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Colitis or Crohn's? Pathology report disagrees with doc's diagnosis

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Ulcerative Colitis
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Posted 6/26/2017 2:42 PM (GMT 0)
OK,

I'm confused now. I've had and upper and 2 lower scopes. Both times diagnosis was colitis/pancolitis.

Just got my pathology report from the 2nd colonoscopy and the diagnosis from pathology is Crohn's disease.


Is there any reason why the pathology would say crohns if I have colitis?


I was on Apriso for 2 months with no improvement, now Im on Lialda and budesomide and have actually been seeing symptoms getting slightly worse.

I'm confused. I have a call in to my doc to see what's what, but wanted to ask here as well.

Thanks so much!
Posted 6/26/2017 3:31 PM (GMT 0)
Colitis means inflammation in the colon. Pancolitis is location meaning throughout your entire colon. Crohn's is what your inflammation, cellular changes and other identify features is consistent with. So, you have Crohn's Colitis throughout your entire colon.

Do you have a copy of your pathology report?

q
Posted 6/26/2017 3:34 PM (GMT 0)
If pathology says Chrons, then it is likely Chrons. COlitis only means inflammation. Ulcerative collitis means chronic inflammation that is not Chrons, and is limited to colon, and is continuous.

IF it is not any of those things - especially if pathology finds deeper lesions, then the best diagnosis is Chrons.

There are seldom exact/final diagnoses for IBD - because they are mostly exclusionary diagnoses.
Posted 6/26/2017 3:51 PM (GMT 0)
Ok, so the doctors office called me back.

They say the pathology report is in error. False alarm I guess.

I do have a copy of the pathology report if there is something on there I should/could be looking for.

Thanks for the quick responses.
Posted 6/26/2017 4:02 PM (GMT 0)
Error in what way? And what is the conclusion?

Why the two scopes....are you having symptoms?

q
Posted 6/26/2017 5:43 PM (GMT 0)
Error in that it should have said colitis, not crohn's. Apparently the pathology lab will be sending an updated report today.

I have been having symptoms since the first of the year.

First doc I went to that diagnosed things turned out to not be a good doc for me. Switched care to another doc and he wanted a new scope and pathology.
Posted 6/26/2017 5:53 PM (GMT 0)
All I can say is that's pretty darn weird, and the 1st time I've heard of a lab writing the wrong thing in the report...

There's quite a lot to biopsy pathology. The most common example is this. UC biopsies have rather shallow tissue damage. Crohn's biopsies have a lot deeper tissue damage. It's rather distinct when your biopsy slide is looked at through a microscope. There are of course many other examples, but that's at least one of the bigger and more common differentiating characteristics a pathologist might see and include within his/her biopsy report when comparing a UC to a Crohn's biopsy finding.
Posted 6/26/2017 5:58 PM (GMT 0)
That was my thought as well. In the lab it should be quite obvious one way or the other I would think.

But humans make error and a diagnostic code would be easy enough mistype I suppose.

Still strange. I am going to be sure and get a copy of that updated report.

The original report is broken down by decending, transverse, sigmoid, and rectum colon.
All four areas report architectural and inflammatory changes consistent with primary inflammatory bowel disease. A couple areas this was diffuse, one was patchy.

Thanks again!
Posted 6/26/2017 5:58 PM (GMT 0)
UC can backwash into your small intestine if you have pancolitis. Maybe they looked at the location of the biopsy and automatically labeled it CD due to inflammation in your Ileum.
Posted 6/26/2017 6:05 PM (GMT 0)
The celiac was diagnosed way back in 1999. Have been symptom free (except for accidental gluten exposure) since then.

New symptoms began in January of this year. That led to the scopes and the UC diagnosis. Had an upper scope in January that showed nothing.

So, in this case, I don't think the UC is the reason for the CD diagnosis.

But thanks for your thoughts and participation in this thread!
Posted 6/26/2017 10:58 PM (GMT 0)
Patchy is a crohn's thing...
Posted 6/27/2017 6:20 PM (GMT 0)
Well, I called the pathology lab myself and they confirmed it is UC, they screwed up the diagnosis code and assured me my doc would be getting an updated report.

I'm starting 40mg of pred daily for 2 weeks, then will hopefully start tapering down if there is any improvement.

I am discontinuing the budesomide.

Doc has started process with insurance to get Remicade started.

Hopefully I'll get some relief from some of this.
Posted 6/27/2017 8:12 PM (GMT 0)
I would take it a bit more seriously if Crohn's is being mentioned. See if they can do an MRI of your pelvis to determine if there is activity in your terminal ileum.

I was diagnosed with UC until a recent abscess/fistula, during which they noticed inflammation at the bottom of my small intestine, which changed everything. It took a while to wrap my head around, but ultimately I'm taking Infliximab and Imuran, which would be prescribed for someone with UC too. I'm also feeling somewhat lucky that this was noticed before any type of stricture, obstruction or worse could occur.

So just to be safe, if I were you, I'd get a CT scan or MRI to confirm the diagnosis.
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