Help me to understand biopsy result

I got diagnosed in April via colonoscopy after two months of symptoms. I was having 4 bms everyday . No blood. No pain. Blood work turned out to be normal. But still the doc went ahead with colonoscopy and inflammation was in the rectum. There was no visible ulceration. After scopy he said it was proctitis,nothing really to worry about. But biopsy read as chronic ulcerative colitis. From then on, I have been on meds. After two months, I did a sigmoidoscopy to see where the disease is. While doing it , doctor said rectum is oedematous and erythematous. This time biopsy came out as mild proctitis. Doctor says there is improvement .

My symptoms have also improved in terms of bms.But I still have the constant urge to pass stool, my rectum( not the anus) still feels sensitive. If I have improved then why do I still have the urge? Does the diagnosis mild proctitis indicate I am in remission or in the active stage? Biopsy did not mention about ulceration and it stated rectal mucosa is with preserved architecture. Lamina propria shows mild edema, infiltrates of lymphocytes and plasma cells.Focal lymphoid aggregates also seen. Can anybody explain what this biopsy result means?Am i really far from histological remission?

Thanks for your detailed reply. I was tested for pathogens but came back negative. My first colonoscopy result is as follows:

Section studied shows fragments of colonic mucosa showing foci of erosion, congestion and ulceration. The crypts show foci of goblet cells depletion, focal areas of crypt atrophy and pseudopolyp formation. The lamina propria shows lymphoplasmacytic infiltration extending beyond muscularis mucosa.

Impression was chronic phase of ulcerative colitis.

Could this result be due to prep?

I am confused because my symptoms were not that severe when compared to what i read here.

Can chronic ulcerative colitis change to mild proctitis in a matter of few months?

This disease can get anybody into severe depression with suicidal thoughts.

This is a hit and run post, but if your IBD is that new I wouldn't expect there to be structural damage to the walls of your colon/rectum yet. I'm not an expert, I'm just literally making a logical deduction which could be off base. If the biopsy showed chronic UC I'd go with that, tbh.

No ulcers but inflammation means it's still at the mild stage, but any rectal inflammation - no matter how mild - is gonna make you want to go to the toilet a lot.

UC can change to proctitis and vice versa. Mild disease can change to severe disease and vice versa. Most people with mild to moderate disease do tend to stay that way, but it's not guaranteed unfortunately.

Dunno what meds you are on, but whatever you are on carry on taking them and increase the dose if necessary. Try rectal meds as well, if you aren't already. Mild disease is the most treatable and the most likely to respond to meds: hit the inflammation as hard as you can, then stay on a maintenance dose of mesalazine to maintain remission for as long as possible (ideally many years or even decades, but not always possible).

Best of luck. I've really got to go now...... ¬_¬

"Could this result be due to prep?" Not due to prep, at most a prep can cause red coloration from irritation. It doesn't change the structure of your biopsies.

"Can chronic ulcerative colitis change to mild proctitis in a matter of few months?" Often a combination of tests give us a diagnosis. One test can suggest one thing, another test suggests another thing. Doctors sort out what you have through a process of ellimination. A number of symptoms overlap multiple diseases and a true distinguishing features might show up later on clarify exactly what's going on. It's possible to start with infectious-proctitis, later get a Ulcerative Proctitis diagnosis, etc. Not super common to have a lot of ambiguity and changes in diagnosis. But it does happen sometimes.

"colonic mucosa showing foci of erosion, congestion and ulceration". An erosion is the starting/early stage of an ulcer. Congestion is a buildup of mucus (like a congested nose). Mucus normally thinly coats the large intestine, and it can become thick and clumpy when underlying inflammation disturbs it. Mucus sheds to clear an irritating substance from your gastrointestinal tract, to expell an allegen like pollen from a runny nose. Same thing happens within the intestine. Ulcers are part of the name of ulcerative colitis, a defining characteristic. Ulcers can have other causes though.

"The crypts show foci of goblet cells depletion, focal areas of crypt atrophy" Normally the large intestine's surface is full of peaks and valleys. The crypt is the valley. It's an area of interest for ulcerative colitis diagnosis as those crypts are often clogged, you'd typically see "crypt abscesses" in a cookie-cutter uc diagnosis. You have different things going on here than a typical uc diagnosis. Foca or focal is the area of focus (likely in a picture of the biopsy). There's some cells missing (goblet cells), and some atrophy (dead stuff).

"Pseudopolyp formation" is caused by inflammation, nothing to worry about, not cancerous.

"The lamina propria shows lymphoplasmacytic infiltration extending beyond muscularis mucosa." More white blood cells within the layers of your colonic mucosa layer.

Health anxiety, worry, and depression are common with a new diagnosis. Hang in there, it does get better. I think you've got a fairly mild case, and once they get it well treated then you'll be fine. Ask your doctor to change your medications if you're struggling with symptoms. You're multiple months in, and different medications could be necessary when you're not fully healed. Some of us do seak out counseling, therapy, support groups, and antidepressants can help. Don't be afraid to seek extra help if you're struggling emotionally. Your gastroenterologist only treats physical symptoms, but he/she can easily refer you to someone who can help you with depression and anxiety.

in this case "dependent" means you are not controlled without it. It is not an acquired dependency like addictive drugs.

While a over quick taper can let a flare re-ignite, the steroid or its removal does not cause the flare in any direct way. The UBD causes the flare and it bounces back as soon as the steroid is removed. That is what "dependency" means in this case. SO while it may turn out you seem to need it for control, you do not "become" dependent form any prolonged use.

Sciatica is usually directly related to the back. If the area gets inflamed or irritated, even from sitting on the toilet and presses on that already touchy nerve, it would give you sciatic pain.

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