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Strictures caused by scar tissue vs. inflammation

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Posted 1/7/2013 10:08 PM (GMT 0)
Strictures are common in Crohn's patients over time.  The strictures can be either primarily scar tissue or caused by active inflammation.  Which one is worse: scar tissue stricture or active inflammation stricture?

Is it true that strictures caused by active inflammation can progress to even narrow opening in the intestines, while strictures mainly made of scar tissue tend to be stable over time?

Which one do you are you more concerned with?  scar tissue or active inflammation?

Posted 1/8/2013 12:41 AM (GMT 0)
Strictures can also be a combination of scar tissue and inflammation, not just one or the other. I think that's the type of stricture I have, as it's manageable while inflammation is kept low on Pred, but once I come off the Pred (ie inflammation increases), I start getting partial blockages again.

Probably fibrotic strictures are worse, since nothing will get rid of them except surgery. But if you have a mainly inflammatory stricture, meds have a chance of treating it.

I'm not sure about fibrotic strictures remaining stable. It makes sense in a sort of way, since scar tissue can't swell the way inflamed tissue can: it's rigid and fixed. But inflamed tissue can swell massively, depending on the depth of inflammation. Over time, inflammatory strictures can turn into fibrotic ones; as the tissue keeps on becoming inflamed and then healing, over and over again, a certain amount of scarring occurs with each healing episode. I'm not sure how long it takes, though - would be interesting to know.
Posted 1/8/2013 2:22 AM (GMT 0)
NCOT has it right. With a stricture caused by active inflammation, there's some chance that it will respond to treatment; with a stricture caused by scar tissue, that chance is gone and the only remedies are physical ones, like surgery. Unfortunately, scans or scopes can't determine which type of stricture you have.

In 2004, tests revealed a footlong stricture in my terminal ileum (or what was left of it, after a resection five years earlier), where my small intestine was narrowed to half its normal width. My doctor put me on 6MP. X-rays over the next few years showed that the same area was now back to normal. So we could conclude that the narrowed area had been caused by inflammation, rather than by scar tissue. I felt as if I'd dodged a high-caliber bullet!

So both scar tissue and inflammation are reasons for concern--since, as NCOT explains, inflammation, over time, can become scar tissue. If you react early enough, and if your body reacts well to treatment, you may be able to avoid surgery and even to achieve remission, at least for a while.
Posted 1/8/2013 4:49 AM (GMT 0)
Thanks for the replies.  The latest CT Enterography technology can tell the difference between scar tissue strictures vs. inflammation strictures.  I had a CT Enterography done last week, which shows multiple strictures.  But the doctor said most of inflammation is gone (when comparing to my last CT Scan 5 years) and most of the strictures (over 90%) are scar tissue related.

Scar tissues are healed wounds and if they cause strictures, they should not grow even more narrow in the intestines, right?  Also, does Remicade promote scar tissue formation?

 

Posted 1/8/2013 6:03 PM (GMT 0)
I have heard of people living with a stricture for years, so, yes, as long as your inflammation remains minimal your strictures should not get worse.

Re Remicade: That's a difficult one :-/ The short answer is 'possibly'. This is quite an interesting post on the subject:

www.medscape.com/viewarticle/729747
Posted 1/8/2013 8:23 PM (GMT 0)
NCOT: your article requires a login name and password.

I have had strictures in my small intestines for more than 12 years and have not have surgery as yet, because my symptoms are manageable. 

I read a lot of research paper today and found that the resection rate tends to be high during the earlier years since diagnosis.  A Danish 2008 study shows that cumulative incidence of intestinal resections was something like 35%, 45% and 60% at year 1,5,10 respectively since diagnosis.  The resection rate curve is very steep in the earlier years of diagnosis.  Thanks

Posted 1/8/2013 9:35 PM (GMT 0)
It doesn't :-/

Unless you are talking about the link within the post; yeah, that does, but you can still read the answer from the doc in the link I gave. I quote:

The rate of SSOs (stenosis, stricture or obstruction) in infliximab-treated patients was about twice as high as in controls (1.95 events/100 patient-years vs 0.99 events/100 patient-years). The adjusted odds ratio was 1.7 (meaning that infliximab-treated patients had a 70% higher rate of SSOs), but this effect was not statistically significant.

In plain English, 2 out of every 100 patients had a stricture or obstruction on Infliximab, compared to 1 out of every 100 patients on non-biologic antiinflammatories. So, yeah, more patients on Infliximab developed strictures, but at those odds, I wouldn't be having sleepless nights over it either.

(Although, with bittersweet irony, I think I may have been among those 2 out of every 100 patients. Hard to tell, though...)
Posted 1/8/2013 9:50 PM (GMT 0)
The link in your post requires a registration.  That is what I was referring to.

Anyway, if the purposes of the treatment is to avoid strictures and obstructions, why would we want Biologics, which have higher probability of causing strictures and obstructions in the first place?  I remember I spoke to my GI last month, who told me that the more recent research shows that Biologics does not hasten the formation of strictures/obstructions.  I do not know which one is right. 

Posted 1/8/2013 10:03 PM (GMT 0)
'Cos for the vast majority of people with inflammatory disease, the biologics do treat the inflammation without creating strictures. If you want to read those stats another way; 98 out of 100 patients on Remicade didn't get a stricture or an obstruction.

I don't know about that recent research, but I'm sure your GI is right. Besides which, untreated inflammation is surely a lot riskier than taking Remicade.
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