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Crohn's & Colitis Community

Expert Q&A Library

Welcome to our Expert Q&A Library. Here you’ll find IBD questions submitted by people like you, and answers provided by our panel of IBD experts.

You can browse the Q&As by clicking on a category on the right side of this page. Or, search a specific Q&A topic by using the “Search Q&As” tool to the right.

If you can’t find an answer to your question here, use the IBD Knowledge Navigator tool. You’ll have the opportunity to submit a question to our panel of experts at the bottom of your IBD Knowledge Navigator results page.

Most Recent

Disease Education - May 2012
Q.What are diseases other than IBD and intestinal TB that cause chronic bowel ulcers? My 30 year old son has had ileum ulcers since 2008, which have spread to other parts of the digestive tract causing diarrhea and no appetite. He has been treated by 3 GI specialists since 2010 and has taken all medication for Crohn’s and TB, but got worse.
A. Ileal ulceration is a finding seen on endoscopic evaluation (such as colonoscopy or enteroscopy). Stool studies, biopsies of the abnormal region, and blood testing may be needed to determine the cause. There are several potential causes which include Crohn’s and tuberculosis (TB), but also include several other diseases. These diseases include, but are not limited to infections (parasites, bacteria, viruses such as cytomegalovirus in immunocompromised individuals), diseases of immune-dysregulation (eosinophilic gastroenteritis; vasculitis such as lupus and polyarteritis nodoum; vascular ischemia, and tumors (such as lymphoma)). Following up with a GI specialist to understand which diseases have been evaluated for is reasonable. A small percentage of Crohn’s patients are also non-responsive to medical therapy and may require surgery.
Disease Education - 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.
Disease Education - May 2012
Q.I was diagnosed with mild Crohn's (indeterminate) 10 years ago during a hospital stay. After treatment with mesalamine (on two different occasions), the off-on again symptoms lessened within about 2 years. I'm no longer taking meds, but have constant problems with bowel consistency. Could it be I was misdiagnosed? Without currently experiencing symptoms, can any test definitively diagnose IBD?
A. A diagnosis of IBD can be made definitively, but patients may not have all the findings at the time of presentation to make a definitive diagnosis. Findings on testing may evolve over time and may require repeat testing to make a diagnosis of IBD. The findings on endoscopic evaluation (such as colonoscopy/endoscopy) along with the findings on biopsies are the gold standard method for diagnosis. When it is difficult to know whether someone has Crohn’s disease or ulcerative colitis, there are also blood tests that can help differentiate the diseases. Clinical remission does not always equal endoscopic remission, so it may be worthwhile repeating testing if the diagnosis was not certain from the start. Additionally, having Crohn’s or ulcerative colitis for more than 8-10 years may increase the risk for colon cancer and colonoscopy (with biopsies) is the recommended screening test.
Treatment - May 2012
Q.What are my treatment options (types of medicines) for IBD?
A. The specific medical treatment options for a patient depend on the type and severity of inflammatory bowel disease. For mild/moderate disease severity, 5-aminosalicylates (5-ASA) are local anti-inflammatory medications which can be given orally or by rectum. When disease is moderate to severe immunosuppressants are used. Immunosuppressants used to treat ulcerative colitis or Crohn’s disease include corticosteroids (such as prednisone), 6-mercaptopurine or azathioprine (pro-drug of 6-mercaptopurine), methotrexate, and biologics (infliximab, adalimumab, certolizumab, natalizumab). Corticosteroids are used for flare-ups of IBD and as a bridge until non-steroid immunosuppressants work. Which medical therapy is used also depends on whether one has Crohn’s disease or ulcerative colitis. The medical therapy that is right for you would need to be discussed with your doctor. Additional information about these medical therapies is available on the CCFA website.
Treatment - May 2012
Q.Is there any information on the effect of over-the-counter fitness supplements on ulcerative colitis? Is there a resource I can go to for more information on these supplements?
A. The real issue is what are the ingredients of the fitness supplement? If it includes lactose or non-digestible sugars such as sorbitol or mannitol, it may make diarrhea and abdominal discomfort symptoms worse. Too much of certain vitamins and minerals may lead to toxicity, such as vitamin A and iron but this may not directly affect ulcerative colitis. If you need to obtain more specific information about a supplement than what the label provides, then you will need to contact the manufacturer of that specific product. Contact information for the manufacturer may be found directly on the label. The FDA does not collect information about all supplements since FDA approval is not needed for the supplements to be sold. By law, dietary supplements need to be safe and data is collected by the FDA on supplements with adverse events reported.
