Small Bowel Series Results

[NewEnglander2015]

My GI Dr doesn't think I have Crohn's because of my age which is 48 and no prior problems before last summer.

I read the report the radiologist did after my small bowel series a few weeks ago and it says: "several abnormal appearing loops which appear segmentally narrowed and sharply angulated. There is some separation of these bowel loops. The terminal ileum could not be clearly identified as there is superimposition of the contrast opacified bowel loops with the cecum which probably resides in the pelvis. There is a segment of the proximal descending colon which appears slightly narrowed. The above findings are suspicious for enteritis and colitis with possible stricturing raising concern for regional enterocolitis or Crohn's disease."

My GI Dr says I am too old to be diagnosed so he's ordered a MRI Enterography because he thinks it's something else. I've been experiencing bad pain in my abdomen (near my belly button), vomiting, constipation, narrow stools and even when I take a laxative it's very hard to get soft diarrhea like stools out of me.

I also have internal hemorrhoids which he has banded two and there are two left, although if that's the reason my stools are so narrow, it hasn't made a difference yet.

I can deal with the vomiting and constipation and bm issues but the pain is horrible. When I get it, every few weeks, it is horrible: sharp, stabbing and will last for a few hours while I am vomiting up and often there's nothing left to throw up, not even stomach acid.

Am I really too old to be diagnosed with Crohn's? Also, I rarely have diarrhea nor is there blood in my stools.

 

[UnXmas]

You're not too old, there are age groups where people are more likely to be diagnosed than others, but it's not a deciding factor. Has your doctor said what he does think is wrong with you or how to treat it?

 

[NewEnglander2015]

Unxmas - I agree with you about the age thing. It's not the norm but from what I read it's not impossible to be diagnosed with crohns at my age.

He sent me in for blood work the other day but the results are not in yet. The MRI is scheduled for next week and then he wants to do a colonoscopy after the hemorrhoids are all banded because he says the prep will make them much worse. I'm long due for a colonoscopy because the last one in 2010 had a few large polyps and I put off getting one in 2011 because my health insurance had such a high deductible. And then I had dysplasia of the cervix and ended up getting a hysterectomy. I'm a single mother so money can be tight. No excuse for ignoring my health but I had to pay off the hysterectomy bill over the course of a year and then just kept putting off the colonoscopy.

I pushed him for an answer last week and he said he really doesn't know and he said it's possible I have an obstruction and then he said "Or god forbid lymphoma". That was a strange thing to say as I definitely don't have any of the symptoms of that and why would he even suggest something like that. Also it would have to be a partial obstruction as I do actually poop once or twice a week. Besides how could someone have an obstruction and not be in constant pain. I have days, like today, where I feel perfectly fine and no pain at all.

 

[NewEnglander2015]

I meant to add to my original post but it's probably not that important. I've had very loud stomach sounds for a few years. So loud that people sitting near me will hear them and comment. Also, sometimes I have mucus in my stools. But not every time I go.

 

[Cat-a-Tonic]

Hi, welcome to the forum. You're never too old to be diagnosed - what an odd thing to say, and if it were me I would start looking around for a better doctor as that sounds like a lame excuse not to take you seriously. I have an aunt who was diagnosed with Crohn's in her 50s, so from personal experience, 48 is not too old. Yes, the majority of IBD'ers tend to have onset of symptoms in their 20s or 30s, but as we all know there are many exceptions to the norm! Very few of us fit what the textbook says perfectly. Unfortunately, that sometimes makes diagnosis more difficult. Don't let your doctor use it as an excuse to blow you off, though.

I can certainly relate to doctor bills and insurance issues - I'm not exactly rich either (I just paid off an MRI from almost 2 years ago, I did a little celebratory dance when I made the last payment!). A couple of thoughts for you - you can apply for financial aid for bigger doctor bills. The first year I was sick, I racked up about $6,000 in doctor bills. I was told about financial aid but it seemed like I wouldn't qualify. I applied anyway, and was actually approved, so overnight I went from $6K in debt to a zero balance! That was fantastic. Also, some insurance plans will fully cover colonoscopies. Mine seems to - I never got a bill for either of my colonoscopies (and I had mine at ages 30 and 33 so my insurance could have easily argued that I didn't need them at such a young age). So check with your insurance, it might cover more than you think. Good luck!

 

[UnXmas]

Well your symptoms do suggest an obstruction - except that, as you say, I haven't heard of obstruction pain coming and going. At least he is still doing tests, and is taking it seriously, but he does sound a bit odd. Is he the only GI doctor you've seen?

 

[NewEnglander2015]

Another thing to note when I got the x-ray is that the barium wouldn't flow through fast enough and after being there for 5 hours (they had me walk around, then eat lunch and go back) the radiologist had me in all kinds of different positions trying to get pictures with the fluoroscope. He said he couldn't view the lower bowel portion well as the barium was just pooled there and wouldn't go thru. I don't know if that even means anything that it was so slow moving or maybe it just happens and it's not indicating anything negative. On his report the radiologist suggested a CT next but the GI doctor was the one who said he'd rather have me get an MRI.

