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Is UC just Crohn's "Lite?"

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Posted 1/28/2016 5:05 PM (GMT 0)
I don't understand the pathology of these diseases at all. How can someone have a biopsy that indicates UC at one time then have the UC progress to Crohn's, with biopsies to confirm the new diagnosis. I see this on these forums all the time. Look at all the stuff about MAP theory and its relation to Crohn's. You rarely see them mention MAP and UC, yet people have conflicting diagnoses between the two diseases. I don't get it. Its like all focus in the medical community relates to Crohn's and UC is just an afterthought. Sorry this is kind of all over the place but hopefully somebody understands what I'm getting at here.
Posted 1/28/2016 5:16 PM (GMT 0)
I don't claim to understand the intricacies of biopsies ... But when my diagnosis was changed from UC to Crohns there was no suggestion one disease (UC) had progressed to Crohns, rather that the first was a misdiagnosis. Perhaps biopsy techniques improved over the years, or the agreed interpretation altered - I wouldn't know. I suspect it's a combination of factors ... Not least that the distinction between the two is not always clear cut so we are diagnosed based on probability in light of results which is therefore open to change.

Just to add - when first diagnosed I was convinced I'd 'caught' something that led to this. This all started after my second child, I was in the hospital for less than 24 hours but caught some bug and was very ill after. Treated with strong antibiotics ... From there on the disease developed ... 2 yrs later diagnosed and told impossible to catch. Ironically I caught this bug at St George's in London ... Where much of the trail blazing for MAPvacc is underway!

Post Edited (Duffle) : 1/28/2016 10:36:22 AM (GMT-7)

Posted 1/28/2016 5:31 PM (GMT 0)
Also, biopsies need to be taken from appropriate tissue to be accurate. Using a scope, looking through a microscope lens, it is easy to be a few millimeters off. This could result in getting a sample from an area that is not really active, which would make it difficult for the pathologist to read.

And there's nothing "lite" about UC for a lot of us!
Posted 1/28/2016 5:52 PM (GMT 0)
UC doesn't process to crohn's. You either have one or the other. If you do research you'll find differences between the symptoms and how it spreads etc
Posted 1/28/2016 6:29 PM (GMT 0)
There is a condition called Crohn's colitis but that is simply Crohn's limited (for the time being) to the large intestine.

I think I've read somewhere that a person can have both, tho it's extremely rare. Not sure how true that is.

But I concur, UC does not turn into Crohn's. It's usually just misdiagnosed.
Posted 1/28/2016 6:31 PM (GMT 0)
My post comes from my frustration with, and lack of confidence in, my current diagnosis of UC. I've had some perianal issues more indicative of Crohn's, but my doctors are not really willing to consider changing my diagnosis. I'm having a hard time deciding how to treat it when I don't fully trust what my doctors are saying.

@Andriana, what I meant by "progress" was that the diagnosis of Crohn's is generally considered a more severe diagnosis, not that one leads to the other. By the way, I also have floaters (of the eye), not to be confused with any other floaters that are mentioned in this forum :). I never realized this could be related to IBD until I saw it in your signature and googled it. I had them before my IBD diagnosis and my ophthalmologist said they are just bacteria in the eye.

@Duffle, I am unsure about all the theories about an infection causing IBD, but I've seen a few studies that theorize that my be the case. I got some kind of bug when visiting Dominican Republic years back that gave me stomach cramps for months. 5 years later I had my first major flare. No clue if the bug I got in DR was a cause or a trigger for UC or perhaps that whole episode was just a minor flare and not a bug at all.
Posted 2/5/2016 7:58 AM (GMT 0)
Charlie, my floaters are definitely not related to UC. I got mine when I was 14 years old. I got UC when I was 17. I remember on the day exactly when I got my floaters. I burned my eyes in the sun during the eclipse on August 11th 1999 and I've had them since.
Posted 2/5/2016 11:30 AM (GMT 0)
I have had floaters for years, too. I got a corneal sunburn when I was 10 and have had those pesky floaters ever since. I do, however, worry that I really have CD and not UC from time to time.
Posted 2/5/2016 6:31 PM (GMT 0)
I have floaters since forever...not ever mentioned that it's UC related.

UC doesnt morph into CD but CD can mimic UC if it follows the pattern of involvement. Personally, i suspect the healing pattern might be a give away.

People without uc or cd can have fistulas or abscesses..

I understand your frustration, because i get like that with other stuff. My UC and asthma is pretty much straight forward....its other stuff that has me feel like a square peg.

q
Posted 2/5/2016 7:10 PM (GMT 0)
Since 2007; after procedures and biopsies I have had the following Diagnosis.

- Non Specific Colitis (no IBD) - 3 times
- Proctitis (No IBD) - 4 times
- Mild Chrohns Colitis - 4 times
- IBS and Haemorrhoids only - Several times

It depends on what they see at any given moment; and my symptoms are mild. I have CD but certainly you'd rather have mild CD than moderate or severre UC.

The label doesn't matter, you have inflammation, and it's about managing and healing it.

Right now I am probably 90% that I have Hemmies, as specks of blood are the only symptom I have, no D or anything. But I am still treating my inflammation with max dose, and booked a GI for a month away in case I need it.

