My new colonoscopy results

[Jonas]

My new colonoscopy results are in (2 years after the first), but the GI doctor is on vacation five more weeks, so there is no one to ask questions to. Maybe you can help?

The results says:
Microscopic fairly normal structured colo / rectal mucosa with mild increasing number of inflammatory cells in the lamina propria. You see places marked increase in lymphocytes intraepithelial. The increase is a bit uneven but some places are more than 20 lymphocytes per 100 surface epithelial cells. An image that is consistent with microscopic colitis. Immunohistochemical examination with CD3 (T lymphocytes) supports the diagnosis. No collagen subepithelial elements. No dysplasia.

What this means is that my colitis is still active. Right?

And that I have lymphocytic colitis. But no cancer in the intestine.

Is there any other information in the text?

And it means that my GI doctor will want me to start with Entocort.

[tex]

What this means is that my colitis is still active. Right?

Yes, but that's not surprising, because MC is very slow to heal. It typically takes at least 4 or 5 years of remission before mucosal cellular histology (physical appearance) will return to normal.

And that I have lymphocytic colitis. But no cancer in the intestine.

Correct.

Is there any other information in the text?

Yes, for example:

rectal mucosa with mild increasing number of inflammatory cells in the lamina propria.

That's usually considered to be a marker of proctitis. But it could also simply be a part of your MC, so your doctor may disregard it.
It boils down to a question of what he prefers to call it.

No collagen subepithelial elements.

That rules out collagenous colitis.

No dysplasia.

That implies normal cellular architecture, which not only rules out cancer, but also Crohn's disease and ulcerative colitis.

Is your vitamin D level at least adequate? If I were in that situation I would keep my vitamin D blood level well above the minimum "sufficient" level, because with continuing inflammation, vitamin D will help to prevent the development of additional IBDs, or other autoimmune diseases.

Tex

[Jonas]

Does this result tell me anything about the mast cell level?

4 or 5 years of remission

This means that you should not make any new colonoscopy within that period to examine the status of your colitis.

[tex]

I don't see any mention of mast cells in the remarks that you posted. Unless you requested a mast cell count (and your GI specialist requested a special tryptase-based stain when he sent the samples to the pathology lab), mast cells will usually not be counted. The tryptase-based stain makes mast cells more easily visible under the microscope, so that the cells will be easier to count, but most labs don't even stock the stain, unless doctors request it.

Your biopsy samples can still be restained and re-examined for mast cell counts if you can convince your doctor to place the request/order with the pathology lab. If I were in your situation, I believe that I would ask my doctor to do that, because excess mast cell activity could be the reason why your inflammation is still present, despite all your efforts to resolve it.

This means that you should not make any new colonoscopy within that period to examine the status of your colitis.

Of course if another reason exists (such as colonic bleeding, or cancer screening), then a colonoscopy would be appropriate, but if the colonoscopy is just to check to see if MC is still present, then there is not much point in going through the expense and discomfort of a colonoscopy any sooner than about 5 years, because complete healing usually takes many years. This is true for adults — kids heal much faster, and they can often heal in 2 or 3 years.

Tex

[Jonas]

My doctor also asked for mast cell activity, but it seems not to have been tested.
Both my doctor and the GI doctor are on holiday for 4 more weeks, maybe I can call directly to the lab and ask them why it was not tested.

Your biopsy samples can still be restained and re-examined

How can they test it afterwards? Are not the samples thrown away after the evaluation?

If there are excess numbers of mast cells, then I also have mastocytic enterocolitis. Right?
Best medication for that is to avoid histamine trigger foods, high histamine foods. Try antihistamine type 1 and 2, DAO and cromolyn sodium. Does Entocort work on mastocytic enterocolitis?

[tex]

How can they test it afterwards? Are not the samples thrown away after the evaluation?

In the U. S., the slides are kept for many years — virtually forever. Doctors can even request that the slides be sent to other labs for evaluation, years later. In some countries however, the slides are discarded after a few months.

If there are excess numbers of mast cells, then I also have mastocytic enterocolitis. Right?

Correct.

Best medication for that is to avoid histamine trigger foods, high histamine foods. Try antihistamine type 1 and 2, DAO and cromolyn sodium. Does Entocort work on mastocytic enterocolitis?

Yes, you are correct. And corticosteroids do help to suppress mast cell numbers. Most doctors claim that it is not known how corticosteroids suppress inflammation, but IMO it is pretty clear that they do so by suppressing mast cell numbers.

Tex