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Can colitis also skip around the colon or is that only Crohn's?

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Ulcerative Colitis
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Posted 7/5/2012 8:00 AM (GMT 0)
Had a chat with my GI following my recent colonoscopy and she said that I have moderate ulcerative Proctitis which she could easily spot with the naked eye and that was confirmed by the histology report.

PLUS, the histology report/biopsies confirmed some "isolated" moderate "microulceration" in the cecum and the ascending colon.

The doc said she would still call my disease UP at the moment due to where I have the most and most severe inflammation.

I'm at a loss though. She took so many biopsies and everywhere other than the areas I've mentioned above was crystal clear. My understanding was that if you have UC, you'd see consistent inflammation rather than the skipping around. I didn't think about all this until this morning and don't have another appointment until the end of the month to ask. She's one of the best GI docs out here, so I'd like to think she knows what she's talking about. Do I need to be concerned about Crohn's now???
Posted 7/5/2012 11:55 AM (GMT 0)
While I can't answer your question exactly, I can tell you that when I was diagnosed I also had mostly inflammation in the rectum but then had an area way farther back in the colon-so in essence it skipped like yours. My GI still felt it was more suggestive of UC. My nephew who was much more ill than I was when diagnosed ALSO had a similar situation and his diagnosis is still UC and his symptoms have stayed consistent with that.

Chinamom
Posted 7/5/2012 12:19 PM (GMT 0)
When I was diagnosed in was just proctitis, but my last colonoscoppy showed patches in different areas.
Posted 7/5/2012 12:28 PM (GMT 0)
Thanks for sharing Chinamom. That's comforting to hear. UC's plenty tough enough, it would take real effort for me to come to grips with a Crohn's diagnosis.
Posted 7/5/2012 12:32 PM (GMT 0)
Hi puffed,

You had patches in various parts of your colon and things were otherwise clear?

I was also initially diagnosed with UP 12 years ago. This progressed to left sided/distal colitis over the past years, but there has always been consistent inflammation up to a point - never any skipping. I think I've had 5 or 6 colonoscopies. This new finding is surprising for me.
Posted 7/5/2012 12:42 PM (GMT 0)

I have UC but it shows up in patches throughout my  whole colon.  For many years (and a different GI) I was told i had most likely crohns.  But with my new GI (since 2006) she diagnosed me as UC, as my symptoms were all suggestive of UC and I had that prometheus test (which many say is unreliable but oh well) which points to UC. 

So UC it is....

In fact, currently i have one isolated patch of inflammation in my sigmoid! my patch in my rectum (and elsewhere) is all healed. 

I'm guessing its not common to have uc in patches but i guess some of us do

Posted 7/5/2012 12:52 PM (GMT 0)
Really hoping you're right ilovecoffee. Thanks for sharing.
Posted 7/5/2012 1:12 PM (GMT 0)
     It was explained to me by my former GI doctor that when there were patches here and there it most likely pointed to Crohn's.  I had UP for twelve years before surgery and, as far as I know, the ulcerations never traveled further into my colon.  However, I had the surgery because my rectum was really badly diseased and the meds all failed sad .
Posted 7/5/2012 3:06 PM (GMT 0)
I also have a tiny bit of inflammation in the ileum and ascending colon, with some inflammation in other parts of the colon that is only visible when the biopsy is looked at through a microscope. In the prior 9 years since I was diagnosed I have always had continuous inflammation from the rectum on up.

There are some things that are unequivocally Crohn's like cobble stoning and inflammation that goes deeper than the mucosal layer.

Having patchy inflammation without the obvious signs of Crohn's does open up the possibility of Crohn's, but does not guarantee it.
Posted 7/5/2012 3:23 PM (GMT 0)
Thanks Christine and CGK. Everything I've read online seems so back and forth. Guess that's typical when you google.
Posted 7/5/2012 5:16 PM (GMT 0)
Just to help you clarify, patchy inflammation, as with CD means the actual inflammed area(s) will have some healthy tissues in/throughout that specific inflammed area ( also refered to as "skipped pattern of inflammation), from what you're describing, it sounds like the patches you have are completely inflammed (with CD there is healthy tissue amongst the inflammed area(s). And yes, with CD the inflammation can go through the many layers of the intestinal lining, unlike with UC where it stays on the surface only. Keeping in mind though, with CD if it's mild enough it may only affect the surface of the lining as well.

Also wanted to add, if your doc ever uses the term crohn's colitis, that does not mean crohn's disease and UC, it means CD is affecting your colon. Many people get very confused when their docs mention crohn's colitis which is not the same as having UC...it's still the pattern of inflammation that goes with having CD but happens to be in the colon (the term colitis means inflammation in the colon).

CD can affect any part of the GI tract from mouth to anus (and even more than one area at a time) where as UC is limited to the colon/rectum.
Posted 7/5/2012 5:29 PM (GMT 0)
Good info pb4 - thanks! Indeed, the areas of inflammation I have are completely inflamed - no healthy tissue in the mix. Doc hasn't used the term Crohn's colitis as yet and I'm hoping she doesn't.
Posted 7/5/2012 5:56 PM (GMT 0)
There you go then, if the entire area of inflammation has no skipped patterns (with healthy tissues involved in that inflammed area) then it would point to UC and not CD.

