I'm more lost than ever

[Jimbo1968]

Hello all I hope I find you well. I'm at a loss, I was told I had Crohns and was given steroids over a year ago now, I'm still on a maintenance dose now. A repeat gastroscopy and capsule endoscopy show no inflammation at all, however as far as the diarrhoea goes it's business as usual on a daily basis.

I have a series ofquestion concerning steroids and Crohns.
1) can the steroids be hiding the Crohns from the cameras
2) if 1) is true would it then show up on biopsies
3) assuming 1) is true can the Crohns be carrying on its dirty buisiness in a clandestine state.

Don't know if I mentioned this before but when I was tested for Pancreatic Insufficiency is was just about ok on the first test (210), then I showed moderate insufficiency on the second test (172), well on a recent repeat it was a very good 435. Again my gut is obviously not aware of this.
At times I also get a nasty burning pain.

I know this is just a microscopic Colitis forum but the most informed comment I've got have been from this group.

[tex]

Jim,

I'm sorry to see that you're still having problems. These are strictly my personal opinions about the answers to your questions:

1. Yes, if there are minimal lesions.

2. Yes, if the disease is active.

3. Yes, because capsule endoscopy (like all endoscopy) is not perfect, and all testing methods have weaknesses that can cause issues to be overlooked.

That said, it shouldn't overlook major areas of active (Crohn's) disease. But if you happen to also (or instead) have undiagnosed MC, then a capsule camera would not detect MC, because MC causes no visible lesions.

The persistence of symptoms might be due to the effect described in the following quote, taking from the first article in the October 1, 2016 issue of the Microscopic Colitis Foundation Newsletter:

Why is pain so persistent in some IBD cases?
An excellent research article published by Azpiroz et al. (2007) describes why
gastrointestinal tract hypersensitivity is a common problem associated with various
functional gastrointestinal disorders (FGIDs), and how inflammation leads to
hypersensitivity in (FGIDs).7 Furthermore, the article discusses why many patients
continue to suffer from abdominal pain and other symptoms even when their disease is
technically in remission (by the medical definition of remission, based on the absence of
diagnostic markers). According to Azpiroz et al. (2007), damage to specialized cells
found in the epithelial lining of the intestines such as Paneth cells and enterochromaffin
cells (ECs) may persist for many years after the onset of remission of the FGID that
was the cause of the damage.


Paneth cells help balance gut bacteria populations.
To comprehend the full implications of this, we need to understand a bit about the
function of these cells and and their important roles in the regulation and performance of
the digestive system. Paneth cells perform several vital functions in the small intestine.
One of the more important functions of Paneth cells is to produce and secrete peptides
and proteins that have antibiotic properties and the ability to prevent further microbe
growth.8 It's known that these antimicrobial secretions play a vital role in maintaining a
balance with gut bacteria in addition to providing protection from invading pathogens.
IBDs are associated with disrupted Paneth cell functioning.


Enterochromaffin cells produce serotonin.
Enterochromaffin cells found in the small intestine are endocrine cells that produce and
secrete approximately 90–95 % of the body's supply of serotonin. The rate at which
serotonin is released by enterochromaffin cells regulates gut motility, and it can also
promote issues such as vomiting, diarrhea, and the symptoms of the syndrome known
as IBS.9 As Camilleri (2009) points out, too much serotonin promotes diarrhea, while
too little can cause constipation.10 Furthermore, these actions are accomplished when
serotonin binds to its receptors, known as 5 hydroxytryptomine receptors (or simply 5-
HT receptors). Diarrhea is associated with an increase in blood plasma levels of 5-HT,
and constipation is associated with a reduction of plasma levels of 5-HT.

Azpiroz et al. (2007) also noted that damage (and therefore, hypersensitivity) may
persist for years in intestinal muscle tissue, and in certain cells in the enteric nervous
system. The enteric nervous system, sometimes referred to as the "second brain",
controls digestive system functioning. This discovery (that incomplete healing persists in
certain parts of the GI tract and enteric nervous system) is not a surprising observation,
since the mechanism responsible for perpetuating IBDs in the first place is based on a
failure of damaged intestinal cells to heal (Persky, 2012, p 226).11

Microscopic Colitis Newsletter, Volume 2 Issue 1

Here are references 7–11 from that quote:

7. Azpiroz, F., Bouin, M., Camilleri, M., Mayer, E. A., Poitras, P., Serra, J., & Spiller, R. C.
(2007). Mechanisms of hypersensitivity in IBS and functional disorders.
Neurogastroenterology & Motility, 19(1 Supplement), 62-88. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1 ... 875.x/full

8. Clevers, H. C., & Bevins, C. L. (2013). Paneth cells: maestros of the small intestinal
crypts. Annual Review of Physiology, 75, 289-311. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/23398152

9. Braun, T., Voland, P., Kunz, L., Prinz, C., & Gratzl, M. (2007). Enterochromaffin cells of
the human gut: sensors for spices and odorants. Gastroenterology, 132(5),1890-1901.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17484882

10. Camilleri, M. (2009). Serotonin in the Gastrointestinal Tract. Current Opinion in
Endocrinology, Diabetes, and Obesity, 16(1), 53-59. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694720/

11. Persky, W. (2012). Microscopic Colitis. Bartlett, TX: Persky Farms.

I hope that some of this is helpful.

Tex

[brandy]

Hi Jimbo,

You are always welcome to hang out with us regardless of your diagnosis.

Brandy

[Gabes-Apg]

You are always welcome to hang out with us regardless of your diagnosis.

Agree totally with this

Tex Said
But if you happen to also (or instead) have undiagnosed MC, then a capsule camera would not detect MC, because MC causes no visible lesions.

Also agree with this - and I am pretty sure that we have discussed before with you, it is possible to have both MC and Crohns.


where are you at with your eating plan?
are you still taking good doses of Vit D3 and magnesium?