One of the most significant factors that influences whether someone stays in remission is how well they stick with treatment, says Cheifetz.
In one study of people in both endoscopic and histologic remission, about 16 percent experienced a relapse of symptoms within two years. The most common risk factor — affecting 23 percent of those who relapsed — was discontinuing medication or missing doses shortly before the disease returned.
“If someone doesn’t take their medication as prescribed, they have an increased risk of flares,” he says.
Sometimes, though, relapse is unpredictable.
“There are people who do great for years, and then they flare,” says Cheifetz. “For whatever reason, their immune system, their biology, changed, and they’re no longer responding to the medication they’re on.”
In those cases, he recommends switching to a new medication that works differently. If symptoms flare, tell your doctor right away. You should also stay in regular contact with your gastroenterologist, even if the condition isn’t causing problems. This way, your doctor can help you stay on track with treatment and identify any early signs of trouble. Cheifetz sees his patients one to four times per year, even when they’re in remission.
“If, all of a sudden, we start to see some endoscopic disease, maybe we can optimize their medication before they develop any symptoms,” he says.
“If someone has marched through each of the various therapies, and they’re still not doing well,” says Cheifetz, “then we’ll discuss surgery to induce and maintain a surgical remission.”
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