How long for scar tissue to form?

[Sea_Star]

Hi all, this is something I will ask my Dr next time I see him but...how long does it take for scar tissue or stricture to form?

My colonoscopy in May didn't show any, just mild inflammation and I was on Entocort 6mg from June to Oct 9...Pentasa 2g from Sept 17th. Started 6mp Oct 27th but had to stop this Thursday awaiting labs...I've had to increase Pentasa to 4g since the RLQ soreness has appeared and increased since stopping Entocort. I've been non-compliant due to fear of med risks, but something clicked this week with that soreness and I'm afraid things progressing...

Can Pentasa act as a barrier? I never thought I'd say it, but I hope to get back on 6mp ASAP! I've tolerated it in the past...

Will hear from nurse this week..

 

[Clash]

Pentasa is rarely enough to stop disease progression as it only affects the top layer of the bowel and CD is transmural affecting all layers. Also it would depend on the location of your disease as to how effective it may be. Each 5ASA drug is formulated to release at different ph levels and therefore different locations in the bowel.

As far as stricturing by scar tissue or fibrosis would depend on a few variables, I would assume. Stricturing caused by inflammation can also form and is something your GI would be able to inform you more about.

A sure sign for my son that inflammation was active in his TI was that it could be felt when palpitated. This also caused him pain.

 

[Sea_Star]

I'm starting to realize that Pentasa might not be enough, as it's been a couple days since increasing to 4g.

Was it RLQ where he felt pain? Or did it radiate elsewhere? Also, I'm sorry if you mentioned this before but did your son have scar tissue or stricturing?

 

[Clash]

Yes it was RLQ, to the right of the belly button. He didn't necessarily feel the pain unless the area was palpitated. The GI could feel the area and tell there was inflammation or fibrosis present.

He had stricturing but it was not fibrotic(scar tissue) it was from the swelling of active inflammation. And although he was asymptomatic when surgery was performed the surgeon was utterly surprised at the severity of ulceration and intestinal fissures present in that area.

 

[Sea_Star]

If it was just inflammation, how come he resorted to surgery? Was the Remicade not enough?

 

[Clash]

He had been on remicade for almost 2 years, we had shortened the scheduled and upped the dose to high dose remicade, 15mg/kg and he had also been on methotrexate for about a year of that time.

There was some betterment showing between initial colonoscopy, MRE, FC result and each subsequent test(yearly for each). But no the meds didn't get him where he needed to be. We are only on a trial of remicade as the GI really feels C is one of the patients that doesn't respond to anti tnf drugs. Our next step would be other biologics in which the mechanism isn't tnf alpha blocker.

 

[Sea_Star]

Hm, was 6mp ever an option? I understand the biologics work faster supposedly, but as one pretty asymptomatic Crohnie to the mother of another, 6mp put my inflammation to rest completely...sure there was some period of inflammation after tapering Entocort with a Pentasa bridge, but it definitely worked...

Is he having symptoms post-surgery?

 

[Clash]

He isn't having symptoms after surgery, but that is no different than before.If other meds were to fail we might try 6MP. At the time my son was put on remicade studies had been published showing that the risk for young males on combo therapy or those that had been on thioprines and later moved to biologics(or vice versa) were at higher risk for HSTCL, a rare side effect and low risk. But due to this, the GI usually px'ed the thioprines to girls and methotrexate to boys. Since then other studies have had different outcomes and mtx was included in the risk.

Since C also has SpA and needs a biologic to treat it as well 6mp hasn't been discussed.