Good morning. Ready for some brief background?
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:
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.
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.
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.
Ulcer in the gastroesophageal junction (biopsy)
Erythema in the whole stomach compatible with gastritis (biopsy)
Erythema in the second part of the duodenum (biopsy)
(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
(D) Stomach Fundus Biopsy
- Gastric mucosa with edema and vascular congestion
(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
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.
Small bleeding grade 2 internal hemorrhoids were noted.
Multiple non-bleeding diverticula with mixed openings were seen in the sigmoid colon. Diverticulosis appeared to be of moderate severity.
Grade 2 internal hemorrhoids
Diverticulosis of the sigmoid colon
Erythema in the whole colon (biopsy)
Erythema in the rectum (biopsy)
(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
(C) Descending colon biopsy
(D) Sigmoid colon biopsy
(E) Rectum biopsy
- Colorectal mucosa with edema and vascular congestion
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!)
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.
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.
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OK great! That’s good news. :)
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?
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?
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.