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.

Remicade, Humira, Cimzia: Life threatening infections including fungal infections, TB, hepatitis B reactivation. Patients are advised to get a yearly PPD and immunized against hepatitis A and B. It can also cause life threatening cancers. Other side effects include CHF, anemia, skin rashes, serious neurological problems, sensitivity to the sun, worsening lupus, sarcoidosis. Moreover, it should be avoided during pregnancy and lactation.

While on these medications, we recommend

1)      Yearly flu shot

2)      Evaluation for hepatitis A and B.  You should get immunized against both

3)      Yearly PPD

4)      Immunization against Pneumonia.

5)      Call your physician IMMEDIATELY if you develop fever.

 

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

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.

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.

 

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