Expert Q&A

Most Recent

February 2023

Q: I was diagnosed with UC a few months ago. I was put on Uceris then Stelara. I have been in remission since I started the Uceris and am tapering off. I have also been recently diagnosed with inappropriate sinus tachycardia (fast resting heart rate), which seemed to start with the UC symptoms. The cardiologist is not worried about it, but cannot explain why it is happening. I have seen that UC can cause a fast heart rate. Is this true? Should it get better if the UC gets better?

A: Sinus tachycardia can occur due to several different causes and typically is considered a response to some underlying process. These can include infections, dehydration, anemia, low blood oxygen saturation, heart disease, lung disease, pain, anxiety ingestion of stimulants, to name a few. Several of these etiologies can occur in the setting of UC, so it is important to work with your doctor to investigate and possibly address these, before a diagnosis of inappropriate sinus tachycardia is made, which is an unusual condition.

read answer

ANSWERED BY:

Rajesh Shah, MD
Gastroenterologist

February 2023

Q: · My son was diagnosed with a Crohn's flare. He started Remicade and methotrexate & having his 3rd infusion next week. More prednisone was also prescribed since his symptoms haven't improved (his doctor said the symptoms might also be side effects of the Remicade). He sleeps all the time, can't work, and is depressed. My son believes the Remicade isn't working and should try Humira. Do you have any recommendations for him?

A: Going through a flare is physically and emotionally difficult. Also, symptoms associated with the flare can worsen or contribute to symptoms of depression. It is recommended that all symptoms be discussed with his IBD specialist. While there may be adjustments in his medication regimen, he may also benefit from a consultation with a GI mental health provider to aid with managing the complexities of IBD. They will assess for severity of mood symptoms and help create a treatment plan to aid in improving mood, fatigue and overall functioning. To locate a mental health provider, encourage your son to speak with his IBD provider as that provider may have someone on the team or have a local resource. He can also use this directory: www.romeGIpsych.org.

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

January 2023

Q: I am wondering if there are ways to help reduce my stress levels related to having a chronic illness in the workplace. Should I tell my supervisor that I have IBD? I feel overwhelmed at times at work and feel like I am not able to complete the task needed on time. I am unsure how to cope.

A: Stress can have a significant impact on our mind and body. Work is one aspect of life that can contribute to stress for various reasons. In people with chronic GI conditions stressors related to work can come from the actual job demands, while also GI-specific stressors such as physical symptoms, access to bathrooms, navigating medical appointments and more. If aspects of IBD are impacting you at work, it is likely time to identify who at work can assist with navigating your rights as someone in the work force with a chronic illness. Depending on your needs and work environment, you may be able to provide very basic information about your needs and the impact of your health on your work. You can share what you feel comfortable sharing. You may benefit from working with your medical provider and employer to complete FMLA (Family and Medical Leave Act) or ADA (Americans with Disabilities Act) paperwork to receive reasonable accommodations. Having these accommodations in place can assist with stress management by reducing some of the burden if you need a day off for the management of your health. You can find important information about your rights as a person with IBD here: https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/employment-and-inflammatory.pdf

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

October 2022

Q: My son was diagnosed with Crohn's at the end of March 2022. He was put on Humira, developed antibodies and was switched to Remicade. He received his 3rd induction dose of Remicade on Sept 8 (his levels look good with no antibodies, and C-reactive is back to normal). He is still having diarrhea 1-2 times per day with some cramping (down from 6-7/day early summer). When should we expect these symptoms to improve?

A: Thank you for your question. I am glad that your son is feeling better, but I you are correct, true clinical remission (absence of symptoms) is the first goal of therapy. Sounds like he is responding to the therapy both by lab data (normal CRP) and symptom improvement. I am not sure how long ago he received the third dose but, he should stay at least as good, if not further improve by dose four. This is important since that is the first “maintenance” dose and is likely scheduled eight weeks after the third. Likely, your son’s gastroenterologist will be checking an infliximab level then to assure the dose is optimized for good disease control going forward. Ultimately, the next goal of treatment is to assure healing of the lining (mucosa) of the bowel. This can first be measured with a stool test for inflammation (calprotectin) and later, by repeating imaging with an MR enterograpy (MRE) or repeat colonoscopy. Studies have shown that healing of the mucosa is associated with our best long-term outcomes, so it is very worthwhile to look for this. Also, if symptoms persist or recur, such follow up testing would help clarify whether active Crohn’s disease is still contributing. Hope he is feeling back to himself soon!

read answer

ANSWERED BY:

Joel Rosh, MD
Director, Pediatric Gastroenterology Vice Chairman, Clinical Development and Research Affairs at Goryeb Children's Hospital/Atlantic Health Professor of Pediatrics at Icahn School of Medicine at Mount Sinai

August 2022

Q: My 14 year old has been in "remission" for about 1 year now and still receives the remicade infusions every 8 weeks, but with this new school year she is now experiencing sort of panic attacks/anxiety. I've made her appointment with pediatrician but looking to see if this is common in youth with an IBD?

A: There can be many anxiety provoking things that happen around back to school time for kids (schedules, lockers, new friends, school changes, etc). So, first it is important to normalize this for kids with and without chronic illness. For those with IBD, there may be some additional stressors that I would encourage you to explore with your daughter. Dr. Brad Jerson is a pediatric GI psychologist who just published a great article recently about school considerations that can impact those with GI conditions (https://www.healio.com/news/gastroenterology/20220823/back-to-school-with-digestive-disorders-parentschool-partnership-key-to-patient-support). Some of the factors to consider include bathroom access, dietary sensitivities, navigating your health with your peers and more. All of this can progress from worry to anxiety to panic if unaddressed. It is a great idea to chat with your pediatrician, and consider talking with a GI psychologist (if you are near one) or a general mental health provider who can assist with anxiety management.

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

August 2022

Q: I have a 19 year old son who is in college, he is very nervous about sharing a room with someone who doesn’t understand his illness. He is not always vocal about having IBD and does his best to manage without many people knowing when he is in pain, etc. How would you recommend he handle the situation with having a roommate and living with IBD? I feel like he may be having anxiety related to this.

A: I would say that the anxiety of having a roommate for the first time is common for most college students. Normalizing this for him may be a good place to start. It would them be helpful to work on language that he can become more comfortable with around talking to his roommate (and friends) to help them understand how IBD can impact his life. While discussing bathroom issues can feel uncomfortable, once he gets the conversation about his needs out there, it will likely help to reduce the anxiety. He doesn’t have to be graphic or overly detailed but help give some context to why he may spend some extra time in the bathroom, need to use the bathroom urgently, need time for rest or eat differently. It typically takes a lot more energy to avoid these types of conversations over time than it will to have the initial conversations and hopefully have them be well received. He may also see that his roommate can be supportive and assist him when and if he needs that.

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

August 2022

Q: Hello. I am a mom of a teen daughter who has been diagnosed for just shy of a year. She is often times staying in her room, avoiding friendships, and even refusing to eat at times. I am worried she might be depressed related to having a chronic illness. Are there things I can do to help as her mom? Ways to teach her to cope with her illness? Anything would help!

A: Thank you for being curious and aware of these changes in your daughter. A new diagnosis of a chronic disease can lead to many life changes, new normal and at times, fear about the future. Watching for signs of anxiety and depression are important. It does sound like your daughter is experiencing some symptoms of depression. I would recommend speaking with her gastroenterologist about whether there is a GI psychologist or GI-specialized mental health professional for her to consult with. If not, you can check www.ROMEGIPsych.org or look for a mental health provider who specializes in working with teens, chronic illness, depression and anxiety via www.psychologytoday.com or another via the Crohn’s and Colitis Foundation resources.

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

July 2022

Q: After being diagnosed with Ulcerative Colitis in Oct 2021, My gastroenterologist put me on Uceris (Corticosteroid) and Lialda. I felt good with no active symptoms for 3 months. I started weaning off Uceris after that and quickly saw my symptoms come back (mainly diarrhea and blood in stool). After starting and weaning off Uceric again, my doctor wants to put me on Imuran or biologics(Humira) since I cannot achieve remission consistently. Do you have a recommendation for first time use?

A: I agree with advancing treatment to biologics or immunomodulators if there are active symptoms despite mesalamine, but I encourage you to a. Verify objective active inflammation with stool calprotectin and/or flexible sigmoidoscopy. b. Have a comprehensive discussion of ALL your medication options (what you listed are only a couple of options - besides azathioprine/adalimumab examples of other options are infliximab, vedolizumab, and ustekinumab). c. come to a shared - decision with your doctor about the best treatment for your UC.

read answer

ANSWERED BY:

Heba Iskandar, MD, MSc
Associate Professor, Director of IBD Clinical Research

July 2022

Q: I have been taking Humira for a year and a half. Since starting the drug, I have had scalp psoriasis. Now, after a year and a half I'm starting to develop the same reaction. I have hives that come and go in different areas as well as some skin inflammation and after my last injection my lips ballooned until I took some Benadryl. My question is, is it possible to have an allergic to a drug like Humira after taking it for so long?

A: Yes , this is entirely possible and skin reactions can occur at any time after starting a medication. Humira can cause certain kinds of psoriasis, hives, and lip swelling in some cases. In your situation, I recommend consulting with a dermatologist, possibly an allergist, as well as your GI to determine the best course of action moving forward.

read answer

ANSWERED BY:

Heba Iskandar, MD, MSc
Associate Professor, Director of IBD Clinical Research

June 2022

Q: My 12 year old son is now facing a ileo colectomy. What can we expect afterwards? How can I help to make the procedure and healing time go well?

A: Surgical intervention is a big step at any age so congratulations on being proactive in helping him (and therefore you!) through this. First and foremost, these are great questions for you to ask your surgeon and their team. I assume you are referring to an ileocecectomy (removal of a portion of the last part of the small intestine along with the first part of colon = cecum). This is the most common surgery performed on those with Crohn’s disease. Accordingly, your son’s team likely has significant experience with this and can assist answering your questions. The hospital may also have a Child Life team and other supports—feel free to use them to get yourself educated and your son educated at an age appropriate level. There may also be other pediatric patients and their families who have been through the same experience who have volunteered to speak to others and share experiences with the Power of Two program. Feel free to take advantage of all such resources. Most commonly, this surgery is now performed laparoscopically (minimally invasive surgery) which allows early hospital discharge and much less post-operative pain than in the past. The surgical team will lay out a plan for return to full activity which will slowly occur over a few weeks. Also, keep in mind that while the surgery will remove the bowel already damaged by the Crohn’s, it does not cure the condition and there will need to be a plan to prevent disease recurrence after the surgery. So be sure to speak with your medical team so that you are fully aware of the post-operative plan to prevent disease recurrence. Also, in addition to using medical therapy to prevent recurrence, it is recommended that a colonoscopy be performed within 6 months of the surgery to assure that the plan is effective and that Crohn’s inflammation has not recurred. Best wishes for a rapid and full recovery!

read answer

ANSWERED BY:

June 2022

Q: My son has been on Remicade since 2013, he has Crohn’s. He has been in remission. He has had issues with acne since he started the medication. Since switching to generic we noticed he began to get cystic acne. He had to have them removed. He is 26 yrs old and is now dealing with all these cysts. Frequent visits to dermatologist, having to get 4 steroid shot in cyst. Do you think this is a side effect from the medication?

A: Thank you for the excellent question. It looks like he started infliximab around age 15 years which is a very common age for acne so this should not be seen as a surprise. However, your concern that this has persisted to this degree is noted. Traditionally, the main medication associated with acne is steroids but it looks like his medical team has done a great job staying away from that. Whether he is receiving originator infliximab (Remicade) or a biosimilar should not make a difference here. Dermatologic issues can be seen with anti-TNF therapy and while acne is not the most common, it is a consideration here. Some of the newer biologics approved for Crohn’s affect the skin to a much less degree and he should be encouraged to have a discussion about this with his team. Additionally, since you discuss this as cystic with the need for removal from his buttock, he should at least confirm that this is truly acne and not a condition called Hidradenitis Suppurativa (HS) which is sometimes associated with IBD (especially in cigarette smokers!) and would require a very different approach.

read answer

ANSWERED BY:

June 2022

Q: After being diagnosed at 78 years old with acute colitis - the hospital and GI Doctor recommended a low fat diet. They did not set me up with a nutritionist or give me a guideline for foods. I still have a lot of gas even with just keeping my diet simple. I know I do fill up with gas if I don't eat every 4/ 5 hours after breakfast/lunch and dinner. Are there some recommendations on diets to follow or go to foods to limit gas?

A: Excessive gas could be due to numerous causes including active inflammatory bowel disease or dietary intolerances. Gas in your stomach can be caused by swallowing air when you eat or drink via drinking through a straw, consuming carbonated beverages (soda, beer), eating too quickly, or chewing gum. Limiting these behaviors and practicing regular, mindful eating may help reduce symptoms. Certain high-fiber foods may also cause gas, including beans/ peas (legumes), raw fruits and vegetables (especially those with intact seeds and skins), and certain whole grains. Sugar substitutes, or artificial sweeteners, such as sorbitol, mannitol and xylitol, found in some sugar-free foods and beverages may also cause excess colon gas. Due to the fact that various medical conditions may increase intestinal gas, bloating or gas pain, I would recommend discussing potential underlying causes with your medical provider that way you can obtain more tailored recommendations for a potential diet plan for your inflammatory bowel disease or food intolerances. For further help finding a qualified registered dietitian nutritionist or food and nutrition practitioner who is right for you, check out: Find a Nutrition Expert (eatright.org)

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

June 2022

Q: Do you have any recommendations on how to help my child get the proper nutrition while also adhering to a special diet? I find it hard to get fruit and veggies in to his diet.

