Diagnosis

I wonder the same thing. They said I have severe uc through out my whole colon. I'm so afraid I will have surgery and then oops you have crohns. Ughhhh One of my biggest fears.

I am scared of this too. I am getting an endoscopy in October due to upper stomache trouble so I am hoping they dont find any inflammation there... I had lots of biopsies taken at dx and at my second colonoscopy this past May and all say UC but I also think you never really know. I have never had any skip patterns in teh inflammation that has always been left sided but the upper GI stuff worries me.

I had an endoscopy not too long ago, just wanted to let you know it's a VERRRRRRY easy test! No prep except for eating a liquid diet from noon the day before swallowing the pill cam until 3 hours after I swallowed it.. Easy Peasy!

Yes, the answer to your question is a colonscopy with biopsies with a pathology report is considered the gold standard for diagnosing Ulcerative colitis.  Yes, there can be adjunct test to help confirm this but a good and complete colonscopy with multiple biopsies is the best way to diagnose this disease.  There can always be pathology or disease that's off the beaten path but this is the best way to diagnose at the present.  The more consistency one has the better for obvious reasons.  I have had 7 colonscopies with a lot of biopsies.  All of them including the pathology reports confirmed UC, nothing else.  I have even had different pathologists read the same slides to make sure they all think it's UC.  So far no discrepancies. 

Hope this helps.

MyUC

Q I know your the queen of the lower rectum but what I am trying to get at is that of course all GI docs will give thier diagnosis based on what they clinically see during the scope.  But again, that's subjective.  Pathology is pathology subject to reading.  Meaning most GI docs will say I think it's so and so but we have to wait for pathology before we give a definative diagnosis.  As a dentist I see lesions in the mouth all the time.  I will give my clinical impression and say I thinks it's this or that.  I will take a biopsy and submit to path and it will confirm or deny my judgement.  If it confirms great we have a working diagnosis.  If not I will submit another biopsy anways for path to look at it again.

Anyways, the answer to your question is that a colonscopy with mulitple biopsies is the best way at present to diagnose UC

MyUC

Q, I meant that as a compliment.  Seriously to me you are the definative authority here on the rectal region.  I look to you when it comes to rectal meds specifically.  Again it's a compliment nothing else.

The mouth can have a variety of lesions from irritation and simple inflammation and trauma to cancer.  There are at least a dozen scenarios where one performs a biopsy and sends it of to path.  I can use a brush or a scapel.  I often will give a description of the visual lesion to the pathologist nothing else.  They come up with their own diagnosis seperate from what I think.  If the path report comes back what I was thinking we have a match.  If not we are more likely going to do another biopsy.

Again I think we are off track again.  The original question is how to best diagnose UC.  A colonscopy with multiple biopsies indicating UC is the best at present.  That's all I am saying.

MyUC

There are five different subtypes of Crohn's...
1) Stomach Area Involvement
2) Upper Small Intestine (Jejunum) Involvement
3) Terminal Ileum Only Involvement (last piece of small intestine)
4) Terminal Ileum + Colon Involvement
5) Colon Only Involvement

#1 and #2 make up like 5-10% of cases and are very rare. Numbers 3-5 make up the rest of the 90-95% of cases with #4 being the most common. Therefore, I think the main way to differentiate Crohn's from UC is involvement of the terminal ileum (last piece of the small intestine) via biopsies of it during a colonoscopy. Now, if you need to differentiate #5 between UC, it gets a little more tricky. The clinical appearance (before starting medicine) is patchiness inflammation with sometimes rectal sparing and sometimes perianal disease (abscess, fistulas, etc). The gold standard though is with biopsies like MyUC and Quincy have stated. But there is no one size fits all for #5 or either of these diseases unfortunately. Hope this helps...

Actually MyUC...not entirely true. U.pancolitis can have backwash into the terminal ileum...still UC.   I don't think it happens with limited involvement.  Although the cecum can be involved.
q

Biopsies should be able to differentiate between backwash ileitis and Crohn's! ;) I don't know if the OP really wanted to get this down and dirty in medical jargon, so I apologize if I took this thread off course.

I have had two colonoscopies in the past 3 years and all biopsies indicated ulcerative colitis. But I also had patchiness and a perianal abscess which points to Crohn's. Subsequent blood tests were equally ambiguous. My small intestine is still clean so far.

My GI did not seem concerned. He said I definitely have IBD and whether it is UC or Crohn's the treatment is the same. But it matters to me. In the worst case scenario UC can be cured with surgery. With Crohn's surgery is almost inevitable brings only temporary relief until you eventually need more surgery.

And Crohn's patients can suffer from abscesses and fissures that can develop anywhere in your digestive system and ooze crud. I don't take meds but I am especially vigilant about diet, take natural supplements that are proven effective for IBD, and watch for any specific foods that seem to help or aggravate symptoms. I never thought I would hope that I have ulcerative colitis but the alternative is much worse.

BITW...all your worrying won't change the facts of what you have. The best thing to do is what you're doing...be aware, take your meds, lessen stress by doing the research, etc. Not everyone has fistulas, etc.

I have a friend who has fistulising CD...she is amazing and deals with grace. She's had multiple surgeries, but the last two have been the most helpful for her. She has a great doctor as well.
I know for sure I wouldn't be able to deal as she has...but I don't know since I don't have what she has.

The permanent ileostomy is always an option, or even a temporary one to allow healing....but you're not at that point or even to say you ever will.

It definitely sounds like CD, but it also sounds like all is controlled. We all search for the balance...not necessarily perfection.

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MyUC....The thread may have gotten slightly off-topic, but still relevant.  Diagnosis is difficult because of the variables...and not all assumed that one test can confirm.  It's more complicated than that.

Yes, it's a great environment here...even talking butts.

q