GI cramping and pain for years

[Cjplus]

Good morning Dr.
I've had ongoing stomach issues for as long as I can remember. When I was child I was told that I was lactose intolerant. In highschool I always had an uneasy stomach and then as I got older I started to get severe cramping. I mean severe. The cramping would always be followed by diarrhea and then more cramping and then diarrhea. That would last for a night or a day sometimes longer and then it would stop.

So three and a half years ago I finally got it checked out. I was given a CT scan of my pelvis and abdomen. The results were as follows: Narrowed edematous distal ileum suggesting Crohn's disease or other ileitis. Mesenteric lymph nodes are seen but less than 1cm. My symptoms went away soon after that and I let it go.

Then in Feb of 2007 I was going through a month of diarrhea. Mild cramping but horrible diarrhea. I had another CT scan. Here are the results: Asymmetric sclerosis involving the iliac and sacral sides of the left greater than the right sacroliliac joints. Apparent mural thickening involving the distal ileum/terminal ileum - Suggestive of colitis - multiple sub centimeter mesenteric nodes. Abnormal in amount.
From here I had a colonoscopy with about 40 biopsies of the colon all of which came back normal. Then it all went away and no one followed up from there.
Just yesterday I had another Ct scan due to abdominal pain and diarrhea. I've been sick with tonsilitis, bronchitis, ear infection and sinus infection and I've been treated with all kinds of antibiotics, Biaxin, cipro and clyndomicin. Here are the results of the scan and my blood work: Mural thickening of the distal descending and rectosigmoid colon. Mildly enlarged mesenteric nodes - mild mesenteric stranding - blood work was normal except for my neutrophils were 75% and my lymphocytes were 17%. There not too far out of whack but still off.
So...what do you think?

[lak]

A related discussion, severe cramping every bowel movement yellow stool was started.

[Cjplus]

Thanks for your insight. I've had my PCP review all of this info, she's from the University of Pennsylvania and the GI was from Thomas Jefferson University Hospital.

So it seems as though colitis should remain in highest suspicion. As I've read about colitis my symptoms completely make sense.

When they take biopsies like that of your colon is the work up for everything or were they only trying to rule out crohn's and/or colitis? I'm not really sure how that stuff works.

[Kevin Pho, MD]

Colitis continues to be suspected, despite the negative biopsies.  Obtaining another GI opinion, preferably at a major academic medical center, can be considered.

I would also consider sending the stool off for culture and analysis.  Malabsorption can be excluded this way as well.

Blood tests to evaluate for celiac disease can be done if the tests remain negative.

If the studies continue to be non-revealing, optimizing treatment for irritable bowel can be discussed.

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

[Cjplus]

I forgot to mention that I'm a 34 year old male.