A: Some additional strategies to incorporate fruit and vegetable intake include “sneaking” them into dishes and using preparation strategies that could improve tolerance (as allowed on your child’s special diet): fruit/vegetable smoothies, juicing, pureeing vegetable soups, cooking rice in vegetable broth, baking fruit muffins, etc. When following a limited diet plan, it is key to get tested regularly for vitamin and mineral deficiencies and supplementing as needed. It is oftentimes recommended to take a multivitamin with additional vitamin and mineral supplementation as needed. Additionally, if overall intake and appetite are limited it can also be helpful to find an oral nutrition supplement drink such as Kate Farms or Pediasure to help fill in the gaps.

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

June 2022

Q: Hello, my husband has UC and finds it difficult to adhere to specific diets. Anything that you find helps with people who have to eliminate so much from their diet?

A: Following elimination based diets can be challenging but finding additional recipes, eating out strategies, or meal delivery services that can assist with food prep can be helpful. Below are some helpful resources for structured elimination based diets, a recipe database for those with dietary restrictions/allergies, and meal delivery services. Food Allergies: Safe Eats® Allergy-Friendly Recipes – Kids With Food Allergies IBD- AID: https://www.umassmed.edu/nutrition/ibd/ibdaid/ SCD: https://www.nimbal.org/ https://gikids.org/ FODMAP: Hundreds of Low FODMAP Recipes & Resources | FODMAP Everyday Low FODMAP Diet | IBS Research at Monash University - Monash Fodmap AIP: https://www.thepaleomom.com/start-here/the-autoimmune-protocol/ https://autoimmunewellness.com/ CDED: https://mymodulife.com/ Meal Delivery: Daily Harvest, Hello Fresh, HungryRoot, Epicured

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

June 2022

Q: Hello, I'm 58 years old and was diagnosed with Crohn's a year ago. I've been receiving infusions of Inflectra every 8 weeks which may be helping because my calprotectin is back to normal. I will know more when I have the next capsule endoscopy. Meanwhile, I am wondering if it is normal to be very tired after the infusions. I am sleeping for hours and don't feel like I can do anything for a couple of days.

A: I agree with your work up to make certain first that the disease is in complete remission and it’s not active disease and inflammation causing your symptoms. Another suggestion could be to determine if you are getting any pre-medications with your infusions such as Benadryl which can cause fatigue and discussing with your providers if there is a -non-drowsy option you could use for premedication instead. Lastly, I would check to see if your vitamin levels have been checked especially your vitamin B12 levels. This is absorbed in the ileum which it seems may be the area of your Crohn’s disease and can commonly be low in Crohn’s patients. Low B12 is associated with fatigue and repletion of this can help energy levels. Additionally, making sure iron levels and vitamin D are replete are also critical. Crohn’s disease has been associated with a chronic fatigue even when in remission that can affect certain people. There is ongoing research in this field to better understand the causes and therefore formulate better therapies to treat it. This is a diagnosis of exclusion and would explore other diagnoses first including checking in with your primary care doctor to make sure other organ systems are checked such as thyroid. One method that helps patients is to increase exercise to 5 times a week for at least 30 minutes. This tends to increase energy.

read answer

ANSWERED BY:

Alyssa Parian, MD
Co-Clinical Director of Gastroenterology & Hepatology at Johns Hopkins School of Medicine

June 2022

Q: I have had a full colectomy for my UC. I'm now experiencing some inflammation in my J-Pouch and my lower intestine. I'm currently treating with steroids but would like to also try an anti-inflammatory diet as well. Have other patients had much luck with this diet? Also, I was advised not to eat nuts after my colectomy but opinions vary. Have others been able to digest almonds or cashews post colectomy?

A: Inflammation in the lower intestine (or pouch) is common but really depends on multiple factors or why that is happening. We don’t have the best evidence for diet therapy in people with J-pouches, and there is argument whether there are diets that are truly “anti-inflammatory” to your bowels. While there are foods that people tolerate differently (nuts, seeds, fatty foods), I don’t usually have diet restrictions for my post-colectomy patients. While some things can perhaps cause more diarrhea, they don’t necessarily cause the inflammation. I would recommend speaking to your doctor prior to making any changes.

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

June 2022

Q: I recently was diagnosed with ulcerative proctitis, a more mild form of ulcerative colitis. I went to see my doctor after having consistent blood in my stool but no other symptoms. I had a colonoscopy done back in September 2021 and was diagnosed with ulcerative proctitis. I was prescribed 1000mg mesalamine suppositories. I have been searching for alternative, natural treatments for my condition as I would prefer to not be on medication. Is it possible to treat my condition without medication?

A: Treatment decisions still are made on a personalized basis. Some of my proctitis patients can go on as-needed therapy, but if you are having consistent blood in the stool, no one wants that for you, and generally speaking, the risks of undertreated inflammation is much higher than any drug that you may take. However, I would recommend speaking to your physician.

read answer

ANSWERED BY:

Sophie Balzora, MD
Clinical Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at the NYU Grossman School of Medicine

May 2022

Q: My daughter has taken Humira and is now Stelera for her Crohn’s. It seemed after her injection she develops a localized reaction at the site that last 3days. She takes Zyrtec 3 days prior and 3 days after. She takes Benadryl and Tylenol pre med the injection. She has no antibodies to the drugs and it seems it may be from the filler in the injections. Are there any medications that do not contain these fillers. Or is there another pre med she can take. At this time she is unable to Remicade.

A: I hope the Stelara is working and that your daughter’s Crohn’s is in deep remission. You are describing a local site reaction, and these can be quite common. You are correct that this may be from the non-active ingredients (we call these excipients rather than fillers) or it could be a local reaction to the medication. One non-drug interventions that helps with this is to assure that the site of injection is rotated from dose to dose. Additionally, we have had great success with “conditioning of the injection site” by applying an ice pack for 10 minutes prior to the dose. Regarding medications, if it is not painful, she may not need the Tylenol and the Zyrtec or a Claritin may be enough to allow her to stop the Benadryl which often times causes drowsiness in adolescents.

read answer

ANSWERED BY:

May 2022

Q: My 16 year old daughter was diagnosed with UC in October. She has taken steroids and Mesalamine with no relief from the bleeding. They are now wanting to put her on Humira. I am nervous about putting her on biologics and was wondering what some of your experiences have been with using biologics? Can she achieve remission?

A: The PROTECT study was a prospective, multi-center, NIH funded study of newly diagnosed children and adolescents with ulcerative colitis (UC). Important findings of this study included the fact that 40% of pediatric UC will be maintained by mesalamine. Which means 60% of children and adolescents with UC will need biologic therapy to maintain steroid-free remission of their UC. In truth, you daughter is already on the most toxic medication we use for UC, that is, Prednisone! In addition to anti-TNF therapy such as Humira or Remicade, Entyvio (vedolizumab) may be an option for her. This is administered intravenously like Remicade but the main target is the proteins in the bowel which assist movement of inflammatory cells from the blood stream to the intestine making the effect more specific to the bowel (“gut specific”). In addition to decreased systemic effect and being a more targeted therapy, there was a head-to-head comparison trial of Entyvio vs. Humira and Entyvio showed some superiority in this trial (called VARSITY). Officially, Entyvio is approved for ages 18+ but there is substantial pediatric experience and in light of the findings in VARSITY, we have had good success getting Entyvio for our less than 18-year-old patients.

read answer

ANSWERED BY:

May 2022

Q: My 23 year old son was diagnosed with severe ulcerative colitis. My question is what to expect after we get his current situation under control. The priority is getting him better but am wondering if he will be able to return to his job as an apprentice lineman when he is in remission. He works long hours outside in the heat? I am worried about him getting dehydrated spending so many hours in the sun.

A: I am sorry that he is having to go through this and want to reassure you that remission = normal. So your health-related concerns would be the same as for anyone else who has a demanding job. Your priorities are exactly correct—first the remission. Once that is there, he should wear sunscreen, cool clothing and stay well hydrated—same as everyone else on the line!

read answer

ANSWERED BY:

February 2022

Q: Hello. I am diagnosed with UC. I have been in an active flare for over year. My doctor wants to put me on a biological since I can not get in remission. He left the choice up to me. Do you have a recommendation for first time use?I have narrowed it down to Humira or Entyvio.

A: This really is more of a personalized decision, and depends not only on your colitis, but perhaps other problems you may have related to your colitis (ex. Arthritis or other conditions outside of the bowels). Both, however, are reasonable choices, and both are better than being on steroids long term or being in a flare all year.

read answer

ANSWERED BY:

Alka Goyal, MD
Clinical Professor- Pediatrics Gastroenterology

December 2021

Q: I am scheduled for laparoscopic surgery for ileocolic resection due to Crohn’s disease. Diagnosed at age 40 with mild disease managed with pentasa and entocort for 14 years but now have strictures one of which is ten cm. Doctor is advising that I also begin remicade but is that before or after the surgery? Does Remicade have anything to do with existing strictures? Thanks I’d also like to know how the recovery is for this surgery.

A: It is likely that your disease progressed to stricture due to ineffective treatment of the Crohn’s disease. Pentasa is not approved in the management of small bowel Crohn’s disease and Entocort should only be used for < 3 months. There are several factors that go into decision making to start therapy after lleocolic resection and it shoulds like your physician has classified you as higher risk of progression/disease. They are likely suggesting you start Remicade after surgery as preventative measure. Remicade is effective drug to prevent post-operative Crohn’s disease recurrence and recurrent disease could lead to further strictures. I would suggest that you review the recovery with your surgery team, if you have laproscopic the recovery is shorter than if required open surgery. Please visit: https://www.crohnscolitisfoundation.org/what-is-crohns-disease/treatment/surgery

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

December 2021

Q: I was diagnosed with crohn's in 7/2020. I find that if I eat broccoli, cauliflower, winter squash, sweet potato, the consistency of my bowel movements changes. I'm just wondering if this is normal. Is it that my system can't handle the fiber in these vegetables? I have no problem with cooked stringbeans, zucchini, yellow squash or carrots.

A: We know that various foods can increase symptoms of gas, bloating and change bowel consistency. If you aren’t having any other symptoms than change in bowel consistency (assume you mean diarrhea) and you are tolerating this without dehydration it might just be the nature of your body’s interaction with these foods. Often times people can tolerate cooked vegetables better. It would be important to know if you have any stricturing of your intestine as raw uncooked vegetables can sometimes be problematic.

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

December 2021

Q: I am a 62 year old female diagnosed in Nov 2019 with Crohn's disease. Initial treatments included prednisone, Pentasa and then Remicade infusions in May 2020. Had a bowel resection in October 2020. In July 2021 had a reaction during Remicade infusion so my doctor started me on Stelara in August 2021. November labs have the highest Calprotectin level ever, and CT scan shows new strictures developing. How long does it take for Stelara to have an effect? Or is this a reaction to Stelara?

A: I am sorry to hear that you aren’t feeling well. Sounds like Remicade was working fairly well for you however it was complicated by an infusion reaction (which we know can happen but is rare). If you are having progression of your disease on the Stelara it might be that it is too soon in the treatment course or you are under medicated, what that means is that you might benefit from escalation of therapy, but this would need to be discussed with your treating provider. They could see if they can get approval for every 4 week dosing or repeat IV loading dose, and if no improvement within the next 2-3 months then consider going back to anti-TNF therapy class with Humira and strongly consider combination therapy with immunomodulator (azathioprine or methotrexate). If you are having significant symptoms now or they are concerned about severity of inflammation they can trial short course of steroid (budesonide vs. prednisone).

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

November 2021

Q: Hi, I am a 28 year old Crohn's patient dealing with ongoing fistulizing perianal complications over the years. I have tried just about every biological drug out there (besides cimzia). But the fistulas have never cleared up and just branch further more. This was initially caused by having a resection after having an ostomy for 7 years, and the answer was to put the ostomy back to divert path of stool away from the fistula tracts. However, 7 years have gone by and there's still constant drainage.

A: This is a tough situation that requires close multidisciplinary care with your colorectal surgeon and gastroenterologist. The first step is to assess the degree of activity of the perianal fistulas as well as the intestinal disease (ie how much Crohn’s disease activity is going on in the small bowel and colon). This would involve getting an MRI pelvis to really examine the perianal area for fistula activity and abscess (sometimes with an MR enterography to look at the small bowel for activity) and a colonoscopy. If there is still quite a bit of activity despite diverting the stool, then the reality is that you may need to have a completion colectomy with permanent ileostomy especially if you have been on so many medications without benefit. If you haven’t been referred to a major IBD center for a consultation with an IBD specialist and IBD colorectal surgeon, we would strongly recommend it as this is a complex case. It is important to advocate for additional opinions – if there is consensus across the board, then that is helpful for decision making, but sometimes a fresh set of eyes can evaluate the situation and potentially identify another option. However, in truth, a surgery does seem like it may be the safest, most effective approach – remember, surgery is not a failure, it is an important treatment to help regain quality of life, control inflammation, and decrease risks of treatments that are not working.

read answer

ANSWERED BY:

Christina Ha, MD
Director of the Inflammatory Bowel Disease fellowship at Cedars-Sinai Medical Center, Associate Professor

November 2021

Q: How do you decide between a Ileostomy vs a colostomy? This will be permanent due to a complicated anal fissula that requires removal of the rectum. My left side of my large intestine has always been red and inflamed it has always been the same section but my right side has been healthy since I began medication for my Crohn's in 2009. The risk is that I would end up having another surgery in a couple of years to remove what is left.

