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Stool test shows 4-5 pus cells, 5-6 rbc cells. On medicine. IBS, lymphocytic colitis history. Suggestions? - Online Doctor Chats

Date : 01-Mar-2013
User rating for this question
Very Good Posted in: Digestion and Bowels
Answered by

General & Family Physician
Practicing since : 2003
Answered : 1549 Questions
User:Hello Doctor,
User:Sir I was diagnoised for IBS about 3 years ago
Doctor:Please proceed with your query
User:The symptoms I was having was 2 loose stools dialy (mushy stools)
User:the issues was I was getting recurrent GI track infection (fever with Chill)
User:I was taking antibiotics and was doing good for about 2 months and symptoms use to come back
User:I am also on PPI for last 3 years
User:I insisted my GI to do colonoscopy about an month ago
User:He said that I have lymphocytic colitis
User:So he put me on Pentasa
User:I am on pentasa for last one month and the last time I took antibiotic (ofloxin) was a month ago (same time as when I started pentasa)
User:Today I again for stool test and it shows 4-5 pus cells/hpf and 5-6 RBC cells/hpf
User:My question is do we get RBC if it is LC?
Doctor:Yes, you can get RBCs in the stools
User:Again in LC mostly the symptoms is chronic water diahrea, but I donot have watery diahrea
Doctor:but it would be more in the favor of a pathological disorder like IBD not IBS
User:So it may not be LC but IBD?
Doctor:It could be,
Doctor:It is my hunch
User:How can this be detected?
Doctor:have you got a colonic biopsy done?
User:Because after doing colonoscopy I asked doctor if it was starting of IBD, and he said it doesnot look to be
User:Yes and it says LC
Doctor:Colonoscopy and biopsy is the gold standard to look for IBD(Inflammatory bowel disease) which includes chron's disease
User:So in this case can I be sure that its LC?
Doctor:I'm sorry, but the histopathological diagnosis is the final
User:So if says LC means its LC and not IBD?
Doctor:So, yes you can be sure about it being LC
User:Now, why I have LC?
Doctor:but if you are not sure, you might get that same slide examined by a different pathologist
User:Can it be because of some chronic infection which is not getting removed? and why my loose stools become hard after taking antiboitics?
Doctor:Because blood(RBCs) in the stools are not a feature of LC
Doctor:Your stools get harder because the inflammation is reduced after taking the antibiotics and mucosa secretes a little less water
User:Or because of LC I am catching infection and hence getting RBC? Or my LC is because of celiac desease without celiac spure?
User:My D2 biopsy and TTG tests were negative
Doctor:the exact cause for this disease is not known yet
User:So RBC in stool is something with which I am not convinced
Doctor:so it is difficult to comment on the association between celiac sprue and LC
User:So what is the diagnosis that I need to do and what are my treatment options, given that Pentasa is not helping much
User:I donot want to take endless antiboitics to get transient improvement
Doctor:Pentasa is almost the last drug that is used in LC, so if that is not helping and also by your symptoms, i doubt it be just LC
Doctor:may be there is a another condition which is making LC worse..
Doctor:Meaning you need further evaluation
User:So what are the possible investigations I can get done?
Doctor:A repeat colonoscopy by a different gastroenetrologist and biopsy
User:Can PPI which I am taking can cause LC?
Doctor:Because this is the only test that can tell us anything about these constellation of disorders which affect the colon
User:and the RBC's in blood
Doctor:PPIs do not cause LC
User:Because when searched on google for LC, it mentioned about NASID's, H2 blockers and PPI's
Doctor:but antidepressants are known to cause LC along with pain killers belonging to the group NSAIDs
User:I was on PPI for six months before I was diagnoised with LC
User:I was taking nexito
User:Sorry I was on SSRI six months before I was diagnoised with LC
Doctor:May be this is the reason
User:When doctor look at the colon he say that there was suttle change in colonic mucosa. It was not contineous change in mucosa
Doctor:have you told your gastroenterologist that you have been taking anti depressants?
User:Yes he only prescribed assuming it was IBS
User:I had done colonoscopy 1 and half year back by different gastroentrologist and he said there is nothing
User:But when my new gastroentrologist did it 1 month back he said its LC
User:So I had doubt if its was SSRI
Doctor:That is a possibility
User:But the question is still is why RBC?
Doctor:That is the question
User:Can there be chronic infection which is not going away
User:I am having only loose stools even today
Doctor:That is the reason I asked you get re-evaluated by another gastroenterologist
Doctor:Chronic infection is very unlikely
User:Another thing was about 6 months back I was having amebasis
User:I have taken enough medication
User:In my last 3 stool tests I have not got cyst
Doctor:ameobiasis can cause chronic infection and it could make LC worse
User:But since I am having so much flautence I am thinking if that is one of the cause for RBC?
User:But even today's stool test didnot show any cyst or trophozoites
Doctor:No, flatulence can not cause any bleeding
Doctor:that is good
User:But may people say that its very difficult to catch cysts (not sure how far its true)
User:I will get another colonoscopy but say if it come out to be LC then what else can be the reason?
Doctor:thats not true, cysts if present can be detected
Doctor:If another biopsy comes as LC, then you should believe that it is LC
User:BTW, are you in bangalore?
User:I might want to have consulation with you
Doctor:I am sorry, that won't be possible.
Doctor:It is not our company policy to make personal consultations
User:Then can I XXXXXXX you in a hospital or you cannot reveal since we are connecting through health care magic?>
Doctor:It is not possible because I am on the panel of doctors who come online to chat with patients
Doctor:so i am bound by the terms and conditions
User:One final question for today.
User:My GI told that I am catching infection because of LC. Is that possible?
Doctor:I do not think so...
User:thank your so much
User:I will get another colonoscopy and biopsy done
Doctor:But it could be possible. because we still do not understand LC so well
Doctor:Thank you for consulting me
User:So if its LC even after second colonoscopy then I need medications to heel LC
User:good nigt
Doctor:You will nedd medications
Doctor:You are welcome
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