Questions Answered By Expert
Rajesh Shah, MD
Gastroenterologist
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. hide answer
A: As you mentioned, some patient’s with Crohn’s disease have impaired ability to absorb vitamin B12 taken orally (whether as pills or in the diet). Therefore, monitoring of B12 levels and correction if needed will be prescribed. In general, total body stores of vitamin B12 are approximately 2-5mg with about half of that in the liver. If B12 intake stops, deficiency typically does not develop for at least 1-2 years. So, it may be reasonable to wait till your doctor is seeing patients in clinic again and then resume your prior injections. Alternatively, there are studies that showed taking high dose (1000 to 2000 mcg) oral vitamin B12 daily can still be absorbed (about 1% of what is ingested) and maintains B12 concentrations. hide answer
A: This is an important topic and can be quite distressing to patients and families. Prednisone is an effective short-term treatment for patients with ulcerative colitis; however, a known side effect of it is psychosis. There is limited research on how often this occurs, but the data suggests <10% of patients develop psychosis, and this is more common with higher doses (>20mg daily) for a longer time period. Keep in mind, prednisone is used as a bridge to another therapy and ideally other medications will be used long term to control UC symptoms. Once stable on another medication, resuming previously used medications, such as Adderall, under the supervision of her PCP may be possible. hide answer
A: It is important to remember that Crohn’s disease can lead to inflammation anywhere along the gastrointestinal tract, from the mouth to the anus. So, despite the inflammation previously being localized to the colon, the possibility for recurrence in other areas of the GI tract should be explored. In terms of joint manifestations of Crohn’s disease, they are more common in patients with large intestine (colon) involvement. Blood tests can be checked to broadly evaluate for inflammation but can reflect both inflammation in joints as well as the intestine, so they can be of limited value. Follow up with a gastroenterologist to evaluate for recurrent Crohn’s disease and possibly a rheumatologist may be warranted. hide answer
A: a. Anal fissures and skin tags are frustrating complications of Crohn’s disease. Anal fissures are ulcerations in the lining of the anal canal due to underlying inflammation, which can lead to bleeding and anal pain. These can be associated with skin tags (also known as acrochordons) and also cause discomfort. In general, persistent anal fissures may be a sign of continued inflammation related to Crohn’s disease, so speaking with a gastroenterologist to optimize Crohn’s disease therapy is recommended. Additionally, therapies, as you mentioned, such as warm sitz baths, topical analgesics and medications, such as topical nitroglycerin or nifedipine have shown benefit. These will be used for 1-2 months and then a response is assessed. In general, medical therapies will be pursued to manage anal fissures, since surgical options carry the risk of fecal incontinence and poor wound healing. hide answer