A: The decision is usually based on extent, location and severity of your Crohn’s disease. If the majority of your colon is involved, then an ileostomy is typically performed due to issues related to inflammatory burden, colorectal cancer risk and blood supply/technical issues related to creating the ostomy. If a limited amount of your colon is involved (especially limited to the sigmoid colon or rectum, and the rest of your colon is normal as well as the small bowel, then a colostomy may be performed. This is a multidisciplinary decision based on careful review of your IBD history, medication use, body type, weight, and prior surgical histories. Make sure to consult with a colorectal surgeon who has expertise in IBD surgeries and, if there is uncertainty, sometimes it is helpful to get an additional opinion at a major IBD center.

read answer

ANSWERED BY:

Christina Ha, MD
Director of the Inflammatory Bowel Disease fellowship at Cedars-Sinai Medical Center, Associate Professor

November 2021

Q: My 22 yr old son is a college student and takes Entyvio infusions for Crohns. I’m concerned and not finding thorough answers to whether or not he should be vaccinated for Covid. And if so, which vaccine is recommended. What are others doing in similar situation?

A: He should be vaccinated for COVID. Back in April 2021, the International Organization of IBD (which is a panel of international experts) said that we should vaccinate IBD patients with whatever vaccine we can first gain access to. All the 3 vaccines available in the US (Pfizer, Moderna and Johnson and Johnson) are fine in IBD patients. They all will need boosters as well. Of note, the response to the vaccine will be decreased by being on Entyvio, but this still confers your son a level of protection he would otherwise not have without the vaccine.

read answer

ANSWERED BY:

Karlee Ausk, MD
associate director of the Swedish IBD Center

November 2021

Q: I'm on mesalamine for crohn's. I've had polyps removed in the past. I battled uveitis the past year and my last colonoscopy showed 2 deep ulcers. One in the colon and a smaller one in the small intestine. I did not take the medication faithfully since I don't experience much pain. Would staying on mesalamine faithfully or at a higher dose help heal the ulcers? Would a bland diet help in the healing?

A: Mesalamines for Crohn’s have limited utility. The deep ulcers usually reach below the mucosa (the inner layer of the colon) but the mesalamines are solely mucosal agents. In my opinion, Crohn’s patients need biologics for optimal management. This is more important than a bland diet. I would stop the mesalamine and try a biologic to prevent uveitis recurrence and ideally heal the ulcers as well.

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

May 2021

Q: I had my second COVID 19 vaccine 2 days ago. I have been very frightened of contracting COVID since losing a 31-y-old cousin to the disease and have not been getting together with family/friends. At my vaccine appointment, I was told that it may take me longer to get full efficacy of the vaccine than other people because I have Crohn’s and take Stelara, which suppresses my immune system. I wasn’t told how much longer to wait to get together with others. How much longer should I wait?

A: There have been initial studies concerned for the possibility of lower antibodies titers after the first vaccine dose in patients who are immunocompromised, but we do not know if this applies specifically to patients with IBD on biologics, and whether that is the case after the second dose. A recent small study, however, found that IBD patients on medical therapy mount the same response as patients without IBD after the Covid Vaccine. So at this point we do not have evidence that patients with IBD on Stelara or other biologic drugs will have a delay in immunity or difference in immunity. Our evidence suggests that after your second dose of vaccine, you can function as if you were a patient who has been vaccinated in the general population. No need to wait any longer than any other vaccinated people.

read answer

ANSWERED BY:

Emmanuelle Williams, MD
Associate Dean for Student Affairs, Penn State College of Medicine, Associate Professor, Department of Medicine, Director of Inflammatory Bowel Diseases, Division of Gastroenterology and Hepatology

May 2021

Q: I am a 52-year-old male who has been suffering from IBD for more than two years. I have been taking mesalamine since then and also have been taking steroid (prednisone) almost fifty percent of the time to control flareup. Recently I came across some research papers that showed direct link between Vitamin D3 and IBD. My current vitamin D level is borderline at 30 nmol/L. Do you think increasing the level to 75 by taking high dosage of vitamin D3 would help to curb the auto immune disease?

A: While there is some data that Vitamin D3 may be associated with IBD, there is not yet strong data that increasing your vitamin D to high level you have mentioned will be beneficial. The goal of IBD treatment is to be in a stable, steroid free remission. If you are requiring steroids 50% of the time, this is a sign that the medication you are taking is not working, and either the dose may need to be adjusted, or a new medication is needed. Steroids are the medications associated with the most risks and side effects in IBD treatment, and should be avoided as much as possible.

read answer

ANSWERED BY:

Sushila Dalal, MD
Assistant Professor of Medicine

May 2021

Q: What antibiotics are best for IBD patients for conditions like sinus infections. Are there particular antibiotics that should be avoided by IBD patients? Should probiotics be taken when you are on an antibiotic?

A: Antibiotics can cause diarrhea by disrupting the normal bacterial community in the intestine. One of the most common ways that antibiotics can cause diarrhea is through increasing susceptibility to C difficile infection. The classes of antibiotics that have the highest association with C diff infection risk are fluroquinolones, Clindamycin, Penicillins, Cephalosporins, and Carbapenems. There is low quality evidence for probiotics. There may be some benefit to taking probiotics such as Saccharyces boulardii, the combination of L acidophilus and L casei, the combination of L acidophilus, L delbrueckii bulgaricus, and B bifidum, or the combination of L acidophilus, L delbrueckii bulgaricus, B bifidum, and S salivarius thermophilus.

read answer

ANSWERED BY:

Sushila Dalal, MD
Assistant Professor of Medicine

May 2021

Q: I'm 30 and I was diagnosed with Crohn's disease last year. I've been suffering new symptoms between infusions. Is it normal for the arthritis associated with Crohn's to be so excruciating? I have trouble gripping a doorknob at times. Also, is nerve hypersensitivity also associated with Crohn's? I just need to know what issues to take to my gastroenterologist and what to discuss with other providers.

A: Unfortunately, arthritis is associated with Crohn’s disease and ulcerative colitis, and can be quite painful. New arthritis symptoms should definitely be discussed with your provider so that she or he can determine whether the symptoms are due to ongoing bowel inflammation, medication side effects, or potentially simply share the same underlying genetic risk as IBD. Some IBD medications are better than others at treating arthritis, and medication adjustments may be needed, or medications may need to be added in order to get the arthritis under control. New nerve symptoms should also be discussed with your IBD provider. Nerve symptoms may be related to vitamin deficiencies that can occur with IBD, or possible medication side effects. It is also best to bring up any new symptoms so that your provider can you let you know if he or she thinks that they may be related to your underlying condition or treatment or not.

read answer

ANSWERED BY:

Sushila Dalal, MD
Assistant Professor of Medicine

May 2021

Q: I am 36 and was recently diagnosed with UC. I take medication for chronic pain syndrome, will this affect my UC ? If so, should I discuss with my gastroenterologist when I get my new medication for UC? And how should I go about this discussion?

A: Discussing any medications that you are taking, whether prescribed, over the counter, or supplements is important in order to make sure there are no interactions with your other medications and that the medications that you are on do not affect your IBD symptoms.

read answer

ANSWERED BY:

Sushila Dalal, MD
Assistant Professor of Medicine

April 2021

Q: I am 21 years old and have been diagnosed with Crohn’s this last month. I am really leaning more towards not taking any medication. Instead taking vitamins and supplements along with cannabis. I have found that helps the most. Is it necessary to take prescription medication, if I have found a way to be in remission?

A: Many patients are anxious about taking medications in the setting of a new diagnosis. A small select group of patients with very mild Crohn’s disease do not need chronic medication, but the of patients majority do. In addition, if Crohn’s is not controlled many patients on no medications known to be effective will go on to eventually have significant complications from their disease and a lower quality of life long term. Unfortunately vitamins, supplements do not have evidence of treating Crohn’s and there still not enough data to determine the impact of Cannabis positive or negative. You may be effectively treating your symptoms but the concern is that your underlying disease will progress if it is not addressed with medications or possibly well timed surgery. The idea is to intervene on your disease, prior to the disease progressing. Please discuss with your gastroenterologist if there are other medical therapies and treatment strategies that could benefit you. In the meantime, good quality sleep, a balanced diet low in processed food, addressing anxiety and depression if present, and even adjunctive measures such as mindful meditation as adjuncts to improve your quality of care can be considered as you and your physician make decisions on treatment.

read answer

ANSWERED BY:

April 2021

Q: I have been on Remicade/Inflectra for 19 years. I receive infusions every 8 weeks along with blood draws as necessary. Because of so many years of this (and maybe because of my age - 64), my veins can be difficult to access. I only have 2 that the clinic seems to be able to use. I am considering a port. My GI is okay with it but I am still on the fence. What are the pros and cons of a port?

A: Pros of a port would be easy access for your infusion nurses, less pain as well less anxiety for you every time you have to think of getting a medication that has kept you well for 19 years. You would also be able to get your labs drawn through the port. Some patients also like having both arms free during treatment. It also would help preserve the veins you do have. Cons would include the risk of infection, which could be severe. This is my greatest concern for patients. Ports also do need upkeep and patients who are vigilant about monitoring for infection or complications: they can malfunction and are susceptible to blood clots and may require replacement. Some patients still get soreness around the site after treatments, not all nurses can access ports, and the port is visible and juts out of the skin, and can be bumped when patients are particularly active. This is a personal decision to be made with joint decision making with your physician. In the meantime, make sure you are particularly well hydrated before you arrive for your infusions, not just the morning of but the whole day before. Identify nurses who have been successful in accessing your veins in the past.

read answer

ANSWERED BY:

April 2021

Q: I was diagnosed with a mild case of Crohns 6 months ago. My doctor tells me that biologics are the only treatment to achieve long-term remission. I'm very concerned about having Stelara in my body for the rest of my life. I'm told that this is the treatment for me. Are there are any other non-biologic drugs that could help me achieve remission, or if dietary changes can achieve the same effect.

A: The details of your case are best known by your primary gastroenterologist. There are various types of medications for Crohn’s. Biologics, for patients who have mild to moderate disease and depending on their risk for progression, in terms of getting patients into remission and keeping them there have the strongest data and best safety records compared to other available non-biologic medications. What I tell all my patients is that you will be on Stelara “Forever For Today” – what I mean by that is that if the medication works we would keep you on it for as long as it works. If the medication does not work or stops working, we do not keep you on it forever. If a new treatment arrives which would be better suited to you, you would be switch you. In short, from the information we have at this time we would hope and wish that we can keep you on this medication that is very effective with a great safety record. The concern about having a medication for a lifetime is understandable. However, at this time there is no cure for Crohn’s and we know that the majority of patients need to be on lifelong medication. There is a dysregulation in your immune system pertaining to your gut, and unfortunately we need to use medications to help regulate that for you. While some dietary interventions have helped patients (less process food diets, Mediterranean type diets), we do not yet have evidence that diet alone can control infection in the long term.

read answer

ANSWERED BY:

April 2021

Q: I have been on Entyvio for a year now and have experienced total remission from my ulcerative colitis symptoms. However, since starting the medication I have had nonstop bloating. I have tried countless treatments, including medication, low fodmap diet, meditation, ibguard, antibiotics, etc. Nothing has stopped the bloating. Considering that the bloating started around the time I started my infusions, could this be a side effect of the Entyvio?

A: Bloating is not a recognized side effect of Entyvio, though every patient is different and every patient’s response to a medication may be unique. It sounds as if you have explored several causes of bloating other than the medication and not found relief. There may be many causes of bloating, including IBS to which patients with IBD are at risk. Celiac disease, lactose intolerance, small bowel bacterial overgrowth and medications are all possible causes. Is it possible that you changed your dietary habits since feeling better from ulcerative colitis standpoint? Has your small bowel been evaluated? Hormonal changes can also impact bloating. If not causes are found, biofeedback can be considered and has been shown to decrease distension.

read answer

ANSWERED BY:

April 2021

Q: I am currently on a biologic (infliximab)regimen for UC. I have the second COVID vaccine shot coming up soon. Two days after the vaccine, I am scheduled for my biologic infusion. Is this safe? Will the vaccine so closely administered adversely affect the effectiveness of either? Should I postpone my infusion?

