Why is MC diagnosed with a colonoscopy?

[desertrat]

Can't MC be diagnosed with an endoscopy? I was reading on a post where Tex stated that

"The problem is that MC is improperly described. Actually, it is found not only in the colon, but almost always in the small intestine, as well, and often in the stomach, (in the form of gastritis). The markers of MC can virtually always be found in the terminal ileum, and quite often even in the duodenum, so that's why digestion is a major problem with MC. If only the colon were involved, malabsorption of nutrients would be impossible, (only electrolytes would be affected). Also, if only the colon were affected, it would be impossible to have a reaction 10 minutes after starting a meal, because it takes over half a day, at least, for food to reach the colon. The diarrhea is triggered in the small intestine, not in the colon, (though it is certainly continued in the colon)."

If MC can be found in the stomach in the form of gastritis, when my GI took biopsies of my endoscopy, why didn't the pathologist find MC? Would it be because the pathologist didn't test for it?
Mandy

[Robin.booboo]

Heck, I had/have rumbling, gas, and D, and still, even on Imodium, have D after eating, so I am very interested in the responses to your questions, too! Ten minutes - ummm - much less for me? I didn't even know it was supposed to take that long to reach the lower intestines!

I think I did see somewhere on this forum, however, that we can manifest the symptoms anywhere from the mouth to the exit route, just like Crohn's does.

[tex]

If MC can be found in the stomach in the form of gastritis, when my GI took biopsies of my endoscopy, why didn't the pathologist find MC? Would it be because the pathologist didn't test for it?

No, it's because the medical diagnostic criteria spell out the pathologic markers that indicate MC, and none of them are found anywhere outside of the mucosa of the colon, so no matter what the stomach or small intestines show, a diagnosis of MC has to be made on the basis of biopsy samples taken from the colon, in order to meet the definition of the disease, and the diagnostic criteria laid out by the powers that be, in the field of pathology.

Having said that, if the rules of pathology were more flexible, yes, any pathologist worth his or her salt should be able to see the markers in the small intestine and note that they match what happens in the colon, but the rules don't allow them such flexibility. They have to follow rigid rules for diagnosing each and every medical condition.

Interestingly, the same lymphocytic infiltration that occurs with MC in the colon, occurs in the small intestine, and can be observed in the mucosal surface of the villi, long before they are eventually flattened by celiac disease. That means that MC and celiac disease have very similar histology changes, but long ago, it was decided that the diagnostic criteria for celiac disease would be defined by examining biopsy samples taken from the small intestine, and MC would be diagnosed by examining biopsy samples taken from the colon, and in the medical profession, rules such as that are usually chiseled in stone, and even an act of congress might not be able to change them.

Tex

[maestraz]

My GI doc did an endoscopy/colonoscopy at the same time, and biopsied from end to end. The MC diagnosis, according to the pathology report, came from the presence of lymphocytes in the lining of the large intestine. My GI doc, however, told me that the appearance of the small bowel biopsy made her think that if I didn't stop gluten for good, I would be on the way to celiac in the future.

For the couple of years prior to my diagnosis, when I was still teaching, I would have GI noise/rumbling during my after-lunch class that my kids could hear in the back of my classroom. We would laugh, and I always chalked it up to wolfing down my food/a diet soda in the barely 15 minutes teachers end up having to eat lunch most days. It never occurred to me to investigate the cause beyond that, until later. Now, it seems that whatever I ate for lunch, I was having a very quick reaction, wherever in the GI system it was happening.

Since I retired, I no longer react after eating lunch in a more relaxed way.

[Joefnh]

Tex how are the multitude of MC conditions described by a pathologist. I seem to remember a couple of threads that talked about the titles given to the differrent diagnostic names based upon the location and tissue morphology.

Joe

[tex]

Joe,

I have no idea what they do about some of the more obscure forms of MC, (if they are even aware of them), but for the common forms, the criteria are pretty simple. I'm sure these descriptions vary by individual pathology labs, to reflect the diagnostic policies and attitude of each particular lab, but the basic concepts should be the same. The site at the following link describes the basic requirements for a diagnosis of either CC or LC. I think the description is wrong, though, about the requirement of a lymphocyte count in excess of 20 per enterocyte, in order to qualify for a diagnosis of CC. That's true for LC, of course, but as far as I'm aware, an increase in collagen band thickness beyond 10 micrometers should be sufficient for a diagnosis of CC. It's true that the lymphocyte count is usually elevated with CC, but I don't believe that any specific minimum lymphocyte count is actually required for a diagnosis of CC.

http://www.histopathology-india.net/MCo.htm

Tex