Questions Answered By Expert
Christina Ha, MD
Director of the Inflammatory Bowel Disease fellowship at Cedars-Sinai Medical Center, Associate Professor
A: Thanks for the question, first, wonderful news that you are in remission! The key, though, is to find out what type of remission you are in as our goal is for your Crohn’s disease to be in “deep remission” which means that your repeat colonoscopy shows complete healing with no active inflammation on biopsies. It’s important to have that relook to make sure your colon has healed as ongoing inflammation, even at the tissue level, can be associated with an increased risk of colon cancer. In terms of life expectancy, your Crohn’s disease diagnosis – especially if well controlled, should NOT impact your overall life expectancy. We do recommend that you maintain a healthy diet, follow preventative care recommendations, and see your primary care provider, gynecologist, and gastroenterologist routinely for scheduled visits, wear sunblock, get your skin exams for skin cancers, and stay on top of your vaccinations – flu, pneumonia, and HPV are the ones we would recommend for you. The most important preventative measure you can take is to keep your Crohn’s disease well controlled – the medications that got you into remission are the one you should likely stay on. Mesalamine (such as Lialda) is controversial for Crohn’s disease – you may or may not need to stay on that in the future, but I would recommend you discuss with your provider. hide answer
A: There is no such thing as a “risk-free” procedure, however, routine diagnostic endoscopy and colonoscopy are relatively low risk in the scope (pun intended ) of procedures gastroenterologists perform. If your provider recommends getting both procedures for a clinically appropriate indication, then getting both at the same time avoids another round of sedation in the future. An upper endoscopy does not require any bowel prep and typically only adds 10-15 minutes more of procedure time. We routinely perform both procedures together if warranted. Moderator Note added: To learn more about diagnostic test download the brochure Diagnosing and Monitoring IBD http://www.crohnscolitisfoundation.org/assets/pdfs/diagnosing-monitoring-ibd-brochure-final-rev062518.pdf hide answer
A: There is no “treatment” for dysplasia, per se. The goal is to try to remove the dysplasia if identified. Risk factors for dysplasia are extent of UC (does it involve more than just the rectum), duration of UC diagnosis (we often recommend surveillance colonoscopies to try to detect dysplasia after 8+ years of diagnosis or sooner if there are higher risk factors such as family history or a liver condition such as primary sclerosing cholangitis or personal history of dysplasia), ongoing inflammation and increasing age. The good news is that your UC is well-controlled. However, you have scopes that show dysplasia – the priority is to try to insure we see and remove the dysplasia as best as possible. I would discuss with your provider using an enhanced imaging technique such as chromoendoscopy to try to identify areas of dysplasia and fully remove them if possible. Sometimes, interventional endoscopists are needed to help with these procedures. hide answer
A: This is a great question – the answer will really depend on where the stricture is located, how many, how tight they are and if there is an active inflammatory component to them or are they the result of chronic changes from disease activity. The recommendations we make for people with Crohn’s disease strictures is to make sure that they are careful about fiber intake and higher-residue food intake. Working with a registered dietitian can help identify a dietary strategy that factors in personal preferences but also safe foods. We recommend small frequent meals, chewing food well, eating slowly, and monitoring for vitamin and mineral deficiencies that can occur due to a restricted diet. hide answer
A: Crohn’s disease – particularly when it is active with associated weight loss, anemia, and decreased nutrition can result in abnormal menstrual cycles or missed cycles. When the anemia, inflammation and weight are corrected, the cycles do tend to return. The medications used to treat Crohn’s disease don’t typically have a direct effect on the period. However, I would definitely discuss this with your gynecologist to make certain there aren’t other additional issues such as endometriosis or fibroids or hormonal changes that can result in abnormal periods. hide answer