What to expect - pill cam

[Maya142]

M's GI symptoms have become worse in the last week. More diarrhea, more pain and more weight loss. She's now lost 13 pounds since April. She had scopes in January which showed mild inflammation in her TI but everything else was fine. She was supposed to have an MRE, but given the last week her GI has decided to do a pillcam first then possibly an MRE.

Since M's scopes always look clean, I was wondering if there even is any point to doing a pill cam, will it even show inflammation? I guess what I'm asking is why a pillcam would be better than an MRE? We're still relatively new to the Crohn's world so I'm not even sure which tests to push for.

Also, what should we expect? Will M have to do the prep? Any tips?

 

[my little penguin]

Typically you do the same prep as a scope .
Clean out .
Mre can show thickening or strictures
Pill cam cam show the surface inflammation or ulcers etc...
Pill cam is easy swallow the pill .. Wear a belt .
Eat x number of hours later
Lots of walking
Six hours later return the belt
Watch for the camera in poop.

DS had one placed during his last scope since there was concern the pill cam would slosh for a few hours in the stomach instead of the small intestine.
Good thing since the Gi had trouble getting the stomach to move the pill cam into the duodendum .

Good luck

 

[DustyKat]

^+1

No pill cams done at our end…

Agree with mlp, a pill cam will show superficial visual evidence. The closest thing you will get to a scope without the biopsies.

An MRE will show what is happening beyond the first layer of the bowel wall…so thickening, fistulae and perforations and it still remains an MRI for the rest of the abdominal cavity.

A pill cam and MRE compliment each other.

If there is no question of stricture then a pill cam will be fine, however if there is any doubt ensure they do a dummy run (dissolvable pill) first to establish if there is patency of the GI tract or have them run the MRE first.

Good luck!

Dusty. xxx

 

[imaboveitall]

Pillcam is excellent. It shows the entire small bowel. It is the only way to visualize it, short of imaging such as MRI/MRE (V's had both) which show only structural changes, not mucosal and should not be used ALONE to diagnose inflammation (per V's docs).

V just had her THIRD pillcam in as many years. Awaiting his read as we speak.

Super easy. Actual photos that cannot lie, no ambiguity with these pictures. You get a disc of the photos too.

It is expensive (around $5000) and takes eight hours for the doc to READ.
V does a patency capsule (dissolvable dummy cap) first to make sure she can pass the pillcam.
No prep, just no food after midnight the night before.

Very beneficial for those like V with primarily small bowel disease not accessible to scopes.

 

[Maya142]

So M swallowed the patency capsule yesterday morning. Is that something we'll see in her poop? She's had 7bms yesterday and 3 today and we haven't seen anything. Does it just dissolve?

 

[DanceMom]

I believe we did see it pass. A only did the "dummy pill" the first time to be sure she could actually swallow it. We weren't concerned with obstructions or strictures.

 

[Maya142]

Hmm that means it's been 30+ hours and we haven't seen anything. M doesn't have strictures though.

 

[Absentminded]

I never found my pill cam, the hospital thought for a while it had got "lost" inside me somewhere, but after having x-rays there was no sign of it so I guess I just missed it coming out.

 

[imaboveitall]

Protocol at V's hosp for the patency cap is if not passed within 24h, they do an X-ray (patency cap has small radio opaque feature to it). It will begin to dissolve after 24h. V passed all 3 within the 24h and we emailed a photo of it to the doc.

 

[Maya142]

She actually passed it last night, but we were going to get an x ray this morning. We'll be doing the real pill cam later this week.
Incidentally, M thinks this test is "very cool." But I haven't told her she has to do a prep yet!

 

[imaboveitall]

What prep. V was told no food after midnight and that was it.

 

[DanceMom]

A has had 3 pill cams. The first 2 required an early light dinner the night before but no other prep. The last one required clear liquids after lunch and half of her usual prep the day prior. The GI wanted to be sure the images were very clear.

