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Raluca Vrabie, MD

Assistant Professor, Department of Medicine at NYU Long Island School of Medicine

Q: I was diagnosed with Ulcerative Colitis in April of 2018 and have been blessed to not really experience any flare ups. However, recently I have been experiencing some itching in the rectum area and was wondering what that could be caused from. It tends to occur in the mornings after having breakfast. I have tried eating different things for breakfast to see if anything changes but it seems to be the same. I was eating some cereal with grains and nuts and tried doing just eggs and bread.

A: Is there a fullness when you wipe? If yes, it might be hemorrhoids. Or, do you do something that might irritate hemorrhoids every morning, like sit on the toilet a long time playing on your phone? You can also see if it gets better with Preparation H. If it does not, you might need to speak to your GI about more testing such as fecal calprotectin or a sigmoidoscopy, though typically UC recurrence is blood and pain, not itching. hide answer

Q: I was very recently diagnosed with Ulcerative Colitis. After my colonoscopy, my Dr removed some samples to do a biopsy, to test for Crohn’s as well. Is it possible to have both Ulcerative Colitis & Crohn’s?

A: No, you can either have ulcerative colitis or Crohn’s. Rarely, you can have something called IBD-U meaning IBD-undifferentiated, where we’re not sure in which category you fit yet. What your doctor meant was that he/she took small bowel biopsies during the colonoscopy and if these are positive for inflammation then it’s Crohn’s. If they are negative it’s MORE LIKELY ulcerative colitis but we can’t be fully sure. The two diseases are hard to tell apart, though as a rule of thumb you CANNOT have ulcerative colitis outside the colon. hide answer

Q: I'm a 61-year-old woman, diagnosed with UC 30 years ago. I've been on azathioprine for about 15 years and have been relatively symptom free, though colonoscopies still show evidence of active disease. I have had few flares, and they subside quickly with a week or so of cortisone enemas. Recently I had a sinus infection that failed to clear after two rounds of antibiotics, and I'm now on a third, which gave me wicked diarrhea and triggered a flare. Should I worry about being on aza?

A: Yes, you should worry. I would worry about a) the long-term exposure to AZA and the associated lymphoma risk b) the long-term history of incompletely treated ulcerative colitis and the associated colon cancer risk and c) the possibility that this “wicked diarrhea” is either a flare of Clostridium difficile (C diff) infection. hide answer

Q: I have had UC for 10 years now, very mild. Went to my endocrinologists appt recently for my 6-month checkup and my liver enzymes are high. Could my Delzicol contribute to this? I have no other symptoms what so ever.

A: Abnormal liver enzymes rarely are “felt” in any way by the patient. That being said, mesalamines can very rarely (3.2 cases/1 million prescriptions, according to an NIH websity named livertox.org) cause liver abnormalities. Why are you seeing an endocrinologist? It’s more likely that either the endocrine condition you have (i.e diabetes) or the treatment for it (i.e hyperlipidemia, statin medications) has caused these liver enzymes. hide answer

Q: When taking 9 mg a day of Budesonide ER for 8 weeks. Do you need to taper off them the same way you would taper off prednisone and if so, how?

A: I taper my patients to 6mg/d for 1-2 weeks then 3 mg/d for 1-2 weeks, then off. I think it can be done even faster and even stopped completely, esp if there was no response in the first place. We taper prednisone because of concern for adrenal insufficiency but that is unlikely with budesonide. hide answer

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