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Eugene Yen, MD

Research Associate Professor, Gastroenterologist

Q: Hello. I am diagnosed with UC. I have been in an active flare for over year. My doctor wants to put me on a biological since I can not get in remission. He left the choice up to me. Do you have a recommendation for first time use?I have narrowed it down to Humira or Entyvio.

A: This really is more of a personalized decision, and depends not only on your colitis, but perhaps other problems you may have related to your colitis (ex. Arthritis or other conditions outside of the bowels). Both, however, are reasonable choices, and both are better than being on steroids long term or being in a flare all year. hide answer

Q: I have been on Humira for years, I have had the shots and booster for Covid. I haven't had problems till I came down with Covid before Christmas. I had 3 rounds of antibiotics and 3 rounds of steroids, monoclonal antibody treatment. Covid seems to be gone but has settled in my lungs, throat sinus, headaches. Now on another round of antibiotic and inhaler and cough meds. I postponed my Humira injections, worried to go back on because of this, advice please.

A: I’m sorry to hear that. Certainly you should talk to your lung doctor about the safety of your biologics in the setting of COVID. However, generally speaking, we do not think that your risk of getting sicker with COVID is not increased on humira. hide answer

Q: My son was diagnosed 10 mo ago w/ Crohn's - pretty severe inflammation but all in the bottom third of his colon. No strictures. Stelara was unsuccessful. Also tried Prednisone as well as Budesonide on top. He's trying Entyvio next. We want to avoid immunomodulators since there's lymphoma in the family, and we're even concerned about anti-TNFs. The statistics for biologics in terms of how often they are successful look bleak. I'm wondering how often it is that no successful treatment is found.

A: Keep in mind that statistics from clinical trials often set a high bar for success, so while the numbers may look bad, most biologics do help with at least an improvement in the inflammation. I think that entyvio sounds like a reasonable choice, but there are other options, including anti-TNFs. Not knowing his entire situation, lymphomas are not often genetic, so the family history, as well as the low likelihood of lymphoma would not sway my decisions. Remember that the risks for unchecked inflammation and chronic steroids in his Crohn’s is almost always higher. I would recommend further conversations with his doctor. hide answer

Q: I was on xeljanz from last three years and i was doing completely fine. My last scope which was held on august 2021 looked good. I developed a bloody stool again recently. I am not sure its working anymore, what should I do?

A: Bloody stool, or pain or diarrhea, is not always ulcerative colitis flaring. You should talk to your doctors to see if anything else could be going on. If the blood in your stool was for a short period, it may not be your colitis. hide answer

Q: I have been reading a lot about my Crohn’s and research into serotonin and dopamine uptake imbalances found in Crohn’s patients. I am looking for more information on the subject. Can you direct me to any resources on this subject?

A: I’m sorry, we don’t know enough about this as it pertains to IBD. For example, >95% of our body’s serotonin is in the gut, and we know that this an important molecule as it pertains to intestinal motility, sensation, and secretion. This is why a lot of us try SSRIs (typically used in depression) for symptoms of pain or diarrhea. However, whether this is a something we can manipulate to treat IBD has not been studied well, mostly because we don’t have a full understanding of the mechanisms of serotonin in regards to IBD inflammation. hide answer

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