In His Grip
AlwaysRosie "We can't control the waves, but we can learn how to surf!!"
Co-Moderator - Lupus Forum
UCTD, Inflammatory Arthritis, Crohns, Diverticulosis, Sjogrens
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My opinion is that pathology can not clearly differentiate between inflammation or ulcers that are caused by NSAIDS or true IBD (Crohn's or UC). My colonoscopy showed patchy inflammation and ulceration throughout my entire colon. Pathology reported chronic moderate to severe inflammation with granulomas, and yet my "previous" GI doc diagnosed UC rather than Crohn's. I had been taking naproxen off and on for years.
My current gastroenterologist co-authored the study here:
After you read that study, look to the right for "Related Links" - there are 5 listed and then "See all Related Articles..." Click on that link and you'll see there are about 13 pages of studies related to NSAIDS and GI problems, both upper and lower. It appears to me that NSAIDS of all types can cause inflammation/ulceration in the terminal ileum and/or colon as well as in the stomach and upper small intestine.
Were you taking ibuprofen right up until the time you had your colonoscopy (ileoscopy)? Probably the only sure way to know if the ibuprofen caused your inflammation would be to stop taking it for a few months and then have another colonoscopy. (probably not something you would gladly choose to do. Ha!)
There are many other folks, myself included, that have been faced with the question of whether NSAIDS caused their GI problems and the resulting abnormal colonoscopy, and then being diagnosed or undiagnosed with Crohn's or UC.
Good luck with fitting together the pieces of your puzzle.
I am kind of in a similar situation. I had inflammation in different areas of my colon as well and I had ulcers in my TI. My GI told me that she believed it was from NSAIDS and that it was not Crohn's. I did not take NSAIDS for, I believe, 3-4 weeks before my colonoscopy.
Anyhow, because I have other symptoms of Crohn's, my Internist believes I have early Crohn's. I am in the process of trying to get another GI for a second opinion.
Part of me honestly hopes that I really don't have Crohn's and that I just have stomach upset because my gut is "sensitive" and that all the extraintestinal symptoms are from something else. I guess only time will tell...
Best of luck with everything and keep us posted!
Well, I'm still trying to put together the pieces of my puzzle. Here's a bit of my history.
My problems began with inflammatory arthritis in 1991. I've had six episodes of iritis since 1997 and one scary incident of bilateral papillitis (swelling of the optic discs) in 2003. My bowel problems began in 2003 and I was diagnosed via colonoscopy with ulcerative colitis, although the pathology report noted granulomas and suggested Crohn's. I don't really understand why my GI doc didn't agree with the path report, but instead diagnosed UC. I was treated with Asacol and then prednisone for the papillitis. I flared again six months later with severe diarrhea (with blood clots) and dehydration and was hospitalized and treated with IV solumedrol and flagyl. I had four months of oral prednisone with taper, then Imuran was added. My arthritis got worse, so I was switched to methotrexate. I haven't really "flared" with the IBD since I was hospitalized.
I still had the ups and downs with the arthritis and have had my swollen knees drained and injected with steroids (Kenalog) numerous times. After my own research on the internet linking iritis and my other symptoms to HLA-B27, I convinced my rheumatologist in 2004 to test me for the antigen. To HIS surprise, I tested positive, and I began Enbrel injections in December of 2004. I saw and felt immediate results, (within three days). I believe Enbrel is MY miracle drug for the arthritis, which my rheumatologist now classifies in the spondyloarthropathy family since I'm HLA-B27 positive, and negative on the ANA, rheumatoid factor and CCP. I know there are quite a few IBD folks who are HLA-B27 positive as well, and they seem to have a lot of inflammatory arthritis problems along with enthesitis and uveitis/iritis.
I quit the Asacol and methotrexate on my own sometime in 2006. My bowel problems have been manageable with only occasional diarrhea and sometimes mucus with blood, but my last ileocolonoscopy showed no evidence of IBD, and my current GI doc believes the Enbrel may be treating the IBD as well as the arthritis. His other theory is that my so-called IBD could have been the result of the NSAIDs I was using for my inflammatory arthritis at the time of my first bowel flare. That was his study I noted in the link above in my previous post. So I don't know if I have an IBD or not, but with the Enbrel I feel great 95% of the time. I only rarely use Aleve.
I didn't mean to hijack your thread, Rosie, and sorry this is so long (I got carried away.) Some folks have "text-book" symptoms and diagnoses of IBD, and others are very complicated. I think most doctors don't take the time to try to research and look at the whole picture. I've researched my case to death, and my hubby calls me the "Internet Goddess" cuz I'm STILL on here doing research.
Good luck to all.
Post Edited (jan2003) : 4/29/2008 8:22:11 AM (GMT-6)
Aw, that's nice of you! But really, I haven't had any major bowel issues since 2003, only occasional diarrhea and sometimes mucus/tissue with blood. My main problems are in my joints, tendons and ligaments, and I'm under the care of a rheumatologist and I'm prescribed Enbrel for that.
I guess I'm kind of a wimp when it comes to questioning or arguing with a doctor about a diagnosis, (besides the fact that my first GI doc who gave me the UC diagnosis is my neighbor who lives across the cul de sac!) Plus, I've had to go through enough puzzle-solving with my rheumatologist to come up with the spondyloarthropathy diagnosis, and there are still differences of opinion there, but I do believe I've researched this area more than he has.
From what I've learned, everything that's happened with me would fit under the umbrella of HLA-B27 related symptoms (including the papillitis - inflammation of optic discs.) There are folks on another spondylitis message board who believe (or they physicians believe) that the bowel inflammation is secondary to the spondyloarthropathy, especially when the joint symptoms came before and are more severe than the GI symptoms. I've also seen studies on PubMed to indicate that bowel inflammation coincides with various joint inflammation, and when the joint inflammation is resolved, the bowel inflammation also resolves. Kind of the opposite of what some GI docs believe.
But somtimes, yes, I do wonder if I have Crohn's or UC, and perhaps only time will tell.
Rosie, what's the word with you? Have you received your lab results from your GI doc?
Rosie, yep, hang in there. I wouldn't call again either and risk being labelled as one of those annoying pesky patients. I'm sure they'll call when they get the report. It's no fun waiting though!
By the way, how are you feeling these days? Are you still taking Entocort?
UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)