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A member recently sent me a PM, asking me why I thought that malabsorption could be due to MC, when obviously, malabsorption is an issue with the small intestine, not the colon, and her doctors have assured her that the small intestine and the colon are two entirely separate organs, and what happens in one, does not affect what happens in the other. IOW, her doctors claim that her weight loss and malabsorption are entirely unrelated to her MC, simply because the small intestine and the large intestine act as seperate organs, in which one doesn't affect the other.
After writing a response to her question, it dawned on me that this is probably at the core of why most GI docs are totally confused about MC, so I thought it might be important enough to post for all the world to see. Who knows, maybe a GI doc somewhere in the world may see this, and the light bulb may come on. LOL. I'm not holding my breath, however.
It's their own fault, of course, for being so short-sighted that they named the disease in such a way, that the name can only refer to the colon, (as our favorite doctor, Polly, has pointed out - colitis means inflammation of the colon), and apparently, "the powers that be" are either too lazy to rename it, or they feel that it doesn't matter.
Because of that misstep right out of the chute, doctors cannot logically understand that MC is similar to Crohn's disease, in that it can affect any part of the GI tract, from mouth to anus. They are bound by the name, to view MC as a disease of the colon. Period. Of course, I respectively suggest that they are totally wrong in their opinion that what happens in either the colon or the small intestine, does not affect the other organ. Obviously, that claim flies in the face of the facts, and I am embarrassed for them, that they would even suggest such a thing, let alone argue that it's true.
Obviously, though, this is not only a convoluted way of viewing the disease, but it's just plain wrong, because exactly the same lymphocytic infiltration that is the marker of MC in the colon, can often be found in the small intestine, the stomach, and even in the mucosa of the mouth, in many MC patients. It is "exactly" the same type of inflammation found in the colon. Even the thickened subepithelial collagen bands that mark CC in the colon, can be found in the small intestine, stomach, etc., of patients who have CC.
Not everyone has small intestinal involvement, of course, but a high percentage of us do. It is easy to check. A stool test at Enterolab, to check for fecal fat absorption, will detect fat malabsorption, due to damage to the small intestine. Since vitamins are fat soluble, if you have a fat malabsorption problem, then you will have a nutrient malabsorption problem. It most definitely is not an unrelated issue, because I can absolutely guarantee you that if/when you control the inflammation in your colon, you will simultaneously eliminate the inflammation in your small intestine, and any other areas where it might initially be present, (including mouth sores that are triggered for some patients with MC).
I went untreated for several years, due to my GI doc not bothering to even look for MC. There was so much damage to my small intestine, that over three years after I adopted the GF diet, (and two years after I was in remission), a fat malabsorption test still showed a significant amount of residual damage to my small intestine.
As to the common claim by GI docs, that the inflammation in the colon cannot affect the small intestine - in fact, the most likely scenario is that rather than the small intestine being affected because of the inflammation in the colon, it's the other way around. The colon is inflamed because of the inflammation in the small intestine. Proof of this can be seen in surgical intervention that has demonstrated that in most cases, if an MC patient undergoes an ileostomy, so that the fecal stream is totally diverted from the colon, subsequent biopsies will show that the histology of the colon will return to normal, and the clinical symptoms of MC, will resolve. If the surgical procedure is subsequently reversed, then the MC will return, as described by the research project documented at the following site.
http://www.ncbi.nlm.nih.gov/pubmed/7615 ... t=Abstract
I believe that pretty well proves my point, beyond a shadow of a doubt. Frankly, I doubt that many GI docs would accept this explanation, though, since most GI docs are very defensive about their professional knowledge, (or lack of it), and as a group, they don't seem to be very open minded. In fact, most of them seem to be offended, when confronted by a patient who appears to know more than they do, about a disease.
The bottom line is, the reason why they seem to be flummoxed, when confronted with MC, may be due to that regrettable indiscretion, (read that "poor judgment"), that was initially made when this disease was originally described and named.
IOW, they keep stumbling over their own nomenclature.Tex