A: These are all good questions. There are no consensus recommendations on spacing our the COVID vaccine with infusions. I advise my patients to leave at least 3 days between the vaccine and an infusion to better decipher if one or the other is causing new symptoms. Three days is generally enough time for any symptoms from the vaccine to resolve. There is nothing to indicate that postponing the infliximab infusion will be helpful for the vaccine. In fact, it may put you at risk for a flare of your UC. We do not yet know if medications like infliximab blunt the effects of the vaccine but this is an active area of study. I advise my patients to get the vaccine and continue their therapies as scheduled until more information is available

read answer

ANSWERED BY:

Lesley Stanford, MS, RD, CSP
Pediatric Nutritionist, Duke University Medical Center

November 2020

Q: My son is 7 and just diagnosed with Crohn's. His disease is severe. The doctor gave us a choice Humira or Remicade. How do you decide about which medication to choose?

A: This is a very common question. In my practice, we stress the importance of shared decision making between the physician, the parents and the most importantly, the patient. When selecting a new medication, it is key to be completely informed. As both adalimumab (Humira) and infliximab (Remicade) target the same inflammatory protein (TNF-alpha), their efficacy (remission rates) are essentially equal for Crohn’s disease. In addition, the safety profile are similar. How are they different. Adalumumab is given as an injection (typically in the lower abdomen or upper thigh) at home and infliximab is given as an infusion requiring an intravenous (IV) catheter with each dose. Adalimumab is injected every 2 weeks (although some patients require weekly dosing). The first 3 doses of infliximab (induction) are given over 6 weeks with maintenance doses given every 8 weeks (some patients may require infusions every 4-6 weeks). Infliximab infusions require outpatient visits at infusion centers with the infusion lasting 1-3 hours. Factors to consider between the two: convenience (home vs. infusion center) and patient preference to medication delivery (injections vs. IV starts). At our center, all patients starting infliximab receive the first 5 doses over 3-hours at our infusion center. If the infusions are well-tolerated, we provide the option of receiving those infusions over 1-hour and at the patients home with a nurse from the home health agency.

read answer

ANSWERED BY:

Phillip Minar, MD
Associate Professor of Pediatrics, Medical Director of the Schubert-Martin IBD Center, and the Program Director for Advanced Pediatric Gastroenterology IBD Fellowship at Cincinnati Children’s Hospital Medical Center

November 2020

Q: I am 15 and my dad has Crohn’s. Recently I’ve started showing symptoms and I know I need to tell my parents so I can see a doctor and find out if that’s what it is, but I don’t know how to tell my parents. I am terrified and I do not know what to do.

A: Whenever a parent is ill, it is natural for a child to be concerned about their own health. Although we know a family history of Crohn’s may increase the risk of Crohn’s disease in their children, it is also important to know that many of the signs and symptoms that are associated with Crohn’s disease are also shared with other illnesses, such as gastrointestinal infections (bacterial or viral causes), irritable bowel syndrome (IBS) or Celiac disease. In my practice, it is common to see siblings or children with a family history of Crohn’s disease and find out (by examination or testing) that the primary symptoms are secondary to another cause and not Crohn’s disease. In your situation, it is important to discuss these symptoms with your parents so they can make an appointment with your regular doctor. Your doctor will carefully listen to your symptoms, check your growth (height and weight), perform a physical exam and potentially order blood or stool tests to determine the cause. The sooner a diagnosis is made, the faster a treatment can be offered. If any of the symptoms are concerning for Crohn’s disease, your doctor will make an appointment with a gastroenterologist, a doctor specialized in diagnosing and treating Crohn’s disease. It’s really important to know that in the present day (2020), there are many more medication and dietary options to better manage Crohn’s disease than were available to previous generations. I tell each patient newly diagnosed with Crohn’s disease, that regardless of the ups/downs or curves in their road to recovery, our goal is to find the best treatment that puts them back on a straight path toward achieving all their personal goals!

read answer

ANSWERED BY:

November 2020

Q: I was recently diagnosed with UC as a 30-year-old female. I had always assumed I would have children, but now I am worried about the risk children might face. What is the absolute risk that my children would develop IBD or another autoimmune disease? Of 100 children born to women who have UC, how many go on to develop an autoimmune disease?

A: While the cause of the inflammatory bowel diseases (IBD, ulcerative colitis and Crohn’s disease) is multifactorial, the current data suggests the absolute risk for UC is 1.6% with maternal UC and 2.7% with maternal Crohn’s disease. If both parents have IBD, then the overall risk is increased. It is important to discuss family planning with your gastroenterologist as there are some medications that may need to be stopped or changed prior to becoming pregnant. While there is so much more to learn about the risks of developing IBD, we do know the three main components are (1) genetic, (2) environment exposures and intestinal microbiome and (3) an inappropriate immune response. For IBD to develop, it’s a combination of the perfect storm of all three components. It’s natural for parents/patients to ask what they can do to prevent IBD in their own children? The latest data would suggest that environmental triggers that increase the risk of IBD are (a) exposure (active or passive) to cigarette smoking (b) increased use of antibiotics, (c) increased use of nonsteroidal anti-inflammatory drugs (NSAIDS like ibuprofen) and (d) consuming a westernized, highly processed diet. The current data also suggests that the key to optimal the best outcomes (child or adult) is recognizing (awareness) the symptoms of IBD, early diagnosis and timely treatment.

read answer

ANSWERED BY:

November 2020

Q: My 18-year-old son was recently diagnosed with ulcerative colitis. He is 5’11” and is down to only 126 pounds. His body is not absorbing nutrients. They are going to put him on Humira and steroids. I have read the side effects of Humira and it scares me. What are his risks of taking Humira at his young age? He is also very depressed. What can I do to help him?

A: Although the diagnosis of ulcerative colitis or Crohn’s disease can be difficult for any patient at any age, it is important to recognize that depression and anxiety are extremely common when the diagnosis occurs during adolescence and young adulthood. At our center, we offer every child/young adult the opportunity to meet with our IBD-focused psychologist. We find that young patients really need an outlet to express their feelings as our behavioral specialists focus on teaching techniques to cope with the disease. Whether it’s use of guided imagery or deep breathing, coping is a learned behavior that young patients may not initially intuitively recognize or take the time to practice. It’s important to recognize when to ask for help with a psychologist or psychiatrist, even if your treatment center doesn’t have access to an IBD-focused psychologist. Adalimumab (Humira) is a medication that binds to a protein in the body called TNF-alpha. The multiple studies in adults and children have shown that it not only heals the intestinal tract, but also improves growth by improving gut absorption of key nutrients and improving the overall quality of life for the patient. It is classified as an immune-suppressing medication. While the use of this medication can be associated with an increase risk of certain infections, this is uncommon. Prior to starting, your doctor will check for an active TB infection and may check for active intestinal infections or fungal infections. The additional risks such as an allergic reactions to the injection, rashes, liver injury, and certain cancers are also very low. It’s important to discuss the specific risk/benefits with your doctor so they can tailor the treatment to your needs.

read answer

ANSWERED BY:

November 2020

Q: My 17-year-old son has now chipped and broke 3 bone areas. He is on Remicade and these areas have not healed after surgery. Does Crohns affect bone health and healing or is it the meds?

A: Crohn’s disease can certainly impair bone health as all patients are at an increased risk of nutrient deficiencies (Vitamin D, Vitamin B12, zinc, iron and folate). Moreover, some Crohn’s disease patients may restrict their diets (such as dairy-free, lactose-free) to control symptoms, and therefore, can further exacerbate the risk of poor bone health by limiting both Vitamin D and calcium. For your 17 year-old son, it would be important to keep a 1-2 week diet history to further review with your gastroenterologist or registered dietician to better understand if his current diet is lacking specific nutrients. Given the history of poor bone health, he may require additional Vitamin D and calcium depending on this diet history. In my practice, we check Vitamin D every 6 months (supplement when needed) and check a bone density at the time of diagnosis and repeat if needed (such as following recurrent fractures or more severe disease). While clinical remission (no active gastrointestinal symptoms) is an important goal, we now recognize that complete gut healing is even more important in order to prevent further complications of Crohn’s disease. It is reasonable to review your laboratory markers with your doctor and ask if further testing is needed (endoscopy or abdominal imaging). In regards to the medication, we typically find that the infliximab (Remicade) improves intestinal absorption of key nutrients by healing the gut. As each patient requires personalized care for their IBD, I would recommend discussing potential medical side effects with your primary gastroenterologist as well.

read answer

Eugene Yen, MD
Research Associate Professor, Gastroenterologist

November 2019

Q: What has been the success or failure of stem cell treatment for ulcerative colitis? How do I find stem cell clinical trials for the treatment of UC that are actively recruiting?

A: The data for stem cells is more common in Crohn’s disease, which overall studies have shown slight or no benefit, which is disappointing given the initial potential. I am not aware of many studies in UC. While this is still a promising field, the good news is that we so many more therapies for UC that are being tested, and we are understanding the safety issues better as well.

read answer

ANSWERED BY:

Eugene Yen, MD
Research Associate Professor, Gastroenterologist

November 2019

A: Please note - nuts and seeds do not increase inflammation or worsen colitis. They are great foods that have fiber, healthy fats, protein, and antioxidants. That said, during a flare the whole food forms may be harder to digest or feel a little irritating to the GI. So the modified texture such as smooth nut/seed butter (almond butter, sunflower butter, cashew butter, etc) or milks (coconut milk, hemp milk, etc) can definitely be more conducive during periods of inflammation. Make sure to reduce added sugars, processed oils, and additives such as carrageenan when choosing nut/seed butters or milks.

read answer

ANSWERED BY:

September 2019

Q: My 13 old son was diagnosed w/mild case of Crohn's a year ago. Pentasa is not working for him and the Dr wants him to go on a biologic. Entyvio seems safest from what I have been reading. Can children be on Entyvio or should another biologic be tried first?

A: Great question! This is a really important question and one that does not have a straight-forward answer unfortunately. The short answer is, we just don’t know. The anti-TNF medications (infliximab and adalimumab) are the only FDA-approved biologics for pediatric patients with moderate-severe Crohn’s disease. Use of any other medication, like Entyvio, is considered off-label use. Entyvio is FDA-approved for adults with ulcerative colitis and Crohn’s disease. With that said, pediatric gastroenterologists have been asking the same question, “is there a certain group of children/adolescents that would benefit from Entyvio as their first biologic?” We don’t have the answer yet. There is some data to support that this could be a good option for some patients and I would encourage you to have this discussion with your primary GI physician.

read answer

ANSWERED BY:

September 2019

Q: My 12 year old daughter was diagnosed with UC, with high grade dysplasia in her colon and low grade dysplasia in her small intestine. She started Prednisone and mesalamine 6 days ago. After consulting with other adult doctors, they have recommended she start Humira or Remicade. Both of these drugs seem pretty serious but is one preferred over the other. They want to scope her again in 3-5 months. Does dysplasia usually go away when the inflammation is reduced?

A: Only infliximab (Remicade) is FDA approved for pediatric UC. Adalimumab (Humira) is FDA approved for adults with UC, however, Humira is often used off-label for pediatric UC. Depending on the severity, Remicade is often preferred given its relative quick onset of action. If your daughter is admitted to the hospital, then Remicade is the preferred biologic. Both medications have a good safety record in children. In regards to the dysplasia question. This is relatively uncommon in children, especially at diagnosis. I would agree with close surveillance. I would also suggest that the biopsies be reviewed by a either a pediatric or adult pathologist who is an expert in intestinal dysplasia to confirm the diagnosis.

read answer

Alanna Cabrero, MS, RDN, CDN
Founder of Alanna Cabrero Nutrition

May 2018

Q: I am 68 years old and have UC. I was switched 4 weeks ago from Remicade (16 months) to Humira. Suddenly I have severe joint arthritis in my left hip that is making it very difficult to work. My GI says the Humira has nothing to do with the arthritis. The timing is too coincidental. Is there a correlation between the new medication and the development of weakness and joint pain arthritis?

A: [It is difficult to answer personal health questions as there can be nuanced causes of arthritis or it may be related to other co-morbidities.] While uncommon, joint pain affecting only one hip can be related to either IBD or its treatments, includes other medications such as prednisone. It would be appropriate for you to also be evaluated by your primary care physician and/or a joint specialist (i.e. rheumatologist) to further determine the cause and treatment of your new hip pain, especially given the severity of your discomfort.

read answer

ANSWERED BY:

Lea Ann Chen, MD
Assistant Professor, Department of Medicine, NYU Langone Medical Center

April 2018

read answer

ANSWERED BY:

Lea Ann Chen, MD
Assistant Professor, Department of Medicine, NYU Langone Medical Center

March 2018

Q: I have Crohn’s and I am considering doing a liver cleanse. Is it safe to do so or not recommended?

A: A liver cleanse is not recommended. There is no scientific evidence to support that a liver cleanse is beneficial for Crohn’s disease.

read answer

ANSWERED BY:

Tina Patnode, RDN, LD
Registered Dietitian Nutritionist

March 2018

Q: I have had Crohn's disease since 2003. All of the research I have done said to cut back on the fiber. I was just put on a high fiber diet. That has left me confused. Is fiber bad for crohn's disease?

