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Comprehensive Stool Analysis Test Results

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Ulcerative Colitis
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Posted 6/14/2017 10:38 AM (GMT 0)
Just wondering if anyone else here has done a Comprehensive stool analysis test, or maybe able to help with my results? The reason I did the test is because I can't help but think that the several courses of antibiotics I took last year really messed up my microbial flora triggering inflammatory bowel disease.

The results do show that I have low beneficial bacteria and also some Dysbiotic flora:

Expected/Beneficial flora:-
4+ Bacteroides fragilis group
1+ Bifidobacterium spp.
No Growth Escherichia coli
2+ Lactobacillus spp.
2+ Enterococcus spp.
4+ Clostridium spp.

Dysbiotic flora:-
3+ Citrobacter koseri

Immunology:-
My secret or IgA was 313 and the normal range is 51 to 204

My butyrate % was 8% and the normal range is 9% to 37%.

I am now only taking prednisolone enemas but everytime I stop them I flare so I can't help thinking that the Citrobacter koseri is not helping.

Does anyone have any advice, tips on how I could reduce the Dysbiotic flora? I have gone back to the SCD intro diet numerous times so I'm reluctant to keep doing that as I am losing weight and in fact I took the test whilst being on the intro for the third time.

Grateful for any advice 😊
Posted 6/14/2017 12:47 PM (GMT 0)
Are you taking oral probiotics?
Although there is no evidence (that I've found/read) that oral probiotics actually remain in the gut permanently there are studies showing that VSL#3 is beneficial, however it needs to be taken at high doses. I've never taken VSL#3 at that high a level but it has definitely been helpful for me in lower doses.

Some people use food probiotics (kefir, yogurt, sauerkraut) to help but my intolerant gut says "no" to those so I get mine in other ways, namely powder or pill probiotics. Have you tried SCD yogurt? Not hard to make at home, it's delicious (sadly my gut hates it).

Some people also take butyrate as a supplement successfully.
Posted 6/14/2017 2:13 PM (GMT 0)
I am extremely skeptical of any "comprehensive" stool test because the vast majority of gut microbiota is "dark matter" meaning that they don't currently know what it is, and thus cannot culture or characterize it. Not only that but a lot of bacteria are anaerobes meaning they live in the absence of oxygen. AND this does not take into consideration the thousands of viruses and bacteriophages that make up the virome. AND it's a very simplistic view, for example some bacteria can be both good but also bad under certain conditions. I think we've got more problems than citrobacter kosi lol
That being said, probiotics are never a bad idea in UC and I would strongly recommend them.
Posted 6/14/2017 3:20 PM (GMT 0)
I think the easiest abnormality to manipulate is butyrate - try some oat bran supplement
Posted 6/14/2017 4:41 PM (GMT 0)
Or any fibre supplements in conjunction with good probiotics.

q
Posted 6/15/2017 2:17 AM (GMT 0)
This is why i didn't bother doing one of these tests. Seems like no one knows what to do with it regardless of what the result is. Yes, fiber and prbiotics, always a good idea.
Posted 6/17/2017 9:30 AM (GMT 0)
Thanks for the responses ☺ just started taking a probiotic by bioplan. Will take a look at the VSL3 one though. Will try to increase fibre, difficult though because I sometimes find it causes symptoms.
Posted 6/17/2017 2:40 PM (GMT 0)
LL....Which one from bioplan? Are you on any meds at all?

q
Posted 6/18/2017 11:22 AM (GMT 0)
Quincy, I'm on the everyday one but I'm thinking of buying the biokult advanced probiotic because it contains more strains one of which is lactobacillus salvarius which is supposed to be good for ulcerative colitis.

I stopped taking prednisolone enemas 2 weeks ago because my GI told me I can't keep taking them because of potential long term side effects. He hasn't given me any meds at the mo as I'm newly diagnosed and the biopsies didn't determine which type of inflammatory bowel disease although my symptoms and scope showed it more likely to be UC. My GI wants to wait for it to flare up again to do another scope and take some biopsies so that he has a concrete diagnosis.
Posted 6/18/2017 4:03 PM (GMT 0)
Maybe get a referral for another GI?

q
Posted 6/18/2017 4:35 PM (GMT 0)
Yes I have been considering it, the only thing is I don't want to slow the process up. I'm concerned that if I go to another GI they may want to do the same thing..... really not sure what is best to be honest. I'm just worried that I may be doing more damage by not being on any meds, but he won't do a sigmoidoscopy until there is bleeding. At the moment I don't have any bleeding which is good but feel that it may be only a matter of time until it flares again.
Posted 6/18/2017 4:51 PM (GMT 0)
What do you mean slow the process? Of what?

q
Posted 6/18/2017 9:53 PM (GMT 0)
Sorry, I meant slow the whole process up of getting treatment, the transfer of my care over to a different gi and then they might also not want to treat until they can determine whether it is UC or crohns.
Posted 6/18/2017 10:25 PM (GMT 0)

quincy said...
What do you mean slow the process? Of what?

q


sorry, but same questions -

i get the whole chromes/UC conundrum, but your current GI seems to be doing very little - how long have you been using the enemas and how often ?

what exactly are your current symptoms ?
Posted 6/18/2017 11:24 PM (GMT 0)
You can tell the doctor what you've tried, and what you want to try. Whether you have UC or Crohn's, you need treatment, and it wouldn't be very fair to make you suffer for a long period of time simply because you've been unable to get a solid diagnosis. Some people have a harder time getting diagnosed than others. How have you gone about getting a diagnosis? Have you had scopes with biopsies? How about endoscopy? FCP? I am not sure any doctor is going to look at these stool results and think it's all that related to your colon situation if that's what you're hoping, unless you go to some type of nautropathic practitioner or dietitian - those "doctors" often will sell you any story you're willing to buy. That's just my opinion.

