Flex sig questions

I'm new here. I've had digestive problems for years. My lactoferrin and SED rate were elevated. I also had a CT scan showing colon thickening. I was told I had colitis from constipation/fecal impaction. My doctors won't look into why I have the fecal impaction.

I recently had a flexible sigmoidoscopy. The scope showed proctitis. The path report showed "mild nonspecific reactive changes including edema and congestion of the lamina propria with focal surface hyperplastic features." What do these terms mean?

The doctor who did the test just said it means swelling from constipation. He wouldn't give me specific info on the terms. He said just to take Miralax.

Thank you.

Post Edited (Caeryn23) : 6/1/2013 10:47:18 AM (GMT-6)

I have mucus and sometimes blood in the stool. I also have pain. He really didn't say what the proctitis was based on. All he gave me was Miralax. I'm just confused om my exact diagnosis.

I see my regular GI doctor in a few weeks. I could ask him.

This paper has helped me to understand some of my biopsy results.

COLLEGE OF AMERICAN PATHOLOGISTS
CONTEMPORARY ISSUES IN LOWER GASTROINTESTINAL PATHOLOGY

http://www.cap.org/apps/docs/annual_meeting/presentations/2004/wednesday/AP118_Lower_Gastrointestinal_Pathology.pdf

Link to PDF document

The link above will attempt to open a PDF (which works fine in my browser), not a web page.

Caeryn23,
It's difficult stuff to understand. With the biopsy report, you're moving from gastroenterology into the field of pathology. A good place to start is to learn about the anatomy of the colon.

The "lamina propria" you mentioned above is one of the inner layers of the colon. Here are links to two sketches that show the layers of the colon.

http://www.symposier.com/document/1071.jpg
http://beneficialbacteria.net/wp-content/uploads/2013/03/colon-and-small-intestine-wall-01.png

The colon has four major layers:
1 mucosa - inner lining that contacts food and stool.
2 submucosa
3 muscularis externa
4 serosa

The mucosa has several sub-layers and is covered with pits called crypts.
1a epithelium - a single layer of cells that line the gut.
1b lamina propria - the fleshy part of the mucosa that forms the 'hills' between the crypts.
1c muscularis mucosa - a thin band of muscle.

In ulcerative colitis the inflammation is typically limited to only the mucosa layer. In Crohn's disease the inflammation can go much deeper and even break all the way through the colon to form a fistula.

I find these pathology reports rather bizarre. Were they both done at the same lab? What strikes me most strange is the mention of loss of vascular pattern & its attribution to constipation. I would associate loss of vascular pattern with chronic inflammation. You may need a second opinion consultation for more accurate diagnosis. / Old Hat (32 yrs with left-sided UC; presently in remission taking brandname Colazal)

Sorry that insurance is also an issue for you. Have you posted on the IBS forum here at HW? If you do indeed have IBS your pathology reports may sound more familiar to members on that forum. They could likely respond to your doctors' past findings as well-- since constipation/impaction + Miralax RX as treatment would be more common to discussion there than it is here. However, it could also be that the doctor who did your colonoscopy misinterpreted the pathology report on your descending colon. People with ulcerative colitis are more prone to frequent diarrhea with bloody mucus and urgency that keeps them running to the toilet day & night, leading to weight loss, cramping, major fatigue & joint pain. In any case, you should bring your past lab reports to the new GI doctor and ask for clarification of points you find confusing, besides describing your current symptoms. / Old Hat (32 yrs with left-sided UC; presently in remission taking brandname Colazal)

Post Edited (Old Hat) : 6/6/2013 1:56:17 AM (GMT-6)

I'm sorry, but an elevated SED rate, ulcers in the descending colon and proctitis all point to an inflammatory condition, not IBS. Your joint pain is no doubt related. I'm not a DR, but dang I hate it when someone says your bleeding and mucous is related to constipation and emotional problems. Ugh, awful.

I'm very sorry that you are struggling with an insurance problem, but now that you've gotten through the procedures hopefully the consults won't be so $$$$. Take your reports to the new GI. Before you get there, though, ask around to make sure that this new GI is familiar with Crohn's and UC. Not all of them are.

The medications to treat these problems can be expensive, but there are suitable generics out there that should work well for you if the GI gives you an IBD diagnosis.

My colonoscopies usually mention loss of vascular pattern in the distal colon, even when all else is well, I haven't had constipation for nearly 30 years, so unless this remains from constipation as a child, which I suppose is possible but no one has ever mentioned, I presumed it was from the UC, I will ask next time about it.

Have you had any bloods done? Do you know if you have raised CRP and ESR?

Sorry you are suffering this way and being given very little in terms of advice and support.