Question about biopsy

[Moggs]

My internal medicine doctor diagnosed me with Crohn's with the blood test. My # was 48 (I don't know the units, but over 20 is positive for Crohn's). I've been on lialda for 6 weeks and a restricted diet. My BM frequency has gone from 7-8 a day to 1-2 a day, but still stringy. My gastroenterologist does not like the blood test and says the only way to diagnose Crohn's is by biopsy. I'm scheduled for a colonoscopy in 2 weeks. My question is this: if my flair-up is subsiding will the doctor be able to find it?
I hate when doctors disagree.:shifty-t:

 

[Grant]

Moggs, your bloods can be normal but you can still have active Crohns. You might feel better but crohns might still be active in a small part of your bowel. If its there & its a specialist worth his salt he'll see it.
Good luck with it
Grant

 

[Moggs]

Thanks Grant

I don't know what to think any more; I'm not sure these two doctors like each other. I just want a good diagnosis and appropriate treatment.

 

[kllyeve]

Whether or not they can find lesions to sample depends on where your Crohn's is located. A colonoscopy will enable them to see all your large colon and a portion of the small intestine. If your Crohn's is just high up in your small intestine - you may need more testing than just the colonoscopy - barium follow thorughs, pill cams, CT scan etc.

And they may take biospsies even if they can't macroscopically see any indications of Crohn's as this would allow them to have a look under the microscope where sometimes the indications of inflammation are still present even if there are no macroscopic indications(lesions).

 

[Moggs]

Thanks for the additional information. I like to know as much as I can and my gastro dosn't tell me much.

 

[SnowDay]

Kllyeve, you seem to know a lot about diagnosis. I have been for a colonoscopy but it came back clear along with the the biopsies being clear(normal ileum).

I have a lot of symptoms of crohn's though and have been told i prob have it.

I am scheduled for an endoscopy but if that comes back clear that still isn't a definite 'no' on crohn's right? What is the best way to get definite diagnosis?

Sorry for derailing your thread a little, moggs .

 

[Moggs]

SnowDay, not a problem, we're all just looking for the right diagnosis. My gastro says he doesn't treat Crohn's patients; he refers them to a Crohn's clinic in Atlanta. That would be fine with me, although it is 2 hours away; the problem is that he says they only take referrals confirmed by biopsy. No biopsy, no expert, I get my local internal medicine doctor treating me, which might be OK. If I go into remission it would be great, but if not, I think I'll start to go through doctors as fast as food goes through me.

 

[kllyeve]

Well, I am a Medical Laboratory Technologist and I specialise in Anatomic Pathology - the area where all our lovely biposies get sent.

Just because your ileum was clear just means the actual lesions could be higher up in the small intestine where the colonoscopy can't reach. Which means maybe more testing to find the lesions. I had a small bowel follow thorugh - barium xray thing, as well as an MRI to be sure only my ileum was involved. Some people, as long as there is no suspected strictures, also have had the pill cam done to find their lesions.

Since the small intestine is so long, it may be difficult to find the lesions which is why they may treat you for it as your symptoms point in that direction.

 

[cb323]

Moggs, I'm so glad you asked about the biopsies. I have a biopsy scheduled for this coming friday. I have been symptom free for a couple of weeks and wondered if biopsy can still detect anything going on. I hope you get your answers soon.

 

[vickyhunter]

I may be wrong but I always thought the biopsies were to examine the tissue which has been part of the active crohns and then they can distinguish it and see whether you have deep mucosal damage (crohns) or superficial muscoal damage (ulcerative colitis) or something else (coeliac?) etc. But like I said I may be wrong.
When I'm having a flare up my bloods always show it but some people are different, and if you have been having a flare it does take quite a while to heal so there will still probably be signs that you had a very recent flare up. Try not to worry about it, but I hope you get a diagnosis/answers
xxxxxxxxx

 

[Mary Forbes]

Response to Moggs

My internal medicine doctor diagnosed me with Crohn's with the blood test. My # was 48 (I don't know the units, but over 20 is positive for Crohn's). I've been on lialda for 6 weeks and a restricted diet. My BM frequency has gone from 7-8 a day to 1-2 a day, but still stringy. My gastroenterologist does not like the blood test and says the only way to diagnose Crohn's is by biopsy. I'm scheduled for a colonoscopy in 2 weeks. My question is this: if my flair-up is subsiding will the doctor be able to find it?
I hate when doctors disagree.:shifty-t:

It took several years before I was diagnosed. I'm not sure what blood test you were given. October 2010 I was hospitalized at Methodist Hospital in Houston, TX - I had a fabulous doctor who is presently retired. She did a biopsy & verified by the colonoscopy I had Crohn's. Even if the flair-up has subsided...your physician will be able to tell by the tissue biopsy. Also, the pictures that are taken of the colon are worth a thousand words. Best Always, Mary from Texas