
Posted 6/9/2018 11:25 PM (GMT 0)
It sounds like you'll have to consider a treatment plan at this point. Remicade or Humira might be the logical choices, but you can try an Immunosuppressant first. Imuran or 6mp are the most likely to be offered.
Posted 6/10/2018 5:43 AM (GMT 0)
To me it's still unclear what is going on. Do you take NSAIDs (aspirin, ibuprofen,etc) at all?

Did they do stool tests to check for infections?

The pancreatic elastase being low indicates possible pancreatic insufficiency, which will probably necessitate further investigation from your GI (possibly an MRI of the pancreas and associated plumbing, called an MRCP).

From what I've read, pancreatic insufficiency can sometimes lead to bowel inflammation. But sometimes Crohn's can lead to pancreatic insufficiency. So it's hard to know which you have, if either, and which is causing which.

Have your symptoms changed at all recently, or still the same since March?
Posted 6/10/2018 12:37 PM (GMT 0)
I don't take any NSAIDS at all.

They were unable to test for infections in the stool for some reason.

Symptoms were better for about a week or so, right after I started Probiotics, until a few days go, now just very constipated.
Posted 6/20/2018 10:22 AM (GMT 0)
current symptoms are floating stools and weight loss - stool test was re-done for infections last week and also re-done for Pancreatic Elastase - but I don't have the results yet.

I have an MRCP scheduled for tomorrow morning.
Posted 6/21/2018 8:28 PM (GMT 0)
I had the MRI /MRCP this morning, so now anxiously awaiting the results. I should hear tomorrow.

Second stool tests results still not in.
Posted 6/27/2018 6:30 AM (GMT 0)
Let us know what the MRCP showed.
Posted 7/1/2018 12:19 PM (GMT 0)
took longer than expected to get the MRCP results

No masses found on MRCP and no evidence of pancreatitis

The GI docs in my area are scheduling into mid-September, I'm still trying to get a sooner appt.

Symptoms are unchanged, weight loss and and floating stools.

Per the PA at the other GI office, who I have lost confidence in, the 2nd stool test was positive for C-diff, which makes no sense to me at all, and she rx'd an antibiotic.
Posted 7/1/2018 9:07 PM (GMT 0)
I think I read on one of your posts that they did not check for infections, hence, the 2nd testing which was positive for c-diff. By all means, take the antibiotics. C-diff can be so wicked left untreated. That would account for weight loss & stool issues. Also, be sure to take a good probiotic.

Take care.
Posted 7/2/2018 6:59 PM (GMT 0)
Hi just a question what is focal active colitis? is it chronic do you have IBD? NSAIDS can give u an infection?

Post Edited (borborygmi) : 7/2/2018 2:18:30 PM (GMT-6)

Posted 7/25/2018 7:17 PM (GMT 0)
borborygmi

Focal Active Colitis is a general term for colon infection
Posted 7/25/2018 9:06 PM (GMT 0)
I completed the antibiotics and was re-tested for c-diff and it was negative.

I finally got in to see an IBD specialist who ruled out IBD based on the stool test results and the colonoscopy biopsy.

He ordered some blood work and referred me to a GI specializing in pancreas issues for pancreatitis, though the MRI showed no pancreatitis - he said that means no acute pancreatitis.

In any event I wanted to thank you for your responses and wish everyone well.

Mike
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