Questions Answered By Expert
Mark Mattar, MD
Quality Improvement Officer for the Division of Gastroenterology
A: There are some recommended dietary modifications that can be used as a complement to traditional therapy for Crohn’s. Please see the Crohn’s and Colitis Foundation website. Most patients need biologic therapy with Crohn’s to truly alter the disease before it gets too late and we run into complications like narrowed bowel (strictures), infections (abscess) and abnormal connections (fistula). Some studies show us that if you wait an average of 13 months before starting biologic therapy then the risk for these complications rises dramatically.the biggest adverse effect in Crohn’s is under treated disease, not the medications. hide answer
A: Humira or Remicade are acceptable therapies for your current situation. Please see answer posted this month for a discussion on biologics. If you absolutely want Entyvio, there are resources on the Crohn’s and Colitis Foundation Website for appeal letter samples that you can send to the insurance company or to your doctor office to use as a template. hide answer
A: Pyoderma gangrenosum is one of the skin manifestations that can be seen in up to 5% of patients with Crohn’s disease. The other main skin manifestation that can be seen is erythema nodosum, painful reddish nodules on the lower legs without actual ulceration or skin breakage. Antibiotics, injections of medications into the ulcers, and topical ointments all may be used as treatments and have good response. Some medications used to treat the underlying Crohn’s can help with the pyoderma. hide answer
A: Crohn’s and ulcerative colitis are considered “immune-mediated.” The same is true with M.S. With that, there is a medication that is approved for treating moderate to severe Crohn’s disease and M.S., which is natalizumab (Tysabri). This is not approved for ulcerative colitis, although it’s sister drug, vedolizumab (Entyvio) is approved for both Crohn’s and ulcerative colitis. hide answer
A: Ulcerative colitis comes in different forms. About 30% of patients will present with inflammation extending beyond the rectum. Some patients have ulcerative colitis of just the rectum, or last 10cm of the colon. This “proctitis” is a part of ulcerative colitis and is treated similarly like the rest of ulcerative colitis. Some patients with just proctitis can stay in remission with topical agents like mesalamine suppositories (Canasa), but others need systemic therapies with mesalamine oral products or even biologic therapy. hide answer