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Jami Kinnucan, MD

Assistant Professor

Q: I am having a period about every 2 weeks since being diagnosed in May. I just finished a two month treatment of budesonide (steroid). Is this typical or should I consult with my OB/GYN? I am 48 so I often get a response that I am perimenopausal.

A: Patients with active Crohn’s disease or ulcerative colitis can have variations in their menstrual patterns. So it is not uncommon to see irregular menses or absence of menses until the body is healing (improved inflammation). However whenever there is a change in vaginal bleeding, I would recommend that you consult with your gynecologist to ensure that no further work-up is needed at this time. hide answer

Q: Can Crohn's disease effect my teeth?

A: The easy answer is yes, without knowing what effects you might be having. Crohn’s disease can lead to malabsorption of important vitamins and minerals that can be important for overall health and can impact your teeth as well. hide answer

Q: What happens if you have a positive TB blood test during treatment with a biologic?

A: Current recommendations would be to have close follow-up evaluation including chest imaging and referral to see infectious disease specialist. Your provider will likely notify you to hold your biologic therapy until confirmation testing is completed. hide answer

Q: I was diagnosed with ulcerative colitis in 2013 and then indeterminate colitis in 2015. I was put on prednisone and azathioprine. My doctor left and I was sent to a new doctor. They ordered colonoscopy and CT which came back showing no IBD. Can this happen because of the medication? All previous scopes, biopsies, and scans since 2013 have come back positive for IBD. I am very confused. Is it possible to get different diagnosis over time?

A: This is a very interesting thing that we have been seeing in some patients. We call it histologic normalization. We recently published something from the University of Chicago with our findings in many patients. See link below. Overall conclusions here: https://www.ncbi.nlm.nih.gov/pubmed/28238954. Histologic normalization of colonic mucosa can be used as a clinical endpoint for patients with UC. We associated histologic normalization with increased odds of relapse-free survival compared with endoscopic healing or histologic quiescence. Further studies are needed to determine whether histologic normalization should be a goal of treatment for patients with UC. hide answer

Q: I was recently prescribed 1g Asacol foam enema. I was on the Salafolk ones for about a week but I was told it was the same stuff so didn’t really worry. I’ve been having a tougher time with these Asacol ones. I just can’t seem to hold them in as long, some nights they seem to come out right away. My usual time of holding them in at the moment is about an hour before I need to go. Is this enough time for the medicine to work?

A: Typically the foam based formulation is easier to hold than the liquid formulation. It should get better the longer you are on therapy. If it is not improving, I would discuss with your physician about a change of the formulation back to the liquid if that was easier to hold. hide answer

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