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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
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Good morning. I am looking for a doctor who is familiar with

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Good morning. I am looking for a doctor who is familiar with inflammatory diseases, specifically psoriatic arthritis/spondylitis and inflammatory conditions of the digestive tract (esophagus, stomach, and colon). I have a few questions about the findings of a pathology report from a recent EGD and colonoscopy. (I will be able to paste the text of the reports into the discussion). I believe the questions are easy ones; I’d just like to get clarification on a few things. I’ll also provide some background in the discussion. Thanks so much.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 2 years ago.
Answers are for informational purposes only.



Hello from JA. I would like to help.
Customer: replied 2 years ago.

Good morning. Ready for some brief background?

Expert:  Dr. Phil, MD replied 2 years ago.
Yes, I am ready. Go ahead. Hit me.
Customer: replied 2 years ago.

Great! Thanks, XXXXX XXXXX Here goes: In January of this year, I was diagnosed with psoriatic arthritis. It comes and goes in most of my joints, spine, and my eyes, at times. In addition to this, for as long as I can remember, I have had GI issues (i.e. chronic diarrhea) and for the last few years (or maybe longer) I’ve had stomach pains, intestinal pains (sometimes severe), heartburn, sour stomach, sometimes trouble swallowing, you name it. Up until this year, because I was undiagnosed, I wasn't taking any medications. After being diagnosed with PsA, I went on NSAIDs for about 2-3 months to see if that would help with the inflammation. Then, I developed a lot of rectal bleeding. I got off of the NSAIDs and a few weeks later went to see a GI guy, who, after hearing about my past history, decided to do a EGD and a colonoscopy.


 


Here are the findings from those tests, plus the path reports:


 


EGD



Findings


 


Esophagus


Excavated Lesions: A single non-bleeding 9mm ulcer was found in the gastroesophageal junction. Cold forceps biopsies were performed for histology at the lower third of the esophagus and middle third of the esophagus to r/o eosinophilic esophagitis.


 


Stomach


Mucosa: Patchy continuous erythema of the mucosa with no bleeding was noted in the whole stomach. These findings are compatible with gastritis. Cold forceps biopsies were performed to assess for H. pylori at the whole stomach.


 


Duodenum


Mucosa: Patchy continuous erythema of the mucosa with no bleeding was noted in the second part of the duodenum. Cold forceps biopsies were performed to r/o celiac sprue.


 


Impression


Ulcer in the gastroesophageal junction (biopsy)


Erythema in the whole stomach compatible with gastritis (biopsy)


Erythema in the second part of the duodenum (biopsy)


 


Pathology



(A) Duodenum Biopsy:


- Benign intestinal mucosa fragments, mild non-specific chronic inflammation


- Intestinal villi are present and well formed


- No acute changes present


- No evidence of celiac sprue


- Mucin stain marks appropriately (PAS)


 


(B) Stomach Antrum Biopsy


- Gastric mucosa with vascular congestion


- Negative for helicobacter pylori (Diff Quick)


- Negative for intestinal metaplasia (ABP)


 


(C) Stomach Body Biopsy


- Gastric mucosa with vascular congestion


- Negative for helicobacter pylori (Diff Quick)


- Negative for intestinal metaplasia (ABP)


 


(D) Stomach Fundus Biopsy


- Gastric mucosa with edema and vascular congestion


- Negative for helicobacter pylori (Diff Quick)


- Negative for intestinal metaplasia (ABP)


 


(E) Lower 1/3 Esophageal Biopsy


- Squamous mucosa within normal limits


- PAS stain negative for fungal organisms


- Negative for eosinophilic esophagitis


 


(F) Middle 1/3 Esophageal Biopsy


- Squamous mucosa within normal limits


- PAS stain negative for fungal organisms


- Negative for eosinophilic esophagitis


 


 


COLONOSCOPY



Findings


 


Mucosa


Localized continuous erythema with no bleeding was noted in the whole colon. Cold forceps biopsies were performed to assess for colitis throughout the whole colon. Localized continuous erythema with no bleeding was noted in the rectum. Cold forceps biopsies were performed for histology to r/u proctitis.


