Gastroenterology Q&A with Dr. Efrat Broide

HMC hosted its monthly Facebook Q&A session, where our members ask questions regarding a certain medical topic and receive answers from a medical specialist in the field.  This month’s topic: Diseases of the Gastrointestinal Tract in both Children and Adults and Hepatitis C Viral Infection.  Dr. Efrat Broide, Israel’s leading gastroenterologist, hosted the Q&A.

Doctor Efrat Broide has over 20 years of clinical experience in pediatrics and gastroenterology. She is currently Head of the Children Gastroenterology Department at one of Israel’s public hospitals, and continues treating adults at her private practice. 

Q: Hi Doctor, I was recently diagnosed with Crohn’s and started treatment with Entocort seven weeks ago, while changing my diet. In the first few weeks, I felt fine, but lately I am starting to lose my appetite and the symptoms have worsened. What should I do?
A: Entocort is a good treatment during exacerbation of the disease. However, it is not a maintenance regiment. Sometimes immunosuppressive or immunomodulatory treatment are needed to maintain remission. You have to consult your doctor.

Q: Hi Doctor, what can be the cause of a strong spasm in the intestines? Should I be worried if it occurs often?
A:  As I do not know your age, I can only say that if you are about older than 40, I suggest you do a colonoscopy to be sure that it is just an irritable bowel syndrome (IBD). Besides that, I also recommend doing a routine blood test to be sure that everything is normal.

Q: Is a scan a better diagnostic tool for IBD than a colonoscopy? What are the advantages of a scan?
A: Usually in IBD, part of the investigation should include both colonoscopy and CT scan or MRI for imaging of both colon and the small bowel.

Q: What is the most important thing to change about my diet if I have IBD?
A: It depends which kind of IBD you have, and which part is involved, and what your clinical symptoms are. Today, there is an etiological association between nutrition and IBD. There are some nutritional formulas, which you can benefit from using.

Q: My son was diagnosed with Crohn’s disease; he is 13 and seems to be having trouble with his growth. His testosterone levels are normal though. Are the two things related?
A: Absolutely, yes. One of the clinical pictures associated with Crohn's disease in children is short stature. It is important to evaluate his bone age by X-ray, growth hormone stats and to be checked by an endocrinologist. However, the most important treatment is high intake of calories in order to maintain adequate growth. I suggest he follows advice (and follow-up) from a dietitian.

Q: Do I have a higher risk of developing colon cancer if I have Crohn's disease?
A: If you have Crohn's disease, which involves the colon, after 15 years of disease, you should be under a surveillance program, meaning periodic colonoscopy with biopsies.

Q: Hi, I suffer from ulcerative colitis for 3 years now, and I was never in remission. I think I probably tried every existing drug out there, and my life is pretty much on hold at the moment. I can’t keep a job or go to school. I am considering a colon removal, but I wanted to know if there are any other options to regain a normal life?
A: I am sorry to hear about your situation. As I do not know exactly the arsenal of drugs you were already treated by, including biologic treatments, the options are Infliximab, Adalimumab, Vedolizumab, and at the end, of course, colectomy. A Colectomy is a salvage procedure for severe disease. This is the only answer I am capable of giving for the limited information you provided us.

Q: I was diagnosed with Hepatitis C, what can I do to manage my condition and improve my quality of life? How efficient is the treatment available today?
A: There are new treatment protocols today to treat chronic hepatitis C in Israel with a new oral treatment for a shorter duration, which can eradicate the virus in almost 100% of the treated patients. It is very important to determine the degree of fibrosis before choosing the treatment. Meanwhile, you have to remember that chronic hepatitis C is a long-life and slowly progressive disease that allows you to continue your daily routine life alongside seeking treatment.

Q: I have been suffering from symptoms related to IBD for a long time now (bloody diarrhea, chronic fatigue, arthritis, depression, etc.), and my blood tests and stool samples did show signs of inflammation, however, those were unnoticeable in a colonoscopy and biopsies, so my doctor offered no treatment for the symptoms. Is it possible that I still have IBD? What should I do?
A: Bloody diarrhea and inflammatory markers may be associated with colitis, meaning inflammation of the large intestine, but there is a differential diagnosis. Sometimes we need to investigate the small bowel as well, by either CT or MRI protocol enterography or video capsule. I would repeat all the endoscopies to be sure that the colon is free of disease and would advise you to take a blood test for IBD serology: ASCA and ANCA.

Q: What are the symptoms that someone with hepatitis C should expect?
A:In the beginning, Hepatitis C is almost asymptomatic, excluding the acute stage; most probably, we find it in a routine blood test depicted as an elevated liver function test. In advanced chronic hepatitis C patients, fatigue and weakness are common. Therefore, it is very important for people in high-risk groups to screen for hepatitis C.

HMC will continue hosting live Q&A sessions with leading physicians every month, to better serve our patients and the public. In case you have any other question regarding diseases of the gastrointestinal tract, or you wish to receive a medical quote, please do not hesitate to contact us.

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