Questions Answered By Expert
Jami Kinnucan, MD
Assistant Professor
A: We are starting to see lymphocytic colitis (a form of microscopic colitis) in a younger population than previously described. If you are not taking an acid suppressing therapy (PPI) or NSAID which are the more common associated therapies but not required for the diagnosis. In addition we see this more commonly in those patients who smoke cigarettes. Patients with microscopic colitis are more likely to have a diagnosis of celiac disease, it would be important to have assessment for this as well. Some patients do require long-term medication, it depends on how you respond to initial course of treatment. My experience with my younger patients diagnosed with microscopic colitis is that they respond well to treatment but often require a maintenance (longer term) medication to continue to stay well. hide answer
A: I am sorry to hear about your son’s recent complications. There have been multiple studies looking at the safety and effectiveness of biosimilar therapies like your son is on. There is no increased risk in biosimlars than that of Remicade (originator therapy). The things to consider when a patient with IBD develops new blood clots is to ensure that his inflammation is under control on his therapy and evaluation for possible hypercoagulation disorder. But based on what we know in clinical trials it would be hard to link his transition to biosimilar to new blood clots. hide answer
A: I hope that you are recovering well from surgery. It is hard to say without knowing more details of your case. If you had adequate levels of Humira (>7.5) and active disease at the time of surgery it is reasonable to consider alternative treatment options as a post-op prevention strategy. However there are times (again depending on the case) that you had surgery because the disease already resulted in scar tissue and that the surgery was not a true failure of treatment but it could be been due to progressive disease prior to Humira or subtheraputic dosing of the Humira. If you have a concern about moving forward with Stelara (which is a very effective therapy for Crohn’s disease) I would consider a formal 2nd opinion. hide answer
A: I am happy to hear that you are clinically feeling better. The real question is if you have achieved objective remission. To assess this we use blood levels for inflammation (CRP), stool studies (fecal calprotectin) and/or repeat colonoscopy. If you have signs of objective remission or mucosal healing and still have ongoing loose stools, your provider can address other causes for diarrhea. If you have objective evidence of ongoing disease activity then this might be the cause of your loose stools, they would want to consider why you have not had a complete response to therapy (mesalamine and 6MP). There are 2 likely explanations: you are on suboptimal dosing (you need more drug) or your disease is not going to response to these types of therapy and achieve complete remission. Next steps: find out if you have ongoing disease activity and work with your provider if you do to determine why. We can often check levels of 6-MP and find out if you are on enough therapy. hide answer
A: The guidelines recommend that patients that have at least 1/3 of their colon involved with disease (in your case Crohn’s colitis) should undergo surveillance colonoscopy every 1-3 years starting 8 years after disease. We base the frequency of surveillance on several factors, if your disease has been well controlled and you have histologic healing (biopsies without disease activity), no family history or personal history of precancerous changes (dysplasia) and no other risk factors for dysplasia, we might consider spacing out your interval. You can read about the recommendations in the SCENIC consensus statement or the ASGE guidelines for colon cancer surveillance in IBD patients. hide answer