Treatment - May 2012
Q.I have a simple perianal fistula that is responding well to adalimumab. However, I believe it has been causing constant headaches and sinusitis for three months. I have rhinitis, so it could have pushed things to a tipping point. I skipped a shot and the issued improved somewhat, but after about 4 weeks the fistula fired up. I re-commenced and within a few days the fistula improved. Are there less sinusitis problems with other biologics?
A. All the anti-TNF therapies (adalimumab, infliximab, certolizumab) used to treat inflammatory bowel disease can increase risk for sinusitis. You may need to see your primary care or an Ear/Nose/Throat specialist to discuss methods of treating and preventing sinusitis. Another option would be to treat you with a different class of immunosuppressants, such as immunomodulators if it is feasible in your case.
Treatment - May 2012
Q.I am having infliximab injections. The 5th one is next month. I have lost almost all of my hair and my scalp and arms are full of sores. Is this a side effect of the medicine? Will the sores go away and will the hair grow back?
A. Infliximab may induce a rash (such as folliculitis and psoriasis) and there are case reports of infliximab inducing hair loss by a psoriasis like syndrome. Some patients with psoriatic like alopecia (hair loss) and rash have responded to topical medications without stopping infliximab. You should be evaluated by a dermatologist to determine the reason for the rash and hair loss in conjunction with your gastroenterologist.
Treatment - May 2012
Q.I am currently taking certolizumab shots and was previously taking adalimumab. Both seem to have a side effect of an uncomfortable and dry mouth, not tasting, and poor appetite. Is this a common side effect of these medications?
A. This is not a common direct side effect of anti-TNF therapies (certolizumab, adalimumab, and infliximab). Although, you may need to be evaluated for infections that anti-TNF therapies may predispose you to, such as thrush (yeast infection of the mouth).
Treatment - May 2012
Q.I was weaned off of a cycle of prednisone about two weeks ago and have had no flares for about a month or so. This past weekend I began flaring and am now in a full on flare. Is there something more I can take or do other than my 4 prescribed mesalamine? Or recommended meals/drinks that will ease the pain? I just feel that there has to be something else that will help me other than prednisone.
A. There are several non-steroid medications aside from mesalamine. Which medications to consider depend on whether you have Crohn’s or ulcerative colitis. The non-steroid medications take time to work and will usually require bridging you to these therapies with steroids. During times of flare ups, low fiber and lactose free diets are recommended to reduce symptoms. Also recommend during flares: avoidance of aspirin and ibuprofen based products and, if you have Crohn’s disease, smoking cessation.
Diet / Lifestyle - May 2012
Q.Is there a risk in having plastic surgery if you have been on immune suppressants or biologics? I have not had infliximab in 4 months, I stopped taking azathioprine three months ago, and I also took steroids but have tapered off. Is it safe to have any surgery after all this medication?
A. The risk of anti-TNF therapies (such as infliximab, adalimumab and certolizumab), 6-mercaptopurine or its prodrug-azathioprine, and corticosteroids have been assessed for postoperative complications in several studies. The risk of postoperative complications with anti-TNF therapy is not clearly increased based on these studies. The same is true for 6-mercaptopurine/azathioprine. Whereas for corticosteroids, if at the time of surgery it is greater than 20mg a day it may increase risk for complications. It takes at least 4 half-lives for minimal drug concentrations to remain in the blood stream. Based on a half-life of 7-9 days with infliximab, infliximab exposure 4 months ago should not affect surgery. The half life of azathioprine’s active metabolite (6TGN) is between 3-13 days, so stopping azathioprine 3 months ago should not have an effect. The half of prednisone is 3-4 hours.
Diet / Lifestyle - May 2012
Q.I've read that people with ulcerative colitis should be on a gluten free diet. Is this true?
A. Gluten is not a known stimulant of ulcerative colitis or Crohn’s disease. Some individuals have gluten intolerance, which causes gastrointestinal symptoms such as bloating and abdominal discomfort. So if a patient also has ulcerative colitis the gluten intolerance may add to symptoms already present.
