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Forum Name: Gastroenterology Topics
Question: Colitis or Crohns
|Sour Puss - Thu Jun 17, 2010 9:54 pm|
Recently in 2005 I went through a series of tests because I was having bouts of diarhea and paid on my lower left quadrant. I was later diagnosed with IBS and Diverticolosis. Did I forget to mention I am only 30 ..My family doctor was a bit surprised I had diverticulosis.
Now it has been 5 years, I took an attack 2 months ago of diarhea, major pains in my left side and some blood in my stool. which was said to be a diverticulitis attack. After the attack my Gi doctor sent me for a colonoscopy a few weeks a go and I was recently told by the GI doctor that he found inflammation of the ileum, not alot but there was some. He has now placed me on Pentasa for 1 month and has scheduled me a barium swallow to see more of my small intestine.
When asked, the Gi doctor could not answer if this was colitis or crohns he said the inflammation is in a spot where the diagnosis is not black or white, he even suggested it might be just a small inflammation and not IBD. Is this possible??
I still have pains on my left lower quandrant and my family doctor says it is just my IBS and my diverticuli being painful. I have only had 1 incident of pain on my right lower quandrant that did not last very long and never did return. I did get it checked out at the hospital, afraid it was my appendix, ER doctor said it was my IBS and prescribed apo-trimebutine which cleared the pain in a few days of taking the meds.
I am so depressed as of lately, I don't know what I have and it is starting to bother me. I've been married for quite some time now and now that I have a stable job I was looking at getting pregnant.. Is this still possible???
Any advice or input???
Thank you in advance.
|Dr.M.Aroon kamath - Wed Jul 07, 2010 4:08 am|
Co-existance of inflammation of the ileum (ileitis) and diverticular disease in your case, raises some interesting possibilities.
a) Involvement of the distal ileum seen in some cases of ulcerative colitis (UC) is termed "backwash ileitis" (BWI).
It can occur
- as a contiguous lesion in UC involving the proximal colon,
- it can occur in the context of pancolitis, or
- sometimes even seen as a non-contiguous feature.
It generally is accepted as a distinct pathologic process in patients with UC. Basically,it is a mucosa-based inflammatory process, unlike crohn's disease, which is transmural.
b) Both inflammatory bowel disease(IBD) and diverticular disease affect elderly western populations(>60y). Thus there is a liklyhood that they may co-exist. Some reports suggest that Crohn's disease of sigmoid colon may induce diverticulosis.
Also, it may preferentially involve sigmoid colon affected by diverticular disease.
( http://ukpmc.ac.uk/articles/PMC1383181/?page=1 )
c) "Diverticular-associated inflammatory bowel disease-like colitis" significantly overlaps clinically with primary inflammatory bowel disease. However, the clinical and the pathologic features of diverticular-associated colitis suggest that it is a distinct clinical entity. Diverticular-associated colitis is a distinct entity that presents with segmental colitis and a variety of clinical, endoscopic, and pathologic features. Diverticular-associated colitis should be considered in the presence of recurrent symptoms after resection for diverticulitis".
( http://www.ncbi.nlm.nih.gov/pubmed/19581849 )
d) Yersinial terminal ileitis: caused by gram negative coccobacilli Yersinia enterocolitica and Yersinia pseudotuberculosis. Mode of spread unclear. Can be due to close contact with animals, or food-borne transmission(dairy products, meat, shell fish).
Common in children but may occur in adolesents or young adults. Causes mesenteric adenitis and terminal ileitis.HLA-B27 phenotypes may be associated with sacroilitis, polyarthritis,or Reiter's syndrome, .
Common symptoms: are fever, diarrhea, and abdominal pain.
Diagnosis: by stool culture.
Serologic tests: useful in diagnosing for past infections.
Prognosis: Mostly self-limiting.
Treatment: appears to be sensitive to amonoglycosides, third generation cephalosporins, chloramphenicol, co-trimoxazole and ciprofloxacin.
Only a full work up may help clarify the reason for the ileitis in your case.
|Sour Puss - Wed Jul 07, 2010 8:01 am|
Thank you for your reply.
Since my last post, I have had bouts of diarhea and the doctor has put me on entocort which has helped control the diarhea. Although just recently I have lost my appetite and feel like I am going to vomit and there is a tighness of feeling full before even eating. I have been told that this is normal for someone with crohns.
I still have more tests to go through, My barium is scheduled on July 16/2010 at 8;45 and here's hoping it goes well.
I am still confused if it is crohn's or not. I have a friend who has diverticulosis and the same symptoms and imflammation in her ileum and was told it wasn't crohns and here I am being told it is. I wish there was a way to actually find out.
|Dr.M.Aroon kamath - Mon Jul 19, 2010 2:56 am|
Thank you for keeping in touch and updating us. I already explained the ways in which inflammatory bowel disease(IBD) and diverticular disease may be related. The final diagnosis of crohn's disease has to be arrived at by way of excluding other likely diseases and by histopathology.
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