Diagnosis still in question

[hudy]

I am 59 yr. woman, hypothyroid, intermittent smoker. Symptoms began five years ago. Blood, tenesmus,fever,pain. Hospitalized iv antiobiotics.6 weeks after ilness began had colonoscopy:colon "tortuous," couldn't get past mid-sigm. Biopsy: "Patchy acute and chr. inflammation within mucosal biopsies.Chronic component manifested primarily as expanded mucosal lymphoid aggregate.Crypt architecture normal and intervening mucosa between lymphoid aggregates has a more normal population of mononuclear cells.There is mild mucosal edema.Neutrophilic crypt and surface epithelial damage with cryptitis and occasional crypt abscesses noted, primarily in areas of expanded mucosal lymphoid tissue.No erosion or ulceration, granulomatous inflammation or neoplasia.No pathogenic organisms or viral inclusions identified on HPS stain." "Dx:non-specific colitis with focal acute and chronic inflammation.Findings non-specific but suggest infectious etiology that requires correlation with clinical and microbiol. studies.No specific features to suggest IBD or isch. colitis."
  I've been symptomatic ever since, every few months, occasionally with some blood and fever, but am never normal. In between. 2nd colonosc. and two more succeeding, findings have shown "mild chronic inflammation of lamina propria" and nothing more. Dx:post-infectious IBS. Since then had one more colonoscopy. Nurse read to me over phone and mentioned hyperemia, but I am waiting for appointment with my GI.
  Two yrs. after this started I developed upper digestive symptoms. pH normal, but esoph. manometry shows very weak peristalsis, and am advised liquid/pureed diet. Endoscopy neg.
  I am now in bowel flare that affects my upper dig. system as well. Tenesmus waking me at night, lower abd. discomfort, bm's 5-6 times/day, no diarrhea or constipation.
  When in flare I usually have hip pain and anal or vaginal ulcers.Biopsies show "focal ulceration of squamous epithelium and adherent acute inflammatory exudates. Subepithelial stroma markedly inflamed." I have also developed psoriasis (biopsy confirmed) of scalp, and now, despite HRT since menopause, I have osteoporosis.  
  I believe this is all relaed, and that I have Crohn's or UC.In my family there's collag. colitis, lymphotocytic colitis, celiac disease. 50 yr-old cousin just diagnosed with UC.  
  Please read biopsy report at beginning -perhaps you have a pathologist that can do this.  Does IBS really seem likely dx?
   Thank you.

[Kevin Pho, MD]

Irritable bowel syndrome isn't really a diagnosis that needs a pathology report.  The biopsy suggested inflammation suggestive of an infectious etiology - and this makes it less likely that it is irritable bowel.

For further evaluation, you can consider stool studies - such as a culture, ova and parasites - to determine whether an infectiou is present.  

Regarding the upper GI symptoms, there has already been a comprehensive evaluation regarding this.  A gastric emptying scan can be considered to evaluate for gastroparesis.  

You may want to consider another GI opinion - or have the biopsy read by a second pathology opinion.  As of now, the results are non-specific and does not point to a discrete disease entity.

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