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Have GERD, IBS-D. Colonoscopy showed ulcers in ileum. Biopsy shows non-specific ileitis. Negative IgA. Does this rule out Crohn's disease?

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I have GERD and was diagnosed with IBS-D, Colonoscopy revealed large intestine to be normal, found small ulcers in terminal ileum.
Does a biopsy report which says - Non - specific ileitis with significant eosinophilic infiltrates and -
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.

Along with a negative result for IgA ASCA (1.17) and p and C XXXXXXX markers and ESR of 11, C- reactive protein of 2.9 does this positively rule out Crohn's? I have soft/ loose stools 2-3 times a day with gas/ very little pain in upper left quadrant which goes away with relieving gas, stool test returned no pus or blood in stool. Took a TTG marker test for Celiac, came back negative.

Clinical diagnosis at the time of colonoscopy was possible Crohns, I cannot see the GI for another week but the reports are back, and want to confirm that looking at all results, can Crohns be ruled out?

How can the ileitis be treated? Is a follow up colonoscopy needed after sometime?
Posted Wed, 23 May 2012 in GERD
Answered by Dr. Vaibhav Banait 7 hours later

Thanks for the query.

Crohns' disease is a difficult diagnosis and I think fair duration of follow up is necessary to diagnose it in case of mild altered bowel habits and isolated terminal ileal erosions or ulcers. In such cases, I would prefer to continue with symptomatic treatment while following them for development of new signs.

I am providing you with an abstract of an article to elucidate this point. This article is from American Journal of Clinical Pathology - "Isolated Ileal Erosions in Patients with Mildly Altered Bowel Habits
A Follow-up Study of 28 Patients - XXXXXXX S. Goldstein, MD"; Posted: 06/07/2006; Am J Clin Pathol. 2006; 125(6):838-846. © 2006 American Society for Clinical Pathology

This study evaluated 28 patients to characterize the morphologic features associated with typical Crohn disease (CD). All patients had similar complaints, an endoscopically normal colon, and small isolated, aphthoid erosions in the terminal ileum. The mean length of follow-up was 5.8 years. Of 28 patients, 25 (89%) were female (mean age, 32.3 years). Four patients were ingesting nonsteroidal anti-inflammatory drugs. All 28 lesions were morphologically similar, with focal lamina propria edema, mild active inflammation, and crypt disarray. Most had a lymphoid aggregate within the region of edema. Erosion was identified histologically in 21 cases. Following colonoscopy, symptoms resolved in all 28 patients. Typical, full-blown CD developed in 8 patients (29%) after a mean interval of 3.6 years. CD lesions were morphologically identical to non-CD lesions. Most focal ileal erosions in patients with mildly altered bowel habits are idiopathic and clinically insignificant. They represent early CD in approximately 30% of patients. The interval between initial examination and typical CD can be long. Pathologists should remain diagnostically vigilant when examining ileal biopsy specimens obtained from patients with previous abnormal ileal biopsy findings, regardless of the interval. Persistent, mild morphologic abnormalities have a high likelihood of being CD.

The terminal ileal eosinophil infiltrate may relate to allergic condition to various agents including drugs, parasites, non-specific or a part of eosinophilic intestinal disease.

Discuss with your doctor when you get to XXXXXXX him.

Hope this information was useful. Let me know if you need more help.

Dr Vaibhav Banait
Above answer was peer-reviewed by
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