How can you make sure colonoscopy (biopsies) show something?

[SN8888]

I Haven't been diagnosed with anything but IBS (many years ago), but I haven't had a colonoscopy since things got pretty serious.

I haven't had a serious flareup in 7+ years and I am getting a colonoscopy in a few months. I would like to make sure there is something for them to see in the biopsy samples. In the past, if I go off saccharomyces boulardii for a week, I will get sick - blood work usually shows low neutrophils, raised liver enzymes, ASCA positive and occasionally other problems. I am a little reluctant to try skipping s. boulardii since it can get pretty bad.

Would eating wheat/dairy/oats (my worst food reactions) for a few days before the colonoscopy be enough to trigger an observable reaction (lymphocyte infiltration or something like that)??

Any ideas about the timing?

Thanks,

Scott

[tex]

Hi Scott,

Would eating wheat/dairy/oats (my worst food reactions) for a few days before the colonoscopy be enough to trigger an observable reaction (lymphocyte infiltration or something like that)??

No. To reach a level of mucosal damage sufficient to allow detection by conventional means, would typically require ingesting gluten for at least 3–6 months in most cases.

The secret to detecting MC during a colonoscopy is for the doctor to know what to look for during the exam so that he or she can collect biopsy samples from productive sites. To save a lot of time typing this information, here's a quote from the beginning of chapter 3 on pages 25–26 of my book Microscopic Colitis:

As described earlier, currently, there is only one method that can be used to definitively diagnose microscopic colitis. This method requires taking biopsy samples of the interior lining (the epithelia) of the large intestine (colon) during a colonoscopy or sigmoidoscopy examination. The surface layer of the epithelia of the intestines is also known as the mucosa, since it is comprised of mucous tissue.

These tissue samples are then examined under a microscope by a pathologist, and if certain markers of the disease are present, a diagnosis can be made. Without the benefit of a pathology report, a valid diagnosis is impossible, since most GI specialists are unable to visually detect the presence of the disease.

Because MC typically occurs in splotches or patches that are scattered around in random locations on the interior surface of the colon, it’s possible to take biopsy samples from unproductive areas, (that is, areas that are not inflamed). If that happens, a diagnosis of MC may be completely missed, simply because the biopsy samples were not taken from optimal locations or because the gastroenterologist just happened to be unlucky on that particular day (Tanaka, Mazzoleni, & Riddell, 1992, Carpenter, Tremaine, Batts, & Czaja, 1992).1, 2

Of course, this same caveat holds true for celiac disease. Villus atrophy, the primary marker of celiac disease, is often present only in scattered patches in various areas of the small intestine If the gastroenterologist takes biopsy samples from unproductive areas of the small intestine, then the presence of celiac sprue obviously can be overlooked, and a misdiagnosis will be the result. In this example, an unproductive area would be considered to be any area of the small intestine that contains no diagnostic markers for celiac disease.

In fact, research shows that even if the biopsy samples are taken correctly, the markers of MC are somewhat frequently overlooked. In one study, for example, the clinical history, including symptoms and medications, was obtained for 25 patients, and this information was correlated with their histological findings. It was discovered that 25 % of the CC patients and 50 % of the LC patients who had biopsies taken prior to their definitive diagnosis, already had exhibited the distinguishing markers of microscopic colitis on their prior biopsies. Unfortunately, the markers had been either overlooked or disregarded by the pathologists who analyzed and interpreted the slides (Shaz et al., 2004).3 The more biopsy samples that are collected from a patient’s colon (from all sections of the colon) the better the chances that the disease will be properly diagnosed.

And here are references 1 thru 3 from that quote:

1. Tanaka, M, Mazzoleni, G, & Riddell, R. H. (1992). Distribution of collagenous colitis: Utility of flexible sigmoidoscopy. Gut, 33(1), 65–70. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1373867/

2. Carpenter, H. A., Tremaine, W., J., Batts, K. P., & Czaja, A. J. (1992). Sequential histologic evaluations in collagenous colitis: Correlations with disease behavior and sampling strategy. Digestive Diseases and Sciences, 37(12), 1903–1909. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1361906

3. Shaz, B. H., Reddy, S. I., Ayata, G., Brien, T., Farraye, F. A., Antonioli, D. A, . . . Wang, H. H. (2004). Sequential clinical and histopathological changes in collagenous and lymphocytic colitis over time. Modern Pathology, 17(1), 395–401. Advance online publication. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14976531

And quoting from page 30:

Upon close scrutiny, it can be seen that in colons where the markers of microscopic inflammation are present, there will be random areas scattered across the normal light pink background of an otherwise unremarkable colon, that will appear to be a slightly darker shade of pink. These slightly darker pigmented areas are more likely to correlate with areas of inflammation. Taking biopsy samples from them can significantly reduce the chances of failing to properly diagnose the disease when it is present.

This ability to visually identify areas of microscopic inflammation during an exam using a colonoscope or a sigmoidoscope was first reported by Dr. Kenneth Fine, an early researcher of MC and celiac disease. The benefits of utilizing the technique have since been noted by other gastroenterologists. Dr. Fine’s website contains the following comment in his discussion of microscopic colitis (Fine, 2000).10

Although originally the colon seen at colonoscopy was thought to be normal, it is routine to notice patchy areas of mild redness and swelling. In fact, I (Dr. Fine) can routinely tell by looking at the surface of the colon with a scope if it is going to be inflamed or not (because of experience). I say this because sometimes, visualization of these changes leads to an errant diagnosis of ulcerative colitis, Crohn's disease, or other forms of colitis.

Many years ago during my own colonoscopy, I was awake and alert during the exam. I was able to see those patchy areas of inflammation on the monitor screen during the exam. I recall asking the doctor what they represented. At the time, he didn’t know, so he shrugged them off as possible sites of previous infections. Of course I didn't know any better then, either.

And here's reference 10 from that quote:

10. Fine, K. D., (2000). Frequently asked questions about microscopic colitis. Retrieved from http://www.finerhealth.com/Educational_ ... c_Colitis/

I hope that this is helpful.

Tex

[SN8888]

Thanks for the detailed response. I am trying to decide if it's worth getting a little sick to help determine what is going on with me. Maybe there will be enough evidence (microscopic or otherwise) without having to break my regimen and make myself sick.
I've handling it on my own for a long time...

[tex]

If we are in remission long enough (2 or 3 years or more), we will no longer have the markers of MC, so it cannot be diagnosed. After our intestines heal completely, there will be no evidence of the disease that can be detected in a biopsy or by any other means.

Tex