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Can Remicade make a Scar Tissue Stricture worse?

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Crohn's Disease
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Posted 3/7/2016 11:14 PM (GMT 0)
My son - age 19 was dx with Crohns last summer. He was almost immediately put on remicade and Imrun (a few weeks after being prescribed probiotics and Pentasa) because of his age and his inflammation markers. The only symptom he had was ongoing diarrhea - no abdominal pain. His colonoscopy / MRI (August 2015) showed a asymptomatic stricture in the Terminal Ileum but it was unknown if it was from the inflammation or scar tissue. He has been responding very well to remicade for the diarrhea. He has had C- Diff (just finishing up a recurrence) and over the past three months has had very strong abdominal pain that the Drs attributed to C - Diff. One week ago he had ongoing vomiting and additional abdominal pain - but no diarrhea. We finally brought him into the ER (after several trips to the GI clinic) and he was immediately put in for five days (constricted stricture, hole in the esophagus from vomiting and C - diff). The doctors were much more concerned about the esophagus tear which fortunately self healed. How can he NOW have abdominal pain when the Remicade treatment is obviously working for the inflammation? Although there was a parade of different doctors in and out (GI, hospitalist, Infection Doctor, surgeon) no one seemed to know. I am diligently researching this and have found several research studies which state that Remicade can increase the size of stricture scar tissue? Has anyone heard of this? Also his primary GI thinks a dose of steroids might be beneficial? Any insight is GREATLY appreciated! Although I certainly believe doctors this "been there done that" is so beneficial to me!
Posted 3/8/2016 11:08 AM (GMT 0)
I'm sorry to hear that your son is having so much trouble right now. To answer you question, Remicade can certainly be the cause of stricturing, but in a round about way. Remicade works incredibly fast for most. If there's alot of inflammation present, it can heal so quickly that it can produce scarring.

Whether it's a problem depends on his symptoms. Was he ever feeling like he was suffering a blockage, or does he get severely constipated? Does he ever feeling like vomitting? How's his appetite.

You very likely need to get some diagnotics done. I would highly recommend an MRE. It's the easiest test to get done, while being very concise.

I'm only guessing, but severe strictuing isn't usually seen in the recently diagnosed. It's usually found in those that were left untreated or under treated for a very long time. It sounds like your GI is progressive since he got your son on Remicade early.

Good luck, hope he's feeling better soon.
Posted 3/8/2016 10:32 PM (GMT 0)
Thanks for your insight. He has never felt like he has had a blockage and has not had severe constipation. He only started vomiting the week before his hospitalization. He did have an MRE prior to all of his treatments (last summer) but I will recommend he gets another one! He is feeling better soon - and back to school (for now). We are hoping to get this figured out - so he can either have surgery or stay better for a while!
Posted 3/8/2016 11:10 PM (GMT 0)
Sounds good Betty,

Definitely push for another MRE. It doesn't sound like he's having the typical stricturing symptoms, so even if he does have a stricture, he may very well be able to live with it. My Daughter has been in that boat for quite awhile. Even if the stricture needs to be treated, there are other options than just resorting to a resection. Many get a baloon dilation done with good results.

Once again, I hope he's feeling better soon.
Posted 3/9/2016 2:54 AM (GMT 0)
Remicade and Humira do cause narrowing higher up in the bowel at the TI. Due to this I have had 4 balloon dilations done over 13 years. Saved me from having further bowel resections. (I've had 3 already in 34 years) This is done during a colonoscopy. My symptoms were abdominal pain, and a tightening feeling around my rib cage (middle). I still went to the bathroom (diarrhea) but one does have gas pain. I just had a colonoscopy done and I have a stricture and inflammation at the resection site. Oh Goody!

I think he needs a colonoscopy for biopsy of inflammation and dilation if needed. One test - done.

All the best,
Julia
Posted 3/9/2016 3:20 AM (GMT 0)
Well to be fair, they can cause this but not necessarily for everyone on either biologic....at least I hope I never have this issue from Humira especially since I take it weekly....but I do have some rectal scaring myself, which was from my over 2 decades of flaring without remission, not from the Humira (which I've been on for 2 yrs now) and I sure hope the Humira doesn't make it worse.
Posted 3/11/2016 12:36 AM (GMT 0)
Thanks for this insight! His GI has sent him to a Colo rectal surgeon to discuss the stricture. I will be armed with questions. I hope that reminde is NOT doing the scarring since it works so well for the diarrhea. I also hope he can have a dilation instead of surgery. One day at a time. This site is truly a lifesaver....
Posted 3/14/2016 9:07 PM (GMT 0)
Hi Betty,

I'm sure that you can continue the remicade after the balloon dilation, I did. I would still be on it if it wasnt for the lupus.

All the best,
Julia
Posted 3/14/2016 10:09 PM (GMT 0)
That is my hope too. We will see the surgeon tomorrow and our fingers are crossed that he can do a dilation and not need surgery! And then continue with Remicade which works so well for the diarrhea! Thanks to all of you for your support!
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