Unxmas - this is the only GI doctor that I've seen. I was referred to him by my primary care doctor.

 

[Cat-a-Tonic]

An MRI is more likely to get you a worthwhile result - my GI explained to me that MRIs see soft tissue better (like intestines) whereas CT scans see hard/dense tissue (like bones) better. He also said that a CT scan gets a decent "overall" picture, but to see good detail of a particular organ (again, such as the intestines), an MRI is the way to go. And of course, with MRI you don't get any radiation but you do get radiation from a CT scan. The main downside of MRI is the cost - I believe mine from a couple years ago was about $4000 and I don't even remember how much I ended up having to pay out of pocket (I think about $1000). So check with your insurance before having an MRI to see how much you'd have to pay, as they can be really pricey. CT scans are cheaper, I think the one CT that I had was about $1500 and I had to pay a few hundred out of pocket? (It was 5 years ago so I am not totally sure on the cost!)

The other downside of MRI is that if you're at all claustrophobic, it's not a fun time. I didn't think I was claustrophobic, and I had an MRI like 4-5 years ago where I was fine and had zero claustrophobia. But the MRI that I had two years ago, the radiology tech put me into the machine rather suddenly before I was ready, and it felt like I just kept going in and the exit was too far away, and my brain just panicked. I did some deep breathing and got the panic under control within a couple minutes, but even so - it was definitely a moment of claustrophobia that I didn't expect at all! So that for me was the other big downside, a momentary freak-out. Other than that, MRIs are easy peasy - just lay in the machine for awhile and follow the tech's instructions (they'll tell you to hold your breath at times and things like that).

 

[UnXmas]

Other than that, MRIs are easy peasy - just lay in the machine for awhile and follow the tech's instructions (they'll tell you to hold your breath at times and things like that).

Unless it's one where you have to drink contrast. I had a small bowel MRI where I had to drink a load of yucky stuff before it. Is that the same test you're talking about? I hated it, but I know I have a harder time than most people consuming huge amounts of horrible tasting liquid. Once I had got the liquid down, the MRI itself was a breeze. They injected me with something as well, but nothing painful. I've had MRIs for a few other things that didn't require drinking anything, and as long as you're not claustrophobic, they're about as easy and pleasant as tests get. I've only had one CT and that was of my head, and to be honest it seemed pretty much the same as an MRI to me, you lie still and it makes a lot of noise.

 

[NewEnglander2015]

Thanks for the responses. I'm not claustrophobic so I don't think that will be a problem. As far as the cost goes there isn't much I can do about it and with the pain I've been experiencing I don't even care anymore about the price. I just want to feel better.
I had to drink 2 cups of barium with the small bowel series but not sure if they use IV contrast or one that I drink with a MRI Enterography.

 

[mikeymac]

I was diagnosed with crohn's when I was 36 after about 5 colonscopy's in one year. But it is in the large intestine. Sigmoid colon. But i think recently my small intestines are being effected. They found a narrowing where the duodenum meets the lelium.

I hope you can make it thru and be healed.

 

[NewEnglander2015]

I had the MRI two days ago, saw the GI doctor today and even though it also says Crohn's he's still not sure that's what it is because my blood tests came back negative, and my age, and no previous history.

So he has scheduled Colonoscopy, Endoscopy, CCK Hida scan of gallbladder, Lactulose test for SIBO. He said maybe pill cam but he wants to see what the others say first. It seems overkill on the tests but if that's what it takes to get a diagnosis for what's wrong with me I guess I have to do them.

 

[StarGirrrrl]

CD can strike at any age, and some with raging, 100% confirmed IBD have normal blood work.

And saying you have no history- presumably you had the first test for a good reason? Every disease starts somewhere in a small way.

The range of tests ordered is a great idea, but don't hesitate to seek a second opinion. Those initial results were abnormal for a reason. In my opinion, your Dr is not focusing enough on that.

 

[NewEnglander2015]

StarGirl, thanks for answering. I've been sick on and off since last summer with abdominal pain, vomiting and constipation. It's not everyday which made me put off doing much until recently.

The MRI Enterography I had this week says in part: "There is narrowing of the distal ileum with possible wall thickening of the distal ileum which is collapsed and accurate evaluation is extremely limited" A lot of other stuff including a cyst on my left ovary and one in my liver. The end of the report says, "Collapsed distal ileum w/ apparent thickening concerning for the stated diagnosis of Crohn's disease".

And the small bowel series x-ray from a few weeks ago mentioned narrowing and separation of the bowel loops and said suspicious for Crohn's.

I'm scheduled for a colonoscopy at the end of April (that was their first available appointment) and he'll do the endoscopy at the same time. I have a history of polyps so even if the colon is not showing any crohn's I can bet there are some polyps to remove so that won't be a waste of time.