Scar Vs. Inflammation

[nogutsnoglory]

It seems doctors can never be sure either from colonoscopy, SBFT, CT scan or MRI whether what they see is inflammation or scar tissue.

I never know whether to try meds or if I should just have surgery. If its just inflammation I would want to try medicine.

 

[Jennifer]

What about the Fecal Calprotectin test or CRP? Even then chances are you're dealing with both. I know before my resection I had both and the medicines I was taking at the time (Asacol, 6MP, Prednisone and Entocort) weren't getting the inflammation under control so we opted for surgery. I took high doses of all four of those meds for about a year before we went through with surgery. In my opinion surgery is a last option unless you're clearly dealing mainly with scar tissue because no meds will help that.

 

[nogutsnoglory]

That's what is so hard to know, it could be 90% scar but with some inflammation those markers will be up.

Those tests have tricked me before and aren't terribly accurate for me personally. I had a totally fine ESR and CRP days before I underwent a big bowel resection. Go figure.

 

[SarahD]

This is a problem I'm facing too so I'd be interested in any responses you get. I see surgery as a last resort too - I'd much rather try medication to bring inflammation under control, but if medication fails to control the inflammation or scar tissue is the cause of your problems then surgery becomes the more attractive (only?) option.

I was under the impression that an MRI with contrast could distinguish quite well between inflammation and scar tissue, but after my last appointment with my consultant I'm not so sure anymore.

 

[nogutsnoglory]

Surgery should always be last resort but I'm also always scared of emergency surgery. I'd rather book an appointment with a good surgeon rather than obstruct and have a non IBD specific surgeon operate.

 

[CrohnsCanuck]

I waited and by the time I went, I was the worst the doc had seen in a non emergency case :-(

That said, life was simpler, albeit more painful, before the surgery. Like any decision, you weigh the risks and take a bit of a leap.

Keep in mind that some of the more aggressive pharma treatments have side effects that rival surgery these days.