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Confused about Biopsy Results

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Ulcerative Colitis
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Posted 9/30/2013 10:58 PM (GMT 0)
I received my biopsy results from my colonoscopy today. Although the doctor went over the results, she didn't really go into detail regarding the findings, terminology, type of UC, etc.

The results showed that both the transverse and descending colon were normal. The ascending colon showed "inactive colitis" and the rectum showed " moderately severe patchy active chronic colitis with cryptitis, crypt distortion, and basal lymphoplasmacytosis".

She prescribed Rowasa enema, wants me to get a blood test to check for Chrohn's and come back in 2 months for follow up.

I know there are different types of UC, but not sure what type I would have based on the biopsy results.

Any information would be much appreciated.

Thanks!!!
Posted 9/30/2013 11:31 PM (GMT 0)
I think because the transverse and descending colon were normal, yet the ascending colon showed inactive colitis and the rectum showed moderately severe patchy active chronic colitis, your colitis is not contiguous. UC tends to be contiguous starting distally and progressing through the colon, while Chrohn's can be patchy with normal areas between.
Posted 9/30/2013 11:41 PM (GMT 0)
Yep, thinking Crohn's as well. Sorry!

That said, about 10% of people have 'indeterminate colitis', where neither UC nor Crohn's can be definitively diagnosed. Article about IC if you're interested:

www.ncbi.nlm.nih.gov/pmc/articles/PMC3280416/
Posted 10/1/2013 12:11 AM (GMT 0)
Thanks for the fast replies!
Posted 10/1/2013 2:13 AM (GMT 0)
Crohn's is patchy inflammation, UC is not...CD can affect any part of the GI tract from mouth to anus and more than one area at a time (or just one area at a time)...CD also means the inflammation can go deeper into the lining, UC is always on the surface of the lining only...I'd say it's CD going on with you, not UC.
Posted 10/1/2013 2:18 AM (GMT 0)
Does chron's show up in a blood test? I actually thought that the only way to DX chrons was with a biopsy.
Posted 10/1/2013 2:02 PM (GMT 0)
I had non-patchy inflammation, so continuous inflammation does not always mean UC. This especially applies if the patient has already been on meds which might have partially and unevenly healed the colon.

Besides, there's microscopic evidence which the docs are looking at, too, they don't just go on the visual appearance of the colon to assess UC/CD.

Edit: And, no, there's no blood test to diagnose Crohn's. Faecal calprotectin (which involves a stool test, but whatevs) is highly sensitive to gut inflammation, which in turn is very useful for distinguishing IBD from IBS but not Crohn's from UC. Blood tests usually test for non-specific inflammation markers, eg CRP. The closest to a diagnostic blood test for Crohn's is the Prometheus test, but that's still a bit controversial and not widely used. Colonsocopy with biopsies are still the standard for diagnosis, really.

Post Edited (NiceCupOfTea) : 10/1/2013 8:17:15 AM (GMT-6)

Posted 10/1/2013 3:37 PM (GMT 0)
I agree. The recommendation to "get a blood test to check for Crohn's" seems like a waste of your time. Your DR is right to prescribe rectal mesalamine. I'd also recommend that you take an oral mesalamine that will be active in the ascending colon. My suggestion would be to use Pentasa - it is active throughout the bowel and will hopefully keep that "inactive colitis" in your ascending colon from becoming "active."
Posted 10/1/2013 5:09 PM (GMT 0)
Crohn's inflammation differs from UC inflammation, it's patchy and can go deeper in the lining, UC is not patchy and does not go deeper into the lining.
Posted 10/1/2013 7:30 PM (GMT 0)
How your inflammation is described, it seems CD, not UC.
q
Posted 10/2/2013 11:36 AM (GMT 0)
Thanks for all the information. Waiting to hear if my insurance will cover the test since it's almost $700.
Posted 10/2/2013 12:22 PM (GMT 0)
Your doctor may be wanting this blood test as a backup for confirmation of what your diagnosis is. Differences between UC and CD and other variations can be hard to pin down in some cases.

My GI, on my c-scope report, uses the words "consistent with ulcerative colitis" (underline is mine) meaning "probably UC" and I never had a blood test either. Knowing exactly what your diagnosis is may or may not influence what meds you take since there are many similarities between UC and CD but it is good to know which it is for future decisions.

If it costs you that much personally then ask your doctor if there is a less expensive way or if it is totally necesary. Doctors don't know how much things cost because people have all different insurance plans.
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