colonoscopy

I've written before. 58 years, female, 4 years ago, pain, fever, bleeding, hospitalized 3 days. Colonoscopy showed non-specific colitis. Further colonoscopy showed "mild chronic inflammation, nonspecific, no evidence active colitis, no evidence of dysplasia or malig." Two years ago epigastric pain, leading to manometric diagnosis of poor esoph. peristalsis. pH was normal. Investigations have shed no light on possible disease process, although since 1988 have had soft diagnosis lupus-like illness.  Hypothyroid.  
In past two months I've been experiencing intermittent nausea, usually three hours after a meal when lying down. Also fatigue, and paresthesia in one leg which lasted 5 weeks.
Bowel problems continue.  I had another colonoscopy two weeks ago.  Results of biopsies:
"Sections show several small fragments of tissue consistent with unremarkable small intestinal mucosa.
  Sections of right colon show only mild edema of lamina propria with no other significant abnormalities.
   Sections from polyp at 70 cm show adenomatous polyp with no evidence of high grade dysplasis.
   Sections from left colon show, once again, mild edema of lamina propria. There is no thickening of the subepithelial collagen layer and no significant lymphocytosis.
   Sections from polyp at 30cm show portios of a tubulovillous adenoma. No high grade dysplasia is identified.
  DX: Biopsies terminal ileum, right colon and left colon: no significant histologic changes. Biopsies of polyps at 70 and 30cm: adenomatous polyps."
My questions:
(1)Is "mild edema of lamina propria" normal?  A past colonoscopy referred to "mild inflammation of lamina propria - I assume it's the same thing. I'm wondering whether this "mild edema" might explain continuing intermittent bowel symptoms, which include abd. pain and tenesmus and fever, as well as vaginal and anal ulcers. (Skin biopsies show inflammation, no herpes.)
(2)Are polyps something to worry about? "No high grade dysplasia" assumedly doesn't mean "no low-grade dysplasia."
(3) Any ideas on the nausea? I had upper endoscopy 18 months ago which was normal. Also MRI, blood tests, etc. all normal.
Thank you.

[Kevin Pho, MD]

To answer your questions:
1) Mild edema is a non-specific finding - meaning there are many causes that can explain it.  The bowel symptoms themselves can result in the mild edema.

2) The key is the tubulovillous.  Tubulovillous adenomas, having 26 to 75 percent villous component, account for 5 to 15 percent of adenomas.  Villous histology is more of a risk factor to develop into cancer.  Closer future colonoscopic monitoring should be discussed.

3) You may want to consider more specialized tests if the upper endoscopy was normal.  This can consider a 24-hr pH study with esophageal motility or a gastric emptying scan.  Of course, I would ensure that the gallbladder be evaluated if not already (i.e. with an ultrasound).

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.
Medical Weblog:
kevinmd_b

[schhaparia]

A related discussion, colonscopy done after right hemicolectomy for adonocarcinoma was started.