Test interpretation?

[skittle]

I got emailed the results of my (limited) colonoscopy and gastroscopy. Can anyone help me understand a little further what the results may indicate please? Thanks



SPECIMEN LABELLED:
1) DUODENUM
2) ANTRUM
3) DESCENDING COLON BXS
4) SPLENIC FLEXURE
5) SIGMOID BXS
6) RECTUM

MACROSCOPIC DESCRIPTION:
1) The specimen consists of three pieces of pale tan tissue ranging from 3mm


to 4mm.
3 NR 3L PIDQC complete
2) The specimen consists of two pieces of pale tan tissue each measuring 5mm.


2 NR 3L HP ABPAS PIDQC complete
3) The specimen consists of four pieces of pale tan tissue ranging from 3mm

to 7mm.
4 NR 3L PIDQC complete
4) The specimen consists of two pieces of pale tan tissue 3mm and 4mm.
2 NR 3L PIDQC complete
5) The specimen consists of four pieces of pale tan tissue ranging from 3mm

to 5mm.
4 NR 3L PIDQC complete
6) The specimen consists of two pieces of pale tan tissue 3mm and 5mm.
2 NR 3L PIDQC complete
Cut by: VC

MICROSCOPIC DESCRIPTION:
1) Sections show multiple biopsies of superficial duodenal mucosa. There is


no alteration of the crypt villous ratio. No intraepithelial lymphocytosis,

active inflammation or granulomas are seen. (No evidence of Coeliac
disease). No parasitic organisms are identified.

2) Sections show normal antral mucosa with minimal chronic inflammation
within the lamina propria. There is no intestinal metaplasia. Helicobacter

pylori organisms are not identified.

3) Sections show multiple pieces of large bowel mucosa one of which contains


an area of ulceration. The ulcerated fragment shows chronic active colitis
with expansion of the lamina propria due to large numbers of inflammatory
cells including numerous neutrophils. Cryptitis and crypt abscesses are
identified. The surrounding glands show reactive features. No dysplasia is

seen. No viral inclusions are identified CMV IHC.

4 & 5) Multiple biopsies are of normal large bowel mucosa. There is no
active inflammation, microscopic colitis or granulomas identified. No
dysplasia is seen.

6) Sections show normal rectal mucosa with possible small hyperplastic
polyp. No active inflammation is seen.

DIAGNOSIS:
1) DUODENUM - NORMAL DUODENAL MUCOSA
2) ANTRUM - NORMAL ANTRAL MUCOSA
3) DESCENDING COLON BIOPSY - FOCAL CHRONIC ACTIVE COLITIS WITH ULCERATION
4) SPLENIC FLEXURE - NORMAL LARGE BOWEL MUCOSA
5) SIGMOID BIOPSY - NORMAL LARGE BOWEL MUCOSA
6) RECTUM - NORMAL RECTAL MUCOSA

 

[Trysha]

It would appear to indicate that you have chronic active colitis and presumably your GI specialist will be wanting to give some kind of treatment.
Tha cause of the colitis will have to be determined by the GI and this will guide the treatments seems you also have some minimal inflammation in the stomach.
It would appear the rest of the areas biopsies are found to be within normal limits.when is your next appointment with the GI
Feel better soon
Hugs
Trysha

 

[Jabee]

It looks as though there is no evidence of active celiac disease (which means your gluten-free diet is working; people sometimes develop refractory celiac disease), and the majority of biopsies showed healthy mucosa. The pathologist found active long term inflammation in a small (focal) area of your descending colon (colitis) The pathologist found no evidence of cytomegalovirus (CMV), testing for it by immunohistochemistry (IHC; there are a few ways to identify the virus). Since I'm not a physician I can't really tell you very much, but I suspect your gastroenterologist will have some ideas about how to treat the inflammation in your colon.

I hope that helps.

 

[skittle]

Thank you both. So would I be right in thinking that because some parts were ok and some showed inflammation/ulceration, I'm more likely to be looking at crohns? I should have added that my ct scan showed something going on in the terminal ileum.

Results from that -

BOWEL/MESENTERY/
PERITONEUM: There is intense mucosal enhancement in the distal 15 cm
of the terminal ileum. The there is mild mild prominence of vessels
on the mesenteric border. Minimal wall thickening. The caecum and
remainder of the colon are normal. No other involved segments of
small bowel are identified.

Am I correct in thinking CD as opposed to UC because of the skip lesions? Or could it still possibly be something else entirely?

 

[Scipio]

Yes, I would say it's more likely that you have Crohn's rather than UC given your evidence of trouble in the ileum seen via CT. That coupled with the fact that the colitis is found in one of the middle sections of the colo0n. UC usually starts at the rectum and works its way back upstream in a continuous fashion as the disease worsens. Your disease is discontinuous and it also involves the ileum, both of which would suggest Crohn's over UC.

 

[Jabee]

I agree that it's more likely to be crohn's than UC. Were they able to visualize your terminal ileum during the colonoscopy? They didn't list any biopsies from that area. Just wondering.

 

[skittle]

No they only got to the descending colon as I had significant looping in my bowel and it was extremely painful. Also despite following the bowel prep instructions to a tee, my bowel had not fully cleared our so they were unable to see a lot. (Talk about embarrassing! )

 

[Jabee]

I'm so sorry! I remember reading that but had forgotten when I was replying to this post. The fact that they couldn't get past the descending colon is very telling. Do you know if they tried to use a pediatric scope? I seem to recall my GI trying that on me one time, but he eventually had success with the regular scope. Historically my crohn's has been further up in my small intestine anyway. When do you hear from your GI?

 

[skittle]

That's ok lol. Lots of people's stories to read!
When you say it's very telling that they couldn't get past the descending colon, what do you mean?

I see the specialist on Feb 2. I have to do a barium swallow tomorrow though and I'm nervous! Haha

 

[Jabee]

They said your large intestine is very loopy and the colonoscopy was painful. The part they did see had significant ulceration, so I'm wondering if the difficulty was because of inflammation, not bowel loops. Just a thought. The barium swallow might very well pick up on the inflammation as well. I've had a couple (when I was first diagnosed with celiac disease every radiologist in the hospital was in my exam room looking at the images; for some reason they couldn't identify what I had with the barium swallow) and they're not too bad. Hopefully you won't be in as much pain during the test.

 

[skittle]

Ahhh I see! Thank you. Yeah I've never had the barium before - my celiacs was diagnosed via gastroscopy after elevated bloods. Fingers crossed they can diagnose me from what they have because the thought of another colonoscopy soon scares me lol