Guys, what's the difference between 'thickening' and a stricture?

My GI printed off my most recent test results yesterday, which included an MRI report (He's good like that! I don't even need to ask now. Americans probably don't understand how refreshing this is, but before him every GI I saw basically acted like the details of my disease was a state secret.)

Anyway, my MRI report says this:

There is mild degree of concentric thickening and enhancement of the rectum extending into the distal ileum at the anastomosis ... No evidence of stricture formation. The rest of the small bowel appears normal.

Remember that I don't have a colon anymore, so the ileum is directly connected to the rectum. I thought thickening of the bowel walls caused by inflammation also created narrowing as well? Before my first surgery I had an officially-recognised stricture (as seen on scans), but that stricture would also come and go according to whether I was on steroids or not. It was diagnosed as an inflammatory rather than a fibrotic stricture.

But now all I'm ever told is there's no stricture, even though there is thickening and I have all the symptoms of a mild narrowing/stricture. I don't have full obstructions but I occasionally get partial ones - if I don't know the symptoms of one by now, then I don't know when I will. The rest of the time food sounds and feels like it's making a bit of an effort to get through that part but not actually getting stuck. It would be worse if I didn't follow a mostly low-residue diet.

I should have explained all this to my GI. I began trying to but made a complete pig's ear of it and gave up in frustration.

Oh yeah, and that 'mild' inflammation that I keep on being told about is described as "acute ulcerated large bowel mucosa with granulation tissue formation" in the rectal biopsy report. Look, I get that I'm not an expert, but acute ulcers sound a tad more severe than mild inflammation. The inflammation in the rectum and terminal ileum is also described as "moderate", not mild either. To be honest, if my inflammation was as mild as all that, I doubt I'd be eligible for Entyvio anyway.

NCOT, I saw my GI on Weds and he told me it was mild inflammation as well, but that I had ulcers as far as he could see in my small intestine. I kind of laid into him about the mild thing, but he said it didn't mean I didn't need treatment just that I didn't need surgery or that I was on the road to worse things. It makes sense, but I still find it such a weird way to classify things.

He also did some serious backpedalling on treatment options. I'm going to retry imuran again and see if I can tolerate it this time, but if not then it's entyvio for me as well.

Hope all the hoops and paperwork happen quickly for you.

I think you can have thickening and not have a stricture, that's what my MRI indicated last year. Not sure if the thickening was inflammatory or scar tissue, probably both.

ncot.. big betty is super correct. you can most certainly have thickining and not have a stricture ever at that point.. by the report saying it was at the anastamosis, its totaly normal. two differnt types of tissue was connected. your body builds tissue to help heal it and it thickens, just like a scar on your skin. what it can do is hurt the normal peristalis of that section and slow or hinder the movemnet of stool through that area.. your rectum is probably the thickest part of the system to begin with as it must take that tight turn to the anus and stay together under the most pressure. i wish i could raw a picture to help explain. all of my strictures have been and the one i have at the moment have been in thin walled sections that go along fine then in a centimeter or so they would narrow off rapidly and then just as quickly revrt back to normal size .. kind of like a bridge symbol on a paper map!.. randy

Sparkleplenty - Hope the pred kicks in and you can enjoy your vacation. Horrible drug but it was the only one which ever gave me any relief from my disease.

Randy - Thanks for trying to explain it. The bit about peristalsis being hindered by scar tissue makes sense. I'm also guessing there is absolutely nothing which can be done about it =/ Your post also reminded me of something my surgeon said after my pelvic MRI last year. She showed me the scan on the computer screen and said that my rectum walls were twice as thick as in a normal rectum. However, I'm not really worried about the rectum, as that's quite wide. I'm worried about the narrow part, the anastomosis.

Does thickening increase the width of the bowel wall? That's what I can't work out. If it does, then it seems to me that if it extends inwards into the lumen, then it must also narrow it. But if it extends outwards, then it won't. I don't know. J-pouch patients don't seem to get these sort of issues, even though they have the same join between rectum (artificial in their case) and small bowel that I do. I had similar mild issues with an ileostomy and expected my reversal surgery to resolve those, even if I ended up going 30x a day. Not only has it not resolved them, they're worse than they were with an ileostomy. I'm still puzzled, although I appreciate you trying to explain it all the same.

well I guess it depends on whether the thickening is on the inside or the outside of the colon. a longer section of inside thickening may cause a narrowed length if it is longer than what I have had I guess. more like a clogged artery would be, gradually getting narrower rather than a sharp decrease in diameter. and the thicker it is the less flexible it would be. did the report give a diameter of the area. ? like in the one I have at the moment, it was at 9mm when we started the stretches, last in may it was stretched to 18mm. but it bleeds to much when they do it, to go more than 2-3 mm at a time. worried about popping me! so try and find out what the measurement was and go from there, maybe talk to dr about a stretch if it get any smaller?

Personally I think you should investigate it sooner rather than later and make sure the thickening does not get worse and become a stricture. I know that feeling of being afraid you're going to be treated like a hypochondriac all too well (so many of my previous doctors made me feel that way even when there was a legitimate problem I still felt like I was inconveniencing them. Now I count myself extremely lucky that I have a group of them that are taking it very seriously and am actually getting somewhere, which is an adjustment because I'm so used to trying to ignore my symptoms) but we all know that you're not and if she doesn't take you seriously than you need to speak to someone else and make sure that everything that could possibly be done to make your quality of as good as possible is being done. I know the first three days after my dilation I realized how much better I actually could feel. Didn't even know how bad I was because I'm so used to telling myself to live with it because there is nothing that can be done and it could be worse.

Cheers randy :p

Not so much anymore, but I used to have a ridiculous amount of internal rumbling almost every day - it both felt and sounded like a blocked-up drain unclogging itself. I was amazed with all those rumbles I didn't pass non-stop gas, but I actually didn't pass a lot - god knows where it all went.