Atypical UC actually Crohns or something else?

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Lotusorb
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Date Joined Apr 2017
Total Posts : 3
   Posted 4/12/2017 4:38 PM (GMT -6)   
Hi Everyone,
I had a Colonoscopy on 3/21 this year. I had inflammation in my rectum, and sigmoid. The inflammation ends there, then skips to the ascending colon and cecum. The ileum appeared normal. I also have a diverticuli at my hepatic flexure. Does this sound like typical UC? I thought UC was continuous inflammation. I did not think it could skip areas like this.
The Dr. Says it is UC, but I feel in the dark about many things and I saw a different dr today who also seemed unsure of the diagnosis. Any thoughts?

NiceCupOfTea
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Date Joined Jan 2010
Total Posts : 9639
   Posted 4/12/2017 6:10 PM (GMT -6)   
Were biopsies taken during the colonoscopy? If so, what do the biopsies show? Skip inflammation isn't typical for UC, but it's possible. There's a rare pattern of UC which appears in the rectum and caecum but nowhere else (I dunno where the ascending colon comes into this, sorry). But I can understand why you're doubtful about the diagnosis. Unfortunately only more time will tell if it's UC or Crohn's. It's not always easy to tell, but if it's Crohn's it tends to eventually make its malign presence felt - not that UC is a bundle of laughs either.
Dx Crohn's in June 2000. (Yay skull)
Tried: 5-ASAs, azathioprine, 6MP, Remicade, methotrexate, Humira, diets.
1st surgery 20/2/13 - subtotal colectomy with end ileostomy.
2nd surgery 10/7/15 - ileorectal anastomosis. Stoma reversed and ileum connected to the rectum.
Current status: Chronic flare. Do I have any other kind?
Current meds: 50mg 6MP; Entyvio (started 3/11/16)

73monte
Veteran Member


Date Joined Mar 2007
Total Posts : 1686
   Posted 4/12/2017 7:00 PM (GMT -6)   
I would second NCOT's post. You would need biopsy results. Diagnosis isn't always easy, and many diagnosed with Colitis, even years later have their diagnosis changed to Crohn's, or Crohn's/Colitis.

Hopefully you get the answers you need soon, as the more exact the diagnosis, the easier it is to arrive at an effective treatment plan.

Lotusorb
New Member


Date Joined Apr 2017
Total Posts : 3
   Posted 4/12/2017 7:34 PM (GMT -6)   
Nicecupoftea,
The biopsy results showed UC. Can you elaborate on that rare pattern of UC being in the rectum and cecum?

NiceCupOfTea
Veteran Member


Date Joined Jan 2010
Total Posts : 9639
   Posted 4/13/2017 6:06 AM (GMT -6)   
Then I would go with the biopsy results and think of yourself as having UC for now. In terms of medical treatment it doesn't make much difference what diagnosis you have, as the meds for both are the same. It only really matters if you have severe disease and are thinking of having surgery - but hopefully your disease will never get that bad.

I may have to eat my own words about an atypical distribution of UC being rare. This study showed that almost 20% of patients had an atypical distribution at diagnosis. They were Asian, so perhaps that makes a difference, I dunno. Here's the link anyway: /www.ncbi.nlm.nih.gov/pubmed/24619632

The appendiceal orifice inflammation is in the caecum by the way.

On the other hand this poster (you'll need Adobe or another PDF reader to open it) puts the prevalence of the caecal patch at 3.3% and has a far larger sample size. So once again, I don't really know.

www.miracalifesciences.com/wordpress/wp-content/uploads/2012/11/ACG_2012_Poster_Cecal_Patch.pdf

The only thing we can be sure of is that UC isn't always cut and dried.
Dx Crohn's in June 2000. (Yay skull)
Tried: 5-ASAs, azathioprine, 6MP, Remicade, methotrexate, Humira, diets.
1st surgery 20/2/13 - subtotal colectomy with end ileostomy.
2nd surgery 10/7/15 - ileorectal anastomosis. Stoma reversed and ileum connected to the rectum.
Current status: Chronic flare. Do I have any other kind?
Current meds: 50mg 6MP; Entyvio (started 3/11/16)

Lotusorb
New Member


Date Joined Apr 2017
Total Posts : 3
   Posted 4/13/2017 6:34 AM (GMT -6)   
I agree. It probably is UC, or maybe Infectious Colitis, but I won't know that until a follow up colonoscopy in a year. I do think my Dr. is smart enough to dx between UC and Crohns Colitis though. Something just feels "off" about all of it. I am not Asian, so all this right-sided activity seems unusual.

NiceCupOfTea
Veteran Member


Date Joined Jan 2010
Total Posts : 9639
   Posted 4/13/2017 6:40 AM (GMT -6)   
I do think my Dr. is smart enough to dx between UC and Crohns Colitis though.

It's not a question of being smart, it's a question of how distinct the disease is. There's a large grey area in IBD where it isn't clear whether it's Crohn's colitis or UC. Try googling indeterminate colitis.
Dx Crohn's in June 2000. (Yay skull)
Tried: 5-ASAs, azathioprine, 6MP, Remicade, methotrexate, Humira, diets.
1st surgery 20/2/13 - subtotal colectomy with end ileostomy.
2nd surgery 10/7/15 - ileorectal anastomosis. Stoma reversed and ileum connected to the rectum.
Current status: Chronic flare. Do I have any other kind?
Current meds: 50mg 6MP; Entyvio (started 3/11/16)
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