Special Populations - May 2012
Q.My primary care doctor has recommended that I use a hormonal form of birth control--either a low-dose estrogen pill or the levonorgestrel-releasing intrauterine device (IUD). This form of IUD is not recommended for people with suppressed immune systems (I am on azathioprine and infliximab, and tapering off of prednisone). However, a recent CDC publication gave the IUD a safer rating than the pill for women with IBD (http://1.usa.gov/bQnOfb). Which form of birth control is safer for me to take?
A. The difference noted by the CDC MMWR publication refers to the risk of blood clots with the use of contraceptives in inflammatory bowel disease patients. Moderate to severely active inflammatory bowel disease increases the risk for developing blood clots. Contraceptives with higher hormonal levels (in the pill, patch, or ring) also are associated with an increase risk for blood clots. In theory, combining oral contraceptives and moderate-severe inflammatory bowel disease may increase the risk even more for developing blood clots. There is no published study as of yet that answers this question. If your disease is not very active, then a pill still may be a reasonable option. You would still need to discuss with your primary care provider or gynecologist if there are other reasons specific to your medical history that would help guide which type of contraceptive to use.

Diet/Lifestyle

May 2012
Q.Is there a risk in having plastic surgery if you have been on immune suppressants or biologics? I have not had infliximab in 4 months, I stopped taking azathioprine three months ago, and I also took steroids but have tapered off. Is it safe to have any surgery after all this medication?
A. The risk of anti-TNF therapies (such as infliximab, adalimumab and certolizumab), 6-mercaptopurine or its prodrug-azathioprine, and corticosteroids have been assessed for postoperative complications in several studies. The risk of postoperative complications with anti-TNF therapy is not clearly increased based on these studies. The same is true for 6-mercaptopurine/azathioprine. Whereas for corticosteroids, if at the time of surgery it is greater than 20mg a day it may increase risk for complications. It takes at least 4 half-lives for minimal drug concentrations to remain in the blood stream. Based on a half-life of 7-9 days with infliximab, infliximab exposure 4 months ago should not affect surgery. The half life of azathioprine’s active metabolite (6TGN) is between 3-13 days, so stopping azathioprine 3 months ago should not have an effect. The half of prednisone is 3-4 hours.
May 2012
Q.I've read that people with ulcerative colitis should be on a gluten free diet. Is this true?
A. Gluten is not a known stimulant of ulcerative colitis or Crohn’s disease. Some individuals have gluten intolerance, which causes gastrointestinal symptoms such as bloating and abdominal discomfort. So if a patient also has ulcerative colitis the gluten intolerance may add to symptoms already present.
April 2012
Q.I have had Crohn’s disease for 48 years and have had a total colectomy and ileostomy and four stoma resections when fistulas appeared. My B12 always appeared normal. I recently read an article from American Family Physician on Vitamin B12 deficiency and purchased 6,000 IUD sublingual B-12 tablets and took them for the last two weeks daily. I feel great with strength and stamina, skin improving, and mentally alert. The article cited 1,000 daily supplementation—is this okay?
A. The Recommended Dietary Allowance for vitamin B12 for adults ranges from 2.4 to 2.8 mcg daily. The article suggests 1000mcg a day for patients with vitamin B12 deficiency. Since your vitamin B12 levels have been normal, you should speak with your doctor about the right dose for you. Although supplementation with excess vitamin B12 is relatively safe, there are toxicities such as blood clots that have been associated with too much vitamin B12.
March 2012
Q.I completed my first half-marathon in December with Team Challenge and would really like to do another. What is recommended in terms of nutrition supplements during a long run for someone with Crohn's? It seems that even with the gels and chews available, I'm just not able to keep my energy up.
A. For long distance running with Crohn’s, the most important part is to be sure you are keeping up with your hydration, both before race day and on race day. Every individual’s needs are different and dependent on their fluid losses (which includes most importantly sweat and stools (diarrhea)). An average recommendation (for people without bowel disease) is to drink 3-6oz every 15-20 minutes during the run (about 1 cup of water every other mile). For a starting point, try to estimate your sweat rate (weigh before and after a good hour run and then convert this to ounces/hour of loss). You will need to be replacing those losses plus adding more for any diarrhea and more if it is hotter. In regards to carb intake (gels and chews), be sure you take something pre-race, and then at least 45 minutes into the run, to help prevent losing steam early on. You will have to adjust this to your own body and may need to take more of these then other people given your Crohn’s. Try out various formulations to see what works best for you. Make a hydration and nutrition plan for race day beforehand and talk it over with your doctor to further tailor it to the specifics of your disease.
