How long until mucoscal healing?

[Optimistic]

Random list of questions for anyone that might know.

How long after various treatments begin does it take or when should you see mucoscal healing? I know that is the goal, but how often does it happen?

I've also been reading about the difference between mucoscal healing and histologic (microscopic healing). Same question - how long does it take to achieve the microscopic healing and does that generally happen?

And, I know some level of inflammation can be missed in scopes that show up in a biopsy. Can MREs miss inflammation?

Is there a difference between inflammation and ulcers and do the they show up on same or different tools or tests?

 

[Mr chicken]

The last two to three scopes Ds has had mucosal healing
No signs of inflammation visually or on biopsy samples
No signs of inflammation on mre
And normal bloodwork/fecal caloprotectin
No signs of ulcers ever except for two found on a pill cam
Clean scope after year on biologics
Scope was not clean after 8 months after dx on EEN /6-mp despite clean bloodwork /cte

 

[Maya142]

On Remicade and Methotrexate, it took just 8 months before we saw mucosal healing for my daughter. The only place that still had inflammation was the terminal ileum, and that was not so bad. Her stomach and entire colon were "beautiful" (as the doctor put it!) and biopsies confirmed that. All the ulcers in her colon had healed.

I guess it would depend on the treatment and how the child responds. With my daughter, we had not treated her aggressively enough for her arthritis and it got really bad, so when she was diagnosed with Crohn's we did not want to make that mistake again. So we treated her very aggressively and she got better relatively fast (whereas her arthritis is STILL a mess).

I think there is the potential for any test to miss inflammation, including MRE's.

Good luck!

 

[Tesscorm]

Mucosal healing varies. Crohns is so frustrating as there are so many variables. My son was on EEN and then supplemental EN for two years - he reached clinical remission (no outwards signs) but inflammation was present throughout the two years. We moved to remicade two years ago and, while I can't say exactly when mucosal healing took place, his recent scope showed complete mucosal healing and biopsies were clean. So, in his case, it took four years. But, EEN did take his inflammatory markers right down to normal... if we had started remicade at that time, perhaps he would have had complete remission in six months or less?? As trial and error of treatment options can sometimes play such a large role while trying to reach remission, it's impossible to work within a 'typical' timeline.

And, as was mentioned above... I think all tests may miss something. I treat each test as a piece of the puzzle.

 

[kiny]

Is there a difference between inflammation and ulcers and do the they show up on same or different tools or tests?

Yes, it's not the same thing, ulcers are a consequence of inflammation. Inflammation is caused by the immune response and upregulation of inflammatory cytokine like TNF-alpha.

A good example is infliximab, when people take it (and this happened with me also), you can feel better 30 minutes after the infusion, especially on your first infusion. Within a day the pain can be gone, as many will attest to, because the inflammatory cytokine are downregulated and this lowers the pain.

However, even though your CRP will drop and pro-inflammatory cytokine in the blood will be lower and anti-inflammatory cytokine higher..., mucosal healing can take several weeks to months.

 

[kiny]

Can MREs miss inflammation?

Yes, but an MRE is a good diagnostic tool combined with a colonoscopy with a biopsy. A colonoscopy can show mucosal inflammation, uclers, granuloma, inflamed peyer's patches, and you can take biopsies.

MRE can show things colonoscopies can't show, transmural inflammation, wall thickening, fistulae. It's a good tool that can help during diagnosis, because crohn's disease, features transmural inflammation, which UC any many other intestinal diseases, do not, and transmural inflammation and wall thickening can easily be seen on MRE.

 

[crohnsinct]

It is hard to answer the question of when mucosal healing occurs because that can only be confirmed with scopes and biopsies and if things are going well clinically you won't have those very frequently. For example if you scope a year after you started treatment and find mucosal healing you really don't know if that occurred when symptoms went away or a month prior to scopes.

We were confident in O's status for three years. Did her routine scope, everything looked great but biopsies showed microscopic inflammation.

Yes, in our case MRE missed T's disease. Good thing we had done scopes prior so doc saw the inflammation, ulcers etc and biopsies confirmed what he saw. But the totally clean MRE's at least made us somewhat confident her disease was contained to what the doc saw.

 

[Optimistic]

Thank you all for the replies. You are so kind to share your knowledge with newbies. I'm glad I found this place!

Does anyone know how common it is for crohn's patients to have inflamnation they never get rid of?

crohnsinct - was the inflamnation decreased from where it had been 3 years before? She went on new meds and then when was it all gone (hoping it is!)?

 

[Mr chicken]

Inflammation goes away with the right meds - scar tissue does not
Mre can't tell the difference between the two

 

[crohnsinct]

Oh absolutely it is much less than it was. But no, it isn't all gone. She hasn't changed meds at all since dx. Started Remicade at dx and still on it. Added Mtx a year later. When O was dx'd her colon was a war zone. 3 years later GI scoped and said it looked pristine, It wasn't until the biopsies came back that we knew there was microscopic inflammation. But still no symptoms so I am confident that after the Fecal calprotectin test and possibly the Remicade levels test we will attack this inflammation head on and take care of it with tweaks to the Remicade dose or schedule.

 

[SupportiveMom]

Because of its invasive nature and probably insurance restrictions I have never been able to have a scope done on my kid in less than a 6 month interval. MRE 9 months. Since these are the only reliable tools to determine mucosal healing it would be hard to know how long it can take. I hope there will be other tools soon to determine healing.