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7mm semi-sessile polyp in 20 year old

Hi Everyone,

A nervous mom here...just got back from scope and overall Crohn's in pretty good control with only mild inflammation in proximal ascending colon and moderate inflammation 15cm proximal to anus (going to ask about a suppository for this area) so it appears increasing Stelara to every 4 weeks is working. Last scope in February was a lot worse.

HOWEVER, the found a 7mm semi-sessile polyp approximately 10cm distal to the cecum. It was fully removed and biopsy was also taken of mucosa at polyp base and it that appeared normal on scope.

Biopsy results in 5-7 days.

Does this mean he is already at risk for cancer at age 20? I really wasn't expecting to worry about that so young. What does "semi-sessile" mean...?semi-flat? I know we need to wait for results but wondering if anyone else has had these findings, especially when so young.

Thanks as always for your experience, guidance and time!

Son dx at age 13 - only terminal ileum at that time
was on pentasa, then methotrexate
Crohn's spread around age 16 througout colon and rectum
Went on Stelara at 18 - helped but then flared - escalated to every 4 weeks which leads us to today.
Also did one round of Uceris when escalating Stelara which gave him normal FCP (21)....last FCP (off Uceris for 8 weeks) was 87....not sure what it would be today but likely most of this was from rectal inflammation.

Thanks again.
 
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Maya142

Moderator
Staff member
I'm going tag some other parents who may be able to help you:
crohnsinct
my little penguin
Tesscorm
Jmrogers4
kimmidwife

I'm really sorry to hear about the polyp but I'm glad he has improved!! How long has he been on Stelara every 4 weeks? Is he on MTX? Because if not, then maybe that would resolve the last of the inflammation.

Other things that might work - enemas may be an option. Actually considering the inflammation in 15 cm in, then an enema might be a better option than suppositories.

EEN could also be used to induce remission.

As for colon cancer, we were told at 8 years after dx they start scoping every 1-3 years to check for colon cancer. My daughter was diagnosed 5 years ago (almost 6) so we're not quite there yet.
 
Thank you for the feedback and for tagging some other parents. I was wondering if I should re-post this elsewhere. I hadn't thought of the enema option. We emailed his doctor today to ask about enemas and about the polyp in someone so young.

We will see what he says but I may also ask about enemas!

Thanks
 

Maya142

Moderator
Staff member
Hmmm...8 months at the higher dose and there is still moderate inflammation in the rectum and mild inflammation in the ascending colon? I know it's a lot better but considering that there is STILL inflammation, I would consider adding on MTX.

A suppository or enema may work for the rectal inflammation but it won't work for inflammation elsewhere and it seems like his disease is not quite under control yet.

My worry is that over time, that inflammation will lead to scar tissue and strictures - we've had some kids on the forum end up with complications from that.
 
He was on MTX for a long time (solo) and did not want to take it while in college due to effects on the liver. I wish he did and didn't drink, but I can't really make that decision for him. I also think it could have larger health effects on his liver if he is on it and continues to drink. He isn't a heavy drinker but does drink in college. He has 1.5 years left and then I hope he will be willing to escalate and add in MTX again. He did get some headaches on it but never too bad that he stopped.
 

Maya142

Moderator
Staff member
So, MANY adult rheumatologists allow their patients to drink on MTX as long as they do not drink too much. My older daughter was the same in college - she was told no drinking on MTX, so she wanted to come off MTX. She tried every single year in college and every single year she'd flare and go back on it :ybatty:.

Her rheumatologist told her she could have a couple drinks a week - just not to overdo it. I'm sure there have been times when she exceeded limit (my younger daughter said "yeah, like every other weekend" when I just told her what I writing about!). Anyway, she had a full and mostly normal college life which I am sure included parties and bars. Her liver numbers were checked regularly and they were absolutely fine.

So while I kept saying "you're going to hurt your liver," since her labs were fine, she didn't listen to me. And she was an adult - over 18 so there was not much I could do except tell her she would hurt her liver and that she had to be 21 to drink (she just laughed at that :ybatty:).

I made her talk to her rheumatologist who said drinking was ok, but not to drink a lot and not to drink on MTX day.

She wasn't on a very high dose of MTX though, she was on 15 mg, and one year she was able to taper down to 10 mg.

But the latest studies say that MTX and alcohol aren't as big a problem as doctors thought. The latest studies say that if you're not an alcoholic and do not consume excess alcohol, you should be ok, even on MTX.

Obviously, ideally he would stop drinking. But he's a college student. I understand wanting to save his liver but what about his gut? There is still inflammation.

It's something to discuss with your GI - he/she will decide how concerning the inflammation is.

Also want to add - college students do grow out of the drinking and partying phase. My daughter was at parties MUCH more often in the first two years of college. Ironically, by the time she was 21, she didn't drink much or go out very much. She said she had gotten sick of parties and bars and while she would drink with her friends, she only had 1-2 drinks.

I'll add links about alcohol and MTX. It is pretty well-studied in the rheumatology world.
 