March 2012
Q.I am running my first half marathon in less than 2 weeks. I’ve been training since November, but I’m having lots of issues and some days it’s just impossible to run - not because of the pain, but because it’s just not in me to run that day. I know that most people are supposed to carb load before a race, but what should someone with Crohn’s do to prepare diet wise?
A. First things first, in regards to poor energy, be sure to talk with your doctor to ensure that your Crohn’s disease is adequately treated. Next, nutrition during training for long distance running is important both for people with and without Crohn’s disease. You should be eating a healthy, balanced diet in addition to being sure you are staying adequately hydrated. Carbs are important in all your meals to provide the energy stores you need for running and protein is especially important post-race to help repair your body. On race days, you can try to eat something light (like a banana or a bagel or something you know you digest well) before the run. It is also important with long runs to consume snacks during the run. There are a wide variety of energy supplements (carbs) that come as gels, chews, or bars that you can take during the run. You want to be sure to consume these early on in the run, and then periodically throughout (make sure you don’t wait too long and lose steam). Many recommend these every 30-45 minutes during the run. You will have to try various products and see what works best for you. And again, being sure you are adequately hydrated is a very important part of this as well.
February 2012
Q.I was 19 when I was first diagnosed with Crohn’s. I have had 2 resections. As time went on I was diagnosed with IBS and now I also have diverticulitis. How do I deal with diet? Crohn’s is low fiber and IBS and Diverticulitis is high fiber.
A. There is a rather obvious link between diet and gastrointestinal illnesses. Unfortunately, it is not a very well understood link at this point in time. What’s certain is that the “wrong” diet will not result in any prolonged negative effects. That being the case, you should feel free to experiment with low or high fiber diets, with the assistance of an expert, until you find the one that’s right for you. No matter the choice, you won’t harm your Crohn’s, IBS, or diverticulosis.
February 2012
Q.My son is 14 yrs old and had his colon removed a couple weeks ago. What can I feed him to put some meat on his bones? He's 5ft 6in and only weighs 105lbs. The doctors tell him he needs to really concentrate on keeping hydrated so he drinks lots of water and Gatorade, but those things fill him up so he isn't hungry.
A. A diet high in protein calories is the best thing for him at this time. It would likely be advisable for him to meet with a nutritionist to get a detailed description of how to accomplish this, but all calories are good calories and high protein calories are best.
January 2012
Q.I have collagenous colities & celiac disease. Should I take a probiotic or any specific vitamins? I take 600 mg calcium pills 3 times a day and multi vitamin and chlorestramine drink 1 or 2 times a day as needed.
A. Probiotics have not been shown to be beneficial for collagenous colitis or celiac disease. Patients with untreated or poorly treated celiac disease can develop malaborption of vitamins and minerals like vitamin D and calcium. Therefore, screening for deficiency in vitamin D and repleting the vitamin D if the level is low is reasonable. Also, screening for bone loss related to celiac disease with a DEXA or bone density is indicated. If bone loss is present, calcium and vitamin D supplements should be given. If the celiac disease is under good control and the bone mineral density is normal, calcium and vitamin D would only be needed if you are not getting sufficient intake in the diet. A daily multivitamin is a reasonable thing for all patients to take. Cholestyramine is not a vitamin but is used as a treatment of the collagenous colitis.
December 2011
Q.I have painful gas daily. Can I take simethicone or beano for this?
A. Beano (the enzyme that helps break down the sugar found in many types of beans) literally only works on breaking down arabinose, which is the sugar in beans. If you do not eat beans, then Beano will not help you. Simethicone breaks up gas bubbles that are in the stomach, but if the gas has already reached your intestine, then simethicone will not help either. Simethicone however is certainly safe to take.

Disease Education

May 2012
Q. What are diseases other than IBD and intestinal TB that cause chronic bowel ulcers? My 30 year old son has had ileum ulcers since 2008, which have spread to other parts of the digestive tract causing diarrhea and no appetite. He has been treated by 3 GI specialists since 2010 and has taken all medication for Crohn’s and TB, but got worse.
A. Ileal ulceration is a finding seen on endoscopic evaluation (such as colonoscopy or enteroscopy). Stool studies, biopsies of the abnormal region, and blood testing may be needed to determine the cause. There are several potential causes which include Crohn’s and tuberculosis (TB), but also include several other diseases. These diseases include, but are not limited to infections (parasites, bacteria, viruses such as cytomegalovirus in immunocompromised individuals), diseases of immune-dysregulation (eosinophilic gastroenteritis; vasculitis such as lupus and polyarteritis nodoum; vascular ischemia, and tumors (such as lymphoma)). Following up with a GI specialist to understand which diseases have been evaluated for is reasonable. A small percentage of Crohn’s patients are also non-responsive to medical therapy and may require surgery.
