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Ask The Expert Archive

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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 48.

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Q : 1

Is there any diet change I can make to help feel better?

n general, there is not a specific diet for patients with Crohn's and colitis. Some patients with Crohn's disease develop strictures or blockage. Until these are adequately treated, patients are often prescribed an ultra low residual diet (low fiber, no overcooked meats, no seeds or nuts) to improve symptoms. There are also studies with enteral diets (canned tube feedings given by mouth or through a feeding tube), mostly done in children, that demonstrated improved outcomes. There has also been a study showing that decreased red meat intake can reduce relapses. Lastly, I tell most of my patients to take a common sense approach, tracking which foods if any seem to bother them, and avoiding the foods if possible. I also remind them that no single food item is going to cause a flare but it might result in symptoms that are bothersome.

Q : 2

My 20-year-old nephew suffers with chronic Crohn's disease. His family support team needs dietary/nutritional help with meals and snacks. He was feeling better for a while he is taking Remicade but it is no longer working. Please help us with single item or combination meal items for him.

In general, there is not a single diet that has been proven to be effective for patients with Crohn's disease. In children, a purely liquid diet (enteral nutrition) either by mouth or by a feeding tube is almost as effective for treatment of Crohn's disease as steroids. One small study showed that the FODMAP diet can also be helpful. Although not based on studies in humans (animal studies only), I often recommend a diet low in red meat, high in fiber (if tolerated), and low in sugary foods. I suggest that you consult with your provider and a dietician to come up with a plan that includes both dietary and medical intervention.

Q : 3

Can patients with Crohn's disease have bariatric surgery?

This is an area of controversy. Currently, the CCFA position statement on bariatric surgery in patients with IBD recommends that patients with Crohn's disease avoid bariatric surgery becuase of the potential risk of short bowel syndrome associated with future surgeries. I would suggest that you discuss this issue in detail with both the surgeon and a gastroenterologist with experience in management of patients with Crohn's disease before you proceed.

Q : 4

Is Chrohn's disease contagious?

Crohn's disease is not contagious.

Q : 5

I've suffered from ulcerative colitis for the last 2 years. About 3 months ago I developed a fistula. I was told that this usally happens with Crohns, is this this true?

Yes, 25% of patients with Crohn's disease develop fistulas. Fistulas do not occur in patients with ulcerative colitis.

Q : 6

I have been on Remicade infusions every 8 weeks x 12 months. I still have multiple bowel movements daily (sometimes, upwards of 8/day). What should I expect of Remicade, and when?

If your symptoms are from Crohn's disease, you should feel better fairly quickly. Typically patients see improvement within a few weeks. If you have not seen any improvement, I would schedule an appointment with your medical provider to elicit reasons why you are not better.

Q : 7

Is it possible for Crohn's Disease to impact the right kidney? I have no function in my right kidney. I had an intestinal resection in 2009 that was done laproscopically.

The kidney can be affected in patients with Crohn's disease. One possibility is extension of fistulas from adjacent loops of bowel to the kidney, ureters or bladder. This can damage the kidney itself or result in chronic infections that can injure the kidney. Some of the drugs used to treat Crohn's disease can also injure the kidney (antibiotics and 5-ASA's). Patients with small bowel Crohn's disease with extensive disease and/or multiple resections of bowel can develop kidney stones which can result in damage to the kidney. Lastly, patients with chronic inflammation, including from Crohn's disease, can develop secondary amyloidosis which can result in kidney damage.

Q : 8

Can or does Crohn's disease aggravate or make it harder to control type 2 diabetes?

Not really; however steroids used to treat Crohn's disease can make the diabetes more difficult to control.

Q : 9

Is Crohn's Disease similar to spastic colon or IBS? Is there any treatment to ease the problems of IBS?

Crohn's disease is not related to IBS. However, the two illnesses can coexist. In fact, in referral to our IBD program, up to 40 percent of patients with Crohn's disease have superimposed IBS. The treatment for IBS is mostly symptoms based; antidiarrheals are used for diarrhea, laxatives are used for constipation, non-narcotic analgesics and antidepressants are use for abdominal pain.