Maya142

Moderator
Staff member
http://rheumnow.com/content/alcohol-and-methotrexate-what-do-you-advise

Price and colleagues reviewed MTX and alcohol in 2010 and made the following recommendations (Citation source http://buff.ly/1QLfgvI ):

Starting methotrexate mandates a good history asking about any previous or existing liver problems;
For patients starting methotrexate – they should be told that the evidence about alcohol use is limited. In the absence of preexisting liver disease, patients should be informed there is a 3% chance of severe liver disease if they drink more than 100g of alcohol per week (approximately 10-12 glasses/wk); also that taking no alcohol is the safest option;
All patients should receive regular liver function test monitoring while on methotrexate; and
Use the lowest dose of methotrexate to control disease activity.
http://www.rheumatologynetwork.com/rheumatoid-arthritis/ra-methotrexate-and-alcohol-may-mix-well-degree

https://rheumatoidarthritisnews.com/2017/04/03/new-alcohol-consumption-study-ra-rheumatoid-arthritis-patients-taking-methotrexate/

The studies are on patients with RA - not IBD. I'd guess there is more risk with IBD and I know they have found there is greater risk of liver issues if you have psoriasis.
 
Thanks so much for this Information! I will definitely discuss this with him and see what he thinks. I don’t think he is a huge drinker like his older brother who I hope slows down when he graduates in May! College years are trying with health conditions since that lifestyle tends to be so unhealthy.

I agree about getting RID of all inflammation and feel even more strong since he has a polyp. Still praying it is hyperplastic. His dad has had hyperplastic polyps but we will see. Dad dx UC at 22 but has been in remission without meds since 25. Still had scopes at 32,40 and 50 with 1-2 hyperplastic polyps each time.

Thanks again for this! It may open him up to adding it in.
 
Spoke to GI NP yesterday and this is the outcome:
1. Polyp was a sessile serrated adenoma - this is pre-cancerous and in the general population would warrant a follow up scope in 3-5 years. She was not too concerned about the polyp and said they felt it was likely not due to Crohns but I am sure we will never really know that.
Main Concern - active moderate inflammation in rectum with mild scarring/stenosis - want to get more aggressive with treatment:
1. Want to add in methotrexate injection (1st choice) or 6mp/Imuran (2nd choice). I used to due MTX injections when he was in high school but he does not want to learn to inject....they don't feel oral works as well.
2. Want him to begin 1-2 months of pred suppository while waiting for mtx or other med to kick in.
3. Sigmoidoscopy in 4-6 months (leaves for internship in late May so will do in April) to see if plan is working.

Questions: Do you all know about oral v injectable methotrexate? He would really prefer oral.

Thanks, wanted to give an update since I think it helps us all to learn when we see how things work out short and long term in threads.
 

Tesscorm

Moderator
Staff member
Sounds like his GI is on top of things and has a clear plan!

My son has never used MTX so I don't have any experience with it. I'm sure I've read though that there are fewer GI side effects (ie nausea) from the injection. With active inflammation, absorption might be a problem with oral, however, as his inflammation is in his rectum, I don't think this would be an issue. I'm sorry I can't be of more help re MTX.

But, I do agree with Maya re college kids 'settling'... I found the same with both my kids. The late teens/very early 20s (ie first couple of college years) seemed to involve lots more parties, drinking, etc. I suppose the novelty of the freedom and social environment begins to wear off a bit. If he's moving onto an internship, it'll take him into a more 'adult' environment, so the parties/drinking may taper off a bit. :ghug:

(And, yes, do appreciate the update... agree that it helps to see how others fare as time goes one. :ghug:)
 
Thanks. He emailed the doc about oral v injection so we will see what they say.

Thanks for your input - it will be nice when they calm down a bit!
 
I've had several pre-cancerous tubular adenomas over the years. My first was in my mid-20s. It was removed and I was told to have another scoping in 2-3 years. In my follow-up colonoscopy another was found. I think I've only had one where I was clear. I'm 37 now, so I've had my share of colonoscopies over the years.



Due to this, I'm on the "three year plan" for the rest of my life. The good news is most colon cancers are slow growing and can often be prevented through routine colonoscopies. Since he's only 20, he'll probably be considered higher risk than the normal population. This is a good thing, because it means he'll receive more frequent screenings.
 
Thanks for sharing that Mountaineer01. Do you have Crohn's disease? I am assuming you do since you are on this forum but wanted to confirm. If so, do they do the scopes more for your polyps or just to monitor Crohn's? They want to do a follow up scope in 1 year with my son and said given his polyp they would do one in 3 years if he was in a "general population." His disease needs close monitoring so they said they would be doing scopes more often anyway. I am glad you keep getting checked and are staying on top of this. My brother has tubular adenomas as well so he gets checked every 2-3 years and I get checked every 5 because he has had several. It is great we have this available for prevention. Thanks again!
 
Thanks for sharing that Mountaineer01. Do you have Crohn's disease? I am assuming you do since you are on this forum but wanted to confirm. If so, do they do the scopes more for your polyps or just to monitor Crohn's? They want to do a follow up scope in 1 year with my son and said given his polyp they would do one in 3 years if he was in a "general population." His disease needs close monitoring so they said they would be doing scopes more often anyway. I am glad you keep getting checked and are staying on top of this. My brother has tubular adenomas as well so he gets checked every 2-3 years and I get checked every 5 because he has had several. It is great we have this available for prevention. Thanks again!

I have Crohn's in the small bowel, ileum, and cecum along with scarring and a stricture in the transverse colon. Mine is a bit different, as it hasn't manifested itself in the lining of the colon beyond some superficial inflammation; however, my diagnosis came from an MRI enterography that showed significant exterior inflammation along with strictures and tethering in the small bowel.



The doctors I saw in my 20s (I'm 37 now) seemed obsessed with the fact that I had polyps at that age over figuring out what was causing my symptoms. While I'm glad I had the follow-up colonoscopies, I feel they weren't seeing the forest for the trees. It's a shame, but in a way one has to be their own doctor when dealing with a disease like this.
 
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