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.
May 2012
Q. I was diagnosed with mild Crohn's (indeterminate) 10 years ago during a hospital stay. After treatment with mesalamine (on two different occasions), the off-on again symptoms lessened within about 2 years. I'm no longer taking meds, but have constant problems with bowel consistency. Could it be I was misdiagnosed? Without currently experiencing symptoms, can any test definitively diagnose IBD?
A. A diagnosis of IBD can be made definitively, but patients may not have all the findings at the time of presentation to make a definitive diagnosis. Findings on testing may evolve over time and may require repeat testing to make a diagnosis of IBD. The findings on endoscopic evaluation (such as colonoscopy/endoscopy) along with the findings on biopsies are the gold standard method for diagnosis. When it is difficult to know whether someone has Crohn’s disease or ulcerative colitis, there are also blood tests that can help differentiate the diseases. Clinical remission does not always equal endoscopic remission, so it may be worthwhile repeating testing if the diagnosis was not certain from the start. Additionally, having Crohn’s or ulcerative colitis for more than 8-10 years may increase the risk for colon cancer and colonoscopy (with biopsies) is the recommended screening test.
April 2012
Q. How can I tell if I have IBS (irritable bowel syndrome) or IBD (inflammatory bowel disease)?
A. While it is possible to have both IBD and IBS, the two disorders can be distinguished by symptoms and by laboratory, x-rays, or endoscopic data. Patients with IBS can have a wide array of symptoms but typically have chronic abdominal pain and altered bowel habits. Patients with IBD who are having a flare often present with increased frequency of bowel movements, rectal bleeding, and abdominal pain. During more severe flares, IBD patients can have fevers, weight loss, laboratory abnormalities, or other manifestations such as inflamed joints or rashes. A colonoscopy, appropriate x-rays, and/or laboratory tests can be done to help determine whether symptoms are from IBD or IBS.
April 2012
Q. My daughter was diagnosed with mild ulcerative colitis (UC) 2 years ago and has never had blood in her stool until now. Her stool is either soft-formed or very hard, never runny or foul smelling. Could the blood be coming from a tear or hemorrhoids since her stool is hard most of the time when she has the blood? The blood is bright red.
A. It is certainly possible that the bright red blood is due to hemorrhoids, a tear (fissure), or from active ulcerative colitis. You should encourage your daughter to follow up with her gastroenterologist to help determine the source of the blood so that she can receive the appropriate treatment.
April 2012
Q. What is being done to advance understanding and treatment of anemia in chronic disease (specifically IBD) to maintain a steady state relationship of levels of iron and hemoglobin? Could correct balance improve the immune system and quality of life in IBD?
A. Anemia is a very common problem in IBD. Although many patients report that they do not experience any symptoms from the anemia, many studies have shown that anemia has a significant negative impact on quality of life. The most common cause of anemia in IBD is iron deficiency (related to gastro-intestinal blood loss). Anemia of chronic disease often occurs at the same time due to immune mediated impaired formation of red blood cells and inappropriate iron metabolism. Both oral and intravenous iron therapy have been shown to be effective in treating iron deficiency, and consequently improve quality of life. Another cause for anemia is from a low B12 level. Low B12 levels can develop in patients with active Crohn’s disease or in Crohn’s patients after removal of the terminal ileum (last part of the small intestines).
April 2012
Q. Is Crohn's a fatal disease and what is the usual time the disease will run its course? My Mother was diagnosed 4 years ago and has had most of her intestines out. It seems to have progressed rapidly - is this a normal course for the disease?
A. Crohn’s disease (CD) is not a fatal disease. Many studies suggest that CD is associated with only a small decrease in overall life expectancy. The typical course for patients with CD includes intermittent worsening of symptoms follow by periods of remission. Patients who have active disease within the past year have a 70% chance of remaining active in the forthcoming year and a 50% chance of being in remission within the following 3 years. Patients can either have mild, moderate or more aggressive disease, and many patients with CD ultimately require surgical intervention. Patients with the more aggressive form of the disease can have earlier return of their Crohn’s disease after surgery and may need more surgery.
