Is there such a thing as "normal inflammation?"

[draperygoddess]

I talked with my doctor this morning about the pathology report his office faxed me yesterday (biopsy results from my colonoscopy in August). The diagnosis is non-specific colitis, but the description reads,

The lamina propria is expanded with edema and mixed inflammatory cells.

When I asked about this, my GI told me that this was "normal inflammation" and that this particular lab says that for everyone with a normal colon. I asked him what the difference was between "normal" and "abnormal" inflammation. Of course, what we came back to was "It's IBS, which means that there's nothing abnormal there, but we don't know that much about IBS." When I kept pestering him, he offered to send my slides to Vanderbilt for a second opinion. This will take a couple of weeks.

So, has anyone else heard of a "normal inflammation" of the mucosal lining? I thought IBS and any form of colitis were mutually exclusive.

[Zizzle]

I do believe LC requires a certain number of lymphocytes to be counted by the pathologist in the biopsy sample. If the concentration of lymphocytes exceeds the threshhold number, then you have LC, if not, I suppose you might be told it's non-specific inflammation. However, who's to say a nearby biopsy sample might not have a greater concentration of lymphocytes? I say, if it acts like a duck, quacks like a duck, you get the idea...

[tex]

Cynthia,

A normal distribution of lymphocytes in the mucosa of the intestine is typically below 15 lymphocytes per 100 enterocytes, (epithelial cells). However, that is not a condition of inflammation. "Normal" colons are not inflamed, and biopsy slides indicating inflammation are not representative of a "normal" colon. If a lab declares that everyone's biopsy samples contain inflammation, then obviously that lab should be avoided - what is the point of sending samples to a lab that shows all samples to contain the markers of inflammation? Of course, the possibility exists that all the samples that are sent to that lab are indeed inflamed, and your doctor just doesn't realize that all of those patients have an IBD.

Edema, as you probably know, indicates swelling, (usually due to fluid retention), and that is another marker of inflammation.

There is a type of LC that your doctor has probably never heard of, called paucicellular LC, which is not marked by a significantly elevated lymphocyte count, (IOW, the lymphocyte count is only minimally increased above normal levels). It's possible that you may have this version of MC, because it is commonly considered to be a "mild" case. Also, as Zizzle pointed out, the lymphocyte count of any sample depends on where the sample was taken in the colon, relative to the areas of the most intense inflammation. Doctors take samples from "unproductive" areas in the colon frequently, and when they do, they miss the diagnosis.

Conventional LC is marked by a lymphocyte count of above 20 lymphocytes per 100 enterocytes. Paucicellular LC is marked by a lymphocyte count that falls below 20 lymphocytes per 100 enterocytes, (thus the name, paucicellular - indicating a paucity of lymphocytes).

http://www.medscape.com/viewarticle/487838_4

Hopefully, the pathologist who analyzes your slides at Vanderbilt will know what he or she is doing, and they will have heard of paucicellular LC. If they haven't, their finding may be the same.

Your doctor's comment, "we don't know that much about IBS", is pretty funny. Of course, they don't know much about IBS - it doesn't exist. IBS is a figment of their imagination - a disease created by doctors who were ashamed or embarrassed to admit that they don't have the foggiest idea what's wrong with all those patients. One day one of them had a brilliant idea - "We'll call it IBS - that way we won't look so dumb".

Obviously, they don't know much about MC, either, unfortunately.

Tex

[draperygoddess]

I am just floored by this whole situation. I know many of you have had similar experiences with your GI's (and other doctors), but this guy is young and seemed to be more "up on things." He is also a really nice guy, very patient, so I hate that I now feel he wasn't honest with me about my results, nor does he know anything about my condition.

I'm wondering--why isn't the ratio of lymphocytes to epithelials part of the pathology report?

[tex]

Cynthia,

He probably isn't being intentionally dishonest. Most likely he has the best of intentions, but he doesn't understand the disease. I'm pretty sure that he's just young, ambitious, and inexperienced with MC.

Pathologists don't normally record the actual lymphocyte counts in the report. Instead, they record their "findings" in terms of general observations, and they enter their diagnosis, or in some cases, they rule out a possibility, such as cancer. They record everything they see, that might be pertinent, but they don't typically record actual counts of the various features. Instead of numbers, they use quantitative terms such as "scattered, or "numerous", and they often use quaint-sounding, medical terms.

He probably feels that he's doing his best.

Tex