A: There is an abundance of information online about dietary fiber’s impact on specific disease states. I understand how it can be confusing. With regard to Crohn’s disease, increasing dietary fiber may be beneficial while the disease is in remission. During a flare-up, a lower-fiber diet (10 grams per day) may help to minimize digestive symptoms such as diarrhea or loose stool. As symptoms subside, you want to gradually increase dietary fiber and drink plenty of fluids. The goal is to eat a well-balanced diet to include foods that are anti-inflammatory. This includes vegetables, fruits, fish, whole grains, legumes, nuts, seeds, herbs and spices such as turmeric, ginger, and garlic.

read answer

ANSWERED BY:

Tina Patnode, RDN, LD
Registered Dietitian Nutritionist

February 2018

Q: Our 9-yr old was diagnosed with Crohn's 8 weeks ago, and is on Remicade. He is on a mostly liquid diet. Because the protein drinks are coming 3 times/day, he started fighting us and not wanting to drink them. Each and every bottle is a battle that has just worn us down emotionally. We're at our wits and creativity end trying to find ways for him to take them. We've tried Special-K chocolate, Ensure Clear, and Carnation Breakfast. This is so very, draining. Any advice is much appreciated.

A: Having a child with medical issues can create many obstacles that sometimes we just need help to navigate. Communication with your son’s gastroenterologist or pediatrician is a great place to start. Discuss your concerns, what you have tried and how this is impacting the family. They will likely be able to provide some suggestions or direct you to a specialist who can help. To address the dietary aspects, ask if there is a pediatric dietitian who specializes in IBD or feeding issues. This person may be able to create a tailored diet plan taking into consideration your child’s age, diagnosis, medication, and medical recommendations. Also, a child psychologist would be a wonderful addition to your child’s team! Perhaps there are some emotions that your son is having a difficult time processing which impacts other aspects of his life (i.e. eating). The child psychologist can aid your child in working through the various aspects of having IBD in a developmentally appropriate way. The psychologist can also work with the family to aid with implementing strategies to make things less challenging at home.

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

February 2018

Q: I was in remission for about 8 months. Recently I had a flare and my doctor wants me to go on Imuran. I have been to the point of having a mental and nervous breakdown over this due to my fear of the cancer side effects. The 2 specialists I saw say to weigh the risks and I know the risks of the flare, however, I literally cannot function or enjoy life at the prospect of taking a medicine that could kill me. This is dramatic but I haven’t been able to cope with this and need help.

A: Taking a new medication, especially one with scary, possible side effects, can be anxiety provoking. Fears related to the unknowns and uncontrollable aspects of the medication can drive that anxiety as well. If you are feeling debilitated by the anxiety and worry over this medication, seeking the support and guidance of a psychologist can be very appropriate and helpful. Look for a mental health provider who specializes in gastrointestinal disorders, chronic health issues and/or anxiety. A provider who specializes in the use of Cognitive Behavioral Therapy (CBT), a type of therapy very commonly used in medical settings and to treat anxiety. CBT is used to address your worrisome thoughts and provide you with tools to better manage them. Mental health care when managing a chronic disease, like IBD, is often just as important as your medical care. Your therapist can aid you in developing tools to better manage stress and adaptively cope with worry and fear. When you feel better about your self-management skills, you can regain focus on the enjoyable aspects of your life.

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

February 2018

Q: My mom thinks I am researching and educating myself on Crohn's because I want attention, wants to lay down and be a "bum" all my life and want pain meds and thinks I'm making up the pain and the whole diagnosis. Says she knows people who have it and are never in pain so I must just want a fix and thinks I'm making myself sick (throwing up and diarrhea) She's causing me more stress and depression. What can I do to inform her better or something?

A: Sometimes having IBD can feel as though you have an invisible illness. That can make it hard for family and friends to truly understand all the ways in which IBD impacts your life. There is a great deal of education that is required to successfully navigate IBD. Asking your loved one to learn with you can be a good starting place. Also, consider outside resources for support, such as friends, the IBD community, and a mental health professional. Here are a couple suggestions to aid with building a support network: • Invite your family member to an appointment with your gastroenterologist. Ask your provider to discuss the disease, impacts on the family, treatment and potential side effects of treatment. • Ask your loved one to read this document about being diagnosed and managing IBD: http://www.crohnscolitisfoundation.org/assets/pdfs/newly-diagnosed.pdf • Invite your family member to a Crohn’s and Colitis Foundation patient education event in your area. • Join an IBD support group to talk with other people who have IBD and have had similar experiences with family and friends. • Invite your family member to sit with you and watch IBD School videos from IBD experts at the University of Michigan: http://www.med.umich.edu/ibd/school/index.html • Communicate how it makes you feel when your loved one doesn’t take your disease seriously. Let them know how they can best support you. • Consider establishing care with a mental health professional who works with people with chronic illness to learn skills to manage the many complexities of IBD.

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

February 2018

Q: My 14 year old daughter is on 6mp and her liver enzyme level is 116. The doctor said that was high but nothing needs to be done about it. Could you shed some light on why nothing needs to be done about a high level?

A: Liver enzyme levels can be elevated for any number of reasons including: medications such as 6-MP, infection, IBD-associated liver disease and other medical conditions. A transient or mild elevation in a liver enzyme test is not typically a cause for concern, but means that the tests should be repeated to ensure that the levels have returned to normal and are not increasing. If the liver enzymes remain elevated additional blood tests and/or imaging of the liver may be warranted. It may also be useful to have the 6-MP level checked to make sure that the blood levels are in the target range.

read answer

ANSWERED BY:

Sushila Dalal, MD
Assistant Professor of Medicine

November 2017

Q: The medical field is growing and advancing rapidly through the years, how come the colonoscopy procedure is so invasive as well as the small bowel follow through? Are there diagnostic tests that are much easier on the patients and less invasive? What would be the worst case scenario if a patient were to refuse those types of procedures when suffering from Crohn's Disease?

A: Colonoscopy provides actual visualization of the inner lining of the colon (large intestine) and the end part of the small intestine and allows for biopsies to be obtained at the time of visualization. Reasons for assessing the lining of the colon and the end part of the small intestine in a Crohn’s patient include screening for colon cancer, assessing for Crohn’s healing, assessing severity and extent of Crohn’s, and at times endoscopic treatment of strictures. Small bowel follow through is an oral barium contrast x-ray test, the barium contrast ingested outlines the inner surface of the small intestine. Other similar tests that evaluate the small intestine include CT enterography and MRI enterography. In order to adequately visualize the gastrointestinal tract in radiologic imaging studies oral contrast is needed. Another method to evaluate the small intestine is by capsule endoscopy, a pill with a camera that takes pictures of inner lining of the small intestine. There are specific reasons to use one test over another and the test chosen is usually influenced by why testing is ordered. In a patient that has Crohn’s involving the colon and is due for colon cancer screening, colonoscopy is the only way to screen adequately for colon cancer. When evaluating for partial small obstruction due to Crohn’s, then radiologic imaging is needed rather than capsule endoscopy since a capsule would get stuck in the intestine. The worst case scenario if someone were to refuse testing depends on the reason for ordering the test.

read answer

ANSWERED BY:

Christina Ha, MD
Director of the Inflammatory Bowel Disease fellowship at Cedars-Sinai Medical Center, Associate Professor

September 2017

Q: I have Crohn’s Disease and was told I was non active. Is this different from remission? If so, how?

A: Hard to Say. Today the goal is to treat to target. Target is defined as clinically inactive (clinical remission) as well as endoscopically normal. Clinical inactivity is measured by 1) absence of symptoms, 2) normal biomarkers (CRP and fecal calprotectin) or 3) CDAI score of 150 or less. Clinical inactivity, does not correlate with endoscopic activity. Remission implies clinically inactivity and endoscopically inactive.

read answer

ANSWERED BY:

Ryan C Ungaro, MD
Gastroenterologist, Assistant Professor, Gastroenterology The Mount Sinai Hospital

June 2017

Q: Is there any treatments for healing fistulas besides Remicade?

A: Yes, other anti-TNF agents such as adalimumab can help treat perianal fistulas. There is some data from the recent national gastroenterology meeting that ustekinumab can help heal fistulas as well and some data on vedolizumab. Recently, studies on stem cells that are directly injected into fistulas show a lot of promise. In severe cases, surgery can be needed.

read answer

ANSWERED BY:

Ryan C Ungaro, MD
Gastroenterologist, Assistant Professor, Gastroenterology The Mount Sinai Hospital

June 2017

Q: Are there any drugs besides Biologics that are being investigated?

A: Yes there are new oral drugs that are in late stage trials or likely soon to be approved. For ulcerative colitis, tofacitinib is a small molecule that blocks inflammation through the JAK pathway and may be approved by the FDA soon. For Crohn’s disease, mongersen is an oral agent that works locally in the intestine to alter inflammation through a novel target in the TGF beta pathway. This drug is in phase 3 trials currently.

read answer

ANSWERED BY:

Ryan C Ungaro, MD
Gastroenterologist, Assistant Professor, Gastroenterology The Mount Sinai Hospital

June 2017

Q: I'm 15 and in high school. I wanted to know if I can get some advice on how to handle my Crohn’s symptoms in school. How to deal with embarrassing situations of needing to go to the bathroom in school and in public.

A: Proper preparation can help with the stress or anxiety of a potentially embarrassing situation. Make sure you have an “emergency kit” in your locker or school office. Tell a trusted friend or teacher where you keep it, in case you need someone to bring it to you in the bathroom. Common items for the kit include: wet wipes, underwear, pants or leggings, large size freezer bag to transport soiled clothes, hand sanitizer and perhaps some Poo-Pourri or air freshener. It is important to remember, you may NEVER need these items, but it can feel reassuring to know they are available. In terms of frequent or urgent bathroom use, speak to your teachers about your IBD and let them know you may need to leave the classroom without permission or a pass. If they know ahead of time, this can take away the focus of your bathroom use and normalize the experience. It is important to de-stigmatize your IBD and therefore, talking with friends and teachers can help them to understand your needs and provide you with support when needed. There are also options for accommodations through the 504 Plan that you, your medical provider, teachers, parents can develop if your IBD and treatments are affecting your school performance or experience. For example, you may be able to “stop the clock” during exams if you needed to use the bathroom. There can even be ways to keep an emergency kit in or very close to the school bathroom you use. It's important to remember that stress doesn’t help anything. Therefore, if you are feeling embarrassed, reach out for support. Often times we experience more anxiety related to the possibility of a situation happening, and forget that whatever you are faced with…you will be able to cope. Having a good support network can make coping much easier. For additional information about being a teenager with IBD, check out: http://www.crohnscolitisfoundation.org/assets/pdfs/teenguide.pdf

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

June 2017

Q: My Daughter is 13 and was diagnosed in March 2017 with very aggressive CD. She is on Remicade, Metronidazole, steroids and an antibiotic. She has a persistent cough that usually makes her throw up. What are some treatment options to get rid of the cough?

A: There seem to be 2 questions here, first, why does your daughter have a persistent cough, and second, how can it be treated. I would suggest that the first is the more critical question to address as the second will almost certainly depend on it. A cough is quite non-specific as it may reflect active infection, non-infectious inflammation or injury, hypersensitivity following acute illness, or tic-like behavior among others. The association with the vomiting is not too helpful in differentiating as while some coughs are classically associated with vomiting, some individuals simply vomit due to stimulation of the gag reflex while coughing. Important questions to consider would be duration of the cough, presence of cough while asleep or not, associated features of illness such as fever, fatigue, or weight loss, and travel or sick contacts leading up onset of the cough. As you mention both metronidazole and an antibiotic, I’m curious whether you meant to write methotrexate- the reason I point that out is that methotrexate has rarely been associated with inflammation in the lungs. Inflammatory bowel disease on its own may also lead to inflammation in the lungs as well, and being on multiple medications that suppress the immune system such as steroids and Remicade further increase the risk of infection. All that said I would say the most important thing would be to make sure you communicate the presence of the protracted cough to your daughter’s physician. If ultimately it is simply a cough without associated inflammation or infection there is unlikely to be any particular medication to prescribe, but breathing exercises and other relaxation techniques may be helpful in enabling a degree of suppression.

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

April 2017

Q: Our 14 yr old son was diagnosed with CD in 7/2016. He was having back pain and had an X-ray. In Jan 2017 had another X-ray and compared to the July one, he had major deterioration even though he hasn't had IBD issues in months. He has compression fractures in his spine. He was on steroids for 2 months but has been doing well on Remicade. He has gained 22 lbs but no growth in height. The dr wants to put him on bisphosphonates. Is this a standard treatment in CD patients with a fracture?

A: Vertebral compression fractures can be caused by osteoporosis, trauma, or diseases affecting bone (pathologic fracture). The trauma/injury to the area would likely need to be substantial and you did not mention any major accident or injury to the area so low density most likely the issue. Other bone diseases could play a role especially given the short time since diagnosis and should be excluded. Young patients should get a bone age and a bone density shortly after diagnosis to see if there is delay in bone growth and to see what the baseline bone density is. There could have been IBD going on that affected the bone that was not severe enough to cause obvious gastrointestinal symptoms prior to diagnosis. If there was a fracture but bone density was not low, bisphosphonates would not be indicated. IBD can affect bone density for multiple different reasons with about half of patients showing a significant reduction in their bone mass. Bisphosphonates would not treat his current fracture but would try to address the low bone density so a future fracture is less likely. This class of medication is not commonly used in pediatrics especially while bone is still gaining in height and mass. Its use is more often reserved for patients with specific bone diseases. It is thought to be reasonable for use in chronic illness if there is history of multiple low trauma fractures or a vertebral fracture history combined with a very low bone density. I would say the next appropriate step is an appointment with a pediatric endocrinologist. Their role is to help advise use of these medications and help weigh risk and benefits and provide other options as well as rule out other issues that could be playing a role. One can also try to improving bone density with increasing weight bearing exercise. This could be done with a physical therapist to make sure this is done safely in someone with a fracture history. Having optimal control of the IBD.

read answer

ANSWERED BY:

Philip Stein, MD
Attending Gastroenterologist, St. Christopher's Hospital for Children

March 2017

Q: I understand that patients can lose response to biologics after a few years? Is it worth the risk of taking a biologic given the potential side effects like cancer or PML?

