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Hi all,
I apologize in advance for the length of this post but I am feeling 
fairly desperate for some guidance.

We just got the pathology report back for my now 18 yr old son's 
upper and lower scopes. Our local GI doc agrees the report does not 
make a whole lot of sense and has ordered a small bowel followthrough 
to see if that will clarify things, but in the meantime I'm hoping 
some of you can give me some comment re concerns I have about the 
report itself, which reads as follows:

A. Duodenum - partial villous atrophy/celiac disease

B. Gastric Anturm - no pathologic diagnosis [the surgeon who 
performed the scope noted "some antritis" and the "pylorus was a bit 
loose appearing" but I take it that it's not from H. pylori. Does a 
"loose appearing" pylorus give any reason for concern if it's not 
from H. pylori? ]

C. Esophagus, low - small intestinal metaplasia with chronic 
inflammation [surgeon noted a hiatal hernia and "small area of 
inflammation at the EG junction on one side. Biopsy was taken there. 
EG junction was at 42 cm and the hiatus at 45 cm."  Can anyone 
clarify whether this means the metaplasia would be considered to be 
in the esophagus or in the cardia? My son is now taking 300 mg of 
Zantac daily. We're hoping the metaplasia will reverse itself. How 
likely is that? ]

D. Ileum - celiac disease, moderate to severe [surgeon noted "ileum 
had an irregular contour to the surface" ]

E. colon - non-specific mild chronic colitis

F. rectum - no histopathologic diagnosis [surgeon had noted the 
rectum looked normal so this at least is good]

Does the above represent a common way to write a pathology report, 
i.e. is it only at teaching hospitals or research centers that more 
specifics re Marsh designation, number of lymphocytes, etc are 
included or should I push to have the biopsy samples sent to a 
different lab for evaluation [and is that even possible to do in 
Canada?] Should I ask for an eosinophil and/or mast cell count or do 
those seem irrelevant given the above?

My son has followed a strict GF diet for abt 6 years now but has had 
recurrent symptoms for most of that time [his symptoms improve 
somewhat when he eliminates a slew of other foods in addition to the 
gluten]. He had a followup duodenal biopsy done abt 2 yrs after dx 
because the ped GI doc was insistent his ongoing symptoms at that 
time were from gluten exposure. That biopsy came back clean but said 
doc could offer no other help, other than to agree that he was indeed 
on a GF diet :-( Equally important, his tTg has been consistently 
normal since a gradual drop over time after going GF and was normal 
at time of these most recent biopsies.

How confident should I be that the pathologist considered all other 
conditions which can cause villous atrophy before proclaiming it is from CD?

There is a serious shortage of GI docs here so we've been working 
with our GP to this point but she has consulted with the GI doc who 
finds it strange that the ileum would be worse than the duodenum if 
the atrophy is from CD. Given that he is on a GF diet and has a 
normal tTg are we looking at refractory sprue or, given the GI doc's 
comment, are we looking at something else? My son will see the GI doc 
after the small bowel test but I have no idea how long that will take 
or how soon he'll get to see him.

  Does Crohn's look much like CD under the microscope? Are there ways 
of determining a more specific definition for the "mild chronic 
colitis" that I should ask about? Should I just expect that the small 
bowel followthrough will clarify what's going on and so just be 
patient [after all this time that is hard to do] or are there other 
things I should followup with our doc about?

Thanks in advance,
Aggi-Rose




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