With IBD I'd say a combination of symptoms have to be there e.g. blood, mucus, Diarrhea, abdominal pain, weighty loss etc.... not all but a couple of them. Just one on it's own is unlikely to be IBD.
Posted 2/5/2016 8:27 PM (GMT 0)
Thanks for the replies. My summer jobs were on boats so I think that was the source of my floaters.

My doctor says the same thing London said, that we treat the inflammation regardless of which disease I have...though she's confident in her diagnosis. I don't care for that answer because if its Crohn's I'd probably be more willing to be aggressive with my medications right away. I also find it easier, mentally, to deal with health issues when they have a name.

I think I just need to sit down with my GI and have a good talk just to get my head around everything. While I accept that IBD is unpredictable, I'd much rather deal with UC than Crohn's because surgery is curative for UC. Not to mention these perianal issues are pretty torturous at times. Perianal Crohn's doesn't sound too fun.
Posted 2/5/2016 9:20 PM (GMT 0)
You should be treating CD and UC just as aggressively as they can both be absolutely devastating. You wouldnt treat acute lymphocytic leukemia less aggressively than Acute myeloid leukemia just because its less deadly...
Posted 2/5/2016 9:49 PM (GMT 0)

Marauder93 said...
You should be treating CD and UC just as aggressively as they can both be absolutely devastating. You wouldnt treat acute lymphocytic leukemia less aggressively than Acute myeloid leukemia just because its less deadly...

Under that logic, should everyone be on biologics as soon as they are diagnosed? I'm trying to make that decision with my GI but it will be tough to pull the trigger without any serious symptoms at the moment.
Posted 2/5/2016 10:20 PM (GMT 0)
IMO, if you have mild IBD (either form cuz both suck!) then they should start you with oral meds but for the moderate to severe IBD they should get to automatically go on biologics if they wish to. Unfortunately, not all GI's have the same views when it comes to treating their patients either and that's too bad in itself.
Posted 2/5/2016 10:42 PM (GMT 0)
Treatment is the same whether it's CD or UC, the only difference are the surgery options. I was upset for a while when my dr switched diagnosis from UC to possible CD, but not so concerned about it now.

After my initial diagnosis that came after I landed in the hospital with a severe flare I responded well to Asacol HD and prednisone. A couple months later I was switched to Apriso because it was easier to take meds just once/day. Apriso didn't work very well for me and for a while I kept going back & forth between Apriso & Asacol on my own for several months. I have never had a bad flare since I was first diagnosed but now I realize I had been simmering (very soft semi formed stools, 4-5x/day blood every few days) almost the entire time.

When my GI wanted me to go on Humira after I failed on azathioprine due to high liver enzymes I was very resistant because my symptoms were so mild and that's when I found a post on this site about home made nopal water. Since it was so safe and cheap to try I decided to do that before I went to a biologic. I started to see more firm stools within just a few days. It worked very slowly and it was about 3 months before I stopped seeing any traces of blood. But it's now been over 9 months that I can say that I am in remission. My last scope in April 2015 only showed very mild inflammation remaining in a few patches. It was shortly after that I stopped seeing any trace of blood at all so I am counting remission from May of 2015. I'm sure that will be confirmed on my next scope

If your symptoms are mild you may want to give nopal a try before going on a biologic. It seems to work for some but not others (same as everything with this disease). It's just not fast acting. I started to see slight improvement within just a few days but it was a long time before all symptoms were gone. I still drink a smaller glass every day as a supplement to my Asacol.

Here's the original thread though if you do a search you will see several other threads on the topic since then. Ignore the word "cure" lol

www.healingwell.com/community/default.aspx?f=38&m=3282660
Posted 2/5/2016 10:45 PM (GMT 0)
Also, I was in my early 20s when I first started seeing floaters in my eyes. They were most pronounced when in bright sunlight. My eye doctor said that most people have them and it's just a normal part of aging of the eyes (aging isn't a word a 20 something wants to hear lol). Not sure about any connection to IBD.

Post Edited (CCinPA) : 2/5/2016 3:51:30 PM (GMT-7)

Posted 2/5/2016 11:12 PM (GMT 0)

Uniform Charlie said...

Marauder93 said...
You should be treating CD and UC just as aggressively as they can both be absolutely devastating. You wouldnt treat acute lymphocytic leukemia less aggressively than Acute myeloid leukemia just because its less deadly...

Under that logic, should everyone be on biologics as soon as they are diagnosed? I'm trying to make that decision with my GI but it will be tough to pull the trigger without any serious symptoms at the moment.

Thats more or less where standard IBD therapy is going, though we arent there yet. Its a tough call but you also dont want to wait until it gets bad
Posted 2/6/2016 2:06 AM (GMT 0)
I had an exact similar discussion with my GI when I was first diagnosed, and he told me that some patients albeit rare they do switch between having UC and CD if I recall correctly he called it indeterminate colitis.
Posted 2/6/2016 2:54 AM (GMT 0)
It's not that the colons switch between UC and CD, it's that they're difficult to determine what exactly the diagnosis is based on some of the pattern features. It's the diagnosis that switches between one or the other, and it's appropriate there's an indeterminate category.

I found this that has more info on indeterminate IBD.
I think it's in part how the pathologist reads it and how the doctor makes the determination based on info and visual.


www.ncbi.nlm.nih.gov/pmc/articles/PMC1770507/

q
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