Is there Anyone that can interpret this please
Here is the Histology report from my colo/endoscopies
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Here is the Histology report from my colo/endoscopies
Is there Anyone that can interpret this please
Hi Jim.
Well, your biopsy samples are not officially diagnostic of anything except general unspecified inflammation. However, many of the markers appear to be somewhat consistent with the early stages of Crohn's disease. The upper two-thirds of your small intestine (the duodenum and jejunum) is inflamed, but the lower third (the ileum) shows no significant inflammation. With either Crohn's disease or MC, the terminal ileum is typically inflamed.
For the biopsy samples from the colon, I don't see any evidence that the pathologist made any effort to make any lymphocyte counts to rule out LC. Nor do I see any evidence that the thickness of collagen bands in the lamina propria was measured to rule out CC. It appears that the pathologist was only looking for either Crohn's disease or UC. It sort of appears that the gastroenterologist did not request that the pathologist rule out LC or CC, he only requested a search for Crohn's disease or UC.
Loss of goblet cells can be caused by Crohn's disease or UC, but they can also be seen in the final stages of celiac disease (Marsh 4 stage damage). But at the Marsh 4 level of damage there would be total villus flattening, and obviously that was not the case with your biopsies, so you do not have celiac disease, at least it has not progressed enough to be officially diagnosable. The chronic duodenitis mentioned in relation to the biopsy samples from the duodenum and the jejunum however could definitely be caused by the early stages of celiac disease or non-celiac gluten sensitivity.
Your elevated calprotectin level might possibly be associated with the early stages of Crohn's or UC. But sometimes the calprotectin level is slightly elevated with MC.
Neutrophils are also associated with Crohn's disease or UC, but not (or only rarely) with MC. However, they are also associated with celiac disease. Your upper small intestine biopsy samples showed significantly increased neutrophil counts.
However, neutrophils can also be associated with mast cell activation disease (MCAD). Mast cells can release TNF-alpha (TNF-a), which can stimulate the production of neutrophils and other proinflammatory mediators. Both mast cells and neutrophils release histamine.
So that's what I see in the report, but no official diagnosis can be made at this point, based on the pathology report of your biopsy samples. Either the pathologist did not bother to look for LC or CC, or your inflammation might possibly be due to the early stages of Crohn's disease or celiac disease. I have a hunch they didn't look for MC. Normally, if a gastroenterologist instructs a pathologist to look for MC (or rule out MC) the report would specifically mention lymphocyte counts, or collagen band thickness, or it would specifically state that the findings were either consistent with, or inconsistent with either LC or CC. None of that is mentioned in the report (unless I overlooked it somewhere).
Did your gastroenterologist tell you that they were going to consider MC? If they didn't look for it, then they probably missed it. My guess is that the inflammation that they described in the report is due to gluten sensitivity and MC, but I can't absolutely say that because they didn't list any lymphocyte counts or collagen band measurements, and your small intestine does not yet have enough damage at this point to warrant a celiac diagnosis.
I'm sorry that I couldn't be more helpful, but it appears that your gastroenterologist did not properly instruct the pathologist to specifically rule out MC.
Tex
Well, your biopsy samples are not officially diagnostic of anything except general unspecified inflammation. However, many of the markers appear to be somewhat consistent with the early stages of Crohn's disease. The upper two-thirds of your small intestine (the duodenum and jejunum) is inflamed, but the lower third (the ileum) shows no significant inflammation. With either Crohn's disease or MC, the terminal ileum is typically inflamed.
For the biopsy samples from the colon, I don't see any evidence that the pathologist made any effort to make any lymphocyte counts to rule out LC. Nor do I see any evidence that the thickness of collagen bands in the lamina propria was measured to rule out CC. It appears that the pathologist was only looking for either Crohn's disease or UC. It sort of appears that the gastroenterologist did not request that the pathologist rule out LC or CC, he only requested a search for Crohn's disease or UC.
