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Rajesh Shah, MD

Gastroenterologist

Q: I have Crohn’s and I just had surgery to drain an anal abscess. There was a fistula, so they placed a seton. What is the treatment for fistula? Are setons permanent? Can fistula heal with medication, like Remicade? My main concern is bowel continence.

A: Unfortunately, patients with Crohn’s disease may develop fistulizing disease around the anus, also termed peri-anal disease. This can lead to complications such as abscesses, which require prompt recognition and management. Overall, treatment of Crohn’s disease with peri-anal involvement involves close coordination between your gastroenterologist and colorectal surgeon. Once the abscess has been drained, a seton is left in place to prevent accumulation of a new abscess. In the meantime, your gastroenterologist may use a combination of therapies (including biologics and antibiotics) to gain control of the inflammation that led to formation of the fistula. Once this is controlled, the seton can be removed and your team will monitor you for improvement and closure of the fistula tract with medications. In cases where the fistula tract dose not close, then additional surgical interventions may be required, with the goal of closing the tract and preserving continence. hide answer

Q: Have been taking Pentasa (mezalazine) for 30 years with no problems but am now experiencing very bad light sensitivity. Even with spf 30 cream getting extreme redness, burning, tingling and swelling. Happens even indoors when in the light. Could it be my tablets causing this?

A: Skin reactions are a rarely reported side effect of mesalamine products, including Pentasa. However, since this is a rare side effect not much has been reported. In a study from the UK, nearly 3 million prescriptions of mesalamine were written and only 14 cases of skin reactions were reported. I would review with your primary care physician and gastroenterologist all your medications, in case another medication is the culprit. If no other medication causing this side effect is found, I would discuss with your gastroenterologist alternative therapies or possibly seeing a dermatologist for further recommendations. In general, patients with IBD should practice skin care and regularly use sunscreen for protection. hide answer

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