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Raluca Vrabie, MD

Assistant Professor, Department of Medicine at NYU Long Island School of Medicine

Q: I'm on mesalamine for crohn's. I've had polyps removed in the past. I battled uveitis the past year and my last colonoscopy showed 2 deep ulcers. One in the colon and a smaller one in the small intestine. I did not take the medication faithfully since I don't experience much pain. Would staying on mesalamine faithfully or at a higher dose help heal the ulcers? Would a bland diet help in the healing?

A: Mesalamines for Crohn’s have limited utility. The deep ulcers usually reach below the mucosa (the inner layer of the colon) but the mesalamines are solely mucosal agents. In my opinion, Crohn’s patients need biologics for optimal management. This is more important than a bland diet. I would stop the mesalamine and try a biologic to prevent uveitis recurrence and ideally heal the ulcers as well. hide answer

Q: My son has Crohns has had it 10 years he is 17 years old. He has been on Humira but it didn't work for him. Has just started Stelara. He has been having like a mucus discharge for several months. His doctor has done a colonoscopy and nothing showed on that other than small Crohns ulcers but was doctor said they wouldn't be causing that drainage. Wondering if there is anything you all have heard even diet changes that could help this.

A: If there is discharge in his underwear he may need an MRI of the pelvis to make sure he doesn’t have a perirectal fistula. If the mucus is in the stool, that could be a number of things including inflammation – I would start with a fecal calprotectin level, and if this is elevated then the ulcers are causing the mucus. If he just started Stelara I would wait max 16 weeks after starting to see an improvement, and if I don’t see one I might see if he needs to switch again – not everyone responds to every biologic and the rate of response decreases after you failed one. hide answer

Q: I was diagnosed with mild to severe Crohns in the small bowel in 2004. I have been on Humira since 2005 but lately it seems like it isn't controlling the symptoms like it was at first. Often I am having symptoms the day after injecting the Humira. Is is possible that a medication stopped working, requiring a change in meds?

A: Yes, this is entirely possible. There are experts who think the average lifespan of a biologic in most patients is 2-3 years, so this is already very long on Humira. Your doctor should check your Humira level and esp your antibodies to Humira, as it is possible that you developed these while taking this medication. If this is the case, we can occ increase the Humira dose but more often we end up switching the drug altogether. The good news is that there are more options since 2004 and the injections are by and large less frequent. hide answer

Q: I am 19 and have ulcerative Colitis. I tend to use toilet 2-3 times a day and don't have diarrhea. I do get blood in my stool though, not a lot but some streaks of blood on the solid stool. I also experience slight pain whenever my abdomen is bloated. I've been prescribed Mesacol suppositories for 4 weeks and I take Mesacol 3.6 grams every day. How can I tell if I am in remission or a flare-up?

A: I think the simplest way is to have your doctor check your fecal calprotectin. It’s a breakdown product of white blood cells and it SHOULD NOT be found in stool. If it’s present in your stool over a threshold value, odds are you are flaring. If you want to figure it out on your own, it’s harder. Is your weight stable? If it’s dropping with no dieting, maybe you’re flaring. Is your energy level good? If you are napping during the day or going to bed at 9pm, maybe you’re flaring. Occasional blood in the stool is not normal, but might be your baseline if you have mild UC affecting the rectum (proctitis). If that is the case, you are on the correct medication regimen. It is possible that the disease is more extensive and the calprotectin would be good place to start seeing if that is the case. hide answer

Q: I get Remicade infusions every 8 weeks for Crohn's. I will soon be eligible to get a COVID 19 vaccination. I need to know whether it is necessary to time the shot around my Remicade. I previously thought vaccinations had to be at least 2 weeks before or after Remicade, but I recently read that this is not necessary. I am anxious to get the vaccine and am hoping for as little delay as possible.

A: I have been telling my patients to take the COVID vaccine whenever they can get it, irrespective of where they are in the infusion cycle. This is because there is no data on taking the vaccine on immunosuppression and the vaccine availability is limited. My theory on this is that there is at all times a minimum of Remicade in your body, which slightly decreases your body’s ability to develop antibodies to COVID. However, there is no data that more Remicade inhibits the antibody rate more. hide answer

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