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Sasha Taleban, MD

Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program

Q: I was recently diagnosed with Crohn’s Disease. My symptoms right now are severe stomach pain several times a week. My GI first prescribed budesonide but the side effects were bad so he has mentioned Remicade/Humira as another option. He is hesitating and wants to redo pill cam study before starting. Will the disease always at some point get worse if I am not on any medication?

A: Thanks for your question. Generally, the chances of your disease worsening are based on the severity of your disease at diagnosis. The severity of your disease is based on your clinical symptoms, labs, imaging, and the endoscopic evaluation. For instance, if you had mild Crohn’s disease at diagnosis, the risk of the disease progressing is lower than if you had moderate or severe Crohn’s disease at diagnosis. Your GI can help determine where you fall in the mild, moderate, and severe range. It is very reasonable to reevaluate your disease as your new GI has suggested prior to starting medications like infliximab/adalimumab (aka Remicade/Humira). hide answer

Q: I am switching to Humira from Remicade due to infusion reaction. What dose and timing of oral prednisone do you recommend to prevent reaction to Humira?

A: That’s an interesting question. With infliximab (Remicade), some providers use steroids (like prednisone) before the infusion with the thought that it prevents infusion reactions. For adalimumab (Humira), I have found that using allergy drugs like diphenhydramine (Benadryl) can be effective in preventing injection site reactions. I have not use steroids with adalimumab in the past to prevent injection site reactions. hide answer

Q: I have ulcerative colitis. I have lost about 20 lbs in the last two months. Is that normal amount of weight loss?

A: I would need more information on this situation to be able to answer this question adequately. hide answer

Q: I am 22 years old and have had Crohn's and ulcerative colitis since I was 5 years old. I just got over a bad flare up and a recent scope shows inflammation is almost gone. However, I have constant pain in the right side of lower abdomen that will not go away. The pain is interfering with daily activities. I have been in and out of the hospital and seen my doctor numerous times and no one seems to figure out how to decrease this pain. Any tips of how to deal with the pain?

A: This is a common scenario and I am glad that you brought it up. We know that there is a group of patients with Crohn’s or ulcerative colitis who have ongoing pain without evidence of active intestinal inflammation. The pain can be due to multiple causes including small bowel bacterial overgrowth, musculoskeletal pain, irritable bowel syndrome, etc. It’s important to work with your gastroenterologist to determine the cause of the pain so it can be adequately managed. hide answer

Q: I have had Crohn's for about 15 years. I recently found out about the MTHFR (C677T) mutation that sounds like it has some relation to IBD. What information can you tell me about this mutation?

A: This mutation may have some relation to the development of IBD. It may place a patient at higher risk for clotting and it is associated with other disease processes so it is not specific for IBD. There have been over 200 different gene mutations found that are associated with IBD. The reality is that most patients do not have any of these mutations because IBD involves a complex interplay between organisms in the gut, environment factors like smoking, and an overactive immune system. hide answer

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