Questions Answered By Expert
Jami Kinnucan, MD
Assistant Professor
A: It is likely that your disease progressed to stricture due to ineffective treatment of the Crohn’s disease. Pentasa is not approved in the management of small bowel Crohn’s disease and Entocort should only be used for < 3 months. There are several factors that go into decision making to start therapy after lleocolic resection and it shoulds like your physician has classified you as higher risk of progression/disease. They are likely suggesting you start Remicade after surgery as preventative measure. Remicade is effective drug to prevent post-operative Crohn’s disease recurrence and recurrent disease could lead to further strictures. I would suggest that you review the recovery with your surgery team, if you have laproscopic the recovery is shorter than if required open surgery. Please visit: https://www.crohnscolitisfoundation.org/what-is-crohns-disease/treatment/surgery hide answer
A: We know that various foods can increase symptoms of gas, bloating and change bowel consistency. If you aren’t having any other symptoms than change in bowel consistency (assume you mean diarrhea) and you are tolerating this without dehydration it might just be the nature of your body’s interaction with these foods. Often times people can tolerate cooked vegetables better. It would be important to know if you have any stricturing of your intestine as raw uncooked vegetables can sometimes be problematic. hide answer
A: I am sorry to hear that you aren’t feeling well. Sounds like Remicade was working fairly well for you however it was complicated by an infusion reaction (which we know can happen but is rare). If you are having progression of your disease on the Stelara it might be that it is too soon in the treatment course or you are under medicated, what that means is that you might benefit from escalation of therapy, but this would need to be discussed with your treating provider. They could see if they can get approval for every 4 week dosing or repeat IV loading dose, and if no improvement within the next 2-3 months then consider going back to anti-TNF therapy class with Humira and strongly consider combination therapy with immunomodulator (azathioprine or methotrexate). If you are having significant symptoms now or they are concerned about severity of inflammation they can trial short course of steroid (budesonide vs. prednisone). hide answer
A: I am sorry to hear about this new diagnosis. It is important that you work with your health care team to manage your disease. I recommend that all patients take multivitamin if you are 71 recommend Centrum Silver as a good option as long as approved by your treating physician. We don’t typically recommend probiotics as treatment of disease with ulcerative colitis (limited evidence). The best thing you can do for your gut microbiome (the bacteria that live in your gut) is to eat a well balanced diet (Mediterranean diet) high in fresh fruits and vegetables and lean proteins and low in processed foods, sugar. hide answer
A: If your stricture is the cause to your symptoms then after the recovery period you should have improvement in those symptoms. Depending how much small bowel they have to resect and whether it involves the ileocecal valve and they have to resect that as well. Some people after resection will have increasing stool frequency (diarrhea) which is thought to be due to bile acid malabsorption and can be treated with bile acid sequestrant therapy. hide answer