Question About Stricture Size

[ItsAlwaysSunny]

I am really excited because my MRI came back showing no active inflammatory bowel disease (I have Crohn's) for the first time in 20 months, but I am a little concerned about a stricture that was noted. The report says:

"There is a short segmental mural thickening within the terminal ileum, with the bowel wall measuring up to 0.6 cm. This extends over the distal 1.5 cm of the terminal ileum. The lumen measures approximately 0.6-0.8 cm in diameter. No pathologic mucosal or intramural enhancement is noted to suggest active Crohn's disease. There is minimal saccular dilatation proximal to the short segment stricture."

Later, under Impression, it says, "Low to moderate grade short segment stricture involving the terminal ileum, chronic in appearance."

I know you guys are not doctors and can't give medical advice and I will be seeing my GI in about 12 days, but I wanted other opinions from those who have had strictures. Does anyone have any idea if this stricture is significant enough that it might require surgery or is this something they may let me just live with? What size strictures have you decided to just live with and did you require surgery for it later? I am not having abdominal pain or difficulty eating and I hope to avoid surgery. Thank you!!

 

[nogutsnoglory]

I think factors that determine whether a stricture needs to be removed depends on the severity of the narrowing, pain, and whether the stricture is mainly inflammation or scar tissue. Inflammation can respond to medication but scar tissue cannot. If you aren't experiencing reduction in inflammation and pain is unbearable surgery may be necessary.

 

[Mehita]

I don't know if it helps, but my son's lumen measured 3mm and he could hardly even get liquids through. Pain, daily vomiting, and lack of growth topped it off. Based on his MRE, his GI and surgeon determined his stricture was due to built up scar tissue. He ended up having surgery.

Many people can manage with strictures for a very long time. Some adapt their diets (low residue, low fiber) while others might need meds to control inflammation. Like nogutsnoglory said though, if the stricture is due to built up scar tissue and is causing issues, then you might have to consider surgery.

 

[amrycrohns]

I was told by 2 surgeons that if the stricture is not causing me pain or symptoms that they see no reason to remove it. It may get smaller over time just because if how scars shrink, but if it's a non issue I would leave it a non issue. Unless of course you doctor highly recomends surgery and has valid reasons.

 

[ItsAlwaysSunny]

Thank you everyone for your replies! The stricture isn't causing me any pain right now, so hopefully I can avoid surgery for a while. I really appreciate your responses!

 

[alex_chris]

Thank you everyone for your replies! The stricture isn't causing me any pain right now, so hopefully I can avoid surgery for a while. I really appreciate your responses!

If you have no pain and no problems than you shouldn't worry. A narrow stricture in the smaller intestine causes bloating and the *gurgeling* noise whenever food goes through, you also end up with a lot of gasing and eventually pain without a possibility to get into remission long term. That's when you go for surgery because a. There is a risk of blockage and b. you want to feel better.

 

[Danico85]

Hi There

Like the previous posters said, it all depends if its an inflammatory stricture or a benign (scar tissue stricture).
If its inflammatory then you should not need surgery, you will firstly be put on a higher dosage of meds, maybe even steroids to get rid of the inflammation, they wouldnt give you surgery straight away, hopefully if the meds work the stricture will start to open up and it will be come easier to pass stool. If the stricture is scar tissue and is causing you problems passing stool then you will have to make a decision, because if it closes up then you will certainly require surgery.

In my case, i went for a recent colonoscopy and the camera wouldnt go through my stricture in my rectum and i was told that if the biopsey comes back that its scar tissue then id almost certainly require surgery, and in my case (where its located), it would have meant a full removal of my colon and rectum. Fortunatly for me it came back that the stricture was infact inflammatory, which was music to my ears, so im now on anal enema's and asacol suppositories, along with my usual meds and the bleeding seems to be decreasing quite well. But ive been told that inflammation over time may cause scar tissue to build up as it heals and that in the distant future i may still require surgery.

So my advice to you would be to find out if its inflammation or scar tissue.. thats the big question that has to be answered. If its infmammation then you will hopefully be able to tweek your meds and get on top of it but if its scar tissue then take your doctors advice.

But never get surgery if you dont think you require it. If heard stories of people who have went under the knife prematurely and have regretted it...

All the best

 

[ItsAlwaysSunny]

Thank you for the advice, Alex_Chris and Danico85. Danico85, I am glad to hear that yours was predominantly inflammation that doesn't require surgery right now. Best of luck to you in the future.

 

[RippMama]

How do they determine if it is inflammation or scar tissue?

 

[SarahD]

For a short stricture they could also do a balloon dilation to open things up enough to delay or avoid surgery. But like others have said, if it's not giving you any problems then doctors probably wouldn't recommend doing anything about it.

 

[Traumanurse]

Sunny:
I have a stricture also. Sounds like a lot of us do after reading the posts on here. It really helped knowing this is common with the disease. Mine is smaller than yours, so the Doc told me to stay on a very low residue/low fibre diet so things don't get "stuck" as they move through. Had a couple of bowel obstructions before I found out about the stricture. I have a very nice picture of the stricture right here by my computer to remind me why I have to watch my diet. But darn, never thought I would miss salads and fresh fruits and veggies, but I do! Alex-Chris described it VERY well!

Might want to watch your diet and exercise and take really good care of yourself so you can continue to be symptom free as long as possible.

 

[Danico85]

whats the best diets if you have a stricture?
ive never been told to watch my diet of any doctor since my diagnosis about 7 years ago.

 

[kat-y]

Danico, I was given a low residue diet to ease pressure on bowel pre surgery, Whenever I have issues with the bowel since then I go back to this basic diet in the hope that it helps, which it does.. a bit. Gastro consultant has never told me to do this, it came from the surgeon so you aren't alone in not being told to use your diet to help ...trial and error.

 

[lizbeth]

whats the best diets if you have a stricture?
ive never been told to watch my diet of any doctor since my diagnosis about 7 years ago.

Below is a link to dietary advice similar to info I was given by my dietitian, I don't see much difference to a regular low residue diet though.

http://www.cuh.org.uk/resources/pdf...e_for_managing_your_diet_with_a_stricture.pdf

I was given a really good one published by Nutrition and diet resources that's called dietary advice for managing strictures in Crohns, I tried to get you a link for it but seems I can only buy a pack not actually see it. Maybe if you tried calling your local hospital dietetics dept and asking if they had one they could give you. I did notice a difference when I started it.

 

[houston]

My stricture/scar tissue is 6cm long been put on azathioprine
to delay surgery.
Sandra