Questions Answered By Expert
Sophie Balzora, MD
Clinical Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at the NYU Grossman School of Medicine
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. hide answer
A: It is certainly possible to have ongoing inflammation without symptoms. Based on your description of the colonoscopy findings, the disease is not well-controlled on current therapy. It’s always important to have a discussion with the gastroenterologist about the risks and benefits of each medication option that is being considered in order to come to a thoughtful decision that is shared, and one with which everyone is in agreement. Remember: the risks of ongoing inflammation on colonoscopy, including flares and hospitalization, surgery, and malignancy, are oftentimes bigger than the potential risks of the medications used to treat the ulcerative colitis, especially when it is severe. Symptom control is important, but ultimately, we must also strive for healing of the lining of the colon (called “mucosal healing”) and symptom control in order to give patients the best chance of being healthy in the longer term. hide answer
A: The short answer is no. The longer answer is that prednisone is a medication that should only be taken in the very short term, and with a finite plan in place for a longer-term, safer medication to take that avoids steroid use. Long-term steroid use is wrought with side effects and is not a safe choice for treatment of inflammatory bowel disease. It is crucial to speak with your gastroenterologist to come up with a formal plan to transition you safely from steroids to a steroid-sparing medication that has been shown to benefit patients with Crohn’s disease. hide answer
A: Budesonide works very well in patients with microscopic colitis, and studies pitting the medication against placebo show that those patients who took budesonide did significantly better than the placebo group. Even though budesonide is a steroid that has little systemic exposure because of how the body metabolizes it, we do not like to use budesonide in the long term, because adverse effects of long-term steroid use is not to be ignored. Generally, for microscopic colitis, the recommendation is to be on the medication for about 6-8 weeks, and then begin a taper and eventually come off the medication entirely. hide answer
A: It’s great to hear the mesalamine is working well to treat your symtoms and the inflammation. Unfortunately, hair loss is a known potential side effect of mesalamine. It is reported to occur in <3% of patients. There are other reasons for hair loss in patients with IBD: telogen effluvium, which usually occurs in the context of active disease, nutritional deficiencies, and stress, for example. Speaking with a dermatologist about concerns of alopecia, or hair loss, may help with overcoming this problem. hide answer