Questions Answered By Expert
Emmanuelle Williams, MD
Associate Dean for Student Affairs, Penn State College of Medicine, Associate Professor, Department of Medicine, Director of Inflammatory Bowel Diseases, Division of Gastroenterology and Hepatology
A: I would recommend first discussing with your physician whether your disease is well controlled and in remission or whether you have active disease. Ideally if your disease is well controlled you should be able to tolerate any type of breakfast. You are not alone. Many patients with active disease tend to have most bowel movements first thing in the morning or after breakfast. I would recommend minimizing caffeine and hot fluids which both can accelerate intestinal transit. Fatty foods may also result in bowel movements soon after eating. Many of my patients anecdotally tolerate oatmeal or cream of rice the best. Bananas and peanut butter also seem to be well tolerated. For patients who have narrowing in the bowel, smoothies are also great breakfast options. hide answer
A: In patients with IBD the sequence of polyp to cancer, if related to IBD, may not follow the same sequence as regular polyps. Colorectal cancer in IBD starts with some type of lesion, but these may be very difficult to see. The timing of dysplasia going to cancer may also be accelerated. For this reason, we recommend frequent screening – every 2 years in all patients after 10 years of disease with Ulcerative Colitis, and in Crohn’s Colitis if more than one third of the colon is involved. Patients with Primary Sclerosing Cholangitis (PSC) need yearly colonoscopies as their risk for colon cancer is particularly high. As lesions predisposing to cancer in IBD may be flat rather than look like polyps, it is also particularly important to have the best preparation possible, and to have a colonoscopy performed by a physician experienced in the care of IBD patients. hide answer
A: I recommend calling your provider to discuss whether you are having a flare of your disease or if you may have concurrent c.difficile infection. Colonoscopy preparations should not cause your IBD to flare, but may alter your gut flora. I would recommend discussing your symptoms with your provider. hide answer
A: The goal in the treatment of patients with IBD is to use steroid sparing medications as much as possible. If you have been on steroids long term, escalation of your therapy should be considered. It is not unusual for patients to be on both steroids and mesalamines while trying to get in control and this is safe. I typically do not have patients both on lialda and sulfasalazine but your provider may have reason for this – perhaps joint pain. Currently there should be no safety issue in the combination that you are currently presently taking. hide answer
A: Given two hospitalizations in a year, I think you should discuss with your provider considering escalation of therapy – proactively your provider can check blood and stool tests to see if there is any active inflammation, a repeat endoscopic evaluation could be in order as well. The goal is that you get off steroids to avoid long term complications of these medications and that your disease be more deeply controlled. Many patients also monitor their symptoms closely by journaling or using apps such as GI Buddy – and this can give helpful information to your provider. hide answer