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I have attached my recent pouch biospy results. I am interested in knowing if anyone has any comments regarding the results.

My GI thinks the results look pretty good, but I am concerned about the chronic 'active enteritis' in the pouch biospy. I am wondering why this is not being called crohn's' disease as I have had chronic pouchitis since my takedown 2 years ago and lately I have a lot of upper left abdominal pain. I was off antibiotic for several weeks at the time of scope and just started them yesterday due to increased frequency, constant cramping and pain. Thanks for any input.

1. NEO TERMINAL ILEUM, BIOPSY:
- SMALL BOWEL MUCOSA WITHOUT SIGNIFICANT ABNORMALITY
- NEGATIVE FOR DYSPLASIA

2. POUCH, BIOPSY:
- MILD CHRONIC ACTIVE ENTERITIS
- NEGATIVE FOR DYSPLASIA

3. RECTAL CUFF, BIOPSY:
- SUPERFICIAL FRAGMENTS OF INFLAMED COLONIC MUCOSA WITH FOCAL HYPERPLASTIC CHANGES
- FRAGMENT OF SQUAMOUS MUCOSA WITH ULCERATION AND ACUTE INFLAMMATION
- NEGATIVE FOR DYSPLASIA

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I read my last pathology report and it didn't have that wording. Mayo GI told me my pouch had a tiny amount of inflammation and that everyone did so it was noting to worry about. That's why I looked at the report. I also googled it, including "chronic" and 99% of the results came up were UC not crohns. So I'd ask my doctor to explain it better if I were you. Some doctors tend to leave out details they don't think are important that we need to know, especially when we are having daily symptoms.

I found out all kinds of things about me my doctors hadn't told me when I read my medical records, that I took to Mayo's, last year.

I have pain in my left abdomen frequently and I wonder what is causing it. I don't think it's gas or adhesion pain and it's not where my pouch is. I wonder if it is pouch pain?
TE Marie
They use the word enteritis because it is an ileal pouch. It is sort of a generic term, meaning inflammation of the intestine.

I can't stress this enough, ALL pouches have some level of mild inflammation, so don't read too much into it, since the pathology report is for correllation with the clinical impression. In addition, they tend to pick biopsy specimens where they see the inflammation, so theycan rule out dysplasia.

Actually, Jeane, your report is very similar to mine the past few years, and my pouch has been the best my GI has seen it.

So, since your report was pretty decent, the next step is to look at your function and symptoms. Hope this helps.

Jan Smiler
Jan Dollar
Thank you got hhe comments and yes Jan, your explanation helped clear things up. I do still wonder about the sharp upper left GI pain I often get and i know antibiotics will be part of my life on and off for as long as I have my pouch, but on a positive note, my cuff and anal area are 100% better than they were a few months ago. Keep thinking positively.
J
Jeane, I'm glad you are feeling better and better, and I suspect that trend will continue. Sometimes tincture of time is the best treatment. Hard to be patient, I know...

Intermittent pains that are sharp and/or crampy often are due to the affect of adhesions on the movement of your intestines for folks who have had abdominal surgery (not just j-pouch). Adhesions don't show up on imaging unless they are causing a major obstruction to the point of causing dilated loops of intestine, so you cannot rely on imaging to rule them out or to confirm them.

Once you rule out other causes of the pain, you just have to assume it is adhesions. Then, you have to decide how problematic they are. If you are in agony on a daily basis and unable to eat or function, then surgical release is your only viable option (although I have heard of a few people getting adhesion release through deep tissue massage). But, if the pain is infrequent and only a few days at a time, you are probably better off just living with it. The first time I had it, I went to the ER because the pain was severe. It passed on its own within the day. The next time I saw my GYN doc and surgeon, and it passed in a few days without intervention. Fast forward 17 years, and I just deal with it when it happens. Good news for me, it is only 2-6 times a year and it is less bothersome as time goes on.

Jan Smiler
Jan Dollar
Thanks Jan, I'm calling my left sided off and on pains adhesion pains, like the rest of them. They can start going away for good any day now Smiler Actually they are better than they were when I look back a year or 6 months ago. I have to look way far back, things are moving slowly here and unfortunately my cuffitis and/or c-diff is back. Frowner
TE Marie
Jan,
I wonder if my pain is gastritis. It is very far up under the rib cage left rib cage and tends to continue lower than the belly button. It feels like a knife is being stuck in my side with the upper left area hurting the most (constant, deep dull aching pain). I have mentioned it to me GI who has also said it could be adhesions, but this is pretty constant at times for several days on end and pretty agonizing. Out next steps are upper GI series if this continues but I often wonder if this pain is just part and parcel with the constant inflammation I have going on in the pouch.
J

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