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Crohn's? UC? Something else?

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Crohn's Disease
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Posted 8/21/2007 10:31 AM (GMT -8)

I'm experiencing some symptoms that are atypical for ulcerative colitis (my diagnosis from 1999). I have pain, discomfort and gas over on the right side. My general practitioner thought I had appendicitis. A CT revealed a "thickened bowel wall" on the ascending side of the colon, near where it turns. Flex sig showed no inflammation on the descending side. No bleeding, either. Nothing showed up on the endoscope. Blood tests and biopsies for celiac were negative.

From what I understand, it's rare, if not unheard of, for UC to present on the right side in isolation. I'm wondering if I've been misdiagnosed. My current GI has waffled around about Crohn's vs. UC. Anyone here have a similar experience?

Posted 8/21/2007 12:33 PM (GMT -8)
To me that sounds like Crohn's more than UC.  UC can definitely affect that area, but when it does, it's nearly always affecting the rest of the colon as well (UC almost always starts at the rectum and goes in from there).  Yours sounds more like the patchy distribution characteristic of Crohn's.

There are several ways to help differentiate the two.  You and your doctor can decide which tests to run:  Do a colonoscopy and take biopsies of the affected area in your colon; have these biopsies checked for UC or Crohn's.  Check the terminal ileum, either in the colonoscopy or with CT scans; if there's disease there, it's Crohn's.  Check the rest of the small intestine, either with CT scans or the capsule endoscopy; again, if there's disease there, it's Crohn's.  Do the Prometheus IBD blood tests, which are pretty accurate at distinguishing UC from Crohn's.

Posted 8/21/2007 12:46 PM (GMT -8)
With UC the entire area is typically inflammed, with crohns there are skipped patterns of inflammation (healthy tissue amongst inflammation)...also with UC the inflammation is surfacable only, with crohns it can penatrate through the many layers of the intestinal tissue...

the symptoms of UC and CD can be often very similar regarding pain and D and gas and such, IBS even has those symptoms in common with IBD, but with IBS there is never inflammation or bleeding.

There are also many other forms of colitis besides ulcerative colitis and crohns-colitis (when crohns is affecting the colon it's referred to as crohns-colitis), there is Ischemic colitis, and microscopic colitis aka: collenagenous colitis.

:)
Posted 8/21/2007 2:12 PM (GMT -8)

beave said...


 

Do the Prometheus IBD blood tests, which are pretty accurate at distinguishing UC from Crohn's.

Actually, my GI just ran the IBD blood test. Results were "positive, indicative of ulcerative colitis," but he agrees the symptoms are not typical. Everything else was really good - iron levels, etc. - so he kinda dismissed the whole bowel wall thickening.
Posted 8/21/2007 5:47 PM (GMT -8)

Yes- i was originally diagnosed with colitis at age 6 and not I am 26 and the new doc i have is telling me i have crohns now. THe blood test showed no crohns. However, I have had a history of rectal fistula and abcess and hemoroids and inflammation was found in my rectum, left side and illeum. (oops i hope i spelled it right). I am confused and do not not any more. I just want to feel better ! They both stink either way( no pun intended).

keep me posted on what they decide.

jamie

Posted 8/21/2007 7:29 PM (GMT -8)
jla :)

When you were initially DX with "colitis" was the doc specific with the type of colitis because there are many types of colitis other then ulcerative colitis....as I stated in my reply above:

"There are also many other forms of colitis besides ulcerative colitis and crohns-colitis (when crohns is affecting the colon it's referred to as crohns-colitis), there is Ischemic colitis, and microscopic colitis aka: collenagenous colitis."

:)
Posted 8/22/2007 5:12 PM (GMT -8)

I was diagnosed with ulcerative colitis- that is all the docs told me. i am so frusterated with not knowing. i think i have severe uc- not crohns.

i am going for a scope next week and hopefully know more. the promethius test came back negative 2 years ago.

sigh.

jla

Posted 8/22/2007 9:08 PM (GMT -8)
Sorry jla but if you've been suffering with fistulas and abcesses then those are crohns related only, not related to UC...the main things is that the meds used to treat UC are the same as the ones used to treat CD affecting the rectom(procititis) and colon (colitis).

:)
Posted 8/23/2007 6:13 AM (GMT -8)
Agreed. Those are definite signs of Crohn's.

To my knowledge, I haven't experienced any fistulas. But this pain and discomfort on the right side certainly doesn't seem like UC. I have decided to see yet another GI for a second opinion. I just got the call... they're going to work me in next Wednesday. As much as I dread it, I really think a colonoscopy to look at the affected area is necessary, and hopefully a biopsy will be taken while they're in there. A member of the UC forum told me he had a similar experience and they found precancerous cells. That put the fear in me.
Posted 8/23/2007 7:44 AM (GMT -8)
You are within the 8-year window when regular scope screening should begin for cell dysplasia and possible colon cancer development with UC anyway . . . and the other posters are correct: CD = skip inflammation and deeper inflammation into the bowel wall; UC = continuous inflammation closer to the surface.

Posted 8/23/2007 9:40 AM (GMT -8)
That's true. And it's been several years since my last one. If the new doc doesn't suggest a scope, I'll ask for it.
Posted 8/29/2007 2:38 PM (GMT -8)
Update: Saw the new doc today for a second opinion. He agreed a colonoscopy and biopsies are in order and that the symptoms are not typical for UC. He said a large percentage of IBD patients have their diagnosis switched in the first 5-7 years of the illness from UC to Crohn's or vice versa. I thought it interesting he also said they're discovering more and more that Crohn's and UC are not so much separate entities and there is some overlap. (This is a nationally acclaimed teaching hospital, so this may be sort of a new concept.)

Anyhow, I'm scheduled for a colonoscopy Sept. 18 and have a follow up appointment the first week of October. As usual, there was no discussion of complimentary therapies - probiotics, fish oil for inflammation, etc. Disappointing, but not unexpected.
Posted 8/29/2007 2:59 PM (GMT -8)
Remember that while medications for UC and Crohns in the rectum and large bowel are similar, not so surgical options. It is very important to have a diagnosis before any surgery, otherwise you might end up with the wrong procedure for your condition -- with crohn's surgery is usually much more conservative than with UC.
Posted 8/30/2007 5:27 AM (GMT -8)
My condition - whatever it is - has been relatively well-managed. I'm not a candidate for surgery any time soon, thankfully.
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