Questions Answered By Expert
Mark Mattar, MD
Quality Improvement Officer for the Division of Gastroenterology
A: Information on the coronavirus is evolving daily. The current recommendation is universal precautions, with strict hand-washing and avoidance of individuals displaying flu-like symptoms. More information on IBD patient guidelines, high risk groups, updates and recommendation on IBD medications and other important information is available on the Crohn’s & Colitis Foundation website at: https://www.crohnscolitisfoundation.org/coronavirus-update/adults hide answer
A: Life expectancy can be affected in patients with ulcerative colitis or Crohn’s colitis when they have at lease one third of the colon involved. The increase in risk of colon cancer is about half a percent per year after 8 years of disease. For example, after 16 years of ulcerative pancolitis, the risk for colon cancer is 4%. If you’ve had the disease for less than 8 years and have no other risk factors like family history of colon cancer, then there is no increased risk to you for cancer. An exception is in those patients with ulcerative colitis and primary biliary sclerosis (PSC). The risk for colon cancer starts to increase before 8 years. The key in any case is the keep the colon in a state of remission and zero to minimal inflammation throughout the duration of disease and to attain appropriately scheduled colonoscopies for early detection of “dysplasia,” precancerous areas or polyps. hide answer
A: Extraintestinal manifestations can occur in up to 25% of patients with Crohn’s. These can be rashes, joint pains or vision problems. We usually recommend working with a rheumatology and dermatologist in these cases. Sometimes, medications like Remicade can cause lupus-like reactions or even types of joint pain called “arthralgias.” Another phenomenon that may be happening is that your body is making antibodies against the Remicade in your body. This can be tested for with a standard blood test that will also check for the appropriate concentration of Remicade in the blood. hide answer
A: With the advent of improved understanding and monitoring mechanisms with the “biologic” medications like Remicade and Humira, we’re realizing these have a better safety and efficacy profile than the Imuran type medications. Make sure you attain age-appropriate vaccines, including influenza and pneumococcal series, which will help with infection risks. Between Remicade and Humira, it’s really up to the patient whether they want infusions (Remicade) every 2 months or injections (Humira) every 2 weeks. Safety and efficacy are similar in this class. Also consider Entyvio or Stelara as future options. hide answer
A: On the contrary, zinc deficiency, along with iron, vitamin D and vitamin B12, can be seen in Crohn’s disease. I would recommend checking zinc levels and if appropriate and normal no need for supplementation. Short courses of zinc supplements for viral infections is considered safe. hide answer