Inflammation in Biopsy - from Crohn's or Ibuprofen?

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AlwaysRosie
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   Posted 4/26/2008 8:05 AM (GMT -7)   
Can a biopsy, taken during colonoscopy, differentiate the cause of inflammation?

I have been taking ibuprofen for years to control connective tissue inflammation and I'm reading how bad ibuprofen is for Crohn's. I was just dx'd with Crohn's less than two weeks ago and am very new at this.

Could my inflammation (ileum/cecum) actually be caused by Ibuprofen and NOT Crohn's??? or would the biopsy give enough information to differentiate.

Thanks for your help!

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

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CrohnieToo
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   Posted 4/26/2008 8:11 AM (GMT -7)   
I'm not sure if the pathologist can tell the cause when it is early Crohn's, Rose. And how experienced the pathologist is in recognizing Crohn's makes a big difference too. BUT, the AREA in which the inflammation was found is pretty darn suspicious for Crohn's. That area is Crohn's favorite "first strike" area. And NSAIDs are more likely to cause irritation, inflammation and bleeding higher up a healthy GI tract.
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.


AlwaysRosie
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   Posted 4/26/2008 8:20 AM (GMT -7)   
*sigh* . . . . a gal can only try . . . . was trying to un-dx myself!! GI doc is Cleveland Clinic so I hope that increases the chance of a good pathologist.

I still have not heard back from the GI doc. She gave me my c-scope results indicating Crohn's and then asked me to take the IBD7 blood work. As of yesterday, she had not received the results. She was waiting for this info to make a final decision on starting me on the Entocort.

Your post was helpful, as I didn't have a clue how NSAID inflam might show up in the gut. I actually thought it would show up in the stomach first.

Oddly, my most severe attack was after a 5 month period w/no meds . . . so that would also argue against NSAID's being the cause. *sigh*

Thanks for your input.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

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CrohnieToo
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   Posted 4/26/2008 8:32 AM (GMT -7)   
Ha! You can't get much better than Cleveland Clinic! They have the second highest rated gastro department in the country! Their pathologists KNOW Crohn's disease. They've had PLENTY of experience w/it. You're in good hands at CC.
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.


yogaprof
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   Posted 4/26/2008 8:43 AM (GMT -7)   
both times I had biopsies they said something like possible crohns, does the patient take a lot of NSAIDs? but I didn't take a lot, so they leaned toward crohns. no real answer, just jumping in! yp
48 y/o woman.  Diagnosed 4/06 after colonscopy, SBFT, CT-scan all showed crohns. 3 months later, after pred and remicade, all tests showed no crohns. December '06 had adhesions cut through a laparoscopy. Now taking Glycolax, Ultra Fiber Plus, Florastor, and DHEA. Have become gluten-free diet per naturopath's tests.


AlwaysRosie
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   Posted 4/26/2008 8:43 AM (GMT -7)   
Thanks C2 . . . I'm trying to "line-up" an entire health team there. Started when I lost my local rheumy because he didn't accept my insurance any longer. I was frustrated with trying to get my doctors to work together and decided to start seeing docs at the CC where they share charts via computer. So my first doc there was the rheumy. The rheumy referred me to the GI . . . and I am seriously considering shopping for a primary care doc there as well. Then all charts and info will be together. I only need to drive 25 minutes to a satellite office and 40 minutes to the main campus. So its great hearing that they have such a good reputation.

Thanks again for your reassurance. I'm getting my head wrapped around all this new stuff and set up my treatment plan and best options so I can put all this to the back of my mind. It's so great to have HW friends who are so knowledgeable.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

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UCTD, Inflammatory Arthritis, Crohns, Diverticulosis, Sjogrens

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jan2003
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   Posted 4/26/2008 12:23 PM (GMT -7)   

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:

http://www.ncbi.nlm.nih.gov/pubmed/15017486?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum 

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.

Jan


AlwaysRosie
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   Posted 4/26/2008 3:04 PM (GMT -7)   
Thanks Jan,

I was asked to stop NSAIDs for two weeks before the scope. . . . which I did. But I sure plan on reading the info you provided. Thanks.

My worst attack was last May after a 5 month period w/o the NSAID's . . . but I hadn't put that piece of the puzzle into place till after I started this topic. I sure would be happy if all the issues are ibuprofen related!! What a simple fix!

Off to read, read, read!!!

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Crohns, Diverticulosis, Sjogrens

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indigosunrise
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   Posted 4/27/2008 5:06 PM (GMT -7)   

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!

 


AlwaysRosie
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   Posted 4/27/2008 8:02 PM (GMT -7)   
Thanks Indigo. I should here from the GI doc soon about the test results from the IBD7. I'll be watching for your updates too. Are you on a treatment plan?

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

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abl
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   Posted 4/27/2008 8:57 PM (GMT -7)   
Hi! I'm new to this forum. I was diagnosed in 2000 with Crohn's. Do you know if your biopsy showed the presence of granuloma cells? That is the only 100% sure way of knowing that someone has Crohn's. Otherwise, there are certain things that your dr. would look for during a colonoscopy that would be consistent with Crohn's for a diagnosis. I do know that NASID's can cause ulceration that mimics inflammatory bowel disease, but it is probably more likely that the medication is exacerbating your underlying disease. I would be very interested to know what your dr. has to say about this! I hope you feel better!
 
