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Biopsy results-don’t understand

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Ulcerative Colitis
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Posted 11/25/2019 4:00 PM (GMT -7)
Was diagnosed with proctitis 8 years ago. Mostly been in remission.

Biopsy of cecum and ascending colon showed “findings consistent with quiescent phase of a chronic inflammatory response”. Rectal biopsy showed proctitis is not active right now.

Stupid patient portal through doctors office was how I got the results. The doctors note says continue meds and they recommend a follow up appt in 3 months or so. I don’t understand any of this. Does this mean I went from proctitis to pancolitis? If so, how come I didn’t have any symptoms outside of one day of diarrhea. Also, how did it just heal on its own? I’m only on Canasa suppositories. So if it went all the way up my colon wouldn’t they want me on oral medicines too and why wait for 3 months or more for a follow up?

Yes, I asked some follow up questions on their patient portal. Probably take a couple more days for them to respond. I’m so frustrated.
Posted 11/25/2019 4:10 PM (GMT -7)
It sounds like it means you're in remission. Quiescent means not active. I don't see why they would add any meds if you are in remission and not having any symptoms. I would have the same question as you, but I wouldn't worry too much about it.
Posted 11/26/2019 7:09 AM (GMT -7)
Congrats on being in a remission (quiescent phase of a chronic inflammatory response)!

There are a few variants of UC that present in only the rectum and Cecum/Ascending colon. So, no, it is not a pancolitis now and it is not a crohn's disease (due to a skip lesion).

Inflammation within the cecum at the junction of the appendix opening: "Appendiceal orifice inflammation (AOI) is a common ‘skip lesion’ in patients with ulcerative colitis (UC)." https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4071881/

The “cecal patch” in patients with ulcerative colitis
UC is a disease that classically begins just inside the anorectum and extends proximally (continuously) for a variable distance in a circumferential and uniform fashion, without “skip” areas. There are 2 types of segmental inflammatory change, however, that may be seen in patients with UC, and that may lead to confusion with Crohn's disease: backwash ileitis and the cecal patch; neither affects the course of the colitis.

An isolated cecal patch of inflammation, as in the present case, is present in many patients with left-sided UC or proctitis/proctosigmoiditis. We have learned that cecal inflammation may be part of normal cecal health, and that the cecum has a higher percentage of eosinophils, Paneth cells, and laminar propria inflammation than do other areas of the colon. The important lesson: don't diagnose Crohn's disease just because you see a patch of cecal inflammation in a patient with distal colitis. Pythagoras believed he could judge the height of Hercules from the length of his foot (ex pede Herculem), and from this it was extrapolated that from a sample one can judge the whole. This adage certainly is not evidence-based, and should not be used to rationalize judgment of the nature of colitis from the presence of a cecal patch. https://www.giejournal.org/article/s0016-5107(08)01639-8/abstract
Posted 11/26/2019 9:09 AM (GMT -7)

iPoop said...
Congrats on being in a remission (quiescent phase of a chronic inflammatory response)!

There are a few variants of UC that present in only the rectum and Cecum/Ascending colon. So, no, it is not a pancolitis now and it is not a crohn's disease (due to a skip lesion).

Inflammation within the cecum at the junction of the appendix opening: "Appendiceal orifice inflammation (AOI) is a common ‘skip lesion’ in patients with ulcerative colitis (UC)." https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4071881/

The “cecal patch” in patients with ulcerative colitis
UC is a disease that classically begins just inside the anorectum and extends proximally (continuously) for a variable distance in a circumferential and uniform fashion, without “skip” areas. There are 2 types of segmental inflammatory change, however, that may be seen in patients with UC, and that may lead to confusion with Crohn's disease: backwash ileitis and the cecal patch; neither affects the course of the colitis.

An isolated cecal patch of inflammation, as in the present case, is present in many patients with left-sided UC or proctitis/proctosigmoiditis. We have learned that cecal inflammation may be part of normal cecal health, and that the cecum has a higher percentage of eosinophils, Paneth cells, and laminar propria inflammation than do other areas of the colon. The important lesson: don't diagnose Crohn's disease just because you see a patch of cecal inflammation in a patient with distal colitis. Pythagoras believed he could judge the height of Hercules from the length of his foot (ex pede Herculem), and from this it was extrapolated that from a sample one can judge the whole. This adage certainly is not evidence-based, and should not be used to rationalize judgment of the nature of colitis from the presence of a cecal patch. https://www.giejournal.org/article/s0016-5107(08)01639-8/abstract

Thanks for your response. This whole thing has been confusing. The nurse from the GI office said doctor said I’m in remission but the biopsy results don’t correlate with what he saw during colonoscopy. He didn’t see any inflammation during colonoscopy and believed the abnormal vascularities were residual from the prep. I have a follow up appt on Dec 16th. The only med I’m on and still take is the Canasa suppositories. I had mild symptoms different from my proctitis to this for a week and a half. Just had two bouts of diarrhea for one day. No urgency, mucous or blood. I wonder if it went away on its own, without medication because I doubled up on my Visbiome probiotics.

Even though this is in remission wouldn’t I have to take some type of oral medication? The doctors office said no.
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