What are the safe therapies for stricture management?

Question

Hi doctor,

I want to ask someone about alternative treatment options for a high risk intestinal stricture for a patient with crohns disease. Crohns disease has been diagnosed for around 15 years (she is 31). She currently takes azathioprine. I am not sure the part of the bowel unfortunately. I believe it is single stricture. She has had severe pain which comes in waves. She has had a CT scan which shows the stricture and she has had it before. Previously the Dr has done endoscopic balloon dilation but now they are not sure if that is an option because it was quite hard last time and also because she is unwell and may not be able to do bowel prep. Basically I just wanted to check there are no alternatives to surgery because they said surgery will result in a stoma which we really want to avoid. I am happy to pay if there are more expensive options but it hard to ask the DR that. I don't expect you to diagnose or suggest treatments for it given my lack of detail. But I just want to know if there are any alternatives I can ask about especially if cost is not a factor.

Kindly help.

Answer 1

Hello..

I welcome you to icliniq.

I understand your concern.

Well, surgery is the last resort, and it may not end up in stoma formation. Most commonly, a resection and anastomosis of the bowel is performed and the lumen is continued without stoma formation. however stoma formation is a possvlibity but not a rule. Biologics like Infliximab (TNF inhibitor) if not effective Vedolizumab (integrin receptor antagonist) are alternative options, can work in stricturing disease without necessitating surgery. Lastly if these above medications are tried and nothing helpful, re attempt to endoscopic balloon or metallic stent is a good option. You can try asking others experts opinion on this if your current physician is not positive about it.

Thank you.