Inflammatory Bowel disease

Generally, Inflammatory Bowel Disease (IBD in short) encompasses two diseases, one Ulcerative Colitis and the other is Crohn's disease.

These diseases typically occur in the younger population - 20 to 40 years of age but it can occur earlier or later also.

Patients often present with diarrhea, rectal bleeding, abdominal pain and cramps. Some patients can have signs and symptoms outside the GI tract including skin lesions, joint pain (arthritis), red eye, mouth sores or back pain. In rare cases, patients can have liver problems also.

It is unclear how and why patients develop these diseases but, there is a genetic component to it - meaning it is more common in patients with relatives having either Ulcerative colitis or Crohn's disease.

Generally, patients who present with these symptoms have a low hemoglobin and a high ESR (a blood test which signifies inflammation in the body) or elevated CRP (a blood test which signifies inflammation in the body).

Treatment usually involves taking a 5 ASA medication (e.g. Asacol, Pentasa, Colazal or mesalamine). In severe cases, patients may need prednisone or hydrocortisone or some other immunosupprant IBD medicationessant (a medicine which suppresses the body immune system) agent e.g. Imuran or methotrexate or cyclosporine.

Crohns Disease or Ulcerative Colitis

This can often be a lifelong disease associated with multiple complications and may require surgery. Side effects of the medications commonly used to treat it are listed below.

Remicade, Humira, Cimzia, Simponi: Life threatening infections including fungal infections, Listeria (infection of brain), Legionella, TB, hepatitis B reactivation, lymphoma and fatal hepatosplenic T cell lymphoma. It can also cause other life threatening cancers. Other side effects include CHF, anemia, skin rashes, serious neurological problems, sensitivity to the sun, worsening lupus, and sarcoidosis. Moreover, it should be avoided during pregnancy and lactation.

When patients are on multiple immunosuppressive agents, additional precaution should be considered including Listeria monocytogenes, Legionella pneumonia, PCP pneumonia

While on these medications, we recommend:

  • Yearly flu shot.
  • Evaluation for hepatitis A and B immunity. You should get immunized against both.
  • Varicella titers and vaccination if not immune.
  • Yearly PPD or Gold TB Quantiferon Test.
  • Immunization against Pneumonia.
  • Call your physician IMMEDIATELY if you develop fever.
  • Monitoring for osteoporosis in patients with IBD.
  • Gardasil vaccination (for men and women between the ages 9-26) to lower risk of cervical cancer, especially in patients with IBD.
  • Annual dermatology evaluation. There's a higher risk of melanomas (agressive skin cancer) in patients on these medications as well as Imuran.

Imuran: This medication can cause life threatening drop in blood counts. You WILL NEED blood tests frequently — initially every week or other week to later on once every 2-3 months INDEFINATELY. Moreover it can cause liver problems, pancreatitis, fever, and a higher chance of cancers like lymphomas. Imuran causes a higher risk of non melanoma skin cancer. They need yearly dermatology evaluation.

Mesalamine (like Lialda, Asacol, Apriso, colazal etc) : Generally very safe. Some patients may develop inflammation of the liver, lungs, kidneys.

Prednisone: Anxiety, insomnia, irritability, cataracts or glaucoma, facial swelling, high blood sugar, increased risk of infections, changes in body fat distribution, skin changes (acne, stretch marks, slow healing), osteoporosis (weakened bones and possible fractures), avascular necrosis of joints, joint pain, muscle weakness, and weight gain. Unlike other prednisone regimens, this requires a tapering regimen over 8 weeks. I usually start at 40 mg a day and reduce it by 5 mg a day every week. So the schedule would be 40 mg a day for 1 week, then 35 mg a day for next week, then 30 mg a day for the third week and so on.