Q : 10

I had surgery for a ruptured colon, in two places and 13 feet of my colon was removed. I have a stricture and was told I probably have Crohn's in what's left of the colon, and in the small intestine, so my doctor put me on Imuran. Is it common for someone to have Crohn's in both the small and large intestine?

Yes, 55 percent of patients with Crohn's disease have involvement of the small bowel and colon, 33 percent have involvement of the small bowel alone, and 20 percent have involvement of the colon alone. Additionally, 2 percent of patients have involvement of the esophagus, stomach, duodenum or jejunum alone.

Q : 11

Is it possible for my IBD to cause liver damage and halitosis?

I am not aware of IBD causing halitosis. However, a small percentage of patients, primarily those with disease of the large intestine, can have a disease of the liver called primary sclerosing cholangitis. This disease causes an obstruction or blockage of the bile ducts which can cause recurrent infections of the bile ducts, hardening of the liver (cirrhosis), and cancer of the bile ducts. In addition, some of the medications used to treat IBD can cause abnormal liver function tests. The two biggest culprits for this are 6 MP/azathioprine and methotrexate.

Q : 12

I am 50 years old and was diagnosed with Crohn's disease a year ago. I get gas in the afternoon. Is there anything that can help? Is this a sign that it's getting worse? I've been taking 2 grams of Pentasa daily.

One thing that I would exclude is a blockage or stricture in the intestines. Patients with a stricture can develop symptoms of bloating/gas, abdominal pain, loud bowel sounds and nausea/vomiting after meals. The symptoms are often worse after eating vegetables and meats. A blockage can be excluded with an x ray, CAT scan, MRI or endoscopy/colonoscopy. In addition, sometimes patients that take Pentasa can have gas as a side effect. Therefore, with your doctor's permission, taking a 3-5 day holiday off the drug to see if the gas improves is reasonable. Other causes of gas include food allergies and superimposed irritable bowel syndrome.

Q : 13

I have diffuse thickening of the terminal ileum with submucosal fatty infiltration and two separate 2 cm strictures. I'm on 30mg of Prednisone and Imuran. My doctor wants to wean me off the Prednisone and start Humira. What does the above mean and what are the chances the strictures will get better and it is not scarring?

Treatment of strictures is difficult. In theory, strictures are thought to be either inflammatory or fibrotic. Inflammatory strictures are thought to be reversible as medical treatment reduces swelling and relieves the obstruction. Fibrotic strictures are thought to be made up of scar and will not respond to medical treatment. In reality, all strictures have features of both. In our experience, the success rate for medical treatment of strictures is low and patients usually require surgery. In your case, it is not unreasonable to try Humira. However, if you are unable to taper off of steroids, surgery is the best option. In that situation, the Humira can be continued alone without other drugs to prevent recurrent Crohn's disease after surgery.

Q : 14

My son has Crohn's and PSC and within the last year contracted C.diff. He has been battling C.diff for a year with vancomycin on three different occasions with limited success. His doctor wants to do surgery and we are looking for other options.

This can be a difficult problem. C.difficile can complicate 10 percent of colitis flares and it can be difficult at times to determine what is causing the symptoms, the Crohn's disease or the C.difficile. In general, initial treatment is with metronidazole and if that doesn't work, vancomycin is given. Lack of response to vancomycin is unusual; these patients are usually very ill in the hospital. We often given metronidazole through and IV, high dose of oral vancomycin and immune globulin. Sometimes a colectomy is needed. More commonly, patients have recurrent C.difficile. In other words, the antibiotics help but when they are stopped the symptoms recur. For these cases we often extend the course of antibiotics and initiate a very slow taper off of the antibiotics.

Q : 15

What are some health questions a physician would ask a patient that he/she expects has Crohn's disease.

Typically, a medical provider will ask questions about energy level, appetite, nausea, vomiting, abdominal pain, diarrhea, and back side issues like fistulas or abscesses. Also, Crohn's can involve other organs like the eyes, joints, skin, or mouth. Therefore, they should be asking questions related to those organs as well.

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