Does granular mucosa of the terminal illeum always mean chrones/colitis or can i!

Does granular mucosa of the terminal illeum always mean chrones/colitis or can it mean something else?

I had a colonoscopy and they took 3 biopsies and said I had granular mucosa of the terminal ileum, I know this is an indicator in chrones and colitis but all the websites I have looked at mention nothing about taking biopsies, this has me worried could it mean i have something worse?

The microscopic finding of granular mucosa on biopsy specimens of the alimentary canal (GI tract) is a nonspecific finding. It is not pathognomonic for any specific disease entity; i.e., it does not diagnose Crohn's Disease, Ulcerative Colitis (UC) nor for that matter any specific bowel disorder.

Infectious and non-infectious inflammatory conditions of the bowel mucosa are the cause of granular changes. Therefore a fairly broad spectrum of conditions result in this finding. Biopsies are used to confirm or exclude the presence of these entities not make the diagnosis. The diagnosis of either UC or Crohn's Disease is based on a number of factors to include:

1. Clinical presentation.
2. The presence or absence of bloody diarrhea.
3. The presence of absence of fistulae of the bowel.
4. Endoscopic findings.
5. Radiographic findings.
6. Biopsy findings.

Listed here are some fairly common conditions in which granulomas or granular mucosa were found in the stomach (not terminal ileum) in a study performed at the Cleveland Clinic between 1975 and 1994. Of the 42 patients studied the percentage found ultimately to have a specific disease were distributed as follows:

1. Crohn's disease (55 percent)
2. Sarcoidosis (21 percent)
3. Distal esophageal adenocarcinoma and chronic active gastritis (5 percent)
4. Mucosa-associated lymphoid tissue (MALT lymphoma) (5 percent)
5. Peptic ulcer complications (5 percent)
6. Hypertrophic gastropathy (2 percent)

Crohn's Disease and Ulcerative Colitis essentially comprise the Inflammatory Bowel Disease. Each has specific findings on colonoscopy, air-contrast Barium Enema and colonoscopy. The biopsy findings and distribution of lesions are the most important considerations to definitively label someone with one of these disorders.

Ulcerative colitis is confined to the Large Bowel; it can involve the terminal ileum in what is referred to as "backwash ileitis." Ulcerative colitis also 99.9 % of the time spares the rectum; that is, if there is no rectal involvement then the disease is very likely not Crohn's disease but UC.

On the other hand, Crohn's Disease can occur anywhere from the mouth to the anus and very typically involves the anus/rectum with fistulas in the buttock region. It also is referred to as "discontinuous" in that there are lengths of bowel, stomach or esophagus with involvement separated by regions with no disease, so called "skip areas." Furthermore, Crohn's disease on biopsy is a transmural inflammatory process, affecting all layers of the bowel wall. Ulcerative colitis is superficial, not extending near the muscular layer of the bowel wall. UC is characterized by crypt abscesses not seen in Crohn's disease.

As you can see, the diagnosis is much more involved than examining a single or even group of bowel mucosal biopsies. Speak with your physician in detail about all of the signs, symptoms and findings he/she determined were present.

I hope this helped to enlighten you about these disease entities.

DrEarp