April 2012
Q. Since a few months ago I started to notice cuts behind my ear lobe. It bleeds and gives out liquid and itches a lot. Is this related to the medicine I take or does it have nothing to do with my ulcerative colitis (UC)?
A. Ulcerative colitis (UC) can be associated with a variety of skin problems that cause inflammation. Occasionally, these skin problems can be a sign of progressive disease even in the absence of gastrointestinal symptoms. However, cuts behind your ear lobe seem unlikely to be associated with your UC. Given that these cuts have been occurring for a few months, you should follow up with your physician, who might then recommend you to see a skin specialist (dermatologist).
March 2012
Q. Why do I have so many body aches and pain that often times will not permit me to walk or stand straight up? I seem to be falling a lot as well.
A. There are a number of things that could be going on to cause your symptoms and you should discuss this with your doctor. Sometimes IBD can be associated with arthritis and this would be at the top of my concerns. If that is the case your doctor may want to send you to see an arthritis specialist and/or choose medications for your IBD that will also help treat arthritis. Arthritis associated with IBD (called spondyloarthropathy) can affect various joints, including the back and pelvis joints and/or the large or small joints of your extremities.
February 2012
Q. My 16 year old daughter was diagnosed 2.5 years ago with UC. When treating a sore throat/ear infection what antibiotics are safe as to not upset the gut?
A. All antibiotics can upset the gastrointestinal system, in part by changing the gut’s flora, the organisms that reside in the gut. For this reason, antibiotics should be used judiciously, such as when a treating physician is reasonably certain that there is a bacterial infection, as opposed to a viral infection.

Special Poputations

May 2012
Q.My primary care doctor has recommended that I use a hormonal form of birth control--either a low-dose estrogen pill or the levonorgestrel-releasing intrauterine device (IUD). This form of IUD is not recommended for people with suppressed immune systems (I am on azathioprine and infliximab, and tapering off of prednisone). However, a recent CDC publication gave the IUD a safer rating than the pill for women with IBD (http://1.usa.gov/bQnOfb). Which form of birth control is safer for me to take?
A. The difference noted by the CDC MMWR publication refers to the risk of blood clots with the use of contraceptives in inflammatory bowel disease patients. Moderate to severely active inflammatory bowel disease increases the risk for developing blood clots. Contraceptives with higher hormonal levels (in the pill, patch, or ring) also are associated with an increase risk for blood clots. In theory, combining oral contraceptives and moderate-severe inflammatory bowel disease may increase the risk even more for developing blood clots. There is no published study as of yet that answers this question. If your disease is not very active, then a pill still may be a reasonable option. You would still need to discuss with your primary care provider or gynecologist if there are other reasons specific to your medical history that would help guide which type of contraceptive to use.
April 2012
Q.Since Crohn's symptoms tend to worsen during menstruation, I've been considering going on a birth control pill that will limit my periods to four times a year instead of monthly. Can the pill be trusted in someone who does not have control over their Crohn's symptoms? Right now, I'm on an alternate form of birth control because I've read in the past that the pill is absorbed through the intestines. Is it beneficial to switch to the pill or is the risk of it failing too great?
A. A decreased ability to absorb what you eat in the setting of active small intestinal Crohn’s disease might lead to a decrease in the effectiveness of contraceptive pills taken by mouth. Oral contraceptives are mainly absorbed in the small bowel and contraceptive efficacy depends on its absorptive capacity. However, limited evidence suggests that there are no differences in the absorption of higher-dose oral contraceptives between women with mild UC and small ileal resections and health women.
March 2012
Q.I have been on adalimumab since 2009 and it has been working to keep my Crohn's under control, but I have very bad perianal disease which the adalimumab does not seem to reach. My doctor wants me to start taking adalimumab every week, but I was wondering if there were any other options to help with the perianal disease.
A. Medical treatments with potential efficacy for treating perianal disease include antibiotics, azathioprine and 6MP, biologics like infliximab and adalimumab, and cyclosporine and tacrolimus. Depending on the specifics of your disease, surgical treatments are a consideration as well, and you should discuss this with your doctor.
March 2012
Q.My son was diagnosed in 2009 with Crohn's disease and is now 14 yrs. old. He is currently taking a biologic. Has there been any research as to the chemical reaction of the disease and/or biologics and depression? I realize having a life long illness takes its toll, but I am wondering about the chemical reaction of having an inflammatory disease.
