stricture pain question

Hi Hoping someone may have some advice for me from their own experiences. I had a resection (due to strictures) in Oct. 2012. I was doing well until spring of this year when I started having waves of severe pain. My crohn's used to be mostly D with difficulty keeping weight on, etc. However it seems to have moved into my small intestine now and I have more C with the narrowing and pain. My GI started me on 40mg prednisone and my pain stopped completely within 2 days. Yay! I tapered over the course of 8 weeks but as soon as I went off the pred, the pain was back just as quickly. I held on for about 3 weeks before I called my doc and he started me on the pred again. It took a little longer to kick in this time and my pain never completely went away but I was doing pretty good, living life, and able to eat pretty much whatever. Again, tapered off over 8 weeks.

In the meantime, I had a small bowel series. Two years ago (just prior to the resection), I had the SBS and it took forever, I was there for hours, things moved slow. This time, I was in and out within 45 minutes. The radiologist said things looked mild. This was while I was on prednisone. During the last prednisone round, we also switched me from Lialda to Pentasa, I've upped my Humira to weekly, and added fish oil and probiotics. The pain returned as soon as I hit 5 mg prednisone and has continued since I've ended this round of prednisone.

Here's my big question: I want to believe these strictures are inflammation b/c the pain goes away with prednisone but it keeps coming back so maybe not? Any thoughts on that? If it were scar tissue, wouldn't the small bowel series have taken longer like last time? I can't keep going on prednisone like this but I don't think I can keep living in pain like this. I'm afraid to eat very much, I get pain immediately. It's not bad enough for the ER yet and I'm sticking mostly to soup and soft foods and skipping meals to avoid any obstruction problems. I have plenty of extra weight thanks to the prednisone so it's not going to hurt me to lose a little weight but I sure am miserable.

Any thoughts before I give in to my GI's request to see a surgeon again? I appreciate everything and thanks in advance.

When I had my partial obstruction last April, the Prednisone did not help at all and I ended out having resection surgery to remove the affected parts of my ileum. After surgery, I was told that there was some inflammation, but it was primarily scar tissue. I think since you have responded so well to Pred that it must be primarily inflammation. So that leads me to believe that maybe your Humira is not working effectively and perhaps you should talk to your GI about switching biologics.

I had the small bowel test just prior to the surgery when I was in the hospital. I hadn't been eating all at due to the obstruction...I was only on liquids. The SBS was not that slow and I was severely strictured and partially obstructed at the time. Having the radiologist say to you that things looked mild also leads me to believe the issue is inflammation and not scar tissue.

I went through years of obstruction and strictures.  At the time, I went through a lot of meds, but the one that helped the most was prednisone, so it was used as my main form of treatment until my surgery in 2003.  After that my doctor wanted me off, but he shouldn't have done that because the surgeon left some crohn's further up from the resection.  A year later, when I went for testing, the CD was back, but somehow I was able to manage it.  My Rheumatologist put me back on Pred shortly after my GI took me off, saying that I needed it for the joint and bone pain because my Adrenal gland  became dependant on prednisone, then went into a sleeping phase,  and wasn't working anymore.  I continued on it until 3, 1/2 years and then quit on my own.  It's been downhill ever since, trying 6MP last year which took off close to 10 lbs of weight off me.    I was really sick.  My GI did not like me going off. 

The GI said that prednisone was keeping me from having severe flares during the remission, but refuses to treat me with prednisone now,  and I didn't want to try Humira because I was on remicade before, so right now I'm not feeling that great.  Hope you feel better soon.