Loss of goblet cells can be caused by Crohn's disease or UC, but they can also be seen in the final stages of celiac disease (Marsh 4 stage damage). But at the Marsh 4 level of damage there would be total villus flattening, and obviously that was not the case with your biopsies, so you do not have celiac disease, at least it has not progressed enough to be officially diagnosable. The chronic duodenitis mentioned in relation to the biopsy samples from the duodenum and the jejunum however could definitely be caused by the early stages of celiac disease or non-celiac gluten sensitivity.
Your elevated calprotectin level might possibly be associated with the early stages of Crohn's or UC. But sometimes the calprotectin level is slightly elevated with MC.
Neutrophils are also associated with Crohn's disease or UC, but not (or only rarely) with MC. However, they are also associated with celiac disease. Your upper small intestine biopsy samples showed significantly increased neutrophil counts.
However, neutrophils can also be associated with mast cell activation disease (MCAD). Mast cells can release TNF-alpha (TNF-a), which can stimulate the production of neutrophils and other proinflammatory mediators. Both mast cells and neutrophils release histamine.
So that's what I see in the report, but no official diagnosis can be made at this point, based on the pathology report of your biopsy samples. Either the pathologist did not bother to look for LC or CC, or your inflammation might possibly be due to the early stages of Crohn's disease or celiac disease. I have a hunch they didn't look for MC. Normally, if a gastroenterologist instructs a pathologist to look for MC (or rule out MC) the report would specifically mention lymphocyte counts, or collagen band thickness, or it would specifically state that the findings were either consistent with, or inconsistent with either LC or CC. None of that is mentioned in the report (unless I overlooked it somewhere).
Did your gastroenterologist tell you that they were going to consider MC? If they didn't look for it, then they probably missed it. My guess is that the inflammation that they described in the report is due to gluten sensitivity and MC, but I can't absolutely say that because they didn't list any lymphocyte counts or collagen band measurements, and your small intestine does not yet have enough damage at this point to warrant a celiac diagnosis.
I'm sorry that I couldn't be more helpful, but it appears that your gastroenterologist did not properly instruct the pathologist to specifically rule out MC.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Tex thank you for taking so much time to read and write me your findings. You don't know how many times I told the gastroentorologist about looking for microscopic colitis because my mum has it. He even wrote it in my notes. I even mentioned it on day of scopes . Seems like he done what he wanted to do and blinkered himself from everything else.
I kind off realised from the conversation I had with Gastroentorologist last week that the Crohns diagnosis was based on intuition rather than lab report as all this time he been saying 'let's wait for lab report and see' then on day of my Appointment all he done was talk about what he visually see on day of scopes and what was visible from small bowel MRE scan.
Thank you ever so much. I now look forward to asking the doctor if he even looked for Microscopic colitis .Jim
I kind off realised from the conversation I had with Gastroentorologist last week that the Crohns diagnosis was based on intuition rather than lab report as all this time he been saying 'let's wait for lab report and see' then on day of my Appointment all he done was talk about what he visually see on day of scopes and what was visible from small bowel MRE scan.
Thank you ever so much. I now look forward to asking the doctor if he even looked for Microscopic colitis .Jim
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Gabes-Apg
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Jim
based on the results and levels of inflammation, my suggestion would be taking 7-8000iu of Vit D3 for a few weeks and then drop down to the 5000iu.
if you are concerned about doing this, a blood test to confirm what current levels are would be a good idea. or get a copy of your most recent results.
the ranges on blood tests that identify if levels are 'ok' are based on healthy people and very generalised. if your result was at the lower range of ok, with the levels of inflammation you are experiencing, you could quickly fall into deficient range.
if your doctor will not order the test for you via the NHS you can do it privately
https://www.medichecks.com/find-a-test/ ... -OH)_VITD/
based on the results and levels of inflammation, my suggestion would be taking 7-8000iu of Vit D3 for a few weeks and then drop down to the 5000iu.
if you are concerned about doing this, a blood test to confirm what current levels are would be a good idea. or get a copy of your most recent results.
