How reliable is a Crohn's biopsy?

Last year when I was very very sick with a flare I had a colonoscopy and endoscopy done as a CT scan indicated my entire GI track was inflamed. The doctors thought I had Crohn's on top of UC. I was relieved when I found out a few days later that the biopsies of my small intestine did not indicate Crohn's.

I'm beginning to have second thoughts about this though. With my last, and current, flare I developed nausea and vomiting as a symptom. I should correct myself in saying I've yet to vomit with my current flare, but I've gotten very close.

It's my understanding that nausea and vomiting are not really symptoms of UC. I'm wondering if the biopsies were incorrect and I've developed Crohn's as well. If it helps any, I have two family members with UC, but none with Crohn's.

I'll ask my doctor when I see her later this week, but the thought of also having Crohn's is worrying me to death. So I thought I'd look for some advice here.

Thanks!

Here's info in my biopsies. The colonoscopy more or less mentions moderate inflammation found throughout the colon with moderate wall thickness in the sigmoid and rectum.

DIAGNOSIS

A. Small intestine, endoscopic biopsy:

Acute duodenitis.
No chronic duodenitis is seen.
No granulomas are seen.


B. Stomach, antrum, endoscopic biopsy:

Gastric antral mucosa with chronic, active gastritis.
No granulomas are seen.
There is no evidence of Helicobacter pylori on H&E-stained slide.
Immunohistochemistry for Helicobacter pylori is pending; results will be issued in an addendum.


C. Stomach, body, endoscopic biopsy:

Gastric oxyntic mucosa with chronic, active gastritis.
No granulomas are seen.
There is no evidence of Helicobacter pylori on H&E-stained slide.
Immunohistochemistry for Helicobacter pylori is pending; results will be issued in an addendum.


D. Esophagus, endoscopic biopsy:

Gastric-type mucosa with chronic, active gastritis.
No squamous mucosa is seen.
Negative for goblet cell intestinal metaplasia.
No granulomas are seen.


E. Terminal ileum, endoscopic biopsy:

Acute ileitis.
No evidence of chronic mucosal injury or granulomas.


F. Colon, right, endoscopic biopsy:

Mild chronic active colitis.
No granulomas are seen.
Negative for dysplasia.
No evidence of viral inclusions is seen on H&E.
Immunohistochemical stain for CMV is pending; results will be issued in an addendum.


G. Colon, left, endoscopic biopsy:

Moderate chronic active colitis.
No granulomas are seen.
Negative for dysplasia.
No evidence of viral inclusions is seen on H&E.
Immunohistochemical stain for CMV is pending; results will be issued in an addendum.

The distinction between UC and CD is usually depth of the ulceration in biopsy tissue. CD goes deeper. But two radiologists do sometimes disagree on where to draw the line between CD and UC. Mostly thought it is a clear shallow vs deep distinction.

They can only get through the stomach to see an inch or 3 into the top of the small intestine, and likewise only an inch or 2 past the colon to see into the terminal ilium. So there is a lot of small intestine not biopsied or seen on scopes - just on MRI. (Unless pill cam is used).

But your colon biopsies look like UC, and the top and bottom of the small intestine do not show inflammation. The stomach and esophagus do show gastritis (inflammation).

The nausea is likely related to this gastritis. Did they prescribe any treatment for gastritis?

Post Edited (DBwithUC) : 5/23/2017 9:21:56 PM (GMT-6)

Thanks for all the input everyone. By the time of the colonoscopy I had been hospitalized 2 prior times within the previous 3 weeks. I was treated with various antibiotics both times, so I doubt I had an infection but I'm not sure. I think I was just having a very severe flare due to my previous hospitalizations not treating me for UC (I went to a different hospital the third time).

I had an MRI done a few days after the colonoscopy, here are the findings for that:

Moderate wall thickening with mucosal hyperenhancement and stranding of the
adjacent fat noted within the rectum, sigmoid and descending colon. The
transverse colon, descending colon, cecum and terminal ileum appear normal.
The stomach and small bowel demonstrate normal wall thickness and caliber.
Prominent scattered mesenteric and retroperitoneal lymph nodes are noted,
likely reactive.

It looks like no inflammation noted in the small intestine, but by this point I had been on IV steroids for about 4 days, and was already feeling much better.

quincy said...
I see terminal ileum...acute inflammation, could mean backwash ileitis.

yes, I meant to type "do not show chronic inflammation"

I have never heard of someone having both UC and CD.

You likely have CD. Diagnosis is never 100% accurate for UC, because it is a diagnosis of elimination. Between the upper-GI gastritis and the fistula, CD is a reasonable diagnosis.

Its all IBD, and the treatments are largely the same.