Digestive Disorders / Gastroenterology Expert Forum
Crohn's Diagnosis
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Crohn's Diagnosis

I am a 40 year old Male and since I was in my late teens, I have been diagnosed with IBS.  For the past several years, however, I have been having Arthritis symptoms which have effected my right sacroiilliac joint and lower back.
Due to the fact that my IBS has been flaring several times a day and always causes pain on my mid to lower right side (several doctors even thought I was having an appendicitis attack!), my Rheumatologist had me undergo an EGD and Colonoscopy.  The findigs were minimal.  The colonoscopy report came out normal and the EGD pathology report said "acute and chronic mixed inflammation of the small intestine of unknown origin".
All my labs have been normal, except I do tend to run a high normal level with my WBC count and my Monocytes run slightly high.
I have had numerous CAT scans, barium enemas, and barium swallows, and all were normal.
I did have gallbladder surgery recently, but did not show any stones.  My HIDA scan showed 8% injection fraction.
My Rheumatologist believes the inflammation shown on the EGD is significant, and her belief is that it is due to Crohn's disease.  The Gastroententeroligst, however, is not ready to confirm this inflammation as Crohn's disease just yet.
Are there any other tests that I haven't had that might help either confirm Crohn's or find the causative digestive problems?  I will say, when the intestinal problems kick up, so does the Arthritis!
I would very much appreciate your input.
Thank You,
Jeff
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Certainly, the GI symptoms with rheumatological symptoms can alert one to inflammatory bowel disease.  The EGD suggested inflammation of the small intestine.  

Although the diagnosis of ileal Crohn's disease is occasionally made by colonoscopy, a barium study of the small bowel remains the mainstay of diagnosing ileal disease as does the upper gastrointestinal series for gastroduodenal disease.

Typical features of small bowel Crohn's disease include narrowing of the lumen with nodularity and ulceration.

A number of autoantibodies have been detected in patients with inflammatory bowel disease some of which may be clinically useful for establishing the diagnosis.  This would include the ASCA and p-ANCA test.  Studies suggest that people who are p-ANCA negative and ASCA positive are more likely to have Crohn's disease.

I would discuss all of these options with your gastroenterologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
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See if you relate to this
Dr. Truss, author of The Missing Diagnosis, is an internist in Birmingham, Alabama. He has had more than 20 years of clinical experience with over 3,000 candida patients. He is convinced that yeast is implicated in a wide variety of human ills, from depression and hormonal disturbances to allergic reactions and auto-immune diseases. Chronic yeast infections, he believes, may be a causative factor in diseases such as multiple sclerosis, Crohn's disease, schizophrenia, myasthenia gravis and lupus.
Article by Dr Truss
Lack of energy and digestive disturbances, arthritic joint pains, skin disease, menstrual problems, emotional instability and depression. All symptoms of what I call the 'antibiotic syndrome' which have greatly increased in frequency in recent years.
On further examination, more symptoms may be discovered. Most of the gastro-intestinal tract is tender when pressed, especially the small intestine, liver and gall bladder. There may even have been a gall bladder operation that failed to improve the condition, sometimes even worsening the symptoms.
There could be a history of thrush or oral, anal or vaginal itching. When these are present the diagnosis of Candida is obvious but it may also be present in the absence of these manifestations and that can be somewhat confusing. The yeast or fungus Candida albicans, of course, thrives during antibiotic treatment. I regard it as reckless negligence to prescribe antibiotics without simultaneous fungicides and replacement therapy with lactobacilli afterwards. I believe that this practice has greatly added to our vast pool of a chronically sick population.
However, the 'antibiotic syndrome' is not just due to Candida. I regard it more generally as a 'dysbiosis' where the wrong kind of microbes inhabit the intestinal tract, not just Candida and other fungi, but many types of pathogenic bacteria including coli bacteria which are normal in the colon but become disease-forming when they ascend into the small intestine.
If the problem has existed for years, there is usually a lack of gastric acid which then allows the stomach to be colonised by microbes, causing inflammation with pain and later, ulcers. The toxins released by the microbial overpopulation cause in addition chronic inflammation of the liver, gall bladder, pancreas and intestines. I regard it as rather likely that a chronic inflammation of the pancreas is a major contributing factor in the development of insulin-dependent diabetes.
Bacterial attack
Specific types of pathogenic bacteria appear to cause or contribute to specific auto-immune diseases. One variety of coli bacteria, for instance, produces a molecule that is very similar to insulin. When the immune system becomes activated against this molecule it may then also attack related features at the beta cells of the pancreas
Another type of bacteria, Yersinia enterocolitica, induces an immune response that attacks the thyroid gland and leads to Grave's disease with a serious overproduction of thyroid hormones.
Ulcerative colitis is linked to overgrowth with pathogenic microbes, the same as Crohn's disease, osteoporosis and ankylosing spondylitis. In ankylosing spondylitis the vertebra of the spine fuse together causing stiffness and pain. Other joints may in time become affected.
Klebsiella, another type of pathogenic bacteria, produces a molecule that is similar to a tissue type found in people with this disease. When klebsiella numbers in the gut decrease, related antibodies in the blood decrease and the condition improves.
Rheumatoid arthritis is linked to other bacteria, called proteus. Proteus is also a common cause of urinary tract infections. Women suffer urinary tract infections as well as rheumatoid arthritis twice as often as men, while men usually have higher levels of klebsiella and three times more ankylosing spondylitis than women.
In addition microbial overgrowth dam ages the intestinal wall so that only partly digested food particles can pass into the bloodstream, causing allergies. In this way all auto-immune diseases can be linked to food allergies.
While rheumatoid arthritis is a frequent feature of the antibiotic syndrome, and I regard it as relatively easy to cure, not many sufferers of this disease seem to be interested in this natural approach. The other day a young man with severe rheumatoid arthritis knocked at my door to collect money for a medically sponsored walkathon. When I told him that I do not give money for drug treatment as it can be overcome with natural therapies, he shouted: 'You are mad!' and left visibly upset.
Other auto-immune diseases that have so far been linked to dysbiosis are psoriasis, lupus erythematosus and pancreatitis. When remedies are given that bind bacterial endotoxins, these conditions usually improve. A further consequence of dysbiosis is susceptibility to food poisoning as with salmonella bacteria, while a healthy intestinal flora prevents these from multiplying and causing trouble.
Staphylococcus aureus or golden staph cause serious infections in hospital patients. It has been found that not only golden staph but also other infections are greatly potentised when they occur with a Candida overgrowth. As Candida overgrowth is a natural outcome of the standard hospital treatment, it is easy to see why golden staph is so deadly in hospitals.
A similar picture emerges with AIDS. People do not die from the AIDS virus but from Candida-potentised bacterial infections. I also see the antibiotic-induced dysbiosis in babies and infants as the main cause of their frequent infections, glue ear and greatly contributing to cot death.
While it used to be uncommon for children to have more than one or two infections a year, now more than six is the norm.
In the 1940's Candida was found in only three per cent of autopsies, now the figure is nearer thirty per cent. There are, of course, other factors that can cause dysbiosis - the contraceptive pill, steroids and other drugs, radiation treatment and chemotherapy - but the main culprit is, without doubt, antibiotics.
Closely related to Candida are the mycoplasms or pleomorphic organisms. These have been shown to be a main factor in the causation of cancer. Therefore, antifungal therapy has also major benefits in cancer treatment.
Dr Orian Truss
In 1953 Dr Orian Truss discovered the devastating effects of antibiotics in  Alabama (USA)
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there are a great many doctors who consider the candida thing quackery in most cases. Myself included. Candida is more or less omnipresent. It causes infections and illness in some circumstances. Lots of people are making lots of money convincing others that they are among that very small unusual group. Which, in most cases, they actually aren't.
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Surgeon , I am in the
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http://www.quackwatch.org/01QuackeryRelatedTopics/candida.html
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I read the article with great interest, well, just because I like to read about different things.

