Fistula/Stricture combo treatment question

[Jakestep128]

Hello! I got diagnosed with Crohn's mostly in the TI 9 years ago, and took entocort which put me in remission and held on 6mp. Then I made a dumb decision last year and stopped taking the 6mp and got another flare up :ybatty:. Started taking entocort again and 6mp, and still on them now and it helps but am definitely not in remission. My two main symptoms now are a fistula and a stricture in the TI, about 50/50 scar tissue and inflammation according to GI. Doc wants me on Remicade, and that sounds good because Remi is generally good for fistulas, but am scared that it will make the stricture worse and cause an obstruction. Would you guys say do the Remicade or does another drug sound better for me? I'm a bit scared and don't know what to do. Thanks!!! <3

 

[PsychoJane]

Hi!
Well well well, I must say that I haven't done much research on the effect of anti-tnf on stricture type crohn as I don't have that condition. I don't know if Remicade could worsen the stricture, I thought all it could do would be beneficial. Maybe someone else can clarify that point?

For fistula, it is definitively a plus. Generally 6MP helps them so chances it is now a need for you to introduce the biologics to improve your condition on that aspect.

 

[Jmrogers4]

I don't think any of them are going to take away the scar tissue if that is what is causing the stricturing but remicade will reduce the inflammation so should help in that sense.

 

[deedee]

None of the IBD drugs should cause a stricture to worsen. I hope you get some relief soon.

 

[Clash]

I do understand about the strictures and for a time it was thought that Remicade did cause stricturing or played a role in stricturing but I do believe that was debunked although someone else might have more info relating to it. I'm going to tag kiny they might can give you more insight.

You could also use our search tools and the key words Remicade and strictures, it may pull up the thread that discusses the Remicade/stricture theory.

 

[kiny]

Yah, the remicade (and humira) causing stricturing is still not solved. The first few big studies in hospitals saw stricturing after remicade use. Stricturing happens when a wound doesn't heal correctly, it heals too fast, there is too much deposition of collagen tissue, there is fat wrapping or other issues. Remicade tends to make someone heal up really fast, which is maybe why they see stricturing sometimes.

Later people debunked that by showing it doesn't happen in mice, and remicade actually blocks some of the cytokine that promote stricture formation in vitro.

So they went over all the studies again and said it might be because of the steroids that were given prior to the start of remicade (remicade was used for patients that were unresponsive to steroid treatment, many were on a high steroid dose before starting remicade)

I personally think it can cause stricturing, I have a little bit of fibrosis and it happened years ago when I had remicade for a few months, but I was really sick back then, I did get entocort before (a corticosteroid), so I am not 100% sure.