 

[nikimazur]

I had the pill cam about a year and a half ago. My only prep was no food after midnight, and a light dinner the night before. I was able to see the trial cap, but when it came time for the real one I couldn't find it. My doc sent me to the hospital for an x-ray just to be sure it passed (previously had a minor stricture). Hope all goes well!

 

[Maya142]

She does have to do a prep but not the full colonoscopy prep. It'll be something like what DanceMom's daughter had to do, the nurse is going to call me with details tomorrow.
Thank you all for your input!

 

[Tesscorm]

Good luck!! Hope it goes smoothly!

 

[Gmama]

Did she do the pill cam yet? Or are you waiting until next week?
Hoping all is going well!

 

[Maya142]

Pillcam done and heard back from the nurse today. Unfortunately I missed her call but she left a message saying it was clear.
I'm confused because M continues to lose weight even though she's really trying to eat more (and is eating more on most days). She still has some stomach pain (which I'm sure they will say is IBS) on the lower right side but the main problem is the weight loss. She has lost 14 pounds in the last year.
What could be causing this weight loss if not Crohn's? M is not a big eater but has been having 3 meals and a snack plus two peptamen jr every day. How is she losing weight???
Does anyone have any ideas?

 

[Mehita]

I'm going to tag Clash. It seems her son has been losing weight too? Also unexplained.

 

[Clash]

Sorry to hear that M is having issues with her weight. I can't be of much help as C's major weight loss came initially from having the flu. His issue has been he is not gaining the weight back. We speak with the GI next week so no opinions there yet. The nutritionist feels C is dealing with malabsorption issues but isnt sure if it is from inflammation or scar tissue(not really for her to define, kwim). Hope to get more answers next week.

I hope you are able to find answers quickly. hUGS

 

[Tesscorm]

I'm not sure how easily scar tissue can be identified?? I know through an MRE, images will show thickening, which can indicate inflammation or scarring but, I'm not sure how easily/clearly scarring can be seen visually. You might want to ask the GI this??? Also, how clear were the pics? There is no control as to speed of movement with the pillcam - if the pillcam was moving quickly in certain segments, could the pics be blurry and, if yes, is it then possible that scarring or inflammation was not clearly seen?

Your signature says that she was diagnosed with ileocolitis - I imagine that she had more inflammation in her terminal ileum?? If yes, I believe I've read that the elemental formulas are absorbed higher up in the small intestine. I think Peptamin is a semi-elemental formula??? Perhaps moving to an elemental formula would help a bit (although, if Peptamin is already semi-elemental, going to elemental probably wouldn't result in a huge or drastic weight gain). How many calories does she get from the formula each day? When S was doing supplemental EN for two years, he was eating three full meals a day plus taking in 1500 cal per night (5 nights/wk) of an elemental formula. This took him to a very healthy weight but, strangely, never pushed him to an overweight level?? While eating 3 full meals plus snacks each day, the inflammation he still had must have lowered his absorption of those calories but, when topped off with the 1500 elemental calories, he was then absorbing the 'right' amount. (Hope that made sense )

 

[Maya142]

Ugh her GI is out for the week so I won't be able to talk to her until next week.
Clash - M actually sort of had the same experience as your son. She lost 5 pounds when diagnosed then remained steady for about 6 months and then lost another 5 when she had cdiff. The last four pounds has been over the last couple of weeks - not sure what that's from.
Tesscorm - I suppose she could have scar tissue, she's never had an MRE so not sure. I suppose that would be the next step. She does have inflammation in the TI but I'm not sure if she would drink an elemental formula - don't they taste even worse than Peptamen?
I think she simply needs a lot more calories than she's getting. I added up her calories last night and since her meals are quite small she can't be getting more 1500- 1700 calories a day. The IBD nurse said she should have 2000 if she was a normal teen and then 2500 since she has Crohn's.
So I think this is very good news because it just means we need to work on how much she eats (easier said than done!). I do think she's going to have to go to an ng tube because there is so no way she can eat 1000 more calories but I think we'll discuss that when we see her GI in March.