the ranges on blood tests that identify if levels are 'ok' are based on healthy people and very generalised. if your result was at the lower range of ok, with the levels of inflammation you are experiencing, you could quickly fall into deficient range.
if your doctor will not order the test for you via the NHS you can do it privately
https://www.medichecks.com/find-a-test/ ... -OH)_VITD/
Gabes Ryan
"Anything that contradicts experience and logic should be abandoned"
Dalai Lama
"Anything that contradicts experience and logic should be abandoned"
Dalai Lama
Jim,
One of the problems with not properly ruling out MC is that it's certainly possible to have both Crohn's disease and UC. In that situation, many GI specialists consider MC to be an irrelevant diagnosis, but that's a counterproductive attitude because even though the Crohn's disease might cause more serious symptoms, the MC still has to be treated or the inflammation will continue to cause damage to the intestines.
Tex
One of the problems with not properly ruling out MC is that it's certainly possible to have both Crohn's disease and UC. In that situation, many GI specialists consider MC to be an irrelevant diagnosis, but that's a counterproductive attitude because even though the Crohn's disease might cause more serious symptoms, the MC still has to be treated or the inflammation will continue to cause damage to the intestines.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Gabes I'm going to have a look through my blood test results of late and see if I got one for vitamin D if not I'll do one privately.
Tex I've got an appointment in 5 weeks where I will be approaching the subject of if I was tested for MC.
You've made an interesting point, I wondered if you have small bowel Crohns then they find colon inflammed will that then also be put down to Crohns or can they have a separate diagnosis of UC, is there any difference within the colon
Tex I've got an appointment in 5 weeks where I will be approaching the subject of if I was tested for MC.
You've made an interesting point, I wondered if you have small bowel Crohns then they find colon inflammed will that then also be put down to Crohns or can they have a separate diagnosis of UC, is there any difference within the colon
Jim,Tex wrote:One of the problems with not properly ruling out MC is that it's certainly possible to have both Crohn's disease and UC.
The "UC" in that sentence was a typo — as Gabes pointed out, I intended to say "MC". That said, surely it is possible to have both Crohn's disease and UC, but I have a hunch that genetics generally target one or the other, rather than both. We can have MC though, and also have virtually any other disease under the sun.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hello Tex Gabes and the rest of the gang . I just wanted to ask a quick opinion and give an update. I hope I find you all in as good a health as possible given the dissorder.
My symptoms have changed a bit, in the last month for instance I've had my longest good period (9days) but also had some of my most severe watery diarrhea bouts too. I went for 3 nights to Strasbourg in France and couldn't leave the hotel for 2 of the days due to continuous diarrhea. I put that down to a forced change of diet due to being away. However my symptoms overall are very cyclical. I don't remember if you remember a while ago I posted my histology reports which you commented on and in fact Tex you reinforced what my Gastro entomologist was saying that it probably is Crohns despite the absence of lab confirmation due to the type of damage .
Well by coincidence a couple of days ago a friend of mine heard that I had an elevated IgE (had it for some time now) she asked if I'd heard of mast cell activation syndrome and mastocytosis , her mont her had one of them (can't remember which) she sent me a link to the symptoms and they were remarkably like mine. Do you think that my histology report (above ) can exclude one or both of these. Many thanks Jim
My symptoms have changed a bit, in the last month for instance I've had my longest good period (9days) but also had some of my most severe watery diarrhea bouts too. I went for 3 nights to Strasbourg in France and couldn't leave the hotel for 2 of the days due to continuous diarrhea. I put that down to a forced change of diet due to being away. However my symptoms overall are very cyclical. I don't remember if you remember a while ago I posted my histology reports which you commented on and in fact Tex you reinforced what my Gastro entomologist was saying that it probably is Crohns despite the absence of lab confirmation due to the type of damage .
