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Mark Mattar, MD

Quality Improvement Officer for the Division of Gastroenterology

Q: I was diagnosed with Crohn's and Prostate Cancer within a month of each other. My Crohn's has been in "flare up" status for well over a year. My GI doesn't want to treat Crohn's until my prostate cancer has been treated because he feels that the biologics/immunosuppressants would make the cancer grow faster. However, my oncologists have indicated that they treat both conditions with Humira. Any evidence to support either opinion?

A: Although we would not use a medication like Humira to treat any form of cancer, we know that this class of medication can increase risk of specific types of cancers. The main types are melanoma and lymphoma. Humira and similar medications have not been associated with solid tumor risk like prostate, breast, and lung cancer. It should be safe to consider continuing Humira in this situation to keep the Crohn’s in remission. Another option would be to try a more specific medication like vedolizumab (Entyvio). hide answer

Q: I was diagnosed with Crohn's (terminal ileitis) in 1990. I have done relatively well after adjusting diet - mostly vegetarian. Meds are Pentasa (1500 mg daily) in recent years with the prednisone at times of flareup (obstruction) ~4 times annually. Recent colonoscopy showed stricture at the ileocecal valve. My (new) Gastro specialist has recommended surgery to remove the problem section of the ileum. Is this a common procedure - what is the typical recovery times and likely meds afterward?

A: Surgery is sometimes needed in the management of Crohn’s complications, including strictures. If the stricture looks more like scar tissue (fibrostenotic) from colonoscopy and MR or CT imaging, then surgical resection is reasonable. If the stricture is short (less than 3cm) then consider balloon dilation with an experienced gastroenterologist during colonoscopy. hide answer

Q: I am 73 years old. I was diagnosed with Crohn's in 1998 and the doctor first put me on Pentasa, which works great, in fact, it put me in remission for years. However, about a year ago, the bleeding started again and so the doctor put me on Humira, which works at first but came back, then prednisone, came back, back on Humira, came back. Now the doctor wants to put me on Entyvio. I am very scared as the side effects is too much for me to bear. What are the risk of this medication?

A: All medications used to treat Crohn’s have potential side effects. We have to measure these side effects and compare them with the risk of untreated or undertreated Crohn’s. Potential complications from Crohn’s include stricture formation, fistulas (abnormal connections from the bowel to bowel , skin or other organs) and abscess formation. The risks of Entyvio are actually potentially slightly lower than Humira, given its more gut-specific mechanism. hide answer

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