Questions Answered By Expert
Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program
A: Sinus/nasal problems would be an unusual effect of a medication like Pentasa. Things like sinusitis (inflammation of sinus tracts) has been reported with medications like Pentasa in large studies but it is uncommon. If you have generally been feeling unwell, from an IBD standpoint, it may be important to ensure that your disease is controlled. Often your symptoms don’t correlate with active intestinal inflammation so it is important that labs, imaging, and/or colonoscopy are performed to obtain an objective assessment of the disease. If you do have active intestinal inflammation, there are several treatment options based on the degree of disease severity that you can discuss with your provider. hide answer
A: This is a very good question. Unfortunately, the answer is more complicated. It’s important to realize that the goals of Crohn’s disease treatment may be different based on a patient’s overall health. Advanced age can occasionally be associated with declining health but not always. Generally, in older age, we treat Crohn’s disease to control symptoms. In younger age (i.e., age <40) , we treat Crohn’s disease to heal the intestinal inflammation and control symptoms. In general, patients who are diagnosed with Crohn’s at age ≥60 have the same risk of developing colorectal cancer as patients diagnosed with Crohn’s at an earlier age. Colonoscopy in Crohn’s disease may be performed to evaluate intestinal disease activity or evaluate for colorectal cancer from long-standing Crohn’s disease and patient age. There is no consensus on this approach but in my older patients regardless of whether they have IBD or not, I do colon cancer screening colonoscopies if the patient can safely undergo surgery in case we discover malignancy. In older patients in whom I am considering a colonoscopy to evaluate for active inflammation, I take into account the patient’s other illnesses before proceeding. I would speak to your provider about the risks and benefits of performing a colonoscopy. hide answer
A: Lymphocytic and collagenous colitis are the two types of microscopic colitis. They fall within the spectrum of inflammatory bowel disease but behave very differently than Crohn's or ulcerative colitis. A patient generally has either Crohn's or ulcerative colitis or they can have microscopic colitis but not both. hide answer
A: This is a controversial topic. There are studies that show that iron can worsen inflammation and those that do not. I tend to avoid oral iron in my patients with more severe disease or who are having flares but I do use it in those patients who need iron and have more mild disease. hide answer
A: And any relationship between UC and rheumatoid arthritis? Microscopic colitis is made up of collagenous and lymphocytic colitis. I have seen microscopic colitis patients who then go on to develop Crohn's or UC but this is uncommon. Microscopic colitis and IBD are diagnosed and behave differently though and the diagnosis should be more clear after an evaluation. UC and rheumatoid arthritis can be found together as they are both autoimmune disorders. You can learn more about microscopic colitis here: http://www.ccfa.org/resources/microscopic-colitis.html. hide answer