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Q. Is it possible that my symptoms are due to either Crohn's or celiac disease?

Answered by
Dr. Parth R Goswami
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Sep 03, 2020

Hi doctor,

I have been unwell for nearly one year. I have deficient iron levels, low B12, borderline to low RCC, neutropenia, high PO4, low levels of uric acid, and low MCHC. I was found to have chronic gastritis, H. pylori, and inflammation last year. I am tired all the time and have numbness in two toes. My back goes all tingly after hot showers. What is wrong with me? Which specialist should I consult?

Dr. Parth R Goswami

Hematology Pathology
#

Hi,

Welcome to the icliniq.com.

Before I comment on your condition, please answer the following questions:

  • What is your vitamin B12 value?
  • How was H. pylori infection diagnosed?
  • Did you undergo a biopsy during endoscopy or by the urea breath test?
  • Have you taken any treatment for H. pylori infection?

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Thank you doctor.

Yes, they did endoscopy and biopsy. It said a moderate inflammatory infiltrate of the gastric mucosa. That was a month back. The lab tests I got back yesterday show that B12 is 255. The serum ferritin is 12. H. pylori infection was never treated.

I was being investigated for parasites as my illness started early last year with skin lesions up one leg, then they moved to one arm on the same side of the body. The lesions cleared before a punch biopsy could be done, but now, two are back. The lesions are slow to heal and seem to exudate thick blobby blood clots.

I have not been myself for a year, but I would not say I am dying either. The fatigue, these skin things, on and off chest pain, and diarrhea are my problems. Also, intermittent pain in the left flank area gets terrible at times, and it has been there all along. Please, I have uploaded some lab results. You can see the attachments.

Dr. Parth R Goswami

Hematology Pathology
#

Hi,

Welcome back to icliniq.com.

Are you having an anxiety issue? Kindly upload the biopsy report and endoscopy result.

Sometimes, chronic stress issues, electrolyte disturbance, and thyroid issues can lead to long term fatigue. Chronic inflammation or infection also can lead to fatigue.

H. pylori can be treated using Omeprazole, Clarithromycin, and Amoxicillin present in the H. pylori medication kit for 14 days. Vitamin B12 is not much low. Cyanocobalamin injection 1000 mcg/mL, once a week, can be administered for six weeks.

I have seen your histopathology report <attachment removed to protect patient identity>. As no other lesions are noted, H. pylori can be treated for your condition. For iron deficiency, Ferrous ascorbate is used. Do you have any other reports?


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Hi doctor,

Thank you for replying. No, I do not have anxiety issues, and I am a professional PhD academic in Psychology. I have already uploaded the endoscopy report.

Dr. Parth R Goswami

Hematology Pathology
#

Hi,

Welcome back to icliniq.com.

H. pylori can be treated with the medication mentioned above. Your provisional diagnosis from the above history is H. pylori gastritis with secondary iron deficiency anemia with mild vitamin B12 deficiency.


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Thank you doctor.

The lesions I refer to are skin lesions. The histopathology report was not from the skin lesions. The lesions appeared on the leg and arm on the left side. The dermatologist remarked that they followed a classic sporotrichosis lymphatic channel pattern. By the time I saw him, the lesions were not active, so he could not biopsy one, but the scars are obvious.

Dr. Parth R Goswami

Hematology Pathology
#

Hi,

Welcome back to icliniq.com.

Chest pain can occur as referred pain from gastritis pain. So, in my opinion, H. pylori should be treated. Whenever lesion is active, a biopsy can be done to reach a diagnosis. As of now, no active lesion is present, so it is difficult to give comment. For now, iron deficiency anemia and H. pylori should be treated as per my opinion.


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Thank you doctor.

Sorry, I think I was confused by the endoscopy. I had a gastric biopsy, not an endoscopy. This showed the inflammatory infiltrate with lymphoid aggregates and H. pylori. Please also note that iron deficiency is unexplained. I do not get my periods, so it is not caused by menstruation, and my diet is also proper. Neutrophilia and low to borderline red cell count have been ongoing for almost one year.

Dr. Parth R Goswami

Hematology Pathology
#

Hi,

Welcome back to icliniq.com.

A gastric biopsy can be taken only during endoscopy. Chronic inflammation or an infection like H. pylori also can lead to iron deficiency anemia, which is called anemia of chronic disease.


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Hi doctor,

Thank you. What kind of doctor should I see to know about it? Am I supposed to see an hematologist?

Dr. Parth R Goswami

Hematology Pathology
#

Hi,

Welcome back to icliniq.com.

You can initially consult a physician or a gastroenterologist for getting a prescription of H. pylori and iron deficiency. Then repeat CBC (complete blood count). After treatment, if still, CBC is not healthy, then consult a hematologist. I hope this will help you.


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Thank you, doctor.

Why have you not considered Crohn's disease, given low folate and B12, chronic gastritis, skin rash or nodules, and fatigue? I have lost a lot of weight (12 kg over two months), had high CRP (C-reactive protein) last month, and possibly early glaucoma suggested by one of your colleagues on this site. I weigh 59 kg, and I am 179 cm, so I am underweight for my height. I have numbness in the toes. Is it possible that I have either Crohn's or Celiac disease? I had my gall bladder removed many years ago.

Dr. Parth R Goswami

Hematology Pathology
#

Hello,

Welcome back to icliniq.com.

Your endoscopy report is not suggestive of inflammatory bowel disease. No granuloma is also present in the histopathology report. That is why here, inflammatory bowel disease is not included in the diagnosis.

For celiac disease, a gluten-free diet can be tried. A gluten-free diet improves symptoms. For celiac disease, anti-endomysial antibody and anti-tissue transglutaminase antibody can be investigated.

For H. pylori infection confirmation, you can investigate a non-invasive procedure like the urea breath test.

And if positive, then it can be treated with the above mentioned antibiotic kit that contains three antibiotics.

In inflammatory bowel disease, chronic diarrhea, chronic abdominal pain, fever, etc., like symptoms, are present.

If your doctor after examination wants to confirm IBD (inflammatory bowel disease) and if the above symptoms are present, then colonoscopy can be done as lesion might be there in the colon.

I hope all this information will help you. Take care.


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