Expert Q&A

A: Urinary symptoms are not a common side effect of infliximab. Infliximab does suppress the immune system and, therefore, you would be more susceptible to infections (including urinary tract infections). However, your frequency of UTI’s since starting infliximab sounds more than what I would expect to see on infliximab. I would recommend checking with your care team to see if there is anything contributing to the frequent urinary tract infections. There may also be measures that you can take to prevent them from occurring this frequently moving forward. hide answer

A: Infliximab does suppress the immune system and, therefore, makes you more susceptible to a variety of infections (including strep throat). This immune suppression is why infliximab works against Crohn’s disease, but infections can be a side effect. However, you also mention that your Crohn’s disease is managing well with this medication. This makes stopping infliximab a complicated and individual decision. With a switch in medicine, there is a risk of a Crohn’s flare. For that reason, when infliximab is working well, I am hesitant to recommend stopping it unless it is causing side effects that the patient can not tolerate. This is where your care team comes in to help guide you through an honest discussion of the risks and benefits of continuing on this therapy versus switching to an alternative medication. Once you have all of the information, you can decide together what would be best for your individual case. hide answer

A: Thank you for this great question. There have been several studies looking at fertility in Crohn’s disease and ulcerative colitis. When Crohn’s disease is in remission (no inflammation remains), there is no sign of decreased fertility. Biologic medications have also never been associated with decreased fertility. There are studies showing a decreased birth rate in Inflammatory Bowel Disease patients. However, researchers took those studies a step further and investigated the reason for the decreased birth rate. They found that the Inflammatory Bowel Disease subjects studied more frequently did not desire a pregnancy compared with the non-IBD subjects. Once they narrowed the studies to subjects who desired pregnancy, there was no decreased fertility among all groups. That said, there are a few individual situations that could impact fertility. If you have had surgery for Crohn’s disease, it is possible that adhesions (or scar tissue) could affect your fallopian tubes. If you have active Crohn’s inflammation, there could also be associated inflammation or scarring of the fallopian tubes. Finally, some medications (not biologics) have been associated with decreased sperm count in male patients – but that decreased fertility is not seen in female patients. hide answer

A: The question of medications versus surgery can be a common situation that arises. The right answer is often very individual depending on your situation. If the problem area in your ileum is mostly scar tissue, then medication may not be able to open it up enough to relieve your symptoms. In that case, surgery is the necessary intervention. However, if there is a large component of the area that is inflammation, then medication may be able to lead to a very significant improvement and prevent or delay any surgeries. Calming down inflammation prior to surgery often also allows the surgeon to limit the amount of intestine resected and improve your healing from a surgery. While hearing the long list of possible side effects is often alarming, it is important to remember that the risk of untreated Crohn’s disease is greater than the risks of these medications. Most people tolerate the medications very well. Finally, I would say that the course after surgery can vary greatly. Remaining off therapy for 10 years is possible, but not the most common outcome. More commonly, Crohn’s disease can begin to return and require treatment at some point after surgery. Guidelines recommend repeating a colonoscopy 6-12 months after surgery to begin monitoring for return of Crohn’s disease. hide answer

A: I would recommend that your daughter’s gastroenterologist examine her perianal area at their next visit. Crohn’s disease can cause fistulas (connections from the rectum to the skin), and a physical exam could check for any sign of fistula. Crohn’s disease can also cause skin tags in the anal canal that may contribute to leakage symptoms. This would also be seen on physical exam. I would recommend watching for fever, pain, or redness in this area as a sign of a developing infection. If that occurs, call your gastroenterologist to be evaluated. hide answer