LC vs MC

[Carole]

Finally had first dr visit today with new gastro (last one moved last year). i wrote down all my questions so i wouldn't miss any, but now, after waiting 6 weeks for my appt i really didn't find out much. He did go over results of my colonoscopy and endoscopy saying after 2 test for celiac that it isn't a problem for me, however MC is definite and there were white cells indicating LC.

Question - is LC a subset of MC or something different?

There were also indications of possible malabsorption. What is the implication of that?

He gave me a pancreatic enzyme to take to and said it should help with the gas and bloating, and wants me to get an x-ray next time i bloat significantly so he can see where it's happening. Again, not sure what he's looking for.

You know, it sounds like i didn't ask any questions, but i really did - i just didn't get answers.

He did tell me to eat more calories - boy i'd love a nice big sundae with hot fudge right now (let's see, do they make those without sugar or dairy )....

I'd appreciate any answers you can give me to help explain what i "found out".
Carole

[tex]

Hi Carole,

There are at least 7 or 8 types of microscopic colitis known at the present time, and the list continues to grow each year, (most doctors are only aware of the 2 most common forms, collagenous colitis, and lymphocytic colitis). Some patients have the markers of both CC and LC, and so their form is often referred to as simply, MC, (however, remember that all forms of this disease can correctly be referred to as MC). Some of the less common forms are clear cell MC, giant cell MC, paucicellular LC, cryptal lymphocytic coloproctitis, Paneth cell hyperplasia, and a type known as "not otherwise specified", ( ).

Many of us have small intestinal damage, also caused by the disease, and in that situation, the villi of the small intestine are damaged, (similar to celiac disease), and fat is malabsorbed, and it passes out with the stool. Since most vitamins are fat soluble, they are also poorly absorbed, and pass through with the fat, to a great extent. IOW, if you have a malabsorption issue, you may need to take supplemental vitamins, and you may need to use a sublingual form, (designed to dissolve under the tongue), of vitamin B-12 and folic acid, in order to avoid anemia, and other deficiency issues.

The gas and bloating are almost surely caused by gluten, (unless you are consuming dairy products- they can cause it also), and the x-rays will simply show that your intestines are inflated with gas. (What else could it be?) I realize that he has determined that you are not a celiac, but that does not mean that you are not gluten-sensitive, (of course, most GI docs don't even realize that non-celiac gluten sensitivity exists).

MC does affect the functioning of the pancreas, but I'm not sure that taking a pancreatic enzyme will be effective for reducing the gas and bloating. When I tried digestive enzymes, they just made me sick as a dog, (world-class nausea and vomiting), but, of course, YMMV.

Tex

[Carole]

Thank you for your speedy response - it clears up a lot of things for me. You bring up a good thought about sublingual B12 and folic acid - i take lots of both, but not sublingual - only makes sense to do that if there are malabsorption issues.
I really didn't understand about non-celiac vs gluten sensitive, but now it seems i need to do more testing to identify if that's the case for me. Think i'll go completely gluten-free for a few days so i can look into it. i did that a few weeks ago and it didn't seem to make a diff but that was before Entocort when everything was a problem.
I tried to indicate my concern to the dr about intestinal strictures - i've had 4 abdominal surgeries and the last one in '92 they had to remove the adhesions that had my small intestine stuck to my tail bone! He pretty much ignored the suggestion that the hard fsit-sized knot in my stomach at night under my belly button and the adjoining constant pain in my left side might be from adhesions and might have something to do with my intestinal problems. i thought perhaps that might have been the motivation for the x-ray of gas and bloating.
Thanks again for all the info...
Carole

[tex]

I would think that if any adhesions are present, they could certainly magnify the pain of gas and bloating. Of course, some members have described the pain level of their gas and bloating as being almost as severe as the pain of childbirth, at times, so even without adhesions, the pain can be pretty rough sometimes.

Any strictures that might be present, should have been noted on your colonoscopy report. I had a stenosis in my Sigmoid colon, which was noted in my colonoscopy report, but the GI doc never mentioned it to me. I found out about it 4 and a half years later, when I had to have emergency abdominal surgery, and a resection, because of it. After that operation, I requested a copy of the previous colonoscopy report, and sure enough, there it was, described in the report.

There is a somewhat rare condition known as diverticular colitis, and approximately 25% of patients with that condition, develop a stenosis in their colon. Of course, the doctors at the hospital where I had the procedure, apparently had never heard of that disease. A lot of doctors don't seem to know how to deal with certain complications related to this disease, so they usually choose to just ignore them.

You could be right, though - that may have been the reason why he ordered the x-rays, because something of that sort might be more likely to be visible on a x-ray, if your intestines were inflated by gas.

You're most welcome,
Tex

[Carole]

tex,
the enzyme worked really well - cut down on gas, bloating, and feel overall much better after eating when i take it with meals. What does that indicate to you - i know dr said something about the malabsorption issue before he gave them to me but i was unclear if that is the connection...any ideas?

Carole

[tex]

That's good news. As to what it indicates to me, well, it suggests that you might have pancreatic insufficiency. I wonder if he actually tested you for pancreatic insufficiency, or he just made a lucky guess. The symptoms of just about any enzyme insufficiency can be very similar to the symptoms of MC, and/or celiac disease, and MC and celiac disease both tend to cause enzyme insufficiencies, as a result of the inflammation.

I assume that his reasoning was based on the fact that pancreatic insufficiency can indeed cause malabsorption issues, but whether or not the supplement might relieve your malabsorption problem, will depend on whether you also have any small intestinal damage from gluten, or casein, or any other similar issue.

Of course, since MC seems to cause pancreatic insufficiency, in some cases, if you happen to be one of those individuals, then he is treating a symptom, rather than treating the disease. If the treatment actually resolves the malabsorption problem, then he might be on the right track. For most of us, though, when we eliminate the inflammation caused by MC, then all those other side issues, (enzyme insufficiencies, arthritis, chronic fatiogue, etc., slowly disappear, also.

I'm glad you're feeling better. Anything that helps us to feel better, while we're trying to get this disease under control, is a good thing, of course.

Tex