remicade

i have not heard of remicade being used for a stricture.....but thats just me. im not even close to an expert. as far as i understand, remicade is a pretty serious treatment, and almost an "end of the line" type of treatment (it was the last thing i tried for my UC before they told me if that doesnt work, nothing else is going it, because weve tried everything). i have heard for a lot of people it does wonders...i just am not sure how a stricture would benefit. i hope someone else has some insight....i guess my only thing id ask at the follow up is why remicade for the stricture.

Message Beckysmom. Her daughter had a stricture at the inlet of her pouch and just had surgery for it to bypass the stricture and basically create a new inlet to the jpouch.

i believe the thought of the remicade is that they are unsure if the stricture is caused by inflamation from crohns or scar tissue i had a biopsy which showed a granuloma but i'm not sure if it was that particular area as the surgeon took a couple of them but put all in one specimen bottle. If the remicade does not make a differance then their thought is that it is caused by scar tissue and they do not advise surgury because of the possible crohns found by the biopsy hope this makes sense

So the remicade is for the possible crohn's, right? It seems that going back to an ileostomy for a stricture is rather severe.

PM Marilyn. She's had a j-pouch since 1985 and has dealt with some pretty bad strictures - but she still has her j-pouch and is doing fine.

kathy

Remicade or Humira does make sense to control active Crohn's disease, but I am unclear how it would actually release a stricture, unless the thinking is that reducing the inflammation and associated swelling would essentially make the stricture less of an issue. However, in my mind, it would make more sense to try a trial of prednisone first, as it would give you a quicker answer (biologics can take up to 3 months to be effective), and is more likely to work. If it works, then you can switch to the biologics for maintenance. Even if the medical treatment puts the Crohn's into remission, you may still need stricturoplasty to open the stricture, as those do not just reverse.

On another note, I've been on biologics (not Remicade, but Enbrel, Humira, and Simponi) for 6 years. I've had zero side effects so far.

Jan

ah thank you for confirming my thoughts. remicade does seem extreme for a stricture.

i hope you find something that works.

No, no. I wasn't implying that Remicade is an extreme treatment, but that they are probably looking at it as a Crohn's treatment in general, not specifically for the stricture.

In fact, they are putting more emphasis on biologics for Crohn's, and at an earlier time in the treatment than in the past. New ones are in the pipeline too as the best targeted approach. You can't really go by what was accepted before when looking at current treatment trends. When I had my colectomy, Imuran was considered experimental. Now, it is pretty mainstream.

Jan

Jan you are correct in your statement it is believed that the swelling from the inflamation is causing the stricture i am not so sure as it has not been proven that the biopsy showing a granuloma was taken from the inlet to the pouch i am going to ask for another scope and biopsy be done of that area as well can they inject a steriod directly into the area at the same time this procedure was mentioned in a article by Dr. Shen that you had posted a link for in one of your posting i printed it off and gave it to my GI for his info hopfully he has read it. I have no symptoms of Crohns ie bleeding high white cell count etc just the issue of not being able to eat food with any bulk this includes cream soups but can eat toast and yogurt if i eat the wrong things it takes at least 24 hours to go through and i am left with a really sore abdomen that takes a couple of days to feel better one side of my stomach swells out with the cramping and there are some weird noises. I really do not want to go back to an ileo but can not continue with this as it will have ben a year in Aug. since i have eaten properly i wish i had shares in ensure which is a liquid meal replacement. thanks for your opinion Jan i appreaciate it. Shawne

The granuloma in the biopsy is pretty much confirmation of the Crohn's diagnosis. They usually don't see it, so it is helpful that it was there. It does not have to be at that particular site for all your small bowel inflammation to be Crohn's. The steroid injection would probably be a good option, since that would be very site specific and hopefully get quick results. But, bottom line, you eventually would need maintenance therapy. If it were me, I'd prefer Humira over Remicade for a couple of reasons. First, Humira is fully humanized antibody, while Remicade is from mouse protein, making it more likely to induce allergic reactions. Second, Humira is a subcutaneous injection, while Remicade is given only via IV infusion, so you can self administer Humira at home and not need those office infusion appointments.

Jan