Diagnosis Dilemma

I am a 30 yr old female with a history of autonomic neuropathy (unknown autoimmune cause), gastroparesis, and phopholipid antibody syndrome. For as long as I can remember, I've had digestive problems that appear to set off other symptoms including joint pain in foot, ankle, and hand, mouth sores, abdominal pain and cramping, and low grade fevers. My gastroenterologist tested me for antibody ASCA IgA & ASCA IgG.  Both came back moderate to high positive. I was told it looks like Crohn's Disease. I had a upper and lower endoscopy done which showed "moderate hyperemia and erythema of distal esophagus, diffuse gastritis, and mild chronic inflammation of duodenum" according to biopsy results. H-pylori testing was negative. The small bowel follow-through appeared to be normal. My gastroenterologist still says most likely Crohn's but not 100% sure. She seems to think that the gastroparesis is a result of inflammation, and that Crohn's is probably the autoimmune disease responsible for my autonomic neuropathy. My father passed away at 52 years old. He had been ill most of his life with many digestive problems (pancreatitis, small bowel dysmotility), no single cause identified though. He also had phospholipid antibodies and joint pain. Also, my paternal grandmother has had bowel problems as well as joint pain her whole life. My questions...based on my biopsies, does this sound like Crohn's? Is it possible to have moderate to high levels of ASCA antibodies without having Crohn's Disease? Is Crohn's/inflammatory bowel disease genetic?

[Kevin Pho, MD]

Crohn's is certainly a possibility.  Those who are ASCA positive and P-ANCA negative have a specificity of having Crohn's disease of 97 percent.  Thus, you may want to consider obtaining a P-ANCA level.  If negative, then Crohn's disease becomes more likely.  

Another antibody to consider would be the anti-OmpC antibody, which can add some clarity to the diagnosis.  

There is a genetic disposition to IBD and Crohn's disease.  

These options can be discussed with your personal physician or GI specialist.

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.

Kevin, M.D.
kevinmd_

[Yezinki]

Hello,

Replies to your 3 questions:

1. No.
2. Yes.
3. Yes.

Good Luck!

[worry1]

i would ask the doc for the camera pill to better look at your small bowell i have had a family memeber with crohns for alot of years since she was 9 she is now 35 she went in to see the doc and she told them she was having a flare of her crohns and the docs said no your fine know sighns of a flare right now the did some tests small bowell with follow threw showed anything when they did the camea pill it showed all the sores in here small bowell the test is very easy to do you prep go in in the morning swollow a pill and wear this data recorder for eight hours the give it back and your all done i just had one done three weeks ago and mine was normal its the only thing out that can see hole small bowell unlike the endoscopy

[lizziecee]

I am going to stop using this forum if I see any more postings from this preposterous doctor. Please sort it out.

[Hanna5918]

Who are you referring too??? Your comment does not make sense.