Questions Answered By Expert
Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program
A: This is a common scenario. Humira and Remicade both have the same mechanism of action and in most people will have similar effects with little difference between the two. The major difference is that Humira is given as a shot (by injection or prefilled syringe) every 2 weeks while Remicade is given like an IV every 8 weeks. Remicade will require that a patient go to an infusion center for each dose. There are infusion centers in most mid-sized to large cities so it may be prudent to determine if there is one near her college. I would suggest that she establish with a gastroenterologist near her college as well hide answer
A: Thank you for the questions. First, I would speak to your gastroenterologist regarding your symptoms and determine if they are due to the Crohn’s or something else. At this point, the two of you can also discuss potential adverse effects from the Lialda. There are other medications in the same family as Lialda and you and your gastroenterologist can discuss the most appropriate treatment plan. By “drinking,” I imagine you are referring to drinking alcohol. Limiting alcohol and a gluten free diet may help but no diet has yet been proven to decrease inflammation from Crohn’s disease that is causing symptoms. When patients have active intestinal inflammation, it may be helpful to decrease high fiber foods and perhaps dairy products and caffeine. I suggest using a food journal to recording food intake and symptoms to determine if certain foods trigger symptoms. hide answer
A: Thank you for your question. The symptoms that you describe are not specific to Crohn’s disease and can be seen with many other disease processes and medications. If a thorough evaluation that may include some combination of endoscopic evaluation (i.e., colonoscopy), imaging, and labs has been done to confirm Crohn’s disease remission, then it may be reasonable to evaluate if the dose of the 6-MP is appropriate. This can be done through lab work. hide answer
A: Good question. Entocort has been studied in Crohn’s disease for up to one year but not beyond. According to these studies, it appears to be most effective within the first 3 months and less effective afterwards. However, some patients may do well on entocort beyond 3 months. The key is regular follow-up with a gastroenterologist with routine labs, colonoscopy, and perhaps imaging evaluating for active intestinal inflammation. During these evaluations, if there is any evidence of nonresponse to entocort or progression of inflammation, an adjustment to your therapy can be made early. hide answer
A: I’m glad you asked this question. This is an important subject and probably does not get the attention it deserves. It’s not unusual for persistently active Crohn’s disease to have affects on intimacy and sex. Mood, self-consciousness, and illness perception are important determinants of sexual health and can also be adversely affected by Crohn’s disease. I would suggest a few different options. First, it’s important that your husband’s Crohn’s disease is evaluated and appropriately treated for any evidence of ongoing active disease by his gastroenterologist. If active Crohn’s is not causing his “flare-ups,” then his symptoms will need to be evaluated for other potential underlying causes. Second, it may be helpful to attend a support group (either an IBD or better yet, an ostomy support group) as this may be a common topic among other patients. Third, I believe it’s important to communicate your feelings and express your concerns to your husband. You may find that your relationship improves as a result. hide answer