Is this the onset of Crohn's

[CDpatient]

I am a 40-year-old male. Three months ago, I went to see a GI specialist after observing a change in the color, consistency and shape of my stool. There was mucus in the stool but no blood.  I also had bloated stomach and felt full after small/medium meals.  No pain.

Blood test: Normal

Colonoscopy: It was reported that there was a thickening of the colon at the fold. Biopsy of the area resulted that it was just an inflammation. Note I have been on an antibiotic for about a week before the colonoscopy because of a tick bite.

CT Scan of abdomen: It showed a tubular structure 6 cm in length and 2 cm in diameter in the vicinity appendix area. GI thought that it was probably appendix but he was not %100 sure.

I had a laparascopic appendectomy. According to the surgeon, the appendix ruptured, had a hard texture and was confined into the muscles around. Lab report came with the conclusion of Crohn’s disease of appendix. I understand my other organs have been checked during laparoscapy and nothing abnormal has been seen.

Currently, I am having about week of light abdomen pain/discomfort and bloated stomach fleeing and light nausea.  In this period I feel tired and sometimes I am having hard stool (small bullet-like pieces attached together), sometimes soft and watery stools. The frequency of BM is about 2 a day (3 – 4 when I have a watery stool). The caliber, amount and color of the stool are also changing from day to day. Then for a week or so I feel no pain, no bloated feeling and relatively normal BMs. This episode has been repeating since a month after the surgery. Also, I have a right hip and knee joint pains since last month. Finally, recently I had upper GI series (for reflux I think) and it was normal.  It looks like that I have the Crohn’s disease, although Colonoscopy and Upper GI were negative? Do you agree? What other tests do you recommend?.. Thanks..

[Kevin Pho, MD]

Crohn's disease should be able to be diagnosed via a colonoscopy.  If there is doubt regarding the inflammation in the colon, you may want to seek a second opinion.

Another consideration would be a malabsorption syndrome - either fat or carbohydrate malabsorption.  Celiac disease can also be considered.  Further tests to evaluate this would include a fecal fat test and serum antibodies for celiac disease.

If all the tests are negative, then irritable bowel may be considered.  Typically characteristic would be the alternating hard and soft stools that you are experiencing.  If this is the case, you may want to optimize treatment for this in conjunction with your gastroenterologist.  

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.

Thanks,
Kevin, M.D.

[RTFLY]

What you're describing sounds a lot like Irritable Bowel Syndrome (IBS). It does not sound like you have Crohns Disease. If your upper GI series was negative, I'd be willing to bet you suffer from IBS and not Crohns, which is also known as IBD.
IBS is often accompanied by loose watery stools with mucous present. There is NO bleeding noted with IBS. Blood in the stools usually indicates the presence of Inflammatory Bowel Disease (IBD) or other more serious complications. It may also be as benign as hemmorhoids.
Hope all works out for you and you feel well soon.
                                              
                                               JCI

[sunny_one]

Have you been tested for intestinal parasites? It's often overlooked in the US, but can be a problem for those who are symptomatic. You must have very specific testing from a reliable lab - often more than once to detect them. I have just found out I have Dientameba fragilis - an intestinal parasite. I have been through a year of hell without proper diagnosis. I encourage all who have ongoing gastro problems to be aware of this. This site has a lot of info about these critters: http://www.badbugs.org/