A. There is no data that I am aware of that has linked the mechanisms (or “chemistry”) of inflammatory bowel disease to causing depression. However, depression is very commonly seen in patients with IBD given the lifelong illness it causes. CCFA has many resources available regarding coping and emotional factors. Be sure to contact our Information Resource Center (888.694.8872) to learn more and check out our educational brochures and fact sheets at http://www.ccfa.org/info/brochures.
March 2012
Q.Is there any research on the safety of taking growth hormones while on a biologic?
A. There have been no controlled studies looking at the safety of taking human growth hormone while also receiving a biologic.
March 2012
Q.I am currently taking mesalamine for my Crohn's. My husband and I decided to have children and I am currently 5 weeks pregnant. My gastroenterologist told me that it was safe to take my meds while pregnant but when I met with my gynecologist she said that it is not considered safe. What do research studies on this find?
A. In general, mesalamines are considered safe during pregnancy. With that said, olsalazine and asacol contain dibutyl pthalatae (DBP) in the coating. Neither of these medications has been associated with birth defects, but DBP has been associated with congenital anomalies in animals. With that said, it is even more important to consider the effects of a flare if these medications are stopped. Active disease during pregnancy can increase the risks of pre-term delivery and low birth weight of the infant. It may also impair the ability of the mother to care for the infant once it is born. Plus even stronger medicines may be required to get mom back under control if she flares.
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?
A. The SSD application should allow for including information about functional limitations related to both your back and your gut. Supporting documentation from your doctors should help. CCFA has sample appeal letters that you or your health care provider can use. Visit the Community Resource Center (http://www.ccfacommunity.org/ResourceCenter.aspx) for more information.
January 2012
Q.What should be the frequency of colonoscopies after age 85 if in remission?
A. In general, most gastroenterology society guidelines do not recommend screening or surveillance colonoscopies in patients of advanced age, such as 85 and older. The decision about continuing screening or surveillance colonoscopies in your case should be discussed with your treating physician. I often consider the following factors when deciding whether or not to pursue further colonoscopies for screening or surveillance in older patients. First, if a problem is detected, is the patient well enough to undergo surgery? Second, would the patient seek treatment if a problem were discovered (for example, would a patient agree to a removal of the colon if cancer were found)? Lastly, are other health problems present which limit the patients 5 year survival? In general, the more other severe health problems that are present make ongoing colonoscopies less beneficial.

Treatment

May 2012
Q.What are my treatment options (types of medicines) for IBD?
A. The specific medical treatment options for a patient depend on the type and severity of inflammatory bowel disease. For mild/moderate disease severity, 5-aminosalicylates (5-ASA) are local anti-inflammatory medications which can be given orally or by rectum. When disease is moderate to severe immunosuppressants are used. Immunosuppressants used to treat ulcerative colitis or Crohn’s disease include corticosteroids (such as prednisone), 6-mercaptopurine or azathioprine (pro-drug of 6-mercaptopurine), methotrexate, and biologics (infliximab, adalimumab, certolizumab, natalizumab). Corticosteroids are used for flare-ups of IBD and as a bridge until non-steroid immunosuppressants work. Which medical therapy is used also depends on whether one has Crohn’s disease or ulcerative colitis. The medical therapy that is right for you would need to be discussed with your doctor. Additional information about these medical therapies is available on the CCFA website.
May 2012
Q.Is there any information on the effect of over-the-counter fitness supplements on ulcerative colitis? Is there a resource I can go to for more information on these supplements?
A. The real issue is what are the ingredients of the fitness supplement? If it includes lactose or non-digestible sugars such as sorbitol or mannitol, it may make diarrhea and abdominal discomfort symptoms worse. Too much of certain vitamins and minerals may lead to toxicity, such as vitamin A and iron but this may not directly affect ulcerative colitis. If you need to obtain more specific information about a supplement than what the label provides, then you will need to contact the manufacturer of that specific product. Contact information for the manufacturer may be found directly on the label. The FDA does not collect information about all supplements since FDA approval is not needed for the supplements to be sold. By law, dietary supplements need to be safe and data is collected by the FDA on supplements with adverse events reported.
May 2012
Q.I have a simple perianal fistula that is responding well to adalimumab. However, I believe it has been causing constant headaches and sinusitis for three months. I have rhinitis, so it could have pushed things to a tipping point. I skipped a shot and the issued improved somewhat, but after about 4 weeks the fistula fired up. I re-commenced and within a few days the fistula improved. Are there less sinusitis problems with other biologics?
