colonscopy/endoscopy results/ questions

[jfem4]

41 yo female..2 yr hx of stomach issues-bloating, bright red blood after straining, rectal pressure relieved with Canasa suppositories.
No diarrhea, most of the times, formed stool...once a day.

Endo results: folcal intestinal metaplasia identified on alcian blue stain.

colon results : bx a- chronic colitis w/regnerative changes = chronis proctitis. no active colitis

bx b- chronic active colitis of marked severity w/ surface erosion and granulation tissue-consistent w/active phase IBD. focal cryptitis = active gland destruction
bx c-chronic colitis
all 3 neg for malignancy + dysplsia
upper gi + abd us - normal





questions:

1. do the endoscopy resuts mean I have cancer?
2. what is metaplasia and what follow-up do I need?

3. The only symptoms that I have related to the colon are rectal pressure/tiny amount of red blood when straining and when I don't have fiber..howver none of these are present as long as I continue to take the Canasa suppositories...Can I safely continue to take them indefinetly?

4. do the results ,mean that I have UC?
5. I don't have the symptoms that I read about, is it becasue I have only had it for about 2 years? Will I eventually get all the bad symptoms that I read about?

6. will/can the proctitis that I have spread to become left sided or pancolitis, and if so is there anything that I can do to prevent it?

thank you

[Kevin Pho, MD]

To answer your questions:
1) I do not see evidence of cancer on the biopsy report you wrote here.

2) Metaplasia are changes in the cells.  Chronic inflammation and ulcerative colitis can lead to this finding.

3) The suppositories are generally safe to take on a longer-term basis.  You may want to consider immunomodulator therapy if the symptoms are refractory.

4) UC is possible.  I cannot give a definitive diagnosis without examination.

5) It is possible for the proctitis to spread without appropriate treatment.  If the suppositories are not enough, consideration for immunomodulator therapy can be considered.

6) It is also possible for the inflammation to spread without appropriate therapy.

I would discuss these questions with your 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_

[lizziecee]

Hi - until the doctor replies, thought I would answer some of your questions to put your mind at rest some.

Your biopsy shows no malignancy - hence no cancer! Great news.

Metaplasia is the Greek term to describe the replacement of one differentiated cell type with another mature differentiated cell type. This could be a precursor to Barrett's esophagus where there is an abnormal change in the cells of the lower esophagus, thought to be caused by damage from chronic acid exposure. The medical significance of metaplasia is that in some sites, cells may progress from metaplasia to develop displasia and then neoplasia (cancer). When metaplasia is detected, efforts are made to remove the causative irritant, and to decreasing the risk of progession to malignancy. It needs to be carefully monitored to ensure that dysplastic change does not begin to occur. A progression to signifcant dysplasia indicates that the area could need removal to prevent the development of cancer.

It looks from the biopsy that you also have active Ulcerative Colitis (inflammation in the colon) and inflammation in the anus (proctitis), but no suggestion of malignancy.  Meds, I would think, are predicated by this biopsy. I would suggest that you see your gastro for appropriate treatment.

It's not too bad - I have had Crohn's since I was 24 yrs old, now 63 yrs. If you get the right medical treatment you will love a long and happy life - but please see a gastro for the right meds - I inject methotrexate weekly, but the meds are different for UC.
Take care,
Liz.

[jfem4]

Thank you so much for your comment on the cancer...

My husband was diagnosed last year with colon cancer and it's just a little too much when I see anything that even remotely resembles cancer!!

The UC isn't really that bad, that's why I can't believe that i really have it, you know??
I just keep takin ghte suppositories, increasing my soluble fiber, taking some probiotics ( VSL) and some vitamins, and go on my merry way..

I just keep waiting for the "bomb" to drop,...that one day I'll wakeup with terrible diarrhea etc...

ANyway,,,thanks for your comments...

good luck to you!!!

J

[jfem4]

Just wanted to say thank you for taking the time to answer all of my questions...

[lizziecee]

Hope Dr. Pho alleviated your anxiety somewhat. However, ulcerative colitis and/or proctitis can be a precursor to cancer of the colon - my Dad died of colon cancer at 59 yrs, and I am at high risk of colon cancer because of Crohn's, due to my recent breast cancer and his history, so I see my gastro every 3 months. I have 3 yrly colonoscopies and occasional endoscopies of the small intestine - just been dx with a stricture there, which is rather disturbing.  Knowledge is indeed power. I have learned to be my best advocate. Do you see a gastroenterologist? Perhaps he can prescribe immunomodulaters - I self inject methotrexate once weekly to keep the Crohn's into remission, but not sure if it works as well with Ulcerative Colitis. It is not without serious side effects to the liver, lungs and bone marrow, but I am doing okay-ish.  I would suggest you go onto the CCFA site (Crohn's and Colitis Foundation of America) for some good technical information. I live in England, but have found some of their technical literature, which you can download, invaluable. There is also a brilliant medhelp gastroenterology site - just google "medhelp gastroenterology forum" and peruse the posts.

I am so sorry to hear of your husband's colon cancer, but if caught early can be cured. My Dad was dx some 33 yrs ago, and it had already spread to his liver, kidneys etc.  He was the original ostrich, and would not confront his problems. That was just the way it was some 30 odd years ago, but cancer is not the taboo subject it was then, and hopefully men especially, can confront their problems much earlier, and get treatment. I feel that IBD is now the taboo subject - no-one wants to know or even understand, how difficult it is to live with constant diarrhea, severe rectal