A: All medication is judge by risk versus benefit. Risk of cancer with biologic medications is no longer considered significant. The risk of PML was seen with only one biologic - natalizumab (Tysabri) - which has since been replaced in treatment protocols by vedolizumab (Entyvio) and that drug has not been associated with PML.

read answer

ANSWERED BY:

Eugene Greenberg, MD, F.A.C.P., F.A.C.G.
Carle Physician Group Urbana, IL

March 2017

Q: I have IBD and I’m looking for good breakfast ideas. It seems no matter what I eat in the morning it goes right through me.

A: I would recommend first discussing with your physician whether your disease is well controlled and in remission or whether you have active disease. Ideally if your disease is well controlled you should be able to tolerate any type of breakfast. You are not alone. Many patients with active disease tend to have most bowel movements first thing in the morning or after breakfast. I would recommend minimizing caffeine and hot fluids which both can accelerate intestinal transit. Fatty foods may also result in bowel movements soon after eating. Many of my patients anecdotally tolerate oatmeal or cream of rice the best. Bananas and peanut butter also seem to be well tolerated. For patients who have narrowing in the bowel, smoothies are also great breakfast options.

read answer

ANSWERED BY:

March 2017

Q: In ulcerative colitis patients, do most cases of colorectal cancer start as polyps or dysplasia? How fast does dysplasia develop and grow to cancer?

A: In patients with IBD the sequence of polyp to cancer, if related to IBD, may not follow the same sequence as regular polyps. Colorectal cancer in IBD starts with some type of lesion, but these may be very difficult to see. The timing of dysplasia going to cancer may also be accelerated. For this reason, we recommend frequent screening – every 2 years in all patients after 10 years of disease with Ulcerative Colitis, and in Crohn’s Colitis if more than one third of the colon is involved. Patients with Primary Sclerosing Cholangitis (PSC) need yearly colonoscopies as their risk for colon cancer is particularly high. As lesions predisposing to cancer in IBD may be flat rather than look like polyps, it is also particularly important to have the best preparation possible, and to have a colonoscopy performed by a physician experienced in the care of IBD patients.

read answer

ANSWERED BY:

March 2017

Q: I have CD for many years. I recently had colonscopy #5. Since then (3 weeks) I'm feeling like I'm still doing the prep!! Urgent rush to the toilet at all hours day and night for a big rush of blood or brown water! How do I make this symptom quit?

A: I recommend calling your provider to discuss whether you are having a flare of your disease or if you may have concurrent c.difficile infection. Colonoscopy preparations should not cause your IBD to flare, but may alter your gut flora. I would recommend discussing your symptoms with your provider.

read answer

March 2017

Q: I am 28 years old and was diagnosed with UC in May 2016 (first flare). I had a second flare in Sept 2016. I was hospitalized both times. I am now on 5 mg of prednisone (every 3 days) and salazopyrin (3mg pd). I feel that a flare might come again. I feel tired and have gas. This potential 3rd one comes 4 months after the last one. Which is exactly the same amount of time between the first two. How can I manage my disease proactively?

A: Given two hospitalizations in a year, I think you should discuss with your provider considering escalation of therapy – proactively your provider can check blood and stool tests to see if there is any active inflammation, a repeat endoscopic evaluation could be in order as well. The goal is that you get off steroids to avoid long term complications of these medications and that your disease be more deeply controlled. Many patients also monitor their symptoms closely by journaling or using apps such as GI Buddy – and this can give helpful information to your provider.

read answer

ANSWERED BY:

March 2017

Q: What percentage of IBD patients have both Crohn's and colitis? Are they both diagnosed the same way?

A: 1a. Patients with IBD cannot have both Crohn’s and Ulcerative Colitis. The diseases are diagnosed/differentiated by history, physical exam, blood tests and most importantly colonoscopy. 1b. Crohn’s disease and spastic colitis (IBS) is seen in 15-20% of the general population and IBD does not exclude IBS from occurring. In other words, you can have IBD and also IBS. IBS is diagnosed by history and using the “Rome Criteria”. 1c. Statics for the occurrence of Crohn’s colitis in patients with Crohn’s disease are: Crohn’s Ileitis - 30% Crohn’s colitis - 25-30% Crohn’s Ileocolitis - 40% Therefore, Crohn’s colitis is seen in 70% of patients and diagnosed by colonoscopy/biopsy.

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

December 2016

Q: I had surgery in 2000. I had my colon removed and had a "j" pouch to avoid an ileostomy. I have developed a skin irritation that will not heal because of the frequency of bathroom use. It is extremely painful and I am requiring prescription pain killers. Is there any information on ways to help the skin heal?

A: Irritation of the skin around the anal area (perineum) caused by frequent stools (diarrhea) or poor control (incontinence) is caused by many factors working together. Frequent cleansing causes damage from abrasions and alters the skin’s protective acid content (pH). Excessive moisture further alters the skin’s pH, which increases its porousness (permeability). In addition to the local inflammation caused by cleansing and moisture, infection may develop as germs contained in the stool can penetrate the traumatized and porous skin. Management of the perineal skin damage requires local measures as well as identification and treatment of the underlying cause. Perineal skin cleansing should be performed after each stool or incontinent episode. Specific cleansers are available in many forms (emulsion, foam, liquid, towelette). Bar soaps, skin cleansing agents, and antibacterial hand-washing products can worsen the problem. The affected skin needs to be moisturized to reinstate the depleted factors. Humectants (glycerin, lanolin, methyl glucose esters, mineral oil) contained in perineal cleansers replace the skin’s natural oils. No-rinse perineal cleansers with humectants minimize drying because they remain on the skin rather than being rinsed away. Moisture barriers (protectants) contain active ingredients (dimethicone, lanolin, petroleum jelly, zinc oxide) to shield the skin from exposure to irritants and moisture. A moisture barrier may be incorporated into skin cleansers or separately applied as a cream, ointment, or paste. Ointments and pastes are longer lasting and more occlusive. Liquid barrier films or skin sealants combine a solvent that evaporates and a polymer that dries to form a barrier when applied. Some solvents may irritate the damaged skin, and any product should be accordingly used only if not associated with stinging during application. A liquid film barrier should not be combined with a moisture barrier because these agents are typically incompatib

read answer

ANSWERED BY:

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

November 2016

Q: I have severe stomach bloating. I look like I’m pregnant. Can IBD cause severe bloating? What can be done to reduce the bloating?

A: Bloating may a symptom of active IBD. Bloating can also occur due to other conditions that may be present in patients with IBD. These conditions include: small bowel bacterial overgrowth, celiac disease, irritable bowel syndrome, lactose intolerance, among others. Your symptoms should be discussed further with your doctor, to better understand the cause. A diet low in fermentable oligo-, di-, and monosaccharides and polyols, called a “low FODMAP” diet, may be helpful. Your doctor can provide you will further details about this diet, or other treatments for your symptoms.

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

October 2016

Q: My 14 year old daughter has Crohn's and takes methotrexate injections. She struggles to eat the most basic foods without feeling unwell. Is there any meal replacement shakes that is suitable for have age?

A: There are definitely several options of nutritional shakes available for her age. Any nutritional supplementation or especially "meal replacement" should be done with the supervision and consultation of a registered dietitian. I would recommend asking your daughter's gastroenterologist for a referral to meet with one to discuss further.

read answer

ANSWERED BY:

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

July 2016

Q: I was diagnosed with UC about 4 years ago. I'm currently on Remicade, 6MP, and Asacol. I'm an avid cyclist and over the past year have started to experience bouts of muscle fatigue and severe muscle cramping. This NEVER happened prior to my life w/UC. It's as if my muscles rebel against me without warning, even when I'm in remission and feeling quite well; it's like I unexpectedly get pushed off a cliff. Could this fatigue be due to the UC, the meds, or a combination?

A: It is difficult to know. If you are having diarrhea, you could be having electrolyte abnormalities and could be more prone to dehydration, which can affect cramping. The medications that you are taking seldom cause muscle aches, so I don't think that the meds are causing the issue, unless you recall getting cramps from one of the above meds. Finally, if you had a prolonged flare, you could have some muscle deconditioning and perhaps need to regain your strength and rebuild your muscle.

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

June 2016

Q: My dad was diagnosed with ulcerative colitis in 1982 and was recently diagnosed with prostate cancer. Treatment for his cancer involves radiation therapy. The doc said the radiation treatment might impact his uc and cause more inflammation or interfere with his uc treatment. What research or information do you have on how radiation treatment might affect uc?

A: Currently we don't have much information about the impact of radiation therapy to ulcerative colitis. We do know that radiation can cause injury and inflammation to adjacent rectum and you can get radiation induced proctitis. Your cancer Doctor may want to adjust the dose and intensity of brachytherapy accordingly. Active cancer may prohibit the use of certain immunosupressive drugs and close monitoring and ensuring colitis is under control is extremely important.

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2016

Q: My 13 yr. old son was diagnosed with Crohn's in 3/2016. His dr. tried weaning him off the prednisone 30mg twice and it’s not working {having stomach pains/vomiting}. So this last time the dr gave him 6-MP 50 mg 1 a day,Flagyl , Pentasa & Lansoprazole but he is getting sick with stomach pain and vomiting. He is afraid to eat solid foods. He only eats applesauce, popsicles, chicken noodle soup and one carnation breakfast drink a day. Any suggestions with getting him to eat solid foods?

A: It is important to collaborate with your son’s physician and dietitian to create a feasible, realistic plan to advance solid food into his diet. Importantly, it is essential to work with the physician to make sure that his Crohn’s disease is under control and in remission and address the cause of his stomach pain and vomiting to minimize issues associated with eating. Also, the physician can advise the dietitian, you and your son of any specific foods that should be avoided given his Crohn’s disease characteristics. The presence of strictures or narrowings of the intestine may impact one’s ability to tolerate certain types of solid foods. (Narrowings can be identified by upper endoscopy/colonoscopy or by MRI imaging of regions of small bowel inaccessible by upper endoscopy/colonoscopy). Patients with strictures may be advised to avoid high fiber foods such as nuts, hard raw vegetables and fruits. If lactose intolerance is identified, lactose-free options or lactase supplements with lactose-containing foods may be advised to address associated symptoms. For some patients, certain foods may trigger or worsen symptoms. This varies between individuals. Identification and removal of specific ‘trigger’ foods may help to minimize your son’s fear of eating ‘all’ solids. The dietitian can work with you and your son to help address any nutritional deficiencies identified and maintain a well-balanced diet to make sure he meets his nutritional needs as best as possible given his specific circumstances. This is done by integrating his food preferences with physician recommendations to create a working plan. If the team decides to eliminate any foods, the dietitian can advise how to substitute other foods that will provide the same nutrients. CCFA brochure: ‘Diet, Nutrition, and Inflammatory Bowel disease’ may be a helpful resource. Link: http://www.ccfa.org/resources/diet-nutrition-ibd-2013.pdf.

read answer

ANSWERED BY:

Sandra C. Kim, MD
Associate Professor of Clinical Pediatrics
The Ohio State University College of Medicine
Pediatric Gastroenterology, Hepatology, and Nutrition
Nationwide Children’s Hospital

May 2016

Q: My 13 year old son diagnosed with Crohn's disease at age 6 has had an allergy to Remicade, and just recently Cimzia after two years of use. He also takes 6MP. Next choice for treatment is supposed to be Humira, but we are wondering what the possibility of another allergic reaction?

A: Although Remicade (infliximab) and Cimzia (certolizumab) are both anti- TNF agents, they are designed quite differently. You mentioned that your son experienced allergies to both of these medications. Adverse reactions to these medications are not always allergies. Typically, having a reaction to an anti-TNF agent would not deter a change to another anti-TNF agent. In fact, if a patient experiences a type of adverse reaction that requires a change in medication (decided by the physician) and the current anti-TNF agent has been effective in treating the Crohn’s disease, often the physician will switch the patient to another anti-TNF agent. Humira (adalimumab) is another anti-TNF agent. One of the most common adverse reactions of adalimumab is an injection site reaction. Clinical studies have reported injection site reactions in 12 to 38 % of adult patients treated with adalimumab. Most injection site reactions are mild and do not require stopping the medication. One cannot predict whether or not your son will develop a true ‘allergic reaction’ to adalimumab. Your son’s pediatric gastroenterologist knows the details of his Crohn’s disease and the types of reactions he has experienced. He/she will be the best resource to discuss his treatment plan and your concerns.

read answer

ANSWERED BY:

Sandra C. Kim, MD
Associate Professor of Clinical Pediatrics
The Ohio State University College of Medicine
Pediatric Gastroenterology, Hepatology, and Nutrition
Nationwide Children’s Hospital

April 2016

Q: I've had UC for 30 plus years and have recently been diagnosed with a rectovaginal fistula at the dentate line. It has been recommended that an abdominal proctocolectomy with an end ileostomy be performed due to the fact that the fistula will be at the level of the cuff if any pouch is made. Does this require an open surgery and is there any way that a pouch or IPAA can be successful?