 


Protruding Lesions


Small bleeding grade 2 internal hemorrhoids were noted.



Excavated Lesions


Multiple non-bleeding diverticula with mixed openings were seen in the sigmoid colon. Diverticulosis appeared to be of moderate severity.


 


Impression


Grade 2 internal hemorrhoids


Diverticulosis of the sigmoid colon


Erythema in the whole colon (biopsy)


Erythema in the rectum (biopsy)


 


Pathology



(A) Ascending colon biopsy


- Colonic mucosa with edema and vascular congestion


- Negative for microscopic colitis / collagenous colitis (trichrome strain)


- No acute changes


- Negative for atypia or malignancy


 


(B) Transverse colon biopsy


- Colonic mucosa with edema and vascular congestion


- Negative for microscopic colitis / collagenous colitis (trichrome strain)


- No acute changes


- Negative for atypia or malignancy


 


(C) Descending colon biopsy


- Colonic mucosa with edema and vascular congestion


- Negative for microscopic colitis / collagenous colitis (trichrome strain)


- No acute changes


- Negative for atypia or malignancy


 


(D) Sigmoid colon biopsy


- Colonic mucosa with edema and vascular congestion


- Negative for microscopic colitis / collagenous colitis (trichrome strain)


- No acute changes


- Negative for atypia or malignancy


 


(E) Rectum biopsy


- Colorectal mucosa with edema and vascular congestion


- Negative for microscopic colitis / collagenous colitis (trichrome strain)


- No acute changes


- Negative for atypia or malignancy


 


 


My GI guy really couldn't tell me what caused the ulcer, my symptoms, or all of the redness/irritation. He kind of shrugged it off, however, given my other inflammatory issues, I am more concerned about the root causer of these symtoms and findings. (From what I read here, it appears as though I have inflammation throughout my entire GI tract. Is that correct?) I am wondering if this is tied to the PsA, and if it is something to keep an eye on and/or be concerned about. I am on a plant-based diet for inflammation, if that makes any difference. :) I also wasn't on NSAIDs for very long, and some of the tests were after being off of NSAIDs for several weeks. Could the NSAIDs have caused all of this? (Sorry for the long message and thank you for your time and help!)

Expert:  Dr. Phil, MD replied 2 years ago.
Can you list your medications for me also?

Customer: replied 2 years ago.

Sure thing. Earlier this year, the NSAIDs were Advil, Aleve, and Nabumetone. (I’m no longer taking anything for pain or inflammation.)


 


Right now, I am on 40mg of Omeprazole to allow the ulcer to heal.

Expert:  Dr. Phil, MD replied 2 years ago.

I think the findings are definitely NSAID related.

 

If there was some other type of inflammation going on like IBD, it should have shown up on biopsy.

 

Please don't click "bad" or "poor" service as this leaves me negative feedback. If you aren't 100% satisfied, just click "reply."

 

 

 

Customer: replied 2 years ago.

OK great! That’s good news. :)


 


To clarify:


 


1) Is it possible that the edema and vascular congestion are an early indication of IBD? (When describing the stomach and colon, these terms mean swelling, redness, inflammation—yes?) Or, do early symptoms of IBD always show up in the pathology?


 


2) Is this something I should have rechecked in the future, and, if so, at what intervals?


 


and


 


3) This would rule out NSAIDs as a treatment plan for my PsA, correct? I am assuming that the chemicals in the NSAIDs irritated the lining of my GI tract, correct?

Expert:  Dr. Phil, MD replied 2 years ago.

1)yes that is possible. You will likely need a follow up scope to ensure resolution. IF it doesn't resolve, then it could be IBD

 

2)see no 1

 

3)YEs, it would. I wouldn't even risk taking a PPI with NSAIDs.

Dr. Phil, MD, Medical Doctor
Category: Medical
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Experience: Medical Doctor Trained at a Top Academic Institution
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