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DiSquared
New Member


Date Joined Sep 2017
Total Posts : 4
   Posted 9/17/2017 11:42 PM (GMT -6)   
I was wondering if anyone could help me out I'm a bit confused after reading some of the posts on here. I'm not sure what is going on I had a colonoscopy/endoscopy(ill post the results below) done last spring that found several site of inflammation... Shortly after I lost insurance coverage until recently. about two months ago I had a calprotectin, crp, and sed/rate test done. The calprotectin was 603 but the crp and sed/rate were normal... I also have a lot of food allergies and take a proton pump inhibitor. Could it be possible that the allergies combined with the ppi could cause such a high calprotectin level? Symptoms I'm experiencing are pain after eating 1-2 hours, random pain right abdomen, severe pain with bowel movement in rectum(no joke this crap hurts literally), diarrhea that is on and off with the harder stools having mucus/blood, and blood when I wipe. I apologize as my grammar is pretty crap.

***Forgot to mention that my GI prescribed sulfasalazine but that didnt work and now im on uceri****

FINAL PATHOLOGIC DIAGNOSIS:
A. Duodenal biopsy:
Duodenal mucosa with intact villous architecture with
increased chronic inflammation of the lamina propria, see
comment.
Negative for intraepithelial lymphocytosis or sprue-like
injury.
Negative for foveolar metaplasia or Whipple's disease
(Alcian blue/PAS stain).
Negative for luminal parasites, dysplasia or malignancy.
B. Gastric biopsy:
Antral and body type gastric mucosa with no significant
abnormality.
Negative for H. pylori, confirmed by immunostain.
Negative for significant inflammation, intestinal
metaplasia, dysplasia or malignancy.
C. Distal esophagus, biopsy:
Squamous epithelium with reactive changes and increased
intraepithelial eosinophils (up to 15/hpf), see comment.
Negative for Candida or other fungal organisms (Alcian
blue/PAS)
Negative for dysplasia or malignancy.

D.Mid esophagus, biopsy:
Squamous epithelium with reactive changes and increased
intraepithelial eosinophils (up to 19/hpf), see comment.
Negative for Candida or other fungal organisms (Alcian
blue/PAS)
Negative for dysplasia or malignancy.
E. Small bowel, terminal ileum, biopsy:
Small bowel mucosa with minimal acute inflammation and focal
pseudopyloric metaplasia (see comment).
Negative for granulomas, dysplasia or maligancy.
F. Colon, random biopsy:
Focal active colitis, see comment.


COMMENTS:
Comment part A: Expansion of lamina propria with mononuclear
cells in absence of villous blunting or intraepithelial
lymphocytosis is a nonspecific finding and may be associated
with infection, inflammatory/immune regulated disorders
(psoriasis), IBD.
Comment part C, D: The esophageal biopsies shows squamous
epithelium with reactive changes (spongiosis, elongated
fibrovascular papilla) and increased eosinophils
(15/hpf-distal, 19/hpf-mid. The findings are etiologically
nonspecific and can be seen in setting of GERD and/or
eosinophilic esophagitis, among other causes. Other causes
of increased eosinophils may include collagen vascular
diseases, hypereosinophilic syndromes, fungal infections,
photodynamic therapy, drug hypersensitivity and allergies.
Comment part E: The biopsy shows small bowel mucosa with
preserved villous architecture , focal acute inflammation of
surface epithelium and focal pseudopyloric metaplasia. These
features suggest name mild chronic active ileitis which may
be seen with inflammatory bowel disease (Crohn's), chronic
NSAID/medication injury, chronic infection.
Comment part F: The biopsies show predominantly unremarkable
colonic mucosa. A focal fragments shows focal active colitis
characterized by focal cryptitis/crypt abscesses. Although
bowel preparation artifact cannot be entirely excluded,
infection, drug injury (especially NSAIDs) and early Crohns
disease are among the major differential diagnoses.

CLINICAL HISTORY:
Signs, symptoms, medications and previous diagnoses:
Diarrhea
Endoscopic findings: A. R/O sprue. Erythematous mucosa in
terminal ileum, biopsy. Entire examined colon is normal,
biopsy. Distal rectum and anal verge are normal on
retroflexion view. Esophageal mucosal changes suspicious for
eosinophilic esophagitis, biopsy. Z line, 46 cm from
incisors. Normal stomach, biopsy. Erythematous duodenopathy,
biopsy.
SPECIMENS:
A. Duodenal bx
B. Gastric bx
C. Distal esophagus bx
D. Mid esophagus bx
E. Terminal ileum bx
F. Random colon bx

Post Edited (Dillin David) : 9/17/2017 11:45:52 PM (GMT-6)


73monte
Veteran Member


Date Joined Mar 2007
Total Posts : 1739
   Posted 9/18/2017 3:15 AM (GMT -6)   
I'm not too sure of the details of your diagnostic report. It sounds like they've ruled out a lot of what it could be.

It did indicate some inflammation in you TI, which might be consistent with IBD, but the report did say minimal acute imflammation.

I think you'll need the results of the biopsies before drawing a conclusion.

NiceCupOfTea
Veteran Member


Date Joined Jan 2010
Total Posts : 9922
   Posted 9/18/2017 1:57 PM (GMT -6)   
Did your GI give you a diagnosis? There's inflammation present, but it all seems to be very non-specific. Did you take any NSAID painkillers in the weeks before your tests? If not, that's one cause of inflammation you can rule out at least. And what's happening in the oesophegus and duodenum is not necessarily related to what's going on in your terminal ileum and colon - in fact I suspect it isn't, but that's something to talk about with your GI.

Antibiotics may work if the inflammation is caused by an infection rather than IBD. But don't take antibiotics at the same time as steroids, 'cos, uh, that's not a good idea. Give the Uceris (a topical steroid) a try for a few weeks first. See if that helps. If not, bring up the possibility of antibiotics with your GI. You may need another colonoscopy to see what is happening.

As for the ppi, I know ppi meds can raise calprotectin levels, but I don't know by how much. Can't really answer that one, sorry.
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)

DiSquared
New Member


Date Joined Sep 2017
Total Posts : 4
   Posted 9/18/2017 6:09 PM (GMT -6)   
Well the colonoscopy was done march last year and his report came through voicemail and wasn't very detailed but said it could be the start of early crohns. I'm not sure I would be able to remember taking any NSAIDs. When I talked to my new doctors triage nurse over the phone I asked her and she kind of hinted that he was not sure if it was crohns/ulcerative colitis. I posted here because of the inflammation in the ileum/duodenum. I still have pain with the uceris for now but it is dulled. My stools have slowed down dramatically so instead of 10 bowel movements a day its like 2-4. Another thing I've noticed is the stools are extremely hard and flat like pancaked thickness and spread out and very hard to pass sometimes not fully emptying at all.

DiSquared
New Member


Date Joined Sep 2017
Total Posts : 4
   Posted Yesterday 6:36 AM (GMT -6)   
Calpro measured at 1250 yesterday Ct scan today... Will update later

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 14991
   Posted Yesterday 11:22 AM (GMT -6)   
I have read your biopsy report about 3 times. From what I have read nothing has been definitive in it. I see the word may be related to this or that from colitis, GERD, food allergies, PPI & NSAID use & other things. I can understand the triage nurse's comment about the dr not sure if this crohns or UC. With a calpro of 1250 you have inflammation somewhere, caused by what will remain to be seen. Very frustrating when you are patient with all of this unknown stuff. I do hope you can get a diagnosis & so you & the dr will know how to proceed from here.

Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums
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