What is this?

Hi Doc:
So I've had stomach issues ever since I can remember.  Bad cramping, diarrhea..etc. 5 years ago i started to get this discomfort in my upper right abdomen that came and went without any obvious reasoning and was certainly effected by my posture. Oh and i always, since I was 19, had this retrosternal pain that was explained as chondritis. This pain can be manipulted by me and reproduced by pushing or changing position.
So over the past 5 years I've had several CT scans, and abdominial ultrasound and a colonoscopy. each CT scan showed mural wall thickening in my intestines. The area of thickening would sometimes be the same but it would also change from time to time. There was also some mesenteric stranding associated with the areas of thickening and mildly enlarged lymph nodes were noted on one of the scans. All organs were found to be normal each time any of the scans were run.

There was one month 4 years ago when i had constant diarrhea. After some ER visits I was diagnosed with crohn's by the ER physicians and my GP. The one ER doc put me on Asacol and some predisone. I didn't really take the prednisone for too long but the asacol seemed to help. My GP sent me down to Jefferson to their GI department. Now this was about a month after everything had happened and I was already feeling better. (By the way - there was never any blood found in my stool and it was checked several times) The GI doc did a colonoscopy and took biopsies. I woke up and was told that I had an absolutely beautiful large intestine. The biopsies also came back normal. So my question here is what the hell?  If there is no active disease will a biopsy come back with a normal result? If this is not Crohn's then what are the differentials. I also often have an itchy spot around my anus, bright red streaks of blood on occasion due to over whiping or hemmoroids (hemorrhoids) and frequent canker sores in my mouth.

Thanks for any help offered.

[Kevin Pho, MD]

You have clearly had a comprehensive evaluation, with a specialist referral at a major academic medical center.

Crohn's disease often affects the small bowel, and thus, cannot always be diagnosed with a colonoscopy.  If the diagnosis is in question, blood antibody tests can be considered to confirm the diagnosis.

Regarding the stomach pain, an upper endoscopy can be done to exclude inflammation of the upper digestive tract or an ulcer.  I would also consider blood tests to look for celiac disease, as well as breath tests to evaluate for bacterial overgrowth or lactose deficiency.

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

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

[Cjplus]

I forgot to metion that all blood work has been normal with the exception of a very slightly elevated ALT level at 60 for my most recent life insurance physical. I've been tested for Hepatitis and most other diseases that have simple blood tests. Oh and I have an abnormally large xiphoid process which may explain the upper right discomfort and retrosternal pain. All chest x-rays have been normal.