Help me

[Annedith]

Mother, sister, brother, and daughter have Crohns Disease. *I am a 41 yo female 5'3" 125lb and healthy.*1.  Summer- pre-existing external hemmoroids became more inflamed and painful. There was minor (thin, bright red) bleeding.*2.  Summer-  I had some mild-moderate pain and diarrhea after eating daily.*3.  More frequent, heavy diarrhea and stomach pain on 8/14.  Headaches and lightheadedness.  Diarrhea watery. No blood. Hemmoroid pain.*4.  For 10 days:  Diarrhea at least 6x per day.  Very large amount of thick darker marroon colored blood (very different) mixed with loose or watery stool, blood heavy for four days.  Pain in stomach (grinding pain.)  Bloating. Joint pain and leg cramps.  Marked fatigue.  Headaches.  Breathless.*5.  8/27: Seen in urgent care, began on Phenobarb/Belladonna - 2 pills/4x per day.  Diarrhea was only 2-3x per day.  No seen blood.  Tried to taper off and diarrhea increased.  Took meds for five more days.  Diarrhea stopped on 9/2.*6.  8/29-9/4 Stool tests neg for parasites, C. Diff., E. Coli, Salmonella.*7.  9/4 Extreme Fatigue continues. Blood tests:  RBC 3.04  HGB  6.4  HCT  23.3.  All other tests (liver, kidney, protein, bili, WBC, thyroid) normal.  Anemia is iron type.*8.  Colonoscopy:  normal.*9.  9/11  Blood tests:  RBC 2.82  HGB  6.0  HCT 21.4.  Given blood - 2 units.*10. Diarrhea w/o visible blood restarts after eating.  No cramps or stomach pain.*11.  CT of abdomen and pelvis.  Normal.*12.  9/14 Post transfusion blood tests:  HGB 9.0  HCT 32.0.  Inflammatory Bowel Disease blood test comes back with "Low Probability."*13.  9/14 Endoscopy.  Stomach normal.  Flecks of blood "stigmata" at mouth of small intestine.*14.  Next tests scheduled:  CT/Barium with small bowel flow through followed by some test where I swallow a camera that can photograph the small intestine.  
15.  Taking FloraQ, Diphenoxyl Atrop, and Phenobarb for diarrhea.  Still have diarrhea 3x per day after meals.*What is it?  Scared.

[Annedith]

Thank you so very much for responding.  I appreciate your comments and testing recommendation, which I have noted.  I am having the camera capsule endoscopy on Thursday.  My barium/small bowel follow through was "normal..."  At this point, I am planning to ask for stool and blood testing and then I am out of ideas...so thanks for differentiating for me the calprotectin test...I had only heard of the malabsorption of fat test.

I would like to be diagnosed soon, because I am so tired of being sick!  My daughter is a teenager, and  like you, has Crohn's throughout her entire digestive tract.  Others in my family have less involvement.  One sibling was symptomatic with a patch that was the size of a pencil eraser in his small bowel.  My daughter has been in remission for some time, taking a variety of meds...I hope your symptoms are somewhat controlled, too.

Thank you for writing to me...it means a lot.

[lizziecee]

Sorry to be so late in responding been away for a week at a nephew's wedding.

I have had Crohn's for 37 yrs, diagnosed when I was 24. There is no-one in my immediate family with Crohn's, although I do recognise it does tend to run in families.   As Dr. Pho said, you have had all the usual tests...but the small flecks of blood at the mouth of the small intestine worries me. My Crohn's was first dx with a laparotomy (no colonoscopies then) but I had no bleeding for some 20 yrs, then horrendous rectal haemorrhages. My problem was at first with the small bowel, around the terminal ileum, since progressed to pan Crohn's colitis - from the mouth to the anus.

Perhaps the barium follow through and capsule camera endoscopy will identify the problem. There is one test you may consider, which I have regularly - a calprotectin assay test of your stool. It is not invasive, and cheap to do. This test will show if you have an inflammatory problem in your intestines, but not where - that is when my gastro does invasive tests. Analaysing the stool for fat content is not conclusive enough. I remember doing fat stool samples when an in patient in hospital 30+ years ago, disgusting to do, and they are not enough. I am surprised that Dr Pho does not recommend the Calprotectin test - but I live in England, where this test was first done, and perhaps it is not done in the USA.

I hope you get a conclusive diagnosis soon.

Liz.

[Kevin Pho, MD]

I agree with the comprehensive workup thus far.  The negative colonoscopy would rule out many of the major diseases that can lead to the symptoms.

I would send to stool off for analysis and culture.  Malabsorption can be evaluated by analyzing the stool for fat content.  I would also obtain blood tests to rule out celiac disease.

With the continuing low blood count, evaluation of the small bowel can be considered to look for bleeding.  Capsule endoscopy or push enteroscopy can be considered.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_