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Raluca Vrabie, MD

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

Q: I was diagnosed with Crohn’s 30 years ago and had a bowel resection. I have not been on medication for 27 years. I just watch what I eat. I’m feeling good except I get bowel obstructions a few times a year which is due to a stricture at the resection site. I am interested in trying an endoscopic balloon dilation, but my GI doctor will not give me any options except taking a biologic. Where can I get info on this and see if I would be a candidate?

A: I think you are right, this stricture is unlikely to respond to biologics. It’s most likely fibrotic. You can check by seeing if you have any elevated inflammatory markers (CRP, ESR, calprotectin). If they are all normal, which based on what you are describing they are likely to be, the biologics don’t have a role. Regarding dilation, the dogma is that if the stricture is less than 5 cm, it’s amenable to balloon dilation. If it’s greater, you might need surgery. The IBD Help Center might be able to direct you to GI doctors who are versed in the literature and have dilation capabilities in their office. hide answer

Q: I was diagnosed with mild to moderate Ulcerative Colitis a year and 6 months ago. I have been taking 1200 mg of mesalamine with good results but lately I had been having more frequent bowl movements and with what felt like stomach spasms. I went to my GI who ordered bloodwork along with stool and urine tests and the results were all normal. He prescribed digestive enzymes to take with along with the other med and the stomach spasms have stopped. Are these in common use with UC?

A: Nope, digestive enzymes (I assume you mean pancreatic enzymes?) are not common. You are likely underdosed on the mesalamine, the maintenance dose is more than 2,000 mg mesalamine a day and the flare dose is more than 4,000 mg a day. hide answer

Q: Six months ago I had Covid-19 and now have the antibodies. My UC is in remission and I take mesalamine for it. I was previously on 6mp until I contracted Covid and then stopped. Is it now safe for me to get the COVID vaccine or should I wait until more information is available about the effects on individuals with auto-immune disease or until I no longer have antibodies?

A: It is safe to get the vaccine. I am telling even people on dual immunosuppression to take it. You are basically on no immune medication, so you are like the general population that the vaccine trials were done on, except for your IBD which is in remission. We don’t know how long the infection antibodies will last, so doctors in the hospital who had COVID are still taking the vaccine, because we believe it’ll protect them from a bad infection. hide answer

Q: I had a colectomy in 2015 and have j pouch. I’ve been battling chronic pouchitis for about three years as have done multiple treatments of Cipro & Metronidazole but have major side effects. I also tried probiotics. Are there any new treatments for pouchitis?

A: Pouchitis is a bear. I don’t have to tell you. Sometimes, all you can do is redo the pouch. There are national leaders in redo pouch surgery. Contact the IBD Help Center for info on health care providers (info@crohnscolitisfoundation.org). hide answer

Q: I am 24 years old. I was diagnosed with crohns when I was 23. I’ve been on remicade, after my 5th infusion I had blood test done and it came back with my liver having high enzymes level. I was wondering if it’s the remicade? I hope not since I feel great being on it. I just don’t know what could cause it.

A: Remicade can cause increase in liver enzymes. However, they can also be increased from other causes: inflammation, drinking the night before the blood test was taken, other medications. If you really like how you feel on Remicade I would: a) repeat the liver enzymes b) check the Remicade level. If the liver enzymes are back to normal, which is often the case, I would proceed as prior with the infusions. If they are still elevated, the Remicade level and antibody level are helpful here, as well as maybe an ultrasound of the liver and a check for viral hepatitis. In brief, I would do more testing before giving up on a drug you feel well on. hide answer

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