Can colonoscopy alone rule out CD in the terminal ileum?

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New Member

Date Joined Oct 2007
Total Posts : 4
   Posted 10/23/2007 8:53 AM (GMT -7)   
Hello, I hope you don't mind if I ask a few more questions in trying to make sense of my symptoms. My GI says no Crohn's based on the colonoscopy I had last Wednesday, no follow up with him was recommmended. I don't know if he took any biopsies, I thought he was going to but now I dont think he did, though I'm still waiting for the pathology report to arrive from a small polyp removed in the rectum.
He did give me three pictures, one is labeled as the TI. If I understand anatomy correctly that is the end of the ileum/small instestine where it joins the large intestine (viewed from the large intestine side) right? So if there is a problem suspected in the TI or ileum area can it be appropriate to rule negative based on the colonoscopy and blood tests alone? He never said anything about an upper, just told me it was IBS and eat more fiber. I'm sounds like I should demand the upper as well, but I don't want to go back to the same GI, he was very patronizing.
I've just been reading that upper right pain (all the way up the right side, to just under the ribs) can be indicative of TI involvement because of the way the nerves work. MY LRQ pain has been around for many years (had appendix out in 2002, but it was healthy, and I do have a history of intestinal adhesions) but since July of this year new URQ pain has shown up as well as milder ULQ pain. Have had abdominal ultrasound, gallbladder is normal, and CT Scan with contrast showed no problems other than a mild thickening in the sigmoid which he said was not seen during the colonoscopy. This right sided pain is usually quite sharp and intense in the lower right, and a feeling of intense pressure and sometimes sharp or burning pain in the upper right, sometimes wraps around to my lower ribs in back. A lot of times it feels like somebody is pushing a fist into my right side. When it gets really bad I have nausea usually followed by either loose BMs or D. I've had a few episodes where it's doubled me over - that peaked in early Sept with an excruciating 15 minute episode that resulted in explosive D, now it's back to just daily mild to moderate pain. Also when the LRQ is really acting up it makes my right leg hurt as well.
Does any of this sound like symptoms you've experienced? Or can IBS cause such extreme pain? Can you have IBD in the TI that's just out of sight from colonoscopy? Thanks again for anything you can share to shed some light.  :)

Regular Member

Date Joined Jul 2007
Total Posts : 73
   Posted 10/23/2007 9:02 AM (GMT -7)   
After a colonoscopy my GI said it was probably Crohn's in Ti, but he would not say for sure until I had a SBFT.
Munchkin 81
26 year old female.  DX June 2007.
abscess Nov. 2006 - drain and surgery
currently taking 9mg Entocort EC and 40mg Prednisone.  This is my last shot at avoiding surgery.  They think it's scarring.
Aciphex 20mg 2xday  Iron, B-12, and folic acid

Veteran Member

Date Joined Mar 2006
Total Posts : 1169
   Posted 10/23/2007 9:27 AM (GMT -7)   
The scope can only visualize the final few inches of the terminal ileum. If there is inflammation higher up it cannot see it. A good follow up test to this would be the pill camera which can see all of the small bowel.

Elite Member

Date Joined Feb 2004
Total Posts : 20577
   Posted 10/23/2007 9:28 AM (GMT -7)   
The colonoscope is a thin, flexible tube that ranges from 48 in. to 72 in. long. A small video camera is attached to the colonoscope so that your doctor can take pictures or video of the large colon. The colonoscope can be used to look at the whole colon AND the LOWER part of the small colon. A test called sigmoidoscopy shows only the rectum and the lower part of the colon.

