Stricture Update / Doctor Visit Today

[MCPayne]

Hi everyone.

I posted quite awhile back stating that I had both a colonoscopy and a barium enema test. The reason being, in the colonoscopy, they encountered a stricture which they couldn't get passed, and they did the barium enema test, which at first, during the pictures, the radiologist couldn't see the stricture. However, in the report he sent to the doctor, he said there was narrowing of the colon, so he did see it.

Anyway, I saw my doctor today. As far as the stricture, there's no immediate need for surgery, as I'm still able to have bowel movements relatively easily. The stricture is small, but didn't specify how small. In the future, if I do need surgery, he said I most likely wouldn't need the bag. I'm guessing they'd just remove that section, then if they can, stretch the colon down if it comes to that.

My doctor wants to do another colonoscopy, this time trying a smaller scope to see if he can get passed the stricture. I don't know what scopes he tried last time, but did say he used 3 different scopes, including an upper endoscopy scope. I think this time he may try a pediatric scope, and if it comes to that, a pediatric upper endoscopy scope, which is the thinnest of all the scopes.

Also, maybe any good news coming out of this is that he wants to stop the Humira, which he'll wait and do after the colonoscopy, which is scheduled for mid-March.

I also have to have a couple routine tests done, one of which is a DEXA scan, and the other iron tests, as I'm taking iron supplements, which poses a risk of constipation. After I do those tests, if it turns out I don't need them, he'll take me off of those as well.

I'll keep you guys updated, maybe in late March after I have the colonoscopy.

 

[shamrock15]

Have to admit to being a bit confused. Your post indicates you have an active inflammation or stricture in your bowel, and they are thinking about reducing and removing medications? I can understand possibly changing them if they have had no effect, but I can't see the logic behind stopping under the circumstances. That much of a stricture is likely going to go away on its own.

 

[MCPayne]

I was a little unclear myself, but the doctor I go to is at a teaching hospital, so I trust his judgement, and I believe he also has Crohn's. Except for the stricture, my Crohn's is pretty much in remission. No bloody stools, and the stools are formed, even though thin, because of the stricture. They were wondering if they could maybe dilate the stricture, which they were going to discuss when they had their next panel discussion.

The reasoning for possibly removing the iron supplements is because those can cause constipation, which I don't have. The doctor stated that the stricture would most likely be permanent, so if I find it becomes more difficult to have bowel movements, then I would need to consider surgery. In another thread, another member asked if there was such a thing as temporary strictures.

 

[David]

Strictures can be reduced somewhat if they're due more to inflammation that has not yet caused significant scarring (fibrosis). Long term inflammation can lead to significant scarring and that is permanent. This is a good article on strictures.

 

[carolhew]

Thank you David! I have been looking for more info on strictures. My last CT enterography shows a stricture in the terminal ileum. I am having a colonoscopy Friday and they are going to try the balloon dilation. Since they believe it to be a small stricture, I am hoping for good results...pain relief!

 

[shamrock15]

Last thing to remember - if you stop remi, it may not work if you need to start it again as your body can develop antibodies. For your sake, and your bowel's, please make sure all the options are considered because if your Crohn's becomes active again, you may not have many options remaining.

Hoping your doc is making a good suggestion for you.

 

[Grant]

McPayne, the problem with a very narrow stricture is that it can cause an obstruction which is serious.
Its ok putting things on hold so to speak but its very restricting for things like foreign holidays knowing that you have a bit of a time bomb inside you. I hope things go ok & as David says its more inflammation than scarring.Did your specialist mention low fiber diet?? Because its important you cut down on stuff like fruit with skins, high fiber cereals, green veg, mushrooms, nuts. These can all cause a blockage/obstruction resulting in hospitilisation so best avoided.
Best Wishes
Grant

 

[MCPayne]

Grant

Yes, my doctor did mention the low residue diet, or low fiber diet, which I'm naturally on anyways. The things high in residue I don't eat / avoid anyway.

Yes, I am aware I would have to start all over if I discontinue the Humira. We ran into a similar problem when I did the Methotrexate injections weekly at the doctor's office. We thought it worked, so we stopped it, then the bloody stools came back, so we had to start all over again. This was with my pediatric GI over 10 years ago!

I'm able to have bowel movements normally now, but as I mentioned, if I find it more difficult to go, then we may have to consider surgery. At my colonoscopy, depending on what they find, I may ask if there's any risk to doing the surgery now, as opposed to later.