Inflammatory Bowel Disease Archive Questions

Below are Dr. Cross’s answers to Inflammatory Bowel Disease 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 15.

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Q : 1 08/13/2009	What is your opinion of Tysabri as a treatment for Chrohn's? Tysabri is an effective agent for the treatment of Crohn's disease in the right patient. At our center, we reserve treatment for patients that have not responded to at least one of the anti-TNF agents (Remicade, Humira, or Cimzia) and whose disease can not be treated surgically. In addition, Tysabri should be considered earlier in patients with co-existing multiple sclerosis. We have used this agent in two patients thus far with excellent results.
Q : 2 07/13/2009	My daughter (18) was diagnosed with Crohn's in December 2008. She has been in the hospital 4 times and is on Remicade and 30 mg of steroids. Her doctors think that the Remicade is not reducing the stricture in her terminal ilium and say that she will need surgery. Is there anything that can be done to avoid surgery? Have you had similar cases? Unfortunately, we have had similar experiences. Strictures in the intestines often require surgery as there is an underlying component of scar tissue that is not treated by the steroids or the Remicade. We usually recommend surgery as the best treatment option in these situations.
Q : 3 06/02/2009	Could Celiac Disease be related to Crohn's Disease? My father-in law has had Crohn's for years but I do not believe that he was ever checked for a gluten allergy. Autoimmune disease such as Celiac and Crohn's disease can be seen together (having an autoimmune disease increases the risk of getting another). Celiac disease can be screened for if there are unexplained symptoms in spite of receiving treatment for Crohn's disease. The best test is an antibody to tissue transglutaminase.
Q : 4 05/05/2009	I was told that IBD presented in two forms, cases characterized by diarrhea type symptoms and the other by constipation. Lately, I have found that IBD is referred to as mainly colitis or Crohn's. I have the constipation type but find it hard to find info on it. Are there treatments for this, and how can I get more info about that condition? I've been battling this for 4 years and will sincerely appreciate your help. IBD is not really categorized into diarrhea and constipation "types." This is more typically used in patients with irritable bowel syndrome. Patients with Crohn's disease are categorized into several groupings: 1) Age at diagnosis (less than 40 or 40 and older) 2) Disease location (small bowel, colon, small bowel and colon, or upper GI tract) 3) Disease phenotype (inflammatory, stricturing, fistulizing). For more information on Crohn's disease, I would recommend that you go to the CCFA's web site or to myibd.org.
Q : 5 04/04/2009	I was diagnosed with diverticulitis and had a colon resection to correct the problem. When my colon was rechecked, I had developed Crohn's Disease. It has been 3 years and the Crohn's is now gone. My doctor said that it was transient and that I could stop taking the 6-mp, but that I should keep the medications in case I needed them. I am afraid to start and stop them, is this okay? If you have biopsy-proven Crohn's disease and you are in remission on 6 MP, I am usually hesitant to stop the 6 MP. Over time, most patients who have gone off of the medications have a recurrence of the disease. The million dollar question of course is when the disease will come back and how severe the recurrence will be. For example, it may be years before symptoms recur and the symptoms may respond rapidly to medications. On the other hand, the flare could be resistant and occur quite rapidly after stopping the drug. This kind of decision requires some counseling in a clinic to make sure that the best decision is made by both you and your physician.
Q : 6 03/02/2009	My 23 year-old daughter was diagnosed with Crohn's 6 weeks ago. She was put on 50mg of Prednisone which stopped her diarrhea and most joint pain for a couple of weeks. She has now seen another specialist who has put her on Imuran and is weaning her from Prednisone because it's not helping. She has constant bloating and stomach pain and joint pain plus red eyes and has become constipated. Does this mean she has a blockage or could there be other explanations? It can take several months for the Imuran (azathioprine) to kick in as this is a slow acting medicine. Generally speaking, if the symptoms recur as the steroids are tapered, we often will increase the dose for a few weeks and try to taper again. The presence of abdominal pain may indicate that a stricture is present. This can also be a reason for the disease being resistant to medical therapy. If it has not been done already, a imaging test such as a CAT scan or small bowel series would be appropriate.
Q : 7 02/11/2009	My daughter suffers from chronic diarrhoea, nausea, headaches, inflamed joints, minor skin rashes and mouth ulcers. She has a raised level of white blood cells. Capsule endoscopy shows lymphoid hyperplasia. Is all this indicative of IBD? The capsule findings are not specific. I would be resistant to making a diagnosis of IBD without the presence of erosions/ulcerations in the intestines or friability of the intestines. I assume the colonoscopy was negative as well which would argue against IBD also. Other disorders aside from IBD can cause inflamed joints, rashes and mouth ulcers. Disorders such as rheumatoid arthritis, lupus, vasculitis, sarcoidosis, and other seronegative arthritis can do this as well. I think a rheumatology referral may be in order.
Q : 8 01/12/2009	I'm a 46-year-old male with moderate Crohn's disease. After trying many years of drug therapy, It seems like the partial blockages are occuring more often, and lasting longer, leading me to think its time for removal of the affected bowel. Do regular surgeons do this, or should I find a specialist? Can you offer me any tips on things I should do before and after surgery to make things easier? I'm rather scared to do this, but not going to the bathroom for days, or weeks, is starting to get old. A general surgeon, minimally invasive surgeon, or colorectal surgeon can do the procedure. I would seek out someone who does a fair number of Crohn's or ulcerative colitis operations per year (25 per year minimum). Prior to surgeon it is important that your nutrition is optimized, you are off steroids and that you have stopped smoking. That is all you can really do to improve your outcomes.
Q : 9 12/18/2008	Does either a biopsy in the transverse colon of colonic mucosa showing mild lamina propria edema or biopsies of right and left colon and rectum colonic mucosa showing focal benign intramucosal lymphoid aggregate formation indicate early, mild Crohn's disease or any other IBD? Also, no active colitis, lymphocytic colitis or collagenous colitis were identified. The biopsies you describe sound non-specific and are not diagnostic of IBD. Pathologic buzz words for IBD include chronic active colitis. Activiity is defined by the presence of ulcers or erosions, cryptitis, and crypt abscesses. Neutrophils are the hallmark inflammatory cell defining active disease. Signs of chronic inflammation include expansion of the basal side of the intestinal lining with chronic inflammatory cells (lymphocytes and plasma cells) and distortion of the architecture. Pathcy inflammation and/or the presence of granulomas is diagnostic of Crohn's disease. I hope this helps.
Q : 10 12/15/2008	Can remicade cause a seizure? There have been post marketing reports/case reports of seizures associated with Remicade use.
Q : 11 12/15/2008	I have Crohn's disease I have a colostomy. I have been operated on my fistula twice. Can you give me ideas on how to get rid of it? This is a difficult question to answer without having more information. Fistula management often depends on the fistula location. Perianal fistula usually improve with medical treatment (antibiotics, immune suppressants, anti-TNF agents); a diverting colostomy also improves symptoms. Sometimes patients do not respond and require removal of the rectum (proctectomy). "Internal" fistula are often associated with bowel blockages and can require a intestinal resection to resolve.
Q : 12 03/20/2008	Wwhat do you do for tenesmus besides taking in fluid and fiber? Is there any other disease that is similar to tenesmus? Tenesumus is not a disease. Tenesmus is an uncomfotable sensation of having to move your bowels often accompanied by passage of blood and mucus. It is usually caused by severe rectal inflammation, most commonly ulcerative colitis. Tenesmus can be improved by treating the underlying disease causing it. In the case of ulcerative colitis, treatment includes suppositories, enemas, oral aminosalicylates, and prednisone.
Q : 13 03/20/2008	I would like to know if a person has Crohn's can they transmit it to another? Crohn's disease is a complex genetic disease with approximately 20% of patients having a family history of the disease. Therefore, the genes inherited from your mother and father can result in developing Crohn's disease. However, Crohn's cannot be passed onto close contacts.
Q : 14 03/18/2008	What is the long-term prognosis of Crohn's on my working/ life expectancy? Most patients with Crohn's disease have mild to moderate disease that does not limit their ability to work or life expectancy. Unfortunately, some patients (5-10%) have more severe disease that can result in disability and decreased life span.
Q : 15 02/17/2008	I was diagnosed with inflammatory bowel disease in 1997 and I want to know if you can eat popcorn and peanuts with this disease? I see my doctor twice a year and have my colon checked every four or five years. My grandmother died of colon cancer. It depends on what type of inflammatory bowel disease you have. Patients with Crohn's disease can develop strictures in the intestines. Patients with strictures can develop abdominal pain, bloating, loud bowel sounds, nausea and vomiting after eating. Eating popcorn, peanuts and other hard to digest foods can increase the bowel symptoms in patients with strictures. Patients with Crohn's disease that do not have strictures and patients with ulcerative colitis can eat foods like peanuts and popcorn without a problem.

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