Scar Tissue or Inflammation?

I don't know the answer to your question, I am sorry, but have you ran this thought by your doctor? I would think your doctor wouldn't change meds unless totally necessary. Are you comfortable with your doctors abilities? I hope you are, and I hope you are able to get the answers you are looking for. Maybe someone who knows more about this than me will come a long with an answer for you. Wishing you all the best!

Really, if you get a gastroenterologist to admit that you have scar tissue- you have just witnessed a miracle.  Most gastro's are against surgery.  There are many pros and cons to it.  Let me tell you a little story.  I was diagnosed with crohn's on my 19th birthday- literally that day July 3 2000.  Within a matter of 5 months i went from massive diahrrea to not being able to go to the bathroom at all. After a small bowel series I was told that I had massive inflamation that only left 1cm of able dilation in the area of my ileosecal valve.  The gastro doubled the steroids that i  had already been on since diagnosis and threw me on imuran.  The combination of the two made me nuts- I typically have every adverse reaction possible w/ meds- i guess i am hypersensitive or something- anywho the combo of being wired and starving from the pred and weak, throwing up and generally feeling like i constantly had the flu, I flushed both meds down the toilet.  Mind you, I was not a person that gave up easily.  I was going to college full time, working part time, I was in a sorority and was a cheerleader at college.  I thought well if eating is what hurts me I just will not do it, and as a classic me always taking things to the extreme I wound up 73lbs the day I got married (2 years after flushing meds and 6months after graduating college)  Anyway, something switched in me looking into my husbands eyes at the altar- how could i marry him and promise my life, when i am slowly killing myself- mind you I was not anorexic because I thought that I was fat- I just knew eating hurt, made me miss class, call off work- etc so I just stopped.  Finally- I took control of my disease again. I saw new gastros, and a surgeon!  When you go to see a surgeon, if he is worth his salt he will ask for all films, write ups, blood work, etc for your first appt- he told me that the lower bowel series I had way back 5 mos after diagnosis was already stricture, and that any med I was put on for that was a waste of time- and actually wrote a letter to the MD I had at the time about his neglet.  ALWAYS FIND OUT IF IT IS SWELLING OR SCAR TISSUE___GET A SURGEONS OPINION!  Taking meds that are so hard on your body for no reason is just rediculous, and I will never forgive myself for what I put myself thru because I was tired of no answers from my doc- get another opinion.  Keep a journal for a month before seeing the new guy or the surgeon.  I know this was very long, and believe me I left out alot, but I hope it helps!  

Usually they can tell by colonoscopy, but if they can't, that's why they do a biopsy. A biopsy will tell them a lot. You need to ask your doctor these questions and if you don't trust him enough to discuss this with you, you have the wrong doctor.

If you have stricturing crohn's disease (where stricture formation is the predominent problem) going on remicade might make things worse. There is a body of evidence that suggests remicade heals ulcerations and inflammation so fast that it can actually contribute to stricture formation. You need to have a really frank discussion with your GI and perhaps ask for a surgical consult.

I agree that surgery should be a last resort, but I also see Remicade as my ace in the hole. If I ever get really sick and nothing else works then biologic therapy will be there, but in 2004 I was 11 years from my last resection and was having obstructive episodes with depressing frequency. At one point my GI started talking about upping the ante and starting my on Remicade. I figured my strictures were already so bad -- a balloon dilatation had only been able to open the stricture to less than 1/8th of an inch -- that I didn't want to waste remicade on a lost cause. I had surgery in 2005 and the pathology proved that my instincts were bang on. The stricture was completely occluding the bowel by that point and ulcerations ahead of the stricture were through the lumen. I made the right decision to have surgery (actually I probably left it a bit too long).

Most recently, during a recent exacerbation of the disease, there was again talk of Remicade, but given all the research my GI is now reluctant to start down that road because of the stricturing nature of the disease. We were able to get the inflammation settled with immuno-suppressants and anti-inflammatories (azathiopri8ne and Pentasa). The biologics are still there for me if I ever really need them (if I get a fistula again) but for now I'm glad that we've charted a more conservative course.

There's is no way to tell immediately. You can tell if you are scoped after you are treated for the inflammation. Once the inflammation is gone (and confirmed by the biopsy done during the scope) the strictures seen in the scope are all scar tissue.

Belleenstein is right to warn you about remicade. I've never taken it for the exact reason she mentioned. Fast healing does cause more scar tissue. For me it wasn't an option because pretty much any additional amount of scarring would entirely close the ileum.

The stricture is not necessarily the cause of all of your problems (and surgery to remove it might not resolve things). I've had mine for years too, and when the inflammation is gone I feel like a normal person. It was the inflammation, not the stricture, that caused the problem. If changing meds helps the inflammation, you may be able to live normally with the stricture.

Good luck.

A GI can tell from a colonoscopy (and sometimes other tests) if a stricture is from inflammation, scar tissue, or as in a lot of cases, both. The surrounding tissue to the stricture tells them a lot (is there active inflammation?), and sometimes the biopsy can tell you if the stricture tissue is fibrous, ulcerous, inlfamed, or not. This is not full proof, but it is how GI's make decisions every day on medications vs. dilation vs. strictureplasty, vs. surgical resection. It is an educated guess on the facts presented to them through the various tests, scopes and radiographs. I'm not saying it's fool proof, but what part of medical science is?

i went on remicade after a year of trying so many meds to help with peri-anal fistulas and abscesses.
the remicade was a miracle for me and i could actually get out of bed for the first time in so so long.
it put me into remission...until i started having extreme stomach cramping.
about 8 months after i first started remicade, i had a SBFT and it showed a major stricture in my illeum where i had initially had minor inflamation (that was from my initial diagnosis)
my GI actually told me that the remicade probably healed the inflamation so well, which then created all the scrar tissue causing a stricture.
he actually recommended the surgery right away, rather than waiting for an emergency situation.
i had a ressection a month or so later (may 2006) and have been in remission since then.....
until about 6 weeks ago..i now have peri-anal abscesses and fistulas again so i've just stared back onto remicade taking the risk of another stricture.
however, since my most recent colonoscopy didnt show any inflamation in my gut at all..i'm hoping that there's nothing to turn into scar tissue.
good luck with everything!

Hi I would just like to comment here that I can see a difference in size of stool passing threw and gage some of my decisions on how things are working if it is narrowing I would think stools would not be able to pass very good.Although the intestine is able to strecth.I don't know but that is how I think about it ,whether or not BM's are getting out. I am sure reducing inflamation lets things work better. lol gail