I am afraid you won't convince PAJ with it, though.  You know how the "scientific community" wants to suppress the discovery of these great cures for whatever ails us...(hope you know I am being sarcastic)!

As always, you rule!
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I'll be away until January 4th - I will answer your question when I return.

Happy holidays,
Kevin, M.D.
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The quackwatch site is that it your argument ? Your information is nothing new, It
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a couple of questions for you....

were biopsies done of the colon and terminal ileum during your colonoscopy?  did those show any inflammation?  have you been tested to rule out celiac disease or checked for lactose intolerance?  have you considered getting a second pathology opinion on your EGD biopsies?  

is your gi doc familiar with IBD?  I ask cause there are some gi's that will only see a few cases thier whole career, unlike others (like my local gi) who treat hundreds.  there are blood tests that can be done, but the accuracy of the results is questionable for a lot of docs.  the tests are expensive and aren't always covered by insurance.  you can check out thier web site  http://www.prometheus-labs.com/

have you had any of the other (besides joint problems) extraintestinal manifestations?... eye inflammation, erythema nodosum, mouth ulcers, etc?

hope you find some answers

take care
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Yes.  Actually I have had other symptoms.  I get frequent mouth sores (around the lip and cracks of the mouth as well as on the tongue)  Also, I have had painful urination and swelling in the testicular area.  All the urinary workups have been negative for bacteria.  With this combination of symptoms, my Rheumatologist has given me a diagnosis of Reiter's Disease.  She seems to be certain that this is being exacerbated by underlying Crohn's Disease.  The only possible sign of Crohn's disease, however, showed up on a small intestine biopsy from an EGD.  It, however, was not conclusive for Crohn's. It just showed chronic inflammation of unknown origin.  I know some of the medication for Crohn's disease and Reiter's are immunosuppresive, and before I go on them, I would like to have a more concrete diagnosis.
As far as the Candida connection is concerned, I don't know what to think about it.  I can tell you I have been on numerous antibiotics including, Cipro, Tequin, Biaxin, Tetracycline, and Augmentin for either the stomach or urogenital problems.  None of them worked! But I do imagine my gut flora is a mess after all these antibiotic series!
Thank you all for your advice,
Jeff
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