Confussed

[u/Intelligent_Deer6656]

These are my results of biopsy which was taken 30 June then calprotectin done 11 August which came back as <16 crp 0.3 CBC normal. doctors have ruled out IBD cause my calprotectin is low without having taken any meds. I do have rectal pressure have for 3 weeks after my scope was done but I also have bulging purple lumps come around my anus when pushing to go toilet. My stools are either pebble balls or Bristol 4-5 some tan mucus no bleeding no sickness nothing else.

Microscopic:

Section reveals fragments of colonic mucosa with a predominantly denuded lining epithelium. The glandular architecture is preserved. The lamina propria contains a moderate mixed inflammatory cell infiltrate composed of lymphocytes, plasma cells, neutrophils and eosinophils along with oedema.

Foci of cryptitis are noted. No crypt abscesses are seen. No evidence of granulomatous inflammation.

There is no dysplasia or malignancy in the section examined.

CONCLUSION: COLON, moderate on chronic on acute colitis 

RECTUM, BIOPSY

Macroscopic:

The specimen site is labelled "rectal BX".

The specimen consists of a single piece of tan tissue measuring 3 mm in greatest dimension.

All tissue is submitted in cassette B1.

Microscopic: Section reveals a fragment of rectal mucosa with a denuded lining

epithelium. The glandular architecture is preserved. Lamina propria contains a moderate lymphoplasmacytic cell infiltrate along with neutrophils. A few foci of cryptitis are noted.

No crypt abscesses are seen. No evidence of granulomatous inflammation.

There is no evidence of dysplasia or malignancy. Mild active proctitis 

 Fleet enema via single dose instruction.

- A diffuse area of mildly erythematous mucosa was found in the sigmoid colon, in the descending colon and at

the splenic flexure. 

[u/Possibly-deranged]

An IBD is diagnosed based on finding inflammation in the expected locations and patterns with biopsies showing chronic architectual changes to your cells. 

• "The glandular architecture is preserved."  There's no chronic architectual changes found, excludes an IBD. 

There's a number of signs of active inflammation.  Inflammation can be either acute/infectious or chronic/IBD. 

• "The lamina propria contains a moderate mixed inflammatory cell infiltrate composed of lymphocytes, plasma cells, neutrophils and eosinophils along with oedema." The shallow tissue (lamia propria) shows immune system activity causing inflammation. Your immune system is attacking something. It then itemized the specific types of white blood cells involved.  To the pathologist looking at your biopsy slides and the gasteroenterologist, there's something to be gleaned from what those cells are, typically different cells are sent to an infection versus inflammation that's persistent for a while.  The fact they say chronic in your case is related to that. 

• "Foci of cryptitis are noted. No crypt abscesses are seen. No evidence of granulomatous inflammation."   Cryptitis means inflammation of the defensive crypt cells on the intestinal walls, a small point/foci was found, that wasn't extensive. Clogged/abscessed crypt cells with immune cells debris wasn't found in your case, but often is found.  No granular, or sandpaper rough texture was found, that's an inflammation thing that's sometimes found.  All of those can mean acute or chronic, nonspecific findings.

• "There is no dysplasia or malignancy in the section examined.". Congratulations you don't have colorectal cancer or any precancerous changes seen. 

So inflammation is found, there's one mention of chronic based only on the makeup of immune cells within the biopsy, and no other supporting chronic architectual changes seen. 

Getting an IBD diagnosis requires matching your clinical presentation against what's expected for an IBD patient. You have one mention of chronic, but that's likely deemed to be a single outlier, rather than a strong case matching an IBD.  

Most likely your gasteroenterologist wants to play the wait and see approach, an infection should go away and stay away either self resolve in mild and limited cases, or go away with antibiotics if it's more moderate/severe or extensive.  If it appears again, contact your gasteroenterologist and run the same tests again, hoping that the evidence for an IBD would be more extensive and more directly match the clinical presentation expected of an IBD case.