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Back Again

I haven't popped into this forum for a while because I thought we had legitimately ruled out IBD. I'm not so sure anymore. I was diagnosed with IBS in '08. Since January, I've had a small bowel follow thru, a fecal fat test, a flexible sigmoidoscopy with biopsies for microscopic colitis, a pill camera, and a pancreatic enzyme check of my stool as well. We began this whole diagnostic process again because I was diagnosed with a form of inflammatory arthritis in November that IBD often accompanies. The elevated fecal fat test suggests that I have malabsorption going on, so we've been looking for the source of that. We've supposedly ruled out crohn's, colitis, bacterial overgrowth, lactose intolerance, and gluten intolerance. We're currently working on ruling out chronic pancreatitis. It doesn't fit a number of my symptoms, but it's basically the only thing left on his ddx for malabsorption.

I've had a couple of recent interesting developments though. I used a medrol dosepack for my arthritis for my recent transatlantic trip over Spring Break. Surprisingly enough, my GI symptoms also simultaneously disappeared. They returned in full force when I tapered off. Now I'm wondering all over again if he has somehow missed IBD in all the imaging of my guts. I asked him a good while ago if it was possible that microscopic colitis is hiding in the portion of my colon that the flex sig doesn't reach. He claimed that it's extremely unlikely and basically wrote that concern off. Also, that portion of my colon hasn't been imaged at all since my '08 colonoscopy since the pill camera and the small bowel follow thru just focus on the small intestine. There was nothing interesting to be seen there in '08 but who knows.

As soon as we finish investigating chronic pancreatitis, I'm off to the local teaching hospital for a second opinion. My GI is supportive of that since I've been such a diagnostic oddity. None of the things that have made sense have panned out.

I guess the good news if it is IBD is that my rheumatologist has already kind of been acting on that assumption. In picking a TNF-inhibitor, we purposely chose one with dual usage. I'm due to start Humira in 2 weeks. Well, I was supposed to start it 2 weeks ago, but had a positive reaction to my TB skin test. That's a whole other can of worms though.

Anyway, I'm back for now. Dunno if this will ever be the right home for me, per se, but I don't really feel we've ruled it out yet. So, hello again!


To save time...Ask Dusty!
Welcome back Lorraine! I'll be curious to know how your starting Humira goes after the positive TB test. My son had his TB test yesterday and will be starting Humira soon as well. Yeah, I'd say if your ibd symptoms improve with the H, it would certainly be a strong indicator wouldn't it!! Good luck!
Thanks Mark. Here's hoping! The other thought I have out of left field is whether my GI symptoms could be caused by GI TB. I know it's extremely rare in 1st world countries, but with the positive skin titre and the fact that it fits literally all of my GI symptoms, it seems worth exploring. By the sounds of it though, it presents much like IBD, so I guess they would have seen some damage somewhere in all the pretty pictures of my intestines.