Doctor's vs pathologist assessment - colonoscopy results

I have to wonder if your dr was looking at the wrong biopsy report. Do you have a copy of the biopsy report, if not I would get a copy. I would then discuss this with the dr. Something is not right.

Are you having any issues & what meds are you on?

A pathologist can only see the biopsy fragments, and nothing else. So the pathologist is speaking from what the biopsies say.

A gasteroenterologist makes a colonoscopy report based on what they saw during that procedure. Ultimately a diagnosis by your gasteroenterologist also considers the pathology report.

Mild features in a colonoscopy report might be erythema/redness as an example. Severe examples in a colonoscopy report might be ulcers, and severe inflammation that the scope cannot pass through.

Thanks everyone. One correction - this was a sigmoidoscopy not a colonoscopy. Here’s what the two doctors said:
Pathologist: Severe active chronic colitis with ulceration and reactive epithelial atypia
Gastro: sigmoidoscopy does reveal mild ulcerative colitis . There is mild inflammation as most areas are Mayo I and two areas are Mayo II inflammation. Several biopsies were taken.
A little background - The scope with the big discrepancy between doc and pathologist was in March. At that time I also had recurrent C Diff (eventually 5x), and perhaps my doc attributed some of the inflammation and symptoms to that rather than colitis, as she was very focused on the C Diff as the cause of my flares. Since then, in late June I had a fecal transplant delivered by colonoscopy, which was performed by a different doc at a different hospital, at my doc's request. His written assessment was severe u colitis in most of the colon, which he thought was driving the C Diff recurrence, and recommended an immediate switch from Entyvio to Remicade or a JAK inhibitor, contrary to my doc's recommendation of stay with entyvio and see what happens. On the gurney he told me that he thought my disease had been unmanaged, which was not great to hear. Anyway I pushed my doc for a medication change and I’m now switched to Remicade and it’s early days but things seem to be settling down. In future I'll certainly follow up if I see that kind of disagreement between pathology and the doctor's assessment.

Could you switch to care by the doctor who did your FMT? From your update giving the sequence of events including C-diff recurrence, he sounds more knowledgeable than the one you've been consulting over time, plus his assessment of your UC status corresponds with the pathologist's report. As Straydog commented above, "something is not right". And he did describe your UC as "unmanaged" during a conversation you had with him. (Maybe that was a polite hint.) / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)

Mayo scores

1 mild disease with erythema, decreased vascular patterns and mild friability;

2, moderate disease with marked erythema, absence of vascular patterns, friability and erosions;

3, severe disease with spontaneous bleeding

My friends used the excuses...the other doc was close to their work so it was easier to make appointment...the other friend used it was closer to her home.... I used...I felt more comfortable with a female doctor.... Sometimes you gotta be truthful but creative.

I'd be wanting to change too. Do you have a PCP that might try to refer you to this guy in like 6 months or so?

Clo

I've also had a lengthy quest for a reliable PCP, dating back 6 years. After I spent 6 months on a waiting list then finally got office visit to an excellent internist, this doctor decided to relocate 5 months later: so frustrating! Last fall I got assigned to a postgraduate resident MD in 1st year of 3 yr program toward full certification. So I can definitely relate to your complication of needing to connect to a new PCP, when the existing PCPs are leaving in droves or declining new patients! *** Probably the best thing you can do for yourself at present is to avoid any known source of C-diff contamination. Did you ever get any medical or dietitian advice on probiotics use? In the 20teens I attended a lecture by an IBD MD/researcher who stated that the Lactobaccillus GG in [original formula] Culturelle could help to prevent C-diff infection. Also, it's important to supplement with probiotics if/when one has to take Rx antibiotics, which makes us more susceptible to C-diff infection. Several forum members have posted that daily Florastor probiotic helps them to avoid antibiotics complications. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)