Expert Q&A

Search our library of questions and answers below, or submit your own question to our panel of experts.

Questions Answered By Expert

Expert Image

Heba Iskandar, MD, MSc

Associate Professor, Director of IBD Clinical Research

Q: I have UC and have recently been prescribed uceris rectal foam to manage a flare up. I am supposed to take the med for 2 weeks. I am also breastfeeding my newborn. Is this medication ok to take while breastfeeding?

A: Yes, it is. The absorption of uceris topical foam is minimal. Of what is absorbed, most is broken down by the liver and very little will every make it to the blood stream or the breast milk. hide answer

Q: How long is it safe to stay on budesonide? I have lymphocytic colitis, and every time my doctor had me taper off my symptoms came right back. Now he says I may need to stay on it indefinitely. What are other treatment options for lymphocytic colitis?

A: While the systemic steroid exposure is low, there are some adverse effects of long-term budesonide treatment, the main one being adrenal gland suppression. Some patients also experience some other steroid side effects, such as poor sugar control in diabetics or irritability. Budesonide’s use is safest when limited to 12 weeks. The return of symptoms is of course a limitation. If long-term budesonide use is planned, use should be accompanied with discussion of risks and benefits and using the minimum effective dose that controls symptoms (while we start at 9 mg, many patients can taper to 6 mg or 3 mg if remaining on the budesonide). Another option is to use intermittent recurrent courses of budesonide if able. Some other tips include discontinuing any culprit medications (such as non-steroidal anti-inflammatories), adding loperamide or cholestyramine to the regimen or adding bismuth subsalicylate. Other options (based on small case series) for long-term maintenance treatment of lymphocytic colitis are biologic agents (anti-TNF like infliximab or adalimumab) or immunomodulators (such as azathioprine). hide answer

Q: I was diagnosed with ulcerative colitis in 2016. In a recent colonoscopy there was no ulcers and no inflammation found. I am presently on mesalamine, gained a lot of weight and still have 4-5 soft bowel movements a day. If I have no ulcers and inflammation why do I continue to have so many bowel movements?

A: Other causes for the frequent bowel movements could be lactose intolerance, a motility disorder in the GI tract, or an infection, or celiac disease, among others. A work-up could be started especially if this affects your quality of life. Sometimes there is some scarring in the recovered colon and that could result in continued frequent bowel movements. hide answer

Q: My wife and I are trying to conceive. I have UC, have been on mesalamine 4.8g for years with no flares. Got a flare about 2 1/2 months ago and have been taking prednisone 40mg to help. I was told I will need to switch to a biologic in coming weeks. Is there any issue with trying to conceive while taking the prednisone and soon the biologic?

A: No. There are no issues in men and you can try to conceive while taking prednisone and biologics. Avoid the medications: methotrexate and sulfasalazine for 3 months as they can affect/lower sperm count. Otherwise for men, it is okay to start a biologic with the eventual goal of tapering off the prednisone soon. Women should not try to conceive in a flare due to the risks of active inflammatory bowel disease to the pregnancy. hide answer

Q: My daughter was diagnosed 11 years ago with Crohn’s disease. She has been in remission without meds for the last five years. Recently diagnosed with recurring anterior uveitis and burning tongue. A new GI Dr and had all the tests done again and diagnosed she was diagnosed with mild to moderate Crohn’s. There was no discussion on previous meds that helped the doctor just said we treat Crohn’s from the top down now, and he wants her on adalimumab. Is top down the way of future treatment?

A: It is true, an aggressive treatment approach and starting with biologics in a top-down approach has been showed to help Crohn’s patients more than the step-up approach in moderate-severe Crohn’s. This minimizes the long-term disease complications. The choice of adaliumumab its reasonable because it is a treatment for uveitis as well as Crohn’s, however, other findings such as colonoscopy results, severity of symptoms are important in order to make this decision and estimate the risk of Crohn’s. hide answer

PREVIOUS NEXT