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Jami Kinnucan, MD

Assistant Professor

Q: I’ve looked at the drug profile for ulinastatin and it seems as though it would be a good fit to treat severe, refractory Crohn's disease. It may also stave off fibro stenosis for those with a stricturing phenotype administered post-op following resection. I wonder why more studies haven't been conducted? What are your thoughts on this as a treatment option?

A: This is not a therapy I had heard of until this question. I was able to find a few in vitro studies, but no clinical trials are currently being conducted. I have passed this along to our clinical trial team as they may have more information. I am sorry I don't have more information for you. http://onlinelibrary.wiley.com/doi/10.1111/j.1744-9987.2011.00967.x/full#references hide answer

Q: I was diagnosed with Colitis last year. I was first prescribed Pentasa and now Mezavant both started to work for 3 months but not anymore. While on both medications I found sex painful. I went to see a Gynecologist who told me that there was a lump on the left side where I felt the most discomfort. Could my colon be inflamed? I'm lost as to what doctor to see and what my options might be.

A: If your gynecologist felt a lump they should have followed this up with an ultrasound. It is possible that your colon is inflamed making intercourse painful. I would follow-up with your gynecologist and your gastroenterologist to ensure that you have healing on these medications. hide answer

Q: I was diagnosed with CD 10 years ago at age 26. The disease is classified as mild to moderate to date. I have managed it with only two antibiotic courses as treatment. My doctor wants me to treat the disease when most days I don’t think my symptoms warrant treatment. In addition the treatments risks don't seem to outweigh the benefits for me. How do you make the decision what treatments are better than the disease itself and which treatments are best for mild to moderate case of Crohns?

A: Mild to moderate Crohn's disease should be treated. As even when you don't have symptoms you likely have ongoing inflammation what we call "subclinical" inflammation. If your disease mild to moderate depending on the location of the disease and whether you have any stricturing or abscess/fistula there are multiple medications that can be recommended. You should follow-up with your gastroenterologist to discuss treatment options. Untreated disease overtime can require surgery, medications prevent surgery and progression of disease including colon cancer related to Crohn's disease in the colon. hide answer

Q: I have not had a bowl movement in almost a week. Can this be a problem associated with Crohn’s Disease? What should I do?

A: Constipation can be associated with Crohn's disease. However this type of problem should be evaluated with your provider. hide answer

Q: I've been on sulfasalazine for 22 years with no problems. My uc has never been severe as far as my symptoms. At 62 years old, I'd like to stay on sulfasalazine. After my recent colonoscopy my GI wants to try Entyvio. I'm very reluctant and can't figure out why. My former GI retired and this is a young new GI. Not doubting his experience but I'm leaning toward staying with sulfasalazine. Are there any long term side effects of sulfasalazine that would justify my GI changing to Entyvio.

A: Since your diagnosis we have changed the way we manage disease. While sulfasalazine is a very effective therapy to manage ulcerative colitis, I assume that your new provider found active inflammation on your colonoscopy (despite you feeling well), we call this subclinical disease. Currently our goals are to treat to mucosal healing which means you feel well and your colon looks healthy. Entyvio is a safe therapy that only impacts the immune system in the gut. If your provider is recommending escalation of therapy it is likely due to the fact you have ongoing inflammation in your colon. I would address your concerns about the new therapy with your new provider or seek a 2nd opinion. hide answer

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