Talk to me about strictures

[lookame]

So on March 13 I had a colonoscopy. I've been pretty symptom free aside from seeing some mucous in my stool, however, my typical symptoms of bloody and diarrhea are virtually nonexistent since starting entyvio. That being said, it was a shock when I went in for my colonoscopy to be told my doctor couldn't go further than a few inches into my sigmoid colon due to a stricture. She tried sizing the scope down but still couldn't move past it. She put me on prednisone and said my biopsies would be back in 7-10 days. Today is day 15 without biopsy results. I called and was told my doctor has been out of the office since last week and won't be coming back until next week and she wont release my biopsy results until she's reviewed them. I don;t remeber much after the colonoscopy as I was still under anesthsia but I remember she seemed concerned and mentioned several times that we need to wait for the biopsy results stating it could be inflammation, scar tissue or possibly something else but to wait until the biopsy results are in. So I'm a tad alarmed that I'm just waiting while she's out of the office.

So please...talk to me about strictures. Is it reletively normal to not really have symptoms but still have a stricture? Is it normal for a person with ulcerative colitis to have strictures? (I guess I'm considered generalized IBD, doctors have learned more toward UC since it visially comes across as UC, however, the diagnosis changes on a scope to scope basis. One scope shows irritation in my small bowel, while another shows my small bowel is fine ect). Do strictures commonly require surgery?

 

[Mountaineer01]

I have several, in both the small and large intestine. By themselves, they can be asymptomatic. One of the most common complications to watch out for is an obstruction at the site of the stricture. Also, fistulas can form at a stricture, especially if there is enough scar tissue that causes thickening to the point it is touching another section of intestine.



As long as you aren't exhibiting signs of either, you probably aren't in any danger now. But, they are something to be mindful of. Some may disagree, but I wouldn't have surgery for it if it is not causing problems.


What I don't like more than anything about your scenario is the doctor disappearing and leaving you in suspense. That's unprofessional. I understand that doctors have to take leave like anyone else, but at least have a contingency plan. Have one of your colleagues review results and contact patients or something.


Also, if you have inflammation in the small intestine, I highly doubt you have UC, as UC is normally localized to the lining of the colon. Small intestine inflammation is a manifestation of Crohn's.

 

[lookame]

I have several, in both the small and large intestine. By themselves, they can be asymptomatic. One of the most common complications to watch out for is an obstruction at the site of the stricture. Also, fistulas can form at a stricture, especially if there is enough scar tissue that causes thickening to the point it is touching another section of intestine.



As long as you aren't exhibiting signs of either, you probably aren't in any danger now. But, they are something to be mindful of. Some may disagree, but I wouldn't have surgery for it if it is not causing problems.


What I don't like more than anything about your scenario is the doctor disappearing and leaving you in suspense. That's unprofessional. I understand that doctors have to take leave like anyone else, but at least have a contingency plan. Have one of your colleagues review results and contact patients or something.


Also, if you have inflammation in the small intestine, I highly doubt you have UC, as UC is normally localized to the lining of the colon. Small intestine inflammation is a manifestation of Crohn's.

I do agree. I wish she would have told me that she was planning a leave when I saw her for my colonoscopy. I'm not typically one to worry about my results because typically there isn't much to worry about, only the confirmation over whatever my doctor told me in the after procedure interview thing, however, she said many times to wait until the biopsies are back which has me on edge. The other thing that bothers me is she won't release the results until shes there to review them. Granted she is the top doctor in the IBD clinic and I tend to be a tricky case where my disease tends to be very difficult to control but if it's just inflammation or heck even if it's some scar tissue we need to keep an eye on...let someone else give me that news....

So in my previous colonoscopies I was told I had some...irritation in my small bowel which in the next colonoscopy wasn't there. My GI at that time told me he felt the previous irritation was from the prep and stated he felt the disease is more UC than crohns. Also, my first colonoscopy I was told I biopsied as having crohns but later biopsies appeared to be more UC. Then in trying to get to the bottom of it all my doctor sent out for a premethius blood test which just came back as generalized IBD. I know it's incredibly rare but I often wonder if perhaps I have both crohns and UC and thats why the doctos have such a hard time determining which one I truly have. I also find my doctors want a definitive because some drugs work for one disease better than the other. Overall its irritating.

I had a CT scan over the weekend and now with my doctor being out until next Monday I wonder if I'll have to wait for those results as well, but I'm not as antsy about those results since I'm not expiriencing symptoms so I bet those will come back fine.

Can the bowel prep cause a stricture to flare up? I had issues with the prep this time which is unusual for me. I did the typical one day prep but after drinking the first half I wasn't feeling the urge to go like I typically would, then after drinking the second half found I wasn't "clear" (it was a murky brown liquid). My scope was postponed and I had to continue preping for 2 more days. The second prep I did (dulclax/miralax) made me sick after not eting for 2 days and trying to chug a bunch of liquid. I backed off trying to chug the stuff and by the next morning found that my colon seemed irritated. By that night I saw blood and mucous in the toliet. So Id get to clear then Id go back to not clear due to the blood and mucous (it wasn't a ton like when I'm symptomatic but enough to notice).

 

[shamrock15]

I have a stricturing type of crohns, and a pretty good case of it.

For me, remicade has been a saviour. Obviously that cannot be started with your doctor not around.

You could ask the office if you should modify your diet while waiting. There are some changes that could be gentler on your bowels and reduce the chance of anything else serious developing.

I do hope you get results shortly. There are some excellent medications, and some here have other approaches, that can help alleviate your problems.

 

[lookame]

I have a stricturing type of crohns, and a pretty good case of it.

For me, remicade has been a saviour. Obviously that cannot be started with your doctor not around.

You could ask the office if you should modify your diet while waiting. There are some changes that could be gentler on your bowels and reduce the chance of anything else serious developing.

I do hope you get results shortly. There are some excellent medications, and some here have other approaches, that can help alleviate your problems.

Hello
I finally got my biopsies back and she feels it’s inflammatory stricture. We discussed where to go since I’m running out of options. I was on remicade but it was incredibly difficult on me. My infusions lasted 8 or more hours and I eventually became allergic to it. I tried humira and it didn’t help at all. I’m on entyvio now and I do t see blood or diarrhea but I have a stricture so she feels it’s not working or not working fast enough. The surrounding area is inflamed and it’s close to my anus (which is also ulcerated and inflamed) so surgery isn’t an option unless it’s to put me on a bag and allow the area to heal for a bit but overall surgery isn’t an option due to the fact it’ll prob cause a perforation.

Treatment plan now is entyvio every 4 weeks, prednisone taper, then budsion(? It’s a milder steroid) and continue with 6mp. I got back in 3 months and re evaluate. The options from there are sterlara or a clinical trial. To say I’m frustrated is an under statement. I’ve had this disease for 10 years and have never achieved remission. They originally thought I had UC since it was ulcerated and inflamed but with the stricture I think it’s now officially crohns

 

[shamrock15]

Keep plugging through. My crohn's was diagnosed in the late 80's, it took until a year after remicade (and azathioprine added) to finally get remission after almost 25 year and 6 surgeries. There are a few biologics out there now, and hopefully one will work. It is possible that there has been sufficient damage that a surgery to remove the damaged section would be necessary. A bag short term actually isn't that bad either. I had one for about 4 months and actually found it to be quite liberating.

As long as the amount removed isn't too significant, there really isn't a whole lot of downside normally to a resection. Fingers are crossed for you, I know it isn't fun.