A. All the anti-TNF therapies (adalimumab, infliximab, certolizumab) used to treat inflammatory bowel disease can increase risk for sinusitis. You may need to see your primary care or an Ear/Nose/Throat specialist to discuss methods of treating and preventing sinusitis. Another option would be to treat you with a different class of immunosuppressants, such as immunomodulators if it is feasible in your case.
May 2012
Q.I am having infliximab injections. The 5th one is next month. I have lost almost all of my hair and my scalp and arms are full of sores. Is this a side effect of the medicine? Will the sores go away and will the hair grow back?
A. Infliximab may induce a rash (such as folliculitis and psoriasis) and there are case reports of infliximab inducing hair loss by a psoriasis like syndrome. Some patients with psoriatic like alopecia (hair loss) and rash have responded to topical medications without stopping infliximab. You should be evaluated by a dermatologist to determine the reason for the rash and hair loss in conjunction with your gastroenterologist.
May 2012
Q.I am currently taking certolizumab shots and was previously taking adalimumab. Both seem to have a side effect of an uncomfortable and dry mouth, not tasting, and poor appetite. Is this a common side effect of these medications?
A. This is not a common direct side effect of anti-TNF therapies (certolizumab, adalimumab, and infliximab). Although, you may need to be evaluated for infections that anti-TNF therapies may predispose you to, such as thrush (yeast infection of the mouth).
May 2012
Q.I was weaned off of a cycle of prednisone about two weeks ago and have had no flares for about a month or so. This past weekend I began flaring and am now in a full on flare. Is there something more I can take or do other than my 4 prescribed mesalamine? Or recommended meals/drinks that will ease the pain? I just feel that there has to be something else that will help me other than prednisone.
A. There are several non-steroid medications aside from mesalamine. Which medications to consider depend on whether you have Crohn’s or ulcerative colitis. The non-steroid medications take time to work and will usually require bridging you to these therapies with steroids. During times of flare ups, low fiber and lactose free diets are recommended to reduce symptoms. Also recommend during flares: avoidance of aspirin and ibuprofen based products and, if you have Crohn’s disease, smoking cessation.
April 2012
Q.Since I have had really bad side effects in the past with prednisone, I am now on budenoside 9 mg/day for Crohn's. How long before I start to see results? Is this a large dose or is it possible I should be taking larger dose?
A. Several studies have shown that budesonide is effective for induction of remission in mild to moderate ileal and ileocecal Crohn’s disease. In these studies, patients were on budesonide 9mg/day for 8 to 12 weeks. However, patients have reported improvement in symptoms as early as a few days from starting therapy. There was no improved benefit seen on higher dose of budesonide.
April 2012
Q.After 29 years averaging 15mg daily on prednisone, I dropped to 5mg daily in a couple of months and am now on infliximab. After two months at 5mg daily, I had a long day where I got dehydrated, short on sleep, and came down with chills, which progressed to severe shakes. I took 15mg of prednisone, which calmed me in 30 minutes. The ER doctor found no cause. Is this a possible side effect of the medication? It has re-occurred twice and was abated by prednisone.
A. Infliximab has been shown to cause severe shakes (rigors) during an infusion. Otherwise, the infliximab suppresses your immune system and as a result makes you more likely to get an infection which can cause you to have the shakes and chills. Taking a higher dose of prednisone at times when you have the chills/shakes can be dangerous as the prednisone can worsen the infection. You should see your gastroenterologist to discuss these symptoms to determine if there are other causes for your chills and rigors.
April 2012
Q.I am taking 100 mg per day of mercaptopur and was wondering how long one can stay on this medication.
A. Mercaptopurine has been shown to be effective in reducing the risk of Crohn’s disease recurrence. Many patients can remain on mercaptopurine indefinitely if needed to control their IBD. Others can be tapered off after several years. Do not stop your mercaptopurine or any of your IBD medications without first speaking to your gastroenterologist.
March 2012
Q.In researching the benefits of aloe supplements, I have found contradicting information. Can you explain what the potential benefits and/or risks are?
A. There is no good data to date to show that aloe benefits colitis. Moreover, there are many forms of aloe and some can even be harmful to the colon. Furthermore, it is difficult to know which of these forms you are getting when you buy it. Studies are ongoing in animals, but at this point it is not a recommended treatment for colitis.
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