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Depleted goblet cells, haustral folds

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Posted 9/2/2016 10:09 PM (GMT 0)
Hello,

I was hoping someone could answer this for me. On my colonoscopy a month ago some of my biopsies stated that the intestinal glands are depleted of goblet cells and the colonic mucosa is moderately infiltrated by chronic inflammatory cells. Occasionally, neutrophils are invading the epithelium of the intestinal glands, but no full blown crypt abscesses are seen.

My question is will my body make new goblet cells? I cannot find this answer from google.

Also, I had a MR Enterography in June and it stated my haustral folds are disappearing. Will they come back? Has anyone had the same thing and it came back?

My GI doctor fired me, so I am in the processing of finding a new one.

I thought I had ulcerative colitis but nothing is definitive even though I have had a flex sigmoid scope in March and a colonoscopy in July. My whole colon is affected along with 6-11cm of my terminal ileum. Two hospital stays within the last 5 months.

Thanks in advance
Posted 9/3/2016 1:48 AM (GMT 0)
Welcome to the forum. Good questions. What you're describing are common hydrological (biopsy) findings that most ulcerative colitis patients have, who've had uc for a while. They're nothing to worry about.

1.) "My question is will my body make new goblet cells?" Nope. Goblet cells are a defensive protection that expels mucus to keep bacteria from advancing into deeper tissue. As a last ditch effort, the goblets expel their inards and then they die. Nope, once goblet cells are gone, then they're gone. Likely many of us are the same here. It's common with UC.

2.) "Also, I had a MR Enterography in June and it stated my haustral folds are disappearing. Will they come back?". Over time our bowel walls thicken and the normal haustral folds become smoother and less obvious. Scaring can also obscure them, as well. In severe cases they can cause muscle motility (motion/emptying) issues or strictures but that's uncommon in uc (more common in Crohn's disease).

3.) Inflammation within the ileum (ileal backwash) is a common finding with pancolitis patients.
Posted 9/3/2016 2:11 AM (GMT 0)
iPoop,

Thank you for your reply, it's very disappointing news. I honestly thought it would correct itself, more like I was hoping it would.

My colonoscopy(july 2016) pathology does not support a diagnosis of ulcerative colitis(it states moderate chronic colitis), but the flex sigmoid(march 2016) pathology does state severe active ulcerative colitis.

At this point, I'm confused about my diagnosis. 11 years ago when all this started I had a flex sigmoid but no biopsies were obtained. After a cycle of on and off for 3 years it totally disappeared for 8 years until this February 2016, unfortunately I have not found a medication that I can take or try until I find a new GI.

What do you mean by muscle motility issues, does that mean constipation.
Posted 9/3/2016 9:56 AM (GMT 0)
It can mean trouble emptying or constipation, it can mean diarrhea, but both only in extreme cases. Motility issues can slow down or speed up the movement of stool in a trouble area. It depends where it is and how much of it there is. It's also known as lead piping and visible through various xrays (radiopaedia.org/articles/lead-pipe-sign) I'm sure what you have is mild, and not enough to be a lot of worry.

I can guarantee you that everyone with uc has permanent histological changes within their biopsies (irregular vascular blood vessel pattern, anomalies within our colon cell structure, wall thickening, crypt abscesses, and other things). It's how they can confirm we have uc. Having chronic inflammation issues creates an, at-times, hostile environment for our cells to develop in. And as a consequence they look different and have marked structutal changed that are an adaptation to their environment.

Do they impact our quality of life? Generally no. The only histological findings we are concerned about are those that indicate active ulcerative colitis or dysplasia (pre-cancerous cells) and it doesn't sound like you have either.
Posted 9/3/2016 11:10 AM (GMT 0)
If the stem cells in the bottom of the crypts are still alive then they can regenerate new goblet cells.
I read that somewhere.
Old Mike
Posted 9/3/2016 2:34 PM (GMT 0)
Old Mike that would be awesome if that was a fact, everything I have been reading about goblet cells since I got my report, they are very very important to the colon wall. I wonder how they find out if the stem cells are still alive?
Posted 9/3/2016 3:08 PM (GMT 0)
Oh, its a fact, you can see the picture here of what goes on,cant get this whole article.
I can guess that if your crypts are not destroyed then you might be in luck.
Of course active inflammation may keep causing problems.
you can search google for goblet cell regeneration colon for more insight.
You can find most anything on goole with the correct search terms.

