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Is there anything that can be done about scar tissue?

You may want to read through the wiki page for strictureplasty, I know some members have had that instead of a resection or had it a couple of times to stretch open the area before moving on to surgery.
 
Since my son isn't having any trouble eating or going now, does that mean he won't need surgery, unless he flares again - causing more inflamation and possibly more scar tissue?

My son REALLY fears surgery.
 
I don't think anyone could say with any certainity whether he will eventually require surgery.

At the time of my son's last scope they were unable to get through the IC valve with the camera, a year earlier they were able to get through the ICV(although it was different GIs). When I asked did that mean he would require surgery the GI said it may be required at some point but as he wasn't experiencing any symptoms due to the narrowing and that there was no ballooning(he used a more scientific word that Tesscorm has used) above the narrowing then right now it didn't need to be considered. Also the scope and MRE done at that time showed very little inflammation so the narrowing was most likely scar tissue.
 
Also meant to add that since scar tissue can shrink which causes the stricture to narrow more over time then even if there isn't another flare something may eventually need to be done to resolve the stricture(strictureplasty in some cases or resection)
 
Yah, they don't understand why in some people the stricturing stops and in others it keeps going even without inflammation present.

Most of the stricture formation is from the deposition of collagen during and after the wound has healed. How the wound actually heals, depends on the person, some people have too much transforming growth factor that causes too much tissue to accumulate, but having too few TGF means the wound won't heal at all. TGF beta 1 is the most important cytokine in the wound healing process, it needs to be balanced correctly to avoid stricturing.
 

Tesscorm

Moderator
Staff member
Clash - proximal dilatation ;)

Kiny - not sure if this question even really makes sense but... I believe a mutation in NOD2 may indicate a greater likelihood of fistulizing disease but does it also indicate a greater likelihood of stricturing disease? Or is there no connection between NOD2, fistulizing or stricturing??
 

my little penguin

Moderator
Staff member
Also keep in mind the age of dx plays a role. They know those over five but less than 15 at dx tend to have a different path / gene at work than adults/adolescents .
Plus the nod2 studies were in adults . Adults tend to have what they have in other words if they have stricturing then it stays stricturing. Kids tend to all start inflammatory and then grow into stricturing or fistulizing or both as they grow up .

The science hasn't caught up to our kids yet :(
 
Kiny - not sure if this question even really makes sense but... I believe a mutation in NOD2 may indicate a greater likelihood of fistulizing disease but does it also indicate a greater likelihood of stricturing disease? Or is there no connection between NOD2, fistulizing or stricturing??
Yah, people with NOD2 mutation tend to have worse disease, they'll have more stricturing too as a result. NOD2 doesn't have anything to do with stricturing directly afaik, it's involved in bacterial recognition and it directs autophagy to kill bacteria. But a NOD2 defect just gives you a worse disease prognosis, which is gonig to make it more likely you have strictures.

I never got tested for NOD2 mutation and I don't want to, I don't know how it would help me, my doctor said he could test me but he asked how it would improve my life if I knew, and I realised it probably won't, so I prefer not to know.
 
Thanks Kiny, Jack had the Prometheus Prognostic as his GI wanted a bigger picture of his disease as he didn't easily fall into a catergory (who does) and he does have the NOD2, it didn't make a difference in our current treatment only because the scope he had done at the same time showed healthy tissue.
He does think there is stricturing in the small intestine and we had talked about doing an MRI/MRE but since he is feeling well and would not change the treatment we are just holding off and watching
 
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Tesscorm

Moderator
Staff member
Stephen's GI booked him to have the prometheus test the day before his next infusion. During the apptmt, I had asked how we would know if the remicade was working (ie MREs?), how we would know if the dose needed to be changed, etc. GI said he was going to test therapeutic levels before next infusion. It only dawned on me that he was probably referring to the prometheus test as we were scheduling it with the secretary (secretary confirmed yes). I'm not sure if these are two separate prometheus tests - does the same test look for therapeutic levels, antibodies AND NOD2?

And, back to Amy2's questions re strictures... I think Clash is right about the strictoplasty being a possibility. Not sure if a current stricture worsens or what could cause it to worsen but I imagine comparisons between MREs, over time, would indicate changes in the stricture.
 

my little penguin

Moderator
Staff member
Tess
The Prometheus test HASA IS WHATyour doc is probably ordering.
It just checks for antibodies to remicade and trough levels ( amount if remicade in his system)
Typically it is run four weeks after your last infusions .
 
Also it seems strictureplasty is only an option if the Stricture is small in length or am I getting that wrong? Oh and of course location too.
 
At diagnosis, we were told that if my son had inflamation, the treatment would work and my son would begin putting on weight. If it were scar tissue, he would not. When he began putting on weight, we thought we'd dodged a bullet.

But, now my son has so much scar tissue that the dr can feel it with his hand. :(
My son was upset by the news - so I didn't question the dr about it, much.

Shouldn't we have that scanned so we can see exactly how bad it is? Or do we just wait for it to cause trouble? Is it possible it won't cause trouble?
 

Kev

Senior Member
I don't know if this helps, or is even pertinent... for those who want to see actual scar tissue, I posted some pics on here (someplace) of mine. My disease has only "officially" involved my colon (the laproscopic surgery was never biopsied, so 'disease' in the upper tract has never been confirmed).. but in the colon I have had both Crohns N Ulcerative colitis.. and you can see in the scar tissue formations what can typically happen. There are stalagmites/stalagtites of tissue.. some joined, even forming like a peace symbol. These appear to be internal fistulas... spanning the much larger diameter of the large colon.. There is also a lump of scar tissue... you can see how it changes the shape of the colon from a circle, to a crescent moon... just accumulated on one side, narrowing down the passage.. a stricture. Picture these formations in the much smaller upper GI tract.. and it helps formulate an idea of how bad it can be..and how scar tissue doesn't follow 2 dimensional thinking. I 'used' to assume scarring inside me would be like, say a sunburn on my arm.. only inverted. My 'imagination' didn't do the actual disease justice.

Like, those photos aren't for the squemish, and there is a definite distinction between the lower & upper tracts.. but if one wants a close visual approximation, feel free to look
 
Like, those photos aren't for the squemish
I should have seen pictures of crohn's disease earlier, I might have taken my disease more serious. It's a shame that not more people know what a serious disease this is, it needs more attention.

For the squemish, here is a picture of a normal intestine and a stricture on a pretty histology slide (it's a small intestine of someone sliced and put under a microscope).

A: normal unaffected part of the ileum:





B: A strictured part of the ileum, the arrows show the collagen

you can see how many thick layers of different tissue, collagen together with regular cells there is, that's causing the inner diameter to become smaller, and you get stricturing

 
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