Expert Q&A

A: There have been initial studies concerned for the possibility of lower antibodies titers after the first vaccine dose in patients who are immunocompromised, but we do not know if this applies specifically to patients with IBD on biologics, and whether that is the case after the second dose. A recent small study, however, found that IBD patients on medical therapy mount the same response as patients without IBD after the Covid Vaccine. So at this point we do not have evidence that patients with IBD on Stelara or other biologic drugs will have a delay in immunity or difference in immunity. Our evidence suggests that after your second dose of vaccine, you can function as if you were a patient who has been vaccinated in the general population. No need to wait any longer than any other vaccinated people. hide answer

A: Many patients are anxious about taking medications in the setting of a new diagnosis. A small select group of patients with very mild Crohn’s disease do not need chronic medication, but the of patients majority do. In addition, if Crohn’s is not controlled many patients on no medications known to be effective will go on to eventually have significant complications from their disease and a lower quality of life long term. Unfortunately vitamins, supplements do not have evidence of treating Crohn’s and there still not enough data to determine the impact of Cannabis positive or negative. You may be effectively treating your symptoms but the concern is that your underlying disease will progress if it is not addressed with medications or possibly well timed surgery. The idea is to intervene on your disease, prior to the disease progressing. Please discuss with your gastroenterologist if there are other medical therapies and treatment strategies that could benefit you. In the meantime, good quality sleep, a balanced diet low in processed food, addressing anxiety and depression if present, and even adjunctive measures such as mindful meditation as adjuncts to improve your quality of care can be considered as you and your physician make decisions on treatment. hide answer

A: Pros of a port would be easy access for your infusion nurses, less pain as well less anxiety for you every time you have to think of getting a medication that has kept you well for 19 years. You would also be able to get your labs drawn through the port. Some patients also like having both arms free during treatment. It also would help preserve the veins you do have. Cons would include the risk of infection, which could be severe. This is my greatest concern for patients. Ports also do need upkeep and patients who are vigilant about monitoring for infection or complications: they can malfunction and are susceptible to blood clots and may require replacement. Some patients still get soreness around the site after treatments, not all nurses can access ports, and the port is visible and juts out of the skin, and can be bumped when patients are particularly active. This is a personal decision to be made with joint decision making with your physician. In the meantime, make sure you are particularly well hydrated before you arrive for your infusions, not just the morning of but the whole day before. Identify nurses who have been successful in accessing your veins in the past. hide answer

A: The details of your case are best known by your primary gastroenterologist. There are various types of medications for Crohn’s. Biologics, for patients who have mild to moderate disease and depending on their risk for progression, in terms of getting patients into remission and keeping them there have the strongest data and best safety records compared to other available non-biologic medications. What I tell all my patients is that you will be on Stelara “Forever For Today” – what I mean by that is that if the medication works we would keep you on it for as long as it works. If the medication does not work or stops working, we do not keep you on it forever. If a new treatment arrives which would be better suited to you, you would be switch you. In short, from the information we have at this time we would hope and wish that we can keep you on this medication that is very effective with a great safety record. The concern about having a medication for a lifetime is understandable. However, at this time there is no cure for Crohn’s and we know that the majority of patients need to be on lifelong medication. There is a dysregulation in your immune system pertaining to your gut, and unfortunately we need to use medications to help regulate that for you. While some dietary interventions have helped patients (less process food diets, Mediterranean type diets), we do not yet have evidence that diet alone can control infection in the long term. hide answer

A: Bloating is not a recognized side effect of Entyvio, though every patient is different and every patient’s response to a medication may be unique. It sounds as if you have explored several causes of bloating other than the medication and not found relief. There may be many causes of bloating, including IBS to which patients with IBD are at risk. Celiac disease, lactose intolerance, small bowel bacterial overgrowth and medications are all possible causes. Is it possible that you changed your dietary habits since feeling better from ulcerative colitis standpoint? Has your small bowel been evaluated? Hormonal changes can also impact bloating. If not causes are found, biofeedback can be considered and has been shown to decrease distension. hide answer