Well by coincidence a couple of days ago a friend of mine heard that I had an elevated IgE (had it for some time now) she asked if I'd heard of mast cell activation syndrome and mastocytosis , her mont her had one of them (can't remember which) she sent me a link to the symptoms and they were remarkably like mine. Do you think that my histology report (above ) can exclude one or both of these. Many thanks Jim
Hello Jim,
I'm sorry to see that you're still having symptoms, but it's good to see an update. MCAD is rather common with MC and many of us here have to deal with it, including me. That's why we have a section in the forums for Mast Cell issues. Looking back at my original comments on your biopsy report, I note that I wrote this:
What are mast cells?
How are mast cells associated with microscopic colitis?
How do I know if mast cells are causing problems for me?
How are mast cell issues treated?
It's possible that you might have mastocytic enterocolitis. If the pathologist had done a mast cell count when examining your biopsy samples mastocytic enterocolitis could have been confirmed or ruled out. It's still possible to do a mast cell count if your gastroenterologist is willing to order it. The pathologist would need to use a tryptase-based stain to re-stain your biopsy slides in order to make the mast cells much easier to see under the microscope.
Anyway, my point is, as I mentioned in my original response to your results, neutrophils can indeed be an indicator of MCAD. I hope that this is helpful.
Tex
I'm sorry to see that you're still having symptoms, but it's good to see an update. MCAD is rather common with MC and many of us here have to deal with it, including me. That's why we have a section in the forums for Mast Cell issues. Looking back at my original comments on your biopsy report, I note that I wrote this:
Mast cell/histamine disorders are not easy to diagnose and most physicians are not trained to even recognize them, let alone treat them (at least that's true in this country). Here are links to 4 brief articles that contain some basic information about mast cell problems and how they relate to MC. See if any of this fits your situation.Your upper small intestine biopsy samples showed significantly increased neutrophil counts.
However, neutrophils can also be associated with mast cell activation disease (MCAD). Mast cells can release TNF-alpha (TNF-a), which can stimulate the production of neutrophils and other proinflammatory mediators. Both mast cells and neutrophils release histamine.
What are mast cells?
How are mast cells associated with microscopic colitis?
How do I know if mast cells are causing problems for me?
How are mast cell issues treated?
It's possible that you might have mastocytic enterocolitis. If the pathologist had done a mast cell count when examining your biopsy samples mastocytic enterocolitis could have been confirmed or ruled out. It's still possible to do a mast cell count if your gastroenterologist is willing to order it. The pathologist would need to use a tryptase-based stain to re-stain your biopsy slides in order to make the mast cells much easier to see under the microscope.
Anyway, my point is, as I mentioned in my original response to your results, neutrophils can indeed be an indicator of MCAD. I hope that this is helpful.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I'm not sure what the health care system custom is in England, but in this country, hospital and clinic laboratories keep biopsy samples for many years. If the samples are still available, but your specialist doesn't seem interested in ordering another analysis of them, you might mention that the presence of neutrophils suggests that you might have mastocytic enterocolitis, mast cell activation disorder (MCAD), or some other mast cell problem contributing to your symptoms.
I'm doing well these days, thank you. Good luck with requesting that your biopsy slides be re-stained and re-analyzed. And please keep us posted.
Tex
I'm doing well these days, thank you. Good luck with requesting that your biopsy slides be re-stained and re-analyzed. And please keep us posted.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi Tex your the best mate. I went well prepared to my consultation tonight , armed with what you said , the doctor sat there and listened intently then said that he would look into the availability of trypase test as my biopsies are still available . He is also going to request a 24hour urine test . I wouldn't have been half as well prepared if it wasn't for you.
My Calprotectin is down to 70's now from 405 and then 211 so inflammation is down but diarrhea is still persisting in a cyclical manner. Also I got a a clear SehCat so no bile acid malabsorption depite a very serious episode of diarrhea in between scans. I will keep you posted many many thanks
My Calprotectin is down to 70's now from 405 and then 211 so inflammation is down but diarrhea is still persisting in a cyclical manner. Also I got a a clear SehCat so no bile acid malabsorption depite a very serious episode of diarrhea in between scans. I will keep you posted many many thanks