Questions Answered By Expert
Eugene Yen, MD
Research Associate Professor, Gastroenterologist
A: Most of us do not think that UC develops into Crohn’s. It’s true that in 5-10% of patients, we don’t always know the difference, since there is a lot of overlap at least clinically so we categorize people as “indeterminate colitis” when we are unsure of the type of IBD. I have patients who have initially diagnosed with UC who in reality find out later to have Crohn’s, and this is in spite of all of our technology and all of our experience seeing IBD patients all day. It’s very challenging and not always straightforward. I’ll also say , however, that we are treating our UC and Crohn’s patients more similarly these days. While most people hear Crohn’s and associate this with a worse diagnosis, we all know Crohn’s patients who are very mild, and UC patients who are very sick. hide answer
A: Yes, Achilles tendonitis can be an extra-intestinal manifestation of IBD. It’s also known as enthesitis, which we often treat like other EIMs, but musculoskeletal EIMs are the most common but often difficult to treat, which is why we usually enlist our rheumatologists to help us. hide answer
A: Usually we give this a few weeks, but I would say that mesalamine should start to work within a few days. If it does not work, some people have the opposite effect (makes their diarrhea worse) or your colitis may just be more severe that the mesalamine is not enough. The latter is usually what happens. This is when I’d be starting to discuss potentially needing the biologic therapies if you are not doing significantly better on the mesalamine. hide answer
A: There are other medications that you can try. Since you responded to remicade initially, adalimumab (humira) and certolizumab (cimzia) is a choice. Keep in mind that there is vedolizumab (entyvio) and also ustekinumab (stelara), in addition to clinical trials. So, there are a lot of choices out there to consider. Surgery is reasonable to consider, depending on how sick you are, but you should talk to your doctor about other non-surgical choices above. hide answer
A: If he is able to get Remicade outside of the US, that would be ideal. I have had patients in this scenario. Alternatively, you can switch him to Humira, which is in the same class. Finally, if he’s doing very well, you may want to consider doing a colonoscopy with your GI doctor to see if he can de-escalate off of remicade. This may or may not be appropriate as I don’t know his IBD history fully, but your doctors should be able to help you to trouble shoot this, as it’s a common scenario. hide answer