Colonoscopy results help

Hey had my colonoscopy yesterday which went from last year I had moderate proctitis -to now my comments were mild-moderate indeterminate patchy proctosigmoiditis from rectum up to 30cm the caecal pole also had 2-3 small aphthous ulcers- quite annoyed as I thought I was getting better less symptoms but seems to of go worse and obviously the rectal mesalmines aren't working as it has spread - has anyone else had similar outcome ? Does this mean more likely crohns- they haven't changed my meds but they are obvs not working maybe they will wait for biopsys also they said they were sending them off as urgent which has also worried me ?

Sure let's take a look at what was said:

"Mild-moderate" this the severity of inflammation seen. It's measured as mild, moderate, or severe. You're on the borderline between mild and moderate.

"Indeterminate patchy proctosigmoiditis from rectum up to 30cm." You had rectum and sigmoid colon involvement which is characteristic of UC and appropriately called UC Proctosigmoiditis here. Some contradicting features were seen and therefore Indeterminate was stated. Specifically patchy is the key word there regarding ambiguity/contradiction. Ulcerative colitis is "distal" starting at a point, the rectum, and is continuous inflammation going up to the sigmoid colon and beyond. Crohn's disease is noted as being patchy and having "skip lesions" where inflamed areas are followed by healed areas which are followed by inflammed areas.

"The caecal pole also had 2-3 small aphthous ulcers" At the beginning of the large intestine is the cecum and a feature known as the caecal pole. The aphthous ulcer is the earliest and most characteristic endoscopic finding in Crohn's disease. UC wouldn't have these ulcers, nor so far disconnected from the inflammation with the sigmoid and rectum. These ulcers kind of look like mouth canker sores, recessed divits.

Your scope had both UC and Crohn's like features. The biopsies might clear things up, so i wouldn't worry about a change in diagnosis just yet. As UC is very shallow inflammation and Crohn's goes very deep into the tissue. Beyond UC and Crohn's disease, there is also Indeterminate Colitis, Crohn's-colitis, as well as other variations.

When you next talk to your gasteroenterologist ask about the "patchy" appearance of the rectal-sigmoid colon and also the "aphthous ulcers" within your cecum as those are Crohn's findings, Indeterminate Colitis, or Crohn's-Colitis findings. Your biopsies may clarify.

Oh and "normal ti" likely means your terminal ileum in the small intestine was normal looking without any issues noted.

^If it's Crohn's colitis, then all those mesalamines - oral and rectal - are not the proper treatment. Crohn's doesn't respond to mesalamines the way UC does.

Mesalamines are still a good med to try as firstline. Oral and re ctal.

Absolutely, there are other meds.

q

uh, what's your reasoning behind that statement, doc ?

And they say that psyllium equals mesalamine in some studies....which is crap.

It would be remiss for docs to at least not try it for the benefits it does have.

q

I'd say it's up to the doctor to decide whether mesalamine is still appropriate should the diagnosis change from UC (at this point it hasn't but might). Admittedly, I'm not nearly as familar with the meds used in Crohn's. Certainly deep tissue inflammation may require different meds in some cases than for UC which is only shallow inflammation (something a topical anti-inflammatory could easily treat).

Beave is absolutely right about mesalamines. Just think about it: mesalamine is a topical med which treats the inner lining of the mucosa only - but, unlike UC, Crohn's goes through all the layers of the bowel. It's literally not even going to touch deep inflammation or fistulas and abscesses.

Edit: Oops sorry, should've read the posts first. iPoop's already covered deep vs. shallow inflammation. But yeah, my point still stands: mesalamine is basically a waste of time for Crohn's disease. It's like taking paracetamol to treat 10/10 pain, or whatever.

Post Edited (NiceCupOfTea) : 1/31/2017 1:09:20 PM (GMT-7)

Do you have a followup consultation scheduled to talk to your doctor about your colonoscopy results? I'm sure any medication or diagnosis changes will be discussed then. You biopsy results should be in soon, if not already.

I just wish i was able to find out if it was uc I have or crohns they still seem to think uc is the most likely but if the treatments not working I hope they try other things

Upanxiety said...
I just wish i was able to find out if it was uc I have or crohns they still seem to think uc is the most likely but if the treatments not working I hope they try other things

The thing is any diagnosis is madeup from the results of many, many tests and there's going to be the occasional contradiction that's interesting but not meaningful in changing an individual's diagnosis. If it was me, I'd call and ask for the biopsy results to see if they confirm or contradict your colonoscopy findings. And remember none of us here are GI doctors or expert histology/biopsy analysts, so we could be totally wrong lol. However, we've all suggested some good points to bring up with your doctor as points of discussion.