A: A rectovaginal fistula is a communication between the rectum and the vagina. Most are due to obstetric injuries. Other causes include irradiation, malignancy, congenital malformations, and inflammatory bowel disease. Rectovaginal fistulas are uncommon complications of chronic ulcerative colitis, and are more often associated with Crohn’s Disease. Many are asymptomatic and found incidentally. If the fistula is symptomatic, methods of treatment such as excision and primary layered repair, fistula plug placement, endorectal mucosal advancement flap can be performed. Success rates range from 50-95%. Rectovaginal fistulas associated with Inflammatory Bowel Disease have lower success rates. Having UC for 30+ years places a person at risk for the development of dysplasia and malignancy. Surveillance colonoscopies are done annually to identify these changes. If high grade dysplasia or malignancy is found, a total procto-colectomy with either end ileostomy or construction of an ileal pouch-anal anastomosis is performed. These procedures are also done for medically refractory cases of ulcerative colitis. Removal of the entire colon and rectum with creation of an end ileostomy is usually performed if the patient has poor anal sphincter function and incontinence is an issue. The total procto-colectomy with ileal pouch-anal anastomosis or “J-pouch” procedure restores near-normal bowel function by creating a neorectum from the terminal ileum. A mucosectomy (stripping the mucosa of the anal canal to the dentate line) with a hand-sewn pouch-anal anastomosis can be performed. Mucosectomy is often associated with injury to the anal sphincters, and impaired fecal continence may be a problem post-operatively. A diverting loop ileostomy is usually performed to allow the anastomosis to heal, and the ileostomy reversed 8-12 weeks later. The operation can be done via an open or a laparoscopic approach. A pouch procedure may be an option for you.

read answer

ANSWERED BY:

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

April 2016

Q: I was diagnosed with UC in 2014 . My dr. prescribed me Lialda but I still bleed with every trip to the bathroom . My flare ups have progressed and he only prescribed a steroid . While on medication is it common to still be bleeding every time I use the bathroom?

A: If you are experiencing ongoing bleeding and flare ups despite Lialda therapy, it is important to be sure that you do not have an infection, Clostridium difficile, which may cause diarrhea and bleeding. If there is no evidence of infection, it is possible that your dose of Lialda is not high enough. Your doctor may consider increasing your Lialda to a dose of 4.8 g (4 tablets) daily. Addition of a mesalamine suppository or enema may help to increase the dose of mesalamine in your rectum and sigmoid colon, to improve disease control. Lialda begins to be released in the end of the small intestine. By the time the medication reaches the rectum, the concentration of the medication is lower and some patients need additional mesalamine delivered directly to the rectum by suppository or enema to control disease. If this does not improve your disease control and you continue to have diarrhea and bleeding, you should be evaluated with a colonoscopy to reevaluate colon inflammation. If there is ongoing active inflammation despite your therapy, you may need to consider an immunosuppressive therapy such as azathioprine, mercaptopurine, infliximab, adalimumab, golimumab, or vedolizumab to gain control of your disease, and to avoid recurrent steroid use, which is the most dangerous therapy in the long term.

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

April 2016

Q: My Daughter is in her 50's and has had Crohn's most of her life, losing many feet of intestine due to surgeries. Many body parts are able to be replaced...heart, liver, lungs, skin, etc...why can't the intestine be replaced?

A: Despite advances in medical therapy for Crohn’s disease, a large proportion of patients with Crohn’s disease will require surgery within 10 years following diagnosis. Repeat surgical resections may result in short bowel syndrome, or an inability to absorb adequate fluids and nutrients. These individuals may require ongoing use of intravenous total parenteral nutrition (TPN) for nutrition. In patients beginning to fail TPN, small bowel transplantation may be considered. However, experience in small bowel transplantation for inflammatory bowel disease is very limited. Outcomes are generally poor, with low rates of survival at 5 years. Complications of the procedure include organ rejection and recurrent infections due to immunosuppression. Small bowel transplantation for Crohn’s disease may be life-saving in a small number of patients, and this procedure may become more common as surgical and postoperative care improve over time. However, further research is needed to better understand bowel immunology, the role of the gut organisms (microbiota) both in Crohn’s disease and in rejection, immune pathways involved in Crohn’s disease and intestinal transplantation, to improve outcomes with small bowel transplantation for Crohn’s disease.

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

March 2016

Q: I have been diagnosed with Crohn's. I frequently get blisters on the roof of my mouth. Is it normal to get these blisters in my mouth? I am being treated with Imuran.

A: Crohn’s Disease can involve any part of the GI tract from “mouth to anus”. The mouth blisters may very well be due to Crohn’s Disease and may respond to a change in therapy, including use of a topical steroid medication. However, you would also want to exclude a drug side effect or certain viral infections that could cause similar findings.

read answer

ANSWERED BY:

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

June 2014

Q: My significant other has Crohn's. I believe his Crohn's has seriously affected our sex life, but I cannot be sure because he won’t talk about it. During what he calls "a flare-up," we cease all intimacy and most affectionate contact. He gets so cranky and critical of me, I lose interest in sex.. He will only occasionally mention symptoms when they become too obvious to ignore. Is it typical for Crohn’s Disease to interfere with intimacy and sex?

read answer

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

January 2014

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

January 2014

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

July 2021

Q: I’ve been reading a book Plant Paradox for patients with UC? Is a plant-based diet beneficial for ulcerative colitis patients? What are the pros and cons?

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

July 2021

Q: I am a 71-year-old female and have just been diagnosed with ulcerative colitis. What would be the best multivitamin for me to take and the best probiotic? I am also diabetic.

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

July 2021

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

July 2021

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

April 2021

read answer

Heba Iskandar, MD, MSc
Associate Professor, Director of IBD Clinical Research

December 2020

Q: Is the Specific Carbohydrate Diet one that is helpful in controlling ulcerative colitis symptoms?

read answer

ANSWERED BY:

Lesley Stanford, MS, RD, CSP
Pediatric Nutritionist, Duke University Medical Center

December 2020

read answer

ANSWERED BY:

Lesley Stanford, MS, RD, CSP
Pediatric Nutritionist, Duke University Medical Center

Mark Mattar, MD
Quality Improvement Officer for the Division of Gastroenterology

February 2020

Q: I have Crohn’s Disease. A lot of foods such as dairy give me painful side effects like gas, stomach aches or nausea. Can you help give me a list of nondairy alternatives?

read answer

ANSWERED BY:

Kalee Eichelberger, RD,LD/N, CNSC
Specialty Dietitian at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease

February 2020

read answer

Lesley Stanford, MS, RD, CSP
Pediatric Nutritionist, Duke University Medical Center

ANSWERED BY:

Alanna Cabrero, MS, RDN, CDN
Founder of Alanna Cabrero Nutrition

March 2018

ANSWERED BY:

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

July 2017

read answer

ANSWERED BY:

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

June 2017

Q: My son has Crohn's and IBS. We have started really focusing on his diet, more veggies less meat and clean, no preservatives. Is there a certain diet that is better than others?

read answer

ANSWERED BY:

Ryan C Ungaro, MD
Gastroenterologist, Assistant Professor, Gastroenterology The Mount Sinai Hospital

April 2017

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

March 2017

Q: I have IBD and I’m looking for good breakfast ideas. It seems no matter what I eat in the morning it goes right through me.

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

February 2017

read answer

ANSWERED BY:

Philip Stein, MD
Attending Gastroenterologist, St. Christopher's Hospital for Children

January 2017

read answer

ANSWERED BY:

Sushila Dalal, MD
Assistant Professor of Medicine

October 2016

read answer

Eva Szigethy, MD, PhD
Professor of Psychiatry, Medicine & Pediatrics
Director, Behavioral Health with the Chief Medical and Scientific Officer
Founder, Visceral Inflammation & Pain (VIP) Center

September 2016

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

September 2016

Q: Would any of the experts recommend a Paleo diet, probiotics (if so what brand or specifics to look for), or the use concentrated cherry juice for ulcerative colitis flares?

read answer

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

July 2016

read answer

ANSWERED BY:

Joshua R. Korzenik, MD
Brigham and Women’s Hospital, Director of Crohn's and Colitis Center, Division of Gastroenterology, Hepatology and Endoscopy

May 2016

Q: What foods should NOT BE eaten to avoid flare-ups? Is there a diet for UC that I can live with and reduce or not have flare ups?

read answer

Eugene Greenberg, MD, F.A.C.P., F.A.C.G.
Carle Physician Group Urbana, IL

August 2015

Q: Sometimes I have stomach aches when I eat gluten and sometimes I don't. So, is it a good idea to go gluten free if you have Crohn's disease?

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

August 2015

read answer

ANSWERED BY:

Robert P. McCabe, MD
Minnesota Gastroenterology, P.A.

August 2015

Q: I have ulcerative colitis. Is it safe to take food grade diatomaceous earth? And if it is safe, can it be ingested it when actively bleeding?

A: There is no substantiated benefit from ingesting diatomaceous earth. Silica can be toxic. Its use is not recommended.

read answer

ANSWERED BY:

Robert P. McCabe, MD
Minnesota Gastroenterology, P.A.

August 2015

A: The stomach is normally very acidic (less than pH 3.5) so subtle differences in drinking water pH should be of no consequence.

read answer

ANSWERED BY:

Robert P. McCabe, MD
Minnesota Gastroenterology, P.A.

July 2015

read answer

ANSWERED BY:

Sandra C. Kim, MD
Associate Professor of Clinical Pediatrics
The Ohio State University College of Medicine
Pediatric Gastroenterology, Hepatology, and Nutrition
Nationwide Children’s Hospital

June 2015

read answer

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

October 2014

read answer

ANSWERED BY:

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

June 2014

Q: My significant other has Crohn's. I believe his Crohn's has seriously affected our sex life, but I cannot be sure because he won’t talk about it. During what he calls "a flare-up," we cease all intimacy and most affectionate contact. He gets so cranky and critical of me, I lose interest in sex.. He will only occasionally mention symptoms when they become too obvious to ignore. Is it typical for Crohn’s Disease to interfere with intimacy and sex?

read answer

ANSWERED BY:

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

June 2014

Q: My significant other has Crohn's. I believe his Crohn's has seriously affected our sex life, but I cannot be sure because he won’t talk about it. During what he calls "a flare-up," we cease all intimacy and most affectionate contact. He gets so cranky and critical of me, I lose interest in sex.. He will only occasionally mention symptoms when they become too obvious to ignore. Is it typical for Crohn’s Disease to interfere with intimacy and sex?

read answer

ANSWERED BY:

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

June 2014

Q: I had surgery to remove my colon in 2000. Should I be supplementing my diet with vitamins? if so, which ones?

read answer

ANSWERED BY:

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

May 2014

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2014

Q: My nine year old granddaughter has Crohn’s disease. She is doing well and feels fine. Since she is doing well, is there a need for her to attend various CCFA programs and events?

read answer

Eva Szigethy, MD, PhD
Professor of Psychiatry, Medicine & Pediatrics
Director, Behavioral Health with the Chief Medical and Scientific Officer
Founder, Visceral Inflammation & Pain (VIP) Center

February 2013

read answer

ANSWERED BY:

Eva Szigethy, MD, PhD
Professor of Psychiatry, Medicine & Pediatrics
Director, Behavioral Health with the Chief Medical and Scientific Officer
Founder, Visceral Inflammation & Pain (VIP) Center

December 2012

Q: I have Crohn's and am almost always extremely dehydrated - eyes so dry I can't blink, finger tips puckery, mouth dry no matter how much water I drink. Is this from Crohn's? What should I do?

read answer

ANSWERED BY:

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

September 2012

read answer

ANSWERED BY:

Robert P. McCabe, MD
Minnesota Gastroenterology, P.A.

May 2012

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

December 2011

Q: I have painful gas daily. Can I take simethicone or beano for this?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

December 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

November 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

November 2011

Q: Has there been any links shown between improved condition and a cessation of wheat in the diet?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

November 2011

read answer

Experts 2010-2011, MD, etc.
n/a

February 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

February 2011

Q: Can I drink wheat grass juice? I have Crohn's disease and I am thinking about going to a juicing program to get more vitamins.

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

January 2011

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

January 2011

Q: I am a vegetarian. What sorts of foods can I eat during a flare that will provide me with protein and nutrients, but still be soothing and allow for healing?

