I am a 37-year-old female. I have a history of Hashimoto's disease and spinal stenosis. It is of the large intestine. My symptoms before this included abdominal pain, RLQ and low midline, intermittent diarrhea, bloating, and at times inability to have a bowel movement, and weight loss of about 15 pounds. Pain and diarrhea have occurred in bouts several times over the years. The doctor noticed a few discrete ulcers on colonoscopy, but that is all I know from the report. My biopsy reports revealed chronic ulcer with inflammatory infiltrate and architectural distortion in the adjacent mucosa with mucosal fibrosis and reactive epithelium. Could you give me your differential diagnosis for the biopsy result from my colonoscopy? Kindly help.
Thank you for your query. I understand your concern. Your biopsy report is inconclusive and of little help in reaching a specific diagnosis. However, the chronicity and clinical symptoms you have described lead to the differentials between inflammatory bowel disease and indeterminate colitis. Laboratory investigations are non-specific, but the following tests will aid in diagnosing IBD (inflammatory bowel disease). IBD is a complex disease involving complex immune mechanisms, and there are remissions and bouts in tandem. So I suggest you to do the following investigations. Check ESR (erythrocyte sedimentation rate). Check CRP (C-reactive protein) levels. Check fecal calprotectin levels. Check ANCA (antineutrophil cytoplasmic antibodies) tests. I hope this has helped you. Thank you.
Thank you for your reply. Can it be non-specific? Kindly help.
Too high levels of fecal calprotectin will favor IBD. ANCA positivity will also favor IBD; raised ESR and CRP are too non-specific. Now intestinal tuberculosis can be ruled out on account of the biopsy description. A malignancy is highly unlikely at this stage as biopsy reveals no such features, and there is no wall thickening or discrete mass. Undergoing a USG (ultrasonography) and CT (computed tomography) would have been better, though. If you respond to the immunomodulator drugs, the diagnosis is confirmed, and other entities are automatically ruled out. I hope this has helped you. Thank you.
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