I have crohn's colitis myself (the same meds used to treat UC are also used to treat CC) however I'm either allergic or non-responisve to the meds...when I first became sick my CD was affecting my small intestine, colon, rectum (proctitis) and anus (with perianal crohn's skin tags) I was easily DX right off the bat with having CD, there was never a question about it since the perianal crohn's tags were a dead give away along with it affecting my small intestine at the time and the skipped pattern of inflammation which is indicative with CD.
Posted 10/18/2012 2:47 PM (GMT 0)
I have question for all people with crohn's colitis. I have been diagnosed 2 years back with couple of inches of inflamation in my sigmoid colon only. Rest of the colon and TI was clear. My symptoms were Blood in the stool but then kind of stool got narrowed and had to run bathroom everytime I eat. No diareaha but most of the time blood/mucus. I took 4 weeks of prednisone and went in remission for 2 years. (I took Asacol 3X3times but stopped. Big mistake). Now back in flare and same symptoms. Doctor is asking me to start Remicade or immuran but I am not ready yet so started Prednisone again. After 4 weeks, I see improvement but this time like to maintain remmission with only 5-ASA if I can. I am vegeterian and I don't smoke or drink and started gluten-free diet too. Any suggestions? I know most of us bleed on and off but what to do when stool gets narrowed. 

pb4, I read each of your comments and wonder how do you maintain without medicine. Thanks.

Posted 10/18/2012 3:32 PM (GMT 0)
Rectal meds would help.
Posted 10/18/2012 5:44 PM (GMT 0)
PamSmith....I am still flaring, always have the entire 21 yrs I've had crohn's and it's been constant in my colon (crohn's colitis) the entrie 21 yrs as well as my anus with perianal crohn's skin tags, only lasted in my small intestine for about the first 2 yrs I became sick and on and off in the rectum (though since taking probiotics daily for about the last 6/7 yrs now I have not had proctitis issues return) the only med I can tolerate is rectal meds (cortifoam) I'm either allergic or non-responsive to the oral RX and that's why I went with the natural route listed in my sig (along with altering my diet).

So I'm not maintaining remission, lol, never had remission but I do have some improvement with symptoms from the natural route/diet altering and smoking 6 cigs/day (I quit smoking for 2.5 yrs and thought it was gonna kill me my symptoms got so bad).

I also exercise regularly, many don't realise the benefit exercising regularly has for the bowel function, not to mention it has helped me greatly with the depression and anxiety I had.

This IBD thing is very individual for each.

Posted 10/20/2012 12:33 PM (GMT 0)
Having left sided colitis with an inflamed cecum(near appendix) is quite common with UC. I've had it for 12 years and had at least 15-20 colonoscopies and that has been the case a couple of times. There is heaps on the net about it
Posted 10/20/2012 1:24 PM (GMT 0)
My UC has changed significantly over the years.
One colonoscopy showed involvement of the entire colon, then, a year later, only left sided and on and on. Mine definitely skips around but is not Crohns.
It's a strange animal this UC...
Posted 10/20/2012 1:37 PM (GMT 0)
It's not uncommon for UCers with limited/distal colitis to have an inflamed "cecal patch" so that may be why your GI is not concerned. I think you need to discuss it with her but if she's a top GI/IBD specialist than she'll likely have a good idea of what to look for when looking for CD. Many UCers for example, have gastritis, duodenitis and even ulcers in their upper gi (stomach, ileum, duodenum). They're starting to see that non IBDers have erosions/inflammation in their GI tract at quite a high rate too (because of the pill cam and other new diagnostic tools). So, I would have a chat with your GI. I know it's hard not to worry.
Posted 10/20/2012 1:53 PM (GMT 0)

PamSmith said...
I have been diagnosed 2 years back with couple of inches of inflamation in my sigmoid colon only. Rest of the colon and TI was clear. My symptoms were Blood in the stool but then kind of stool got narrowed and had to run bathroom everytime I eat. No diareaha but most of the time blood/mucus. I took 4 weeks of prednisone and went in remission for 2 years. (I took Asacol 3X3times but stopped. Big mistake). Now back in flare and same symptoms. Doctor is asking me to start Remicade or immuran but I am not ready yet so started Prednisone again. After 4 weeks, I see improvement but this time like to maintain remmission with only 5-ASA if I can.


I am not an expert on meds or 5-ASA but I have seen many stories such as yours by people who eventually found effective relief thru rectal meds, especially Rowasa enemas. I am sure that those with more experience with that sort of thing will soon chime in.
Posted 10/20/2012 7:54 PM (GMT 0)
Thanks everyone. It is indeed hard not to worry, but I'm working on it. Did have a chat with GI and she mirrored what a lot of you said in that skipping is fairly common in UC and that biopsies and patterns of inflammation still point to UC and not Crohn's.
Posted 10/21/2012 12:44 AM (GMT 0)
Are you using rectal meds? They can cause things to look patchy if you heal more in one area than another. I have had "patchy" inflammation, i think it was due to rectals.
Posted 10/21/2012 9:21 AM (GMT 0)
Interesting. I hadn't thought of that before. I think at the time I may have been using rectal meds, but I don't recall for sure. Will keep that in mind.
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