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Sasha Taleban, MD

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

Q: I was told one year ago that I had ulcerative colitis. Is constant pain, cramps and an extended abdomen common symptoms of the disease?

A: Ulcerative colitis can present with a variety of symptoms including abdominal pain and bloody diarrhea. However, symptoms don’t always indicate that the ulcerative colitis is active. The reason is that several other disorders can also cause the symptoms your describe. Your doctor through various objective tests (i.e., imaging, endoscopy, and labs) can determine if it is your ulcerative colitis or another disorder that is contributing to your symptoms. hide answer

Q: How definitive is a diagnosis of Ulcerative Colitis? I have been in remission for 11 years, and have not taken any medication for 5 years. Does it make sense to get reevaluated to see if this diagnosis can be removed from my medical history?

A: Thanks for your question. Without seeing the records, your first question is a difficult one to answer. Occasionally, the diagnosis of ulcerative colitis may be more difficult to make. Having the diagnosis of ulcerative colitis in your records can be challenging for several reasons. If you have no symptoms and your colonoscopy continues to show no active colon inflammation, then your disease may be in remission. I would discuss the validity of the ulcerative colitis diagnosis with your gastroenterologist who has access to your previous records. hide answer

Q: I am 40 years old and have had ulcerative colitis for 30 yrs. I've been on 5ASAs most of the time with Prednisone to help on the occasional flare-up (once every few years). Recently flare ups have been coming back more often (2 flare ups in the last 9 months) and my doctor wants me to change to a stronger medication. He has suggested either 6MP or Humira. Does one work better in terms of response, safety and side effect? How do I choose one over the other?

A: Great question. The side effect profile and safety issues for 6-MP and Humira are actually very similar. 6-MP is typically started with prednisone because it takes 2-3 months to work. Humira usually starts working in 4-6 weeks and may require a shorter course of prednisone before it kicks in. As far as which agent is more effective, this may vary from patient to patient. In general, Humira appears to be more effective. The choice of one over the other really depends on multiple factors including choosing between injections vs. pills, the labs sent prior to starting these therapies, and insurance coverage. hide answer

Q: I have had a rash around my mouth and now has moved around my eyes for about 9 months now. The doctors thinks it is perioral dermatitis, but they aren't sure? I have been on remicade for about two years and currently on prednisone to reduce lip swelling and the rash goes away. The rash comes right back after I’m off the prednisone. How can this condition best be treated?

A: Thanks for your question. I would see your primary care doctor and perhaps a dermatologist as the rash could represent other diseases apart from inflammatory bowel disease. After you obtain a more formal diagnosis of the rash, a better treatment regimen may be recommended. Staying on prednisone for the rash is not the ideal treatment strategy. hide answer

Q: I recently had a small bowel series, it showed that I had focal narrowing in small intestine with possible structure findings concerning for underlying IBD. They did an MRI a week later, nothing showed up on MRI. I'm so frustrated. I have been struggling with trying to find out what's going on with my stomach for years now. After small bowel series I thought I finally had an answer. Now I'm back to square one. Is it still possible I had inflammation and then it wasn't present at time MRI?

A: I can understand your frustration. Typically, an MRI is a better test for a stricture than a small bowel series. It may be that the small bowel series findings were falsely positive. If there is ongoing concern for IBD, there are potential lab tests that may be helpful as well. hide answer

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