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Have diarrhea, bloating. Colonoscopy reveals small ulcers in terminal ileum. Is it viral infection or Crohns ?

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I have diarrhea and gas/bloat on and off(2 episodes 4 days each in 9 months), no weight loss, no loss of appetite, no bleeding (stool is not black or red), just XXXXXXX sometimes from passing too fast through the intestines, or its watery when the diarrhea is severe. Physician suspected IBS or lactose intolerance or celiac disease since everything else was normal. I saw a Gastro too, he was of the same opinion since my stool sample returned negative for parasites/ infections - he recommended a colonoscopy to rule out other possibilities.
I got a colonoscopy done, Large intestine was normal but terminal ileum has very small ulcers and some inflammation. GI suspects crohns disease, asked me to get XXXXXXX and ASCA marker tests done, and also sent samples from colonoscopy for biopsy. I also took a TTG test, results for all these will come back in a week. My blood test report is as follows -
Leucocyte count - 9330
Erythrocyte count - 5.49 millions/c
WBC differential count -
Neutrophils - 59.5
Lymphocytes - 32.2
Eosinophils - 2.5
Monocytes - 5.5
Basophils - 0.3.
Erythrocyte Sedimentation rate is 11. I also got a C-reactive protein test, result was 2.79.
all other blood work is normal, stool sample returned no parasites/ there is no blood in stool.

I am a little disturbed over the possibility of Crohns, but since the blood work - specially the differentials, ESR, C-reactive protein are normal, would like to know if there is a possibility of Crohns and how strong that possibility is - and also what else could this be? Could this be a viral infection or intestinal tuberclosis? Are terminal ileal ulcers always crohns? both times, I think trigger was beer, i had 3-4 pints the preceding 2-3 days. other forms of alcohol does not affect me/ cause symptoms, just beer, i am a moderate drinker normally have 1 or 2 drinks a day at most, regularly.

Also, I have never had nausea or vomitting.
Posted Mon, 21 May 2012 in Abdominal Pain
Answered by Dr. Poorna Chandra K.S 9 hours later
Hi and thanks for the query
Crohn's disease typically has abdominal pain with diarrhoea and significant weight loss. It is usually associated with a high CRP and ESR although at times these can be normal. Stool examination frequently shows a lot of pus cells. It can affect any part of the gut and is associated with linear ulcers and skip inflammation.
Isolated ileal ulcers can be because of a variety of causes including infections, drug intake and nonspecific. Chances of crohn's is high if it is a XXXXXXX linear ulcer and if there are discrete scattered ulcers. However in view of the limitation of insertion of the scope into terminal ileum it may be difficult to comment on the multiplicity. If needed a barium meal folow throuh or a CT enteroclysis helps to look at the rest of the small bowel.
TB frequently affects either side of the ileocecal valve ie the ceacum, ileocecal valve and the terminal ileum and usually has circumferential ulcers.
On the whole your profile doesnot fit a diagnosis of crohns but there can be surprises.
Hence donot panic and wait for the biopsy report
Above answer was peer-reviewed by
Follow-up: Have diarrhea, bloating. Colonoscopy reveals small ulcers in terminal ileum. Is it viral infection or Crohns ? 3 hours later
Thank you - how are ulcers caused by infections, drug intake and nonspecific causes treated? or do they go away on their own? Also, can celiac disease cause these? how is TB treated? does no fever rule out any of the above conditions? Also, how do I have ulcers/ inflammation and still no blood/ puss in stool? I have had 3 stool tests since last august, none of them show any parasites, blood cells or pus in stools.

How is crohns ruled out once the biopsy is back?

Also, i just want to confirm one more thing - I travelled from the US to Dubai, Dubai in singapore and singapore to India and back to singapore over a period of 10 days on work, with absolutely very little sleep, i did not eat my regular sized meals - smaller size meals with fruits like watermelon thrown in - the 2 days i was in india, i did not sleep both days (slept for 2 hours a day) - and also had a colonoscopy done - I had to flush my colon out and did not eat anything for an entire day - i checked my weight yesterday and I've lost 5-6 pounds - is this normal? my weight has been pretty stable at 164 pounds over the last one year.

Weight loss is also considered one of the symptoms of crohns, and i wanted to check if this was uncontrolled or caused due to my travel. Since i have never had fever, no blood or puss in my stools, and no loss of appetite, if the weight loss is normal, i will be a little more calm.

Also, loperamide and bananas along with psyllium husk and probiotics help my diarrhea, my stool comes out well formed thick and long, but i still feel a little gassy and sometimes because of that, not empty, could this be the psyllium husk causing the gas?

Answered by Dr. Poorna Chandra K.S 10 hours later
Hi and thanks for the follow up
Ulcers due to infections, drug intake and nonspecific causes usually heal by themselves once the inciting agent is taken off.
Celiac disease by definition doesnot cause visible ulcers and TB is treated with a combination of drugs.
Absence of fever, pus cells and blood in stools may suggest few ulcers only and rule out extensive involvement. If pus cells and blood are scant they are degraded in the intestines and may not be found.
Biopsy in crohns disese show a combination of acue and chronic changes which arenot seen in infective or drug related causes. Presence of non caseating granulomas with absent acid fast bacilli is callsical of Crohn's disease.
Your hectic schedule and poor intake can defenitely cause weight loss and doenot point at crohns disease
As I had written earlier the possibility of crohns is quiet low.
I would advice you to avoid loperamide as it is an antimotility drug and unnecessary use creates more problems than good
Above answer was peer-reviewed by
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