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

December 2010

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

December 2010

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

November 2010

Q: Would going on a liquid diet help to reduce disease symptoms?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

Karlee Ausk, MD
associate director of the Swedish IBD Center

August 2021

Q: I am a 71 year old female and have just been diagnosed with ulcerative colitis. What would be the best multivitamin for me to take and also the best probiotic? I am diabetic. Thanks

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

August 2021

read answer

ANSWERED BY:

Raluca Vrabie, MD
Assistant Professor, Department of Medicine at NYU Long Island School of Medicine

October 2020

Q: Is it normal to have problems with sex while in a flare? I am a young woman with UC and I would like to know if there is anything that can be done about pain during sex?

read answer

ANSWERED BY:

Sushila Dalal, MD
Assistant Professor of Medicine

October 2020

read answer

ANSWERED BY:

Sushila Dalal, MD
Assistant Professor of Medicine

July 2020

read answer

ANSWERED BY:

Sophie Balzora, MD
Clinical Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at the NYU Grossman School of Medicine

June 2020

Q: I have Crohn’s disease and was recently diagnosed with Immune thrombocytopenia purpura (ITP). How common is it in Crohn’s patients? What are some concerns I should discuss with my doctor.

read answer

ANSWERED BY:

Mark Mattar, MD
Quality Improvement Officer for the Division of Gastroenterology

December 2018

Q: I was diagnosed with Multiple Sclerosis (M.S). 15 years ago. I just spent 4 days in the hospital and diagnosed with UC on top of the M.S. Are the two disease related in any way?

read answer

ANSWERED BY:

Mark Mattar, MD
Quality Improvement Officer for the Division of Gastroenterology

December 2018

read answer

ANSWERED BY:

Mark Mattar, MD
Quality Improvement Officer for the Division of Gastroenterology

November 2018

read answer

May 2018

read answer

ANSWERED BY:

Lea Ann Chen, MD
Assistant Professor, Department of Medicine, NYU Langone Medical Center

February 2018

read answer

ANSWERED BY:

Stacy A. Kahn, MD
Attending Physician Boston Children's Hospital

January 2018

Q: I have ulcerative colitis. I have lost about 20 lbs in the last two months. Is that normal amount of weight loss?

A: I would need more information on this situation to be able to answer this question adequately.

read answer

March 2017

read answer

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

January 2017

read answer

Eva Szigethy, MD, PhD
Professor of Psychiatry, Medicine & Pediatrics
Director, Behavioral Health with the Chief Medical and Scientific Officer
Founder, Visceral Inflammation & Pain (VIP) Center

October 2016

Q: How do you deal with chronic mouth ulcers

A: There are numbing agents that you can swish in your mouth that your gastroenterologist can tell you about. Hypnosis can also be very useful for helping ulcers.

read answer

ANSWERED BY:

Eva Szigethy, MD, PhD
Professor of Psychiatry, Medicine & Pediatrics
Director, Behavioral Health with the Chief Medical and Scientific Officer
Founder, Visceral Inflammation & Pain (VIP) Center

October 2016

Q: Can you talk about the impact of disrupted sleep on Crohn's disease and what is being done to help patients who have these issues (who aren't on steroids)?

read answer

ANSWERED BY:

Eva Szigethy, MD, PhD
Professor of Psychiatry, Medicine & Pediatrics
Director, Behavioral Health with the Chief Medical and Scientific Officer
Founder, Visceral Inflammation & Pain (VIP) Center

October 2016

Q: For pain management does an IBD patient need to go to a pain management specialist or solely to the gastroenterologist or both?

read answer

ANSWERED BY:

Eva Szigethy, MD, PhD
Professor of Psychiatry, Medicine & Pediatrics
Director, Behavioral Health with the Chief Medical and Scientific Officer
Founder, Visceral Inflammation & Pain (VIP) Center

October 2016

read answer

ANSWERED BY:

Eva Szigethy, MD, PhD
Professor of Psychiatry, Medicine & Pediatrics
Director, Behavioral Health with the Chief Medical and Scientific Officer
Founder, Visceral Inflammation & Pain (VIP) Center

September 2016

read answer

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

July 2016

read answer

ANSWERED BY:

Joshua R. Korzenik, MD
Brigham and Women’s Hospital, Director of Crohn's and Colitis Center, Division of Gastroenterology, Hepatology and Endoscopy

July 2016

read answer

Karlee Ausk, MD
associate director of the Swedish IBD Center

April 2016

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

March 2016

Q: I have been diagnosed with Crohn's. I frequently get blisters on the roof of my mouth. Is it normal to get these blisters in my mouth? I am being treated with Imuran.

read answer

ANSWERED BY:

John S. Hanson, MD
Gastroenterologist, Carolinas HealthCare System

March 2016

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

January 2016

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

November 2015

read answer

ANSWERED BY:

Joshua R. Korzenik, MD
Brigham and Women’s Hospital, Director of Crohn's and Colitis Center, Division of Gastroenterology, Hepatology and Endoscopy

November 2015

read answer

ANSWERED BY:

Joshua R. Korzenik, MD
Brigham and Women’s Hospital, Director of Crohn's and Colitis Center, Division of Gastroenterology, Hepatology and Endoscopy

November 2015

read answer

ANSWERED BY:

Joshua R. Korzenik, MD
Brigham and Women’s Hospital, Director of Crohn's and Colitis Center, Division of Gastroenterology, Hepatology and Endoscopy

October 2015

Q: I have both Crohns and Candidiasis. The diets for each seem to be mutually exclusive. I've been eating the same few foods for two years and am going nuts. What can I eat?

read answer

ANSWERED BY:

Karlee Ausk, MD
associate director of the Swedish IBD Center

September 2015

read answer

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

August 2015

read answer

ANSWERED BY:

ANSWERED BY:

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

May 2015

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2015

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

June 2013

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

June 2013

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

January 2013

Q: Is there any guidance for the frequency of having a colonoscopy for someone with long standing Crohn's (30 years)?

read answer

ANSWERED BY:

Sandra C. Kim, MD
Associate Professor of Clinical Pediatrics
The Ohio State University College of Medicine
Pediatric Gastroenterology, Hepatology, and Nutrition
Nationwide Children’s Hospital

January 2013

read answer

ANSWERED BY:

Sandra C. Kim, MD
Associate Professor of Clinical Pediatrics
The Ohio State University College of Medicine
Pediatric Gastroenterology, Hepatology, and Nutrition
Nationwide Children’s Hospital

January 2013

read answer

ANSWERED BY:

Sandra C. Kim, MD
Associate Professor of Clinical Pediatrics
The Ohio State University College of Medicine
Pediatric Gastroenterology, Hepatology, and Nutrition
Nationwide Children’s Hospital

December 2012

Q: When my Crohn's disease is flaring, I shake, or vibrate so bad it wakes me up. I'm not diabetic. Is this from Crohn's?

read answer

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

September 2012

read answer

ANSWERED BY:

Robert P. McCabe, MD
Minnesota Gastroenterology, P.A.

September 2012

read answer

ANSWERED BY:

Robert P. McCabe, MD
Minnesota Gastroenterology, P.A.

September 2012

Q: Is it okay to continue medical treatment of IBD during pregnancy?

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

June 2012

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2012

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2012

Q: Is there any evidence that anabolic steroids can cause and/or inflame ulcerative colitis?

A: There is no data to state whether or not anabolic steroids cause or worsen ulcerative colitis.

read answer

Experts 2010-2011, MD, etc.
n/a

December 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

December 2011

Experts 2010-2011, MD, etc.
n/a

November 2011

Q: Is suddenly developed eczema after starting a new medication a common side effect?

A: The new development of eczema or any new skin rash is not common with most medications and should be discussed with one’s physician.

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

September 2011

Q: My son was diagnosed with erythema nodosum. He also has ulcerative colitis. How, if at all, is this related?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

September 2011

Q: I had an ileostomy 6 months ago after 1 bout of suspected colitis and a perforated bowel. Now my doctors are unsure if it was ulcerative colitis or Crohn's. Why can they not tell which it was?

read answer

Experts 2010-2011, MD, etc.
n/a

May 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

May 2011

Q: What happens when a flare up occurs? What should I look out for? My understanding is abdominal pain, diarrhea, and bloody stools. How long do flare ups last?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

April 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

March 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

March 2011

Q: I am experiencing lower back pain that stretches across my buttocks and up to waist. Is this part of Crohn's?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

March 2011

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

March 2011

Experts 2010-2011, MD, etc.
n/a

August 2022

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

August 2022

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

August 2022

read answer

ANSWERED BY:

Megan Riehl, PsyD
Assistant Professor of Medicine

June 2022

ANSWERED BY:

November 2020

read answer

Sandra C. Kim, MD
Associate Professor of Clinical Pediatrics
The Ohio State University College of Medicine
Pediatric Gastroenterology, Hepatology, and Nutrition
Nationwide Children’s Hospital

Robert P. McCabe, MD
Minnesota Gastroenterology, P.A.

December 2012

Q: Should recurring C Diff in a child be a cause for concern? Say recurring 3 times in 2 months and after taking antibiotics?

read answer

ANSWERED BY:

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

December 2012

read answer

ANSWERED BY:

Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine

September 2012

read answer

ANSWERED BY:

Robert P. McCabe, MD
Minnesota Gastroenterology, P.A.

March 2012

Experts 2010-2011, MD, etc.
n/a

February 2012

Q: I have Crohn's disease and also have back issues (herniated discs, tarlov cyst, spinal stenosis, etc), plus nerve damage. I am in the process of applying for SSD. How can I explain my inabilities?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

February 2012

A: It is possible that he might do okay with rectally administered mesalamines. If he proves intolerant to these, then thiopurines and/or infliximab might be helpful.

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

May 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

April 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

March 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

February 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

January 2011

Q: What is the effectiveness and safety rates of immunomodulators and biologic drugs prescribed for infants and toddlers?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

December 2010

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

November 2010

Q: My child has Crohn's disease and is much smaller than his classmates. How can we help him achieve his full growth potential?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

April 2021

read answer

ANSWERED BY:

April 2021

read answer

Jami Kinnucan, MD
Assistant Professor

ANSWERED BY:

Raluca Vrabie, MD
Assistant Professor, Department of Medicine at NYU Long Island School of Medicine

read answer

ANSWERED BY:

Eugene Greenberg, MD, F.A.C.P., F.A.C.G.
Carle Physician Group Urbana, IL

August 2017

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

August 2017

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

August 2017

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

August 2017

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

August 2017

Q: I have not had a bowl movement in almost a week. Can this be a problem associated with Crohn’s Disease? What should I do?

A: Constipation can be associated with Crohn's disease. However this type of problem should be evaluated with your provider.

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

August 2017

read answer

ANSWERED BY:

Jami Kinnucan, MD
Assistant Professor

July 2017

read answer

Eugene Greenberg, MD, F.A.C.P., F.A.C.G.
Carle Physician Group Urbana, IL

March 2017

read answer

ANSWERED BY:

Eugene Greenberg, MD, F.A.C.P., F.A.C.G.
Carle Physician Group Urbana, IL

March 2017

Q: I have chronic UC which is in approximately 85% remission. Would it be safe to have a total hip replacement and take Coumadin for 6 weeks? Could Coumadin trigger a flare up in some uc patients?

read answer

ANSWERED BY:

Eugene Greenberg, MD, F.A.C.P., F.A.C.G.
Carle Physician Group Urbana, IL

March 2017

read answer

Sushila Dalal, MD
Assistant Professor of Medicine

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

June 2016

Q: I am on Lialda and my GI said I should let surgeons, dentist and other doctors know that I am on this med. Why is it important for other health care providers to know about this medication?

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

June 2016

read answer

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

June 2016

read answer

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

June 2016

A: Anti TNF drugs such as you mentioned are not known to cause stomach ulcers.

read answer

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

June 2016

read answer

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

May 2016

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2016

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

A: While possible, this is not a frequent adverse event with Uceris and is probably an unlikely cause of your problems.

read answer

ANSWERED BY:

Eugene Greenberg, MD, F.A.C.P., F.A.C.G.
Carle Physician Group Urbana, IL

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

July 2015

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

July 2015

read answer

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

July 2015

read answer

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

July 2015

Q: Is there is any new research into the use of suboxone in the treatment of Crohn’s?

read answer

ANSWERED BY:

Tauseff Ali, MD
University of Oklahoma, Saint Anthony Hospital

June 2015

read answer

ANSWERED BY:

Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

June 2015

read answer

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2015

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

April 2015

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

January 2015

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2012

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2012

read answer

ANSWERED BY:

Faten N. Aberra, MD, MSCE
Assistant Professor of Medicine
Division of Gastroenterology
Perelman School of Medicine at the University of Pennsylvania
Hospital of the University of Pennsylvania

May 2012

read answer

Experts 2010-2011, MD, etc.
n/a

February 2012

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

February 2012

Q: I was put on prednisone a couple of days ago for my Crohn’s disease; my face is very flush--is that a normal side effect?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

February 2012

read answer

Experts 2010-2011, MD, etc.
n/a

November 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

November 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

November 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

September 2011

read answer

Experts 2010-2011, MD, etc.
n/a

June 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

June 2011

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

April 2011

read answer

Experts 2010-2011, MD, etc.
n/a

February 2011

read answer

Experts 2010-2011, MD, etc.
n/a

December 2010

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

November 2010

Q: What is the standard length of time to notice the effectiveness of my medication? Is there a difference response time for each class of medication?

read answer

ANSWERED BY:

Experts 2010-2011, MD, etc.
n/a

▲ back to top