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Ask The Expert Archive

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Ulcerative Colitis Archive Questions

Below are Dr. Flasar’s answers to Ulcerative Colitis questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 38.

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Q : 1

What tests do you perform to definitively diagnose UC rather than Crohn's or Crohn's Colitis?

There is no single test. It is a 'forest-through-the-trees' interpretation of a patient's symptoms, scope results, radiology test results, lab results, and biopsy results (if available). There was a blood test which had been previously hoped would differentiate between these, but it was not accurate.

Q : 2

Is there any relationship between having lupus and ischemic colitis?

No strong relationship. Only if the reason for the ischemic colitis was related to a increased risk of clotting which can sometimes occur with SLE, but that is a bit of a stretch.

Q : 3

Are there any clinical trials going on for ulcerative colitis at this time?

Yes. Please see the following link to the NIH clinical trials website:

Q : 4

In 2012 I had my first colonoscopy and was told that I had ulcerative colitis. I tried the pills, multiple kinds. I was still having flair ups almost every month, they were bad. Just this past week I had my second colonoscopy and my doctor said that there was no signs of ulcerative colitis during the colonoscopy or in the biopsy, that it had cured itself. How is that possible? I've done the research. I've asked him every question possible and it boiled down to "you're overweight, eat a BRAT diet to lose weight and your problems will go away." My question is, 1 is it possible for UC to cure itself and not show up on a biopsy and 2 if it wasn't UC what else could present itself with all the same symptoms?

It has been known to happen, but it is not too common. What is more likely was that you had an episode of acute self-limited colitis (essentially an infection from any of a number of minor pathogens that is not typically tested for or that there are no available diagnostic tests for). This would make the initial scope and biopsies look abnormal, and mimic Crohn's or ulcerative colitis in appearance. However, the changes resolve with tincture of time and the biopsies normalize (typically the biopsies in UC will be abnormal even when it looks normal to the scope. The residual symptoms are then most often related to post-infectious IBS #irritable bowel syndrome).

Q : 5

Do you ever use Xifaxan for moderate to severe colitis before going on Remicade? If you do what is the dosage and success rate? Is there any reason not to try Xifaxan?

It depends on the diagnosis. There is very limited data in Crohn's colitis with unimpressive results. I am not aware of data in Ulcerative Colitis. The main time we use it is for Cdiff infection if it is found. To answer your direct question, in our practice, we don't use it as a step to treat IBD colitis (in the absence of Cdiff) before infliximab. If a colitis patient has disease that needs infliximab, then we proceed to this therapy

Q : 6

My brother-in-law has ulcerative colitis. It was diagnosed last year and he has lost about 14kg body weight and since last week his bleeding is non-stop. How it can be cured?

The only permanent cure is to remove the colon with surgery. However, short of this, there are numerous medications that can be tried to keep symptoms under control.

Q : 7

My 30 year-old daughter was recently diagnosed with ulcerative colitis. She was put on Predisone then Remicaid infusions every eight weeks. No other medications were tried. Is this a normal course of treatment for UC? It seems Remicaid is typically used when other drugs fail. Are there circumstances when it is used first?

It all depends on how sick the patient is and what risk factors they have for having difficult to treat disease moving forward. There is a growing body of literature for using more aggressive medical approaches early in the disease in order to prevent complications before they occur, though this approach is not yet universally accepted.

Q : 8

Are dairy products good for UC while in a flare?

If lactose intolerance is present, they will cause bloating, gas, diarrhea and possibly abdominal pain. However, they will not worsen or cause the colitis--just give similar symptoms which may confuse things.

Q : 9

I am unable to travel to Maryland for my treatment. How can I find an expert like you in my area?

Try the website and investigate physicians though their 'find physicians' link.

Q : 10

Are there certain foods that should or should not be eaten by people who have UC?

There are no guidelines or rules about what a patient can and cannot eat. We suggest an individual approach which involves avoiding foods which reliably cause an individual to have symptoms of diarrhea or pain. However, no foods are known to cause or worsen the colitis per se.

Q : 11

I have UC but after two weeks of Canasa (1000 mg suppository at bedtime), I have no improvement with my tenesmus and rectal discomfort. For some patients, could stopping the Canasa and switching to Anucort only (i.e. once daily 25 mg Hydrocortisone acetate suppository) be a reasonable and acceptable next step?

Sometimes the Canasa can take longer to work than two weeks, though trying a steroid suppository is not unreasonable.

Q : 12

Is taking Humira on a weekly basis advisable/safe if taking it once every two weeks doesn't seem to be controlling my UC?

There is a theoretical increase in risk of side effects from doubling the dose, though patients do not appear to have more frequent side effects.

Q : 13

Can a diagnosis of UC in a five year old have Celiac disease as an underlying cause?

Celiac disease and UC are different diseases with different causes and locations (Celiac in the small intestine, UC in the large intestine). There are rare times when they both occur in the same patient, but the vast majority of UC cases do not occur with Celiac at the same time.

Q : 14

Can the body build up an immunitity to Remicade treatment? It has worked well for me for about 7 years, but has seemed to stop helping.

In more than 1/3 of patients who initially become well on infliximab, the response diminishes over time due to increased clearance of the drug and/or development of antibodies which prevent it from working as well. Such patients often need to have their doses increased or be given the drug more often than every 8 weeks.

Q : 15

Can an abrasion in the ileum cause UC?

By definition, UC is a disease limited to the colon or large intestine. Ileal involvement is generally suggestive of another diagnosis, such as Crohn's disease.

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