I think if I were in your shoes, I would want to attempt to get the diagnosis and find out the severity of the inflammation so I could treat based on what's visually happening vs. treating based on stool tests that have no scientific path to recovery. I hate to be negative, but if you have severe UC or Crohn's, the likelihood of some probiotcs and diet helping significantly are about zero. Best of luck & I hope i am wrong - opinion again.
Posted 6/19/2017 2:01 PM (GMT 0)

sorry, but same questions -

i get the whole chromes/UC conundrum, but your current GI seems to be doing very little - how long have you been using the enemas and how often ?

what exactly are your current symptoms ? said...


I was hospitalised in January for dehydration and blood loss and was discharged in 5 days after being re hydrated and sent away with antibiotics. I was told I would have a colonoscopy within 2 weeks. Well I didn't hear anything and symptoms were worsening so went to my GP who said it I is most likely IBD, to stop the antibiotics and gave me prednisolone enemas. I started the enemas and they helped stop the bleeding quickly. My appointment came through for appointment colonoscopy on 10th March during which my GI found inflammation in the splenic flexure and said the enemas had probably healed the rectum appointment nd sigmoid appointment need prescribed me more enemas.

I then had a followup appointment with my GI in May where he said the biopsies showed chronic inflammation and IBD but could not determine which type. So he said stop the enemas to allow symptoms to worse so he can do another scope whilst I am not on any treatment and hopefully he would be able to determine which type that way. I did flare end of May but he was on holiday so had to go back on the enemas. Symptoms have subsided and at the moment I only have lower abdomen burning type pain. So basically I've got to wait to start bleeding before he will do a scope.

I have used the enemas on and off for 3 months or so but when I stop them the bleeding and urgency usually returns within 2 to 3 weeks. My symptoms when it happens includes tummy cramping and loud gurgling at first which then progresses within 24 to 48 hours to diarrhea, pus, mucus and bleeding and burning type pain in lower abdomen. It's really getting me down because I feel like a sitting duck waiting to get ill again!

Notsosicklygirl I have had a colonoscopy as mentioned above, I haven't had an endoscopy, not sure what an FCP is?I agree with you, I do want an accurate diagnosis but I have been having flare ups since June 2016 and they seem to be happening more frequently now, I. E. When I stop the enemas symptoms return within a few weeks. Even if the bleeding doesn't return even in a month or so, is it right that I am not on medication? Just concerned that I can't see what's going on in my bowel and that my next flare might end up being worse..... But my GI won't do another scope until there is bleeding so it's wait and see at the moment.

I honestly did not think it would be this difficult to get a diagnosis.

Posted 6/19/2017 2:41 PM (GMT 0)
The scope you had, what did the biopsies show? Were they indeterminate? I don't really understand waiting until there is blood to do another scope. If you're having symptoms, something is likely going on. I think Q is right, see someone else.
Posted 6/19/2017 3:22 PM (GMT 0)
Yes, the biopsy report said the following:

"Clinical Details:
? Half treated L sided main inflammation in splenic flexure

Microscope:
A: Transverse colon - normal large bowel mucosal pieces
B: Descending colon - large bowel showing crypt architecture distortion, paneth cell metaplasia, there is mild focal acute cryptitis. No crypt abscesses, no granulomas, no parasites. The lamina propria shows excess diffuse chronic inflammation with basal cell plasmacytisis.
C: Sigmoid Colon - Normal colonic mucosal pieces, save for a mildly oedema to us lamina proprietary.
D: Rectum - Normal rectal mucosa pieces

Conclusion:
Focal active colitis in the descending colon with features of inflammatory bowel disease "type not specified". Clinical and endoscopic correlation required."

Yes I've been debating getting a second opinion for a while to be honest, but thought as I've only met this GI twice whether or not I should stick with him. The more I think about it and get feedback from yourselves which is really helpful I think I should see another GI.
Posted 6/19/2017 4:54 PM (GMT 0)
Hmmm yeah it is definitely IBD as you have permanent changes to the cells within your large intestine (noted as crypt architecture distortion). Other things, like paneth cell metaplasia (or cryptitis), are much, much more common in IBD patients.

It sounds like an IBD of either indeterminate-colitis or crohn's-colitis, as the rectum is spared/normal. There are no crohn's-like features (no granulomas or skip-lesions). There's no UC-like features (no rectum involvement, or crypt-abscesses).

How long have you had a diagnosis? These things tend to sort themselves out over time, as you have repeat colonoscopies, new symptoms, etc. In the end, it doesn't make a whole lot of difference in how you are treated, as far as what exact form of IBD it is. As mostly the same medications are used to treat them all. I'd treat symptoms and not worry so much about what exactly it is, you'll findout in good time. As your rectum and sigmoid colon are spared, don't rely on suppositories, foams or enemas as they will not help you.
Posted 6/19/2017 8:16 PM (GMT 0)
Thanks iPoop.ive had the diagnosis since March. The only treatment I've been taking is prednisolone liquid enemas, they are the only thing that stops the bleeding, when I stop taking them the bleeding and symptoms return. This is why I can't help thinking that it is UC and that the enemas had healed upto the splenic flexure the time leading up to my colonoscopy if that's possible?
Posted 6/19/2017 8:55 PM (GMT 0)
It's certainly possible but biopsies don't lie when it comes to chronic changes to the cell architecture. That would be present if active disease was once there...
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