Crohn's disease inflammation

[B542]

"I am suffering from a stricture in the area where the cecum meets the small intestine. I recently had a CT scan, and the results showed some important findings. There is thickening of the intestinal wall with submucosal edema and increased mucosal enhancement, particularly in the cecum and terminal ileum, leading to a lumen narrowing that extends over 4.2 cm with a wall thickness of 1.2 cm. Additionally, mild fat stranding was noticed around the stomach, with two small pockets near the cecum, one measuring 2.4 cm and the other 1.1 cm. There are no fluid collections or signs of bowel obstruction.

The medical impression indicates mild active non-obstructive stricture due to Crohn's disease in the terminal ileum area, with two small pockets around the cecum. The CRP level remains elevated even after completing a course of corticosteroids at a dose of 40 mg, with a gradual reduction to 5 mg.

As for the treatment, I have been on biologic therapy (Stelara) every four weeks for the past nine months, but unfortunately, I have not noticed significant improvement in my condition, which has led to feelings of frustration. Is the medication unsuitable for my condition? Please, I would appreciate any advice."

 

[Scipio]

No two cases of Crohn's disease are exactly alike. Medications that work well for one patient may fail miserably for another. Like you, I have Crohn's inflammation in the terminal ileum with non-obstructive stricturing in that area. But unlike you, Stelara (90 mg every 8 weeks) has worked very well for me, keeping me in remission with only very mild residual inflammation still present and almost no symptoms at all for 7 years now.

I'm surprised that your doc is still prescribing Stelara after 9 months of futility. It may be past time for you to request that other medications be tried, say Remicade, Humira, Entyvio, or even Skyrizi. It's clear that Stelara is not doing the job.

 

[B542]

No two cases of Crohn's disease are exactly alike. Medications that work well for one patient may fail miserably for another. Like you, I have Crohn's inflammation in the terminal ileum with non-obstructive stricturing in that area. But unlike you, Stelara (90 mg every 8 weeks) has worked very well for me, keeping me in remission with only very mild residual inflammation still present and almost no symptoms at all for 7 years now.

I'm surprised that your doc is still prescribing Stelara after 9 months of futility. It may be past time for you to request that other medications be tried, say Remicade, Humira, Entyvio, or even Skyrizi. It's clear that Stelara is not doing the job.

Thank you for sharing your experience. I was wondering, was the length and thickness of your stricture similar to mine? And how many months after starting the treatment did you start feeling better?
Honestly, I’m surprised by the doctor as he didn't try other medications. I was expecting it to take a year to change the medication

 

[Pangolin]

My guess is that you're going to need surgery to remove that stricture. The medicine will probably work better after that stricture is gone.

 

[Scipio]

Thank you for sharing your experience. I was wondering, was the length and thickness of your stricture similar to mine? And how many months after starting the treatment did you start feeling better?
Honestly, I’m surprised by the doctor as he didn't try other medications. I was expecting it to take a year to change the medication

I don't know the dimensions of the stricture, only that it was narrow enough that the doc could not pass the colonoscope through it in my most recent colonoscopy. The ileal area of thickness/inflammation was 6 cm long back when it was first diagnosed years ago. I don't know whether it is any longer or shorter today - I assume the same or shorter since the Stelara has all but abolished the inflammation.

 

[B542]

I don't know the dimensions of the stricture, only that it was narrow enough that the doc could not pass the colonoscope through it in my most recent colonoscopy. The ileal area of thickness/inflammation was 6 cm long back when it was first diagnosed years ago. I don't know whether it is any longer or shorter today - I assume the same or shorter since the Stelara has all but abolished the inflammation.

After treatment, how many months did it take for you to feel comfortable?

 

[B542]

My guess is that you're going to need surgery to remove that stricture. The medicine will probably work better after that stricture is gone.

Do you think my condition is closer to surgery and why?

 

[Pangolin]

Do you think my condition is closer to surgery and why?

Strictures are pretty serious and often require survery. If Stelara didn't substantially reduce the stricture, it's unlikely any other medicine will, either. You can try, but if it doesn't start going away soon, you'll really want to get that out.

 

[B542]

Strictures are pretty serious and often require survery. If Stelara didn't substantially reduce the stricture, it's unlikely any other medicine will, either. You can try, but if it doesn't start going away soon, you'll really want to get that out.

But it may not be suitable for my case

 

[Jo-mom]

My son has a similar case to @Scipio where scope could not pass through in his colonoscopies. However, it's been now 6 years, and he has no pain and is on Remicade and MTX. Although one day, he might need to have surgery, it can be many years from now, or it can be months, but he is doing well (like Scipio) and the obviously when/if the time comes, then surgery would be the right option, but for now, it's not necessary.

 

[Scipio]

After treatment, how many months did it take for you to feel comfortable?

My Crohn's symptoms began to noticeably improve within 2 to 3 weeks after the initial loading dose. I achieved my current level of remission within 6 weeks to two months. But others have reported it taking longer, several months, for the Steleara to kick in. However, I've never heard of anybody suddenly having success with a drug after 9 months of failure.

As for surgery, despite the stricture that the colonoscope could not pass, my gut seems to be functioning well on Stelara - month after month, year after year. So unless something goes wrong and food can no longer pass the stricture, I do not plan to get any surgery. If it ain't broke, don't fix it.