Colonoscopy showed ulcers in terminal ileum, Biopsy shows non-specific ileitis with eosinophilic infiltrates. Can Crohns disease be ruled out?

Posted on Thu, 4 Oct 2012 in Digestion and Bowels
Question: I had a colonoscopy last week, doctor said it might be crohns as there were very small ulcers in terminal ileum - ASCA and XXXXXXX serological markers came back negative, ESR was 11 and C-reactive protein was 2.97. RBC count was 9300, WBC differentials are all normal(please see my previous question asked about 4 days ago on healthcare magic for complete info)
Biopsy report came back today -
This is what it says -
Microscopic Appearance - Sections revealed fragments of ileal mucosa showing intact mucosal lining and normal villous configuration. Stroma shows scattered mixed inflammatory cells including several eosinophils.

Pathological diagnosis - Non - specific ileitis with significant eosinophilic infiltrates.

What does this diagnosis mean? Also can crohns be ruled out now?

My symptoms are gas, occasional diarrhea - loose soft stools, sometimes watery, never more than 2-3 times a day. Was diagnosed with IBS-D earlier, I have noticed I have triger foods. This was a routine colonoscopy done to rule out IBD.


Answered by Dr. Ajit Naniksingh Kukreja 5 hours later

Thanks for posting your query

Unfortunately we can not have a look at the queries posted by you earlier, you have to send the details again if you want a review of the same

All your symptoms are more specific of IBS-D, your biochemistry is normal

Your colonoscopy is normal, except for the non specific ileitis

Yes all these together rules out the possibility of Crohn's Disease

My suggestion would be - Manage your stress levels
A healthy diet
And a good probiotic

Rifaximin is a molecule which has been found useful in IBS-D

Hope this helps
Am available for followup queries
Get Well Soon
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ajit Naniksingh Kukreja 4 hours later
thanks for the reply doctor, what do you suggest for the non specific ileitis? since the biopsy says elevated eosinophil levels, could this be eosinophilic gastroenteritis? i currently have budesonide 3mg which the gastro prescribed for crohns. he suggested 2 tablets in the morning everyday, I have 10 tablets, can i use these for the ileitis? also for my GERD, he prescribed Rabeprazole one tablet a day, can i use this?

I have pain in the upper left quadrant - nothing serious, just a dull pain - no discomfort but I can notice it is there, is this gas or GERD? normally goes away when i burp or pass gas or stool, comes back in maybe 30 mins to 2-3 hrs.

Also is it normal for stool to have mucus during IBS attacks when diarrhea is watery or severe?

Thanks for the info on Rifaximin, before i can get my hands on it, can i use loperamide to control diarrhea?

Thanks again
Answered by Dr. Ajit Naniksingh Kukreja 1 hour later
Thanks for your followup query :

Eosinophilic gastroenteritis is an uncommon gastrointestinal disease affecting both children and adults.

Eosinophilic gastroenteritis is characterized by the following:

1]The presence of abnormal GI symptoms, most often abdominal pain
2]Eosinophilic infiltration in one or more areas of the GI tract, defined as 20 or more eosinophils per high-power field
3]The absence of an identified cause of eosinophilia
4]The exclusion of eosinophilic involvement in organs other than the GI tract

Just with a biopsy report we cannot stamp it as Eosinophilic gastroenteritis

Regarding Busdesonide, it is a steroid preparation and is used for established Crohn's disease, I would suggest you may stop this, you may take Rabeprazole for GERD

The left quadrant issue could be due to non ulcer dyspepsia - pyloric spasm secondary to gastritis - Rabeprazole will help here

Ileitis - Antiinflammatory and antibiotics may help but the following tips will help :

Avoid spicy foods, as they tend to aggravate the inflammation.
Drink lots of pure water every day.
Try softer forms of foods such as cottage cheese, yogurt, and ricotta cheese.
Stay away from chunky, high fiber foods that are hard to digest.
Soups are a wonderful source of nutrition that can be very healthy and easy to digest. Homemade with fresh ingredients is the best.

Yes it is common to have mucus in IBS stools

I would prefer avoiding Loperamide as it has been demonstrated to cause ileus

Hope this helps
Am available for any followup queries
If there are no further doubts, do accept this reply and rate it

Get Well Soon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Ajit Naniksingh Kukreja

Gastroenterologist, Surgical

Practicing since :1984

Answered : 923 Questions


The User accepted the expert's answer

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