My bum is broken....there's a big crack down the middle of it!  LOL  :)

Veteran Member

Date Joined Oct 2006
Total Posts : 2079
   Posted 10/23/2007 9:39 AM (GMT -7)   
When I had my first full scope, the GI told me that my terminal ileum "looked good" and he felt sure that it wasn't Crohn's. He did take biopsies, including the TI. My biopsies came back showing Crohn's in the TI. The evidence can be microscopic. I had visible inflammation in 3/4 of the colon, but it wasn't visible at the TI

Crohn's can cause much pain, but pain alone isn't necessarily indicative of Crohn's. IBS can be extremely painful, and many of us have both. If you're seeing blood other than from hemorrhoids, have severe diarrhea, have dropped weight, have unexplained arthritis, eye inflammation, or red bumps on your shins, you really need to get to someone else soon. I've discovered that some GIs aren't that interested in Crohn's or just don't know enough about it to want to bother. Sorry about your experience. I hope you can find a better GI. -Joy
48 yr. old. Ileocolitis.  CD since early teens, misdx'd until age 36.  Hemicolectomy-left side in 2001.  Disease returned in 2003. Arthritis, episcleritis, chronic pain due to surgeries (nerve damage, adhesions) and disease.  Recently dx'd scoliosis.  History of endometriosis.

Veteran Member

Date Joined Apr 2006
Total Posts : 1665
   Posted 10/23/2007 10:21 AM (GMT -7)   
adhesions can cause much pain, too. I have been diagnosed and undiagnosed and now, who knows, with crohns as I had inflammation, but no relief from pain with meds. you should certainly have a SBFT, and also know that if often takes many tests and much time to get this figured out, sadly! take care, 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. In December had adhesions cut through a laparoscopy. Now just taking Glycolax, metamucil, and began Humira 9/07.

Veteran Member

Date Joined Jan 2004
Total Posts : 598
   Posted 10/23/2007 10:43 AM (GMT -7)   
I would suggest going to another gi doctor and even asking for a trial of medication based on my experience.
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin and now trying good ol' zoloft

Veteran Member

Date Joined Jan 2003
Total Posts : 1150
   Posted 10/23/2007 12:11 PM (GMT -7)   
maybe request a Small Bowel Follow Thru (SBFT) and a Capsule Endoscopy (CE).

Veteran Member

Date Joined Mar 2006
Total Posts : 501
   Posted 10/23/2007 12:17 PM (GMT -7)   
I had the same pain and the same tests but did not find crohns until I had a capsule endoscopy, where it took the video of my small intestine. Keep testing...
Diagnosed 1/06
CD of Terminal Ileum
Taking Pentasa, Prograf and Remicade.

Regular Member

Date Joined Oct 2007
Total Posts : 241
   Posted 10/23/2007 5:20 PM (GMT -7)   

I had a normal endoscopy and colonoscopy. luckily,  i had a capsular endoscopy after the others were negative and my pain was not going away. it demonstrated ulcers and inflammation in the jejunum and proximal ileum. I would find someone else, and get a capsular study. you need to be able to trust your gi.

good luck

Regular Member

Date Joined Oct 2007
Total Posts : 106
   Posted 10/23/2007 6:42 PM (GMT -7)   
The GI's had crohns ruled out for me until a biopsy was done and then further tests were ordered like the camera pill and small bowel follow through. I've read that its not an easy diagnosis so you may need to go see another doctor for a second opinion. I experience symptoms just like yours and I find that it can be very depressing and uncomfortable to even live anymore. I'm sorry that you are going through this and good luck finding out what the problem may be! :)
DX: Crohns in March 2007
Meds: Remicade

Regular Member

Date Joined Nov 2006
Total Posts : 304
   Posted 10/24/2007 7:29 AM (GMT -7)   
I had 2 scopes 6 months apart and both were negative for crohns, although the doc could not get into my TI because it was so painful, i was sent for a CT scan and that is was showed thickening and distention of my TI, and evidence of inflamation, so there was my diagnoses of crohns.
I'm cute. Let's put me in charge.(happy bunny)
 anemia, b12 deficiancy, and malobsorption, moderate joint pain,severe weight loss, gastritis
 omega 3, digestive enzyme, calcium, vit d, flax oil, aloe vera juice, 9mg of entecort
 diagnosed with a CT scan september of 2007.

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