More on Crohn's vs UC

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Date Joined Dec 2010
Total Posts : 3332
   Posted 8/17/2011 10:26 AM (GMT -6)   
I saw my gi doctor yesterday and we talked about his thinking on my diagnosis before/after surgery and we also reviewed his recommendations about surgery. Everything was very rushed then and I was very sick, and mostly I'm just trying to make more sense of things now that things are calmer; I'm not really doubting my choices or his recommendations. Since I know some folks on here are trying to make decisions with indeterminate diagnoses, I thought I'd relay some of what he said, as it might be helpful.

He mentioned that Dr.Crohn's first paper on the disease was published in 1932, but it wasn't until the 1960's that Crohn's colitis was accepted as a diagnosis at all; before then, they didn't think Crohn's could be in the colon. Crohn's colitis is still not well understood.

The ways that you can diagnose Crohn's definitively from the pathology after a resection (removal of all or part of intestine) are a) granulatomas on biopsy and b) deep layers of tissue are affected. However, only 40-60% of surgical resections in people w/crohn's see granulatomas, so lack of granulatomas doesn't prove anything.

In my case, the evidence for Crohn's was a) patchy inflammation on scopes, b) responded to antibiotics in a flare sometimes c) granulatomas on biopsy of a skin abscess on my hip. The evidence for UC was a) no granulatomas on colon biopsy, b) deep layers of tissue not affected, and c) clinical symptoms were always like UC, no small intestine involvement

He said he still leans toward my having Crohn's (although this is not what he said last time), and that if I have UC, I have some variant of UC that is more like Crohn's, and hence would have been more likely to have failure with a j pouch.

He is not clear how the disease boundaries will play out when more is known, but the area of overlap is complicated, and it's not quite accurate to say that there are these two completely different diseases, and that you just have to figure out which one you have.

We also went over my last bone density scan, which shows some issues. He said the bone density is also affected by chronic inflammation, not just by prednisone use, and that the bone density is more affected in Crohn's patients than UC patients. (He wants me to see an endocrinologist about the results).

I also asked about lifetime colorectal cancer risk, had I kept my colon. The figure in people w/colitis is 30% but he said mine was higher because I had chronic inflammation for so many years.

It was a helpful conversation for me, and it made me feel more solid in my decisions. If I didn't have this lingering butt wound, I wouldn't even be thinking about it.....
48 years old, female.
2004 dx indeterminate colitis. Back and forth between Crohn's and UC dx. Many drugs, minimal success.
2010-11 Crazy skin and eye complications, high fevers, bad flaring. Out of good drug options, tired of scary drugs.
Feb 2011 -- proctocolectomy with permanent ileolostomy; abscess, blood clot. Still healing, still glad for the surgery

Veteran Member

Date Joined Feb 2011
Total Posts : 4540
   Posted 8/17/2011 3:39 PM (GMT -6)   
The biggest thing I worried about with having surgery is what if I had Crohn's. I opted for J pouch surgery mainly because my sister had it done 20 years ago and had great results. It's been a year for me now with my j pouch and I have done really well. Everything pointed to me having UC and not Crohns so I went for it. Now I am positive it was defiantely UC because I have had no issue at all with my J pouch. My cousin's wife had j pouch surgery a while back and she turned out to have Crohns and is still having many problems and she's still on the heavy big gun drugs. It's a crap shoot sometimes. For me I am extremely grateful that it all turned out OK.
DX UC - in 2005 when I was 37
Tried every drug-even Remicade-Tried diets-nothing worked
Step 1: J-pouch surgery (Laparoscopic restorative proctocolectomy w/ temporary diverting loop ileostomy) 6-25-10
Step 2: Take down surgery (Ileostomy reversal) 10/8/10
No more UC!!! Very happy with my results of this surgery!

Veteran Member

Date Joined Oct 2009
Total Posts : 1054
   Posted 8/17/2011 5:34 PM (GMT -6)   
Thanks so much for posting's good to hear more of an explanation.
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