Bloody Stools: No diagnosis after multiple tests

[brittani25]

Hi. My brother is a 23 year old male with increasingly worse bloody stools. About three years ago he was admitted to the hospital for three days with lower abdominal pain in the colon area. It was a blinding pain and the ER doctor ran CT Scans of his pelvis, abdomen with contrast and said they found nothing. I review the radiologist results and it states he has Mesenteric Adenopathy Medial to the Cecum. No thickening of the wall of the bowel, etc. My brother was discharged after four days with no answers and no treatment plan.
My brother has a history of juvenille rheumatoid arthritis that he overcame when he was 15 years old. His family doctor at the time related it to that and said that he would have Crohn's disease some day and to change his diet.
Three years later my brother was admitted again for bloody stools this time, nausea, weight loss of more than 10 pounds, diahrrea, severe abdominal pain. A colonoscopy was scheduled and an edoscopy which they stated was negative for anything more than mild gastritis. He had labs that where negative for h-pylori and a positive  gram stain for many gram positive cocci, many gram negative rods, moderate yeast, few wbcs, moderate gram postitive rods from a stool sample. Family doctor had no idea what to do next and has no idea what to do for my brother. His bleeding is increasing and he is becoming severly depressed. He can bleed up to four hours straight with his bowel movements. I am very concerned!!!
Any advice or counseling of where to go to next?

[Brokanhalo]

I was diagnosed with Crohn's disease when I was 20 (I am 41 now) and I began to have symptoms when I was 17. Bloody stool is common in my disease, especially during a flare up. The disease is difficult ot diagnose without surgery because unless the bowel has obstructed the current tests they have available just are not sophisticated enough to be able to see the disease. I don't like that years ago a Dr told him that his RA meant he'd develop Crohn's. They can go hand in hand but just because you have RA doesn't mean you will develop Crohn's. I htik your brother needs to see a gastroenterologist. A family Dr just cannot handle this level of specialty and he needs someone who can. Continuing to bleed like he does isn't good. He could pass out with very little warning. As for diet it can help but it isn't a cure. I don't eat meat, I don't drink and I don't smoke. I consume a low fiber, low fat diet because it's easier to digest.
As for tests. I would recommend a CAT scan to see where the source of bleeding is coming from. Any upper GI series with Barium isn't really going to show much if it's Crohn's unless there is a blockage and then barium is the last thing you want to ingest (hardens like cement once it's inside and can cause a blockage all on it's own)
North America has the largest population of Crohn's and colitis in the world and they don't know. The typical age of diagnosis is between 15-25 then typically over the age of 50.
I have had 4 bowel resections and has no idea what this was when I began. If you have any more questions please feel free to ask.
Take Care
Rita

[Ratnakar Kini]

Hi brittani25,
Since he is having recurrent bleed, he obviously has some lesion inside. Colonoscopy helps to look at the colon only. Upper GI scopy helps to view upto duoedenum only. There is still quite a long part of small intestine that cannot be visulaized by these two procedures. Bleeding can occur from this region also.

Some of the options avialable to look at these part are - capsule endoscopy, enteroscopy and barium studies.

The exact bleeding spot can be made out with angiography also.

Discuss with your doctor regarding these options.
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.