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Eugene Yen, MD

Research Associate Professor, Gastroenterologist

Q: I have Crohn's and have tried several medications, and none have seemed to help. My doctor is discussing the use of a biologic treatment. What is the best way to determine which biologic treatment to use?

A: There isn’t a clear winner with the different biologics. I would say that it depends a lot on what your insurance will cover, and where your Crohn’s disease is located. If you are not doing well on the other medications, then I too would recommend biologics, and all of them would likely be better than what you are doing now. The Crohn’s and Colitis Foundation has a great web site where they discuss all of the different medications, but your doctor should hopefully steer you in the right direction. hide answer

Q: What has been the success or failure of stem cell treatment for ulcerative colitis? How do I find stem cell clinical trials for the treatment of UC that are actively recruiting?

A: The data for stem cells is more common in Crohn’s disease, which overall studies have shown slight or no benefit, which is disappointing given the initial potential. I am not aware of many studies in UC. While this is still a promising field, the good news is that we so many more therapies for UC that are being tested, and we are understanding the safety issues better as well. hide answer

Q: I have been in a flare for the last 8 months in which I have basically experienced nothing but diarrhea every single day. Recently, I have experienced more instances of formed stools. I feel that my rectum is “out of shape” and lacks the strength to pass some of these more formed stools. I fear this could lead to constipation. Is there anything that I can do to aide in the passing of these more formed stools?

A: Even without IBD, people can suffer with poorly formed BMs, which usually has nothing to do with the shape of your colon or the strength of the colon wall. We often try fiber supplements for this. However, if you have Crohn’s or ulcerative colitis, this is a disease that can affect the rectum. Inflammation in the rectum is the most important thing to ensure that you have more formed stools. So, the answer to your question is likely that you need to work with your doctors to best control your IBD inflammation. hide answer

Q: I have had Crohn's since 2003 and over the past several years I have had periods of random swelling on my feet and hands not the whole foot or hand. The size is anywhere from a marble size to golf ball size. Can this swelling be associated with Crohn’s.

A: There are extraintestinal manifestations in the skin (as well as the joints and eyes) which are related to Crohn’s disease but separate from the bowels. However, I am not sure about the random episodes of varying sizes. Nothing specific to IBD or your IBD meds comes to mind, so I recommend you follow up with your gastroenterologist. hide answer

Q: After 20 years with UC, I had a total colectomy 5 years ago. I was recently diagnosed with Episcleritis. Is it common for autoimmune symptoms to occur in other organs, even after a colectomy?

A: Yes, you are at risk for other autoiummune disease in association with IBD, even if you don’t suffer from IBD any more. This is essentially what a rheumatologist does. The good news is hopefully episcleritis is easier to treat than UC and hopefully a rare occurrence for you. hide answer

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