Follow up from my last question

[Cjplus]

Just a very quick follow up and then a question. I have gone back to my GI at Jefferson to follow up and have some more tests done. She checked for Celiac, b12 deficiency, liver function tests, she did the blood test that checked markers that would indicate an IBD and she did c1 inhibitor deficiency test. Everything came back normal. Still no diagnosis. She wants to say IBS but with the Bowel wall thickening she's still stumped.

New question but still in the same general area. Since my stomach pains a little over a month ago I've been having discolored stool. Pale, then more yellowish but not really yellow, brownish-orange, brownish-yellow and then green. I was looking at blood work from about 6 months ago and my Lipase level was at 258. The reference range was from 140 to 286. Could I be having some sort of problem with my pancreas causing the odd colored stool for so long now OR does that go more towards an IBSish diagnosis? I don't have pain in my upper abdomen though i still have a wierd discomort under my right rib cage that has been ultrasounded and CT scanned out the whazoo over the past 5 years. I do have generalized itching which is controlled just fine with Zyrtec but ya never know. If my itching was cause by something other than allergies would it be controlled by Zyrtec? I also just had strep throat a couple days ago and am now recovering. Could I have had a strep infection in my intestines first which caused all this and is now finally being taken care of with antibiotics. Thanks

[Ekylesage]

Hello,
I read your issue and I found it interesting because I had a barium ct scan which showed wall thickening in the sigmoid and descending colon and increased shotty nodes in the mesentery and yet my colonoscopy also came back normal.  I also have pretty significant pain except it's on my left side and sometimes in my groin and hip and I feel tired pretty much all the time.  This issue has been going on for several years now.  They also haven't diagnosed me with anything -- the gi guy said I might have colitis from an infection.  I also came back with a vitamin b12 deficiency and a vitamin d-25 deficiency and a low hdl of 28.  I was wondering if they ever diagnosed you with anything because I'm in a similar boat with a normal colonscopy and wall thickening on the ct scan.  From what I've read, sometimes they have to look in your small intestine using a different procedure from colonoscopy to rule out diagnosis of crohn's.  Also, I read that crohn's often develops slowly and that one of the first symptoms to present is mild to moderate wall thickening picked up on a ct scan.  Another journal article I read suggested that people with crohn's go an average of 7 years before diagnosis because symptoms present so slowly, especially in cases where the colon is primarily affected.

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation.

The lipase level were still within the reference range, making pancreatitis less likely.  

That said, pale-colored stools can be due to a biliary blockage, so and MRCP or ERCP to evaluate the biliary tree can be considered.  

Generalized itching can be by to primary biliary cirrhosis, which again, can be evaluated with an ERCP as well as blood auto-antibody tests.  

If an upper endoscopy hasn't been done, I would pursue this test as well.

These options can be discussed with your GI physician.

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.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd