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 18.

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Q : 1 11/10/2009	I have been battling GI symptoms such as abdominal pain, bloating and constipation. I have had blood work indicating Crohn's disease and have had two colonoscopies with biopsies showing chronic inflammation and CT's showing thickening and narrowing of TI. I was diagnosed with Crohn's 3 years ago, but now my doctor is unsure. What does a colonoscopy have to show for diagnosis? A colonoscopy is usually very useful in the diagnosis of Crohn's disease. First, the gastroenterologist can see areas of inflammation in the colon and the end of the small bowel. Patients with Crohn's disease have certain characteristics that suggest the diagnosis of Crohn's disease. In addition, a biopsy can be done to confirm the diagnosis at the time of the colonoscopy. Unfortunately, 10-15% of patients will not have a certain diagnosis after colonoscopy. Additional tests may be required such as small bowel imaging tests, upper endoscopy, capsule endoscopy, and single or double balloon enteroscopy.
Q : 2 10/20/2009	I have Crohn's disease and am confused about what type of diet I should be eating. There is not a specific diet for Crohn's disease that has proven to be effective. In patients with strictures or blockages of the intestines, we often recommend an ultra low residual diet or melts in your mouth diet. Otherwise, I recommend that patients take a common sense approach (avoid foods that bother you) and eat a heart healthy diet. I also recommend that all of my patients supplement with Calcium 600 mg twice daily and vitamin D 400 IU twice daily.
Q : 3 09/14/2009	My son has been doing well with his Crohn's taking 6mp and Remicade for the last 9 months. I know there is a cancer risk in taking these medicines, especially for males. Should one or both be stopped, and if so, when? Also, what is your opinion on his taking the flu shot and/or swine flu shot. The decision whether to be on both 6 MP and Remicade is in flux. Some studies have suggested that continuing 6 MP after Remicade is started does not improve outcomes. In addition, one study showed that you could stop the 6 MP without increasing the risk of the disease worsening. There is also a concern about increased risk of infection and certain cancers on both drugs (however the actual risk to an individual patient is very low). On the other hand, a recent well done study showed that combining the two drugs was better than either alone. For patients in our practice, I have a detailed discussion about the risk and benefits of being on both drugs. Unless problems have developed, I tend to keep patients on both drugs. Your son should receive both the standard flu shot and the H1N1 shot.
Q : 4 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 : 5 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 : 6 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 : 7 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 : 8 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 : 9 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 : 10 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 : 11 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 : 12 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 : 13 12/15/2008	Can remicade cause a seizure? There have been post marketing reports/case reports of seizures associated with Remicade use.
Q : 14 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 : 15 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.

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