~Anna

AlwaysRosie
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   Posted 4/27/2008 11:55 PM (GMT -7)   
Hi Anna . . . I was hoping to get a copy of the biopsy report, but haven't yet. She sure sounded convinced that it was Crohn's, but no mention of granuloma. She referred to a couple reasons why she stated crohn's: the biopsy, the area of attack, the pattern of attack. My brain is just working overtime trying to get this whole thing in perspective and move on. This forum has been a true blessing! Thanks for your encouragement!

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

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jan2003
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   Posted 4/28/2008 5:36 AM (GMT -7)   

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.

Jan


AlwaysRosie
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   Posted 4/28/2008 3:45 PM (GMT -7)   
Hi Jan . . . no highjack at all . . . your post is great information. Did you take the IBD7 blood test??? If so, how did your results look. I'm still waiting for my results.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

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jan2003
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   Posted 4/29/2008 7:10 AM (GMT -7)   
Rosie,
 
I hate waiting for lab results, too! I hope you get yours back soon.
 
Like you, I had to switch physicians due to insurance issues. My first GI doc who diagnosed me with UC in 2003 didn't do any labs to differentiate between UC vs Crohn's, since he was certain I had UC. With my next severe flare and right before I was hospitalized, I had a CT scan which showed mild wall thickening of the ascending and transverse colon and some infiltration of fat around the ascending colon ("fat wrapping"). First GI doc stuck to the UC diagnosis.
 
Fast forward two years, and my new GI doc thought the CT scan report - fat wrapping and bowel thickening, biopsies - granulomas, and pathologist report - chronicity and patchiness, looked more like Crohn's, but the subsequent ileocolonoscopy with him was normal both macroscopically and microscopically. I was also on Enbrel and methotrexate at the time and had no symptoms of IBD. He did order the labs for ANCA and ASCA, which were sent to Quest, but I don't know if those results would be different when one is in remission vs having active disease. I think the Prometheus IBD 7 consists of those two tests, plus some others.
 
Anyway, my results for the ANCA were negative, and the ASCA had three different ranges: negative, equivocal, and positive. My ASCA IgG came back "out of range," but in the middle range, higher than negative, but lower than positive, so ?!?! My doc dismissed it and said those labs aren't always reliable or definitive anyway.
 
So my puzzle is still unfinished. The arthritis/enthesitis has always been my main problem, and I know the Enbrel is working for me and I'm able to function. I only occasionally have diarrhea with bits of bloody mucus/tissue, but it doesn't cause me to lose weight or become anemic; maybe I'm being too nonchalant about that. I don't have any follow-up appointments with the GI doc, but I do see my primary for my yearly gyne exam next week, so maybe I'll ask what she thinks.
 
I hope you get your results soon, AND they are definitive one way or the other. Good luck!
 
Jan

Post Edited (jan2003) : 4/29/2008 8:22:11 AM (GMT-6)


abl
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   Posted 4/29/2008 1:54 PM (GMT -7)   
Jan2003~ I am confused about your diagnosis! If you had the presense of granuloma cells, that is the one way they can that it is Crohn's and NOT UC. Did they give you a reason why they weren't factoring in the granuloma cells into your diganosis? You've been through so much and I can't imagine being up in the air for this long without really knowing what's wrong! I'm so sorry!

jan2003
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   Posted 4/29/2008 7:43 PM (GMT -7)   

Hi abl,

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?

Jan


AlwaysRosie
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   Posted 4/30/2008 4:11 PM (GMT -7)   
Jan . . . nothing yet . . . still waiting. I've called twice, so I better behave and just wait. Thanks.

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

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UCTD, Inflammatory Arthritis, Crohns, Diverticulosis, Sjogrens

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jan2003
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Date Joined Jul 2004
Total Posts : 92
   Posted 4/30/2008 4:41 PM (GMT -7)   

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?

Jan

 


AlwaysRosie
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   Posted 4/30/2008 5:22 PM (GMT -7)   
Jan . . . my last appointment was 16 days ago. GI told me to wait to fill the Entocort rx until she saw the results of the IBD7 blood work. So, I'm not taking any new meds yet. My connective tissue issues have been quiet recently . . . YEAH! Gut is rumbling, a bit bloaty sometimes, a bit of discomfort, but nothing bad right now. Thanks for asking Jan.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Crohns, Diverticulosis, Sjogrens

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AlwaysRosie
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   Posted 5/13/2008 7:40 PM (GMT -7)   
Bump!!! Up you go for Karen!!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

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Jen77
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   Posted 5/13/2008 8:21 PM (GMT -7)   
Well in my case they felt the NSAIDS made my ulceration worse, but my doctor said it was Crohn's all the way. So he must of had some way of telling.
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Currently taking Predisone 40mg, and Asacol.

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