Old Mike

www.nature.com/nrm/journal/v15/n1/fig_tab/nrm3721_F1.html
Posted 9/3/2016 3:11 PM (GMT 0)
Interesting, I didn't know this, thanks mike.

Certainly not a guarantee it applies to you, but gives some hope at least.
Posted 9/3/2016 10:48 PM (GMT 0)
Old Mike,

That was a fantastic find, apparently I didn't use the correct words in the search engine. Since I got my report I have been googling like crazy.

1. to try to understand it, 2. to find out if it's possible to undue the damage this disease has done to my colon.
Posted 9/10/2016 11:11 AM (GMT 0)
If you are still here, this is a new study, seems we even have reserve stem cells.
Old Mike
www.ncbi.nlm.nih.gov/pubmed/27610020
Posted 9/10/2016 2:08 PM (GMT 0)
Regarding the haustral folds disappearing, this could be permanent or temporary. As ipoop previously mentioned, scarring (from long-term inflammation) can cause permanent damage to the structure of the bowel and result in the loss of the haustral definition of the bowel wall. Similar loss of haustral definition can occur during a flare and be temporary - in other words, once the inflammation during a flare subsides, the normal haustral definition of the bowel will return.

The loss of haustral definition - the worm-like structure of the bowel, which is designed to slow down the movement of poop and allow the water to be absorbed etc - is the reason for diarrhea as a symptom of UC.

If you have an MRI scan and have a loss of haustral definition, it will refer to "lead pipe colon". Before I had surgery, a MRI scan indicated I had a "lead pipe" appearance to my colon. When I asked the question if this will be permanent or not, the answer was there's no way of knowing and only if the inflammation subsided would the answer be known (I still don't know the answer because I had surgery to end all the uncertainty!).
Posted 9/12/2016 12:41 AM (GMT 0)
@ Old Mike

Thanks for that find, so I'm hoping on my next colonoscopy everything will be normal.

@GC4249

Yes the MRI said it was diminished haustral folds, not quite lead pipe yet which is why I was hoping to find a way to reverse it.

@ Connor77

My flares have not lasted 10 years, I was in remission for 8 years without medication or diet mods. I'm was hoping to find out how long before the damage is permanent. For example if your flare lasts for 6 months then the damage is permanent. So histological change is permanent, I did not realize that. Though Old Mike found out that some things are repairable like goblet cells. Which histological change is permanent.


When I was in remission I had absolutely no symptoms. What would a histological remission say? Would the word active just be eliminated? I ask because my scope in July doesn't say ACTIVE, it just says moderate chronic, doesn't feel like remission to me. Though I am on oral entocort even though my scope pathology doesn't say ACTIVE.
Posted 9/12/2016 2:42 AM (GMT 0)
There is no definitive answer to how long you need to have UC before damage to the haustral definition of the colon is permanent. It is the old proverbial "how long is a piece of string" answer.

However, when I asked my doctor this same question you have posed about the haustral folds his response had two points. First, the more flares and the more severe the flares = the greater the chance of permanent damage to the haustral folds. If you have not had many flares and the flares you have had were quickly brought under control then the balance of probability is there will not be permanent damage.

Second, if you are currently in a flare, it will not be possible to know if the damage to the haustral folds is permanent or a temporary structural change as a consequence of the inflammation. You will need to wait until the inflammation has subsided to find out.

Some people with UC do end up with permanent damage to the haustral folds and have chronic problems with diarrhea irrespective of whether or not they are in a flare or not. But I would expect those who have such chronic problems would be the ones with prolonged severe UC flares.

I never found out the answer to whether the haustral folds of my colon had been permanently damaged (like you, I had UC for many years without flares until a severe flare earlier this year, so probably not permanent damage) because I elected to have surgery and be done with the UC devil!
Posted 9/12/2016 11:34 AM (GMT 0)
Personally, I wouldn't fret over the histological and scope results you cited as they don't often impact or day-to-day uc symptoms. If your uc is well managed and you stay in long remissions then you have the best odds of having some things heal more completely histologically. Whenever you flare, they'll likely re-appear again. We're never 100 percent normal under a microscope, never will be, as we are diagnosed with a chronic illness.
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