Ileum

[crystal552000]

Is it normal for you to haven collagen deposits in the ileum and isn't that considered the small bowel instead of the colon. Im confused my GI doctor told me that he doesn't know why I have low vitamin levels because I don't have proof of small bowel involvement then Im reading my colonoscopy report which says biopsies were taken from the right side colon Ileum.

[Joefnh]

Crystal I believe what may be stated there is that the deposits were near the ileum on the colon side. The ileum is the last segment of the small bowel before it joins the colon (aka large intestine). I should say in my case biopsies were able to be taken 10" into the small bowel and CC was identified in that area along with crohns disease.

I believe as time goes on, and the body of evidence mounts, that MC will be found to be almost common throughout large and small intestine. There is even a variant called collagenous gastritis that affects the stomach lining. More to the point, the tissue type that makes up the large intestine is somewhat common throughout the alimentary canal, so it stands to reason that this disease mechanism may affect any part of it; just an observant hypothesis.

Thanks for posting the question Crystal

--Joe

[tex]

Exactly what does the pathology report say, regarding the ileum?

I believe that Joe is quite correct, by the way. My small intestine was certainly involved, and I believe that this is somewhat common with both LC and CC. The medical community is slowly learning that this disease is much more complex than was originally thought, when it was initially (incorrectly) described. Crohn's disease can affect the entire GI tract, and so can MC.

Tex

[crystal552000]

The only thing it says is that multiple biopsies take from the right side ileum, and the biopsy report just says that there is increased chronic inflammatory cells in the lamina propria and with the surface epithelium. There is is thickening of the subepithelial basement membrane by increased collagen. very vague Im trying to understand what all this means and why he said that i didn't have small bowel problems only colon.

[Joefnh]

Crystal & Tex I would interpret that to mean that the samples were taken at or near the ileum terminus.

--Joe

[tex]

The only thing it says is that multiple biopsies take from the right side ileum

That sounds like a misprint. The terminal ileum crosses from left to right, just above the beltline, and it joins the cecum, there. One does not speak of "the right side ileum". Instead, a GI doc would refer to "the terminal ileum", if he or she were describing the segment of the ileum that's proximal to the colon. The descriptive phrase "right side colon" is frequently used to refer to the ascending colon, but side designation is never used in reference to the ileum, (because it is not located on either side - it's mostly located in the center of the abdominal cavity, though it extends down into the pelvic area, as well.

IOW, I get the impression that the GI doc was referring to taking biopsy samples from the right side colon, and miswrote the word "ileum" by accident. I wouldn't want to stand by that claim, though, since you only mentioned a tiny portion of the report, and unless you understand "medicalese", so that you are able to interpret the report accurately, it's easy to be misled, and you may have overlooked, (and omitted), a vital part of the report that would change my view of that statement.

Also, most endoscopy reports include a reference to the extent of the area examined. Obviously, the scope has to go through the cecum, in order to get into the ileum, and usually, if a GI doc stops the progression at the cecum, he or she will use language such as "the ileocecal valve was identified, but not entered", if the the exam stopped short of the cecum, (in which case, obviously, neither the ileocecal valve, nor the ileum, would be examined). A notation of some sort should be recorded, to indicate the total extent of the scope exam, and the language used in these reports is not generally intuitive - again, you have to be able to understand medicalese. Many/most GI docs record a play-by-play progress report of what they can see, as the exam progresses. To understand the full implications of the report, you have to look at the entire report. Typically, everything observed, will be recorded there.

Concerning the brief notes that you mentioned from the pathology report:

"increased chronic inflammatory cells in the lamina propria", describes lymphocytic infiltration between the enterocytes of the epithelium, which is the primary marker of lymphocytic colitis. "thickening of the subepithelial basement membrane by increased collagen", refers to the thickened collagen bands that define collagenous colitis. IOW, you have the markers of both CC and LC, (usually referred to as simply MC). Based on your post, it is impossible to tell whether this is referring to the colon alone, or to samples from both the colon and the ileum, or if the the ileum was even entered, during the exam. A careful review of both reports, (in detail), would probably resolve those questions.

Tex

[wonderwoman]

I just went over the 8 pathology reports yesterday from my colonoscopy in February and it clearly indicates where each biopsy was taken.

the 3 tissue samples from the terminal ileum (dictionary says the lowest part of the small intestines) showed no significant inflammation or villous abnormality; GREAT! This tells me he was in the small intestines.

2 tissue samples from the IC valve (located at the end of the small intestine) show Collagenous colitis.

then the 20 tissue samples from the appendiceal stump, the cecum, right colon, transverse colon, left colon, sigmoid, all indicate Collagenous colitis.

Also, on the report for the transverse colon under TEST it says Additional Procedure and under RESULT it says TRICHROME. And that is the part I don’t understand.

http://www.med-chem.com/procedures/MODIFIEDTRICH.pdf


According to this site it appears they were checking for Microsporidia or parasites. Is that correct? But no where does it say weather it was negative or positive. Maybe someone can explain this to me.

I am seeing the GI dr on next Friday for another un-prepped sigmoidoscopy. He wants to check out the sigmoid and collect some more stool samples for examination due to the continuing D. I am eager to have this done just to rule out other possibilities.

IMO, I believe I may have decreased my Balsalazide Rx too rapidly and then with the stress I had in May and the traveling in June I really went backwards. I have continued to be on a very simple GF,DF,SF diet along with 9 Balsalazide a day and L-Glutamine for the last 2 weeks. Yesterday and this morning my BM was firmer rather than liquid or mush. Maybe it has just taken this long to correct the damage done the end of May and beginning of June.

[tex]

Hi Charlotte,

Masson's trichrome stain is very commonly used by pathologists, to distinguish collagen fibers from surrounding tissue, (so that it's visible under the microsccope). This is necessary for the diagnosis of CC, (or to rule out CC).

There's a good chance that you may be right about reducing your treatment too soon. I's good to hear that you are doing better, again.

Tex

[wonderwoman]

Tex, your explaination was so simple, and I agree, why couldn't I figure that out.