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Reply to "j-pouch 22 years , now health issues"

My Dx of UC was in 1987. Proctocolecomy with open, 2-stage, IPAA 1990 @ UCLA. In fact, I'd never even heard of "indeterminate IBD" until decades later. I'm sorry to add this, but that Dx has got to be a kick in the sore butt when one presents with features of two generally quite distinct diseases.

For me, since my ileal pouch became fully functional 4-6 months after stoma takedown, keeping my body hydrated has been a constant and unavoidable theme in my life.  Of course this makes perfect sense as water absorption is really the colon's central physiological function. Perhaps oddly, however, my plasma electrolytes have remained within acceptable ranges even when I'm "a quart low" (or more) on the dipstick.

That said, I've been to the ED plenty of times (maybe 1-3X yr) solely for fluids 2* to pouchitis and/or overexertion in the summer.  However, this does have the unexpected benefit of a bona fide excuse for letting me mow the lawn on a more casual schedule
 
TNF-α inhibitors like the prototypical adalimumab (Humira) had not yet been conceived of when I had active UC, thus I have no personal experience with antibody-based ("biologic") therapies.

If I could go back in time, however, I'd be very keen on trying vedolizumab (Entyvio), an α-4β7 inhibitor, which works mostly within the gut lumen, suggesting (at least to me) that it is likely to have fewer systemic side effects than TNA-α mAbs.But I definitely have to do more study regarding "indeterminate" IBD.  Is it an actual third, previously unrecognized IBD? with distinct diagnostic markers yet to be identified?  Or merely an actual simultaneous presentation of both diseases, difficult to infer histologically or otherwise?

 Please post any academic papers you my come across regarding indeterminate IBD, various Txs including Entyvio, and their side effect profiles.

Cheers,
Steven

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