Questions Answered By Expert
Jami Kinnucan, MD
Assistant Professor
A: Treatment with Remicade isn’t associated with increase in allergies, or at least hasn’t been reported. I would work closely with allergist regarding what could be causing your allergy symptoms (allergic rhinitis is a common cause). However chronic sinusitis should be evaluated with ENT and consider imaging as this could be due to sinus polyps/sinus obstruction and can be treated. Anti-TNF therapies have been associated with rare risk for chronic sinusitis. We have to weigh the risks and benefits of therapy, sometimes if patients have elevated Remicade levels we can reduce the dosing/frequency and improve some of these rare complications of therapy. hide answer
A: We can see patients that also have a diagnosis of Raynaud’s which can cause issues with circulation especially in fingers and toes. I would be more concerned about the lack of mobility in your left leg which could be a sign of something more serious like a stroke. I would recommend that you review with your primary care physician and treating ulcerative colitis provider. hide answer
A: Congrats on achieving remission! I assume when you say remission they have either done stool testing, imaging with CT or MRI or a colonoscopy/endoscopy. If that is the case and you do not have any active inflammation then I suspect that your diarrhea might be due to a condition called bile acid malabsorption. Bile acids (made in the liver and stored in the gallbladder) are released when you eat and are typically reabsorbed in the terminal ileum (where I suspect you have had surgery several times). If you are missing your terminal ileum or a portion of it you get bile acid malabsorption which leads to diarrhea, bloating and cramping. We have medications called bile acid binders that can improve these symptoms dramatically, you should discuss this with your primary GI provider. Another possible cause of diarrhea that can respond to antibiotics would be small intestinal bacterial overgrowth and that typically responds well to antibiotics. hide answer
A: There are several reasons that patients might have increasing symptoms after feeling well for a period of time. Even when patients feel well they might have subclinical inflammation, and this increases the risk for clinical symptoms/relapse (flare). Most patients who experience an intolerance to mesalamine will experience early in treatment course, so I think I would look at other reasons for active symptoms. Your health care team should assess for infection as possible cause and consider other objective assessments (CRP, fecal calprotectin or possible endoscopy). If you have active symptoms but evaluation is without active disease, consider other causes for symptoms. If you have active inflammation, the location of the inflammation will help your team guide therapy. hide answer
A: First I think that active symptoms/inflammation x 4 months is too long. If you did not have a response to steroids that raises a concern for more severe disease and that mesalamine therapy (Pentasa) is probably not the optimal choice of therapy (only indicated for mild-moderate inflammation and not indicated in steroid refractory cases). Ozone therapy has been studied in limited number of patients and has minimal data in the use in IBD. The study was done with mild-moderate disease taking sulfasalazine, the study done in 2010 looked at outcomes/improvement by both symptoms and endoscopy at 4 weeks. I would say at most I would give this regimen 4 weeks, however ensure you are under the care of an IBD specialist who has done a thorough assessment for other possible causes for a prolonged flare. hide answer