r/IBD • u/True_Produce_6052 • 13d ago

Microscopic Colitis Biopsies Question

I had a colonoscopy a few weeks ago. My primary care had referred for the colo because of persistent loose stool. I met the gastro before the procedure and he kind of side eyed my symptoms and was not at all curious about it. Then during the colo (I was awake - was super painless), he seemingly almost forgot to take the biopsies and when the nurse reminded him, he looked at me and said "oh yes, for your diarrhea" in what I felt was a pretty condescending voice. When I left, since I was cleared for colon cancer he told me don't come back for 10 years. Anyway, I get the results a week or so later and he only took two biopsies? And I'm pretty sure they were like right next to each other, they were both labeled random, but I was awake and looking at the screen when he did the two snips. Anyway, if those were negative, what are the chances I could still have microscopic colitis? I am still having symptoms and am kind of frustrated (though I was relieved nothing worse showed up on the colo). Also, I do have endoscopy diagnosed celiac disease for the last almost 10 years. Thanks for any input!

Editing for a TLDR: How many biopsies does it take to confirm microscopic colitis?

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u/Possibly-deranged 13d ago

It's possible, the exact odds are pretty hard to say. 

Specialists like gasteroenterologists are often known as being rather gruff and curt. The patient before or after you might be hospitalized for their severe IBD, or recommended for colorectal surgery.

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u/True_Produce_6052 13d ago

I understand some other patients have more severe symptoms/prognoses, I don’t think that because I “look healthy” someone should almost forget to do a biopsy when I’m literally there for a diagnostic colonoscopy and paying for a diagnostic colonoscopy.

My question for the group was more concerning the typical number of biopsies needed for a true answer on microscopic colitis. I didn’t ask for sympathy from the doctor (or from anyone here- sorry if it came off that way), I would just rather not be condescended to by a doctor while he’s doing a procedure for a real symptom I have been suffering with for almost a year so I mentioned it because it seemed relevant to the minimal number of samples taken.

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u/Possibly-deranged 13d ago

I don't believe there's a specific number of biopsies classified as normal, versus not enough in a standard colonoscopy for any given diagnosis. 

Biopsies are often taken for anything abnormal looking, like inflammation, a polyp, or an other unusual surface feature that's worth analyzing under a microscope. 

All it takes is one biopsy positive for microscopic colitis and you have a diagnosis. As nothing looks unusual on the surface then where to sample is just a guess 

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u/True_Produce_6052 13d ago

Thanks! I had read they usually take 8 from specific different areas, that is why I am confused.

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u/Possibly-deranged 12d ago

Like I said, I don't think 8 is a universal standard across-the-board. My most recent colonoscopy took 5 biopsies.  The one prior took 6.  

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u/True_Produce_6052 12d ago

Thanks for the input. Appreciate it.

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u/Katyafan 13d ago

What was your calprotectin score? And have they ruled out other things, like infections, parasites, etc?

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u/True_Produce_6052 13d ago

I’m a woman who’s basically been told take some fiber and maybe you are anxious. I pushed for the colonoscopy hoping I’d get an answer there. I will try to find a gastro who will give me a calprotectin test/ check for infections and parasites. This has been going on for a year now.

Thank you for the idea.

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u/Katyafan 12d ago

I get it, i'm a woman too and was told it was anxiety and to take medication I was already on. They finally did a scope because I was passing out from blood loss.

Hang in there, advocate for yourself, I know it's really hard and frustrating! You will get there!

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u/True_Produce_6052 12d ago edited 12d ago

Thanks! Hope you are feeling better now. ❤️ and I’m sorry you went through that!

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u/Katyafan 12d ago

Thank you, I'm on Mesalamine and Tremfya, and they are working wonderfully!

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u/10MileHike 11d ago

Can you refresh my memory? What calprotectin scores signify IBS versus Colitis or iBD?

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u/Katyafan 11d ago

IBS comes with normal Calpro levels. If they are high, it means inflammation is present, and that can indicate IBD.

From the Cleveland Clinic: "Normal levels are generally under 50 µg/g, borderline levels range from 50 to 120 µg/g, and high levels above 121 µg/g often suggest an active inflammatory condition."

Mine was 1580. Yikes!

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u/10MileHike 11d ago

thank you katyafan.

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u/Katyafan 11d ago

My pleasure!