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Heba Iskandar, MD, MSc

Associate Professor, Director of IBD Clinical Research

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. hide answer

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. hide answer

Q: I am 21 year old gay man. I’ve had ulcerative colitis for about a year now. It has been very hard on my mental health, particularly the sex aspect of my life. It feels like I’ll never be able to do the “back door” part of being intimate with someone. Will I ever be able to?

A: With full mucosal healing in the rectum and no urgency, bleeding or perianal fistulas or fissures, sexual activity is possible. I recommend discussing your sexual health as a goal of your treatment with your gastroenterologist and continuing to adjust your treatment to achieve healing of your colon. Also, getting appropriate psychological counseling is a great addition to your care. hide answer

Q: I was diagnosed with Microscopic Lymphocytic Colitis in April 2018. It is like Budesonide works well if I stay on it. My GI doctor's keep moving me on and off different treatments and none of them seem to work. Is MLC an IBD? Is MLC an autoimmune disease? Is there a standard treatment for MLC and where can I get more information on this condition?

A: Budesonide is a very effective treatment for microscopic colitis. Microscopic colitis has 2 subtypes, collagenous and lymphocytic colitis. Yes, this is a type of inflammatory bowel disease but generally has a good prognosis in that it does not increase colon cancer risk like ulcerative colitis can. The cause of microscopic colitis is unknown, but the immune system is definitely involved ast is is an inflammatory condition. Some microscopic colitis can be triggered by certain medications (like NSAIDS, acid suppressants, antidepressants), so I recommend a thorough review of your medication list with your GI physician. Budesonide is the most effective treatment for microscopic colitis, even though it can also be treated with cholestyramine and bismuth. If there is no response to budesonide, other conditions/problems should be considered and a work-up for other causes such as food intolerances and celiac disease initiated. For certain refractory cases of microscopic colitis, the use of medications normally used for Crohn’s and ulcerative colitis like biologic therapies and immunomodulators may be needed. Some resources for reading: https://gastro.org/guidelines/liver-diseases/the-medical-management-of-microscopic-colitis/ https://www.mayoclinic.org/diseases-conditions/microscopic-colitis/diagnosis-treatment/drc-20351483 hide answer

Q: I am a 57-year-old female diagnosed with Crohn's November 2014. I take Humira weekly injections. I suffer from anal bleeding and horrific burning in my belly, four out of five days a week. Can these symptoms be side effects of the disease, the medication or something else? Is there something that can be done to eliminate these side effects?

A: Rectal bleeding and burning in the abdomen are not side effects of the medication humira itself, however, they could be a flare of Crohn’s disease itself or a complication of Crohn’s (such as a stricture, partial bowel obstruction, abscess). The symptoms need to be evaluated with endoscopy/colonoscopy or imaging studies. They could mean that the humira is not working well for your Crohn’s or that your medication or treatment needs to be adjusted. hide answer